Diabetes Mellitus, Type 2 ; complications ; diagnosis ; therapy ; Humans ; Liver Diseases ; complications ; diagnosis ; therapy

PURPOSETo review evidence-based management of nephropathy in patients with type 2 diabetes.

DATA SOURCESA literature search (MEDLINE 1966 to 2000) was performed using the key word "diabetic nephropathy". Relevant book chapters were also reviewed.

STUDY SELECTIONWell-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.

DATA EXTRACTIONData and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.

RESULTSHypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions.

CONCLUSIONSDiabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.

Albuminuria ; diagnosis ; therapy ; Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Nephropathies ; epidemiology ; therapy ; Dietary Proteins ; administration & dosage ; Humans ; Hyperlipidemias ; therapy ; Hypertension ; therapy

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.
Anti-Bacterial Agents/therapeutic use ; Diabetes Mellitus, Type 2/complications/diagnosis ; Fasciitis, Necrotizing/*diagnosis/drug therapy/microbiology/surgery ; Fatal Outcome ; Humans ; Leg/surgery ; Liver Cirrhosis/complications/diagnosis ; Male ; Middle Aged ; Streptococcal Infections/*diagnosis/drug therapy ; Streptococcus pneumoniae/isolation & purification

Our study was performed to determine whether cardiac autonomic neuropathy can predict deterioration of the renal function in normoalbuminuric, normotensive people with type 2 diabetes mellitus (DM). One hundred and fifty-six normoalbuminuric, normotensive people with type 2 DM were included in our retrospective longitudinal study. We categorized normal patterns, early patterns, and definite or severe patterns according to the results of the cardiac autonomic function test. Of 156 patients included, 54 had normal patterns, 75 had early patterns, 25 had definite or severe patterns, and 2 had atypical patterns. During a median follow-up of nine years, glomerular filtration rates (GFR) remained stable in the normal and early pattern groups (mean changes, 4.50% and 0.77%, respectively) but declined in those with definite or severe patterns (mean change, -10.28%; p=0.047). An abnormal heart response to the deep breathing test of the cardiac autonomic function tests was an independent predictor of GFR decline. Our data suggest that cardiac autonomic neuropathy, especially with a definite or severe pattern, might be associated with a subsequent deterioration in renal function in normoalbuminuric, normotensive people with type 2 DM.
Aged ; Blood Pressure ; Diabetes Complications ; Diabetes Mellitus, Type 2/*diagnosis/*pathology ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Heart Diseases/*complications ; Heart Rate ; Humans ; Kidney/*pathology ; Kidney Diseases/*therapy ; Male ; Middle Aged ; Nephrology/methods ; Neurodegenerative Diseases/*complications

Hepatic subcapsular steatosis is a rare and specific form of fatty change in the liver. It is a unique finding in diabetic patients receiving continuous ambulatory peritoneal dialysis (CAPD) and intraperitoneal insulin treatment. Intraperitoneal administration of insulin causes a unique pattern of fatty infiltration in the subcapsular location of the liver. Here we report a case of hepatic subcapsular steatosis in a diabetic CAPD patient who received intraperitoneal insulin. A 46-year-old diabetic woman on CAPD presented with general weakness. The patient received a total amount of 110 units of regular insulin via intraperitoneal and subcutaneous injection. Her initial blood chemistry showed increased serum lipid and liver enzyme profiles. Abdominal CT scan images and MRI revealed characteristic findings consistent with hepatic subcapsular steatosis. We assumed that the cause was CAPD and concomitant intraperitoneal insulin treatment; therefore, the patient was switched from CAPD to hemodialysis (HD) and began to receive insulin subcutaneously. Two months after the beginning of HD, the hepatic subcapsular steatosis completely resolved.
Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Middle Aged ; Insulin/*administration & dosage/adverse effects ; Injections, Intraperitoneal ; Humans ; Female ; Fatty Liver/diagnosis/*etiology ; Drug Monitoring ; Diabetes Mellitus, Type 2/drug therapy/physiopathology/*therapy ; *Diabetes Complications

Sleep has important effects on physical and mental health, and sleep disorders are associated with increased mortality and morbidity. This study was conducted to evaluate the relationship between sleep duration or sleep quality and the risk of type 2 diabetes. The FACTS (FAmily CohorT Study in primary care) was established to investigate the relations between familial environment and health which was conducted at 22 family medicine outpatient clinics in general hospitals. Total 563 patients without diabetes who received > or =1 year follow-up examination were included in the analysis. We used the Pittsburgh Sleep Quality Index to determine sleep quality, and a score of > or =5 was considered to define poor sleep quality. Patients taking oral hypoglycemic agents, having a fasting glucose level of >126 mg/dL, or diagnosed with diabetes by physicians were classified as having diabetes. The median follow-up period was 2.5 years. Poor sleep quality was associated with a higher risk of diabetes after adjusting for age, sex, body mass index, income, physical activity, and family history of diabetes (relative risk=2.64; 95% confidence interval, 1.03-6.78). As a risk factor for the development of diabetes, poor sleep quality may independently increase the incidence of diabetes.
Aged ; Blood Glucose/analysis ; Body Mass Index ; Cohort Studies ; Demography ; Diabetes Mellitus, Type 2/complications/*diagnosis/drug therapy ; Female ; Follow-Up Studies ; Humans ; Hypoglycemic Agents/therapeutic use ; Male ; Middle Aged ; Obesity/complications ; Primary Health Care ; Risk Factors ; *Sleep ; Surveys and Questionnaires

