Preoperative Assessment of the Patient with Diabetes Mellitus

Diabetic Patients ◽

Key Words Diabetes ◽

Hyperglycemic Hyperosmolar State ◽

Diabetes mellitus is a major cause of morbidity and mortality. Nearly 30 million Americans have diabetes, more than 25% of which are undiagnosed. Patients with diabetes have multiple problems that should be addressed prior to surgery. They often have uncontrolled glucose levels that should be treated preoperatively. Current studies suggest that outcomes may be improved if perioperative glycemic control is optimized. Patients with diabetes develop end-organ dysfunction that can complicate perioperative management. Preoperative assessment of cardiac, neurologic, vascular, and renal function is necessary for all patients with diabetes that undergo major surgery. Optimization of cardiac disease in particular can reduce major adverse cardiac events for patients with risk factors such as diabetes. Diabetic patients can occasionally present for major surgery with hyperglycemic emergencies such as diabetic ketoacidosis and hyperglycemic hyperosmolar state. These conditions require urgent treatment to prevent mortality regardless of the need for surgery. This article reviews the preoperative assessment and management of these issues. This review contains 1 figure, 4 tables, and 37 references. Key Words: diabetes mellitus (DM), end-organ damage, hyperglycemia, polyuria, polydipsia, polyphagia, perioperative glycemic management, diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), perioperative cardiac risk factors

Heart failure in patients with diabetes in Campania

The Journal of AMD ◽

10.36171/jamd19.22.4.06 ◽

2019 ◽

Vol 22 (4) ◽

pp. 219

Author(s):

Botta, A.

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Ejection Fraction ◽

Clinical Symptoms ◽

Healthcare Services ◽

Diabetic Patients ◽

Key Words Diabetes ◽

Antidiabetic Therapy ◽

Heart Failure (HF) and Type 2 Diabetes Mellitus (T2D) are important clinical conditions that often coexist, mutually influencing intra- and extra-hospital morbidity and mortality. In order to characterize the diagnostic and therapeutic management of patients with HF and T2D, a retrospective observational study was conducted on database of the last 12 months in 8 Campania Diabetology Centers. 164 patients were affected by HF and T2D. Among them, 123 patients had a medical record with reproducible data and were recruited for the study. Diabetic patients were divided into three groups: group A included patients with preserved ejection fraction (EF) (> 50 %), group B patients with midrange EF (40-49%) and the group C patients with reduced EF (< 40%). All patients had performed ECG and echocardiography, repeated every 6 months; 41 patients (33% of the sample) also performed a cardiac Holter. The most frequent causes of HF were ischemic heart disease and hypertension. After a 12 months follow up, the clinical and laboratory parameters and the treatments adopted were re-evaluated. The antidiabetic drugs resulted modified with a reduction in the use of metformin, sulfonylureas, glinids and pioglitazone; at the same time a greater use of gliptins, gliflozines and GLP1 AR and a lower use of insulin therapy was observed. Cardiological therapy was modified with a greater use of diuretics and nitrates and a reduction of ACEI and ARB, probably due to the use of sacubitril/valsartan association in the group of patients with reduced EF. According to the recent guidelines, antidiabetic therapy must be tailored to the characteristics of the patients with diabetes and heart failure, preferring the use of molecules that have shown a cardiovascular protection effect or, secondarily, those with cardiovascular neutrality. Similarly, cardiological therapies have to consider the type of antidiabetic agents used and benefit from molecules that impact clinical symptoms and natural history. Finally, the approach to the patients with both the pathologies must necessarily take place in the healthcare districts and absolutely be multidisciplinary and integrated, involving firstly Diabetologists and Cardiologists, but also other professional roles (nurses, psychologists, physiotherapists, caregivers) operating in the territorial healthcare services. KEY WORDS diabetes mellitus; heart failure; ejection fraction.

The perception of Italian diabetologists on anti-influenza and anti-diphtheria-tetanus-pertussis vaccinations in subjects with diabetes mellitus: the AMD survey

The Journal of AMD ◽

10.36171/jamd19.22.3.03 ◽

2019 ◽

Vol 22 (3) ◽

pp. 99

Author(s):

Candido, R.

