Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde / Color retinography as a means of screening for diabetic retinopathy in the tertiary hospital of Unified Health System

RESUMO Objetivo Avaliar o impacto da triagem de retinopatia diabética de paciente diabéticos realizada com retinografia colorida. Métodos Estudo retrospectivo, de caráter descritivo, avaliando laudos de retinografias realizadas desde a implementação do protocolo da triagem de retinopatia diabética de paciente diabéticos acompanhados no Ambulatório de Endocrinologia de um hospital terciário do Sistema Único de Saúde, de maio de 2018 até maio de 2020. Resultados Realizaram retinografia 727 pacientes diabéticos, que tinham entre 14 e 91 anos, sendo a maioria com 60 anos ou mais (53,2%), do sexo feminino (68%) e brancos (87,6%). Não apresentavam retinopatia diabética 467 (64,2%) pacientes, 125 (17,2%) tinham retinopatia diabética não proliferativa, 37 (5,1%) retinopatia diabética não proliferativa grave e/ou suspeita de edema macular, 65 (8,9%) retinopatia diabética proliferativa, 21 (2,9%) suspeita de outras patologias, e as imagens de 12 (1,7%) pacientes eram insatisfatórias. Foram considerados de alto risco (aqueles com retinopatia diabética não proliferativa grave e/ou edema macular, retinopatia diabética proliferativa ou imagem insatisfatória) 114 (15,68%) pacientes. Conclusão O rastreio de retinopatia diabética com retinografia colorida possibilitou a detecção de pacientes diabéticos de alto risco que necessitavam atendimento com brevidade, permitindo o acesso deles à consulta oftalmológica e diminuindo a morbidade da doença relacionada ao tratamento tardio. Os demais foram encaminhados à Atenção Primária para regulamentação, por meio do Sistema de Regulação.

ABSTRACT Objective To evaluate the impact of diabetic retinopathy (DR) screening using color retinography in diabetic patients. Methods Retrospective descriptive study, evaluating reports of all retinographs performed since the implementation of the protocol for screening for diabetic retinopathy in diabetic patients followed up at the endocrinology outpatient clinic of a tertiary hospital of the Unified Health System, from May 2018 to May 2020. Results 727 diabetic with age range from 14 to 91 years old, the majority being 60 years old or older (53.2%), female (68%) and white (87.6%), patients underwent retinography. Of the patients, 467 (64.2%) did not have DR, 125 (17.2%) had non-proliferative DR, 37 (5.1%) had severe non-proliferative DR and/or suspected macular edema, 65 (8.9%) had proliferative DR, 21 (2.9%) had suspicion signs of other pathologies and 12 (1.7%) had unsatisfactory images. A total of 114 (15.68%) patients were considered at high risk (those with severe non-proliferative NP and/or EM, proliferative DR or poor image) and were referred for comprehensive ophthalmic evaluation. Conclusion The screening of RD with color retinography enabled the detection of high-risk diabetic patients who needed assistance sooner and enabled their access to ophthalmologic consultation, which decreased disease morbidity. The others were referred to primary care for regulation through the Regulation System (SISREG).

Incidence and risk factors of ischemic stroke in patients with type 2 diabetes among urban workers in Beijing, China / 北京大学学报(医学版)

OBJECTIVE@#To explore the incidence of ischemic stroke after the onset of type 2 diabetes, and further analyze the risk factors, so as to provide a basis for further research.@*METHODS@#The data were obtained from the database of the Beijing Urban Employee Basic Medical Insurance Database. The study used a prospective design to describe the incidence of ischemic stroke in patients with type 2 diabetes. In our study, these patients were followed up for seven years. Multivariate Logistic regression models were used to analyze the risk factors of ischemic stroke in patients with type 2 diabetes.@*RESULTS@#A total of 185 813 newly diagnosed type 2 diabetes patients were enrolled, with an average age of (58.5±13.2) years, and 49.0% of them were males. A total of 10 393 patients with newly diagnosed ischemic stroke occurred in 7 years, with a cumulative incidence of 5.6% and an incidence density of 8.1/1 000 person-years. Ischemic stroke occurred in all age groups in patients with type 2 diabetes. The cumulative incidence was 1.5% (95%CI: 1.3%-1.6%) in group ≤44 years old, 3.6% (95%CI: 3.4%-3.7%) in group 45-54 years old, 5.4% (95%CI: 5.2%-5.5%) in group 55-64 years old, and 9.2% (95%CI: 9.0%-9.4%) in group ≥65 years old, and the cumulative incidence increased with age (P < 0.05). Cumulative incidence rate of the males (6.8%, 95%CI: 6.7%-7.0%) was higher than the females (4.4%, 95%CI: 4.3%-4.6%). Among the patients < 80 years old, the cumulative incidence rate of the males was higher than that of the females in all the age groups. In the patients ≥80 years of age, the cumulative incidence was higher in the females (9.2%) than in the males (7.9%). Further analysis revealed that complications, such as coronary heart disease (OR=3.18, 95%CI: 2.72-3.72), heart failure (OR=1.53, 95%CI: 1.32-1.79) and kidney failure (OR=1.45, 95%CI: 1.20-1.75) were associated with ischemic stroke in the patients with type 2 diabetes.@*CONCLUSION@#The incidence level of ischemic stroke in patients with type 2 diabetes is high. It is necessary to strengthen the management of risk factors in elderly patients, screen the complications of type 2 diabetes as early as possible, and take active preventive and control measures.

