Scores of peripheral neuropathic pain predicting long-term mortality in patients with type 2 diabetes: A retrospective cohort study.

Objectives: Diabetic peripheral neuropathic pain (DPNP) is a prevalent chronic complication in patients with diabetes. Using a questionnaire is helpful for DPNP screening in outpatients. In this retrospective cohort, we aimed to examine whether DPNP diagnosed based on scoring questionnaires could predict long-term mortality in outpatients with type 2 diabetes. Methods: We enrolled 2318 patients who had joined the diabetes pay-for-performance program and completed the annual assessments, including both the identification pain questionnaire (ID pain) and Douleur Neuropathique en 4 questionnaire (DN4), between January 2013 and October 2013. Information on registered deaths was collected up to August 2019. Results: There was high consistency in the scores between the ID pain and DN4 (r = 0.935, P < 0.001). During the median follow-up of 6.2 years (interquartile range: 5.9-6.4 years), 312 patients deceased. Patients with an ID pain score of ≥ 2 had a higher mortality risk than those with a score of < 2 (hazard ratio [HR] = 1.394, 95%CI: 1.090-1.782), and patients with a DN4 score of ≥ 4 had a higher mortality risk than those with a score of < 4 (HR = 1.668, 95% confidence interval [CI]: 1.211-2.297). Patients consistently diagnosed with DPNP by the ID pain and DN4 had a significantly higher mortality risk (HR = 1.713, 95% CI: 1.223-2.398, P = 0.002), but not those discrepantly diagnosed with DPNP (P = 0.107), as compared with those without DPNP. Conclusions: Both the ID pain and DN4 for DPNP screening were predictive of long-term mortality in patients with type 2 diabetes. However, a discrepancy in the diagnosis of DPNP weakened the power of mortality prediction.

Improvement in health-related quality of life, independent of fasting glucose concentration, via insulin pen device in diabetic patients.

RATIONALE AND AIMS: Using an insulin pen may improve the quality of life (QOL) for diabetic individuals. However, glycemic control and its relationship to better QOL are controversial. The aim of this study was to determine the relationship between health-related QOL and glycemic control in diabetic patients using insulin pen. METHODS: All of the participants were diabetic patients receiving insulin therapy by syringe injection for longer than 1 month. One group of enrolled subjects changed over to use of insulin pen for 12 weeks, while the other group (age-matched control subjects) continued to use syringe for insulin-injection during the same period. Fasting plasma glucose, HbA1c and a 36-Item Short-Form Health Survey (SF-36) were assessed in both groups before and after the 12-week study. RESULTS: A total of 32 subjects in the insulin pen group and 33 subjects in the syringe group completed the assessment. In comparison with baseline, fasting glucose significantly decreased in the insulin pen group (-57 +/- 14 mg dL(-1), P < 0.001), and the reduction was significantly greater than that in the syringe group (P = 0.003). The summary scale of physical components but not mental components in the SF-36 was significantly higher in the insulin pen group than in the syringe group (P = 0.037). This improvement was independent of the change in fasting glucose. CONCLUSIONS: Using insulin pen for insulin-injection improved glycemic control and health-related QOL in diabetic patients. The better functional health status as a result of physical improvement was independent of the glycemic control.

Relationship of stressful life events, anxiety and depression to hyperthyroidism in an asian population.

BACKGROUND: Psychological disturbances are well-known disorders in patients with hyperthyroidism, with anxiety and depression being the most commonly described. Stressful life events may play an important role in the relationship of anxiety, depression and hyperthyroidism. We assessed the associations of these disorders by three-part rating scales, including the Hamilton Rating Scale for Anxiety (HAM-A) indicating anxiety, the Zung Self-Rating Depression Scale (Zung Scale) indicating depression and the Social Readjustment Rating Scale (SRRS) indicating external stress from life events in this study. METHODS: Eighty-six outpatients who visited an endocrine clinic with suspicion of thyroid disease and 18 healthy volunteers were enrolled in the study. In all of these individuals, thyroid functions were assessed and questionnaires were completed during an interview. RESULTS: The outpatients with hyperthyroidism (n = 39) had higher scores of HAM-A (15.7 +/- 1.1 vs. 8.0 +/- 0.8, p < 0.001), Zung scale (46.2 +/- 1.5 vs. 37.5 +/- 1.4, p < 0.001) and SRRS (92.9 +/- 13.5 vs. 56.9 +/- 8.4, p = 0.015) than those with euthyroidism (n = 47). The scores of the three-part rating scales were also higher in the outpatients with hyperthyroidism than in healthy volunteers (n = 18), with no significant differences between the outpatients with euthyroidism and healthy volunteers. CONCLUSION: In patients with hyperthyroidism, anxiety, depression and stressful life events were more severe than in those with normal thyroid function. There were no correlations between these psychological disorders and thyroid function tests of the subjects with hyperthyroidism. The role of psychotherapy in the development of hyperthyroidism deserves further investigations.