Rare case of diabetic neuropathic cachexia along with diabetic amyotrophy

2021 ◽  
Vol 14 (5) ◽  
pp. e239869
Author(s):  
Zahid Ullah Khan ◽  
Nasrullah Ghuman ◽  
KaHinKaren Mak
Keyword(s):  
Gunshot Wounds ◽  
Lumbosacral Spine ◽  
Haemoglobin A1c ◽  
Early Referral ◽  
Specialist Nurse ◽  
Good Glycaemic Control ◽  
Diabetes Specialist ◽  
Electrophysiological Studies ◽  
Diabetic Amyotrophy

A 65-year-old patient with background of alcohol excess and previous gunshot wounds was admitted with significant weight loss, leg cramps, dizziness and lethargy for the last 3 months. He was diagnosed with type 2 diabetes mellitus in July 2020 and was started on Metformin and Gliclazide by his in July; he was later commenced on alogliptin and empaglaflozin by diabetes specialist nurse in early August. He also had generalised muscle wasting, dorsal guttering in both hands and was cachectic when he presented to hospital. His haemoglobin A1c (HbA1c) was 124 mmol/mol in July 2020 and was 63 mmol/mol in September 2020. The patient had negative autoimmune and TB screen. CT abdomen/pelvis and CT lumbosacral spine that showed mild diverticular disease and bilateral L5 spondylolysis with L5-S1 spondylotic changes. Electrophysiological studies confirmed sensory motor peripheral neuropathy. Patient was diagnosed with diabetic neuropathic cachexia secondary to poorly controlled diabetes and was commenced on 30 units two times per day of NovoMix 30 insulin; this was adjusted to 24 units two times per day in endocrine clinic 3 months later, after gaining 10 kg in weight. Good glycaemic control is key to the management of such cases and, therefore, we recommend early referral to diabetes specialist input for consideration of insulin therapy.

Outcomes of a digitally delivered, culturally-sensitive behaviour change platform for BAME adults with type 2 diabetes: 1 year health and engagement outcomes (Preprint)

2020 ◽  
Author(s):  
Charlotte Summers
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Health Outcomes ◽  
Behavioural Change ◽  
Culturally Sensitive ◽  
Lifestyle Changes ◽  
Haemoglobin A1c ◽  
Central Asian ◽  
Increased Risk

BACKGROUND People from Black, Asian and Minority Ethnic (BAME) groups are known to have an increased risk of developing type 2 diabetes and face greater barriers to accessing healthcare resources compared to their “white British” counterparts. The main mediators of lifestyle behavioural change are gender, generation, geography, genes, God/religion, and gaps in knowledge and economic resources. Dietary and cultural practices of these individuals significantly vary according to gender, generation, geographical origin and religion. Recognition of these factors and implementing culturally sensitive interventions for type 2 diabetes prevention and management is essential in increasing knowledge of healthy eating, engagement in physical activity and improving health outcomes in BAME communities. Few health apps are tailored for BAME populations, and BAME communities are considered hard-to-reach. OBJECTIVE Our objective was to establish whether the Low Carb Program is a viable scalable solution that can be used as an effective tailored type 2 diabetes intervention for BAME communities. We hypothesized that by taking into account cultural sensitivities, providing the platform in native languages and personalising the platform in accordance with known barriers to health disparities including gender, generation, dietary preferences and religion, the app would engage BAME communities and improve type 2 diabetes related health outcomes. METHODS The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. All 705 adults with type 2 diabetes who had activated their referral to the Low Carb Program as a result of an NHS consultation between September 2018 and March 2019 were followed for a period of 12 months; mean age 54.61 (SD 16.69) years; 58.2% (410/705) women; 45.1% (318/705) white, 28.5% (201/705) Indian/Pakistani/Bangladeshi/Other Central Asian, 10.8% (76/705) Arab, 6.2% (44/705) Mixed/Multiple ethnic groups, 6% (43/705) black, 1.8% (13/705) other, (7/705) 1% Chinese/Japanese/Other East Asian. Mean starting glycated haemoglobin A1c (HbA1c) 7.99% (SD 2.05%); mean body weight 88.96kg (SD 23.25kg). RESULTS Of the 705 study participants, 513 (72.76%) had completed the Low Carb Program at 12 months. There were statistically significant reductions in body weight and HbA1c in white, Indian/Pakistani/Bangladeshi/Other Central Asian, Arabic and black participants with the most significant differences in the Indian/Pakistani/Bangladeshi/Other Central Asian population HbA1c -1.18% (SD 1.49%) and weight 8.03kg (SD 10.65kg). 82.9% of all participants (419/705) of all participants lost at least 5% of their body weight. CONCLUSIONS Offering the culturally tailored Low Carb Program that empowers members to make dietary and lifestyle changes to different BAME groups is an effective and engaging tool in the management of type 2 diabetes. Most importantly, BAME populations in particular people from Indian/Pakistani/Bangladeshi and Arabic groups who achieve better health outcomes than their white counterparts.