Psychiatric illness, emotional distress, glycemic control and chronic complications in type 1 diabetes subjects

ABSTRACT Objectives: To assess the prevalence of psychiatric disorders in patients with type 1 diabetes mellitus (T1D) and to compare patients with and without psychiatric disorder. Materials and methods: We made a cross-sectional study including patients with T1D assisted in the outpatient clinics of the Brazilian National Health System. To assess depression and anxiety, we used the PHQ-9 questionnaire and the DSM-5th edition criteria, respectively. B-PAID evaluated the level of emotional distress associated with diabetes; EAT-26, eating disorders; SCI-R, adherence to the proposed clinical treatment. Results: We analyzed 166 patients aged 33 (22-45.2) years, 53.6% female. The prevalence of depression and anxiety was 20.5% and 40.4%, respectively. HbA1c was worse in the depressed (9.0% vs. 8.4%, p = 0.008), in the anxious ones (9.0% vs. 8.3%, p = 0.012) and in the patients with high levels of B-PAID (8.8 % vs. 8.3 %, p = 0.009). There was no difference in the prevalence of complications related to diabetes. Conclusions: The prevalence of psychiatric disorders and emotional distress related to diabetes was high in our population of T1D patients, and depression and high levels of B-PAID were associated with the worse glycemic control.

Disfunções do trato urinário inferior em pacientes com diabetes mellitus tipo 2 / Disfunciones del tracto urinario inferior en pacientes con diabetes mellitus tipo 2 / Lower urinary tract symptoms in patients with type 2 diabetes mellitus

RESUMO Introdução: A Disfunção do Trato Urinário Inferior (DTUI) é uma complicação do Diabetes Mellitus (DM) e embora cause impacto negativo na qualidade de vida, não é contemplada nos programas de atenção a essa população. Objetivo: Levantar a ocorrência de DTUI em uma população com DM Tipo 2e avaliar sua associação com a história clínica. Método: Estudo transversal. Entrevista com 60 pacientes de um centro privado de DM por meio de instrumento contendo dados sociodemográficos, clínicos e sintomas de armazenamento e esvaziamento vesical apresentados nos últimos 30 dias. Análise estatística por meio do programa computacional IBM SPSS Statistics, v20.0. Resultados: Amostra predominantemente aposentada com alta escolaridade, bom padrão alimentar e intestinal, sedentária, obesa ou em sobrepeso, com taxas de hemoglobina glicada elevadas. Do total, 25% apresentavam incontinência urinária aos esforços, 60% pelo menos um sintoma de bexiga hiperativa, 41,7% pelo menos um sintoma de esvaziamento vesical incompleto, 70,1% pelo menos um sintoma de DTUI. Foi encontrada associação entre os sintomas urinários e o tempo de diagnóstico de DM. Conclusão: A população com DM tipo 2 apresenta alta ocorrência de DTUI, com predominância de sintomas de bexiga hiperativa, associada ao tempo de diagnóstico de DM.

RESUMEN Introducción: la Disfunción del Tracto Urinario Inferior (DTUI) es una complicación de la Diabetes Mellitus (DM) y aunque cause impacto negativo en la calidad de vida, no es contemplada en los programas de atención a esa población. Objetivo: obtener la incidencia de DTUI en una población con DM Tipo 2 y evaluar su asociación con la historia clínica. Método: estudio transversal. Entrevista con 60 pacientes de un centro privado de DM a través de un instrumento que contiene datos sociodemográficos, clínicos y síntomas de almacenamiento y vaciado vesical presentados en los últimos 30 días. Análisis estadístico por medio del programa computacional IBM SPSS Statistics, v20.0. Resultados: muestra predominantemente jubilada con alta escolaridad, buen patrón alimentario e intestinal, sedentaria, obesa o en sobrepeso, con niveles de hemoglobina glicosilada elevados. Del total, el 25% presentaba incontinencia urinaria a los esfuerzos, el 60% por lo menos un síntoma de vejiga hiperactiva, el 41,7% por lo menos un síntoma de vaciado vesical incompleto, el 70,1% por lo menos un síntoma de DTUI. Se encontró asociación entre los síntomas urinarios y el tiempo de diagnóstico de DM. Conclusión: la población con DM tipo 2 presenta alta incidencia de DTUI, con predominancia de síntomas de vejiga hiperactiva, asociada al tiempo de diagnóstico de DM.

