Case for diagnosis

We present a case of bullosis diabeticorum. It is a rare disorder, probably underdiagnosed, associated with long-term diabetes mellitus. Its etiology remains unclear. It is characterized by tense blisters, with serous content, recurrent and spontaneous on normal skin especially in the acral regions. Displays self-limiting course. No specific laboratory tests for diagnosis of this bullous disease exist. Clinical and conservative management to prevent secondary infection reduces morbidity in diabetic patients.

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The Relationship of Metabolic and Endocrine Parameters with Associated Diseases in Diabetes Mellitus

Revista de Chimie ◽

10.37358/rc.18.5.6311 ◽

2018 ◽

Vol 69 (5) ◽

pp. 1288-1291 ◽

Cited By ~ 1

Author(s):

Mariana Cornelia Tilinca ◽

Sandor Pal ◽

Zoltan Preg ◽

Eniko Barabas Hajdu ◽

Raluca Tilinca ◽

...

Keyword(s):

Diabetes Mellitus ◽

Scoring System ◽

Laboratory Tests ◽

Treatment Plan ◽

Individual Treatment ◽

Diabetic Patients ◽

Thyroid Disorders ◽

Associated Diseases ◽

Investigation Methods ◽

Predictive Role

The most common comorbidities in patients with diabetes mellitus are cardiovascular diseases, obesity, dyslipidemia, thyroid disorders but other associated diseases may frequently occur. Laboratory tests are useful investigation methods that may reveal the subclinical manifestations of the disease but they are also essential for patient monitoring. The aim of the study was to assess laboratory parameters and associated diseases in diabetic subjects and to implement a scoring system with a predictive role in the evolution of the cases. Material and methods: The study group consisted of 195 subjects with documented type 1 or type 2 diabetes. About half of the cases were collected from the Procardia outpatient unit, and the rest were patients admitted to the Diabetology Clinic in T�rgu Mure�. The study was performed between January - June 2017. The results of the laboratory tests, as well as the information regarding comorbidities and treatment, was collected and patients� body mass index was calculated. Based on the clinical data, a scoring system, called Diabetes Complication Severity Index (DCSI) with a predictive role, was implemented. The diabetic outpatients presented significantly better carbohydrate metabolic balance compared to the hospitalized subjects. No significant differences could be observed regarding kidney function, hepatic status and lipid profile of the two subgroups of diabetic subjects. The most important comorbidity observed in both patient groups was arterial hypertension. The hospitalized diabetic subjects had significantly higher incidence of ischemic heart disease and significantly lower incidence of thyroid disorders compared to the outpatients. The DCSI scoring system revealed that comorbidities are more frequently present in the hospitalized patients compared to the ambulant diabetic subjects. Evaluation of clinical status and laboratory results in diabetic patients followed by implementation of a scoring system based on the data obtained regarding comorbidities could help clinicians to set up an individual treatment plan for these patients, focusing on preventing other complications.

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Effectiveness of mobile applications on healthy lifestyles aimed at diabetic patients: review of systematic reviews. (Preprint)

10.2196/preprints.16098 ◽

2019 ◽

Author(s):

