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Aims Transition from pediatric to adult care is difficult for patients with chronic diseases. In this study, factors associated with metabolic control in childhood-onset type 1 diabetes (T1D) after transfer to adult care were analyzed. Methods Overall, 224 persons with T1D were contacted yearly from 1998 to 2019. They voluntarily answered a questionnaire about their current hemoglobin A1c (HbA1c) levels, diabetes-associated complications, kind of care, living conditions, and family situation. Then, mixed longitudinal-cross-sectional analyses were carried out. Results Overall, 190 patients answered at least once (mean age: 26.6 years). Diabetes complications were mentioned by 10 patients (5 microalbuminuria, 5 retinopathy). Most patients (92.6%) were in diabetes-specific care during the first year after transfer, with a trend to leave diabetes-specific care during the observation period. Patients in diabetes-specific care displayed lower HbA1c levels (%/mmol/mol) (7.1/54 vs. 7.5/58). An important predictor for HbA1c after transfer was HbA1c during the year before transfer (r=0.67, p <0.001). Patients living alone showed no difference in HbA1c levels from those living with their parents. Married patients had lower HbA1c levels (7.0/53 vs. 7.3/56, p<0.05) than unmarried ones. Patients with children (15.8%) presented lower HbA1c levels (6.9/52 vs. 7.3/56, p <0.01) than those without. Conclusions Good metabolic results are favored in patients followed-up in specialized care, are married, and are parents. We recommend transfer to a diabetologist with experience in T1D at an individual age. [ABSTRACT FROM AUTHOR]

There is growing interest in the perioperative management of patients who have indications for hip and knee arthroplasty in the setting of modifiable risk factors such as morbid obesity, poorly controlled diabetes, and smoking. A recent survey of the American Association of Hip and Knee Surgeons (AAHKS) found that 95% of respondents address modifiable risk factors prior to surgery. The aim of this study was to poll Australian arthroplasty surgeons regarding their approach to patients who have modifiable risk factors. The survey tool used in the AAHKS study was adapted for use in the Australian context and distributed to the membership of the Arthroplasty Society of Australia via SurveyMonkey. There were 77 responses received, representing a response rate of 64%. The majority of respondents were experienced, high volume arthroplasty surgeons. Overall, 91% of respondents restricted access to arthroplasty for patients who have modifiable risk factors. There were 72% restricting access for excessive body mass index, 85% for poor diabetic control, and 46% for smoking. Most respondents made decisions based on personal experience or literature review rather than hospital or departmental pressures. While 49% of surgeons believed that current payment systems did not impair their ability to achieve good outcomes, 58% believed that certain arthroplasty patients would benefit from additional intervention, based on their socioeconomic status. Over 90% of surgeons who responded address modifiable risk factors prior to surgery. This finding aligns with the practice patterns of AAHKS members, despite differences in healthcare systems. [ABSTRACT FROM AUTHOR]

A survey of the American Association of Hip and Knee Surgeons (AAHKS) reported that 95% of respondents attempted to modify risk factors prior to arthroplasty. This study investigated Indian arthroplasty surgeons' approach to patients who have modifiable risk factors. The AAHKS survey tool was adapted for Indian surgeons and distributed to the membership of the Indian Society of Hip and Knee Surgeons and Indian Arthroplasty Association via a Survey Monkey. A total of 92 survey responses were received, representing a response rate of 12%. Overall, 87% of respondents restricted access to arthroplasty surgery for patients who have modifiable risk factors, but only 51% of respondents reported delays or restricted treatment because of risk factors. Respondents reported that financial implications were more likely to delay or restrict treatment in 97% and social/family reasons in 66%. Poor diabetic control (81%), previous infection (57%), and malnutrition/hypoalbuminemia (47%) were the most frequent modifiable risk factors. There were 82% of surgeons reporting that the patient's socioeconomic status influenced treatment including: 71% of patients who have low socioeconomic status, 57% who do not have insurance, and 45% who have limited social supports. Most surgeons (92%) reported that funding influenced the type of care provided and the choice of implants. Over 97% of Indian arthroplasty surgeons thought socioeconomic factors impaired access to orthopaedic treatment. Only half the surgeons restricted access for comorbidities and these were more often related to infection risks and diabetes. These findings contrast dramatically to the practice patterns of American AAHKS members. [ABSTRACT FROM AUTHOR]