ABSTRACT Introduction: Lower Urinary Tract Symptoms(LUTS) are a complication of Diabetes Mellitus (DM) and although it negatively impactsthe quality of life, it is not considered in care programs for this population. Objective: To survey the occurrence of LUTS in a population with Type 2 DM and assess its association with clinical history. Method: Cross-sectional study. Interview with 60 patients from a private DM clinic using a tool with sociodemographic and clinical data and symptoms of bladder storage and voiding in the last 30 days. Statistical analysis was performed using the computer program IBM SPSS Statistics, v20.0. Results: Most of the participants were retired with high education, good dietary, and intestinal pattern, sedentary, obese, or overweight, with high glycated hemoglobin rates. Of the total, 25% had stress urinary incontinence, 60% had at least one symptom of overactive bladder, 41.7% had at least one symptom of incomplete bladder voiding, 70.1% had at least one LUTsymptom. An association was found between urinary symptoms and time since DM diagnosis. Conclusion: The population with type 2 DM has a high occurrence of LUTS, with a predominance of symptoms of overactive bladder, associated with the time of DM diagnosis.

Protective effects of folic acid on retina in diabetic mice and its anti-oxidative stress mechanism / 中华实验眼科杂志

Objective To explore the protective effects of folic acid on retinas and its anti-oxidative stress mechanism in diabetic mice.Methods Thirty-two 16-week-old SPF degree male db/db mice were randomized into model group and folic acid group,and 16 matched C57BL/KsJ mice were used as controls.Folic acid was used to the mice by oral gavage once per day with the dose of 71 μg/kg (2 ml) for 60 days in the folic acid group,and the same volume of normal saline solution was used in the model group and control group in the same way.The activities,mental state,body weight,and fasting plasma glucose (FPG) of the mice were recorded during experiment.At the end of the intervention,the mice were sacrificed and the retinas and blood sample were obtained.The histopathology of the retinas was examined with hematoxylin-eosin staining;serum homocysteine (Hcy) was detected by ELISA assay;the relative expressions of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) mRNA were detected in the retinas by real-time fluorescence quantitative PCR;the relative expressions of B lymphoma 2 protein (bcl-2),bcl-2 related X protein (bax),3-nitrotyrosine (3-NT) and 4-Hydroxynonine (4-HNE) proteins were assayed by Western blot assay;superoxide dismutase (SOD),8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels in the retinas were detected by biochemical kits,and immunofluorescence assay was used to detect the expression of NADPH oxidation 4 (NOX4) in the retinas.The use and care of the experimental animals adhered to the ARVO Statement by the American Association for Vision and Ophthalmology Research and this study protocol was approved by Ethic Committee of Qinghai University (QHDX 2018-35).Results Over the experimental period,The FPG was normal and body weight was gradually increased in the mice of control group.The FPG＞16.7 mmol/L and the mice appeared obese.In the folic acid group,both body mass and FPG of the mice were gradually reduced.At the end of drug administration,serum Hcy concentration of the mice was (27.18± 3.18)μmol/L in the model group,which was significantly higher than (8.28±2.18) μmol/L in the control group and (13.73±2.54) μmol/L in the folic acid group (all at P＜0.05).The retinal structure was intact in the control group,and the retinas were thinning with more capillaries and inflammatory cells in the model group,the thickness of the retinas was increased and the capillaries and inflammatory cells were decreased in the folic acid group.The relative expressions of TNF-α and IL-6 mRNA in the retinas were significantly higher in the model group than those in the control group,and those in the folic acid group were reduced in comparison with the model group (all at P＜0.05).The relative expression of bcl-2 protein in the retinas of folic acid group was lower than that in the control group and higher than that in the model group,and the relative expressions of bax,3-NT and 4-HNE proteins in the retinas of the folic acid group were significantly higher than those in the control group and lower than those in the model group (all at P＜0.05).The T-SOD activity in the folic acid group was significantly stronger than that in the control group and weaker than that in the model group,and the concentrations of 8-OHdG and MDA in the retinas of the folic acid group were significantly reduced in comparison with those of the control group and elevated in comparison with those of the model group (all at P＜0.05).The expressing intensity of NOX4 protein in the retinas of the folic acid group was significantly weaker than that of the model group.Conclusions Folic acid appears aprotective effect on retinal tissue in diabetic mice by reducing serum Hcy,inhibiting oxidative stress and cell apoptosis.

