Frequency and Overlap of Cachexia, Malnutrition, and Sarcopenia in Elderly Patients with Diabetes Mellitus: A Study Using AWGC, GLIM, and AWGS2019.

This study aimed to estimate the frequency and overlap of cachexia, malnutrition, and sarcopenia in elderly patients with diabetes mellitus. Patients who were aged at least 65 years, had diabetes mellitus, and were regularly visiting the Ise Red Cross Hospital on an outpatient basis were included. The patients were assessed to determine whether they had cachexia, malnutrition, and sarcopenia according to the Asian Working Group for Cachexia criteria, the Global Leadership Initiative on Malnutrition criteria, and the Asian Working Group for Sarcopenia 2019 criteria. A total of 510 patients (310 men and 200 women) were analyzed in this study. Sarcopenia, cachexia, and malnutrition were found in 84 patients (16.4%), 40 patients (7.8%) (17.8% among patients with chronic diseases), and 110 patients (21.5%), respectively. Among patients with sarcopenia, the frequencies of cachexia and malnutrition were 30% and 71.4%, respectively. Among patients with cachexia, the frequencies of sarcopenia and malnutrition were 65% and 90%, respectively, and among those with malnutrition, the frequencies of sarcopenia and cachexia were 54% and 32.7%, respectively. The overlap among cachexia, malnutrition, and sarcopenia appears to be an important factor to be considered in the treatment of elderly patients with diabetes mellitus.

Human immunodeficiency virus, diabetes mellitus and thyroid abnormalities: Should we be screening?

BACKGROUND: Diabetes mellitus (DM) and human immunodeficiency virus (HIV) are associated with thyroid abnormalities. Scarce literature exists on the prevalence of thyroid abnormalities in people living with HIV (PLWH) and DM (PLWHD). Guidelines vary regarding thyroid-stimulating hormone (TSH) screening in PLWH and/or DM. OBJECTIVES: This study describes thyroid abnormalities in PLWHD and HIV-uninfected people living with DM (PLWD). METHOD: This was a cross-sectional analysis of demographic, clinical and biochemical data including TSH results of first-visit patients to the Edendale Hospital diabetes clinic between January 2016 and December 2017. RESULTS: A total of 915 patients were enrolled: 165 PLWHD and 750 PLWD. Overall prevalence of thyroid disorders in PLWD was 8.53% (64/750). The occurrence of 'total' thyroid disorders and of 'subclinical-hypothyroidism' (SCH) was higher in PLWHD than PLWD (23.03% vs. 8.53% and 20.61% vs. 4%, p < 0.001; respectively). People living with HIV and diabetes with thyroid disorders had lower CD4 counts than PLWHD without thyroid disorders (376.08 ± 333.30 vs. 509 ± 341.7 cells/mm3; p = 0.004). Subclinical-hypothyroidism was more common in patients on antiretroviral therapy [ART] (27/136 [19.85%] vs. 4/27 [14.81%], p < 0.001). A significant number of PLWHD acquired HIV before the onset of DM (107/165 [64.85%] vs. 58/165 [35.15%], p < 0.001). Patients on ART were more likely to develop DM, OR 2.66 (95% CI 1.11-6.38). CONCLUSION: Our study showed an increased prevalence of thyroid disorders (especially SCH) in PLWD and a higher prevalence in PLWHD. Young, overweight, female PLWHD were at risk of SCH. People living with HIV and DM on ART demonstrated an increased prevalence of thyroid dysfunction and poor lipaemic control. The introduction of combined communicable-non-communicable disease clinics might provide an integrated patient screening option.

The Triglyceride/HDL Ratio and Triglyceride Glucose Index as Predictors of Glycemic Control in Patients with Diabetes Mellitus Type 2.

