Foot complications are a well known factor which contribute to the morbidity of diabetes and increases the chance of amputation. A total of 126 consecutive diabetic patients were evaluated by diabetic foot screening. Forty-one patients showed an impaired protective sense when tested with Semmes-Weinstein monofilament 5.07 (10 g), and 92% of them showed peripheral polyneuropathy in nerve conduction study (NCS). The mean vibration score of the Rydel-Seiffer graduated tuning fork in patients with peripheral polyneuropathy in nerve conduction (NCV) study was 5.38+/-2.0, which was significantly different from that of patients without polyneuropathy in NCS. Among the deformities identified on examination, callus, corn, and hallux valgus were the greatest. While checking the ankle/ brachial index (ABI), we also evaluated the integrity of vasculature in the lower extremities. After extensive evaluation, we classified the patients into eight groups (category 0,1,2,3,4A,4B,5,6). The result of this study suggested that the Semmes-Weinstein monofilament test, Rydel-Seiffer graduated tuning fork test, and checking the ankle/brachial index were simple techniques for evaluating pathologic change in the diabetic foot by office screening, and that this screening based on treatment-oriented classification helps to reduce pedal complications in a diabetic population
Diabetic Angiopathies/diagnosis ; Diabetic Angiopathies/complications ; Diabetic Foot/physiopathology ; Diabetic Foot/diagnosis* ; Diabetic Foot/classification ; Diabetic Neuropathies/diagnosis ; Diabetic Neuropathies/complications ; Female ; Foot/physiopathology ; Human ; Male ; Mass Screening ; Middle Age ; Podiatry/methods ; Sensory Thresholds

In cases of chronic hyperglycemia, advanced glycation end-products (AGEs) are actively produced and accumulated in the circulating blood and various tissues. AGEs also accelerate the expression of receptors for AGEs, and they play an important role in the development of diabetic vascular complications through various mechanisms. Active interventions for glucose and related risk factors may help improve the clinical course of patients by reducing AGEs. This review summarizes recent updates on AGEs that have a significant impact on diabetic vascular complications.
Diabetes Complications ; Diabetic Angiopathies* ; Glucose ; Glycosylation End Products, Advanced* ; Humans ; Hyperglycemia ; Risk Factors

A 39-year-old woman visited the emergency room complaining of right eye pain and swelling over the preceding three days. The ophthalmologist's examination revealed orbital cellulitis and diabetic retinopathy in the right eye, although the patient had no prior diagnosis of diabetes. It was therefore suspected that she had diabetes and orbital cellulitis, and she was started on multiple antibiotic therapies initially. She then underwent computed tomography scans of the orbit and neck and magnetic resonance imaging of the brain. These studies showed an aggravated orbital cellulitis with abscess formation, associated with venous thrombophlebitis, thrombosis of the internal carotid artery, and mucosal thickening of maxillary sinus with multiple paranasal abscesses. Three days later, initial blood culture grew Klebsiella pneumoniae. She recovered after incision and drainage and antibiotic therapy for 37 days.
Adult ; Angiography ; Diabetes Mellitus, Type 2/*complications ; Diabetic Angiopathies/*complications/radiography ; Female ; Humans ; Klebsiella Infections/*complications/radiography ; *Klebsiella pneumoniae ; Orbital Cellulitis/*complications/microbiology/radiography ; Tomography, X-Ray Computed

In order to investigate the risk factors of ischemic brain stroke (IBS) in diabetic patients, we analyzed 416 cases selected from 6239 diabetic patients admitted to Severance Hospital from Jan. 1983 to Dec 1987. Two hundred and eight cases had IBS. The other 208 cases without IBS were selected as a control group by a stratified random sampling method. The two groups were compared using various clinical characteristics of diabetes mellitus (DM) and known risk factors of IBS. In diabetics with IBS, the duration of DM was longer (9.2 +/- 7.1 years), hypertension was more frequently associated (68.2%) and the serum cholesterol level was higher (213.0 +/- 55.2 mg/dl) than in diabetics without IBS (7.6 +/- 7.1 years, 32.1% and 192.1 +/- 44.8 mg/dl, respectively). By means of Stepwise Logistic Regression Analysis (SLRA), it was found that the strong risk factors were hypertension and serum cholesterol level. The serum triglyceride level, type of DM and response to diabetes treatment were also thought to be risk factors of IBS by the retrial of SLRA of residuals after exclusion of hypertension and serum cholesterol level. IBS was not significantly related to the duration of DM, fasting blood glucose level, body weight, glycosylated hemoglobin value, and serum high-density lipoprotein-cholesterol level.
Adult ; Aged ; Aged, 80 and over ; Brain Ischemia/*etiology ; Cross-Sectional Studies ; Diabetes Mellitus/*complications ; Diabetic Angiopathies/*complications ; Female ; Human ; Korea ; Male ; Middle Age ; Retrospective Studies ; Risk Factors