In the present study, Zinc oxide nanoparticles andSilver Oxide nanoparticles were evaluated for their in vivo and in vitro antidiabetic activity. The resulting ZnO, Ag2O were characterized via various methods like UV, XRD, FTIR, PSA and SEM, TEM, and ICP-OES. The synthesized NPs were tested sub-acute oral toxicity model by abiding by the OECD425 guidelines. The male Wistar rats with a weight ranging from 180-200 g were grouped as follows: normal control: those that didn't received any treatment, Diabetic control: who received a single intraperitoneal dose of streptozotocin (45mg kg-1), Zinc Oxide Nanoparticles: received single daily oral dose of (30mg kg-1), Silver Oxide Nanoparticles: received a single daily oral dose of (30mg kg-1) Combine Zinc Oxide and Silver Oxide Nanoparticles (60mg kg-1). Metformin received a single daily oral dose of 100mg kg-1. Synthesized Zn and Ag2O nanoparticles showed no toxic effect and were considered safe. From the experimental results, it may be concluded that the combined dose of ZnO and Ag2O had more potent antihyperglycemic activity, further studies are required to establish the mechanism of action. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is an increasingly prevalent condition that is associated with significant complications, especially when glycemic control is poor. This study explored what biopsychosocial factors are associated with poor vs. very poor glycemic control among Malaysian patients with sub-optimal glycated hemoglobin (HbA1c) levels. Methods: This cross-sectional study recruited diabetic patients with poor glycemic control (HbA1c ≥ 7.0%) from the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. The Generalized Anxiety Disorder (GAD)-7, Beck Depression Inventory (BDI) and Big Five Inventory (BFI) questionnaires assessed for anxiety, depression and personality traits, respectively. Multivariate logistic regression analysis was performed to evaluate associations between biopsychosocial factors and the occurrence of poor vs. very poor glycemic control, using the median HbA1c level of the study sample as the cutoff point. Results: The median age of participants (n = 176) was 61.5 years. The median duration of diabetes was 15.0 years, and the median HbA1c level was 8.5%. Very poor control of diabetes (HbA1c > 8.5%) was associated with younger age, single status, retirement, hypertension and dyslipidemia in bivariate analysis. However, in the final multivariate regression model, only agreeableness was associated with very poor glycemic control (p < 0.01). There were no differences in depression and anxiety scores between the poor and very poor glycemic control groups. Discussion: This study suggests that the agreeableness personality trait may be associated with very poor glycemic control. The effects of personality traits on glycemic control might be influenced by sociocultural factors. Further investigations are needed to provide a better understanding of this area. [ABSTRACT FROM AUTHOR]

Indonesia faces a double burden of communicable and non-communicable diseases, including metabolic and degenerative problems. Delay in the detection of diabetic nephropathy (DN) as one of the chronic microvascular complications is often seen, leading to the need for hemodialysis due to the end-stage renal disease (ESRD). An assessment of diabetes mellitus (DM) control target achievement, based on the guideline from the Indonesian Society of Endocrinology (Perkumpulan Endokrinologi Indonesia, PERKENI), and nephropathy early detection was performed in 54 Type-2 DM patients from 5 private hospitals in Pekanbaru Riau, Indonesia, from November 2018 to September 2019. Results showed poor achievement of DM control with 61.1% had abnormal body mass index, 57.5% had HbA1c>7%, and 77.7% had LDL serum >100 mg/dL. Nevertheless, most patients achieved good blood pressure control (74%). A high percentage of nephropathy-proteinuria was seen (40.7%) with 40.9% of them revealed renal insufficiency classified as chronic kidney disease (CKD) stage 3 and 4. There was a significant correlation between proteinuria and declined GFR (p=0.016), onset of DM (p=0.02), and diastolic blood pressure (p=0.03). No correlation was found between HbA1c and declined GFR, which may be due to the cross-sectional nature of the study. It will be interesting to perform a prospective study on proteinuria modification as a predictor of nephropathy early detection in DM patients since kidney biopsy and urine albumin creatinine ratio assessment are not available in primary health care services in remote areas.

Background & Objective: As an autoimmune disease, Type-1 diabetes mellitus (DM) may be associated with other autoimmune disorders, the presence of thyroid antibodies could be negatively impact the diabetic control. Our objective was to investigate thyroid autoimmunity in a cohort of children and adolescents with Type-1 diabetes and the Influence of the presence of thyroid autoimmune abnormalities on the control of diabetes in group of Iraqi pediatric patients with Type-I D.M. Methods: This study was conducted at the Medical City Complex, Children Welfare Hospital, Baghdad, Iraq. This study was carried out from the first of January 2016 till the end of September 2017. Data were analyzed from 150 patients with Type-1 diabetes, aged 1–18 years who were treated and are coming for regular follow up in the diabetic clinic. Thyroid functions tests, Antibodies to thyroglobulin (anti-TG) and thyroperoxidase (anti-TPO) were measured, documented and correlated with diabetic control according to glycated haemoglobin (HbA1c) level. Results: In the total of 150 patients, positive Antibodies to thyroglobulin (anti TG) were more in ≤3 years duration group of Diabetes mellitus( DM) and negative anti TG was less in the >3 years duration of DM group with statistically significant results (p=0.043), Regarding the distribution of thyroid antibodies (AB) according to HbA1c group, there was progressive positive anti thyroperoxidase (anti TPO) titer with glycemic status, good glycemic control had the lowest positive anti TPO titer and poor glycemic control group had the highest positive anti TPO titer and the result was statistically significant (p=0.048). Conclusions: Thyroid autoimmunity may be associated with poor diabetic control and elevated TSH levels, indicating subclinical hypothyroidism that my affect the diabetic control. [ABSTRACT FROM AUTHOR]

