High Incidence of Adverse Outcomes in Haemodialysis Patients with Diabetes with or without Diabetic Foot Syndrome: A 5-Year Observational Study in Lleida, Spain.

BACKGROUND: We evaluated whether, in subjects receiving haemodialysis (HD), the presence of diabetic foot syndrome (DFS) was associated with increased mortality compared with subjects with diabetes mellitus (DM) without DFS and with non-diabetic subjects. METHODS: Retrospective, observational study in 220 subjects followed for six years. We calculated and compared the frequency and 5-year cumulative incidence of all-cause mortality, cardiovascular (CV) mortality, CV events, major adverse CV events (MACE), and new foot ulcer (FU) or amputation. We also examined prognostic factors of all-cause and CV mortality based on baseline characteristics. RESULTS: DM patients had a 1.98 times higher probability of all-cause mortality than those without DM (p = 0.001) and 2.42 times higher likelihood of CV mortality and new FU or amputation (p = 0.002 and p = 0.008, respectively). In the DM cohort, only the risk of a new FU or amputation was 2.69 times higher among those with previous DFS (p = 0.021). In patients with DM, older age was the only predictor of all-cause and CV mortality (p = 0.001 and p = 0.014, respectively). CONCLUSIONS: Although all-cause and CV mortality were increased on HD subjects with DM, the presence of DFS did not modify the excess risk. Additional studies are warranted to further explore the impact of DFS in subjects with DM undergoing HD.

Comportamiento pernicioso: el efecto de las consecuencias en la elección entre perjudicar/no perjudicar a un compañero / Pernicious Behavior: the Effect of the Consequences in the Choice between to Harm/do not harm a Classmate

Resumen La presente investigación, se realizó con base en dos supuestos interconductuales: 1) el comportamiento es susceptible de modularse por factores históricos y/o situacionales; 2) el comportamiento pernicioso puede regularse por factores situacionales como las consecuencias. El objetivo fue evaluar el efecto de las consecuencias (positivas y negativas) sobre la elección entre perjudicar o no a un compañero durante la solución de una tarea. Participaron 35 estudiantes universitarios distribuidos aleatoriamente en cinco grupos. La tarea experimental consistió en la solución de operaciones aritméticas proporcionalmente puntuadas (1 a 5 puntos). El principal resultado fue que las consecuencias negativas por no perjudicar modulan mayoritariamente la ocurrencia de comportamiento pernicioso. Los resultados se discuten en términos del papel regulador de las consecuencias (en relación con el comportamiento pernicioso) en tanto factor situacional.

Abstract This research was based on two main interbehavioral suppositions: 1) Behavior is likely modulated by historical and/or situational factors; 2) Pernicious behavior can be regulated by situational factors such as the consequences. The objective was to evaluate the effect of the consequences (positives and negatives) on the choice between to harm or do not harm a classmate while solving a task. Thirty-five college students were randomly assigned into one of five experimental groups. The task consisted in solving arithmetic operations proportionally scored from 1 to 5 points. The results are discussed in terms of the regulatory role of the consequences (in relation to pernicious behavior) as a situational factor. The main result was that the negative consequences by the choice of do not harm the partner mainly modulated the occurrence of pernicious behavior.

Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain.

Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care.

Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial.

OBJECTIVE: Medical nutrition therapy based on the control of the amount and distribution of carbohydrates (CHO) is the initial treatment for gestational diabetes mellitus (GDM), but there is a need for randomized controlled trials comparing different dietary strategies. The purpose of this study was to test the hypothesis that a low-CHO diet for the treatment of GDM would lead to a lower rate of insulin treatment with similar pregnancy outcomes compared with a control diet. RESEARCH DESIGN AND METHODS: A total of 152 women with GDM were included in this open, randomized controlled trial and assigned to follow either a diet with low-CHO content (40% of the total diet energy content as CHO) or a control diet (55% of the total diet energy content as CHO). CHO intake was assessed by 3-day food records. The main pregnancy outcomes were also assessed. RESULTS: The rate of women requiring insulin was not significantly different between the treatment groups (low CHO 54.7% vs. control 54.7%; P = 1). Daily food records confirmed a difference in the amount of CHO consumed between the groups (P = 0.0001). No differences were found in the obstetric and perinatal outcomes between the treatment groups. CONCLUSIONS: Treatment of women with GDM using a low-CHO diet did not reduce the number of women needing insulin and produced similar pregnancy outcomes. In GDM, CHO amount (40 vs. 55% of calories) did not influence insulin need or pregnancy outcomes.