OBJECTIVE: To evaluate the relationship between type 2 diabetes mellitus (DM) and oncological outcomes in early stage cervical cancer patients who underwent radical surgical resection. METHODS: Patients with early stage cervical cancer diagnosed between 2001 and 2014 were retrospectively enrolled. We assessed the outcomes of 402 non-DM and 42 DM patients with cervical cancer. We tested the prognostic value of DM via Cox proportional hazard modeling. RESULTS: Patients with DM were more likely to be older and overweight. In the DM group, 20 and 22 patients were and were not taking metformin, respectively. The 5-year recurrence-free survival (RFS) and 5-year overall survival (OS) rate for the whole study population were 88.49% and 96.34%, respectively. In the DM group, there was no evidence that metformin affected the RFS (p=0.553) or the OS (p=0.429). In multivariate analysis, age (p=0.007), histology (p=0.006), and deep stromal invasion (p=0.007) were independent adverse prognostic factors for RFS. There was a borderline significant association of increased RFS with DM (p=0.051). However, a time-varying-effect Cox model revealed that the DM was associated with a worse RFS (hazard ratio, 11.15; 95% CI, 2.00 to 62.08, p=0.022) after 5 years. DM (p=0.008), age (p=0.009), and node status (p=0.001) were the only 3 independent prognostic factors for OS. CONCLUSION: Early stage cervical cancer patients with type 2 DM have a poorer oncological outcome than patients without DM.
Adult ; Age Factors ; Diabetes Mellitus, Type 2/*complications/drug therapy ; Female ; Humans ; Hypoglycemic Agents/therapeutic use ; *Hysterectomy ; Metformin/therapeutic use ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Analysis ; Uterine Cervical Neoplasms/*complications/diagnosis/surgery

We investigated the frequency of sleep disturbances and the association between sleep disturbances and glucoregulation in type 2 diabetic patients. The frequency of sleep disturbances in 614 type 2 diabetic patients was investigated using validated sleep questionnaires. There were 381 male and 233 female patients. The mean age was 59.7 +/- 11.1 yr; the mean body mass index was 24.9 +/- 4.4 kg/m2; the mean HbA1c was 7.8% +/- 1.5%; and the mean duration of diabetes was 10.3 +/- 8.4 yr. The questionnaires revealed insomnia in 48.2% of the patients while 8.5% reported excessive daytime sleepiness. A total of 49% of the patients was poor sleepers, while 28.5% had depression. Multivariate logistic regression analysis showed that there was no significant association between HbA1c and other sleep disturbances, such as poor sleep, insomnia, and short duration of sleep. Sleep disturbances were very common in patients with type 2 diabetes mellitus, whereas there was no association between poor or short sleep and glucoregulation. Awareness and identifying sleep complaints in such patients are necessary to improve their quality of daily life.
Adult ; Aged ; Body Mass Index ; Depression/epidemiology ; Diabetes Mellitus, Type 2/complications/*diagnosis/drug therapy ; Female ; Hemoglobin A, Glycosylated/analysis ; Humans ; Hypoglycemic Agents/therapeutic use ; Logistic Models ; Male ; Middle Aged ; Quality of Life ; Questionnaires ; Sleep Disorders/*complications ; Sleep Initiation and Maintenance Disorders/epidemiology

No abstract available.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bursitis/*diagnosis/drug therapy/microbiology ; Cefoperazone/therapeutic use ; Diabetes Mellitus, Type 2/complications/*diagnosis ; Humans ; Male ; Nocardia/genetics/*isolation & purification ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/chemistry/genetics ; Sequence Analysis, RNA ; Sulbactam/therapeutic use

OBJECTIVETo observe the efficacy of integrative Chinese and western medicine (ICWM) in treating diabetic foot.

METHODSSixty-three patients were randomly divided into the treated group (n = 33) and the control group (n = 30). Both groups were treated by same baseline treatment with vasodilator, anti-agglutination agents and external treatment, to the treated group, Chinese drugs were given additionally according to the Syndrome Differentiation.

RESULTSIn the treated group, the treatment showed markedly effective in 12 patients, effective in 18 and ineffective in 3, the total effective rate being 90.0%, while in the control group, the corresponding numbers were 9, 14, 7 and 76.7%, comparison between the two groups showed significant difference (chi 2 = 15.8, P < 0.05). The case number of Grade II, III and IV in the treated group reduced, and those recovered to Grade 0 increased, as compared with those in the control group, the difference was significant (P < 0.05). Patients with healing of ulcerative wound and fresh wound granulation in the treated group, as compared with those in the control group, the difference was significant (P < 0.05). Levels of fasting blood glucose and blood glucose 2 hrs after meal were all improved in both groups, which showed significant difference as compared with those before treatment (P < 0.05).

CONCLUSIONThe efficacy of ICWM treatment in treating diabetic foot was better than the treatment of western medicine alone.

Aged ; Combined Modality Therapy ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Foot ; drug therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Insulin ; therapeutic use ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Scopolamine Hydrobromide ; therapeutic use