A Fuzzy Approach for Diabetes Mellitus Type 2 Classification

Abstract This paper proposes an automatic fuzzy classification system for glycemic index, which indicates the level of Diabetes Mellitus type 2. Diabetes is a chronic disease occurred when there is deficiency in insulin production or in its action, or both, causing complications. Neuro-fuzzy systems and Decision Trees are used to obtain, respectively, the numerical parameters of the membership functions and the linguistic based rules of the fuzzy classification system. The results goal to categorize the glycemic index into 4 classes: decrease a lot, decrease, stable and increase. Real database from [1] is used and the input attributes of the system are defined. In addition, the proposed automatic fuzzy classification system is compared with an "expert" fuzzy classification system, which is totally modeled using expert knowledge. From linguistic based rules obtained from fuzzy inference process, new scenarios are simulated in order to obtain a larger data set which provides a better evaluation of the classification systems. Results are promising, since they indicate the best treatment - intervention or comparative - for each patient, assisting in the decision-making process of the health care professional.

How much to invest in glycemic control of a patient with diabetes mellitus type 2? A constant dilemma for the Brazilian Public Health System (SUS)

Diabetes mellitus type 2 (DM2) affects millions of people worldwide and causes several complications for the patient, consuming large sums of financial resources from the health services. This study aims to estimate the financial investment of DM2 treatment for glycemic control of the patient, from the point of view of the municipal Public Health System (SUS). The Delphi technique was used to validate the opinion of a team of judges, specialists in DM2, and health service managers, on the investment necessary for glycemic control of patients with DM2 through the application of questionnaires. In order for the patient to achieve glycated hemoglobin (A1c) < 7%, an investment of US$ 2,419.06 (value/patient/year) is necessary. As the value of A1c increases, investment is reduced. This result reveals the intention to allocate resources for the prevention of DM2 and its complications

Application of quality by design approach in RP-HPLC method development for simultaneous estimation of saxagliptin and dapagliflozin in tablet dosage form

A simple, sensitive, precise, accurate and robust high performance liquid chromatographic method has been developed for simultaneous estimation of saxagliptin (SAXA) and dapagliflozin (DAPA) in pharmaceutical formulation. Design of experiments (DoE) was applied for multivariate optimization of the experimental conditions of RP-HPLC method. Risk assessment was performed to identify the critical method parameters. Three independent factors; mobile phase composition, flow rate and column temperature were used to design mathematical models. Central composite design (CCD) was used to study the response surface methodology and to study in depth the effects of these independent factors. Desirability function was used to simultaneously optimize the retention time and resolution of SAXA and DAPA. The optimized and predicted data from contour diagram consisted of acetonitrile and ortho phosphoric acid (0.1%) in the ratio of 50:50 respectively, at a flow rate of 0.98 ml/min and column temperature 31.4 °C. Using these optimum conditions baseline separation of both drugs with good resolution and run time of less than 6 min were achieved. The optimized assay conditions were validated according to ICH guidelines. Hence, the results clearly showed that Quality by design approach could be successfully applied to optimize RP-HPLC method for simultaneous estimation of SAXA and DAPA.

Characterization of users at risk of developing diabetes: a cross-sectional study / Caracterización de usuarios en riesgo de desarrollar diabetes: un estudio transversal / Caracterização de usuários em risco de desenvolver diabetes: um estudo transversal

ABSTRACT Objective: To characterize the profile of users at risk of developing diabetes mellitus type 2 according to sociodemographic and clinical variables. Method: Cross-sectional study, descriptive, quantitative approach conducted with 266 users of Basic Care. Inferential statistics analysis, calculating the crude prevalence ratio with confidence interval of 95% and Kruskal-Wallis test, and application of the multivariate technique simple Correspondence Analysis. Results: It was noted that 83.1% were women and 36.4% frequented the Family Health Unit from 1 to 5 years. Regarding the factors associated with diabetes mellitus type 2, 66.5% of the users were overweight and 77.9% were rated with central obesity. The great majority, 77.4%, did not practice physical activities and 21.1% had altered glycemia. Conclusion: The results showed that many risk factors for developing diabetes mellitus type 2 were among the population of the study.