This paper introduces a cutting-edge sensing technology that combines quantum conductance and capacitance signal analyses extracted from impedance measurements for the detection of acetone in gaseous or liquid forms. The electrochemical oxidation of a single-layer graphene (SLG) was employed through chronoamperometry, resulting in enhanced acetone sensing capability, enabling potential diabetes control using acetone as a marker. The modified SLG exhibits a distinct impedance response, offering access to the concentration of oxidized groups as a secondary signal in the capacitive Nyquist diagram. This methodology involves measuring the quantum conductance and capacitance of oxidized single-layer graphene by the Quantum Rate theory and applying these highly sensitive signals to measure acetone. Significantly low limits of detection were attained (∼ 0.13 nM). This study confirms that measuring the quantum properties of chemically modified graphene layers can be used to track environmental changes caused by different acetone concentrations. The findings reported here constitute a proof-of-concept that rightly modified 2D-carbonaceous materials can serve as effective analytical and sensing tools for the detection of acetone in the medical field of diabetes management. • Sensing platform technology based on quantum conductance and capacitance signal. • Significant low limits of detection for acetone (remarkable level of sensitivity). • Quantum properties of chemically modified graphene. • Utilization of the quantum properties as an efficient analytical and sensing tool. • A proof-of-concept as a sensing tool for the detection of acetone. [ABSTRACT FROM AUTHOR]

Context: Hyperglycemia is the most important factor for development of complications. A high level of hemoglobin A1c (HbA1c) is linked with such complications of diabetes. Aims: The aim of this study was to compare diabetic care between community diabetic center (CDC) and primary health centers. Settings and Design: This was a retrospective cohort study conducted at King Abdulaziz Medical City for National Guard Health Affairs at Riyadh, Saudi Arabia. Subjects and Methods: Data were retrieved from electronic medical records for diabetes mellitus Type 2 patients who were treated at two settings: CDCs and primary healthcare. Statistical Analysis Used: SPSS (V21) was used to analyze the univariate and bivariate analysis, Student′s t-test for continuous variables and Chi-square test for binary variables were used. P value was set as statistically significant if it is

