Cardiovascular Diseases ; epidemiology ; etiology ; China ; epidemiology ; Diabetes Complications ; complications ; epidemiology ; Diabetic Foot ; epidemiology ; etiology ; Diabetic Nephropathies ; epidemiology ; etiology ; Diabetic Neuropathies ; epidemiology ; etiology ; Diabetic Retinopathy ; epidemiology ; etiology ; Humans

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

Recently chronic angiopathy of diabetes mellitus has become serious complication of diabetes mellitus. Chronic angiopathic complication of diabetes mellitus is divided into macrovascular disease and microvascular disease. Macrovascular disease includes coronary arterial disease, cerebrovascular disease, foot lesion and microvascular disease includes diabetic retinopathy, nephropathy and neuropathy. It is well known that microvascular disease'is relatively unique in diabetic patients and macrovascular disease is frequently found in non diabetic patients, although prevalence rate is still high in diabetic patients. This finding supports the view that microvascular disease and macrovascular disease have different pathogenesis. The authors evaluated and invested the 180 patients with diabetes mellitus who have taken neurologic examination and NCV studies f rom January 1, 1990 to September 30, 1992. The results were as followed: 1.There is a significant tendency that diabetic patients with neuropathy are accompanied by other microangiopathy (retinopathy or nephropathy) than diabetic patients without neuropathy. 2.Between diabetic patients with peripheral neuropathy and without peripheral neuropathy, there is no difference in the prevalence of macroangiopathy.
Diabetes Complications* ; Diabetes Mellitus ; Diabetic Neuropathies* ; Diabetic Retinopathy ; Foot Diseases ; Humans ; Neurologic Examination ; Peripheral Nervous System Diseases ; Prevalence

For patients with insulin dependent diabetes mellitus (IDDM) and renal failure from diabetic nephropathy, simultaneous pancreas-kidney transplantation(SPK) has become an accepted therapy. The benefits of pancreas transplantation are that it normalizes glucose control without the need for insulin administration, improves QOL (quality of life) of diabetic patients and prevents sequelae of hyperglycemia such as diabetic neuropathy, retinopathy and nephropathy. At present, over 1,000 cases/year of pancreas transplantation are performed worldwide, the majority in the US. Currently, there are three types of pancreas transplantation: SPK (simultaneous pancreas and kidney), PAK (pancreas after kidney), and PTA (pancreas transplantation alone). SPK transplantation is the most prevalent, representing 80~90% of the cases, but sometimes PTA is considered in the early stage of diabetic complications to prevent the progression of diabetic retinopathy. Management of surgical complications and rejection has been the key to success of pancreas transplantation. Surgical technique can be categorized according to different pancreas exocrine secretion drainage, including enteric drainage, duct injection and bladder drainage. Medications for postoperative management include antibiotics to prevent infectious disease, anticoagulants and immunosuppressants. Usually, the immunosuppressive protocol for pancreas transplantation is more aggressive than that for kidney transplantation. It is very important to closely monitor graft function for the successful outcome. Currently graft survival has been improved as around 85% of 1 yr graft survival and fairly good longterm survival. In near future islet cell transplantation will be an alternative treatment modality in DM in the condition of improved long term graft survival.
Anti-Bacterial Agents ; Anticoagulants ; Communicable Diseases ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Nephropathies ; Diabetic Neuropathies ; Diabetic Retinopathy ; Drainage ; Glucose ; Graft Survival ; Humans ; Hyperglycemia ; Immunosuppressive Agents ; Insulin ; Islets of Langerhans ; Kidney Transplantation ; Pancreas Transplantation ; Pancreas* ; Renal Insufficiency ; Transplants ; Urinary Bladder

BACKGROUNDPrevious studies suggested that zinc level was related to a certain diabetic microvascular complication. However, the relationship between zinc level and all the microvascular complications in type 2 diabetic patients remains unknown. The purpose of this study was to analyze the relationship between zinc level and each diabetic microvascular complication and identify the features related to low serum zinc level.

METHODSWe included the hospitalized patients with type 2 diabetes (T2D) at our department from May 30, 2013 to March 31, 2014. We initially compared the serum zinc levels between patients with specific microvascular complications and those without. We then analyzed the association between zinc level and each microvascular complication. Furthermore, we identified the unique features of patients with high and low serum zinc levels and analyzed the risk factors related to low zinc level.

