Maior frequência de neuropatia periférica diabética associada ao hiperparatireoidismo secundário / Higher prevalence of diabetic peripheral neuropathy associated with secondary hyperparathyroidism

INTRODUÇÃO: A neuropatia periférica diabética (ND) é comum na nefropatia diabética (NFD) e não há informações se o hiperparatireoidismo secundário (HPS) aumenta seus sintomas. O objetivo foi determinar ND por sinais em pacientes com HPS. MATERIAL E MÉTODOS: É um estudo caso-controle. O Grupo Controle (GC) é composto por doentes com NFD e valores de paratormônio (PTH)<60pg / ml. O Grupo de Hiperparatireoidismo (GH) engloba pacientes com NFD e PTH≥60pg/ml e critérios bioquímicos de HPS. As variáveis foram, entre outras, a presença de sinais de ND e foram comparados com o teste t de Student e o qui-quadrado. RESULTADOS: Foram 60 participantes em cada grupo, sendo 35 (58,3%) homens no GC vs 33 (55,0%) em GH (p = 0,713). A idade do GC foi de 67±11,0 anos, vs 72±11 anos GH (p=0,009). A taxa de filtração glomerular (TFG) no GC foi 53,82±25,13 vs GH 35,34±18,43ml/min/1,73m2 (p <0,001). O PTH no GC foi de 38,02±15,32 pg/ml, em GH 119,07±84,33 pg/ml (p <0,001). A ND, devido aos sintomas no GC, foi de 28,3% e 36,6% no GH (p=0,330). A neuropatia por sinais no GC foi de 38,3% e no GH 83,3% (p<0,001). O odds ratio de GH para neuropatia presente devido a sinais foi de 8,044 (IC 95% 3,42­8,92). CONCLUSÃO: Constatou-se uma maior presença de sinais de NPD em pacientes com HPS em nosso centro.

BACKGROUND: Diabetic peripheral neuropathy (DN) is common in diabetic nephropathy (DNP), and there is no information if secondary hyperparathyroidism (SHP) increases its symptoms. The purpose was to determine DN by signs in patients with SHP. METHODS: It is a case-control study. Control patients (CG) with DN and parathyroid hormone (PTH) values<60pg/ml. The Hyperparathyroidism group (HG), patients with DNP and PTH≥60pg/ml and HPS biochemical criteria. The variables were, among others, the presence of DN signs, and were compared with Student's t and chi-square. RESULTS: There were 60 participants in each group, 35(58.3%) men in CG vs.33(55.0%) in GH (p=0.713). The age of the CG was 67±11.0 years, vs 72±11years HG (p=0.009). The glomerular filtration rate (GFR) in the CG was 53.82±25.13 vs in HG 35.34±18.43ml/min/1.73m2(p<0.001). The PTH in the CG were 38.02±15.32pg/ml and in GH 119.07±84.33pg/ml(p<0.001). The DN due to symptoms in CG was 28.3% and in GH 36.6%(p=0.330). Neuropathy due to signs in the CG was 38.3% and in GH 83.3% (p<0.001). The HG odds ratio to present neuropathy due to signs was 8.044 (95% CI 3.42­18.92). CONCLUSION: There was a statistical association between HPS and signs of DN in patients with DNP in our canter.

Diabetes mellitus tipo 2 de inicio en paciente joven: implicancias en la población chilena / Young-onset type 2 diabetes mellitus: implications in the chilean population

La diabetes mellitus tipo 2 (DM2), habitualmente asociada a adultos en edad media y adulto mayor, ha presentado un aumento en su incidencia en pacientes menores de 40 años, lo que se conoce como DM2 de inicio en paciente joven. Varios estudios sugieren que este tipo de diabetes presenta no sólo un deterioro más rápido de las células beta-pancreáticas en comparación con la DM2 de inicio más tardío, sino que también un mayor riesgo de complicaciones que pacientes con DM Tipo1, lo que sugiere una variable independiente de los años de exposición a la enfermedad y por tanto, un fenotipo más agresivo. Por otra parte, hay evidencia que afirma que existen grupos poblacionales en mayor riesgo de desarrollar esta patología, particularmente ciertas etnias. En el presente trabajo se exponen los principales hallazgos de una reciente revisión del tema y se los compara con los datos nacionales disponibles. Dada la alta prevalencia de DM2 en la población chilena y la escasa cantidad de estudios epidemiológicos de calidad que permitan conocer nuestro panorama con mayor precisión, es que se destaca la importancia de estos últimos para poder tomar medidas de salud pública adecuadas.

Type 2 diabetes mellitus type 2 (T2DM), commonly associated with the middle to old aged adults group, has shown an increase in incidence in patients younger than 40 years old, which is known as young-onset type 2 diabetes mellitus. Several studies suggest that this type of diabetes not only exhibits a faster deterioration of the beta-pancreatic cells in comparison with type 1 diabetes mellitus patients, but also a greater risk of complications not regarding the time of exposure to the disease, therefore a more aggressive phenotype. Otherwise, there is evidence which asserts that some population groups are in mayor risk of developing this disease, especially certain ethnics. In this work it is exposed the main findings of a recent review of the subject and it is contrasted with available national data. Given the high prevalence of T2DM in the chilean population and the little amount of epidemiological high-quality studies that allows us to know our outlook with greater precision, it is highlighted the need for them in order to make adequate public health decisions.