Keyword(s):

Diabetes Mellitus ◽

Influenza Vaccine ◽

Pertussis Vaccine ◽

Online Survey ◽

Influenza Infection ◽

Diabetic Patients ◽

Key Words Diabetes ◽

Patients With Diabetes ◽

Prevention Plan

Diabetes mellitus is associated with an increased incidence of some infections and a greater severity and/or frequency of complications related to these diseases. Influenza is characterized by an increased severity of clinical course and risk of complications, especially in diabetic patients who are more susceptible to influenza infection. For these reasons, the Italian Vaccine Prevention Plan 2017-19 provides an active and free offer of influenza vaccine for the diabetic subjects. In addition, among the vaccinations recommended by the Italian Prevention Plan in adults, including the diabetes ones, there is the diphtheria-tetanus-pertussis vaccine and the decennial booster. To investigate what is the perception of Italian diabetologists on the role and importance of the influenza and the diphtheria-tetanus-pertussis vaccines, AMD has promoted an online survey. Participants claimed to be aware of the importance of carrying out and recommending influenza vaccination, while awareness of the usefulness of performing and suggesting the decennial booster for diphtheria-tetanus-pertussis was lower. Diabetologists attribute to patients’ resistance and lack of interest in such vaccinations the main motivation for which they are not used to recommend them, even if they acknowledge that they have little knowledge about the decennial booster of diphtheria-tetanus-pertussis vaccine. The survey shows that the percentage of patients with diabetes who seek advice on these vaccinations is inadequate and the diabetologists’ knowledge of the National Vaccination Prevention recommendations and the need to actively promote vaccinations is inappropriate. This survey has allowed to highlight the opinion, of a significant percentage of Italian diabetologists, on some key aspects of the vaccination therapy indicated in diabetic patient, allowing to gather important information to open a debate, to know strengths and weaknesses on this topic and implement training activities. KEY WORDS diabetes mellitus; influenza vaccine; diphtheria-tetanus-pertussis vaccine; survey.

When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

Journal of Fungi ◽

10.3390/jof7040298 ◽

2021 ◽

Vol 7 (4) ◽

pp. 298

Author(s):

Teny M. John ◽

Ceena N. Jacob ◽

Dimitrios P. Kontoyiannis

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Clinical Features ◽

The Other ◽

Diabetic Patients ◽

Epidemiological Factors ◽

Uncontrolled Diabetes ◽

Diagnostic Certainty ◽

Patients With Diabetes ◽

Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

Journal of the American Podiatric Medical Association ◽

10.7547/1010049 ◽

2011 ◽

Vol 101 (1) ◽

pp. 49-54 ◽

Cited By ~ 12

Author(s):

Aynur Gulcan ◽

Erim Gulcan ◽

Sukru Oksuz ◽

Idris Sahin ◽

Demet Kaya

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Fasting Blood Glucose ◽

Diabetic Patients ◽

Essential Components ◽

Patients With Diabetes ◽

Epidemiologic Risk

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

Glucose Control

10.2310/7ccsp.8017 ◽

2020 ◽

Author(s):

Timothy P. Graham ◽

Erich N. Marks ◽

Joshua J. Sebranek ◽

Douglas B. Coursin

Keyword(s):

Diabetes Mellitus ◽

Critically Ill ◽

Glucose Control ◽

Cost Of Care ◽

Hospital Length Of Stay ◽

Glucose Measurement ◽

Key Words Diabetes ◽

Adult Intensive Care Unit ◽

Patients with diabetes mellitus routinely require management in the adult intensive care unit (ICU). These patients have increased morbidity, mortality, hospital length of stay, cost of care, and frequency of hospital and ICU admission. Glucose control in these patients presents challenges for the clinician. In the critically ill, hyperglycemia does not occur exclusively in patients with diabetes or prediabetes but may be related to stress-induced hyperglycemia or iatrogenic causes. Hyperglycemia can contribute to decreased wound healing and immune function and a host of cellular and molecular dysfunctions and has been linked to increased hospital mortality. Hypoglycemia in the ICU is associated with patients with preexisting diabetes, those receiving insulin and other medications, and septic individuals, among others. Insulin therapy is the mainstay of glucose management in the critically ill. ICU practitioners should be aware that point-of-care glucose meters are not as accurate as core laboratory results. Finally, both hypoglycemia and wide fluctuations in blood glucose during critical illness are also associated with increased mortality, although clear cause-and-effect relationships have not been established. This review contains 1 figure, 8 tables, and 71 references. Key words: Diabetes mellitus, glucose measurement, glucose targets, hyperglycemia, hypoglycemia, insulin

