Treatment choices for managing glucose control in impaired renal function: Interim Results

ABSTRACT ObjectivesPatients with chronic kidney disease (CKD ≥3) and diabetes mellitus comprise approximately 25% patients with diabetes. These patients are at a higher risk of cardiovascular morbidity and mortality and furthermore therapies targeting glucose control are limited. The management of glycaemic control in type 2 diabetes and chronic renal disease is difficult with limited therapeutic choices. This issue has been a matter of longstanding debate. Following a number of joint Diabetes-Renal meetings between the Diabetes and Renal teams based in Hywel Dda and ABM University Health Boards, a proposal was put forward to the SAIL team to examine the relationship between diabetes therapies in relation to eGFR, as this may influence further practice and guidance for patients with type 2 diabetes and renal impairment. ApproachLinkage and re-use of routinely collected anonymised clinical data held in the SAIL databank was employed, to identify a cohort of adult patients in Abertawe Bro Morgannwg Health Board (ABMU) having type 2 diabetes (excluding type 1 diabetes). Diagnosis of diabetes was achieved by use of National Health Service ‘Read’ codes. Creatinine, eGFR, age, gender, weight, height, cholesterol, LDL, HDL, TG, systolic blood pressure, diastolic blood pressure, diabetes medication prescriptions, the use of statins, ACEis, aspirin, CHD status, CVD status, duration of diabetes were identified in primary care GP and pathology datasets. Results42170 (6.0%) of adults in ABMU were identified as having type 2 (excluding type 1) diabetes , 13369 of which had good GP registration coverage. The gender split was male 56%, female 44%. Duration of diabetes (years) was (mean/median/SD/IQR) 9.96/8.97/6.78/8.10; weight (Kg) was 86.94/85.00/21.23/28.19; age (years) 65.49/66.74/13.75/19.03; BMI 31.57/30.70/6.62/7.99. Incidence of CKD as defined by GP coded data was 24%, renal replacement therapy 0.4%, Ischaemic Heart Disease 22%. Prevalence of prescriptions during 2014 was: Anti-diabetic medication 72%, statins 75%, aspirin 34%, ACEi/ARB 61%. The import of pathology laboratory data into SAIL is currently pending, and is anticipated before April 2016. This will allow the accurate stratification of CKD status and detailed description of use of anti-diabetic agents. ConclusionThe project methods and coding structure are well place to provide anticipated results as soon as pathology data arrives. The percentage of ABMU patients having type 2 diabetes is in line with other literature for adults in the UK.

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Clinical significance of intramammary arterial calcifications in diabetic women

Vojnosanitetski pregled ◽

10.2298/vsp0402163m ◽

2004 ◽

Vol 61 (2) ◽

pp. 163-167 ◽

Cited By ~ 2

Author(s):

Zorica Milosevic ◽

Jelica Bjekic ◽

Stanko Radulovic ◽

Branislav Goldner

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Control Group ◽

Duration Of Diabetes ◽

Diabetic Macroangiopathy ◽

Indirect Sign ◽

Significant Difference

Background. It is well known that intramammary arterial calcifications diagnosed by mammography as a part of generalized diabetic macroangiopathy may be an indirect sign of diabetes mellitus. Hence, the aim of this study was to determine the incidence of intramammary arterial calcifications, the patient?s age when the calcifications occur, as well as to observe the influence of diabetic polineuropathy, type, and the duration of diabetes on the onset of calcifications, in comparison with nondiabetic women. Methods. Mammographic findings of 113 diabetic female patients (21 with type 1 diabetes and 92 with type 2), as well as of 208 nondiabetic women (the control group) were analyzed in the prospective study. The data about the type of diabetes, its duration, and polineuropathy were obtained using the questionnaire. Statistical differences were determined by Mann-Whitney test. Results. Intramammary arterial calcifications were identified in 33.3% of the women with type 1 diabetes, in 40.2% with type 2, and in 8.2% of the women from the control group, respectively. The differences comparing the women with type 1, as well as type 2 diabetes and the controls were statistically significant (p=0.0001). Women with intramammary arterial calcifications and type 1 diabetes were younger comparing to the control group (median age 52 years, comparing to 67 years of age, p=0.001), while there was no statistically significant difference in age between the women with calcifications and type 2 diabetes (61 years of age) in relation to the control group (p=0.176). The incidence of polineuropathy in diabetic women was higher in the group with intramammary arterial calcifications (52.3%) in comparison to the group without calcifications (26.1%), (p=0.005). The association between intramammary arterial calcifications and the duration of diabetes was not found. Conclusion. The obtained results supported the theory that intramammary arterial calcifications, detected by mammography could serve as markers of co-existing diabetes mellitus and therefore should be specified in radiologic report in case of their early development.

