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About Shanghai
The 1st Asia Pacific Congress on
Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy)
Shanghai, China, June 2-5, 2011
 
  Diabetes Complications Print

STROKE AND HIGH BLOOD PRESSURE

N. Aliramaei (1), K. Zobeiry (2)

1 Kurdistan University of Medical Science, Sanandaj, Iran

2 Tehran University of Medical Science, Tehran, Iran

 

Introduction: High blood pressure is the most significant known risk factor for stroke. Hypertension is often called ‘the silent killer’ because most people don’t even realize they have it.  High blood pressure is when your blood pressure is consistently over 140/90.  A person with untreated hypertension is four times more likely to have a stroke than someone whose blood pressure falls within the healthy range.

Methods: This study is done by a cross-sectional descriptive method. All the 100 patients with CVA    who were present in the place of research were selected on an easy and objective- based method. The information was completed through questionnaire and interview, and then scored and statistically analyzed.

Results: Results showed that the samples (53%) females aged 70-51 years with majority of 48% and 38% housewives, the majority of illiterate, and 55% with previous history of stroke did not attack. Total days of hospitalization varied between 5 and 9 days with 43% of rural residence, and admission with 42% suffering from paralysis of four limbs that 79% had no obvious impairment of speech and they mostly had high blood pressure for 4-7 years. Also between high blood pressure and stroke with P< 0/005 a significant relationship was shown.

Discussion: A stroke is a medical emergency and can cause permanent neurological damage, complications, and death. It is the leading cause of adult disability in the United States and Europe and it is the number two cause of death worldwide. Risk factors for stroke include advanced age, hypertension, previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and arterial fibrillation. High blood pressure is the most important modifiable risk factor of stroke Artillery hypertension is the most important hygienic problem in developed countries, which if not cured will lead to fatal complications.

 

PULMONARY COMPLICATION OF DIABETES MELLITUS

S. Alsayed (1), E. Mousa (1)

1 New Jeddah Clinic Hospital, Jeddah, KSA

 

Study of the patients with type I or type II diabetes showed that the epithelial and capillary basal lamina of the alveoli were significantly thicker than those of age matched normal control subjects. Studies in the past years focused repeatedly on finding a link between pulmonary function and diabetes mellitus Results of such investigation were controversial.

Methods:The aim of this study is to asses the influence of insulin dependent diabetes mellitus including the presence of complications on the pulmonary function. This study was carried out on 100 patients diagnosed as insulin dependent diabetes mellitus (IDDM) and 50 subjects as healthy controls.

Type I "Insulin dependent diabetes mellitus" is a systemic disorder that influence the biochemical, morphological and functional properties of the various tissues of a number of body organs e.g eyes, kidneys, lungs, nerves and blood vessels

The result of this study as regards the pulmonary function tests:

1. There is significant reduction FVC, FEV1, TLC. RV. RV/TLC and FRC in IDDM patients

2. As regards the metabolic state, there is significant reduction in pulmonary function test in poor metabolic IDDM patients

3. As regards the sex there is no significant reduction the pulmonary function and there is no correlation with sex.

4. There is –ve. correlation between age, duration of disease of IDDM and pulmonary function tests.

Conclusion: As there is an evidence that pulmonary changes occurs in IDDM patients and these changes increased with age and duration of the disease and poor metabolic state, regular performed pulmonary function test by Spiro meter and chest x-ray to every patient are useful in early detection of respiratory manifestation and management of diabetic complications. Keywords: pulmonary function, diabetes mellitus.

 

PROFILES OF CARDIOVASCULAR RISK IN PEOPLE WITH TYPE 2 DIABETES: BASELINE DATA FROM A1CHIEVE STUDY

L.M. Chuang (1), Z. Hussein (2), M.I. Hasan (3), P. Home (4), C. Shen (5), M.E. Khamseh (6)

1 National Taiwan University Hospital, Taipei, Taiwan

2 Hospital Putrajaya, Putrajaya, Malaysia

3 Diabetic Institute Pakistan (DIP), Lahore, Pakistan

4 The Medical School, Newcastle Upon Tyne, UK

5 Novo Nordisk Pharmaceuticals, Beijing, China

6 Tehran University of Medical Sciences, Tehran, Iran

 

