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Girish Degavi,1 Hazaratali Panari2 1Department of Nursing, College of Health and Medical Science, Bule Hora University, Hagere Mariam, Ethiopia; 2Department of Nursing, Institute of Medicine and Health Sciences, Debre Berhan Univerity, Debre Berhan, EthiopiaCorrespondence: Girish DegaviDepartment of Nursing, College of Health and Medical Science, Bule Hora University, P.O Box 144, Hagere Mariam, EthiopiaEmail girishdegavi1984@gmail.comBackground: Impotence incidence in patients with elevated glycemic index valuesis 30%– 69.01%. While impotence is very prevalent among diabetic men, the condition is mostly left unaddressed and needs assessment and care. Impotence can influence the quality of social, mental, leisure, and sexual life, and can contribute to broken relationships, depression, and reduced self-esteem. The goal of the present work was to research the commonness and determinants of impotence among diabetic patients in hospitals in the northwestern region of Nefasit .Methods: A cross-sectional hospital analysis was done of 239 patients with diabetes mellitusin five of six hospitals in Nefasit by means of systemic random sampling. methods. Data were collected for 2 months from Februaryto April 2019.Results: The mean age of participants was 43.32 years and mean duration of diabetes 8.7 years. Impotence prevalence was found to be 74.2%: 36.1% mild, 34.2% moderate, and 5.8% serious sexual dysfunction. Statistical analysis showed that impotence was considerably associated with being elderly (AOR 14.21, 95% CI 3.22– 70.00), prolonged diabetes (AOR 4.1, 95% CI 1.22– 11.16), and lower monthly income (AOR0.279, 95% CI 0.133– 0.614). There was no association found with BMI, comorbidity, sugar control, or intake of alcohol.Conclusion: The prevalence of impotence in the present study was quite high. Very few patients (5.1%) had been screened for impotence. Care of impotent patients in hospitals for diabetes should be a regular health protocol during follow-up care.Keywords: Asmara, determinants, DM, Nefasit, prevalence

Girish Degavi,1 Hazaratali Panari2 1Department of Nursing, College of Health and Medical Science, Bule Hora University, Hagere Mariam, Ethiopia; 2Department of Nursing, Institute of Medicine and Health Sciences, Debre Berhan Univerity, Debre Berhan, EthiopiaCorrespondence: Girish DegaviDepartment of Nursing, College of Health and Medical Science, Bule Hora University, P.O Box 144, Hagere Mariam, EthiopiaEmail girishdegavi1984@gmail.comBackground: Impotence incidence in patients with elevated glycemic index valuesis 30%– 69.01%. While impotence is very prevalent among diabetic men, the condition is mostly left unaddressed and needs assessment and care. Impotence can influence the quality of social, mental, leisure, and sexual life, and can contribute to broken relationships, depression, and reduced self-esteem. The goal of the present work was to research the commonness and determinants of impotence among diabetic patients in hospitals in the northwestern region of Nefasit .Methods: A cross-sectional hospital analysis was done of 239 patients with diabetes mellitusin five of six hospitals in Nefasit by means of systemic random sampling. methods. Data were collected for 2 months from Februaryto April 2019.Results: The mean age of participants was 43.32 years and mean duration of diabetes 8.7 years. Impotence prevalence was found to be 74.2%: 36.1% mild, 34.2% moderate, and 5.8% serious sexual dysfunction. Statistical analysis showed that impotence was considerably associated with being elderly (AOR 14.21, 95% CI 3.22– 70.00), prolonged diabetes (AOR 4.1, 95% CI 1.22– 11.16), and lower monthly income (AOR0.279, 95% CI 0.133– 0.614). There was no association found with BMI, comorbidity, sugar control, or intake of alcohol.Conclusion: The prevalence of impotence in the present study was quite high. Very few patients (5.1%) had been screened for impotence. Care of impotent patients in hospitals for diabetes should be a regular health protocol during follow-up care.Keywords: Asmara, determinants, DM, Nefasit, prevalence