This study was conducted to compare the impact of cinnamon silver nanoparticles (C-Ag-NPs) and cinnamon aqueous extract (CAE) on the total body weight (TBW), body weight gain (BWG), blood count (BC), fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), low-density (LDL-C) and high-density (HDL-C) lipoprotein cholesterol, liver function enzymes, superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) of normal and streptozotocin (STZ) diabetic rats. The CAE was administered to rats at different doses (50.0 and 100.0 mg/kg bw), whereas the C-Ag-NPs were ingested at doses of 25.0 and 50.0 mg/kg bw for 30 days. At the end of the experiment, the administration of high or low dosages of CAE or C-Ag-NPs to diabetic rats significantly reduced the FBG, TC, TG, and LDL-C and significantly increased the HDL-C compared with the diabetic control rats. The highest dose (50.0 mg/kg bw) of the C-Ag-NPs was the most efficient at significantly reducing ( P < 0.05) the levels of all the analyzed parameters compared with the CAE. However, the treated and normal rats did not show any hypoglycemic activity after ingesting the CAE or C-Ag-NPs. Such effects were associated with considerable increases in their BWG. The diabetic rats that ingested the CAE or C-Ag-NPs showed a gradual decrease in their FBG, TC, LDL, and TG levels, but they were still higher than those in the normal rats. Furthermore, the C-Ag-NPs and CAE considerably enhanced the hepatic (GPT, GOT, ALP, and GGT) and antioxidant biomarker enzyme activities (SOD, CAT, and GPx) in diabetic rats. Relative to the untreated diabetic control, the C-Ag-NPs were more effective than the CAE in the diabetic rats. The C-Ag-NPs exhibited a protective role against hyperglycemia and hyperlipidemia in the diabetic rats and modulated their liver function enzyme biomarkers and antioxidant enzyme activities more than the CAE., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective There has been a growing recognition that obstructive sleep apnea (OSA) could increase the propensity for type 2 diabetes the metabolic syndrome. However, studies concerning about the impact of non-apnea sleep disorders (NSD) on diabetes control and metabolic outcomes are relatively scarce. Our aim is to investigate the impact of non-apnea sleep disorders (NSD) on diabetic control and associated metabolic outcomes in patients with type 2 diabetes. Methods The data were obtained from two nationwide population-based databases for a period 2007 to 2012. A total 66,992 patients with type 2 diabetes were enrolled and divided into two cohorts based on comorbidity with or without a NSD diagnosis, and were followed up four years. The primary outcomes were to compare rate of change in HbA1c and associated metabolic outcomes during follow-up visits between patients with or without NSD. The secondary outcome is to examine whether NSD were associated with poor glycemic control of the last clinical records while controlling for the baseline HbA1c value. Results Of the 66,992 patients with type 2 diabetes, 14.82% had comorbidity with a NSD. HbA1C decreases were significantly lower by 0.04% in the NSD group (P < 0.05), and triglyceride (TG) decreases remained significantly lower by 2.53% in the NSD group (P < 0.05). Furthermore, patients in the NSD group had an 8% higher risk of poor glycemic control (HbA1C >9) (OR = 1.08; 95%CI, 1.01–1.16). Conclusion Our findings indicated patients with type 2 diabetes comorbid with NSD had a slower improvement in HbA1c compared with the comparison cohort. It may because there may exist potential floor effect given those with NSD having significantly lower HbA1c values at baseline. On the other hand, the poor diabetic control among those with NSD may be also affected by other confounders such as medical treatment or interventions. Nevertheless, given the rapidly increasing prevalence of metabolic diseases and subsequent complications, the results may highlight the importance of sleep in the clinical management of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Following a recent publication of the American Association of Hip and Knee Surgeons (AAHKS) which found that 95% of respondents address risk factors before surgery and the challenges in the ultimate access to care, the authors proposed an international collaboration in order to gain insight on how performance measures affect access to care as well as what medical and/or socioeconomic factors are considered obstacles to good outcomes from an international perspective. The aim of this study was to poll Colombia's arthroplasty surgeons regarding their approach to patients who have modifiable risk factors. The survey used in the AAHKS study was adapted for use in the Colombian context and distributed to the members of the Colombian Society of Hip and Knee Surgeons (SOCCAR) via a collaborative format online, and it was completed by 109 out of 163 members, a response rate of 67%. Overall, 67% limit or restrict surgery in patients with specific modifiable risk factors. Those factors most likely to delay or restrict treatment were malnutrition/hypoalbuminemia (95.9%), poor diabetic control (89%), and active smoking (61.6%). Limited social support was considered a liability by 82.2% of surgeons. Over 80% of respondents decide based on personal experience or literature review. Low socioeconomic status was considered a factor for limiting access by 53.4% of polled surgeons. 91.8% believe some patient populations would benefit with better access to care if payment systems provided better risk adjustment. Only 67% of Colombian arthroplasty surgeons limit or restrict elective surgery in patients with modifiable risk factors, mainly considering malnutrition and poorly controlled diabetes as a cause for restriction, and half of the surgeons consider low socioeconomic status as a limitation to arthroplasty surgery. These findings contrast dramatically to the practice patterns of American AAHKS members. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To estimate serum vitamin B12 levels in type 1 diabetes and to evaluate the influence of duration of diabetes, diabetic control, and age on B 12 levels. Importance of Study: Vitamin B12 deficiency is known to be associated with autoimmune disorders. However, currently there is very limited and controversial data regarding the prevalence of B12 deficiency in type 1 diabetes in South Indian population. If our study demonstrates the presence of low serum B12 levels in type1 diabetes in our population, a recommendation for regular screening and supplementation of vitamin B12 could be considered in these patients. Materials and Methods: This was a cross- sectional study. Ninety type 1 diabetic patients (44 males and 46 females) were randomly selected based on inclusion/ exclusion criteria from the diabetes registry at Bangalore Diabetes Centre. Serum vitamin B12 level and parameters for diabetic controls were estimated using fully automated methods. All statistical analysis was carried out using SPSS version 16. Results: The study showed that 45.5% of the diabetics had low B12 using the manufacturer′s cut - off of 180 pg/mL and 54% had low B12 using the published cut - off of 148 pmol/l (200pg/mL). There was no significant difference in B12 levels between males and females (mean difference = - 14.3: P > 0.05). The study did not demonstrate any significant correlation between vitamin B12 levels and age, duration of diabetes, and diabetes control (the r values being - 0.18, - 0.11, and - 0.08 respectively and the P-value > 0.05). Conclusion: Results of our study shows the presence of low serum B12 levels in type 1 diabetics. These findings merits further research on a larger population to investigate into the cause of deficiency and the benefit of B12 supplementation in these patients.