People with type 2 diabetes (T2DM) are at high risk of developing cardiovascular disease. Baseline data from the A1chieve observational study provide epidemiological data on cardiovascular risk profiles of people with T2DM (n>30,000 for all measures) in 28 countries from Asia, Africa, Europe and Latin America. Regional diversity was found in the prevalence of elevated BMI (>30.0 kg/m2), being 6.0% in China and 56.1% in Russia. Systolic blood pressure (sBP) was 133 (SD 20) mmHg. Regionally mean total serum cholesterol (TC) ranged from 4.7 (north Africa) to 6.0 mmol/L (Russia). Mean sBP was also lowest in north Africa and highest in Russia, 127 and 144 mmHg respectively, while TC was 5.2 (1.3) mmol/L, and LDL-C, HDL-C and triglycerides (TG) were 3.1 (1.1), 1.2 (0.4) and 2.1 (1.1) mmol/L, respectively. The overall percentage of patients failing to reach IDF-recommended target values of LDL-C <2.5, HDL-C >1.0, TG <2.3 mmol/L and sBP <130 mmHg were 70.1, 35.3, 30.8 and 43.9%, respectively. The overall prevalence of microalbuminuria was 24.8%, with the highest prevalence in people from the Middle East/Gulf region (37.9%). Overall, proteinuria was reported in 6.4%, with marked regional variation from 2.4% (east Asia) to 12.2% (north Africa). Of 40,456 people not achieving target values, only 26.2% were being treated with ACE inhibitors, 22.4% with aspirin and 20.1% with statins. Thus, overall control of cardiovascular risk globally is poor, with many people with T2DM not meeting guideline targets for risk protection.

 

THE EXPERIENCE OF BACTERICEMIA OF TYPE 2 DIABETES MELLITUS IN NORTHERN TAIWAN

J.C. Huang (1), Y.S. Peng (1), J.H. Sun (2), Y.Y. Huang (2)

1 Chang Gung Memorial Hospital, Chiayi, Taiwan

2 Chang Gung Memorial Hospital, Taoyuan, Taiwan

 

Background: More incidences with higher mortality rate of sepsis made aggressive treatment in diabetes. We aimed to describe the recent experience in Northern Taiwan.

Methods and Materials: Using the Taiwan Chang Gung Memorial Hospital In-patient Diabetes Registry, hospitalized cases with type 2 diabetes mellitus were integrated with definite bactericemia. The age, gender, hospital stay, organ system failure, complications and comorbidities were analysis for mortality evaluation.

Results: The overall mortality rate is 13.0% and the most common bacteria are Escherichia coli (E. coli). Comparing to else microorganism, the group presented older, female dominant, more comorbidities, less failed organs, shorter hospital stay, and extremely low mortality rate.

Discussion: The relative low mortality rate in patients with diabetes was reconfirmed recently. The effects of E. coli on gender distribution, length of hospital stay, and mortality need to be considered for clinical practice.

Conclusion: The significant variation of mortality between common pathogenic bacteria indicates the need of clinical practice remodeling.

 

CLINICAL CHARACTERISTICS OF PATIENTS WITH RAMBDOMYOLYSIS IN HYPERGLYCEMIC EMERGENCY STATES

T.S. Jung (1), J.R. Hahm (2)

1 Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju city, South Korea

 

Objective: The purpose of this study was to investigate the prevalence of rhabdomyolysis in a hyperglycemic emergency state and its significance on the clinical course and prognosis of patients with hyperglycemic emergency state.

Patients and Methods: We reviewed medical records of hyperglycemic emergency patients who were checked serum creatine kinase levels from May 2003 to April 2010. We assessed clinical characteristics, biochemical profiles, and clinical course of the patients and analyzed according to the occurrence of rhabdomyolysis.

Results: The prevalence of rhabdomyolysis was 27.1% (n = 36) among 133 patients. Patients with rhabdomyolysis had higher rates of hemodialysis and mortality than those without rhabdomyolysis. The factors associated with rhabdomyolysis in hyperglycemic emergency state were increased serum anion gap and serum creatinine (P < 0.05).

Conclusion: Rhabdomyolysis was commonly combined with hyperglycemic emergency state and this aggravated clinical course and increased mortality. Our results suggest that rhabdomyolysis in hyperglycemic emergency is associated with increased serum anion gap and serum creatinine on admission.

