Immunologic studies of patients with diabetes mellitus who have received long term insulin therapy: Lymphocyte reactivity to insulin is correlated with impaired immunoglobulin secretion in vitro

Abstract PurposeTo investigate the long-term prognostic value of coronary CT angiography (cCTA)-derived plaque information on major adverse cardiac events (MACE) in patients with and without diabetes mellitus. Methods64 patients with diabetes (63.3±10.1 years, 66% male) and suspected coronary artery disease (CAD) who underwent cCTA were matched with 297 patients without diabetes according to age, sex, cardiovascular risk factors, statin and antithrombotic therapy. Major adverse cardiac events (MACE) were recorded. cCTA-derived risk scores and plaque measures were assessed. The discriminatory power to identify MACE was evaluated using multivariable regression analysis and concordance indices (CIs).ResultsAfter a median follow-up of 5.4 years, MACE occurred in 31 patients (8.6%). In patients with diabetes, cCTA risk scores and plaque measures were significantly higher compared to non-diabetic patients (all p<0.05). The following plaque measures were predictors of MACE using multivariable Cox regression analysis (hazard ratio [HR]) in patients with diabetes: segment stenosis score (HR 1.20, p<0.001), low-attenuation plaque (HR 3.47, p=0.05), and in non-diabetic patients: segment stenosis score (HR 1.92, p<0.001), Agatston score (HR 1.0009, p=0.04), and low-attenuation plaque (HR 4.15, p=0.04). A multivariable model showed significantly improved C-index of 0.96 (95% CI 0.94-0.0.97) for MACE prediction, when compared to single measures alone.ConclusionDiabetes is associated with a significantly higher extent of CAD and plaque features, which have independent predictive values for MACE. cCTA-derived plaque information portends improved risk stratification of patients with diabetes beyond assessment of obstructive stenosis on cCTA alone.

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FACTORS OF POOR ADHERENCE TO INSULIN THERAPY IN PATIENTS WITH DIABETES MELLITUS AND THEIR FAMILIES

Nursing and Midwifery Journal ◽

10.52547/unmf.19.7.6 ◽

2021 ◽

Vol 19 (7) ◽

pp. 568-581

Author(s):

Babak Pezeshki ◽

Mostafa Bijani ◽

Azizollah Dehghan ◽

Zahra Salehi ◽

◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Therapy ◽

Poor Adherence ◽

Patients With Diabetes

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PROSES PENYEMBUHAN LUKA ULKUS DIABETIKUM DENGAN METODE MODERN DRESSING DIKLINIK MAITIS EFRANS WOUND CARE

JURNAL MEDIA KESEHATAN ◽

10.33088/jmk.v10i2.336 ◽

2018 ◽

Vol 10 (2) ◽

pp. 146-151

Author(s):

Nadya Putri Nabila

Keyword(s):

Diabetes Mellitus ◽

Wound Healing ◽

Wound Care ◽

Healing Process ◽

Case Study Research ◽

World Population ◽

Care Clinic ◽

Diabetic Ulcer ◽

Patients With Diabetes

Diabetes mellitus (DM) is one of the most common chronic diseases experienced by the world population and ranks fourth cause of death in developing countries. Long-term complications of diabetes mellitus one of them is diabetic ulcer (15%) and is the most cause (85%) of amputation in patients with diabetes mellitus. Currently, more than 5,000 modern types of dressings are reported to be available to treat wounds, especially diabetic ulcers. To know the process of wound healing diabetic ulcer was done with the design of case study research with a sample of 2 people and this study was conducted for 4 weeks. The study was conducted at the Maitis Efrans Wound Care clinic in Bengkulu City. The result was obtained that the assessment of diabetic ulcer wounds before modern wound care on the respondents was a total score of 54 and the respondents two total score of 50 were stated wound regeneration. The healing process of the responder's second ulcers progressed, the total score of one respondent was 30 and the respondent two was 28. Respondents. Progress on the two respondents stated better influenced by wound healing factor that is, age factor.