Context: Hyperglycemia is the most important factor for development of complications. A high level of hemoglobin A1c (HbA1c) is linked with such complications of diabetes. Aims: The aim of this study was to compare diabetic care between community diabetic center (CDC) and primary health centers. Settings and Design: This was a retrospective cohort study conducted at King Abdulaziz Medical City for National Guard Health Affairs at Riyadh, Saudi Arabia. Subjects and Methods: Data were retrieved from electronic medical records for diabetes mellitus Type 2 patients who were treated at two settings: CDCs and primary healthcare. Statistical Analysis Used: SPSS (V21) was used to analyze the univariate and bivariate analysis, Student's t-test for continuous variables and Chi-square test for binary variables were used. P value was set as statistically significant if it is <0.05. Results: The mean difference for HbA1c from first to last visits increased significantly +0.2 ± 1.67 with P = 0.002 while the low-density lipoprotein (LDL) on the other way around improved by decrease of -0.159 ± 0.74 and P < 0.000. Body mass index (BMI) among the sample increased by +0.134 ± 1.57 with no significant, P = 0.078. Among the sample, 39.5% improved their HbA1c while 56.8% deteriorated and 3.6% of the samples' readings remain the same. 55.3% of the sample improved in LDL and 52.4% in the high-density lipoprotein while 53.7% improved in triglycerides. The BMI was improved among 43.4% of diabetic patients. Conclusions: The 5-year management of diabetic patients failed to improve the A1c or BMI, at both CDC and primary health-care centers. [ABSTRACT FROM AUTHOR]

Background: Secure messaging use is associated with improved diabetes-related outcomes. However, it is less clear how secure messaging supports diabetes management., Objective: We examined secure message topics between patients and clinical team members in a national sample of veterans with type 2 diabetes to understand use of secure messaging for diabetes management and potential associations with glycemic control., Methods: We surveyed and analyzed the content of secure messages between 448 US Veterans Health Administration patients with type 2 diabetes and their clinical teams. We also explored the relationship between secure messaging content and glycemic control., Results: Explicit diabetes-related content was the most frequent topic (72.1% of participants), followed by blood pressure (31.7% of participants). Among diabetes-related conversations, 90.7% of patients discussed medication renewals or refills. More patients with good glycemic control engaged in 1 or more threads about blood pressure compared to those with poor control (37.5% vs 27.2%, P=.02). More patients with good glycemic control engaged in 1 more threads intended to share information with their clinical team about an aspect of their diabetes management compared to those with poor control (23.7% vs 12.4%, P=.009)., Conclusions: There were few differences in secure messaging topics between patients in good versus poor glycemic control. Those in good control were more likely to engage in informational messages to their team and send messages related to blood pressure. It may be that the specific topic content of the secure messages may not be that important for glycemic control. Simply making it easier for patients to communicate with their clinical teams may be the driving influence between associations previously reported in the literature between secure messaging and positive clinical outcomes in diabetes., (©Stephanie A Robinson, Mark Zocchi, Carolyn Purington, Linda Am, Kathryn DeLaughter, Varsha G Vimalananda, Dane Netherton, Arlene S Ash, Timothy P Hogan, Stephanie L Shimada. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 23.03.2023.)

Abstract: The association of hyperglycemia with postoperative infectious complications after foot and ankle surgery has been well studied. However, many surgeons in their current practice use the somewhat arbitrary cutoff of 7% glycosylated hemoglobin (HbA1c) as the level above which surgery is considered unsafe and conducive to complications. Our goal in the present study was to assess the relationship between the HbA1c levels and the rate of postoperative infection to begin to determine whether 7% is a suitable cutoff or whether this level needs to be reevaluated. Furthermore, we were interested in the general trends relating to the infection rates and preoperative HbA1c levels. Our preliminary, subjective, analysis has indicated that infection rates increase steadily as the HbA1c increases toward 7.3%, increase rapidly at an HbA1c of 7.3% to 9.8%, and then level off. Additional study is warranted to better understand the role played by other covariates in determining the infection rate and to investigate whether patient selection has influenced the appearance of decreased infection rates at high HbA1c levels. Additional study could also assess similar relationships for other types of complication, such as nonunion, and perhaps examine different foot and ankle procedures in isolation. [Copyright &y& Elsevier]

Purpose: To determine the frequency of diabetic retinopathy and its risk factors in diabetic patients attending the eye clinic at the University Hospital of the West Indies (UHWI). Materials and Methods: This was a prospective cohort study of diabetic outpatients attending the Eye Clinic at the UHWI. Data were collected on age, gender, type of diabetes mellitus (DM), type of diabetic retinopathy, other ocular diseases, visual acuity, blood glucose and blood pressure. Statistical Package for Social Sciences (SPSS version 19.0) was used for data analysis. Results: There were 104 patients (208 eyes) recruited for this study. There were 58.6% (61/104) females (mean age 53.6 ± 11.9 years) and 41.4% (43/104) males (mean age 61.7 ± 12.1 years). Type II DM was present in 68.3% (56% were females) of the patients and Type I DM was present in 31.7% (69.7% were females). Most patients (66%) were compliant with their diabetic medications. The mean blood glucose was 11.4 ± 5.3 mmol/L. Elevated blood pressure (>130/80) was present in 82.7% of patients. The mean visual acuity was 20/160 (logMAR 0.95 ± 1.1). The frequency of diabetic retinopathy was 78%; 29.5% had background retinopathy, and 50.5% of eyes had proliferative diabetic retinopathy (PDR) of which 34% had tractional retinal detachments. The odds ratio of developing PDR was 1.88 (95% confidence intervals (CI): 1.02-3.3) for Type I DM compared to 0.74 (95% CI: 0.55-0.99) for Type II DM. PDR was more prevalent in females (ϰ2, P = 0.009) in both Type I and II DM. Conclusions: Jamaica has a high frequency of PDR which is more common in Type I diabetics and females. This was associated with poor glucose and blood pressure control. [ABSTRACT FROM AUTHOR]