Altered touch perception and associated risk factors in individuals with diabetes mellitus / Percepción alterada del tacto y factores de riesgo asociados en individuos con diabetes mellitus / Percepção do tato alterada e fatores de risco associados em indivíduos com diabetes mellitus

ABSTRACT Objective: To evaluate the prevalence of altered touch perception in the feet of individuals with diabetes mellitus and the associated risk factors. Method: Cross-sectional study with 224 individuals with diabetes mellitus conducted in an endocrinology clinic at a public hospital in Campina Grande, Paraíba. The evaluation used touch sensitivity and perception, and a descriptive and multivariate analysis with Poisson regression was performed. Results: We found the prevalence of altered touch perception to be 53.1%. The risk factors that had a significant and joint impact on its occurrence were: female gender; previous ulcer; diabetes mellitus type 2; burning sensation, cracks, fissures, calluses, and Charcot foot. Conclusions: This study found a high prevalence of altered perception of touch, and this should support the planning of actions aimed at preventing the problem. The study showed the relevance of the phenomenon as a nursing diagnosis that could be included in NANDA-International.

RESUMEN Objetivo: Evaluar la prevalencia de la percepción alterada del tacto en los pies de individuos con diabetes mellitus y los factores de riesgo asociados. Método: Estudio transversal con 224 individuos con diabetes mellitus conducido en ambulatorio de endocrinología del hospital público de Campina Grande, Paraíba. Testes de sensibilidad y percepción del tacto han sido empleados en la evaluación; y ha sido realizado análisis descriptivo y multivariado con regresión de Poisson. Resultados: Ha sido encontrado prevalencia de la percepción alterada del tacto de 53,1%. Los factores de riesgo que tuvieron impacto de forma significativa y conjunta en su ocurrencia han sido: sexo femenino; úlcera previa; diabetes mellitus tipo 2; irritación, rajaduras, fisuras, callosidades y pies de Charcot. Conclusiones: Alta prevalencia de la percepción alterada del tacto ha sido encontrada, y esta debe subsidiar el planeamiento de acciones vueltas para la prevención del problema. El estudio evidenció la relevancia del fenómeno en cuanto un diagnóstico de enfermaría pasible de inclusión en la NANDA International.

RESUMO Objetivo: Avaliar a prevalência da percepção do tato alterada nos pés de indivíduos com diabetes mellitus e os fatores de risco associados. Método: Estudo transversal com 224 indivíduos com diabetes mellitus conduzido em ambulatório de endocrinologia de hospital público de Campina Grande, Paraíba. Testes de sensibilidade e percepção do tato foram empregados na avaliação; e foi realizada análise descritiva e multivariada com regressão de Poisson. Resultados: Encontrou-se prevalência da percepção do tato alterada de 53,1%. Os fatores de risco que tiveram impacto de forma significativa e conjunta na sua ocorrência foram: sexo feminino; úlcera prévia; diabetes mellitus tipo 2; queimação, rachaduras, fissuras, calosidades e pés de Charcot. Conclusões: Alta prevalência da percepção do tato alterada foi encontrada, e esta deve subsidiar o planejamento de ações voltadas para a prevenção do problema. O estudo evidenciou a relevância do fenômeno enquanto um diagnóstico de enfermagem passível de inclusão na NANDA-International.

Caracterización clínico epidemiológica de pacientes afectados por pie diabético / Clinical epidemiological characterization of patients affected by diabetic foot

ntroducción: el pie diabético constituye un problema de salud en los pacientes portadores de diabetes mellitus y se registra como la primera causa de amputación no traumática de los miembros. El conocimiento de sus particularidades clínico-epidemiológicas resulta de sumo interés. Objetivo: caracterizar clínica y epidemiológicamente a los pacientes con pie diabético neuroinfeccioso en el Hospital Dr. Joaquín Castillo Duany de Santiago de Cuba. Método: se realizó un estudio descriptivo retrospectivo. El universo estuvo constituido por 96 pacientes diagnosticados con pie diabético durante el periodo comprendido entre el 2011 y el 2015. Se emplearon variables demográficas y relacionadas con factores de riesgo generales y específicos del pie diabético. Resultados: el pie diabético predominó entre la cuarta y sexta décadas de vida (24,7 por ciento) y en pacientes del sexo femenino (59,7 por ciento). La diabetes mellitus tipo 2 estuvo representada en el 52,5 por ciento. Mientras el factor de riesgo general de pie diabético más frecuente fue la obesidad (56,7 por ciento), la neuropatía diabética, como factor de riesgo específico se presentó en el 98,9 por ciento de los enfermos estudiados. Conclusiones: el pie diabético predominó en la cuarta y sexta décadas de la vida y en el sexo femenino. El mayor porcentaje de los pacientes era portador de diabetes mellitus tipo 2. La obesidad, la neuropatía diabética periférica, el sobrepeso, y la hiperglucemia constituyeron los factores de riesgo prevalecientes(AU)