Francisco Jesús Represas Carrera Sr ◽

Ángel Alfredo Martínez Ques Sr ◽

Ana Clavería Fontán Sr

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Systematic Reviews ◽

Mobile Applications ◽

Control Group ◽

Diabetic Patients ◽

Healthy Lifestyles ◽

Major Public Health Problem

BACKGROUND Diabetes mellitus is currently a major public health problem worldwide. It is traditionally approached in a clinical inpatient relationship between the patient and the healthcare professional. However, the rise of new technologies, particularly mobile applications, is revolutionizing the traditional healthcare model through the introduction of telehealthcare. OBJECTIVE (1) To assess the effects of mobile applications for improving healthy lifestyles on the quality of life and metabolic control of diabetes mellitus in adult patients. (2) To describe the characteristics of the mobile applications used, identify the healthy lifestyles they target, and describe any adverse effects their use may have. METHODS Review of systematic reviews and meta-analysis, following the guidelines of the Cochrane Collaboration and the Joanna Briggs Institute. We included studies that used any mobile application aimed at helping patients improve self-management of diabetes mellitus by focusing on healthy lifestyles. Studies needed to include a control group receiving regular care without the use of mobile devices. In May 2018, a search was conducted in Medline, Embase, Cochrane, LILACS, PsychINFO, Cinahl and Science Direct, updated in May 2019. The methodological quality of the studies was assessed using the Amstar-2 tool. RESULTS Seven systematic reviews of 798 articles were initially selected for analysis. The interventions had a duration of between 1 and 12 months. Mobile applications focused singly or simultaneously on different lifestyles aspects (diet, physical exercise, motivation, blood glucose levels, etc.). There are significant changes in HbA1c values, body weight and BMI, although in others, such as lipid profile, quality of life, or blood pressure, there is no clear improvement. CONCLUSIONS There is clear evidence that the use of mobile applications improves glycemic control in diabetic patients in the short term. There is a lack of evidence in its long-term benefits. It is thus necessary to carry out further studies to learn about the long-term effectiveness of mobile applications aimed at promoting the healthy lifestyles of diabetic patients. CLINICALTRIAL PROSPERO Register: CRD42019133685

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Prognostic Utility of Coronary CT Angiography-derived Plaque Information on Long-Term Outcome in Patients With and Without Diabetes mellitus

10.21203/rs.3.rs-276309/v1 ◽

2021 ◽

Author(s):

Christian Tesche ◽

Moritz Baquet ◽

Maximilian Bauer ◽

Florian Straube ◽

Stefan Hartl ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Ct Angiography ◽

Risk Scores ◽

Diabetic Patients ◽

Cardiac Events ◽

Coronary Ct ◽

Adverse Cardiac Events ◽

Patients With Diabetes ◽

Low Attenuation Plaque

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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Outcomes and complications after percutaneous release for trigger digits in diabetic and non-diabetic patients

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415590389 ◽

2015 ◽

Vol 40 (7) ◽

pp. 735-739 ◽

Cited By ~ 17

Author(s):

H.-K. Huang ◽

J.-P. Wang ◽

S.-T. Wang ◽

Y.-A. Liu ◽

Y.-C. Huang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Patients ◽

Short Term ◽

Level Of Evidence ◽

Evidence Level ◽

Percutaneous Release ◽

Patients With Diabetes

We compared the short-term (3 months) and long-term (2 years) outcomes and complications of percutaneous release of 187 trigger digits of 154 patients treated between 2009 and 2012, all treated by a single surgeon. The 154 patients included 48 patients with diabetes mellitus and 106 non-diabetic patients. The only short-term complication was pain, occurring in three digits (5%) in the diabetic patients and six digits (5%) in the non-diabetic patients. The long-term complications were pain in 15 digits (25%) in the diabetic patients and 18 digits (14%) in the non-diabetic patients. This was not significant ( p = 0.058). Recurrent triggering occurred in nine digits (15%) in the diabetic patients, which was significantly greater than the six digits (5%) in the non-diabetic patients ( p = 0.013). The non-diabetic patients were significantly more satisfied. Level of Evidence: level III

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Predictive Value of N-Terminal Prohormone of Brain Natriuretic Peptide in Long-Term Remodeling of the Left Ventricle in Diabetic Patients of Young and Middle Age With Acute Coronary Syndrome After Percutaneous Coronary Intervention

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-4-511-520 ◽

2021 ◽

Vol 9 (4) ◽

pp. 511-520

Author(s):

Z. Wang ◽

E. A. Asaphyeva ◽

T. I. Makeeva

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Middle Age ◽

Coronary Intervention ◽

Diabetic Patients ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Patients With Diabetes ◽