Objective: Insulin pumps have been well established for insulin delivery. However, questions about long-term efficacy of insulin pump therapy still remain. We evaluated the long-term efficacy of continuous insulin infusion pump therapy (CSII) in pediatric patients with type 1 diabetes mellitus (T1DM). Methods: This was a retrospective observational study which included 131 patients with T1DM who transitioned to an insulin pump from multiple daily insulin (MDI) injections between 1999 and 2009 and were followed by one endocrinologist. Data were collected from 6 months prior to switching to CSII to 30 months after initiation of CSII and included glycated hemoglobin (HbA1c) and insulin requirement. Of the 131 patients, 45 had complete data consisting of a visit and HbA1c every 6 months for 30 months after transition to CSII and were included for analysis. Results: Mean HbA1c prior to starting the CSII was 8.0 +0.9 %, 7.7 +1.0 % at 6 months and 7.8+1.2 % at 1 yr post initiation of CSII. However, at 30 months, HbA1c increased to 8.0+1.3%. A trend in transient improvement in HbA1c was limited only to those patients >11 yr of age and those requiring >0.75 u/kg/day of insulin at transition and was not seen in those <11 yr of age or those requiring <0.75 u/kg/day and did not persist beyond 1 year. Conclusions: There was no long-term significant difference in glycemic control in patients with CSII as compared to MDI. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To estimate serum vitamin B12 levels in in type 1 diabetes and to evaluate the influence of duration of diabetes, diabetic control, and age on B 12 levels. Importance of Study: Vitamin B12 deficiency is known to be associated with autoimmune disorders. However, currently there is very limited and controversial data regarding the prevalence of B12 deficiency in type 1 diabetes in South Indian population. If our study demonstrates the presence of low serum B12 levels in type1 diabetes in our population, a recommendation for regular screening and supplementation of vitamin B12 could be considered in these patients. Materials and Methods: This was a cross- sectional study. Ninety type 1 diabetic patients (44 males and 46 females) were randomly selected based on inclusion/ exclusion criteria from the diabetes registry at Bangalore Diabetes Centre. Serum vitamin B12 level and parameters for diabetic controls were estimated using fully automated methods. All statistical analysis was carried out using SPSS version 16. Results: The study showed that 45.5% of the diabetics had low B12 using the manufacturer's cut - off of 180 pg/mL and 54% had low B12 using the published cut - off of 148 pmol/l (200pg/mL). There was no significant difference in B12 levels between males and females (mean difference = - 14.3: P > 0.05). The study did not demonstrate any significant correlation between vitamin B12 levels and age, duration of diabetes, and diabetes control (the r values being - 0.18, - 0.11, and - 0.08 respectively and the P-value > 0.05). Conclusion: Results of our study shows the presence of low serum B12 levels in type 1 diabetics. These findings merits further research on a larger population to investigate into the cause of deficiency and the benefit of B12 supplementation in these patients. [ABSTRACT FROM AUTHOR]

Background. Chronic kidney disease (CKD) is an increasing public health problem. However, there have been limited data on the trend of CKD prevalence, along with the changes of health-related behaviors and other chronic diseases in an adult Korean population.Methods. Data from the Korean National Health and Nutrition Examination Survey in 2005 and 2007 were analyzed. The study subjects comprised 8400 participants aged ≥20 years with creatinine data. CKD was defined as estimated glomerular filtration rate (GFR) <60 mL/min/1.73m2. GFR was estimated by the abbreviated Modification of Diet in Renal Disease equation.Results. The CKD prevalence was significantly decreased from 2005 to 2007 (8.8 versus 7.2%; P = 0.010). The prevalence of hypertension was stable but that of diabetes was increased. The proportion of blood pressure (BP) <130/80 mmHg in the whole population, and HbA1c <7% in the diabetic participants was increased from 2005 to 2007. Participants in 2007 walked more than those in 2005. The proportion of current smoking and sodium/energy/protein excess was decreased from 2005 to 2007. In subgroup analysis, only hypertensive participants without diabetes revealed a decreasing trend of CKD.Conclusions. The CKD prevalence was decreased from 2005 to 2007. Since increased diabetes and improved diabetic control neutralized their impact on CKD, improved BP was the fundamental reason for the decrease. Various health-related behaviors may have indirectly affected the decrease of CKD through their effect in controlling BP and diabetes. [ABSTRACT FROM PUBLISHER]