Protective effects of folic acid on retina in diabetic mice and its anti-oxidative stress mechanism / 中华实验眼科杂志

Objective@#To explore the protective effects of folic acid on retinas and its anti-oxidative stress mechanism in diabetic mice.@*Methods@#Thirty-two 16-week-old SPF degree male db/db mice were randomized into model group and folic acid group, and 16 matched C57BL/KsJ mice were used as controls.Folic acid was used to the mice by oral gavage once per day with the dose of 71 μg/kg (2 ml) for 60 days in the folic acid group, and the same volume of normal saline solution was used in the model group and control group in the same way.The activities, mental state, body weight, and fasting plasma glucose (FPG) of the mice were recorded during experiment.At the end of the intervention, the mice were sacrificed and the retinas and blood sample were obtained.The histopathology of the retinas was examined with hematoxylin- eosin staining; serum homocysteine (Hcy) was detected by ELISA assay; the relative expressions of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) mRNA were detected in the retinas by real-time fluorescence quantitative PCR; the relative expressions of B lymphoma 2 protein (bcl-2), bcl-2 related X protein (bax), 3-nitrotyrosine (3-NT) and 4-Hydroxynonine (4-HNE) proteins were assayed by Western blot assay; superoxide dismutase (SOD), 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels in the retinas were detected by biochemical kits, and immunofluorescence assay was used to detect the expression of NADPH oxidation 4 (NOX4) in the retinas.The use and care of the experimental animals adhered to the ARVO Statement by the American Association for Vision and Ophthalmology Research and this study protocol was approved by Ethic Committee of Qinghai University (QHDX 2018-35).@*Results@#Over the experimental period, The FPG was normal and body weight was gradually increased in the mice of control group.The FPG>16.7 mmol/L and the mice appeared obese.In the folic acid group, both body mass and FPG of the mice were gradually reduced.At the end of drug administration, serum Hcy concentration of the mice was (27.18±3.18)μmol/L in the model group, which was significantly higher than (8.28±2.18)μmol/L in the control group and (13.73±2.54)μmol/L in the folic acid group (all at P<0.05). The retinal structure was intact in the control group, and the retinas were thinning with more capillaries and inflammatory cells in the model group, the thickness of the retinas was increased and the capillaries and inflammatory cells were decreased in the folic acid group.The relative expressions of TNF-α and IL-6 mRNA in the retinas were significantly higher in the model group than those in the control group, and those in the folic acid group were reduced in comparison with the model group (all at P<0.05). The relative expression of bcl-2 protein in the retinas of folic acid group was lower than that in the control group and higher than that in the model group, and the relative expressions of bax, 3-NT and 4-HNE proteins in the retinas of the folic acid group were significantly higher than those in the control group and lower than those in the model group (all at P<0.05 ). The T-SOD activity in the folic acid group was significantly stronger than that in the control group and weaker than that in the model group, and the concentrations of 8-OHdG and MDA in the retinas of the folic acid group were significantly reduced in comparison with those of the control group and elevated in comparison with those of the model group (all at P<0.05). The expressing intensity of NOX4 protein in the retinas of the folic acid group was significantly weaker than that of the model group.@*Conclusions@#Folic acid appears aprotective effect on retinal tissue in diabetic mice by reducing serum Hcy, inhibiting oxidative stress and cell apoptosis.

A study to assess clinical profile of Indian type 2 diabetes mellitus patients treated with Teneligliptin-ASPIRE study

Background: Teneligliptin is a DPP-4 inhibitor with unique chemical structure. Efficacy and safety of Teneligliptin is well established in the patients with type 2 diabetes mellitus (T2DM) in different randomized controlled trials. However, limited real-world data is available for Teneligliptin pertaining to Indian T2DM patient profile such as demographics, duration of disease, currently prescribed anti-hyperglycemic drugs, initiation of Teneligliptin as monotherapy or as an add on therapy.Methods: A cross-sectional, multicenter, non-interventional study was conducted to understand the demographics and clinical profile of Indian T2DM patients (n=5091) who were prescribed Teneligliptin.Results: Majority of patients were male (65.2%) with family history of T2DM present in 43.45% of cases. Age at onset of T2DM was 51.1±11.6 years. Among the T2DM patients, 36.2% of patients were newly diagnosed and more than half of them (54.7%) were uncontrolled with current anti-hyperglycemic drugs. Mean HbA1c level among these patients was 8.09±1.3%. Mean fasting and postprandial blood glucose levels were 170.2±46.9 mg/dl and 255.3±69.3 mg/dl respectively. Teneligliptin was prescribed as monotherapy in 2165 (41.66 %) of patients while as dual, triple and quadruple therapy in 2346 (46.08%) and 551 (10.82%) and 29 (0.56%) respectively. Among the patients on current anti-hyperglycemic treatment, most commonly prescribed drugs along with Teneligliptin were metformin (43.39%) followed by glimepiride (11%) and voglibose (3.42%).Conclusions: Teneligliptin is preferred as monotherapy and combination with metformin and sulfonylureas (mostly glimepiride) in newly diagnosed and uncontrolled T2DM patients in Indian scenario.