Long Term Prognosis

Abstract. Recently, quantitative analysis of the level of the N-terminal prohormone of the brain naturetic peptide (NT-proBNP) has been widely used to diagnose heart failure (HF). A statistically significant correlation was found between the serum NT-proBNP concentration and HF stage. It was found that in patients with high cardiovascular risk, NT-proBNP has the highest predictive value in relation to mortality. In young and middle-aged patients with diabetes mellitus (DM) with myocardial infarction (MI) and stents of an infarct-associated artery, the frequency of unfavorable remodeling (UR) of the left ventricle (LV) in the long-term prognosis was studied. The frequency of atherosclerotic lesions of the coronary arteries (CA) in patients with diabetes in acute coronary syndrome (ACS) was determined, the results of echocardiographic parameters were presented in the follow-up dynamics, the value of serum NT-proBNP in predicting LV UR 12 months after myocardial infarction (MI) was determined.Aim of study. To assess the diagnostic capabilities of NT-proBNP in the long-term prediction of the development of LV infarction in patients with MI with diabetes in young and middle age after percutaneous coronary intervention (PCI).Design. Prospective controlled non-randomized trial. The patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months after AMI. The study included 191 patients with ACS with / without ST-segment elevation, who were divided into two groups. The main group included 76 patients with ACS with diabetes mellitus, the comparison group included 115 patients with ACS without diabetes mellitus. Patients in both groups were comparable in age, gender, comorbidity, and complications of AMI. The duration of diabetes was, on average, 6 years (from one to 12 years).Material and methods. All patients underwent electrocardiography, echocardiography, tests for the content of troponin I, NT-proBNP, glycosylated hemoglobin, lipids, determined the level of creatinine in the blood and the glomerular filtration rate according to the Modification of diet in renal disease (MDRD). All patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months later.Results. In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the diagnosis and prognosis of LV UR after 12 months.Conclusion. The NT-proBNP level of more than 776 pg/ml on the first day after PCI is an indicator of an unfavorable long-term prognosis in patients with young and middle-aged diabetes in terms of the development of LV systolic dysfunction.

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Focal crisis originating from movement in a hyperglycemic nonketotic patient

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1991000200020 ◽

1991 ◽

Vol 49 (2) ◽

pp. 222-224

Author(s):

J. Adamo Jr. ◽

F. Forti

Keyword(s):

Diabetes Mellitus ◽

Case Report ◽

Diabetic Patient ◽

Serum Levels ◽

Passive Movement ◽

Diabetic Patients ◽

Rare Type ◽

Initial Manifestation ◽

The Right

Case report of a long term diabetic patient with partial motor crises originating from passive movement of the right arm. This is a rare type of crisis when compared to spontaneous partial crisis in diabetic patients. Partial crises are often the initial manifestation of diabetes mellitus (about 19% of the cases reported). As in those cases registered in the literature, crisis control in this case was obtained by normalization of glycose serum levels. Possible mechanisms involved in the pathogenesis are discussed.

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Complications of Diabetes Mellitus

10.2310/im.1158 ◽

2019 ◽

Author(s):

Samuel Dagogo-Jack

Keyword(s):

Diabetes Mellitus ◽

Diabetic Neuropathy ◽

Key Words ◽

Diabetic Patients ◽

Chronic Complications ◽

Complications Of Diabetes ◽

Vessel Disease ◽

Key Words Hyperglycemia ◽

Large Vessel Disease

The long-term complications of diabetes mellitus include those attributable to hyperglycemia-mediated small vessel (microvascular)and neuropathic complications and syndromes resulting from multifactorial large vessel disease (macrovascular complications). Diabetic patients with evidence of chronic complications are best managed in consultation with appropriate specialists. The microvascular and neuropathic complications, which are specifically related to hyperglycemia, include retinopathy, nephropathy, and diabetic neuropathy. This review contains 8 figures, 9 tables, and 83 references. Key Words: Hyperglycemia, hypoglycemia, macrovascular, microvascular, neuropathic

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Older patients with diabetes mellitus who are obese have a better long-term prognosis: an analysis of outcome in 12,025 diabetic patients

European Heart Journal ◽

10.1093/eurheartj/eht308.1611 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. 1611-1611

Author(s):

P. Costanzo ◽

P. Pellicori ◽

D. Hepburn ◽

E. S. Kilpatrick ◽

K. Goode ◽

...