Tirkkonen T, Heikkilä P, Huupponen R, Laine K (University of Turku; Turku University Hospital; and StatFinn Ltd; Turku, Finland). Potential CYP2C9-mediated drug–drug interactions in hospitalized type 2 diabetes mellitus patients treated with the sulphonylureas glibenclamide, glimepiride or glipizide. J Intern Med 2010; 268: 359–366. Objectives. Sulphonylureas are widely used in the treatment of type 2 diabetes mellitus (T2DM). Based on laboratory findings, we determined the clinical significance of potential CYP2C9-mediated drug–drug interactions in hospitalized patients receiving glibenclamide, glimepiride or glipizide, all of which are metabolized by CYP2C9, together with a CYP2C9 inhibitor. Design, setting and subjects. An observational pharmaco-epidemiological database study was performed in a university hospital setting with 3884 patients with T2DM. Main outcome measures. Efficacy and safety of sulphonylurea therapy during the potential interaction (sulphonylurea treatment with a CYP2C9 inhibitor) vs. control periods (sulphonylurea treatment without a CYP2C9 inhibitor) were estimated using laboratory parameters. Results. Almost 20% of patients were exposed to a potential drug–drug interaction with a CYP2C9 inhibitor during sulphonylurea treatment. More than 75% of the potential interactions occurred with trimethoprim, metronidazole and fluconazole. When all sulphonylureas were pooled and adjusted for age, gender, ward and sulphonylurea dose, mean and maximum fasting plasma glucose concentrations as well as maximum values of glycosylated haemoglobin were significantly lower during the interaction periods compared with control periods, whereas mean and minimum activities of alanine amino transferase and gamma-glutamyl transferase were higher. The minimum fasting plasma glucose values were more often below the target range in patients with potential interactions. The sulphonylurea dose did not differ significantly between patients who were or were not concomitantly treated with a potentially interacting drug. Conclusions. Concomitant use of a CYP2C9 inhibitor results in exaggerated pharmacodynamic effects of sulphonylureas and increases the risk of hypoglycaemia in T2DM patients receiving glibenclamide, glimepiride or glipizide. [ABSTRACT FROM AUTHOR]

The article presents an overview of the changes that are seen in the needs of children with type one diabetes as they grow and of methods that school nurses can use to help support children and young people with type one diabetes in day care settings and in schools. A discussion of a survey on the prevalence of diabetes among British children and youth which was conducted by the Royal College of Paediatrics and Child Health is presented. The management of diabetes in children and youth is discussed.

Aim To clarify the relationship of aerobic fitness and handgrip strength with glycaemic control (HbA1c), body composition and lipid profile in Type 1 diabetes. Methods Aerobic capacity (Chester Step Test), handgrip strength and body composition (bioelectrical impedance) were measured in 141 patients with Type 1 diabetes. Results Aerobic capacity correlated positively with HbA1c and lean body mass and negatively with body mass index and fat mass. Handgrip strength correlated positively with aerobic capacity and negatively with HbA1c and fat mass. In addition, there was a positive correlation between HbA1c and total cholesterol. Conclusion Patients with Type 1 diabetes who have good aerobic capacity have poorer glycaemic control. However, this was an observational study and the results must be interpreted with caution. Further investigation into how these patients manage blood glucose during exercise is required. [ABSTRACT FROM AUTHOR]

Abstract: This preliminary research has identified that there are issues concerning a lack of understanding of the available information, both clinical and social, provided to people with diabetic retinopathy. An integrated holistic health and social care approach could satisfy the needs of the patient, where both their clinical needs and their social needs run in tandem. Access to information regarding training, education and employment needs to be addressed through further research. Problems with monitoring their diabetes are an issue for many visually compromised people with diabetes. The provision of visual awareness training for front line staff in all health care establishments would help to eliminate the difficulties faced by people with a visual impairment in accessing health care. [Copyright &y& Elsevier]

Purpose: To identify differences that may affect morbidity and mortality of type 2 diabetic patients reaching ESRD between countries with different socioeconomic conditions. Methods: Comparison of clinical and laboratory features between 21 Nigerian (N) and 57 American patients (A) reaching ESRD over a 30month period. Results: Differences were noted in age at ESRD (N, 55.5±9.8; A, 64.5±9.6years), duration of diabetes (N, 5.2±2.8, A: 14.9±4.9years), body mass index (N, 24.5±4.1; A; 27.6±6.3kg/m2), prevalence of left ventricular hypertrophy (N; 14%; A, 89%) and ischemic heart disease (N, 26%; A, 67%), blood pressure (N, [166.2±26.7]/[98.6±16.5]mmHg; A, [146.8±23.6]/[72.5±13.3]mmHg), creatinine clearance (N, 6.1±3.6; A, 14.8±3.5ml/min), urine protein excretion (N, 1.2±0.7; A, 6.1±4.9g/24-h), hematocrit (N, 28.0±6.0; A, 35.0±5.0%), serum glucose (N, 5.6±1.6; A, 10.5±5.5mmol/l), and serum cholesterol (N, 5.32±2.57; A, 4.19±1.16mmol/l) (all at P≤0.05). Differences were also found in the number of antihypertensive medications (N 1.4±0.6; A 2.4±1.2 per patient), and use of medications for diabetes (N 29%, A 79%), statins (N zero, A 61%) and erythropoietin (N zero, A 39%). 72% of the A, but none of the N patients had a functional dialysis access prior to ESRD. Conclusions: Between A and N patients reaching ESRD, there are differences in clinical features and laboratory values that may affect morbidity, mortality and impact on the health care resources. These differences indicate areas where further studies that could assist in the planning for ESRD care in both Nigeria and USA are required. [ABSTRACT FROM AUTHOR]