INTRODUCTION: Poor glycemic control, assessed by higher glycated hemoglobin (HbA1c) levels, is associated with greater risk of diabetic complications. AIM: The aim of this study was to assess the association of triglyceride - to - HDL cholesterol (TG/HDL-C) ratio and triglyceride glucose (TyG) index with HbA1c and to evaluate their potential role as predictors of glycemic control in patients with diabetes mellitus type 2 (DM2). PATIENTS AND METHODS: This cross-sectional study was conducted in Health Center Banovici and included a total of 113 patients with DM2 classified according to their HbA1c values in two groups: DM2 HbA1c <7% - DM2 patients with good glycemic control (n=39) and DM2 HbA1c ≥7% - DM2 patients with poor glycemic control (n=74). Anthropometric, biochemical parameters and blood pressure values were measured, while TG/HDL-C ratio and TyG index were calculated. RESULTS: TG/HDL-C ratio and TyG index were significantly higher in DM2 HbA1c≥7% compared to DM2 HbA1c<7% group (p=0.003 and p<0.001; respectively). Both TG/HDL-C ratio and TyG index were positively associated with HbA1c levels (Rho=0.29; p=0.002; Rho=0.37; p<0.001; respectively). In linear regression analysis TG/HDL-C ratio and BMI, and also TyG index and BMI were significantly independently associated with HbA1c even after controlling for age, gender, diabetes duration and smoking. When we stratified patients according to BMI values, independent association between TG/HDL-C ratio and HbA1c remained significant only in normal weight subjects (OR 0.21; 95%CI: 0.05-0.37; ß=0.65; p=0.017), while independent association between TyG index and HbA1c remained significant only in overweight and obese subjects (OR 0.063; 95%CI: 0.01- 0.12; ß=0.24; p =0.027). CONCLUSION: TG/HDL-C ratio might be a useful predictor of glycemic control in normal weight, and TyG index in overweight and obese patients with DM2.

An assessment of self-care knowledge among patients with diabetes mellitus.

PURPOSES: This study aimed to (1) assess the level of diabetes self-care knowledge among patients with diabetes mellitus and (2) examine the relationship between patients' diabetes self-care knowledge and their demographic and medical characteristics. METHODS: A cross-sectional design was used to implement the study. A convenience sample of 273 diabetic patients were recruited from five primary health-care centers in Amman- Jordan. RESULTS: The overall level of knowledge of diabetes self-care in the total sample was moderate (58.28% (SD = 18.24)). The highest level of knowledge was meal planning (70.2%) followed by monitoring, causes of diabetes, foot care, symptoms and complication, diabetic medication, and the lowest level was exercise (42.5%). Furthermore, knowledge of diabetes self-care was found to be associated with age, educational status, diabetic medications and years with diabetes. CONCLUSION: and Practice implications: The study findings emphasized that diabetic patients had a moderate level of knowledge and there were many of the learning needs for each area of knowledge. The health-care professional has an important role in developing the appropriate diabetes educational programs based on patients' learning needs and patients' characteristics. These programs that enhances knowledge on diabetes could be reduced or prevented diabetes-related complications.

Competência e comportamento em informação: uma análise social / Competencia y comportamiento de la información: un análisis social / Information competence and behavior: a social analysis

Reflexão crítica sobre a interferência do ambiente social na conformação do comportamento em informação dos pacientes portadores de Diabetes Mellitus, do Centro Médico Senador José Ermírio de Moraes (CMSJEM), Pernambuco, Brasil, tendo como horizonte o desenvolvimento da sua autonomia. As análises foram referenciadas na perspectiva sociocognitiva da Ciência da Informação e se fundamentaram em concepções teóricas, relacionando os conceitos de comportamento em informação e competência em informação. As análises acentuaram as observações de Chatman de que as pessoas que vivem fora de um contexto social considerado especializado em informações (outsiders, neste estudo, os portadores de Diabetes Mellitus), de forma geral escamoteiam e ignoram informações sobre o seu mundo real, as quais poderiam ser de ajuda para lidar com o seu cotidiano e problemas diários, porque seguem padrões sociais, compartilhados coletivamente. E aqueles que vivem dentro desse contexto social (os insiders, neste estudo, os profissionais de saúde e os especialistas em informação) veem nisso uma disfunção, porque os mesmos não examinam o efeito das normas culturais e sociais, e como elas afetam os modos sob os quais as pessoas (outsiders) escolhem e respondem à busca e ao uso de informação.