scholarly journals Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110308
Author(s):  
Andrew Platt ◽  
Mostafa H. El Dafrawy ◽  
Michael J. Lee ◽  
Martin H. Herman ◽  
Edwin Ramos
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Gunshot Wounds ◽  
Operative Management ◽  
Operative Intervention ◽  
Lumbosacral Spine ◽  
Random Effects Model ◽  
Significant Difference

Study Design: Systematic review and meta-analysis. Objectives: Indications for surgical decompression of gunshot wounds to the lumbosacral spine are controversial and based on limited data. Methods: A systematic review of literature was conducted to identify studies that directly compare neurologic outcomes following operative and non-operative management of gunshot wounds to the lumbosacral spine. Studies were evaluated for degree of neurologic improvement, complications, and antibiotic usage. An odds ratio and 95% confidence interval were calculated for dichotomous outcomes which were then pooled by random-effects model meta-analysis. Results: Five studies were included that met inclusion criteria. The total rate of neurologic improvement was 72.3% following surgical intervention and 61.7% following non-operative intervention. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 1.07; 95% CI 0.45, 2.53; P = 0.88). In civilian only studies, a random-effects model meta-analysis failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 0.75; 95% CI 0.21, 2.72; P = 0.66). Meta-analysis further failed to show a statistically significant difference in the rate of neurologic improvement between patients with either complete (OR 4.13; 95% CI 0.55, 30.80; P = 0.17) or incomplete (OR 0.38; 95% CI 0.10, 1.52; P = 0.17) neurologic injuries who underwent surgical and non-operative intervention. There were no significant differences in the number of infections and other complications between patients who underwent surgical and non-operative intervention. Conclusions: There were no statistically significant differences in the rate of neurologic improvement between those who underwent surgical or non-operative intervention. Further research is necessary to determine if surgical intervention for gunshot wounds to the lumbosacral spine, including in the case of retained bullet within the spinal canal, is efficacious.

scholarly journals Sex differences and correlates of poor glycaemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023401 ◽  
Author(s):  
Fernanda G Duarte ◽  
Sandra da Silva Moreira ◽  
Maria da Conceição C Almeida ◽  
Carlos A de Souza Teles ◽  
Carine S Andrade ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Treatment Guidelines ◽  
Specific Treatment ◽  
Nationwide Survey ◽  
Haemoglobin A1c ◽  
Cross Sectional ◽  
Factors Associated ◽  
Adherence To Diet

ObjectiveExamine whether glycaemic control varies according to sex and whether the latter plays a role in modifying factors associated with inadequate glycaemic control in patients with type 2 diabetes (T2D) in Brazil and Venezuela.Design, setting and participantsThis was a cross-sectional, nationwide survey conducted in Brazil and Venezuela from February 2006 to June 2007 to obtain information about glycaemic control and its determinants in patients with diabetes mellitus attending outpatient clinics.Main outcome measuresHaemoglobin A1c (HbA1c) level was measured by liquid chromatography, and patients with HbA1c ≥7.0% (53 mmol/mol) were considered to have inadequate glycaemic control. The association of selected variables with glycaemic control was analysed by multivariate linear regression, using HbA1c as the dependent variable.ResultsA total of 9418 patients with T2D were enrolled in Brazil (n=5692) and in Venezuela (n=3726). They included 6214 (66%) women and 3204 (34%) men. On average, HbA1c levels in women were 0.13 (95% CI 0.03 to 0.24; p=0.015) higher than in men, after adjusting for age, marital status, education, race, country, body mass index, duration of disease, complications, type of healthcare, adherence to diet, adherence to treatment and previous measurement of HbA1c. Sex modified the effect of some factors associated with glycaemic control in patients with T2D in our study, but had no noteworthy effect in others.ConclusionsWomen with T2D had worse glycaemic control than men. Possible causes for poorer glycaemic control in women compared with men include differences in glucose homeostasis, treatment response and psychological factors. In addition, sex modified factors associated with glycaemic control, suggesting the need to develop specific treatment guidelines for men and women.