RESUMEN Objetivo: Caracterizar el perfil de usuarios en riesgo de desarrollar diabetes mellitus tipo 2 de acuerdo con las variables sociodemográficas y clínicas. Método: Estudio transversal, descriptivo, de abordaje cuantitativo realizado con 266 usuarios de la Atención Básica. Análisis estadístico inferencial, con el cálculo de las razones de prevalencias brutas con intervalo de confianza del 95% y la prueba de Kruskal-Wallis, y la aplicación de la técnica multivariada Análisis de Correspondencia simple. Resultados: Se constató que el 83,1% eran mujeres y el 36,4% frecuentaban la Unidad de Salud de la Familia de 1 a 5 años. Sobre los factores asociados a la diabetes mellitus tipo 2, el 66,5% de los usuarios estaba con sobrepeso; el 77,9% fue clasificado con obesidad central; la gran mayoría, el 77,4% no practicaba actividad física y el 21,1% tenía la glucemia alterada. Conclusión: Los resultados mostraron que diversos factores de riesgo para el desarrollo de la diabetes mellitus tipo 2 estuvieron presentes en la población del estudio.

RESUMO Objetivo: Caracterizar o perfil de usuários em risco de desenvolver diabetes mellitus tipo 2 de acordo com as variáveis sociodemográficas e clínicas. Método: Estudo transversal, descritivo, de abordagem quantitativa realizado com 266 usuários da Atenção Básica. Análise estatística inferencial, com o cálculo das razões de prevalências brutas com intervalo de confiança de 95% e o teste de Kruskal-Wallis e a aplicação da técnica multivariada Análise de Correspondência simples. Resultados: Constatou-se que 83,1% eram mulheres e 36,4% frequentavam a Unidade de Saúde da Família de 1 a 5 anos. Quanto aos fatores associados ao diabetes mellitus tipo 2, 66,5% dos usuários estavam com excesso de peso 77,9% foram classificados com obesidade central; a grande maioria, 77,4% não praticava exercício físico, 21,1% possuíam glicemia alterada. Conclusão: Os resultados mostraram que vários fatores de risco para o desenvolvimento do diabetes mellitus tipo 2 estiveram presentes na população do estudo.

Unsatisfactory glycemic control in type 2 Diabetes mellitus patients: predictive factors and negative clinical outcomes with the use of antidiabetic drugs

ABSTRACT Many factors can interfere with glycemic control in patients with type 2 diabetes mellitus and this patient group has an increased risk of experiencing drug-related negative outcomes (DNO). The aim of this study was to identify the predictive factors of unsatisfactory glycemic control and DNO in this group of patients. A cross-sectional study was conducted collecting data from prescriptions and interviews with 100 patients of the Endocrinology Clinic of the Hospital Complex of Sorocaba, São Paulo, Brazil. Variables associated with unsatisfactory glycemic control were determined and the DNO associated with antidiabetic drugs identified. Age (<65 years) (OR=4.09), family history of diabetes (OR=3.24), use of combined therapy to treat diabetes (2-4 antidiabetic drugs) (OR=5.13) and presence of DNO (OR=5.92) were found to be predictive factors for poor patient glycemic control. DNO were observed in 49% of the patients and were caused predominantly by ineffectiveness in patients with poor glycemic control (p<0.05). There was no significant difference between groups (satisfactory and unsatisfactory glycemic control) for DNO caused by safety issues (p>0.05). Characterization of the profile of patients with uncontrolled diabetes and of aspects associated with drug treatment can contribute to the planning of interventions to improve patient care

Receiver operating characteristic curve analysis of BMI and percentage body fat in type 2 diabetics of Punjab.

The present study attempted to establish appropriate cut off levels of Body Mass Index (BMI) for defining overweight as a risk for the development of type 2 diabetes considering percentage body fat (BF) as standard. A total of 300 patients of known type 2 diabetes participated in the study (150 males and 150 females, all > or = 40 years of age). Clinical examination was done. Anthropometric measurements as BMI, Waist Circumference (WC) and Waist-hip ratio (WHR) were calculated. Percentage BF was calculated using skinfold thickness method from the equation of Durnin and Womersley. Mean BMI for males was 24.97 (SD 4.3) kg/m2 and for females was 27.56 (SD 5.14) kg/m2. Mean percentage BF for males was 28.19 (SD 0.74) and for females was 38.22 (SD 5.29). A comparison of BF and BMI data with various ethnic groups revealed conspicuous differences. Receiver operating characteristic (ROC) curve analysis showed a low sensitivity of conventional cut off value of BMI (25 kg/m2) in identifying subjects with overweight as compared to the cut off values based on percentage BF (males > 25, females > 30). This results in substantial misclassification. Based on the ROC curve, a lower cut off value of BMI 22.3 kg/m2, displayed the optimal sensitivity and specificity, and less misclassification in identification of type 2 diabetics with high percentage BF. BF: BMI was calculated and was found to be higher in females.