Asociación del control glucémico con la disfunción eréctil en pacientes diabéticos

Revista Mexicana de Urología ◽

10.48193/rmu.v77i1.2 ◽

2017 ◽

Vol 77 (1) ◽

Author(s):

Juan Figueroa García Juan

Keyword(s):

Diabetes Mellitus ◽

Erectile Dysfunction ◽

Glycemic Control ◽

Odds Ratio ◽

Glycated Hemoglobin ◽

Diabetic Patients ◽

Key Words Diabetes ◽

Control Glucémico ◽

Inadequate Glycemic Control

ANTECEDENTES: la disfunción eréctil es la incapacidad para conseguir y mantener una erección que permita una penetración sexual satisfactoria en 50% de las veces, en un periodo de tres meses. Entre las causas orgánicas, la diabetes mellitus representa 30%. A pesar de esta relación la prevalencia es poco conocida en nuestro medio.OBJETIVO: determinar la asociación entre el control glucémico y la disfunción eréctil en diabéticos.MATERIALES Y MÉTODOS: estudio observacional, transversal y analítico al que se incluyeron pacientes que no refirieron complicaciones al momento del estudio. A todos se les aplicó el cuestionario IIFE-5 (Índice Internacional de la Función Eréctil) para detectar si padecían o no disfunción eréctil, se compararon las concentraciones de hemoglobina glucosilada (HbA1c), y se analizó su asociación mediante la aplicación de la razón de momios.RESULTADOS: en 362 pacientes se encontró una prevalencia de disfunción eréctil de 72.3% (n=272), de estos 80.9% (n=212) estaban en descontrol glucémico, con una razón de momios de 6.92 (IC95%: 4.16 a 11.50).CONCLUSIONES: en los pacientes diabéticos existe una relación 7:1 de probabilidad de disfunción eréctil versus pacientes con adecuado control glucémico.PALABRAS CLAVE: diabetes mellitus, disfunción eréctil, hemoglobina glucosilada, control glucémico. AbstractBACKGROUND: Erectile dysfunction is the inability to achieve and maintain an erection that enables satisfactory sexual penetration 50% of the time, within a 3-month period. Diabetes mellitus is the organic cause in 30% of cases, but despite this relation, the prevalence of erectile dysfunction is not well known in Mexico.OBJECTIVE: To determine the association between glycemic control and erectile dysfunction in diabetic patients.MATERIALS AND METHODS: An observational, cross-sectional, analytic study included diabetic patients that did not complain of complications at the time of the study. The International Index of Erectile Function (IIEF-5) questionnaire was applied to detect whether or not the patients presented with erectile dysfunction. Their glycated hemoglobin (HbA1c) levels were compared and the association with erectile dysfunction was analyzed through the odds ratio.RESULTS: The prevalence of erectile dysfunction in 362 patients was 72.3% (n=272). Of those patients with erectile dysfunction, 80.9% (n=212) had inadequate glycemic control, with an odds ratio of 6.92 (95% CI: 4.16 to 11.50).CONCLUSIONS: The odds ratio of presenting with erectile dysfunction for diabetic men with inadequate glycemic control and patients with adequate glycemic control was 7:1.KEY WORDS: Diabetes mellitus; Erectile dysfunction; Glycated hemoglobin; Glycemic control

Risk factors for eye complications in patients with diabetes mellitus: development and progression

Eastern Mediterranean Health Journal ◽

10.26719/2000.6.2-3.313 ◽

2000 ◽

Vol 6 (2-3) ◽

pp. 313-325

Author(s):

M. El Shazly ◽

M. Zeid ◽

A. Osman

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Diabetic Retinopathy ◽

Case Control Study ◽

Case Control ◽

Diabetic Patients ◽

Patients With Diabetes ◽

Control Study

A multicentre case-control study was conducted to identify and quantify risk factors that may influence the development and progression of diabetic retinopathy. A total of 200 diabetic patients with nonproliferative retinopathy were compared with 400 diabetic patients without any eye complications with regard to the development of diabetic retinopathy. They were also compared with 200 diabetic patients with major eye complications to study the progression of diabetic eye complications. Results showed that the progression of diabetic eye complications was preventable since all the variables significantly affecting the process of progression, except type of diabetes, were avoidable

Prevention and treatment of diabetic microangiopathy: A lecture

Problems of Endocrinology ◽

10.14341/probl11491 ◽

1995 ◽

Vol 41 (6) ◽

pp. 29-34

Author(s):