In order to investigate the risk factors of ischemic brain stroke (IBS) in diabetic patients, we analyzed 416 cases selected from 6239 diabetic patients admitted to Severance Hospital from Jan. 1983 to Dec 1987. Two hundred and eight cases had IBS. The other 208 cases without IBS were selected as a control group by a stratified random sampling method. The two groups were compared using various clinical characteristics of diabetes mellitus (DM) and known risk factors of IBS. In diabetics with IBS, the duration of DM was longer (9.2 +/- 7.1 years), hypertension was more frequently associated (68.2%) and the serum cholesterol level was higher (213.0 +/- 55.2 mg/dl) than in diabetics without IBS (7.6 +/- 7.1 years, 32.1% and 192.1 +/- 44.8 mg/dl, respectively). By means of Stepwise Logistic Regression Analysis (SLRA), it was found that the strong risk factors were hypertension and serum cholesterol level. The serum triglyceride level, type of DM and response to diabetes treatment were also thought to be risk factors of IBS by the retrial of SLRA of residuals after exclusion of hypertension and serum cholesterol level. IBS was not significantly related to the duration of DM, fasting blood glucose level, body weight, glycosylated hemoglobin value, and serum high-density lipoprotein-cholesterol level.
Adult ; Aged ; Aged, 80 and over ; Brain Ischemia/*etiology ; Cross-Sectional Studies ; Diabetes Mellitus/*complications ; Diabetic Angiopathies/*complications ; Female ; Human ; Korea ; Male ; Middle Age ; Retrospective Studies ; Risk Factors

OBJECTIVETo understand the relationship between prevalence rates of chronic diabetic complications and related macro-vascular diseases and hypertension, to provide evidence for diabetes prevention and control.

METHODSTo retrospectively analyze the clinical and laboratory data on 24 496 in-patients with diabetes during Jan. 1, 1991 to Dec. 31, 2000 from 30 provinces, municipalities and autonomous regions.

RESULTSThe prevalence rate of hypertension was 31.95%. The prevalence rates of other chronic diabetic complications and related macro-vascular diseases were 12.2% for cerebrovascular diseases, 15.9% for cardiovascular diseases, 5.0% for lower extremity vascular diseases, 34.3% for eye diseases, 33.6% for nephropathy and 60.3% for neuropathy, with a total rate of chronic diabetic complications and macro-vascular diseases of 73.2%. Hypertension was related with all kinds of chronic diabetic complications and macro-vascular diseases odds ratio (OR) of related systolic blood pressure was 1.148 - 1.866, and OR related diastolic was 1.141 - 1.242.

CONCLUSIONSThe prevalence rates of chronic diabetic complications and related macro-vascular diseases of in-patients with diabetes mellitus were much higher than those of non-diabetics, and was close to the levels seen in the western countries. Hypertension, especially high systolic blood pressure was the most important risk factor of chronic diabetic complications and the related macro-vascular diseases.

Adult ; Aged ; Chronic Disease ; Diabetes Complications ; Diabetic Angiopathies ; etiology ; Female ; Humans ; Hypertension ; complications ; epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors

BACKGROUND: Laminin, the main non-collagenous constituent of vascular basement membranes, can be changed by alteration of metabolism and distribution in diabetic microangiopathy. The serum laminin levels are known to reflect these histological changes. The aim of present study was to investigate whether the serum laminin levels are related to carotid atherosclerosis and diabetic complications, and to assess what clinical variables influence on the serum laminin levels in type 2 diabetes. METHODS: The subjects were 103 type 2 diabetic patients (51 in the no complication group and 52 in the complication group) and 39 controls. We evaluated the intima-media thickness (IMT) and plaques in both carotid arteries by duplex scan. and the serum laminin levels were measured. RESULTS: The serum laminin levels were higher in the group with complications complication group compared to the no complication group (p<0.01), and in the no complication group compared to the control group (plt;0.01). There were no differences in the carotid parameter values between the complication group and the no complication group. The correlations between the serum laminin levels and the measured IMT values were not significant.However, there were significant correlations between the serum laminin levels and the plaque counts and scores (r=0.24, plt;0.05). The presence of diabetic complications, the waist hip ratio, plaque score and apo B affected the elevation of the serum laminin levels (plt;0.05). CONCLUSIONS: The serum laminin levels were related to the presence of diabetic complications. Such levels may be a risk factor for plaque progression rather than the initiation of plaque formation or IMT thickening in the carotid atherosclerosis of type 2 diabetic patients.
Apolipoproteins B ; Basement Membrane ; Carotid Arteries ; Carotid Artery Diseases ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Diabetic Angiopathies ; Humans ; Laminin* ; Metabolism ; Risk Factors ; Waist-Hip Ratio