Intake of Fruits for Diabetics: Why and How Much? / 임상당뇨병

Fruits are universally promoted as healthy. Fruits supply dietary fiber, vitamins, minerals and phytochemicals that function as antioxidants. But many people often have concerns that fruit intake has a negative impact on glycemic control in patients with diabetes. The results of a related study showed fruit intake may have no overall effect on fasting glucose and HbA1c. Also increased fresh fruit intake in ranges commonly consumed was associated with reduced risks of death and development of major vascular complications in diabetic patients. Korean Diabetes Association and American Diabetes Association recommend carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products. Fruit intake for diabetics should be included as part of a balanced diet and individual meal composition within the range of two exchanges (100~300 g).

Heart Failure: Complications of Type 2 Diabetes / 임상당뇨병

There is a close relationship between diabetes mellitus and heart failure, both of which are known to increase morbidity and mortality. Diabetes can cause or aggravate heart failure, and heart failure can precipitate diabetes. Diabetes mellitus causes structural and functional changes in the heart, such as fibrosis of the myocardium and left ventricular dysfunction. The mechanisms of diabetic cardiomyopathy are metabolic disturbance, myocardial fibrosis, microvascular disease, and autonomic dysfunction. Improper blood glucose control leads to deterioration of heart failure, but the role of strict glycemic control in reducing heart failure is unclear. The role of SGLT2 inhibitors in reducing the incidence of heart failure is of great importance in the treatment of diabetic patients. However, further long-term follow-up and safety studies are needed.

Intervenciones de enfermería para mejorar la calidad de vida de las personas con pie diabético / Nursing interventions to improve the quality of life of people with diabetic foot / Intervenções de enfermagem para melhorar a qualidade de vida das pessoas com torta diabético

Objetivo: analizar la mejor evidencia científica disponible en la intervención de enfermería a las personas con pie diabético para el mejoramiento de su calidad de vida. Método: revisión de literatura. La metodología para la práctica clínica basada en evidencia, que consta de cinco pasos: 1. Presentación de la pregunta clínica según el acrónimo PICO (población, intervención, comparación y resultado); 2. Buscar información en bases de datos indexadas: Medline, PubMed, EBSCo, CINAHL; 3. Análisis crítico de la documentación seleccionada; 4. y 5. Transferencia y evaluación de evidencia científica. Resultados: las intervenciones educativas y el empoderamiento al usuario sobre su enfermedad es esencial en la atención a los pacientes diabéticos para la prevención de complicaciones incidiendo en la calidad de vida y prevención de los reingresos hospitalarios. Conclusión: existe evidencia científica de buena calidad metodológica que indica que la atención al paciente con pie diabético debe ser multidisciplinar, donde la enfermería tiene un papel fundamental educando para el empoderamiento de la enfermedad al usuario y de esta manera mejorar la calidad de vida disminuyendo las complicaciones asociadas al pie diabéticico.(AU)

Objective: to analyze the best scientific evidence available in the nursing intervention for people with diabetic foot disease in order to improve their quality of life. Method: literature review. The methodology for clinical practice based on evidence, which consists of five steps: 1. Presentation of the clinical question according to the acronym PICO (population, intervention, comparison and result); 2. Search for information in indexed databases: Medline, PubMed, EBSCo, CINAHL; 3. Critical analysis of the selected documentation; 4. and 5. Transfer and evaluation of scientific evidence. Results: the educational interventions and the empowerment to the user on his illness is essential in the attention to the diabetic patients for the prevention of complications affecting the quality of life and prevention of the hospital re-admissions. Conclusion: there is scientific evidence of good methodological quality that indicates that care for patients with diabetic foot should be multidisciplinary, in which nursing plays a fundamental role educating for the empowerment of the disease to the user and thus improve the quality of life decreasing the complications associated with diabetic foot.(AU)