Reflexión crítica sobre las interferencias del ambiente social en la formación del comportamiento informacional en pacientes portadores de Diabetes Mellitus, del Centro Médico Senador José Ermírio de Moraes (CMSJEM), Pernambuco, Brasil, teniendo como objetivo el desarrollo de su autonomía. Los análisis tienen como marco de referencia la perspectiva sociocognitiva de la Ciencia de la Información y se fundamentan en concepciones teóricas, relacionando los conceptos de comportamiento informacional y competencia informacional. Los análisis destacaron las observaciones de Chatman de que las personas que viven fuera de un contexto social que se considera especializado en informaciones (outsiders, en este estudio, los portadores de Diabetes mellitus), de forma general escamotean e ignoran informaciones sobre su mundo real, que podrían ayudarles a lidiar con su cotidianidad y problemas diarios, porque siguen patrones sociales, compartidos colectivamente. Aquellos que viven dentro de ese contexto social (insiders, en este estudio, los profesionales de salud y los profesionales de la información) ven en eso una disfunción porque no examinan el efecto de las normas culturales y sociales, y cómo ellas influyen sobre los modos en que las personas (outsiders) escogen y responden a la búsqueda y uso de la información.

Critical reflection about the interference of the social environment in shaping the information behavior of patients with Diabetes Mellitus (DM), of Senador José Ermírio de Moraes Medical Center (CMSJEM), Pernambuco, Brasil, having as horizon the development of their autonomy. Analyzes were referenced in the socio-cognitive perspective of the Information Science (IS) and were based on theoretical conceptions, relating the concepts of information behavior and information literacy. The analyzes emphasized Chatman's observations that people who live outside a social context (outsiders, in this study, patients with DM) which is considered specialized in information, generally conceal and ignore information about the real world, which could be helpful to cope with their everyday and daily problems, because they follow social standards, collectively shared. And those who live within this social context (the insiders, in this study, health professionals and information specialists) see this as a dysfunction, because they do not examine the effect of cultural and social norms, and how these affect the ways in which people (outsiders) choose and respond to search and use of information.

Do dipeptidyl peptidase IV (DPP-IV) inhibitors cause heart failure?

PURPOSE: Although recent reports suggest an association between saxagliptin and an increased risk of admissions for heart failure, it is not clear whether dipeptidyl peptidase IV (DPP-IV) inhibition contributes to heart failure in high-risk patients. The purpose of this research is to understand heart failure risk among high-risk patients with type 2 diabetes. METHODS: This is a systematic review of data published in full papers and abstract form using the terms DPP-IV inhibitors and heart failure published since October 2013. Data from insurance and hospital databases were combined with those from multiple published trials, including the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) trial; Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care (EXAMINE), and Vildagliptin in Ventricular Dysfunction Diabetes (VIVIDD) trial as well as pooled analyses of linagliptin and saxagliptin placebo-controlled trials to examine heart failure among patients represented in those datasets. FINDINGS: A meta-analysis of the 9 datasets showed an increase in heart failure with dipeptidyl peptidase IV inhibitors of 15% (P = 0.017). There was no statistical heterogeneity, nor was there a statistical difference between cohort studies and randomized, controlled trials (P = 0.3), even though cohort studies alone were not significant (relative risk: 1.1; P = 0.32). Removing SAVOR-TIMI 53 data produced an insignificant increase in heart failure of 12% (P = 0.09) in the rest of the studies. In the randomized, controlled trials, the increased risk was 24% (P = 0.002). There was no statistical difference between those studies with and without baseline cardiovascular disease (P = 0.58), although the cardiovascular disease studies were borderline significant (P = 0.06). There was no publication bias. IMPLICATIONS: There are data from studies using sitagliptin, saxagliptin, and alogliptin showing that these agents may increase the risk of hospitalization for heart failure. More data are required for a definitive conclusion.

Fractional flow reserve-guided coronary artery bypass grafting: can intraoperative physiologic imaging guide decision making?