Introduction: Diabetic foot is a health problem in patients with diabetes mellitus and is registered as the first cause of non-traumatic amputation of limbs. The knowledge of its clinical-epidemiological characteristics is of great interest. Objective: Clinically and epidemiologically to characterize patients with neuroinfectious diabetic foot in the Hospital Dr. Joaquín Castillo Duany of Santiago de Cuba. Method: A retrospective descriptive study was carried out. The universe consisted of 96 patients diagnosed with diabetic foot during the period between 2011 and 2015. Demographic variables related to general and specific risk factors of diabetic foot were used. Results: The diabetic foot predominated between the fourth and sixth decades of life (24.7 percent) and in female patients (59.7 percent). Type 2 diabetes mellitus was represented in 52.5 percent. While the most frequent risk factor for diabetic foot was obesity (56.7 percent), diabetic neuropathy as a specific risk factor was present in 98.9 percent of the patients studied. Conclusions: The diabetic foot predominated in the fourth and sixth decades of life and in the female sex. The highest percentage of patients was a carrier of type 2 diabetes mellitus. Obesity, peripheral diabetic neuropathy, overweight, and hyperglycemia were the prevailing risk factors(AU)

Prevalência e fatores associados à neuropatia periférica em indivíduos com diabetes mellitus / Prevalencia y factores asociados con la neuropatía periférica en individuos con diabetes mellitus / Prevalence and factors associated with peripheral neuropathy in individuals with diabetes mellitus

Objective: To estimate the prevalence of polyneuropathy (PND) in type 2 diabetic individuals assisted at the Center for Health Hiperdia in Viçosa and to identify factors associated with a positive diagnosis of PND through the score of neuropathic symptoms and susceptibility testing. Methods: Cross-sectional quantitative study performed from December 2013 to June 2014, through secondary source. The prevalence of PND and its association with each variable was assessed using the chi-square test and the Fisher exact test. In the logistic regression it was used the method of disposal backward by the Wald test. Results: It was found the prevalence of PND: 36.89%, higher in males, in patients with delayed diagnosis of diabetes mellitus (DM) and with the absence of protective sensation plant (SPP). Conclusion: The study found a high prevalence of PND, reinforcing the need for early diagnosis in order to prevent ulcers and improving the quality of life of diabetic patients.

Objetivo: Estimar a prevalência da polineuropatia (PND) em indivíduos diabéticos tipo 2 assistidos no Centro de Atenção à Saúde Hiperdia, em Viçosa/MG e identificar fatores associados ao diagnóstico positivo da PND através do escore de sintomas neuropáticos e testes de sensibilidade. Métodos: Estudo quantitativo transversal realizado de dezembro de 2013a junho de 2014, através de fonte secundária. A prevalência da PND e sua associação com cada variável foi avaliada pelo teste Qui-quadrado de Pearson e o Teste Exato de Fischer. Na regressão logística utilizou-se o método de eliminação backward pelo teste de Wald. Resultados: Verificou-se a prevalência de PND: 36,89%, sendo maior em indivíduos do sexo masculino, em indivíduos com maior tempo de diagnóstico do Diabetes Mellitus (DM) e ausência de sensibilidade protetora plantar(SPP). Conclusão: O estudo detectou uma alta prevalência de PND, reforçando a necessidade do diagnóstico precoce, a fim de prevenir ulcerações, melhorando a qualidade de vida dos indivíduos diabéticos.

Objetivo: Estimar la prevalencia de polineuropatía (PND) en el tipo 2 individuos diabéticos atendidos en el Centro de Salud Hiperdia en Viçosa e identificar los factores asociados con un diagnóstico positivo del PND a través de la puntuación de los síntomas neuropáticos y las pruebas de sensibilidad. Métodos: Estudio cuantitativo transversal realizado desde diciembre 2013 hasta junio 2014, a través de fuentes secundarias. La prevalencia de PND y su asociación con cada variable se evaluó mediante la prueba de chi-cuadrado y la prueba exacta de Fisher. La regresión logística se utilizó el método de eliminación hacia atrás mediante la prueba de Wald. Resultados: Se encontró que la prevalencia del PND: 36.89%, mayor en los hombres, en los pacientes con diagnóstico tardío de la diabetes mellitus (DM) y la ausencia de plantas sensación protectora (SPP). Conclusión: El estudio encontró una alta prevalencia de PND, lo que refuerza la necesidad de un diagnóstico precoz para prevenir las úlceras, la mejora de la calidad de vida de los pacientes diabéticos.

