Diabetic peripheral polyneuropathy in the practice of a primary care physician

Диабетическая периферическая сенсомоторная нейропатия относится к числу наиболее распространенных осложнений сахарного диабета. Диагностика диабетической периферической нейропатии состоит из оценки симптомов и клинического неврологического обследования с применением количественных тестов для оценки степени выраженности неврологических расстройств. В статье рассматриваются современные подходы к комплексному лечению болевой формы диабетической периферической нейропатии, начиная с компенсации углеводного обмена. Если, несмотря на нормализацию гликемии, у пациента сохраняются жалобы на боли или другие неприятные ощущения, необходимо назначать средства патогенетической либо симптоматической направленности с целью их уменьшения или полного исчезновения. Рассмотрены средства местной терапии для лечения диабетической периферической нейропатии, целью которой является купирование болевой симптоматики (антидепрессанты, противосудорожные средства, анальгетики, средства местного воздействия), а также средства патогенетической терапии, базирующиеся на воздействии на основные патогенетические компоненты диабетической периферической нейропатии (применение препаратов α-липоевой (тиоктовой) кислоты). Diabetic peripheral sensorimotor neuropathy is one of the most common complications of diabetes mellitus. Diagnosis of diabetic peripheral neuropathy consists of symptom assessment and clinical neurologic examination using quantitative tests to assess the severity of neurologic disorders. The article discusses modern approaches to the complex treatment of pain form of diabetic peripheral neuropathy, starting with the compensation of carbohydrate metabolism. If, despite the normalization of glycemia, the patient continues to complain of pain or other unpleasant sensations, it is necessary to prescribe pathogenetic or symptomatic agents in order to reduce or completely disappear. The means of local therapy for the treatment of diabetic peripheral neuropathy, the purpose of which is to relieve pain symptoms (antidepressants, anticonvulsants, analgesics, topical agents), as well as pathogenetic therapy, based on the effect on the main pathogenetic components of diabetic peripheral neuropathy (use of drugs α-lipoic (thioctic) acid).

Glycated Hemoglobin and Methods for Its Point of Care Testing

Glycated hemoglobin (HbA1c) is a product of the spontaneous reaction between hemoglobin and elevated glucose levels in the blood. It is included among the so-called advanced glycation end products, of which is the most important for the clinical diagnosis of diabetes mellitus, and it can serve as an alternative to glycemia measurement. Compared to the diagnosis of diabetes mellitus by glycemia, the HbA1c level is less influenced by a short-term problem with diabetes compensation. Mass spectroscopy and chromatographic techniques are among the standard methods of HbA1c level measurement. Compared to glycemia measurement, there is lack of simple methods for diabetes mellitus diagnosis by means of the HbA1c assay using a point-of-care test. This review article is focused on the surveying of facts about HbA1c and its importance in diabetes mellitus diagnosis, and surveying standard methods and new methods suitable for the HbA1c assay under point-of-care conditions. Various bioassays and biosensors are mentioned and their specifications are discussed.

Diagnosis of gestational diabetes in Uganda: The reactions of women, family members and health workers

Objectives: In Uganda, as in many other low- and middle-income countries, screening for gestational diabetes mellitus is suboptimal and is rarely embedded in routine antenatal care. We describe the experiences of women in Uganda who underwent screening for gestational diabetes mellitus and were diagnosed with the condition as they navigate both the reaction of family members and their interaction with health workers. Methods: Pregnant women aged 18 years or older and between 24 and 28 weeks of gestation were enrolled from the antenatal clinics at one of the five hospitals between 13 June 2018 and 31 October 2019. Ten women with gestational diabetes mellitus, ten family members and six health workers were purposively selected to take part. Interviews and focus group discussions were used to collect data on the socio-cultural and health system factors that influence timely screening and effective management of gestational diabetes mellitus in Uganda. Data were analysed thematically. Results: Women generally reflected on the importance of gestational diabetes mellitus screening and felt that an early diagnosis helped them to get timely medical attention, and most reported a positive experience of the care provided by health workers. However, women who were diagnosed with gestational diabetes mellitus reported feeling fearful and anxious, and some were worried that the condition might be life-threatening. Many women reported that they were upset and largely unprepared to receive a gestational diabetes mellitus diagnosis. A gestational diabetes mellitus diagnosis not only stirred intense feelings of fear and anxiety in women but also affected their spouses and other family members. Many male partners were sympathetic and willing to provide support. Conclusion: Our findings highlight the need to understand the perceptions and emotions that accompany a gestational diabetes mellitus diagnosis to best support women and their family members. An improved recognition of these factors can inform the development of effective gestational diabetes mellitus screening and management programmes.

Systemic conditions of diabetic patients diagnosed with apical periodontitis

ABSTRACT Objective: This study aimed to evaluate the association between glycemic control status in type 2 diabetes mellitus (T2DM) patients and apical periodontitis. Methods: Twenty-seven patients were involved in this study. The survey was based on anamnesis, intra and extra oral examination and radiographic evaluation. Diabetes mellitus information involved type of diabetes and blood glucose analysis. Patients were divided according to their metabolic control status (glycemic controlled and poorly controlled T2DM patients). Results: A higher fasting blood glucose level (p = 0.004) and a higher percentage of HbA1c (p = 0.0001) were demonstrated in poorly controlled T2DM patients when compared to glycemic controlled T2DM. However, the frequency of apical periodontitis and the elapsed time since diabetes mellitus diagnosis were higher in controlled T2DM patients, reaching 64%. Nevertheless, controlled T2DM patients presented a higher number of apical periodontitis cases (p < 0.05). Findings support that controlled patients T2DM presented higher presence of apical periodontitis than poorly controlled T2DM ones. In these patients, the time elapsed since the diagnosis was higher, which may have provided a longer period of oscillation and/or uncontrolled metabolism. Conclusions: Therefore, it might contribute to the development and maintenance of apical periodontitis in glycemic controlled patients of this study.

Children with type 1 diabetes mellitus: the experience of disease

ABSTRACT Objective: To identify the main challenges faced by children with type 1 diabetes mellitus and describe their coping strategies. Method: Qualitative study conducted with a semi-structured interview with children aged 8 to 11 with type 1 diabetes mellitus diagnosis who received care in the outpatient clinic of a university hospital in the state of Rio de Janeiro, Brazil. The results have been analyzed and categorized as per thematic analysis. Results: Five children have participated. The reports have emerged from the systematization of the qualitative data, in a process of apprehending meaning from statements of children and adolescents, which led to the category “Living with diabetes”, including two subcategories: “Challenges to disease coping” and “Family participation and support in the disease process”. Conclusion: The process of disease coping is observed to occur differently for each child. However, family participation and support, as well as communication with health professionals, are fundamental in this process.