scholarly journals Validity of the Finnish Diabetes Risk Score for Detecting Undiagnosed Type 2 Diabetes among General Medical Outpatients in Botswana

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Bernard Omech ◽  
Julius Chacha Mwita ◽  
Jose-Gaby Tshikuka ◽  
Billy Tsima ◽  
Oathokwa Nkomazna ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Score ◽  
Predictive Value ◽  
Total Population ◽  
Diabetes Risk ◽  
Undiagnosed Diabetes ◽  
Haemoglobin A1c ◽  
Diabetes Risk Score ◽  
Medical Outpatients

This was a cross-sectional study designed to assess the validity of the Finnish Diabetes Risk Score for detecting undiagnosed type 2 diabetes among general medical outpatients in Botswana. Participants aged ≥20 years without previously diagnosed diabetes were screened by (1) an 8-item Finnish diabetes risk assessment questionnaire and (2) Haemoglobin A1c test. Data from 291 participants were analyzed (74.2% were females). The mean age of the participants was 50.1 (SD = ±11) years, and the prevalence of undiagnosed diabetes was 42 (14.4%) with no significant differences between the gender (20% versus 12.5%,P=0.26). The area under curve for detecting undiagnosed diabetes was 0.63 (95% CI 0.55–0.72) for the total population, 0.65 (95% CI: 0.56–0.75) for women, and 0.67 (95% CI: 0.52–0.83) for men. The optimal cut-off point for detecting undiagnosed diabetes was 17 (sensitivity = 48% and specificity = 73%) for the total population, 17 (sensitivity = 56% and specificity = 66%) for females, and 13 (sensitivity = 53% and specificity = 77%) for males. The positive predictive value and negative predictive value were 20% and 89.5%, respectively. The findings indicate that the Finnish questionnaire was only modestly effective in predicting undiagnosed diabetes among outpatients in Botswana.

Impact of haemoglobin A1c trajectories on chronic kidney disease progression in type 2 diabetes

Nephrology ◽  
2019 ◽  
Vol 24 (10) ◽  
pp. 1026-1032 ◽  
Author(s):  
Serena Low ◽  
Xiao Zhang ◽  
Jiexun Wang ◽  
Lee Y Yeoh ◽  
Yan L Liu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Progression ◽  
Haemoglobin A1c ◽  
Chronic Kidney Disease Progression ◽  
Kidney Disease Progression

scholarly journals High Fiber Caribbean Diets with Low-Intermediate GI Improve Glycemic Control, Cardiovascular and Inflammatory Indicators in Overweight Persons with Type 2 Diabetes: A Randomized Control Study

2015 ◽  
Vol 3 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Perceval Singh ◽  
Cliff K Riley ◽  
Andrew Wheatley ◽  
Michael Boyne ◽  
Errol Morrison ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fasting Blood Glucose ◽  
Intervention Group ◽  
Dietary Treatment ◽  
Treatment Modalities ◽  
Control Group ◽  
Haemoglobin A1c ◽  
High Fiber ◽  
Hs Crp

This study focused on the effect of consumption of indigenous Caribbean foods with low and intermediate glycemic index (GI) high fiber contents on glycated haemoglobin (A1c), insulin, fasting blood glucose, homocysteine (tHCY), high sensitivity C-reactive protein (hs-CRP), HOMA-IR and lipoprotein profile levels in overweight persons with type 2 diabetes. The methodology followed a randomized controlled parallel design, which compared two dietary treatment modalities in adult Jamaicans who were overweight and diagnosed with type 2 diabetes (mean age 42.5 ± 2.0 years, 55% females, mean A1c 9.30 ± 0.56%) over six months. The intervention group (n=32) underlined the consumption of low-intermediate-GI foods, whereas the control group (n = 33) were not so advised and consumed a high-GI diet. Attempts were made to ensure that both groups were isocaloric with 45-50% of energy from carbohydrates. Consumption of low-intermediate GI foods resulted in significant reductions (p<0.005) in A1C compared to participants who consumed high GI foods (-0.84 ± 0.26 vs. -0.35 ± 0.04%), hs-CRP (-0.52 ± 0.17 vs. -0.17 ± 0.31 mg/dL) and tHCY (-1.32 ± 0.39 vs. -0.59 ± 0.38 µmol/L). Insulin sensitivity, HDL-C and triglycerides significantly improved in participants who consumed the low-intermediate-GI diet. The data strengthen the metabolic benefits of meal plans that emphasize the consumption of low and intermediate GI high fiber foods, particularly, indigenous Caribbean complex starchy foods.