Avaliação de neuropatia e complicações vasculares em pacientes com diabetes mellitus em um município rural de Santa Catarina / Evaluation of neuropathy and vascular complications in patients with diabetes mellitus in a rural town of Santa Catarina

Introdução: A neuropatia periférica, caracterizada pela degeneração progressiva dos axônios das fibras nervosas, e a doença arterial periférica (DAP) são complicações do diabetes mellitus (DM). São considerados fatores de risco para o desenvolvimento de úlceras nos pés de pacientes diabéticos. Métodos: Trata-se de estudo transversal que objetivou caracterizar a prevalência de neuropatia diabética e DAP em pacientes com DM atendidos na Estratégia Saúde da Família. Foi utilizado um formulário de avaliação de dor neuropática, perda de sensibilidade protetora (PSP) e DAP. Ainda, foi realizada aferição do Índice Tornozelo-Braquial e teste com monofilamento 10 gramas. Resultados: Foram avaliados 113 pacientes, dos quais 59 eram mulheres (47,79%). Observou-se que 26,55% (n= 30) apresentava PSP, sendo mais prevalente em mulheres (n= 17) e entre os que não utilizavam insulina (n= 27). A frequência de DAP foi de 13,27% (n= 15). Pacientes do sexo feminino apresentaram associação positiva para o desenvolvimento de DAP + PSP (OR= 3,81; IC 95%= 1,0 -14,53). O uso de insulina esteve associado ao desenvolvimento de risco 2 (OR= 4,02; IC 95%= 1,15 - 14,04). Entre aqueles com HbA1c entre 9,01% e 10%, verificou-se uma associação significativa para a classificação de Risco 3 (OR= 7,25; IC 95%= 1,06 - 49,27). Conclusões: O estabelecimento do perfil de diabéticos em risco para o desenvolvimento de úlceras pode permitir intervenções precoces nos segmentos mais afetados (AU)

Introduction: Peripheral neuropathy, characterized by progressive degeneration of nerve fibers axons and peripheral arterial disease (PAD) are complications of diabetes mellitus (DM). They are considered risk factors for developing ulcers in the feet of diabetic patients. Methods: This cross-sectional study aimed to characterize the prevalence of diabetic neuropathy and PAD in patients with DM treated at the Family Health Strategy. An evaluation form of neuropathic pain, loss of protective sensation (LPS) and PAD was used. In addition, determination of the Ankle-Brachial Index and test with monofilament 10 grams were performed. Results: We evaluated 113 patients, of whom 59 were women (47.79%). It was observed that 26.55% (n = 30) had LPS, which was more prevalent in women (n = 17) and among those who did not use insulin (n = 27). The frequency of PAD was 13.27% (n = 15). Female patients showed a positive association for the development of PAD + LPS (OR = 3.81; 95% CI = 1.0 -14.53). Insulin use was associated with development of risk 2 (OR = 4.02; 95% CI = 1.15 to 14.04). Among those with HbA1c between 9.01% to 10%, there was a significant association for risk category 3 (OR = 7.25; 95% CI = 1.06 to 49.27). Conclusions: Establishing the profile of diabetics at risk for developing ulcers may allow early interventions in the most affected segments (AU)

Prevalencia de neuropatía periférica en diabéticos tipo 2 en el primer nivel de atención / Prevalence of peripheral neuropathy among primary care type 2 diabetic patients

Background: Neuropathy is a common complication of diabetic patients. Aim: To determine the prevalence of diabetic peripheral neuropathy in Type 2 diabetic patients attended at a family medicine unit. Material and Methods: Cross-sectional assessment of 348 type 2 diabetic patients aged 34-89 years (60% females) with a disease duration of 5 to 15 years. Peripheral neurological status was evaluated using The Michigan Neuropathy Screening Instrument, a tool that includes a self-assessment of symptoms and a physical examination. Results: Diabetic neuropathy was found in 240patients (69%). The prevalence in males and females was 72 and 67% respectively. The prevalence in patients with a disease duration of 5, 10 and 15 years, was 59, 69 and 77%, respectively. Fifty percent of patients with neuropathy complained of dry skin, 2% had ulcers, 43% had an abnormal perception of vibration and 29% had an abnormal monofilament test. Conclusions: The overall prevalence of peripheral neuropathy in this group of patients was 69% and was directly associated with the duration of the disease.

Actividades de prevención del pie diabético en pacientes de consulta externa de primer nivel / Primary-care prevention activities in outpatients suffering from diabetic foot care

Objetivo Determinar la frecuencia de actividades de prevención del pie diabético recomendadas por el médico y efectuadas por pacientes de consulta externa en medicina general, para autocuidado de los pies y describir los hábitos alimentarios. Metodología Estudio descriptivo de corte transversal, realizado en dos instituciones de salud de Bogotá, marzo-octubre 2008; muestra ponderada, por conveniencia, 307 pacientes diabéticos mayores de 18 años. Resultados Antecedente de úlceras en pies 13 por ciento, amputaciones en miembros inferiores 1,6 por ciento. Refirieron: disestesias 65,5 por ciento y claudicación intermitente 33,6 por ciento; no habían recibido educación sobre el cuidado del pie por parte del médico 78,2 por ciento. Su médico no le había examinado los pies en el último año al 76,2 por ciento; a pesar de presentar disestesias y claudicación intermitente no se indagó sobre estos síntomas al 89 por ciento y 93 por ciento de pacientes respectivamente. Actividades de pacientes: no revisaban diariamente los pies 63,1 por ciento, no realizaban automonitoreo 93,4 por ciento, consumían más de dos fuentes de carbohidratos en comidas principales 38,1 por ciento; adicionaban a las preparaciones azúcar, panela, miel de abejas 38,8 por ciento. Conclusiones La prevalencia de actividades de prevención del pie diabético recomendadas por médicos y efectuadas por pacientes fue deficiente. Es necesario crear y fortalecer programas interdisciplinarios para la prevención de la diabetes mellitus y del pie diabético a nivel primario de atención, además de formación del equipo de profesionales en salud.