OBJECTIVES: Fractional flow reserve-guided coronary artery bypass grafting is emerging in cardiac surgery, in which the nature (anatomic and functional characteristics) of the target vessel epicardial coronary artery stenosis is important in graft site selection. The nature of the stenosis might determine a different physiologic response to bypass grafting. We report our recent experience using near infrared fluorescence complex angiography and perfusion analysis to identify the nature of stenoses in the target vessel by imaging the physiologic response to grafting. METHODS: In 167 patients who underwent consecutive multivessel coronary artery bypass grafting cases (63% off-pump coronary artery bypass grafting) with traditional anatomy-based revascularization, we imaged and analyzed 359 grafts (53% arterial). This platform provides angiographic data of both the target vessel epicardial coronary artery and graft simultaneously (to assess the imaged competitive flow); and because a change in fluorescence intensity is proportional to the change in blood flow and perfusion, the quantified change (if any) in regional myocardial perfusion surrounding the grafted target vessel epicardial coronary artery. RESULTS: The patient outcomes in our series were excellent. All 359 grafts were widely patent by angiography, and 24% of the arterial and 22% of the saphenous vein grafts showed no regional myocardial perfusion change in response to bypass grafting. In 165 in situ internal mammary artery grafts to the left anterior descending artery (>70% stenosis), 40 had no change in regional myocardial perfusion, and 32 of the 40 had competitive flow imaged. CONCLUSIONS: An important number of angiographically patent bypass grafts demonstrated no change in regional myocardial perfusion, suggesting anatomic, but nonfunctional, stenoses in those target vessel epicardial coronary arteries. In in situ arterial grafts, imaged competitive flow is associated with nonfunctional stenoses in the target vessel epicardial coronary artery. Imaging these physiologic responses to target vessel revascularization might be useful in the emerging fractional flow reserve-guided era.

Influence of systematic nursing model on treatment compliance and clinical efficacy of elderly patients with diabetes / 中国实用护理杂志

Objective To probe into the effect of systematic nursing model on treatment compliance and clinical efficacy of elderly patients with diabetes. Methods 100 elderly patients with diabetes in our hospital were selected from January 2008 to December 2010.The patients were divided into the study group and the control group randomly,50 cases in each group.The patients in the control group were treated with conventional care model,while the patients in the study group were treated with systematic nursing model.The compliance,clinical treatment effect,and improvement of clinical indicators were compared and ana lyzed in two groups respectively. Results Compared with the control group,treatment compliance indexes such as self-monitoring,diet control,medication compliance,exercise therapy in the study group were significantly improved,the difference was statistically significant.Compared with the control group,the clinical efficacy of patients in the study group was significantly improved.Compared with the control group,the FBG,PBG and HbAlc were improved significantly,the difference was statistically significant. Conclusions Systematic nursing model plays a positive role in promoting treatment compliance and clinical effects of elderly patients with diabetes mellitus.The interventions need to be further enriched and perfected.

Influence of nursing intervention on patients with diabetes mellitus receiving intensive treatment of in-sunn pump / 中国实用护理杂志

Objective To discuss the influence of nursing intervention on psychological state and glu-cose control of patients with diabetes mellitns before and after intensive treatment of insulin pump. Methods 120 patients who were going to receive intensive treatment of insulin pump were divided into the control group and the observation group with 60 patients in each group by simple random method.The two groups both re-ceivecl routine nursing. The observation group was given psychological intervention along with health education by application of progressive dominant content education method. The psychological state and glucose control of the two groups were compared by χ2 test and t test. Results The score of health knowledge and satisfaction degree with health education in the observation group were higher than those of the control group.The score of anxiety and depression in the observation group decreased more significantly and satisfaction rate of glucose control was higher than that of the control group after 14 days of insulin pump treatment. Conclusions Health education to patients with intensive treatment of insulin pump by application of progressive dominant content education method can make patients to master health knowledge easily.Psychological intervention can alleviate the negative emotion of these patients and facilitate better effect of insulin pump treatment.

[Eye surgical aid to patients with diabetes mellitus in the Krasnodar Branch of the state institution "Eye Microsurgery" Intersectonal Scientific-and-TechnoIogical Complex].

The setting up of a vitreoretinal surgery department "Eye Diabetes" and the introduction of the basic rates of medical officers into the structure of an anesthesiological department have increased the flow of patients referred for surgical treatment at the expense of patients with diabetes mellitus (DM). The charges for purchase of diagnostic equipment and medicines, those for additional rates of medical officers are compensated for by the increased activity. The active treatment-and-prevention tactics allows detection of DM, preoperative correction without hospitalization to a speciailized hospital, by reducing the time of preoperative preparation. By taking into account the experience in working with patients with DM and their great need for eye surgical aid, the authors consider it necessary to develop an endocrinological service in future and to set up new medical surgical centers of this specialty.