Assisting Lucinda: A Depressed Individual with Diabetes Mellitus, Numerous Complications, Poor Control, and High Service Use

2018 ◽  
pp. 19-39
Author(s):  
Roger G. Kathol ◽  
Rachel L. Andrew ◽  
Michelle Squire ◽  
Peter J. Dehnel
Keyword(s):  
Diabetes Mellitus ◽  
Service Use ◽  
Depressed Individual ◽  
Poor Control ◽  
High Service

Dissociation of cortisol and adrenal androgen secretion in poorly controlled insulin-dependent diabetes mellitus

1992 ◽  
Vol 127 (2) ◽  
pp. 115-117 ◽  
Author(s):  
RM Couch
Keyword(s):  
Diabetes Mellitus ◽  
Good Control ◽  
Insulin Dependent Diabetes Mellitus ◽  
Dehydroepiandrosterone Sulfate ◽  
Insulin Dependent Diabetes ◽  
Dependent Diabetes Mellitus ◽  
Poor Control ◽  
Adrenal Androgen ◽  
Insulin Dependent ◽  
Androgen Secretion

In acute illness, cortisol secretion increases whereas that of the adrenal androgens, dehydroepiandrosterone and dehydroepiandrosterone sulfate declines. The present study examined if a similar dissociation of cortisol and adrenal androgen secretion occurs in poorly controlled diabetes mellitus. Serum concentrations of cortisol, dehydroepiandrosterone and dehydroepiandrosterone sulfate obtained at 08.00 were compared in 13 post-pubertal diabetics (mean age 18.0 years) in good control (HbA1C<8.0%) and 10 post-pubertal diabetics (mean age 17.0 years) in poor control (HbA1C> 10.0%). Those in poor control had significantly higher serum cortisol (597±94 nmol/l vs 479±208, p < 0.05), lower dehydroepiandrosterone (13.1±5.5 nmol/l vs 25.3±16.9, p<0.025) and lower dehydroepiandrosterone sulfate (4.5±2.4 μmol/l vs 7.0±3.7, p<0.025). The ratios of dehydroepiandrosterone and dehydroepiandrosterone sulfate to cortisol were also significantly lower in those with poor control. It is concluded that poor control of insulin-dependent diabetes mellitus results in a dissociation of cortisol and adrenal androgen secretion.

scholarly journals Frequency of Hepatitis C infection in diabetes mellitus

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Masroor A Qazi ◽  
Fayyaz M ◽  
Hyuddin Ch G Muhyuddin ◽  
Aftab Jamil ◽  
Malik A H ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Hepatitis C ◽  
Insulin Therapy ◽  
Blood Donors ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Type I ◽  
Diabetic Mellitus ◽  
Hepatitis C Infection ◽  
Poor Control

Place and duration of study: The study was conducted at diabetic clinic B.V. Hospital/Q.A.M.C Bahawalpur from December 1st, 2004 to March 15th, 2005. Background: Diabetes mellitus and hepatitis C infections are common and emerging problems of the society. Either diabetes mellitus is common in chronic hepatitis C patients as reported initially by Ellison and co-workers or hepatitis C infection is more frequent in diabetes mellitus. We want to study the frequency of hepatitis c infection in diabetes mellitus. Objectives: To study the frequency of hepatitis C infection in diabetic patients and to note any risk factors of diabetic patients predisposing to hepatitis C infection. Designs: A cross-sectionalObservational-descriptive analytic study. Subjects and Methods: A total of 250 consecutive diabetic patients of either sex were compared with 6574 blood donors for hepatitis c infection .They were evaluated for hepatitis C infection by using Enzyme Linked Immunosorbant Assay (ELISA-3) which is an anti-HCV anti body test. On basis of this test, the patients were divided into two groups, anti-HCV +ve and anti-HCV -ye. Different variables of these patients were studied and compared in these two groups Variables studied were as follows:- Age, Sex, BMI, Mode of therapy area of their residence(rural or urban) Duration of diabetes mellitus, Blood pressure, Nephropathy and Control of diabetes mellitus. Results: Among a total of 250 patients, 120 (48%) were male and 130 (52%) were female. Two hundred and forty-four (97.6%) patients were of type-II DM and 06 (2.4%) patients were of type-I DM. 22 (8.8%) patients were on insulin therapy while 228 (91.2%) were on oral hypoglycemic agents. Anti-HCV test was positive in 69 (27.6%) diabetic patients as compared to blood donors 41 (0.62%). In anti-HCV positive group, longer duration of diabetic mellitus (15yrs 15.94%), poor control of diabetic mellitus(87%), insulin therapy(17.39%) hypertension(91.3%) and nephropathy(94.2%) were the significant vari ables while BMI, age, sex and whether they were belonging to either rural or urban area were not significant in both the groups. Conclusion: Hepatitis C infection is common in diabetic patients as compared to control group (27.6% vs 0.62%). Out of diabetic patients HCV infection is more common with longer duration of diabetic mellitus, poor control of diabetic mellitus, hypertension, nephropathy and insulin therapy.