BACKGROUND: Elevated plasma homocysteine is a recently-recognized independent risk factor for cardiovascular disease. In patients with non-insulin dependent diabetes mellitus (NIDDM), plasma homocysteine concentration was reported to be elevated in association with nephropathy. However, inconsistent results were reported about the association with other microvascular complications. METHODS: To determine the relationship between plasma homocysteine and the development of chronic diabetic microvascular complications, fasting plasma homocysteine, glycemic control, lipid and lipoprotein levels, vitamin status, renal function test, and chronic diabetic microvascular complications were assessed in 101 patients with NIDDM in the present study. RESULTS: There was no difference in the plasma levels of homocysteine by sex, age, status of sugar control, duration of diabetes, other cardiovascular risk factors. Patients with diabetic microangiopathy had higher plasma homocysteine concentrations than those without diabetic microangiopathy. Moreover, there was a significant correlation between amount of urinary albumin excretion and plasma homocysteine level (p=0.004, r=0.357). However, multivariate analysis showed that only serum creatinine (beta=0.635) was independently associated with plasma homocysteine level in NIDDM patients. The increase in plasma homocysteine was not shown to increase the risk of diabetic microvascular complications independently on multiple logistic regression analysis. CONCLUSION: In conclusion, decrease of renal function is an independent determinant of plasma homocysteine level and higher plasma homocysteine is associated to diabetic microangiopathy. But an increase in plasma homocysteine in patients with NIDDM is not independently associated with diabetic microvascular complications considering renal function. Therefore, the renal function should be considered in study about relationship between plasma homocysteine level and the development and/or progression of chronic diabetic microvascular complications in diabetic patients.
Cardiovascular Diseases ; Creatinine ; Diabetes Complications* ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Diabetic Angiopathies ; Fasting ; Homocysteine* ; Humans ; Hypercalcemia ; Lipoproteins ; Logistic Models ; Multivariate Analysis ; Plasma* ; Risk Factors ; Sclerosis ; Vitamins

We examined whether alterations in vascular endothelial function and early structural changes in atherosclerosis are associated with microvascular complications in patients with type 1 diabetes mellitus (DM). Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) measurement were performed in 70 young adults (aged 19 to 35 yr), 48 with type 1 DM, and 22 normal controls. Patients with diabetes had a lower peak FMD response (7.8+/-3.9 vs. 11.1 +/-1.9%, p<0.001) and increased IMT (0.51+/-0.10 vs. 0.42+/-0.07 mm, p<0.001) compared with controls. Twenty (41.7%) of the patients had microvascular complications including neuropathy, nephropathy, or retinopathy. In these complicated diabetic patients, we found a lower FMD response (6.1+/-2.5 vs. 9.9+/-3.5%, p=0.001) compared with diabetics without microvascular complications. The presence of microvascular complications was also associated with older age and longer duration of the disease. However, no differences were observed in IMT, body size, blood pressure, HbA1c, C-reactive protein, low-density lipoprotein or high-density lipoprotein cholesterol levels between complicated and non-complicated patients. Endothelial dysfunction and early structural atherosclerotic changes are common manifestations in type 1 DM, and endothelial dysfunction is thought to be an early event in the atherosclerotic process and important in the pathogenesis of microvascular complications.
Adult ; Diabetes Mellitus, Type 1/*complications ; Diabetic Angiopathies/*etiology ; Endothelium, Vascular/*physiology ; Female ; Humans ; Male ; *Microcirculation ; Tunica Intima/pathology ; Tunica Media/pathology ; Vasodilation

BACKGROUNDThere is no agreement as to whether intensive glucose control in type 2 diabetes can reduce the incidence of macrovascular events in these patients. We performed a meta-analysis comparing intensive glucose control or conventional glucose control in randomized controlled trials.

METHODSDatabases including MEDLINE, EMBASE, and Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were the incidence of major macrovascular events.

RESULTSSix trials involving 28 065 patients were included. Analysis suggested that there was an obviously decreased incidence of major macrovascular events in patients having intensive glucose treatment vs. controls (RR 0.92; 95%CI 0.87, 0.98; P = 0.005). However, intensive glycemia control strategies in type 2 diabetes showed no significant impact on the incidence of death from any cause compared with conventional glycemia control strategies, intensive 14.7%, controls 12.0% (RR 0.95; 95%CI 0.80, 1.12; P = 0.55), as well as on the incidence of cardiovascular death, intensive 3.7%, controls 3.6% (RR 1.10, 95%CI 0.79, 1.53; P = 0.57).

CONCLUSIONSControl of glycemia to normal (or near normal levels) in type 2 diabetes appears to be effective in reducing the incidence of major macrovascular events, but there were no significant differences of either the mortality from any cause or from cardiovascular death between the two glycemia-control strategies.

Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; blood ; complications ; drug therapy ; mortality ; Diabetic Angiopathies ; prevention & control ; Glycated Hemoglobin A ; analysis ; Humans ; Randomized Controlled Trials as Topic