 

DOES THE CKD EPIDEMIOLOGY COLLABORATION (CKD-EPI) EQUATION PERFORM BETTER THAN THE MODIFICATION OF DIET IN RENAL DISEASE (MDRD) STUDY EQUATION FOR ESTIMATING GFR LEVELS ABOS 60 ml/min/1.73m2 IN SUBJECTS WITH DIABETES?

R.J. MacIsaac (1,2,3), K. Cheong (2), E. Ekinci (2), S. Verma (2), E. Premaratne (2), G. Jerums (2,3)

1 Department of Endocrinology and Diabetes, St. Vincent's Hospital, Fitzroy, Australia

2 Endocrine Centre, Austin Health, Heidelberg West, Australia

3 University of Melbourne, Australia

 

Background. The MDRD equation underestimates reference GFR levels > 60 ml/min/1.73m2 whereas GFR levels estimated from the CKD-EPI equation are generally reported to be less biased. However, for subjects with diabetes the relative performance of the CKD-EPI and MDRD equations remains to be defined.  We assessed the performance of the CKD-EPI and MDRD equations for estimating GFR (eGFR) compared with reference GFR measurements > 60 ml/min/1.73m2 in subjects with diabetes.

Methods. In a cross-sectional study of 199 consecutive clinic patients with diabetes, a reference GFR was measured using 99mTc-DTPA plasma clearance (iGFR). The mean iGFR was 80 ± 2.2 ml/min/1.73m2 (mean ± SEM) and there were 139 subjects with a GFR > 60 ml/min/1.73m2. The bias (iGFR – eGFR) for the CKD-EPI and MDRD equations was compared.

Results. In the subgroup of subjects with an iGFR > 90 ml/min/1.73m2 (mean GFR 112 ± 2.0, n = 76) both equations significantly underestimated iGFR to a similar extent, CKD-EPI (-12 ± 1.4 ml/min/1.73m2, p < 0.001) and MDRD (-11 ± 2.6 ml/min/1.73m2, p < 0.001).  In contrast, in the subgroup of subjects with an iGFR 60 to 89 ml/min/1.73m2 (mean GFR 77 ± 1.2, n = 59) the CKD-EPI equation significantly overestimated iGFR values (+5.5 ± 1.5 ml/min/1.7 m2, p < 0.001) whereas the MDRD equation did not (+4.3 ± 1.9 ml/min/1.73m2).

Conclusions. The CKD-EPI equation does not improve the bias of the MDRD equation when estimating GFR in subjects with diabetes and a reference GFR measurement > 60 ml/min/1.73m2. Both equations significantly underestimate reference GFR levels > 90 ml/min/1.73m2.

 

STUDY SEXUAL DYSFUNCTION IN WOMEN WITH DIABETES AND ITS IMPACT ON SEXUAL SATISFACTION AND THEIR SATISFACTION WITH LIFE

F. Tairi (1), A. Gharanfoly (1)

1 Kurdistan University of Medical Science

 

Introduction: Diabetes epidemic or off, a major global health problem that its incidence during the past risen dramatically and further physical health, the impact on mental health Puts. Diabetes in women with decreased libido, reaching orgasm or called orgasm, decreased sexual arousal, pain and infections near the vagina is associated with sexual side effects of diabetes disregarding the life of the individual in long-term marriage with serious risks facing the hive intimacy and comfort of man and woman is stripping and sexual satisfaction and life satisfaction affects women negative effects of this study to examine sexual dysfunction in women with diabetes and its impact on sexual satisfaction and their satisfaction with life in the city of Sanandaj deals.

Methods: This descriptive analysis of 100 cases of women with diabetes who were disposed to cooperate with the completed questionnaire to make based on DSM IV-R questionnaire marital satisfaction (ENRICH), and interviews, the information they collect and SPSS software were analyzed.

Results: The most common age adolescence (25 to 40 years) with a frequency of 60%, illiterate, 30%, housewives, 62% and 74% residing townspeople60% of patients some degree of depression (mild, moderate, severe) have sexual dysfunction in studied women with decreased libido 57%, difficulty reaching orgasm (orgasm) 51%, 38% decreased sexual arousal, and pain is near 21%. between type 1 diabetes to depression and sexual dysfunction is a significant relationship between women with life satisfaction and sexual satisfaction are significantly related sexual dysfunction.

Conclusion: Diabetes in women with depression, sexual satisfaction and life satisfaction is their close relationship.

