Diabetes Management Update: Individualizing Treatment.
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Diabetes management
Disease management
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Critical limb ischemia
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Objective To analyzed the clinical characters of diabetes mellitus complicated with skin ulcer.Methods The clinical data of 55 patients with diabetes mellitus complicated with skin ulcer were analyzed.Results Of 55 patients,there were 50 cured with controlling blood glucose and treating local wound.Conclusion The methods of treatment of diabetic skin ulcer are complicated,which include controlling blood glucose and treating local wound.
Diabetic ulcers
Skin ulcer
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Objective To investigate the cardiovascular complications of diabetes,especially the hypertension risk factors.Methods The clinical manifestation of 156 cases of diabetic patients in our hospital were summarized,the diabetes and cardiovascular complications,especially the hypertension were analyzed.Results The rate of diabetes in 5 years with hy pertension was 18.75% and it was significantly lower than that of 5 years or more(P 0.05),the occurrence rate of coronary heart disease and angina pectoris in two groups had no statistically significant(P 0.05).Conclusion Diabetic with cardiovascular complications are related to many factors,and the hypertension is the most common complication of diabetes,combi nation of effective auxiliary examination can better early detection and prevention of diabetic cardiovascular complications.
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Abstract Background Diabetes is related with both AF occurence and increased thromboembolic risk. There is scarce data about the outcomes of AF catheter ablation in patients with diabetes. Purpose We aimed to evaluate outcomes of AF catheter ablation in patients with diabetes. Methods All patients underwent AF cryoablation between January 2013 and January 2018 were included . Results A total of 493 patients were enrolled. Mean age was 59.6 ± 11.8 years and 253 (51.3 %) patients were female. Median follow up time was 28 (6-59) months. Recurrence occured in 61 (12.4%) patients. Diabetes was present in 78 (16%) cases. Mean HbA1c value of the diabetic patients was 6.79 ± 1.02 %. 50 (64.1 %) patients was under treatment with only oral antidiabetics while others were using insulin. Diabetic group was older (p < 0.001) and hypertension prevalance was significantly higher in diabetics(p < 0.001). Complication and recurrence rates were similar between the two groups (Table-1). Subgroup analysis revealed that there was not significant difference by AF recurrence between not only patients treated with OAD alone and treated with insulin but also patients with HbA1c value <7 and HbA1c value ≥7 (p = 0.064). Conclusion Recurrence and complication rates were similar between diabetic and non-diabetic patients. Despite neuropathy is a well known manifestation of diabetes; phrenic nerve damage rate is similar in diabetic patients with non-diabetic counterparts. Table-1 Diabetic group (n = 78) Non-diabetic group (n = 415) p value Age, (years) 64.38 ±10.12 58.91 ±11.84 <0.001* Gender, female (%) 45 (57 %) 207 (49.8 %) 0.267 Follow up, (months) 29.5 (6-59) 28 (6-58) 0.987 Hypertension, n (%) 57 (73%) 191 (46 %) <0.001 StrokeTIA, n(%) 4 (5.1 %) 8 (1.9 %) 0.104 Coronary artery disease, n (%) 39 (50 %) 176 (42.4 %) 0.242 AF type, Paroxysmal, (%) 65.7 % 71% 0.367 LV EF, % 59.81 ± 8.44 61.82 ± 6.89 0.027* LV end diastolic diameter, cm 4.90 ± 0.49 4.82 ± 0.46 0.160 LA diameter, cm 3.88 ± 0.51 3.81± 0.58 0.361 Recurrence 8 (10.2 %) 53 (12.7 %) 0.708 Phrenic nerve damage, n (%) 0 (0 %) 17 (4.1 %) 0.088 Inguinal hematoma, n (%) 7 (8.9%) 44 (10.6 %) 0.647 Pseudoaneurysm, n(%) 1 ( 1.2%) 3 ( 0.7 %) 0.502 Comparison of diabetic and non-diabetic patients
Cryoablation
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Background Diabetic dermopathy is the most common cutaneous marker of diabetes mellitus. The relationship of diabetic dermopathy to internal complications of diabetes mellitus, such as nephropathy, retinopathy, and neuropathy, is still unknown. Methods The possible role of diabetic dermopathy as a clinical sign of internal complications in diabetes mellitus was investigated. One hundred and seventy‐three patients with diabetes mellitus, of whom 125 (72%) had insulin‐dependent diabetes mellitus and 48 (28%) had non‐insulin‐dependent diabetes mellitus, were studied. Results Diabetic dermopathy was present in 69 (40%) of patients, statistically more significant in patients 50 years of age and older. The mean diabetic duration was significantly higher in patients with diabetic dermopathy than in those without. The associations of diabetic dermopathy with retinopathy, nephropathy, and neuropathy were each statistically significant, and the increased frequency of diabetic dermopathy correlated with an increased number of these three complications in each patient. Conclusions Some of the factors that affect the development of internal complications in diabetes mellitus may play a role in the development of diabetic dermopathy, and diabetic dermopathy may serve as a clinical sign of an increased likelihood of these internal complications in diabetic patients.
