RESUMO
Objective: To examine the parameters affecting the existence and prevalence of malnutrition in type 2 diabetic patients at initial presentation
Design: Cross-sectional study
Setting: Department of Internal Medicine, Sakarya University Research and Education Hospital, Turkey
Subjects: Nutritional screening of 580 outpatients with the diagnosis of type 2 diabetes who presented to an outpatient clinic
Intervention: Medical treatment of diabetic patients
Main outcome measure: The parameters affecting the existence and prevalence of malnutrition in type 2 diabetic patients
Results: Mean +/- standard deviation age of the patients was 54.6 +/- 10.7 years. Of the 580 patients, 327 were women [56.4%]. Malnutrition prevalence was 11.4% with Subjective Global Assessment and 9% with Mini Nutritional Assesment and Malnutrition Universal Screening Tool. Body mass index [BMI], albumin, fat%, mid-arm circumference and calf circumference were significantly lower and glycated hemoglobin [HbA1c] was significantly higher in patients with malnutrition, compared to patients without alnutrition. Malnutrition was significantly associated with weight loss, change in dietary intake and diminished physical activity [p = 0.005]. Logistic regression model, including BMI /= 8.69 mmol/mol, fat%
Conclusion: Type 2 diabetic patients are often obese and thus higher cut-off for BMI and fat% may be necessary to detect malnutrition. Poor glucose control, decreased fat%, change in dietary intake and especially diminished physical activity are independent predictors of malnurition in this population
RESUMO
Objective: To evaluate the relationship of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid [SUA] levels, and microalbuminuria [MAU] in patients with type 2 diabetes [T2DM] and chronic kidney disease [CKD]
Subjects and Methods: A total of 1,463 patients with T2DM and CKD [aged 14-88 years], 927 females and 536 males, were included in this study. The serum data of 25-hydroxyvitamin D, i.e., 25[OH]D, level, SUA, hemoglobin [Hb]A1[c], creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio [UACR] were obtained from the medical records. The Mann-Whitney U test, the chi[2] test, the Mantel-Haenszel test, and linear regression models were used for data analysis
Results: Vitamin D deficiency and insufficiency were evident in 770 [52.0%] and 357 [24.0%] patients, respectively. Median HbA1[c] levels [7.3 [IQR 3.9] vs. 6.5 [IQR 2.3]%; p < 0.01] were significantly higher in patients deficient in vitamin D than in those with a normal vitamin D status. A significantly low level of vitamin D was noted with a high UACR [beta -0.01; 95% CI -0.01 to -0.001; p = 0.017] and HbA1[c] [beta -1.1; 95% CI -1.6 to -0.6; p < 0.001], but with low levels of SUA [beta 1.3; 95% CI 0.5-2.2; p = 0.002]. Vitamin D replacement was associated with a significantly low level of HbA1[c] [7.4 [2.7] vs. 6.7 [1.9]%; p < 0.001]
Conclusion: In this study, there was a high prevalence of hypovitaminosis D among T2DM patients with CKD, with a higher UACR, higher HbA1[c], and lower SUA being noted as playing a role in predicting a decrease in vitamin D levels and potential benefits of vitamin D replacement therapy on glycemic control in T2DM management
RESUMO
Background and Objective: During the course of the autoimmune thyroid diseases, ultrasonography change parallel to histopathology. Vitamin D is associated with autoimmune diseases and thus can affect thyroid blood flow. Our aim was to investigate the relationship between vitamin D insufficiency/deficiency and thyroid hemodynamic indices in patients with Hashimoto thyroiditis
Methods: A total of 93 patients who presented to Sakarya University Endocrinology outpatient clinic from April to September 2016 and diagnosed with Hashimoto thyroiditis were included in this study. Clinical and serologic data, thyroid antibodies and 25[OH] D3 were evaluated. Mean peak systolic velocity [mPSV], mean end-diastolic velocity [EDV], mean resistive index [RI] flows of superior and inferior thyroid arteries were measured with B-mode Doppler ultrasonography
Results: Vitamin D insufficiency/deficiency was detected in 59 [63.4%]. TPO Ab and TgAb levels were found higher in patients with vitamin D insufficiency/deficiency. In the normal vitamin D group, superior thyroid artery mPSV [32.21+/-6.73cm/s] and EDV[13.27+/-2.80 cm/s] were higher than in the low vitamin D group [mPSV [28.32+/-8.99cm/s] and EDV[10.67+/-3.68 cm/s]] [P=0.034, P=0.001, respectively]. Inferior thyroid artery EDV value was higher in the normal compared to the low vitamin D group [0.032]. RI measured in all arteries were higher in the vitamin D insufficient/deficient group compared to the Vitamin D normal group [p=0.001]
Conclusion: Vitamin-D insufficiency/deficiency has led to reduced parenchymal blood supply and increased micro-vascular resistance in Hashimoto thyroiditis patients
RESUMO
Background and Objective: Diagnostic performance of troponin assays is affected by renal insufficiency. Neutrophil to lymphocyte ratio[NLR] is an independent predictor of acute coronary syndrome.Our objective was to evaluate performance of NLR in diagnosing acute myocardial infarction [AMI] among patients with elevated serum creatinine
Methods: Patients with elevated creatinine levels evaluated for coronary artery disease were included [n=284].Patients were divided into two groups according to having AMI or non-specific chest pain. AMI diagnosis was made based on clinical and laboratory data, including serial EKG and cardiac enzymes, ECHO and coronary angiography
Results: Troponin, neutrophil, and NLR were found to be higher in patients with AMI, compared to patients without AMI [P= 0.001, P= 0.001 and P=0.028, respectively]. ROC curve analysis for NLR in diagnosing AMI was significant[AUC:0.607; P=0.003]. Sensitivity, specificity, LR +, LR-, PPV and NPV for NLR>7.4 were found as 42.3%, 74.7%, 1.68%, 0.77%, 77% and 40%, respectively. Logistic regression analysis revealed that patients whose NLR>7.4 were 2.18 times as likely to have AMI
Conclusions: NLR can be used as an independent predictor of AMI in patients with renal insufficiency. This seems to get more important in the era of high sensitivity troponin assays. Our results might also help in early diagnosis of AMI in this high risk population while serial cardiac enzyme results are pending
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To determine the rate of distal symmetrical polyneuropathy [DSP] in patients with type 2 diabetes mellitus, to evaluate the role of history, neurological examination and the electrodiagnostic methods in the diagnosis of DSP, and to determine the association between electromyography-supported neuropathy [ESN], neuropathic complaints [NCs] and risk factors. A total of 191 type 2 DM patients [109 female, 82 male; mean age 58.7 +/- 10 years] were recruited. The NCs were recorded. All patients had electromyographic [EMG] examinations. The relationship between ESN, NCs and risk factors were evaluated. Of the 191 patients, 83 [43.5%] had DSP on EMG examinations and 92 [48.2%] patients suffered from NCs. Among the ESN patients, a significant relationship existed with HbA1[c] level, illness duration, smoking, male gender or insulin usage [p < 0.05] but not with age, hypertension, hypercholesterolemia or hypertriglyceridemia. The frequency of NCs was higher in patients with ESN. There was also a significant association between NCs and ESN [p < 0.05]. The presence of NCs was not related to age, gender, smoking, hypertension, hypercholesterolemia and hypertriglyceridemia [p > 0.05] but NCs were correlated to HbA1[c] level, illness duration and insulin usage [p < 0.05]. Our data show that a strong association exists between the presence of DSP and illness duration, HbA1[c], smoking, thereby indicating that cessation of smoking and near normal glycemic control would be additional precautions to delay the beginning or progression of polyneuropathy