Yue Huang,1,* Wenxun Huang,2,* Jing Wei,3 Zubin Yin,1 Hanjing Liu4 1Department of Psychosomatic Medicine, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China; 2Department of Infectious Disease, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China; 3Department of Endocrinology, Chongqing Municipality Wanzhou District People’s Hospital, Chongqing, 404000, People’s Republic of China; 4Department of Clinical Psychology, The Chinese People’s Armed Police Force Zhejiang Corps Hospital, Hangzhou, 310051, Zhejiang Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hanjing LiuDepartment of Clinical Psychology, The Chinese People’s Armed Police Force Zhejiang Corps Hospital, No. 86, Jiangnan Avenue, Hangzhou, 310051, Zhejiang Province, People’s Republic of ChinaTel +86 13874451742Email liuhanjing666@126.comBackground: Existing studies have reported that patients with diabetes mellitus (DM) have an increased risk of depressive symptoms. We aimed to evaluate the association between serum cystatin C levels and depressive symptoms in DM patients.Methods: Serum levels of cystatin C were measured in 254 patients with DM at baseline. Cox proportional hazard analysis was used to evaluate the value of serum cystatin C in predicting depressive symptoms in patients with DM.Results: Multivariate linear regression analysis showed that serum cystatin C levels were independently associated with Centre for Epidemiological Studies Depression (CES-D) scores after adjusting for age, sex, body mass index (BMI), current smoking status, current drinking, admission systolic and diastolic blood pressure (BP), cardiovascular disease (CVD) history and laboratory measurements in patients with DM at baseline (Sβ= − 0.127; 95% CI, - 0.185– - 0.083; P=0.002). The multivariate Cox proportional hazard analysis revealed that serum cystatin C (HR=2.360, 95% CI 1.500– 3.891, P-trend < 0.001) was an independent prognostic factor for cognitive decline in these patients with DM during the follow-up period.Conclusion: Our results showed that increased serum cystatin C levels were significantly and independently associated with depressive symptoms and had independent predictive value for depressive symptoms in patients with DM. Serum cystatin C might enable early recognition of depressive symptoms among DM patients.Keywords: cystatin C, DM, depressive symptoms, prognostic value

Ahmed Hussein,1 Sharaf ED Mahmoud,1 Mohammad Shafiq Awad,2 Hossam Eldin M Mahmoud3 1Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag 82524, Egypt; 2Department of Cardiology, Faculty of Medicine, Beni Suef University, Beni Suef City 62511, Egypt; 3Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena City 83511, EgyptCorrespondence: Ahmed HusseinDepartment of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag 82524, EgyptTel +20 1011145537Fax +20 934600349Email ahmed_hussien@med.sohag.edu.egBackground: A large percentage of diabetic patients also have other components of metabolic syndrome, which is a group of cardiovascular (CV) hazard factors related to both diabetes mellitus (DM) and cardiovascular diseases (CVD). We do not know about the prevalence of CV risk factors in diabetic patients in Upper Egypt. We aimed to assess the CV risk factors in type 2 diabetic patients in Upper Egypt villages.Methods: We conducted a cross-sectional study that included 800 patients with type 2 DM. We classified the participants into three groups according to the hemoglobin A1c (HbA1c) levels. We assessed the prevalence of other cardiovascular risk factors and their association with HbA1c levels through a detailed history, full clinical examination, and laboratory tests.Results: We found that 75% of the participants were males, 25.5% elderly, 60.25% had hypertension, 60.75% had dyslipidemia, 33.25% were overweight or obese, 19.75% had a family history of coronary artery disease (CAD), 55.75% had established CVD, 42.5% were smokers, and only 12.25% were physically inactive. We found that 84% of the participants had ≥ two cardiovascular risk factors other than DM. HbA1c level was ≥ 7% in 77% of patients. After multivariate regression analysis, we found a significant association of higher systolic blood pressure (BP), more elevated diastolic BP, higher body mass index (BMI), increased waist circumference, old age, long duration of DM, and an increase in the number of clustered CV risk factors with a higher HbA1c level. At the same time, insulin therapy was significantly associated with a lower HbA1c level.Conclusion: All type 2 diabetic patients in Upper Egypt villages have other associated CV risk factors. The clustering of cardiovascular risk factors showed a significant association with higher HbA1c levels. These findings require the thought of associated CV risk factors in choosing medical treatments to optimize glycemic control and multifactorial intervention to improve CV risk.Keywords: DM, HbA1c, CV risk factors, CVD