Diabetic Neuropathy
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Purpose: To analyze the results of total knee arthroplasty (TKA) in patients with diabetes mellitus (DM). Materials and Methods: Between 1996 and 2001, 601 TKAs in 373 patients were performed by a single surgeon. From this series, 45 patients (74 knees) were diagnosed as type II DM and osteoarthritis of the knee. The mean follow-up was 49 months (6-108 months), and the mean age was 68.6 years (54-83 years). The clinical outcome of the diabetic and non diabetic group was compared using the Hospital for special surgery score (HSS) and the Knee society clinical and radiological scoring system. The radiological loosening and perioperative complications were evaluated. The plasma Hemoglobin A1c (HbA1c) level of the diabetes patients was examined pre and postoperatively. Results: The knee and pain scores were higher in the diabetes group postoperatively (p=0.040, p=0.039, respectively), whereas the HSS scores and overall function scores were lower in the diabetes group postoperatively (p=0.021, p=0.016, respectively). The rate of superficial wound problems was greater in the diabetes group (8.1% versus 2.4%, p=0.032). However the incidence of a deep infection was similar in the diabetic and non diabetic group (2.7% versus 0.9%). The mean HbA1c level was significantly higher in the diabetic patients with a superficial and deep infection than in the remaining diabetic patients (p=0.033). Conclusion: The HbA1c level might be a valuable predictor of superficial wound complications and deep infection. Although the clinical results were similar in the diabetes and non diabetes groups, special precautions should be taken for diabetic patients undergoing TKA to minimize complications.
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Objective To investigate the prevention and treatment for diabetic patients with hypertension measures.Methods From March 2010 to December 2012 in our hospital between diabetic and hypertensive patients with 45 cases,according to the clinical and pathological data,were retrospective analyzed,summarized in the prevention and treatment of the disease.Results All the patients in this group underwent clinical treatment and followed up for 4 to 8 months.Of which more than 80% patients to control their blood pressure,decreased significantly,the symptoms of diabetes effectively relieve.Individual patients in the treatment process of adverse drug reaction,can effectively control.Conclusion The implementation of treatment and intervention system specialized measures for high-risk groups to diabetes and hypertension,which can effectively alleviate the disease,improve the prognosis,and to reduce and prevent the occurrence of cardiovascular events and serious complications of diabetes mellitus,has important clinical significance.
Drug treatment
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PREVIEWLimited joint mobility, or cheiroarthropathy, in patients with diabetes mellitus usually is painless and generally involves only the small joints of the hands. Most patients do not seek help until hand deformity interferes with daily life. However, because cheiroarthropathy is linked with more serious microvascular complications of diabetes, recognition is important. Improved control of diabetes is the cornerstone of management, but some treatment options are available for severe impairment. In this article, Drs Aljahlan, Lee, and Toth discuss causes, diagnosis, and treatment of this often misunderstood disorder.
Cornerstone
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To determine the long-term influence of the severity of preoperative diabetes mellitus on the results of coronary bypass, a review was made of 212 diabetics operated on between 1968 and 1973, of whom 87 patients (41%) were receiving no drugs, 108 patients (50.9%) were receiving oral hypoglycemic agents, and 17 patients (8%) were receiving insulin. They were compared with 1,222 nondiabetic patients operated on over the same period. Perioperative mortality was similar in the diabetics and nondiabetics: 7.1% vs 4.5%. Improvement in anginal symptoms was similar in all patient groups: 85.9% to 92.7%. Overall 15-year survival probability was .53 for the nondiabetic group, .43 for the diabetics not receiving drugs, .33 for those receiving oral agents, and .19 for the insulin-treated patients. Late graft patency ranged from 78% to 90% and was comparable in all groups. The preoperative blood glucose level was an important predictor of late mortality in all diabetic patients. Thus, coronary bypass surgery was effective in all groups of diabetic patients in long-term relief of anginal symptoms. Intermediate-term survival rates were good in all groups, but the initial severity of the diabetes was an important determinant of long-term survival rates.
Bypass surgery
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Few reports have focused on whether old diabetic patients had worse outcomes compared to old nondiabetics after coronary artery bypass grafting (CABG). This study aimed to evaluate the outcomes of old diabetic patients compared to old nondiabetics following isolated CABG.From January 2004 to December 2008, the relevant pre-, intra-, and postoperative materials of all CABG patients over 65 years of age in our center were investigated and analyzed retrospectively. In this study, diabetes is defined as the need for oral medication or insulin. A total of 140 diabetic patients over 65 years of age were entered in the study, accounting for 31.7% of the total population. Diabetic patients over 65 years of age were less likely to have undergone previous percutaneous coronary intervention (P < 0.0001) and more likely to undergo CPB (P = 0.03) during CABG as compared to nondiabetics over 65 years of age. Univariate analysis and multivariate logistic regression analysis showed diabetic patients over 65 years of age only had a higher rate of deep sternal wound infection (OR = 2.76, 95%CI 1.22-7.83, P = 0.002), while sharing almost similar rates among other morbidities and mortality as compared to nondiabetic patients over 65 years of age.Excellent results following CABG may be expected in old diabetic patients.
Univariate analysis
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