Objective Determining the prevalence of prevention activities regarding diabetic foot recommended by doctors and carried out by out-patients attending general medicine self-care foot control and describing food habits. Methods This was a descriptive and cross-sectional studywhich was carried out in two health-care institutions in Bogotá, from March to October 2008, by weightedconveniencesampling of 307 diabetic patients, aged over 18 years. Results Some patients had a background of foot ulcers (13.0 percent) and amputations of the lower limbs(1.6 percent). Some patients referredto dysesthesia(65.5 percent) and intermittent claudication (33.6 percent)whilst many stated that they had received no education about foot care from their doctors(78.2 percent). Many stated that the doctor had not checked their feet during the last year (76.2 percent)and others that, despite presenting dysesthesia and intermittent claudication(89.0 percent and 93.0 percent, respectively), the patients had not been asked about these symptoms. Regarding patient activities,some did not checktheir feet each day (63.1 percent), did not perform self-monitoring (93.4 percent), consumed more than two sources of carbohydrateduring the main meals (38. percent)and/or added sugar, "panela" or honey to preparations (38.8 percent). Conclusions The prevalence of diabetic foot prevention practices recommended by doctors and carried out by patients was poor. Interdisciplinary programmes must thus be created and strengthenedfor preventing diabetes mellitus and diabetic foot, at primary- attention out-patient level, besides providing pertinent trainingfor health teams.

Correlation between retinopathy, nephropathy and peripheral neuropathy among adult Sudanese diabetic in patients

Diabetes Mellitus is a worldwide common metabolic disorder. Increasing prevalence of diabetes, lack of proper education about the nature and course of the disease and necessary control are the main factors for an early onset of micro vascular complications. To correlate between retinopathy, nephropathy and neuropathy, among adult Sudanese diabetic patients at Elshaab Teaching hospital, Ahmed Gasim Teaching hospital and Gabber Abu Eleaz centre, from December 2006 to September 2008. This is a descriptive prospective cross sectional hospital based study, 71 patients were included. Male to female ratio was1.4:1.Common age group affected was 60-69 [32.4%].Common duration of diabetes mellitus was 20-24 years [23.9%].All patients who had diabetes for 25 years or more had developed complications [19.7%].The commonest long term microvascular complication was found to be retinopathy [71.2%], followed by neuropathy [69%] and nephropathy [50.7%].It was found that [47.6%] of our patients had the three complications. Long-term micro vascular complications affect male more than female, with average age of onset 60-69 years. All patients who had diabetes for 25 years or more had developed complications. Retinopathy is the most common micro vascular complication, followed by neuropathy. There is a significant correlation between retinopathy, nephropathy and neuropathy in association with the duration and control of blood glucose level

Prevalence and risk factors for severity of diabetic neuropathy in type 2 diabetes mellitus.

Purpose: To estimate the prevalence of diabetic neuropathy (severity wise) and associated risk factors in a population having type 2 diabetes mellitus. Materials and Methods: A population-based sample of 1401 persons with diabetes (identified as per the WHO criteria) underwent comprehensive eye examination including stereoscopic digital photography (45° four field) for diabetic retinopathy grading. Vibration perception threshold (VPT) measurements were done to assess neuropathy (cut off ≥ 20 V). Severity of neuropathy was graded into three groups based on VPT score as mild (20-24.99 V), moderate (25-38.99 V), and severe (≥39 V). Univariate and multivariate analyses were done to find out the independent risk factors for severity of diabetic neuropathy. Results: In the overall group, the prevalence of diabetic neuropathy was 18.84% (95% CI: 16.79-20.88). The prevalence of mild diabetic neuropathy was 5.9% (95% CI: 4.68-7.15), moderate diabetic neuropathy was 7.9% (95% CI: 6.50-9.33), and severe diabetic neuropathy was 5% (95% CI: 3.86-6.14). Increasing age per year (P < 0.0001) was a statistically significant risk factor for all - mild, moderate, and severe - types of diabetic neuropathy. For severe diabetic neuropathy, other significant risk factors were duration of diabetes mellitus (P = 0.027), macroalbuminuria (P = 0.001), and presence of diabetic retinopathy (P = 0.020). Conclusions: The results suggested that every fifth individual in a population of type 2 diabetes is likely to have diabetic neuropathy. Nearly 13% had neuropathy of moderate and severe category, making this group vulnerable for complications such as foot ulceration or lower limb amputation.