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Pasireotide in an insulin-requiring diabetic acromegalic patient without worsening of hyperglycemia

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-17-0003 ◽

2017 ◽

Vol 2017 ◽

Cited By ~ 2

Author(s):

Murray B Gordon ◽

Kellie L Spiller

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

List Type ◽

Effective Treatment Option ◽

Patients With Diabetes ◽

Long Acting ◽

Learning Points

Summary Long-acting pasireotide is an effective treatment option for acromegaly, but it is associated with hyperglycemia, which could impact its use in patients with diabetes. We present a case of a 53-year-old man with acromegaly and type 2 diabetes mellitus (glycated hemoglobin (HbA1c): 7.5%), who refused surgery to remove a pituitary macroadenoma and enrolled in a Phase 3 clinical trial comparing long-acting pasireotide and long-acting octreotide in acromegalic patients. The patient initially received octreotide, but insulin-like growth factor 1 (IGF-1) levels remained elevated after 12 months (383.9 ng/mL; 193.0 ng/mL; reference range: 86.5–223.8 ng/mL), indicating uncontrolled acromegaly. He switched to pasireotide 40 mg and subsequently increased to 60 mg. Within 6 months, IGF-1 levels normalized (193.0 ng/mL), and they were mostly normal for the next 62 months of treatment with pasireotide (median IGF-1: 190.7 ng/mL). Additionally, HbA1c levels remained similar to or lower than baseline levels (range, 6.7% to 7.8%) during treatment with pasireotide despite major changes to the patient’s antidiabetic regimen, which included insulin and metformin. Uncontrolled acromegaly can result in hyperglycemia due to an increase in insulin resistance. Despite having insulin-requiring type 2 diabetes, the patient presented here did not experience a long-term increase in HbA1c levels upon initiating pasireotide, likely because long-term control of acromegaly resulted in increased insulin sensitivity. This case highlights the utility of long-acting pasireotide to treat acromegaly in patients whose levels were uncontrolled after long-acting octreotide and who manage diabetes with insulin. Learning points Long-acting pasireotide provided adequate, long-term biochemical control of acromegaly in a patient with insulin-requiring type 2 diabetes mellitus who was unresponsive to long-acting octreotide. Glycemic levels initially increased after starting treatment with pasireotide but quickly stabilized as acromegaly became controlled. Long-acting pasireotide, along with an appropriate antidiabetic regimen, may be a suitable therapy for patients with acromegaly who also have insulin-requiring type 2 diabetes mellitus.

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RELUCTANCE OF PATIENTS WITH DIABETES MELLITUS TO INSULIN THERAPY; PSYCHOLOGICAL INSULIN RESISTANCE

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.4137 ◽

2021 ◽

Vol 71 (2) ◽

pp. 602-05

Author(s):

Umair Ali ◽

Muhammad Wajid Munir ◽

Jahanzeb Maqsood ◽

Mahwash Jamil ◽

Syed Saif Ur Rehman ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Insulin Therapy ◽

Demographic Data ◽

Tertiary Care ◽

Negative Attitude ◽

Cross Sectional Study ◽

Cross Sectional ◽

Validated Questionnaire ◽

Patients With Diabetes

Objective: To evaluate factors resulting in reluctance of initiation of insulin therapy in patients with type 2 diabetes mellitus. Study Design: Cross sectional study. Place and Duration of Study: Medical OPD of a private tertiary care multi-specialty hospital in Islamabad, from Apr to Jul 2019. Methodology: Patients with diabetes mellitus between age of 30-70 years, who had poor glycaemic control on two oral antidiabetic drugs having HbA1c>9% and were insulin naïve, were included in this study. A validated questionnaire was developed which had two sections; first including the demographic data of the study populations and second having closedended dichotomous questions which were asked from patients by the treating physicians Results: A total of 180 patients with diabetes mellitus eligible for insulin therapy were included in the study, among them 52 (28.9%) were agreed to initiate the insulin. Negative attitude and beliefs include painful way of administration 85 (66.4%), difficult insulin storage 98 (76.6%), risk of hypoglycemia 82 (64.1%).The mean negative perception Score was 7.35 (SD 0.98). Conclusion: Psychological insulin resistance is present in significant diabetic population, and it is a big obstacle in insulin therapy initiation and compliance.

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