RESULTSThe 412 patients included 271 with microvascular complications and 141 without any microvascular complications. Serum zinc level was significantly lower in patients with diabetic retinopathy (P < 0.001), diabetic nephropathy (DN, P < 0.001), or diabetic peripheral neuropathy (P = 0.002) compared with patients without that specific complication. Lower zinc level was an independent risk factor for DN (odds ratio = 0.869, 95% confidence interval = 0.765-0.987, P < 0.05). The subjects with lower serum zinc level had manifested a longer duration of diabetes, higher level of hemoglobin A1c, higher prevalence of hypertension and microvascular complications, and lower fasting and 2-h C-peptide levels.

CONCLUSIONSLower serum zinc level in T2D patients was related to higher prevalence of diabetic microvascular complications, and represented as an independent risk factor for DN. Patients with lower zinc level were more likely to have a longer duration of diabetes, poorer glucose control, and worse β-cell function.

Adult ; Aged ; Diabetes Mellitus, Type 2 ; blood ; complications ; Diabetic Nephropathies ; blood ; etiology ; Diabetic Neuropathies ; blood ; etiology ; Diabetic Retinopathy ; blood ; etiology ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Zinc ; blood

OBJECTIVE: To investigate and describe the peak plantar pressures and ground contact times of the foot during walking in diabetic patients and healthy adults. METHOD: 17 age-matched diabetic patients without any complications and 33 healthy adults participated in this study. The foot was divided into 10 different areas, and peak plantar pressures and ground contact times were measured during walking by EMED system . RESULTS: There were no significant differences in peak plantar pressures of both feet in both groups, but there were significant increases in peak plantar pressures of hindfoot and hindfoot contact times in the diabetic group. CONCLUSION: Despite having no definite diabetic neuropathy and vascular disease, diabetic patients have higher peak plantar pressures of hindfoot and prolonged hindfoot contact times because limb muscle dysfunction or impairment of proprioception may induce faster descent of the foot towards the ground or improper pattern of stance phases.
Adult* ; Diabetic Angiopathies ; Diabetic Neuropathies ; Extremities ; Foot ; Humans ; Proprioception ; Walking

OBJECTIVETo investigate the relationship of erectile dysfunction (ED) with blood vessel-, nerve- and androgen-related factors in young and middle-aged men with type 2 diabetes mellitus (T2DM) in order to provide some clinical evidence for early prevention and treatment of ED.

METHODSWe divided 53 male T2DM patients under 50 years into an ED group (IIEF-5 score < or = 21, n = 28) and a non-ED (NED) group (IIEF-5 score > or = 22, n = 25). We detected the levels of blood lipid, glucose, total testosterone (TT), sex hormone-binding globulin (SHBG), sulfate dehydroepiandrosterone (DHEA-S), calculated free testosterone (cFT), and examined the complications of macroangiopathy (MA), diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN), and compared the above indicators between the two groups.

RESULTSThere were no significant differences between the two groups in age, diabetes duration, body mass index, blood pressure, and blood lipid and glucose levels (P > 0.05). The incidence rate of DR was significantly higher in the ED than in the NED group (39.3% vs 4.0%, P < 0.05), but no statistically significant differences were found in the levels of TT, cFT, SHBG and DHEA-S and the incidence rates of MA and DPN between the two groups (P > 0.05).

CONCLUSIONThe incidence of ED is closely related to DR in young and middle-aged men with T2DM. Therefore particular attention should be paid to the erectile function of T2DM patients with DR as early as possible.

Adult ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Neuropathies ; complications ; Diabetic Retinopathy ; complications ; Erectile Dysfunction ; etiology ; Humans ; Male ; Middle Aged

Sixty diabetic cystopathy patients (symptomatic DCP, 4.9%) among 1236 patients of diabetes mellitus (DM) from May, 1995 to June, 1996 were analyzed to ascertain the usefulness of urodynamic study in the diagnosis of DCP. The mean age was 58 (24--80) years and mean duration of DM was 9 (1~30) years. 36 (60%) patients had diabetic neuropathy, 31 (52%) had diabetic retinopathy and 4 (7%) had diabetic nephropathy. DM was managed by insulin pump (DIABECARETM, 52%) and subcutaneous insulin injection (42%). In residual urine and voiding diaries, residual urine volume more than 40ml was 83%, voiding interval less than 2 or more than 5 hours was 67% and voiding amount less than 200ml or more than 400ml was 48%. According to urodynamic findings, patients were classified as detrusor areflexia (63%), impaired detrusor contractility (18%), detrusor instability (15%) and normal detrusor contraction (3%). There were no significant differences of age, semm-HbA1C, treatment method and duration of diabetes mellitus among above groups. Mean duration of DM in irritative symptom group (32%), combined symptom group (23%) and obstructive symptom group (45%) were 2 years, 8 years and 15 years respectively (p<0.001). The shape of the cystometrographic curve was not influenced by the rate of bladder filling (40ml/min versus 100ml/min). In conclusion, because DCP is marked by insidious onset and progression with minimal symptoms, DCP can be early diagnosed using urodynamic study especially in patients with voiding symptoms and 1ong.DM duration.
Diabetes Mellitus ; Diabetic Nephropathies ; Diabetic Neuropathies ; Diabetic Retinopathy ; Diagnosis ; Humans ; Insulin ; Urinary Bladder ; Urodynamics*