scholarly journals TYPE 2 DIABETES MELLITUS;

2013 ◽  
Vol 20 (02) ◽  
pp. 237-243
Author(s):  
GHULAM HUSSAIN BALOCH ◽  
ABDUL QADIR DALL ◽  
ATIF SITWAT HAYAT ◽  
Syed Zulfiquar Ali Shah ◽  
Bikha Ram Devrajani
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
University Hospital ◽  
Diabetic Patients ◽  
Haemoglobin A1c ◽  
Type 2 Diabetic Patients ◽  
History Of ◽  
Upper Molar

Objective: To determine the frequency and pattern of dental carries in patients with type 2 diabetes mellitus. Design: Crosssectional descriptive study. Patients and methods: Patients with history of type 2 diabetes mellitus for ≥ 02 years duration with ≥ 35 years ofage and of either gender with dental pain visit at medical and dental outpatient department (OPD) of Liaquat University Hospital Hyderabad.The detail history was taken and the blood samples were taken for haemoglobin A1c (HbA1c) to assess the glycemic status. The existenceof dental carries and its pattern was diagnosed through dental examination by consultant dentist had clinical experience ≥05 years. The datawas collected on pre-designed proforma, entered and analyzed in SPSS version 11.00. Results: A total of 137 type 2 diabetic patients wereselected for this study, out of these 82 were males and 55 females. The dental carries was found in 98 (71.5%) patients. Out of these ninetyeight, 53 (54.08%) were males and 45 (45.92%) were female. Upper molar teeth involvement was present in 46 patients and lower molarteeth were involved in 52 patients. Dentine carries was seen in 35 patients, enamel carries in 19, white spot carries in 20 patients, pulpitis in16 patients, and pulp capping in 8 patients. Involvement of individual teeth was also assessed, the upper molar involvement was present in32 patients, premolar involvement was present in 11, incisor involvement in 03 patients. The lower molars were involved in 28 patients,lower pre molar in 21 and lower incisors in 03 patients. Dental carries was present in 43 (43.9%) patients in patients whose duration ofdiabetes was between 5-10 years, whereas those patients having duration >10 years had 31.6% frequency of dental carries, whileregarding duration of <5 years only 24 (24.5%) patients had dental carries. Conclusions: The diabetic patients are more prone to acquiredental caries.

scholarly journals Immunohistochemical evidence for the Na + /Ca 2+ exchanger in squid olfactory neurons

2000 ◽  
Vol 355 (1401) ◽  
pp. 1215-1218 ◽  
Author(s):  
Mary T. Lucero ◽  
Wei Huang ◽  
Tu Dang
Keyword(s):  
Polyclonal Antiserum ◽  
Specific Staining ◽  
Olfactory Neurons ◽  
Pseudostratified Epithelium ◽  
Electrophysiological Studies ◽  
Immunohistochemical Evidence ◽  
Olfactory Organs ◽  
Rapid Activation ◽  
Lolliguncula Brevis

The olfactory organs from the squid Lolliguncula brevis are composed of a pseudostratified epithelium containing five morphological subtypes of chemosensory neurons and ciliated support cells. Physiological recordings have been made from two of the subtypes and only the type 4 neuron has been studied in detail. Odour–stimulated increases in intracellular calcium and rapid activation of an electrogenic Na + /Ca 2+ exchanger current in type 4 neurons suggest that the exchanger proteins are localized very close to the transduction machinery. Electrophysiological studies have shown that olfactory signal transduction takes place in the apical ciliary regions of olfactory neurons. Using polyclonal antiserum against squid Na + /Ca 2+ proteins, we observed specific staining in the ciliary region of cells that resemble type 2, 3, 4 and 5 neurons. Staining was also observed in axon bundles, and in muscle tissue. Collectively, these data support the model that Na + /Ca 2+ exchanger proteins are localized to transduction machinery in cilia of type 4 neurons and suggest that the other olfactory subtypes also use Ca 2+ during chemosensory responses.

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