SummaryAims Young people in Russia with diabetes have an increased morbidity and a 10-fold increase in mortality compared with many European countries. This joint international study was set up to compare of care and outcomes against published guidelines in three Russian centres and one UK centre. Methods An assessment of the diabetic care of 368 children, based on the principles of the St Vincent Declaration, was undertaken in each centre. Data on prevalence, management, control and complications were collected in young people with diabetes < 16 years of age in each of the four centres over a 4-week period. Results The prevalence of diabetes was greater in Southampton (1 : 702 vs. 1 : 1378). At diagnosis Russian children had a higher incidence of ketoacidosis (69 vs. 29%) and stayed in hospital longer (30 vs. 3 days). In management Russian children received more injections per day (5 vs. 2). There was no significant difference in insulin dose for those under 10 years between countries (Southampton 0.69 U/kg vs. Russian 0.73 U/kg, P = NS). Older Russian children did not increase their insulin dosage, while children over 10 years in Southampton received significantly more insulin than the Russian children (Southampton 1.0 U/kg vs. Russian 0.77 U/kg, P ≤ 0.001). Twenty-nine per cent of the Russian children reported that they had insufficient insulin and 14% had to buy extra. HbA1c was higher in the Russian children (9.8% vs. 8.3%), increasing significantly with age. The Russian children showed a height deficit which correlated with HbA1c and diabetes duration. The Southampton children were heavier and with a higher body-mass index and their HbA1c did not rise similarly as in Russia. Severe hypoglycaemia was more common in the Southampton children (32 vs. 12%). Retinopathy was reported in 12% of the Russian children (Southampton 0%) and systolic blood pressure > 95th centile in 21% (Southampton 8%). Conclusions This study... [ABSTRACT FROM AUTHOR]

Seventy two children with diabetes and their parents were studied to examine the relationship between family functioning and diabetic control. Children in families characterised by cohesion, emotional expressiveness, lack of conflict and a mother Satisfied with her marriage, had better diabetic control than children living in families with opposing characteristics. Children living with both biological parents or with a single parent had significantly better diabetic control than thaw living with a step-parent or adoptive parents. There was no relationship between social class, family income, employment status or educational attainment of either parent, and diabetic control. [ABSTRACT FROM AUTHOR]

In 44 diabetic patients treated either with insulin or with oral antidiabetic agents, non-enzymatic glycosylation of serum proteins (GSP), expressed as nmol of 5-hydroxymethylfurfural/mg protein, showed higher values than those found in control subjects. In the diabetics GSP was more closely correlated to the degree of glycometabolic control during the 15 days preceding the assay, than to the glycosylated hemoglobin (HbAl). However, GSP values did not correlate significantly with fasting blood glucose levels. It may be concluded that GSP can be used as an index of the medium-term control of diabetes mellitus. [ABSTRACT FROM AUTHOR]

Several metabolic (HbA, HDL-C, triglycerides) and hemostatic (VIIIR:Ag, VIII:C, B-TG) variables were investigated in 35 non-obese, insulin-dependent diabetics without clinically evident vascular complications. B-TG was high but did not correlate with other metabolic and hemostatic parameters, suggesting that elevated B-TG in diabetes might be an expression of in vitro platelet activation. VIIIR:Ag and the ratio of VIIIR:Ag to VIII:C were markedly increased. There was a significant correlation of the HbA and HDL-C levels with VIIIR: Ag, indicating that VIIIR:Ag is another reflection of metabolic control in diabetes. Additional pathogenic mechanisms, however, appear to be involved in causing the changes in VIIIR: Ag in diabetes. [ABSTRACT FROM AUTHOR]

In the present study we investigated platelet phospholipid concentration in diabetic patients in various conditions of metabolic control. We found an increase in total phospholipid concentration as well as in phosphatidylserine and phosphatidylethanolamine, the most pronounced changes being observed in poorly controlled patients. We discuss our findings in relation to the metabolic control of the disease and the high incidence of atherosclerotic lesions in these patients. [ABSTRACT FROM AUTHOR]