A. K. Dreval

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Blood Pressure ◽

Coronary Heart Disease ◽

Diabetic Microangiopathy ◽

Diabetic Patients ◽

Atherosclerotic Vascular Disease ◽

Diabetic Macroangiopathy ◽

Prevention And Treatment ◽

One of the main complications leading to high disability and mortality in patients with diabetes mellitus is atherosclerotic vascular disease (diabetic macroangiopathy). At the same time, the frequency of atherosclerosis among patients with diabetes mellitus is significantly affected by the so-called risk factors for atherosclerosis. In particular, the incidence of atherosclerosis among the general population and among diabetics increases with increased levels of cholesterol (cholesterol) in the blood, blood pressure, smoking and obesity. However, in patients with diabetes mellitus, mortality, for example, from coronary heart disease increases by 3 times against any of the known risk factors. But even without risk factors, the frequency of atherosclerotic vascular damage in patients with diabetes is much higher than in non-diabetic patients, i.e. diabetes in itself is a risk factor for atherosclerosis.

The risk factors of developing diabetic foot ulcers incidence with diabetic patients in Mukalla/Yemen

Sudan Journal of Medical Sciences ◽

10.18502/sjms.v15i2.6750 ◽

2020 ◽

Author(s):

مريم باراس ◽

Eidha A. Bin Hameed

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Blood Glucose ◽

Bacterial Infection ◽

Diabetic Foot ◽

Age Groups ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Patients ◽

Background: Diabetes is on the rise worldwide and is already considered as an epidemic by some experts. So, there is a need to raise awareness on the important factors that can help prevent bacterial infection in wounds of patients with diabetes. Objective: To study the risk factors of developing diabetic foot ulcer (DFU) in patients with diabetes. The study is the first in Yemen to investigate the prevalence of bacterial infection in wounds of diabetic patients. Materials and Methods: This is a case-control study carried out from November 2018 to May 2019. Twenty diabetic patients with foot ulcer and twenty without foot ulcer were examined. Risk factors and clinical profile of patients were studied by using a standardized questionnaire that included gender, age groups, past history of diabetes, duration of the disease, type of diabetes, DFU, type of ulcer, smoking, glucose level, and control of blood glucose level. Results: The risk factors that affected significantly the occurrence of DFU were gender (0.038), age groups (0.010), and duration of diabetes mellitus (DM) while hyperglycemic control, smoking, and family history were not. There was no significant difference (0.977) in mean fasting blood glucose (MBG) between the DM and DFU patients. Conclusions: Male diabetic patients aged more than 55 years and suffering from DM for more than 10 years were most likely to have DFU. Key words: diabetic foot ulcer, diabetes mellitus, risk factors, Yemen

Consequences of misdiagnosis of diabetic charcot anthropathy of the ankle

Ibrahim Medical College Journal ◽

10.3329/imcj.v4i2.6503 ◽

1970 ◽

Vol 4 (2) ◽

pp. 83-86

Author(s):

Chowdhury Iqbal Mahmud

Keyword(s):

Diabetes Mellitus ◽

Ankle Fracture ◽

Ankle Arthrodesis ◽

Fracture Dislocation ◽

Diabetic Patients ◽

Key Words Diabetes ◽

Charcot Arthropathy ◽

Uncontrolled Diabetes ◽

History Of

Permanent deformity and disability can occur in diabetic Charcot arthropathy (neuropathic arthropathy) if not diagnosed and treated promptly. We report two patients with uncontrolled diabetes mellitus in whom the diagnosis of ankle neuro-arthropathy was delayed by up to six months, with misdiagnoses including ankle arthritis, osteomyelitis and cellulitis. The clinical scenario and appearances of the ankle and foot were typical of Charcot arthropathy. Unfortunately, both of them sustained ankle fracture-dislocation without a history of significant trauma. Both the patients were treated by ankle arthrodesis (fusion of joint). Prevention and early diagnosis of diabetic foot is the key to avoid the development of complications. In diabetic patients, a higher index of suspicion for the possibility of Charcot’s disease is needed. Key Words: Diabetes mellitus; Charcot arthropathy; ankle fracture-dislocation; arthrodesis. DOI: 10.3329/imcj.v4i2.6503Ibrahim Med. Coll. J. 2010; 4(2): 83-86