Objetivo: analisar as melhores evidências científicas disponíveis na intervenção de enfermagem para pessoas com doença do pé diabético, a fim de melhorar sua qualidade de vida. Método: revisão de literatura. A metodologia para a prática clínica baseada em evidências, que consiste em cinco etapas: 1. Apresentação da questão clínica de acordo com a sigla PICO (população, intervenção, comparação e resultado); 2. Busca de informações em bancos de dados indexados: Medline, PubMed, EBSCo, CINAHL; 3. Análise crítica da documentação selecionada; 4. e 5. Transferência e avaliação de evidências científicas. Resultados: as intervenções educativas e o empoderamento do usuário em sua doença é essencial na atenção aos diabéticos para a prevenção de complicações incidindo na qualidade de vida e na prevenção das readmissões hospitalares. Conclusão: há evidência científica de boa qualidade metodológica indicando que o atendimento de pacientes com pé diabético deve ser multidisciplinar, onde a enfermeira desempenha um papel fundamental na educação para o empoderamento da doença para o usuário e, assim, melhorar a qualidade de vida diminuindo as complicações associadas ao pé diabético.(AU)

St udy on rta ditional Chinese med icine constitution in the patients with type I diabeet s in Baoshan District,Shanghai / 上海预防医学

Objectvi e To understand the correlation between the diabetes and the complications and the constitution of traditional Chinese medicine ( TCM ) in Baoshan District in Shanghai , and to provide scientific evidence for carrying out the targeted prevention and intervention measures.M ethods TCM body mass table was used to distinguish the TCM constitution of the diabetic patients and the control group .The relationship between TCM constitution and diabetes and its complications was analyzed by single factor and multiple factor logistic regression . Results There were less patients with yin-yang harmony constitution and yang deficiency constitution in the case group than in the control group , while more with qi deficiency constitution and phlegm-damp constitution than in the control group .Among a total of 879 cases of diabetic patients with1 235 physical elements , the top four biased constitution elements were identified including constitution of qi deficiency ( 15.22%), yin deficiency ( 8.42%), yang deficiency ( 8.42%) and phlegm-damp ( 8. 34%).The yin deficiency, qi deficiency and phlegm dampness constitution elements in the case group were significantly higher than in the control group .Among 875 cases in the control group with 1 129 physical elements , the top four biased constitution elements were yang deficiency (12.40 %), qi deficiency( 9.65%), yin deficiency (5.05%) and phlegm-damp (4.52%), which yin-yang harmony constitution and yang deficiency constitution elements were significantly higher than those of the case group .The incidence of complications of the diabetic patients with biased constitution was significantly higher than those with the yin-yang harmony constitution . Conclusion Phlegm dampness constitution , qi deficiency constitution and yin deficiency constitution are the main dangerous constitution of diabetes mellitus .The protective constitution of diabetes is yin-yang harmony constitution and yang deficiency constitution .The biased constitution elements are the risk factors of diabetes complications .

The antioxidant effect of grape seed proanthocyanidin extracts on diabetic retinopathy and its mechanism / 中华实验眼科杂志

Background The pathogenesis of diabetic retinopathy (DR) might be related with oxidative stress and its mechanism has not been fully elucidated.Grape seed proanthocyanidin extracts (GSPE),a powerful antioxidant,plays roles in some systemic diseases.However,the effect and mechanism of GSPE in DR has not been illuminated clearly.Objective This study was to investigate whether GSPE has a protective effect on the retinas of diabetic subjects and explore its mechanism.Methods Thirty SPF adult Wistar rats were divided into the control group,diabetic group and diabetes + GSPE group according to the randomized number table.Diabetic models were induced by intraperitoneal injection of 100 mg/kg strebtozotocin (STZ) prepared with citrate buffer,and only the equal amount of citrate buffer was used in the same way in the control group.GSPE solution was intragastrally used 250 mg/kg daily in the rats of the diabetes+GSPE group from injective day through 8 weeks,and distilled water was used in the same way in the rats of the control and diabetic groups.The rats were sacrificed in the eighth week after injection and the retinas were isolated.The morphology of the retina were examined by hematoxylin and eosin stain.Retinal homogenatewas prepared for the assay of superoxide dismutase (SOD),glutathione peroxidase (GSH-Px) activity and malonaldehyde (MDA) content.The expressions and location of nuclear erythroid related factor 2 (Nrf2) was determined by immunochemistry,and the expressions of Nrf2 and heme oxygenase-1 (HO-1) were quantitatively analyzed by Western blot.The apoptosis of retinal cells was detected by TUNEL.Results In the eighth week after modeling,the blood glucose levels were significantly higher and the body weight was lower in the rats of the diabetic group and diabetes+GSPE group compared with the control group (all at P＜0.01).Retinal structure was normal in the rats of the control group.However,loose tissue,irregular arrangement of cells and thickness decrease of retinal fiber layer,retinal ganglion cell layer and inner plexiform layer were exhibited in the rats of the diabetic group,while the morphology abnormality was slight in the rats of the diabetes+GSPE group.The SOD and GSH-Px activities and MDA content were significantly different among the 3 groups (F =11.010,P =0.001 ; F =12.072,P =0.000 ; F =25.224,P=0.000),and activities of SOD and GSH-Px in the retinas were significantly lower,and the MDA level was higher in the rats of diabetic group than those of the diabetes+GSPE group and the control group (all at P＜0.01).The relative expressing levels of Nrf2 were (165.5±29.4) ％ and (134.8 ±7.8) ％ in the diabetes+ GSPE group and diabetic group,with a significant difference between them (t=2.450,P=0.044).Compared with the diabetic group,the expressing level of the HO-1 was sigficantly increased ([170.2±22.0)％ versus [125.3±9.2] ％,t =2.360,P =0.002).TUNEL showed that the retinal apoptotic cells of diabetic rats were mainly located in the retinal fiber layer,RGCs layer,inner and outer nuclear layer,and the number of apoptotic cells was less in the diabetes+GSPE group compared with the diabetic group under the fluorescence microscope.Conclusions GSPE can play a protective role on diabetic rats by activating Nrf2 pathway and therefore improving retinal oxidative stress and decreasing apoptosis.