Long term complications of type 1 diabetes mellitus in children and young adults

Diabetes mellitus is a common chronic metabolic syndrome characterized by impaired metabolism of glucose; morbidity and mortality come from acute metabolic derangement and from long term complications that affect small and large vessels. The assessment of the long term complications of diabetes mellitus in children and young adults. The study included 150 patients with typel diabetes mellitus attending the diabetic clinic of Children Welfare Teaching Hospital who were assessed for the presence of long term complications of diabetes mellitus. The total number of the sample was 150 patients with male to female ratio of 1:1.2 with median age of 12.2 years. Long term complications occurred in 26.7% of patients; [75%] of them had diabetes for more than 5 years. These complications include eye complications [retinopathy and cataract] 12.6%, Renal complications [albuminuria, oedema, and hypertension] 10.6%, peripheral neuropathy 4.6%, limited joint mobility 6.6%, and short stature 17.3%. Long term complications were found in significant number of patients with type I diabetes mellitus which can occur in children with short duration of diabetes, and their frequency increases significantly with increasing duration of diabetes

Heterogeneidade clínica e coexistência das neuropatias diabéticas: diferenças e semelhanças entre diabetes melito tipos 1 e 2 / Clinical heterogeneity and coexistence of diabetic neuropathies: difference and similarities between types 1 and 2 diabetes mellitus

OBJETIVO: Estudar a heterogeneidade e a coexistência das neuropatias no diabetes melito tipos 1 (DMT1) e 2 (DMT2). MÉTODOS: Foram avaliados 74 DMT2 e 20 DMT1 em relação à idade (anos), tempo de diagnóstico do DM (TDDM, em anos), índice de massa corpórea (IMC, kg/m²), HbA1c e tipo de neuropatia (critérios da American Diabetes Association). RESULTADOS: DMT1 era mais jovem (32,7 ± 11 versus 56,9 ± 10,3; p = 0,0001), com maior TDDM (17,1 ± 9,7 versus 10,4 ± 6,8; p = 0,003) e menor IMC (23,6 ± 3,8 versus 28,4 ± 5,3; p = 0,0005). A neuropatia autonômica cardiovascular (NAC) (60 por cento versus 32,4 por cento; p = 0,02) e a coexistência desta com polineuropatia (PND) (62,5 por cento versus 33,3 por cento; p = 0,03) foram mais prevalentes no DMT1; a PND dolorosa crônica (PNDDC) (60,8 por cento versus 30,0 por cento; p = 0,009) o foi no DMT2. A HbA1c (p = 0,04) foi preditiva de PND em ambos os grupos. O TDDM (p = 0,03) e a PNDDC (p = 0,003) foram preditivos de NAC no DMT1. A idade (p = 0,0004) teve valor preditivo para PNDDC no DMT2. CONCLUSÕES: As neuropatias apresentam distribuição heterogênea no DMT1 e no DMT2. Com exceção do controle glicêmico, os fatores relacionados a essa complicação diferem de acordo com o tipo de diabetes.

OBJECTIVE: To evaluate the heterogeneity and the coexistence of diabetic neuropathy (DNP) in type 1 (T1DM) and 2 (T2DM) diabetes mellitus. METHODS: 74 T2DM and 20 T1DM patients were evaluated according to age (years), time from diagnosis of diabetes (TDD, years), body mass index (BMI, kg/m²), HbA1c and DNP type (American Diabetes Association criteria). RESULTS: T1DM was younger (32.7 ± 11.0 versus 56.9 ± 10.3; p = 0.0001), leaner (BMI: 23.6 ± 3.85 versus 28.4 ± 5.3; p = 0.0005) and they had longer TDD (17.1 ± 9.7 versus 10.4 ± 6.8; p = 0.003). Cardiovascular autonomic neuropathy (CAN) (60 percent versus 32.4 percent; p = 0.02) and its coexistence with polyneuropathy (PN) (62.5 percent versus 33.3 percent; p = 0.03) were more common in T1DM. Chronic painful polyneuropathy (CPP) was more prevalent in T2DM (60.8 percent versus 30.0 percent; p = 0.009). Logistic regression showed HbA1c as an independent variable related to PN (p = 0.04) in both groups. TDD (p = 0.03) and CPP (p = 0.003) were related to CAN in T1DM. Age (p = 0.0004) was related to CPP in T2DM. CONCLUSIONS: The DNP have shown a heterogeneity distribution in type 1 and type 2 diabetes mellitus. The related factors to different phenotypes of this complication, apart from hyperglycemia, may be variable between these two types of diabetes mellitus.

Prevalence and characteristics of diabetic polyneuropathy in Passo Fundo, South of Brazil

PURPOSE: The aim of the study was to investigate the prevalence of peripheral diabetic neuropathy (PDN) and associated characteristics among type 2 diabetic mellitus (DM2) patients in Passo Fundo, a city on Southern Brazil. BASIC PROCEDURES: A cross-sectional study was conducted with 340 patients with type 2 diabetes mellitus. Tests were performed to evaluate vibration (tuning fork), light touch (10-g monofilament), temperature, and pain (pinprick) sensations, as well as ankle reflexes and heel walking. The condition was classified as peripheral diabetic neuropathy when results in at least three of these tests were negative. The electrically induced Hoffmann reflex test was performed in a group of patients to define the criterion standard used in the assessment of clinical examination sensibility in the diagnosis of neuropathy. Sensitivity was 83 percent, specificity, 91 percent, positive predictive value, 63 percent, and negative predictive value, 90 percent. The monofilament, pinprick and deep tendon reflex were the most accurate tests in the diagnosis of neuropathy. MAIN FINDINGS: Seventy-five patients (22.1 percent) had peripheral diabetic neuropathy, nephropathy in 29.5 percent and retinopathy in 28.8 percent. CONCLUSIONS: Logistic regression revealed that only duration of diabetes, creatinine and glycated hemoglobin concentrations were significantly associated with neuropathy.