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Diabetes and liaison psychiatry: the characteristics of patients with diabetes referred to a liaison psychiatry service in London

BJPsych Open ◽

10.1192/bjo.2021.309 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S104-S104

Author(s):

Alexandra Simpson ◽

Lucy Bradford ◽

Marilia Calcia

Keyword(s):

Mental Health ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Diabetic Patients ◽

Diabetes Diagnosis ◽

Psychiatric Consultation ◽

Liaison Psychiatry ◽

Self Harm

AimsTo determine the characteristics of adult patients referred to a Liaison Psychiatry service in a general teaching hospital in London, UK with 950 inpatient adult beds.MethodAll referrals for adult inpatient psychiatric consultation made during a period of 9 months were reviewed; those that involved a patient with a diagnosis of diabetes were analysed. Descriptive statistics were used; data were collected on demographic characteristics and physical and mental health parameters, including type of diabetes, number of years since diabetes diagnosis, glycaemic control, presence of diabetes-related complications, reason for Psychiatry consultation request, psychiatric diagnosis, psychotropic medication, frequency of admissions to general hospital, psychiatric risk issues and outcome of psychiatric consultation.ResultPilot results indicate that 30 diabetic patients were referred for a psychiatric consultation in 9 months. Of those, 9 had type 1 diabetes, 17 had type 2 diabetes and 1had pre-diabetes 3 were unknown. 13 were male and 17 were female; the median age was 46 (range 18 to 68); the ethnicities were 6 White, 15 Black, 1 Asian and 8 other.Diabetes-related complications were present in 77% (retinopathy 10%, kidney disease 27%, neuropathy 13%, diabetic foot 16%). 6% had comorbid cardiovascular disease. 10% were on dialysis and 3% had had amputations.The main reason for referral for psychiatric consultation was low mood and self harm; other reasons were recurrent DKA, anxiety and self neglect. Psychiatric risk issues included 20% risk of self-harm/suicide; 13% risk of violence; 10 risk of self-neglect. The outcomes of liaison psychiatry consultation were: 30% received an assessment that led to recommendations to the general medical team and did not require further psychiatric input; 27% received continued psychiatric follow-up during the admission. With regards to treatment, 36% had psychiatric treatment (including medication) reviewed; 47% received general treatment recommendations, including recommendations for new laboratory or radiological investigations or change in level of nursing care. 20% required transfer to an inpatient psychiatric unit, with 33% discharged to care of community mental health.ConclusionOur findings indicate the scope of practice for a Liaison Psychiatry service with regards to adult hospital inpatients with diabetes. Our data suggest that patients with type 2 diabetes are the majority of inpatients with diabetes that require psychiatric consultations, and that the majority of those are patients already known to psychiatric services due to long-term severe mental disorders, particularly schizophrenia, schizoaffective disorder or bipolar disorder. Most of those patients have medical comorbidities and severe diabetes-related complications. Patients with type 1 diabetes, despite making up a smaller proportion of referrals for psychiatric consultations, also tend to have recurrent hospital admissions and features of self-neglect.

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1888-P: Impaired Insulin Clearance Relates to Increased Liver Fat Content in Recent-Onset Type 2 Diabetes and to Impaired Glucose Control in Recent-Onset Type 1 Diabetes

Diabetes ◽

10.2337/db19-1888-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1888-P

Author(s):

SOFIA ANTONIOU ◽

OANA P. ZAHARIA ◽

KLAUS STRASSBURGER ◽

YANISLAVA KARUSHEVA ◽

KALMAN BODIS ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Glucose Control ◽

Liver Fat ◽

Liver Fat Content ◽

Recent Onset ◽

Onset Type ◽

Impaired Insulin

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The validity of the diabetes mellitus diagnosis in the Medical Birth Registry of Norway

Norsk Epidemiologi ◽

10.5324/nje.v17i2.158 ◽

2009 ◽

Vol 17 (2) ◽

Cited By ~ 2

Author(s):

Lars C. Stene ◽

Ingvild Eidem ◽

Siri Vangen ◽

Geir Joner ◽

Lorentz M. Irgens ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Gestational Diabetes ◽