Zohair Jamil Gazzaz,1 Rahila Iftikhar,2 Tahir Jameel,1 Mukhtiar Baig,3 Manal Abdulaziz Murad2 1Department of Internal Medicine, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Rahila IftikharDepartment of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 22431, Saudi ArabiaTel +13467541966Email rahila_iftikhar@hotmail.comPurpose: To find out the association of dyslipidemia and comorbidities with risk factors among type-2 diabetes mellitus (T2DM) patients attending King Abdulaziz University Hospital (KAUH) Jeddah, Saudi Arabia (SA).Patients and Methods: Three hundred and twenty-five T2DM patients were enrolled from the electronic record of the KAUH. The patients’ existing comorbidities and dyslipidemia correlation with demographic, clinical, and available laboratory data were sought. Statistical analysis was performed on SPSS-23.Results: Of the total 325 T2DM patients with a mean age of 60.13± 10.5 years [males 95 (29.23%) and females 230 (70.77%)] were included from the electronic record. Poor glycemic control was observed in 222 (68.31%) subjects (HbA1c > 7%), and 154 (47.39%) subjects had DM for more than ten years. Among our study subjects, 103 (31.69%) were hypertensive (HTN), 112 (34.46%) had ischemic heart disease (IHD), 45 (13.85%) were obese, 8(2.46%) had a stroke and 269 (82.77%) had dyslipidemia. Of the total 269 dyslipidemic patients,168 (62.45%) were on hypolipidemic treatment. On comparison of study variables according to dyslipidemia versus normal lipid levels, the lipid profile, including HDLc, LDLc, TC, and TG, revealed a highly significant difference (p-value < 0.001) whereas many variables were not significantly different. HBA1c, FBG, and RBG were significantly higher in dyslipidemic subjects. Logistic regression analysis of risk factors and comorbidities in our patients revealed that age 60– 69 years and 70– 79 years had a significant association with comorbidities. Similarly, logistic regression analysis of risk factors and dyslipidemia in our patients revealed no statistically significant association.Conclusion: Our results observed that the comorbidities were associated with increasing age and common comorbidities were HTN, IHD, dyslipidemia. Our study has highlighted the current trends in T2DM symptomatology and comorbidities. Efficient management and control by early screening and developing healthy lifestyles in our patients can be very helpful in the prevention of all these highly morbid complications of this preventable disease.Keywords: dyslipidemia, DM, IHD, cholesterol, comorbidities, HbA1c, hypertension

Yue Huang,1,* Wenxun Huang,2,* Jing Wei,3 Zubin Yin,1 Hanjing Liu4 1Department of Psychosomatic Medicine, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China; 2Department of Infectious Disease, Chongqing University Three Gorges Hospital, Chongqing, 404000, People’s Republic of China; 3Department of Endocrinology, Chongqing Municipality Wanzhou District People’s Hospital, Chongqing, 404000, People’s Republic of China; 4Department of Clinical Psychology, The Chinese People’s Armed Police Force Zhejiang Corps Hospital, Hangzhou, 310051, Zhejiang Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hanjing LiuDepartment of Clinical Psychology, The Chinese People’s Armed Police Force Zhejiang Corps Hospital, No. 86, Jiangnan Avenue, Hangzhou, 310051, Zhejiang Province, People’s Republic of ChinaTel +86 13874451742Email liuhanjing666@126.comBackground: Existing studies have reported that patients with diabetes mellitus (DM) have an increased risk of depressive symptoms. We aimed to evaluate the association between serum cystatin C levels and depressive symptoms in DM patients.Methods: Serum levels of cystatin C were measured in 254 patients with DM at baseline. Cox proportional hazard analysis was used to evaluate the value of serum cystatin C in predicting depressive symptoms in patients with DM.Results: Multivariate linear regression analysis showed that serum cystatin C levels were independently associated with Centre for Epidemiological Studies Depression (CES-D) scores after adjusting for age, sex, body mass index (BMI), current smoking status, current drinking, admission systolic and diastolic blood pressure (BP), cardiovascular disease (CVD) history and laboratory measurements in patients with DM at baseline (Sβ= − 0.127; 95% CI, - 0.185– - 0.083; P=0.002). The multivariate Cox proportional hazard analysis revealed that serum cystatin C (HR=2.360, 95% CI 1.500– 3.891, P-trend < 0.001) was an independent prognostic factor for cognitive decline in these patients with DM during the follow-up period.Conclusion: Our results showed that increased serum cystatin C levels were significantly and independently associated with depressive symptoms and had independent predictive value for depressive symptoms in patients with DM. Serum cystatin C might enable early recognition of depressive symptoms among DM patients.Keywords: cystatin C, DM, depressive symptoms, prognostic value