scholarly journals Direct medical costs of type 2 diabetes mellitus in the Philippines: findings from two hospital databases and physician surveys

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e049737
Author(s):  
Cecilia Jimeno ◽  
Rosa Allyn Sy ◽  
Pepito De La Pena ◽  
Chritopher Cipriano ◽  
Rima Tan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Medical Cost ◽  
Outpatient Care ◽  
Good Control ◽  
The Philippines ◽  
Poor Control ◽  
Control Range

ObjectiveTo estimate the annual direct medical cost of type 2 diabetes mellitus (T2DM) in hospitals and outpatient care clinics from a healthcare payer perspective in the Philippines.Design and participants(1) A review of electronic hospital records of people with T2DM in two tertiary hospitals—Ospital ng Makati (OsMak) and National Kidney and Transplant Institute (NKTI) and (2) a cross-sectional survey with 50 physicians providing outpatient care for people with T2DM.SettingPrimary, secondary and tertiary healthcare facilities in Metro Manila.Outcome measuresCost of managing T2DM and its related complications in US dollars (USD) in 2016.ResultsA total of 1023 and 1378 people were identified in OsMak and NKTI, with a complication rate of 66% and 74%, respectively. In both institutions, the average annual cost per person was higher if individuals were diagnosed with any complication (NKTI: US$3226 vs US$2242 and OsMak: US$621 vs US$127). Poor diabetes control was estimated to incur higher per person cost than good control in both public outpatient care (poor control, range: US$727 to US$2463 vs good control, range: US$614 to US$1520) and private outpatient care (poor control, range: US$848 to US$2507 vs good control, range: US$807 to US$1603).ConclusionThe results highlight the high direct medical cost resulting from poor diabetes control and the opportunity for cost reduction by improving control and preventing its complications.

Psychosocial Aspects of Diabetes Mellitus*

1983 ◽  
Vol 28 (3) ◽  
pp. 219-223 ◽  
Author(s):  
Gary M. Rodin
Keyword(s):  
Diabetes Mellitus ◽  
Life Stress ◽  
Sense Of Self ◽  
Well Being ◽  
Self Esteem ◽  
Treatment Modalities ◽  
Poor Control ◽  
Emotional Factors ◽  
Self Sufficiency ◽  
Control Of Diabetes

The significance of emotional factors in diabetes mellitus is reviewed in the light of recent changes in treatment. Newer evidence has not supported the concept of a specific diabetic personality. However, lowered self-esteem and feelings of depression have been found to be common in diabetics and particularly in those with poor control of their illness. Illnesses such as diabetes may be associated with feelings of defectiveness and helplessness about regulating bodily functions and achieving a sense of self-sufficiency. Poor control of diabetes in children appears to be associated with pathological interactions in their families. Also, the course of the illness in most patients is correlated with measures of life stress. Newer treatment modalities offer the possibility for improved metabolic control and perhaps for increased psychological well-being.

scholarly journals Awareness about diabetes mellitus and diabetic retinopathy in patients with diabetes mellitus

2017 ◽  
Vol 5 (8) ◽  
pp. 3570
Author(s):  
Neeti R. Sheth ◽  
Nabilah A. Sareshwala ◽  
Sushil G. Chaudhary ◽  
Hiren D. Matai
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Public Awareness ◽  
Good Control ◽  
Poor Control ◽  
Medical College ◽  
Patients With Diabetes ◽  
Detailed Search ◽  
Age Range ◽  
Poor Practice

Background: Awareness about diabetes mellitus and diabetic retinopathy in patients with diabetes mellitus.Methods: 50 patients of diabetes mellitus attending Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India, were randomly selected during January 2017 to March 2017. 11-point questionnaire obtained on detailed search of literature on published reports were administered by interviewers well versed in English and Gujarati.Results: Total of 50 patients were randomly selected.42%- females and 58% - males. Mean age - 58.5 years. Age range 40 to 71 years. Patients with good sugar control -26% and poor control - 74%. 94% of the patients were taking treatment for DM and 6% were not on any treatment. 48 % of the patients were illiterate, 10% were graduate and 42% had education below 12th standard. 50% were aware about DM affecting the eye .38% had taken eye treatment and 62% had not. 26% were aware of DM affecting eye inspite of good control and 26 % aware of the need of check-up in poor control. 40% aware of the complications related to DM.Conclusions: Better literacy rates is contributory to public awareness, however trend for poor practice needs to be radically changed with aggressive public motivation emphasizing the necessity of screening and follow ups.

scholarly journals Hypertriglyceridemia in Diabetes Mellitus: Implications for Pediatric Care

2018 ◽  
Vol 2 (6) ◽  
pp. 497-512 ◽  
Author(s):  
Jacob C Hartz ◽  
Sarah de Ferranti ◽  
Samuel Gidding
Keyword(s):  
Diabetes Mellitus ◽  
Children And Adolescents ◽  
Pediatric Care ◽  
Poor Control ◽  
Atherogenic Lipid Profile ◽  
Increased Risk ◽  
Atherogenic Lipid