Influence of platelet endothelial cell adhesion molecule-1 on diabetic retinopathy in patients with type 2 diabetes / 中华实验眼科杂志

Background To study diabetic retinopathy (DR) related risk factors is very important in the prevention of DR.Platelet endothelial cell adhesion molecule-1 (PECAM-1) is an important mediator that mediates high blood glucose-induced vascular diseases in diabetic patients.However,its mechanism is still below understood.Objective This clinical study was to investigate the effect of serum level changes of PECAM-1 on DR in type 2 diabetic patients.Methods Fifty-four patients with type 2 diabetes were enrolled from the endocrinology department of the Third People' s Hospital of Nantong City.Fundus examination was performed using the ophthalmoscope and fundus fluorescence angiography (FFA) on all the patients,and these patients were grouped as the non-DR (NDR)group (18 cases),non-proliferative DR(NPDR) group (20 cases) and proliferative DR group (PDR) (16 cases) based on the DR staging criterion of the Chinese Medical Association (1987 version).Eighteen age-and gender-matched normal subjects served as the normal control group.Peripheral blood was collected,and serum PECAM-1 levels were assayed using ELISA.Serum HbA1c levels were detected using the high performance liquid colorimetric(HPLC) method.The correlation of serum PECAM-1 level with serum HbA1c level was analyzed.All results were compared among the groups.Results The serum PECAM-1 levels were (10.907 ± 2.792),(7.024 ±2.377),(5.231 ± 1.816) and (3.817 ± 1.045) μg/L,respectively,in the PDR group,NPDR group,NDR group and normal control group,showing a significant difference among the 4 groups (F =12.630,P =0.02).Serum PECAM-1 content was significantly higher in the PDR group when compared with the NPDR group,NDR group and normal control group (P＜0.05).The serum HbA1c levels were (12.596±3.148)％,(9.118±3.356)％,(5.491±1.017)％ and (4.992 ± 0.725)％ in the PDR group,NPDR group,NDR group and normal control group,respectively,with a significant difference among these 4 groups (F =7.130,P =0.015),and those in the PDR group and NPDR group were significantly elevated in comparison with the NDR group and normal control group (P＜0.05).Significantly positive correlations were seen between serum PECAM-1 level and HbA1 c level in the PDR group,NPDR group and NDR group (r=0.799,P＜0.01 ;r =0.647,P＜0.01 ;r =0.685,P＜0.01).Significantly more patients with a disease course of ≥ 10 years were in the NPDR group in comparison with the PDR group (P =0.023).Conclusions Increase of serum PECAM-1 level is closely associated with blood glucose level,and it is an important factor in the pathogenesis and development of DR.These results imply that control of blood glucose is crucial for the prevention of DR in patient with type 2 diabetes.

Fatal Facial Mucormycosis on a Diabetic Patient: A Case Report

PURPOSE: Mucormycosis generally occurs in patients with uncontrolled diabetes mellitus and immunocompromised conditions. It is rare, but once a patient is infected with it, it can occur as a rapidly extending, aggressive, and life-threatening rhinocerebral infection with a high mortality rate. METHODS: A 70-year-old female patient had a 40 years of history of adult onset diabetes mellitus. She presented herself with severe right hemifacial pain, swelling, and weakness for 3 days and was admitted to ENT. On a facial computed tomography(CT) scan, it was found that her infection extended from her inferior temporal scalp to her submental area and involved her submandibular, masseter, prevertebral, parapharyngeal, retropharyngeal, and pharyngeal mucosal space and pansinusitis. Through endoscopic sinus surgery, mucormycosis was confirmed via histologic examination. RESULTS: Despite empiric antibiotics and amphotericin B administration, the patient was in a septic condition and in a coma. The patient's family wanted to withdraw her life support, and the patient expired. CONCLUSION: Mucormycosis is very rare, but is one of the disastrous complications of uncontrolled diabetes mellitus. Suspicion of its occurrence, based on identified risk factors, and its rapid diagnosis can enhance the chance of its cure.