Keyword(s):

Diabetes Mellitus ◽

Older Patients ◽

Diabetic Patients ◽

Patients With Diabetes ◽

Long Term Prognosis

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Characteristics of Long Term Peritoneal Dialysis Survivors: 18 Years Experience in One Center

Peritoneal Dialysis International ◽

10.1177/089686089701700209 ◽

1997 ◽

Vol 17 (2) ◽

pp. 151-156 ◽

Cited By ~ 13

Author(s):

Emaad M. Abdel-Rahman ◽

Maureen Wakeen ◽

Stephen W. Zimmerman

Keyword(s):

Diabetes Mellitus ◽

Type Ii Diabetes ◽

Type I Diabetes ◽

Type Ii Diabetes Mellitus ◽

Diabetic Patients ◽

Type I ◽

Term Survival ◽

Hospital Days ◽

Long Term Survivors

Objectives Long-term experience of patients on peritoneal dialysis (PD) in general, and in diabetic patients specifically, is limited. Few patients have been followed on PD for over 8 years. Our aim was to evaluate and characterize long-term survivors (L TS) on PD for more than 100 months. A retrospective analysis of 20 patients who survived on PD for more than 100 months was performed. Data on long-term survivors was compared to data of 103 patients who died or switched to hemodialysis (HD) in less than 100 months. Design The study included all patients starting PD prior to 1 January 1986. Demographic, biochemical, dialysis prescription, and morbidity data were obtained on these patients. Characteristics of long-term survivors on PD (more than 100 months), was compared with those who died or switched to HD in less than 100 months, using Student t-test. Setting An experienced single center, university-based dialysis program. Patients 165 patients started PD at the University of Wisconsin prior to 1 January 1986. Forty three had type I diabetes mellitus and 24 had type II diabetes mellitus as the cause of their renal failure. Results Twenty patients survived on PD more than 100 months (L TS). Long-term survival of type I diabetic patients was seen in 7 of 43 patients at risk. Seventeen type I diabetics received renal transplants and ten died. 103 patients either died or switched to HD in less than 100 months. Long-term survivors were significantly younger, weighed less, had fewer episodes of peritonitis, fewer hospital days, and were prescribed more dialysis per kg body weight, than those who died or switched to HD prior to 100 months. Conclusions Long-term survival on CAPD for longer than 100 months is possible with survival periods up to 18 years in both males and females and in nondiabetics as well as patients with type I diabetes mellitus. No patient with type II diabetes mellitus survived longer than 100 months on CAPD. In comparison to short-term survivors, long-term survivors were characterized by being younger, weighing less, having fewer episodes of peritonitis, fewer hospital days, and were prescribed more dialysis/kg body weight.

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HEART TRANSPLANTATION IN DIABETIC RECIPIENTS

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2018-1-120-126 ◽

2018 ◽

Vol 20 (1) ◽

pp. 120-126 ◽

Cited By ~ 1

Author(s):

V. N. Poptsov ◽

E. N. Zolotova

Keyword(s):

Diabetes Mellitus ◽

Heart Transplantation ◽

Severe Disease ◽

Treatment Options ◽

Diabetic Patients ◽

Post Transplantation ◽

Term Survival ◽

Severe Diabetes ◽

Artery Disease

Diabetes mellitus is one of the most prevalent chronic metabolic disorders. Its role in patients with heart transplantation is not unifi ed. According to some authors, post-transplantation diabetes mellitus increases the risk of acute rejections and infections, increases the incidence of coronary artery disease of the graft and reduces long-term survival of patients with heart transplantation. On the other hand other studies did not confi rm these fi ndings. However, when diabetic patients were stratifi ed by disease severity, recipients with less severe disease achieved better survival. Accordingly, posttransplant survival was not signifi cantly different between recipients with uncomplicated diabetes and nondiabetic recipients. Diabetes alone should not be a contraindication to heart transplantation. Well-selected diabetic patients achieve the same survival as nondiabetic patients. Conversely, patients with complicated diabetes have signifi cantly worse survival. Therefore, given the critical shortage of transplantable organs, maximal benefi t may be achieved by exploring alternative treatment options in individuals with severe diabetes. These include use of high-risk transplant lists and destination therapy.

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