Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 5 Articles
Background: It is essential to anticipate and limit the social, economic and sanitary cost of type 2 diabetes (T2D),\nwhich is in constant progression worldwide.\nWhen blood glucose targets are not achieved with diet and lifestyle intervention, insulin is recommended whether\nor not the patient is already taking hypoglycaemic drugs. However, the benefit/risk balance of insulin remains\ncontroversial. Our aim was to determine the efficacy and safety of insulin vs. hypoglycaemic drugs or diet/placebo\non clinically relevant endpoints.\nMethods: A systematic literature review (Pubmed, Embase, Cochrane Library) including all randomised clinical\ntrials (RCT) analysing insulin vs. hypoglycaemic drugs or diet/placebo, published between 1950 and 2013, was\nperformed. We included all RCTs reporting effects on all-cause mortality, cardiovascular mortality, death by\ncancer, cardiovascular morbidity, microvascular complications and hypoglycaemia in adults ââ?°Â¥ 18 years with\nT2D. Two authors independently assessed trial eligibility and extracted the data. Internal validity of studies\nwas analyzed according to the Cochrane Risk of Bias tool. Risk ratios (RR) with 95 % confidence intervals (95 % CI)\nwere calculated, using the fixed effect model in first approach. The I2 statistic assessed heterogeneity. In case of\nstatistical heterogeneity, subgroup and sensitivity analyses then a random effect model were performed. The alpha\nthreshold was 0.05. Primary outcomes were all-cause mortality and cardiovascular mortality. Secondary outcomes\nwere non-fatal cardiovascular events, hypoglycaemic events, death from cancer, and macro- or microvascular\ncomplications.\nResults: Twenty RCTs were included out of the 1632 initially identified studies. 18 599 patients were analysed:\nInsulin had no effect vs. hypoglycaemic drugs on all-cause mortality RR = 0.99 (95 % CI =0.92ââ?¬â??1.06) and\ncardiovascular mortality RR = 0.99 (95 % CI =0.90ââ?¬â??1.09), nor vs. diet/placebo RR = 0.92 (95 % CI = 0.80ââ?¬â??1.07) and\nRR = 0.95 (95 % CI 0.77ââ?¬â??1.18) respectively. No effect was found on secondary outcomes either. However, severe\nhypoglycaemia was more frequent with insulin compared to hypoglycaemic drugs RR = 1.70 (95 % CI = 1.51ââ?¬â??1.91).\nConclusions: There is no significant evidence of long term efficacy of insulin on any clinical outcome in T2D.\nHowever, there is a trend to clinically harmful adverse effects such as hypoglycaemia and weight gain. The only\nbenefit could be limited to reducing short term hyperglycemia. This needs to be confirmed with further studies....
Background: Type 1 Diabetes Mellitus is a rapidly growing problem in Tanzania. Children and adolescents with\ntype 1 diabetes have previously been found to have poor glycaemic control and high prevalence of complications.\nStrict glycaemic control reduces the incidence and progression of chronic complications. The aim of this study was\nto identify the factors associated with glycaemic control among children and adolescents.\nMethods: A cross sectional study was done at the diabetes clinic for children and adolescents. Data on\nsocioeconomic, demographic and diabetes specific variables including adherence, diabetes knowledge, caregivers\nknowledge and their involvement in the care of the child was obtained. Glycaemic control was assessed by\nmeasuring glycosylated hemoglobin. (HbA1C). Linear regression analysis was done to determine factors associated\nwith glycaemic control\nResults: Seventy-five participants were recruited into the study (51 % males). The mean HbA1c was 11.1 Ã?± 2.1 %.\nChildren aged <10 years were found to have a significantly better glycaemic control (9.8 %) as compared to 10ââ?¬â??\n14 year olds (11.5 %) and >14 year olds (11.4 %) (P value = 0.022). Sixty-eight percent of patients had good\nadherence to insulin while adherence to blood glucose monitoring regimen was 48 % and to diet control was\n28 %.\nYounger age, having the mother as the primary caregiver, better caregiver knowledge of diabetes, better\nadherence to blood glucose monitoring regimen and diabetes duration of less than 1 year were associated with\nbetter glycaemic control.\nIn multivariate analysis, age, adherence to blood glucose monitoring regimen and the mother as the primary\ncaregiver were found to independently predict glycaemic control (R2 = 0.332, p value = 0.00).\nConclusions: Children and adolescents with type 1 diabetes in Dar es Salaam have poor glycaemic control. In\norder to improve metabolic control, adherence to blood glucose monitoring should be encouraged and caregivers\nencouraged to participate in care of their children especially the adolescents....