PROPOSITO: O objetivo deste estudo foi investigar a prevalência da neuropatia diabética periférica (NDP) e características associadas entre pacientes com diabetes melito tipo 2 (DM2) na cidade de Passo Fundo, sul do Brasil. PROCEDIMENTOS BASICOS: Um estudo de corte foi realizado com 340 pacientes portadores de DM2. Testes foram conduzidos a fim de avaliar sensações de vibração (diapasão), de toque leve (monofilamento 10 g), de temperatura e de dor (agulha), bem como reflexos do tornozelo e caminhar com os calcanhares. A condição foi classificada como NDP quando os resultados em pelo menos três desses testes foram negativos. O teste reflexo de Hoffman induzido eletricamente foi conduzido em um grupo de pacientes a fim de determinar o critério padrão usado na avaliação da sensibilidade do exame clínico no diagnóstico de neuropatia. A sensibilidade foi de 83 por cento, especificidade, 91 por cento, valor preditivo positivo, 63 por cento e valor preditivo negativo, 90 por cento. O teste do monofilamento, a dor e o reflexo do tendão foram os mais precisos no diagnóstico de neuropatia. PRINCIPAIS ACHADO: Setenta e cinco pacientes (22,1 por cento) foram diagnosticados com NDP, nefropatia em 29,5 por cento e retinopatia em 28,8 por cento. CONCLUSÕES: Regressão logística revelou que somente a duração do diabetes e as concentrações de creatinina e hemoglobina glicada foram significativamente associados à neuropatia.

Frequency of chronic complications of type II diabetes

To assess the frequency of chronic complications of type II diabetes in subjects attending a tertiary care unit in Karachi, Pakistan. Design: A cross-sectional analytical study. Place and Duration of Study: First visit of all type II diabetic subjects attending the outpatient department of Baqai Institute of Diabetology and Endocrinology from September 1996 to December 2001. Subjects and Computerized clinical records of 2199 type II diabetic subjects were analyzed for this study. The clinical and laboratory variables were statistically evaluated with significance at p. Means of glycosylated hemoglobin HbA1c, fasting and random plasma glucose levels, systolic blood pressure, triglycerides and high density lipoproteins [HDL] were higher than the risk indicator value for both genders [p<0.005]. Mean body mass index and total blood cholesterol was higher for females only. Hyperglycemia was present in 88%, high HbA1c in 81%, low HDL in 81%, obesity in 66% and hypertriglyceridemia in 54%, neuropathy in 36%, proteinuria in 28% and hypertension in 50% of the subjects. Frequency of obesity, low HDL and hypertension was higher among females [p<0.001 in each case]. Retinopathy [p<0.05], nephropathy [p<0.005], neuropathy [p<0.005] and foot ulcers [p<0.001] were higher among males. Frequency of obesity was significantly higher among those with shorter duration and in younger group while frequency of other complications was higher among those with longer duration and in the older groups. Higher rates of complications were observed compared to previous studies. Certain variables showed significant association with gender and age as described above

Nerve conduction in children suffering insulin dependent diabetes mellitus.

OBJECTIVE: To determine the incidence of peripheral neuropathy in children suffering Insulin Dependent Diabetes Mellitus (IDDM) as well as to determine the relationship between other criteria of the disease and neuropathy. METHODS: 40 children (17 males, mean age 11.9 years) suffering IDDM and receiving insulin therapy involving two injections a day and 30 healthy children (17 males, mean age 11.7 years) were included in the study. They were inquired about their demographical characteristics as well as the presence of neurological symptoms. Their detailed neurological examinations were conducted. Their glycemic control values (Hb A1C) were recorded, and their nerve conduction studies were performed from right upper and lower extremities. RESULTS: All nerve conduction values of children with IDDM were found to be significantly lower (p<0.0001) as compared to the control group. 60% of diabetic children (n=24) were found to suffer peripheral neuropathy. Statistically significant relationships were found between the glycemic control values and the peroneal, sural, tibial, ulnar and median nerve conduction velocities, and also between the duration of disease and the peroneal, sural, tibial and median nerve conduction velocities. CONCLUSION: The peripheral neuropathy is rather a frequently observed complication in diabetic children. The duration of disease and impaired glycemic control play an important role in the development of neuropathy. The introduction of new methods designed to ensure better glycemic control will reduce the incidence of the complication.

Prevalence of pathogens in diabetic foot infection in South Indian type 2 diabetic patients.