Zohair Jamil Gazzaz,1 Rahila Iftikhar,2 Tahir Jameel,1 Mukhtiar Baig,3 Manal Abdulaziz Murad2 1Department of Internal Medicine, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Rahila IftikharDepartment of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 22431, Saudi ArabiaTel +13467541966Email rahila_iftikhar@hotmail.comPurpose: To find out the association of dyslipidemia and comorbidities with risk factors among type-2 diabetes mellitus (T2DM) patients attending King Abdulaziz University Hospital (KAUH) Jeddah, Saudi Arabia (SA).Patients and Methods: Three hundred and twenty-five T2DM patients were enrolled from the electronic record of the KAUH. The patients’ existing comorbidities and dyslipidemia correlation with demographic, clinical, and available laboratory data were sought. Statistical analysis was performed on SPSS-23.Results: Of the total 325 T2DM patients with a mean age of 60.13± 10.5 years [males 95 (29.23%) and females 230 (70.77%)] were included from the electronic record. Poor glycemic control was observed in 222 (68.31%) subjects (HbA1c > 7%), and 154 (47.39%) subjects had DM for more than ten years. Among our study subjects, 103 (31.69%) were hypertensive (HTN), 112 (34.46%) had ischemic heart disease (IHD), 45 (13.85%) were obese, 8(2.46%) had a stroke and 269 (82.77%) had dyslipidemia. Of the total 269 dyslipidemic patients,168 (62.45%) were on hypolipidemic treatment. On comparison of study variables according to dyslipidemia versus normal lipid levels, the lipid profile, including HDLc, LDLc, TC, and TG, revealed a highly significant difference (p-value < 0.001) whereas many variables were not significantly different. HBA1c, FBG, and RBG were significantly higher in dyslipidemic subjects. Logistic regression analysis of risk factors and comorbidities in our patients revealed that age 60– 69 years and 70– 79 years had a significant association with comorbidities. Similarly, logistic regression analysis of risk factors and dyslipidemia in our patients revealed no statistically significant association.Conclusion: Our results observed that the comorbidities were associated with increasing age and common comorbidities were HTN, IHD, dyslipidemia. Our study has highlighted the current trends in T2DM symptomatology and comorbidities. Efficient management and control by early screening and developing healthy lifestyles in our patients can be very helpful in the prevention of all these highly morbid complications of this preventable disease.Keywords: dyslipidemia, DM, IHD, cholesterol, comorbidities, HbA1c, hypertension

Hua Sun,*,1 Man Liang,*,2 Na Zheng31Department of Endocrinology, The Affiliated Hospital of Beihua University, Jilin City, Jilin 132011, People’s Republic of China; 2Department of Forensic Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People’s Republic of China; 3Department of Pathology, Health Science Center, Shen Zhen University, Shenzhen, Guangdong 518066, People’s Republic of China*These authors contributed equally to this workWe read with great interest the recently published article by Vasheghani et al.1 In the article, the authors showed that the prevalence of CAN was increased with prolonged duration of DM, but not the glycemic control level.View the original paper by Vasheghani and colleagues.