Osteopontin for Early Detection of Microvascular and Macrovascular Type 1 Diabetic Complication

AIM: To evaluate the relationship between osteopontin and diabetes complication in type 1 diabetic patient. PATIENTS AND METHODS: Seventy types 1 diabetic and 60 healthy volunteers were studied. Full history, examination, laboratory tests of glycosylated haemoglobin (HbA1c), serum lipids {cholesterol, triglyceride (Tg), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein – cholesterol (LDL-c)}, oxidised low-density lipoprotein (OxLDL), Osteopontin and urinary microalbuminuria (albumin/creatinine ratio) were done. Image study in the form of a carotid intimal medial thickness (cIMT) and aortic intimal medial thickness (aIMT), renal doppler for resistivity index was also done for all participant included in the study. RESULTS: Urinary albumin/creatinine ratio, lipid profile, osteopontin, cIMT and aIMT were higher in people with diabetes. Osteopontin was higher in people with diabetes with positive microalbuminuria and cIMT. Systolic blood pressure, microalbuminuria and cIMT had a positive correlation with osteopontin in people with diabetes. Stepwise multiple regression analysis showed that osteopontin had a significant correlation with cIMT. Receiver operating characteristic (ROC) curve showed that the cut off value of Osteopontin for detection of cIMT was > 60 with a specificity of 100% and sensitivity 80.5%, while that of albumin/creatinine ratio was > 64 with a specificity of 66.7 and sensitivity of 92.3. CONCLUSION: Osteopontin is higher in type 1 diabetics and is useful for early detection of diabetic microvascular and macrovascular complication

Diagnosis and Treatment of Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is the most frequent hyperglycaemic acute diabetic complication. Furthermore it carries a significant risk of death, which can be prevented by early and effective management. All physicians, irrespective of the discipline they are working in and whether in primary, secondary or tertiary care institutions, should be able to recognise DKA early and initiate management immediately. South African Family Practice Vol. 50 (1) 2008: pp. 35-3

Efek N-Asetil-L- Sistein (NAC) Terhadap Kadar Adma Plasma Dan Ekspresi Protein Vcam-l Pada Disfungsi Endotel Tikus Diabetes

Endothelial dysfunction is an early state of symptoms in a cardiovascular disease. An elevated oxidative stress plays a key role in the pathogenesis of macrovascular diabetic complication. The present study was design to evaluate the effect of NAC on plasma ADMA level and the expression of VCAM-1 protein on endothelial dysfunction in diabetic rats. Thirty male Sprague–Dawley rats were divided into 5 groups i.e. normal rats, diabetic rats, treatment with NAC 30 mg/kgBW, NAC 56 mg/ kgBW and NAC 100 mg/kgBW. Diabetic rats model was induced by intraperitonial administration of alloxan monohydrate at dose of 150 mg/kgBW, diabetes occurred on 3nd day after alloxan injection and then started treatment of N-acetyl-L-cystein for 28 days. ADMA plasma level was analyzed with Elisa Reader and the expression of VCAM-1 protein was evaluated by immunohistochemistry. Conclusion of this research is that treatment with NAC 30 mg/kgBW, NAC 56 mg/kgBW and NAC 100 mg/kgBW for 28 days may prevent oxidative stress indicated by the decreasing of plasma ADMA level by 45.8%: 55.75% and 65.92%, respectively and the decreasing of the expression of VCAM-1 protein on endothelial dysfunction in diabetic rat by 24%: 31.75% and 58.92%, respectively

Awareness of Ocular Complications of Diabetes Among Diabetic Patients In A Tertiary Hospital In Western, Nigeria

Background:- Diabetes is no longer a disease of affluent and industrialized countries. It affects virtually all ocular structures and can lead to blindness. Routine eye examination is necessary for early detection of ocular involvement and prevention of blindness. Only few diabetics have regular eye examination. Aim:- To study the awareness of ocular complications of diabetes among diabetic patients Methodology:- A cross-sectional prospective study of 148 randomly selected diabetic patients was done. A semi structured questionnaire was administered to these patients by an interviewer who is medical personnel, not below the level of a house-officer. Informed consent was obtained from the patients before filling the questionnaires. The information obtained include the biodata, educational level, duration of diabetes, whether they were aware that diabetes can affect other parts of the body, if yes which parts, which parts of the eye can it affect, how can it affect the eye, whether or not routine eye examination is necessary in diabetics, if yes how often, how did they learn about diabetes and how they think awareness of diabetic complications can be improved. The results were collated and analyzed using SPSS version 13, with chi square done where necessary. Results:- A total of 148 patients were studied. Their ages range between 21years and 82years, with a mean of 58.53 +10.4years. Majority were between 36-60yearrs of age. Eighty-three (56.1%) had educational level within secondary level 40(27 %) tertiary education while 25(16.9 %)) do not have formal education. Most common co morbid factor was hypertension, found in 44.6%. One hundred and twenty three (83.1%) were aware that diabetes could affect other parts of the body, 41% were aware of brain affectation, 54% were aware that it can affect the kidneys, 77.7% were aware that it can affect the eyes, 39.2% blood vessels, 66.2% the legs, 40.5% the skin and 41.9% were aware that it can affect the genitals. Of the 77.7% who were aware that it can affect the eyes, more than half (58.8%) did not know the part of the eye that can be affected. 20.3% knew that it can affect the crystalline lens,4.1% external eye, 13.5% the retina and 3.4% thought it can affect the combination of external eye, lens and the retina. Forty nine respondents (33.1%) did not know that routine eye examination is necessary in diabetics, 16.2% says eye examination should be once, 18.2% twice, 18.9% thrice and 26.4% none. Only 18 (12.2%) respondents got their information of eye complication from eye specialists. Sixty- one respondents (41.2%) do not know how diabetes can affect the eye, 29.7% knew that poor control is the problem, 8.8% think it is due to long duration, 7.4% believe it was a combination of poor control and long duration, 2% claim it is due to infection, 8.8% combination of infection, poor control and long duration and 0.7% erroneously believe thinking too much of DM can result in eye complication. Patients who have been diabetic for more than 10years are more aware that diabetes can affect the eye than those below 5years (92.3% vs. 7.2%, p=0.001). Awareness of diabetic complication is better in those with tertiary education than others (p=0.001). Conclusion:- We conclude that though awareness of ocular complication of diabetes mellitus is high, the level of knowledge is low. Health Practitioners especially eye care specialist need to intensify health education through media, regular health talks in clinics to increase knowledge and increase health seeking behaviours of diabetics in the