Concordance between retina specialists and a preferred practice pattern in treatment and follow-up criteria for diabetic retinopathy

Proper detection, adequate laser therapy and follow-up of diabetic retinopathy (DR), using guidelines established by landmark studies, are important to prevent blindness. In this report we analyze the agreement between 11 retina specialists and the Preferrred Practice Pattern of the American Academy of Ophtlamology in the therapeutic and follow-up criteria for DR. Color fundus stereophotographs of seven standard fields of each eye of 15 diabetics were sent to 11 retina specialists. Their treatment and follow-up criteria were surveyed. For treatment of DR mean percent agrement was 65 percent. Kappa statistic, which corrects for chance agreement, was between -0.23 and 0.63 with a mean of 0.26. The therapeutic recomendations for macular edema were analyzed separately and the mean kappa was between -0.10 and 0.71 with a mean of 0.32. With respect to recommendations for interval until follow-up, following initial visit, mean percent agreement was 73 percent with a kappa statistic between -0.22 and 0.33 and a mean of 0.07. Based on conventional interpretation of kappa statistic these mean values are in the range of poor agreement. Since there is a significant discrepancy in the concordance level in both therapeutic and follow-up recommendations for the management of DR, there is a need to improve agreement in these criteria, since these are key elements in the decision making process of the specilist caring for diabetic patients

Sindrome X / Syndrome X

La forma mas comun de Diabetes Mellitus es la no Insulino dependiente (DMNID) que por lo general se osocia con obesidad e hipertension arterial, las tres patologias son factores de riesgo independiente de enfermedad cardiovascular (ECV). Los pacientes con DMNID suelen presentar hiperinsulinemia en ayunas post pandrial y se cree que el factor determinate de tal hiperinsulinemia es la insulinoresistencia, la cual efecta principalmente al musculo esqueletico, lo que causa una secresion compensadora exagerada de las celulas beta de los islote de Langerhans en el pancrea y cuando esta respuesta compensadora empieza a fallar se manifiesta como intolerancia a la glucosa. Esta insulinoresistencia-hiperinsulinemia es el punto central del SINDROME X.

Prevalencia del síndrome de Sjögren en diabetes mellitus / Prevalence of Sjögren's syndrome in diabetes mellitus

El objetivo del presente estudio fue conocer si el síndrome de Sjögren presenta una mayor prevalencia en los pacientes con diabetes mellitus que la población general. Se realizó un estudio prospectivo, ciego simple, comparativo en 50 pacientes con diabetes mellitus tipo I, 50 pacientes con diabetes mellitus tipo II y 50 sujetos control a los que se le diagnosticó síndrome de Sjögren definitivo o probable en base a criterios universalmente aceptados. Los pacientes con síndrome de Sjögren definitivo y probable en el grupo con diabetes mellitos tipo I fueron cinco, en el tipo II y en los controles dos sujetos, sin existir diferencia estadísticamente significativa entre ellos (x2=1.53, p=NS). Se puede concluir que la prevalencia del síndrome de Sjögren en los pacientes con diabetes mellitus no es mayor que en la población general

Diabetes mellitus en niños y adolescentes: tipos y características / Diabetes Mellitus in children and adolescent: characteristics and type

48 pacientes con diagnóstico de Diabetes Mellitus hasta los 20 años de edad fueron evaluados en el Hospital Nacional `Guillermo Almenara I'. Hallándose mayor frecuencia en el sexo masculino, no se encontró diferencia estacional, ni antecedentes patológicos previos al diagnóstico. La DMID representó 85.7 por ciento de la población y DMNID el 14.3 por ciento; en este último grupo el 50 por ciento asociado a obesidad. El grupo etario en que se presentó mayor frecuencia de casos fue entre los 9*12 años. Antecedentes familiares de DM en primer grado se observó en 11.1 por ciento de DMID y en 80 por ciento de DMNID; y la forma de presentación más frecuente fue la sintomática con 62.5 por ciento

Diabetes mellitus: a study utilizing the revised diagnostic criteria

A group of 167 patients with various degree of glucose inlerance or at high risk of developing glucose intolerance were followed for five years at the Caguas Family Practice Center. Patients were classified using the criteria proposed by the National Diabetes Data Group and were monitored for the development of: a) diabetic complications, b) fasting glycemic control, c) changes in classification. There were 8 patients with IDDM, 55 patients with NIDDM and 104 patients in the high risk group. Only 6.2% of the high risk group developed complications while 87.5% of the IDDM and 67% of the NIDDM groups developed complications The most common overall complication was coronary artery disease. Three patients died of myocardial infarction during the study and nine patients changed classification. Two high risk patients developed overt diabetes, four shifted within the diabetic group, two within the high risk group and one diabetic regained a normal glucose tolerance