Background: Diabetic foot ulceration is receiving more attention because of its high amputation and mortality\nrate. It is essential to establish the frequency of amputations in people with diabetes after any change to the\nmanagement of diabetic foot care. The present study aim to compare the frequency of lower-extremity\namputations in patients with diabetes foot ulcer over a ten-year period.\nMethods: Six hundred forty eight patients with diabetes foot ulcer were retrospectively studied from 2004 to 2013.\nThe clinical features, laboratory results and the lower-extremity amputations were recorded. Major amputation was\ndefined as amputations above the ankle while minor amputation was amputations below the ankle in the present study.\nResults: Patients with diabetic foot ulcer were old (age 66.96 �± 11.96 years), with a long duration of diabetes\n(10.30 �± 6.94 years), high HbA1c (9.19 �± 2.62 %), SBP (144.05 �± 24.18 mmHg), DBP (79.53 �± 11.88 mmHg), LDL-C\n(2.71 �± 0.93 mmol/L) and had great frequency of neuropathy (62.7 %), retinopathy (45.0 %), nephropathy (39.5 %) and\nPAD (33.2 %). From 2004 to 2013, the frequency of all lower-extremity amputations is 12.0 % (5.2 % major amputation,\n6.8 % minor amputation). The frequency of major amputations decreased from 9.5 % in 2004 and 14.5 % in 2005 to less\nthan 5.0 % after 2006. In particular, there was a significant decline in major amputations of diabetic foot patient with\nWagner 3 to 4 wounds. The frequency rate of major amputations in diabetic foot patient with Wagner 3 to 4 wounds\nfell from 35.7 % in 2004 to 4.4 % after 2007. The change in frequency of minor amputations was fluctuation.\nConclusion: This study demonstrates that the introduction of a multidisciplinary team, coordinated by an\nendocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the\nfrequency of major amputations in patients with diabetes....
Background: Diabetic retinopathy (DRP) is a common microvascular complication seen in patients with type 1 diabetes\nmellitus (T1DM). The effects of T1DM and concomitant (proliferative) DRP on retinal blood flow are currently unclear.\nTherefore, we measured retinal vascular blood flow in T1DM patients with and without DRP and non-diabetic controls.\nWe further assessed the acute effects of panretinal photocoagulation on retinal microvascular bloodflow in eight\npatients with diabetes.\nMethods: Thirty-three T1DM patients with proliferative DRP, previously treated with panretinal photocoagulation (pDRP),\n11 T1DM patients with untreated non-proliferative retinopathy (npDRP) and 32 T1DM patients without DRP (nDRP) were\ncompared with 44 non-diabetic gender-matched controls. Using scanning laser Doppler flowmetry (HRF, Heidelberg)\nblood flow in the retinal microvasculature was measured temporal and nasal of the optic disc and averaged into one\nflow value per eye. The right eye was used as a default for further analyses. Eight patients with novel proliferative\nretinopathy (4 T1DM and 4 with type 2 diabetes) were measured before and several months after photocoagulation.\nBetween-group differences in retinal blood flow were assessed using ANOVA corrected for multiple comparisons\n(Bonferroni).\nResults: Retinal blood flow was higher in the treated pDRP compared with the nDRP group and controls\n(all PBonferroni < 0.01). Furthermore, there was a positive linear trend for blood flow with lowest blood flow in\nthe control group and highest in the pDRP group (P-for-trend < 0.01). In the eight patients with novel proliferative\nretinopathy, blood flow did not significantly change before and after panretinal photocoagulation (P > 0.05). Using\nregression analysis, no variables were found as predictors of retinal blood flow.\nConclusions: In comparison with controls and nDRP patients, retinal blood flow significantly increased in the pDRP\ngroup, which previously underwent photocoagulation treatment, but not in the npDRP patients. These changes may\nbe a consequence of a failing vascular autoregulation in advanced diabetic retinopathy....
Background: Patients with type 2 diabetes mellitus (T2DM) who participate in diabetes management programs\nhave been shown to have better glycemic control and slower disease progression, although program participation\nremains low. In the USA, increasing participation in diabetes management support programs may also directly\nimpact provider reimbursement, as payments are increasingly based on patient-centered measures. However, little\nis known about factors that may enhance patient participation. This study aimed at further understanding what is\nimportant in diabetes management support from the patientsâ�� perspective and at assessing the utilization of\nvarious types of diabetes-management programs.\nMethods: A two-phase mixed-methods study was conducted of adult US members of PatientsLikeMe�®, an online\nresearch network of patients. Phase 1 comprised qualitative interviews with 10 individuals to inform the online\nsurveyâ��s contents, aided by literature review. During phase 2, this online survey was completed by 294 participants\nwho reported on their diabetes goals and preferences for T2DM self-management support programs.\nResults: The majority of the respondents were not participating in any program (65 %), but most had goals of\nimproving diet (77 %), weight loss (71 %), and achieving stable blood glucose levels (71 %). Among those currently\nparticipating in programs, clinic, hospital-based, or other health-care professional programs were the most commonly\nused (51 %). The most preferred type of support was diet/weight-loss support (62 %), while doctors or nurses (61 %)\nand dietitians (55 %) were the most preferred sources of diabetes support.\nConclusions: The low participation in diabetes self-management programs revealed in this study underscores the\nneed for strategies to improve patient engagement. The results revealed support types and formats that patients with\nT2DM prefer and need. These findings may help improve patient engagement by guiding the future design of more\neffective diabetes management support programs....
Loading....