AIM: To determine the prevalence of pathogens in diabetic foot infections, in relation to parameters like Wagner's grading, duration of diabetes and healing time. MATERIAL AND METHODS: A group of 654 (M:F, 433:221) type 2 diabetic patients with foot ulcers were studied. Specimens like pus, wound exudate and tissue were processed for smear for Gram's staining, aerobic and anaerobic culture, and biochemical identifications. RESULTS: In 654 diabetic patients, 728 pathogens were isolated. Aerobic pathogens were isolated in 437 (66.8%) patients and anaerobic pathogens were isolated in 217 (33.2%). As Wagner's grading increased, the prevalence of anaerobic pathogens also increased. Neuropathy was common in diabetic patients infected with both aerobic and anaerobic pathogens. Ulcers infected with anaerobic pathogens showed a longer healing time than ulcers infected with aerobic pathogens. There was no significant difference in peripheral vascular disease (PVD) in patients selected for the study. Among aerobic pathogens, Enterobacteriaceae family (48%), Staphylococcus species (spp) (18.2%), Streptococcus spp (16.8%) and Pseudomonas spp (17%) were seen frequently. Among anaerobes Peptostreptococcus spp and Clostridium spp formed 69.4%. Gram-negative anaerobes like Bacteroides spp and Fusobacterium spp were present in 30.6%. Healing time was longer when strict aerobic pathogen Pseudomonas spp and strict anaerobic pathogens were present (136.1 +/- 28.6 and 136.4 +/- 34.7 days, respectively). CONCLUSIONS: Diabetic foot infection is polymicrobial in nature. The healing time of wound infected with anaerobic pathogens was higher than those infected with aerobic pathogens. Anaerobic pathogens increased with the Wagner's grading. Presence of neuropathy increased the risk of foot infection.

Vasculopathy in the diabetic foot

This paper attempts to distil some of the results of vasculopathy studies performed on Jamaican diabetic clinic attendees. Doppler measurements of ankle/brachial pressure index (A/BI) revealed that 23of the diabetics had peripheral occlusive arterial disease (POAD) which was mostly asymptomatic. Plethysmographic blood flow studies revealed a profound reduction in the vasodilatory response to increased flow demand. Prevalence of POAD determined by Doppler testing of A/BI reported by other researchers ranged from 13in a large community study, one-third of whom were diabetic, to 47in patients who had been diabetic for 20 years. Isolated posterior tibial disease has been reported to carry a three-fold risk of all cause mortality and a four-fold risk of coronary heart disease mortality. This underscores the need for regular Doppler A/BI testing in order to improve the recognition, and treatment of POAD, and prevent further cardiovascular morbidity and mortality.

Prevalencia de uveítis aguda anterior en el paciente diabético / Prevalence of acute anterior uveitis in diabetic patient

Antecedentes: La diabetes mellitus ha sido descrita en poblaciones de pacientes con uveítis. Objetivo: Demostrar la prevalencia de uveítis en una población abierta de pacientes diabéticos y determinar sus características clínicas. Material y métodos: Realizamos un estudio prospectivo, observacional y transversal en un periodo de nueve meses, con criterios internacionales clasificamos a los pacientes en no insulino dependientes (DMNID) y en diabetes insulino dependiente (DMID), así como la neuropatía autonómica y retinopatía diabética. Resultados: Revisamos 135 pacientes diabéticos, 70 DMNID y 65 DMID, la uveítis se presentó en 10 sujetos (7.6 por ciento), con una relación entre DMNID y DMID de 6:4; de estos 10 pacientes, seis presentaron neuropatía autonómica y seis retinopatía. La uveítis se caracterizó por ser anterior aguda con depósitos retroquer ticos finos, con intensa reacción inflamatoria incluyendo fibrina en la mitad de los casos y bilateral en siete pacientes. Conclusiones: la uveítis es una alteración ocular que puede presentarse en la diabetes mellitus, se asocia a descontrol y complicaciones tardías como la neuropatía autonómica y la retinopatía.

Diabetes en el senescente / Diabetes in the senescent

La diabetes mellitus (DM) en el senescente muestra un notable aumento de prevalencia, 15 a 18 por ciento actualmente, constituyendo un problema de salud pública por las complicaciones crónicas que la acompañan, las que determinan una menor expectativa y calidad de vida. Su escasa sintomatología hace que el diagnóstico se haga generalmente por exámenes de rutina, por complicaciones de la enfermedad o en un coma hiperosmolar, de allí la necesidad de pesquisar la DM en las etapas precoces. La DM del adulto mayor corresponde generalmente a una diabetes tipo 2. El tratamiento de la DM en el senescente no difiere sustancialmente del efectuado en sujetos más jóvenes, pero en más del 50 por ciento la DM se controla con medidas no farmacológicas. Cuando se requiere el uso de drogas orales, deben emplearse las de más baja potencia- preferentemente tolbutamida o gliclazida- en las dosis mínimas necesarias, a objeto de no provocar hipoglicemias, las que suelen ser severas e incluso mortales. Pueden presentar complicaciones agudas metabólicas, coma hiperosmolar no cetósico con mayor frecuencia y, en forma excepcional, cetoacidosis diabética grave, ambos cuadros de elevada mortalidad en estos pacientes. La hipoglicemia es la complicación aguda más relevante, la que debe prevenirse con un adecuado tratamiento y controles periódicos. Las complicaciones crónicas micro y macrovasculares son de alta prevalencia, así como las patologías asociadas. De allí que estos pacientes requieren de una atención integral