Predictors of Vascular Complications among Patients with Type 2 Diabetes / 기본간호학회지

PURPOSE: The purpose of this study was to predict the risk factors for vascular complications among patients with type 2 diabetes. METHOD: The data were collected from August to September, 2007 using clinical examination and questionnaires. Patients (N=101) were recruited from the endocrinology department of P University hospital in D city. Descriptive statistics, Pearson correlation coefficients and multiple linear regression were used to analyze the data. RESULTS: The cardiovascular risk of patients with diabetes was significantly related to self care behavior, family history, and smoking status. The risk of peripheral vascular complications was not related to predictors included in the study. With multivariate analyses, significant predictors of cardiovascular risk for these patients were self care behavior, family history, and smoking status (R2=.40, p<.0001). CONCLUSION: The findings of this study indicate that smoking cessation and improving self-care behavior are essential to reduce the risk of cardiovascular complications among patients with diabetes. To enhance self-care practices for the patients with diabetes, nursing interventions, such as telephone counseling, problem focused nursing counseling, and peer group activities should be considered.

Relationship Between Metabolic Syndrome and Risk of Chronic Complications in Koreans with Type 2 Diabetes / 당뇨병

BACKGROUND: We examined the relationships between components of metabolic syndrome at the time of diagnosis of type 2 diabetes, and the development of chronic complications in Korean patients with type 2 diabetes. METHODS: The medical records of patients with type 2 diabetes who had undergone treatment for at least five years prior were collected from 10 general hospitals in Korea. Among a total of 1,418 patients reviewed for possible inclusion in this study, 603 patients were selected, and the occurrence of complications among these patients was evaluated. RESULTS: Among the 603 patients (male, 253; female, 350), 154 males (60.8%) and 266 females (76.0%) were diagnosed with metabolic syndrome at the time of initial diagnosis of type 2 diabetes. The incidence of chronic complications (average follow-up 15.2 +/- 4.9 years) included 60 cases of coronary artery disease (CAD), 57 cases of cerebrovascular accident (CVA), 268 cases of diabetic retinopathy (DR), 254 cases of diabetic nephropathy (DN), and 238 cases of diabetic peripheral neuropathy (DPN). As compared to patients without metabolic syndrome, the adjusted relative risks (95% CI) of incidental diabetic complications in patients with metabolic syndrome were 3.28 (1.40~7.71) for CAD, 2.04 (0.86~4.82) for CVA, 1.53 (1.10~2.14) for DR, 1.90 (1.29~2.80) for DN, and 1.51, (1.06~2.14) for DPN. With the addition of just one constituent of metabolic syndrome, the relative risk of developing CAD, CVD, DR, DN, and DPN increased by 2.08 (95% CI, 1.27~3.40), 1.16 (0.80~1.66), 1.09 (0.93~1.26), 1.29 (1.06~1.57) and 1.06 (0.87~1.26), respectively. CONCLUSION: Metabolic syndrome in Korean patients with type 2 diabetes increases the risk of developing both macrovascular and microvascular complications.

Clinical Observation on 36 Cases of Diabetic Cerebral Infarction Treated by Gegen Tongluo Decoction / 中医杂志

Objective:To observe clinical effects of Gegen Tongluo Decoction on diabetic cerebral infarction.Methods:Seventy-two cases of diabetic cerebral infarction were randomly divided into a treatment group and a control group,36 cases in each group.The control group was treated by routine therapy and the treatment group by routine therapy plus Gegen Tongluo Decoction.Their therapeutic effects and blood glucose,blood lipids and hemorheological parameters were investigated.Results:The total effective rate was 94.44% in the treatment group and 72.22% in the control group with a significant difference between the two groups (P

Clinical Study on Wrist-Ankle Acupuncture for Treatment of 30 Cases of Peripheral Neuritis Complicated by Diabetes / 中医杂志

Objective:To study on mechanisms of wrist-ankle acupuncture for prevention and treatment of peripheral neuritis complicated by diabetes.Methods:Ninety cases of peripheral neuritis complicated by diabetes were treated respectively by wrist-ankle acupuncture and body acupuncture,with western medicine routine treatment used as control group,30 cases in each group.The therapeutic effects and laboratory results were compared.Results:Therapeutic effects in wrist-ankle acupuncture group and body-acupuncture group were significantly superior to that in control group,with no significant difference between wrist-ankle acupuncture and body-acupuncture group.Conclusion:Wrist-ankle acupuncture can improve blood glueose and metabolism blood lipids,decrease blood viscosity and recover function of peripheral nerve cells and it has a definite effect on diabetic peripheral neuritis.