Abstract Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). It is estimated that the risk of CVD in diabetes mellitus (DM) is 2 to 10 times higher than in the general population. Much of this increased risk is thought to be related to the development of an atherogenic lipid profile, in which hypertriglyceridemia is an essential component. Recent studies suggest that dyslipidemia may be present in children and adolescents with DM, particularly in T2DM and in association with poor control in T1DM. However, the role of hypertriglyceridemia in the development of future CVD in youth with DM is unclear, as data are scarce. In this review, we will evaluate the pathophysiology of atherogenic hypertriglyceridemia in DM, the evidence regarding an independent role of triglycerides in the development of CVD, and the treatment of hypertriglyceridemia in patients with DM, highlighting the potential relevance to children and the need for more data in children and adolescents to guide clinical practice.

scholarly journals A comparative evaluation of blood sugar and glycosylated hemoglobin in clinically manifested diabetic neuropathy

2018 ◽  
Vol 5 (4) ◽  
pp. 997
Author(s):  
Md. Mubasheer Ali ◽  
Ahmed Mohiuddin
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Neuropathy ◽  
Blood Sugar ◽  
Glycosylated Hemoglobin ◽  
General Medicine ◽  
Diabetic Control ◽  
Cross Sectional Study ◽  
Poor Control ◽  
Cross Sectional ◽  
Control Of Diabetes

Background: It is very well established that tight control of diabetes reduces if not prevents the risk of neuropathy.  The benefit of other mode of therapy like myo- inositol supplementation and aldose reductase inhibitors remain to be established. Objective of present study to compare blood sugar and glycosylated hemoglobin in clinically manifested diabetic neuropathy.Methods: Hospital based cross sectional study was carried out at Department of General Medicine, from August 2016 to October 2017 among 60 patients of diabetic neuropathy. These patients were subjected thorough evaluation as per the proforma.Results: As per the blood sugar levels, 15% were normal. As per glycosylated hemoglobin levels, only one patient was found to be normal. Thus, glycosylated hemoglobin showed evidence of poor control more frequently than blood sugar estimation in these patients. Patients with both retinopathy and neuropathy in this study had diabetes mellitus for periods 2 months to 20 years.  (Mean 8.2yrs).  Thus, it can be seen that glycosylated hemoglobin is a more sensitive indicator of poor control of diabetes mellitus than blood sugar. This difference is statistically significant (P <0.05).Conclusions: Thus, as an integral of diabetic control, glycosylated hemoglobin (HbA1C) estimation is superior to the conventional measures in assessment of control.

scholarly journals Effect of Diabetes Mellitus on short-term prognosis of 227 pyogenic liver abscess patients after hospitalization

2019 ◽  
Author(s):  
Zhaoqing Du ◽  
Xinchen Zhou ◽  
Junzhou Zhao ◽  
Jianbin Bi ◽  
Yifan Ren ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Liver Abscess ◽  
Pyogenic Liver Abscess ◽  
Rank Test ◽  
Poor Control ◽  
Short Term ◽  
Candida Spp ◽  
Term Survival ◽  
Log Rank Test

Abstract Background: Pyogenic liver abscess (PLA) is an inflammatory disease with increasing incidence. When it occurs with diabetes mellitus (DM), risk of recurrence and the mortality may increase. However, the effect of DM on short-term prognosis of PLA patients after hospitalization remained unknown.Methods: 227 PLA patients who received treatment at the First Affiliated Hospital of Xi’an Jiaotong University from January 2011 to January 2018 were retrospectively enrolled. They were divided into two groups as DM group (n=61) and Non-DM group (n=166). In the DM group, HbA1C level <7% was considered to be good-control of glycaemia (n=23). The clinical characteristics and overall short-term survivals were analyzed.Results: The proportion of PLA patients with DM was 26.87%. In the DM group, there was a higher incidence of hypertension and Candida spp. infection. Conservative administration and percutaneous drainage were mainly used in patients with good- (60.87%) and poor-control (60.53%) of glycaemia, respectively. During follow-up, 24 (10.57%) died due to uncontrolled systemic infections and other serious complications. Compared with PLA patients without DM, patients in the DM group had significantly increased 6-month mortality rate after discharge (Log-Rank test, P =0.021). Poor-control of glycaemia did not reduce the six-month survival, while the recurrence rate of PLA within three months showed an almost 3-fold increase (13.16% vs. 4.35%). Further multivariate analyses found that DM was the only independent risk factor for the PLA six-month survival (odd ratio [OR]: 0.097, 95% confidence interval [CI]: 0.018-0.526, P =0.007). However, the blood glucose level had no significant effect on the short-term survival of PLA patients with DM (Log-Rank test, P =0.218).Conclusions: In PLA patients, DM aggravated short-term mortality and blood glucose levels should be well controlled.

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