Objective: This study aims to determine the prevalence of sexual dysfunction among premenopausal Filipino women with type 2 diabetes mellitus at the outpatient department of a tertiary hospital through the use of the Female Sexual Function Index (FSFI) and identify factors that could be associated with sexual dysfunction. Methodology: Seventy-five women with type 2 diabetes mellitus, aged 38 to 49 years old, received the FSFI questionnaire. Their age, history of hypertension, smoking habit, alcohol intake, body mass index, waist circumference, fasting blood sugar, HbA1c, creatinine, lipid profile, albuminuria or proteinuria, presence of microvascular complications such as diabetic retinopathy, neuropathy and nephropathy and their association with sexual dysfunction was determined. Results: Seventy-two percent of the participants have sexual dysfunction scoring lowest in the lubrication, orgasm and pain domains. Age (p=0.016), a high body mass index (p=0.001), a fasting blood sugar above 100 mg/dl (p=0.006) and the presence of microvascular complications of diabetes mellitus namely, retinopathy (p=0.046) nephropathy (p=0.004) and neuropathy (p=0.001) were associated with sexual dysfunction. Conclusion The prevalence of sexual dysfunction is high among premenopausal Filipino women with type 2 diabetes mellitus, and is associated with age, a high body mass index, an uncontrolled fasting blood sugar and the presence of microvascular complications of diabetes mellitus.
Diabetes Mellitus, Type 2 ; Premenopause ; Diabetic Neuropathies ; Diabetic retinopathy ; Diabetic Nephropathies

BACKGROUND: It is not clear whether microangiopathies are associated with subclinical atherosclerosis in type 2 diabetes mellitus (T2DM). We investigated the relation of cardiac autonomic neuropathy (CAN) and other microangiopathies with carotid atherosclerosis in T2DM. METHODS: A total of 131 patients with T2DM were stratified by mean carotid intima-media thickness (CIMT) > or = or <1.0 mm and the number of carotid plaques. CAN was assessed by the five standard cardiovascular reflex tests according to the Ewing's protocol. CAN was defined as the presence of at least two abnormal tests or an autonomic neuropathy points > or =2. Diabetic microangiopathies were assessed. RESULTS: Patients with CAN comprised 77% of the group with mean CIMT > or =1.0 mm, while they were 29% of the group with CIMT <1.0 mm (P=0.016). Patients with diabetic retinopathy (DR) comprised 68% of the group with CIMT > or =1.0 mm, while they were 28% of the group without CIMT thickening (P=0.003). Patients with CAN comprised 51% of the group with > or =2 carotid plaques, while they were 23% of the group with < or =1 carotid plaque (P=0.014). In multivariable adjusted logistic regression analysis, the patients who presented with CAN showed an odds ratio [OR] of 8.6 (95% confidence interval [CI], 1.6 to 44.8) for CIMT thickening and an OR of 2.9 (95% CI, 1.1 to 7.5) for carotid plaques. Furthermore, patients with DR were 3.8 times (95% CI, 1.4 to 10.2) more likely to have CIMT thickening. CONCLUSION: These results suggest that CAN is associated with carotid atherosclerosis, represented as CIMT and plaques, independent of the traditional cardiovascular risk factors in T2DM. CAN or DR may be a determinant of subclinical atherosclerosis in T2DM.
Atherosclerosis ; Carotid Artery Diseases* ; Carotid Intima-Media Thickness ; Diabetes Mellitus, Type 2 ; Diabetic Angiopathies ; Diabetic Neuropathies* ; Diabetic Retinopathy ; Humans ; Logistic Models ; Odds Ratio ; Reflex ; Risk Factors