Medical Record ◽

Diabetes Diagnosis ◽

Registration Form ◽

Birth Registry ◽

Medical Birth Registry

<p>The Medical Birth Registry of Norway (MBRN) has registered all births in Norway since 1967 and diabetes is registered as a maternal diagnosis. We present original data assessing the validity of the diabetes diagnosis. Among women with known pre-gestational type 1 diabetes, 97% of births during 1976-1998 (old registration form) were identified as pre-gestational diabetes in the MBRN. For births 1999-2004 (new registration form), 94% were identified as pre-gestational diabetes in the MBRN. Of cases coded as pre-gestational diabetes by the MBRN, 80% were confirmed by the medical record for births during 1998, while more than half of the births incorrectly coded as pre-gestational diabetes really were gestational diabetes. Among births coded as gestational diabetes, 89% were confirmed in the medical record. In conclusion, the sensitivity of the pregestational diabetes diagnosis in the Medical Birth Registry of Norway was very good, particularly in the earlier period, but the information in the MBRN on births before 1999 was not sufficient to classify pregestational diabetes as type 1 – or type 2 diabetes. The type of diabetes can be specified for births from 1999 onwards, but the predictive values are unknown. The predictive value for pre-gestational diabetes in 1998 was less than optimal but acceptable for a routine registry not specialised for diabetes</p><p>Gravide kvinner med type 1 diabetes har økt risiko for komplikasjoner i svangerskapet, medfødte misdannelser og dødfødsel. Data fra medisinsk fødselsregister (MFR) har vært grunnlag for viktige publikasjoner om risiko for komplikasjoner hos gravide kvinner med diabetes. I tillegg til å gi en kort oversikt over disse publikasjonene presenterer vi data om validiteten til diabetesdiagnosen. Av fødsler til og med 1998 med kjent type 1 diabetes før svangerskapet basert på opplysninger fra Norsk diabetesregister (NDR) ble 97% registrert som diabetes før svangerskapet i MFR (gammelt registreringsskjema). For fødsler 1999-2004, ble 94% kodet som pre-gestasjonell (type 1- eller type 2-) diabetes. Ved sammenligning med sykehusjournalen til kvinner identifisert i MFR med diabetesdiagnose før svangerskapet (fødsler i 1998) ble diabetes før svangerskapet i følge MFR bekreftet i journalen i 80% av tilfellene. Av fødsler kodet med svangerskapsdiabetes ble 89% bekreftet i journalen. Vi konkluderer med at sensitiviteten for pre-gestasjonell diabetes er meget god, spesielt for fødsler før 1999, men MFR kan for denne perioden ikke brukes til å klassifisere pre-gestasjonell diabetes hos mor som type 1- eller type 2 diabetes. For fødsler fra og med 1999 kan type diabetes spesifiseres, men prediktiv verdi for disse diagnosene er ikke undersøkt. Prediktiv verdi for diagnosen pre-gestasjonell diabetes i MFR for fødsler i 1998 er ikke optimal, men akseptabel for et rutineregister som ikke har diabetes som hovedfokus.</p>

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Practical aspects of cardiovascular risk factors identify in patients with diabetes type 1 and 2

Clinical Practice ◽

10.17816/clinpract83803 ◽

2011 ◽

Vol 3 (1) ◽

pp. 4-9

Author(s):

Mehman N. Mamedov ◽

Marina N. Kovrigina ◽

Marina B. Buzurtanov

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Capillary Blood ◽

The Difference

The aim of this study was to investigate the characteristics of the risk factors and comparative analysis of different methods of identify of cardiovascular risk factors in outpatient with diabetes mellitus (DM) type 1 and 2. Methods. In cross-sectional clinical study included 244 persons with type 1 and type 2 mean age 46,4 yrs. All patients were interviewed using a questionnaire of WHO, they were measured blood pressure, heart rate, anthropometric data, including total fat mass with fat analyzer OMRON BF508. All patients were also measured venous and capillary blood glucose level, glycated hemoglobin (%), total cholesterol and triglycerides. Results. The difference between the two measurement glucose methods (in venous and capillary blood) was 6,7 0,6%. In patients with type 1 diabetes hypertension occurs 2.5 times in less compared with patients with type 2 diabetes. The difference between blood pressure measured by mechanical and automatic devices was less than 1%. The percentage of body fat, including visceral fat, both women and men with type 2 diabetes by age corresponds to the high deviation from the norm. Most men and women with type 1 and type 2 had hypercholesterolemia. Conclusion. Traditional cardiovascular risk factors are identified, not only among individuals with type 2 diabetes, but among patients with type 1 diabetes.

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