Factors associated with quality of life among adult patients with Type 2 Diabetes Mellitus

The prevalence of Type 2 Diabetes Mellitus (T2DM) in Malaysia is increasing. It is essentials to assess the quality of life (QoL) of T2DM to measure outcome of T2DM for better care and control of the disease. This study aimed to determine the factors associated with QoL among adult patients with T2DM. A cross-sectional study was conducted among patients attending diabetic clinic in Seremban 2 Health Clinic. Patients were selected using systematic random sampling method and data collection gathered by self-administered questionnaire. SF-36 was used for assessing the QoL which has 8 health domains and 2 component summaries that incorporated both physical and mental component. The response rate was 89%. QoL were found significantly associated with socio-demographic factors such as age (PF: p=0.043), gender (PF: p<0.001, BP: p=0.013 & PCS: p=0.007), ethnicity (BP: p=0.03), education level (RP: p=0.006, GH: p=0.038, VT: p=0.009, RE: p=0.012, MH: p=0.001, PCS: p=0.037, & MCS: p<0.001), marital status (VT: p=0.027), and employment status (PF: p<0.001, RP: p<0.001, GH: p<0.001 & VT: p=0.041). Lower QoL scores were observed in older age group, females gender, lower education, divorced/widowed and unemployed. Clinical profiles such as diabetic duration (PF: p=0.005, RP: p=0.033, GH: p=0.004, RE: p=0.044 and PCS (p=0.003), and presence of co-morbidity (PF: p=0.012) were also significantly associated with QoL in various SF-36 domains. Type of treatment was significantly associated with QoL in all domains (p<0.05) except in BP. Glycemic control significantly associated with QoL in RP (p=0.008), BP (p=0.002), GH (p=0.003), RE (p=0.009), PCS (p=0.001), and MCS (p=0.017). Diabetic complication was significantly associated with all the 8 health domains and 2 component summaries (p<0.01). In conclusion, socio-demographic, diabetic complication, co-morbidity, duration, treatment types and glycemic control were found to be associated with QoL among T2DM patients

Health-related quality of life and health preference of Chinese patients with diabetes mellitus managed in primary care and secondary care setting: decrements associated with individual complication and number of complications

Background: Health-related quality of life (HRQoL) and health preference of patients with diabetes mellitus (DM) are essential in health economic evaluations but data on Chinese population is rare. This study aims to evaluate HRQoL and health preference of diabetic patients with different diabetic complications in Chinese population. Methods: A cross-sectional study was conducted in 1275 patients with DM, including 518 subjects with various DM-related complications. HRQoL and health preference were estimated using SF-12 and SF-6D questionnaires, respectively. Disease status of DM and complications were identified from documented clinical diagnosis. Multivariable regression was used to investigate the effects of specific complications on HRQoL and health preference, adjusting for socio-demographic and clinical parameters. Results: The presence of any diabetic complication was associated with lower physical component summary (−3.81 points, P < 0.01), and end-stage renal disease (ESRD) showed greatest reduction (−7.05 points, P < 0.01). Mental component summary and mental health (MH) scores were not decreased in any of the diabetic complications. The health preference score for diabetic subjects without complications was 0.882 (95% CI, 0.778 to 0.989). The reductions of health preference score were significant for stroke (−0.042, 95% CI -0.072 to −0.012), ESRD (−0.055, 95% CI -0.093 to −0.017), and sight-threatening diabetic retinopathy (STDR) (−0.043, 95% CI -0.075 to −0.010), while heart disease had an insignificant reduction (−0.017, 95% CI -0.042 to 0.008). Conclusions: The presence of any of the four major diabetic complications (heart disease, stroke, ESRD and STDR) was associated with lower HRQoL and health preference scores. Findings of this study facilitated the cost-effectiveness studies of alternative management strategies for prevention of diabetic complications in Chinese population.published_or_final_versio

Oral Hypoglycemic Drugs in the Management of Type 2 Diabetes Mellitus: A Review

Diabetes mellitus is a chronic, progressive, heterogeneous group of metabolic disorder mainly characterized by hyperglycemia. T2DM results due to insulin resistance or secretory defects of a beta cell or both and gradually progress to a state characterized by complete loss of pancreatic beta cells secretion. 2hour oral glucose tolerance test or HbA1c testing is performed for the screening for diabetes mellitus. In this review, we attempt to outline the basic pharmacological and non-pharmacological principles for the management of T2DM. Keywords: diabetes, clinical management, non-pharmacological management, primary car