 

DIABETES COMPLICATIONS AND BMI IN ASIA, AFRICA, EUROPE, AND LATIN AMERICA: A1CHIEVE BASELINE DATA

W. Yang (1), G. Gonzalez-Galvez (2), P. Home (3), I.M. Hajjaji (4), P.N. Chakkarwar (5), P. Soewondo (6)

1 China-Japan Friendship Hospital, Beijing, China

2 Instituto Jalisciense de Investigacion en Diabetes y Obesidad, Jalisco, Mexico

3 ICM-Diabetes, The Medical School, Newcastle Upon Tyne, UK

4 National Centre for Diabetes & Endocrinology

5 Novo Nordisk International Operations A/S, Zürich, Switzerland

6 Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

 

A1chieve is a multinational, open-label, observational study evaluating the safety and effectiveness of insulin analogues in people with type 2 diabetes (n=66,726) in routine clinical practice. The prevalence of complications at baseline, categorised by BMI according to WHO Asia criteria (<20.0; 20.0–<23.0; 23.0–<25.0; 25.0–<27.5; 27.5–<30.0; >=30.0 kg/m2), was estimated using a multivariate logistic regression model, and presented as mean value of predicted probability (%). Overall, the probability of experiencing any complication was lowest in the BMI group <20.0 kg/m2, 59.7% and greatest in the BMI group >=30.0 kg/m2, 75.2%. The trend of increasing probability of microvascular or macrovascular complications with increasing BMI was seen across almost all regions. However, BMI appeared to have little impact on predicting microvascular complications in China (<20.0 vs. >=30.0 kg/m2: 55.5 vs. 58.2%), while a decreased probability with higher BMI was found in Latin America where BMI <20.0 kg/m2 had a possibly higher probability of complications (79.0 vs. 64.5% for BMI >=30.0 kg/m2). Russia had the highest probability of reporting microvascular or macrovascular complications compared with other regions, with 92.2 and 76.4% likelihood respectively in people with BMI >=30.0 kg/m2. The lowest probability of microvascular complications was in south Asia with a 51.3% likelihood with BMI <20.0 kg/m2, and of macrovascular complications in Latin America with a 14.1% likelihood with BMI <20.0 kg/m2. In general, increasing BMI was associated with higher probability of having microvascular/ macrovascular complications, although with regional variations.

 

CORNEAL CONFOCAL MICROSCOPY: A NOVEL NON-INVASIVE METHOD FOR EARLY DIAGNOSIS OF DIABETIC PERIPHEREAL NEUROPATHY

C. Xue (1), J. Shao (2), Z. Huang (1)

1 Department of Ophthalmology, Nanjing General Hospital of Nanjing Military Command, Nanjing, China

2 Department of Endocrinology, Nanjing General Hospital of Nanjing Military Command, Nanjing, China

 

OBJECTIVE: Corneal confocal microscopy is a novel, rapid, non-invasive in vivo clinical examination technique. We aimed to explore the alterations in the early corneal innervation in relation to diabetic peripheral neuropathy using laser confocal microscopy.

METHODS: Forty-five type 2 diabetes were recruited and stratified into diabetic peripheral neuropathy group (DPN), non-neuropathy diabetic group (NDPN) and 10 age-matched healthy control subjects were studied. Diabetes duration, fasting plasma glucose, and HbA1C were recorded. All underwent corneal confocal microscopic examination using the Heidelberg retina tomograph II with the Rostock corneal module. The following parameters were measured and analyzed: (1) Nerve fibre length (NFL); (2) Nerve branch density (NBD);(3) Tortuosity coefficient (Tc).

RESULTS: There were no significant differences of diabetes duration, fasting plasma glucose, and HbA1C between DPN and NDPN group at recruitment. Corneal epithelium nerve was straight and few bifurcation in control group. Corneal NFL was significantly decreased in DPN group when compared with control group and NDPN group (P<0.05). NBD was increase in NDPN group, but greatly decreased in DPN group when compared with control group (P<0.05). Tc was significantly increased in in NDPN group, further aggravated in DPN group (P<0.05). Correlation analysis revealed that there were no significant correlation of age, diabetes duration, fasting plasma glucose, and HbA1C with NFL, NBD and Tc.

CONCLUSIONS:  Corneal confocal microscopy is a rapid, non-invasive in vivo clinical examination technique which accurately defines the extent of corneal nerve damage and acts as a surrogate measure of diabetic neuropathy.


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