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

BJPsych Open ◽  
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.

scholarly journals Prevalence and risk of appearence of skin lesions considered to be cutaneous markers of diabetes in a population group in bihor county

2012 ◽  
Vol 19 (3) ◽  
pp. 285-290
Author(s):  
Denisa Kovacs ◽  
Luiza Demian ◽  
Aurel Babeş
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Skin Lesion ◽  
Skin Diseases ◽  
Population Group ◽  
Skin Lesions ◽  
Diabetic Patients ◽  
Cutaneous Lesions

Abstract Objectives: The aim of the study was to calculate the prevalence rates and risk ofappearance of cutaneous lesions in diabetic patients with both type-1 and type-2diabetes. Material and Method: 384 patients were analysed, of which 47 had type-1diabetes (T1DM), 140 had type-2 diabetes (T2DM) and 197 were non-diabeticcontrols. Results: The prevalence of the skin lesions considered markers of diabeteswas 57.75% in diabetics, in comparison to 8.12% in non-diabetics (p<0.01). The riskof skin lesion appearance is over 7 times higher in diabetic patients than in nondiabetics.In type-1 diabetes the prevalence of skin lesions was significantly higherthan in type-2 diabetes, and the risk of skin lesion appearance is almost 1.5 timeshigher in type-1 diabetes than type-2 diabetes compared to non-diabetic controls.Conclusions: The diabetic patients are more susceptible than non-diabetics todevelop specific skin diseases. Patients with type-1 diabetes are more affected.

Complications of Diabetes Mellitus

2010 ◽  
Author(s):  
Samuel Dagogo-Jack
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Diabetic Complications ◽  
Diabetic Patients ◽  
Complications Of Diabetes ◽  
Risk Of Death

The long-term complications of diabetes mellitus include retinopathy, nephropathy, and neuropathy. Diabetic retinopathy can result in loss of vision; nephropathy may lead to end-stage kidney disease (ESKD); and neuropathy poses the risk of foot ulcers, amputation, Charcot joints, sexual dysfunction, and potentially disabling dysfunction of the stomach, bowel, and bladder. Hyperglycemia sufficient to cause pathologic and functional changes in target tissues may be present for some time before clinical symptoms lead to a diagnosis of diabetes, especially in patients with type 2 diabetes. Diabetic patients are also at increased risk for atherosclerotic cardiovascular, peripheral vascular, and cerebrovascular disease. These conditions may be related to hyperglycemia, as well as to the hypertension and abnormal lipoprotein profiles that are often found in diabetic patients. Prevention of these complications is a major goal of current therapeutic policy and recommendations for all but transient forms of diabetes. This chapter describes the pathogenesis, screening, prevention, and treatment of diabetic complications, as well as the management of hyperglycemia in the hospitalized patient. Figures illustrate the pathways that link high blood glucose levels to microvascular and macrovascular complications; fundus abnormalities in diabetic retinopathy; the natural history of nephropathy in type 1 diabetes; cumulative incidence of first cardiovascular events, stroke, or death from cardiovascular disease in patients with type 1 diabetes; the effect of intensive glycemic therapy on the risk of myocardial infarction, major cardiovascular event, or cardiovascular death in patients with type 2 diabetes; and risk of death in patients with type 2 diabetes who receive intensive therapy of multiple risk factors or conventional therapy. Tables describe screening schedules for diabetic complications in adults, foot care recommendations for patients with diabetes, and comparison of major trials of intensive glucose control. This chapter has 238 references.

Altered energetic properties in skeletal muscle of men with well-controlled insulin-dependent (type 1) diabetes

2003 ◽  
Vol 284 (4) ◽  
pp. E655-E662 ◽  
Author(s):  
Gregory J. Crowther ◽  
Jerrold M. Milstein ◽  
Sharon A. Jubrias ◽  
Martin J. Kushmerick ◽  
Rodney K. Gronka ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Glycolytic Flux ◽  
Resonance Spectroscopy ◽  
Diabetic Patients ◽  
Control Subjects ◽  
Energetic Properties ◽  
Insulin Dependent

This study asked whether the energetic properties of muscles are changed by insulin-dependent diabetes mellitus (or type 1 diabetes), as occurs in obesity and type 2 diabetes. We used 31P magnetic resonance spectroscopy to measure glycolytic flux, oxidative flux, and contractile cost in the ankle dorsiflexor muscles of 10 men with well-managed type 1 diabetes and 10 age- and activity-matched control subjects. Each subject performed sustained isometric muscle contractions lasting 30 and 120 s while attempting to maintain 70–75% of maximal voluntary contraction force. An altered glycolytic flux in type 1 diabetic subjects relative to control subjects was apparent from significant differences in pH in muscle at rest and at the end of the 120-s bout. Glycolytic flux during exercise began earlier and reached a higher peak rate in diabetic patients than in control subjects. A reduced oxidative capacity in the diabetic patients' muscles was evident from a significantly slower phosphocreatine recovery from a 30-s exercise bout. Our findings represent the first characterization of the energetic properties of muscle from type 1 diabetic patients. The observed changes in glycolytic and oxidative fluxes suggest a diabetes-induced shift in the metabolic profile of muscle, consistent with studies of obesity and type 2 diabetes that point to common muscle adaptations in these diseases.

scholarly journals Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review

2021 ◽  
Vol 11 (3) ◽  
pp. 230
Author(s):  
Mar Sempere-Bigorra ◽  
Iván Julián-Rochina ◽  
Omar Cauli
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Nervous System ◽  
Screening Tests ◽  
Cardiac Autonomic Neuropathy ◽  
Blood Levels ◽  
Diabetic Patients ◽  
Diabetes Patients

Background: Diabetic neuropathy is defined as the dysfunction of the peripheral nervous system in diabetic patients. It is considered a microvascular complication of diabetes mellitus. Its presence is associated with increased morbidity and mortality. Although several studies have found alterations at somatic motor, sensory levels and at the level of autonomic nervous system in diabetic patients, there is not a systematic approach regarding the differences in neuropathy between the major variants of diabetes, e.g., type 1 and 2 diabetes at both neurological and molecular level. Data sources: we systematically (Medline, Scopus, and Cochrane databases) evaluated the literature related to the difference of neuropathy in type 1 and 2 diabetes, differences in molecular biomarkers. Study characteristics: seventeen articles were selected based on pre-defined eligibility criteria. Conclusions: both superficial sensitivity (primarily thermal sensitivity to cold) and deep sensitivity (such as vibratory sensitivity), have been reported mainly in type 2 diabetes. Cardiac autonomic neuropathy is one of the diabetic complications with the greatest impact at a clinical level but is nevertheless one of the most underdiagnosed. While for type 1 diabetes patients most neuropathy alterations have been reported for the Valsalva maneuver and for the lying-to-standing test, for type 2 diabetes patients, alterations have been reported for deep-breathing test and the Valsalva test. In addition, there is a greater sympathetic than parasympathetic impairment, as indicated by the screening tests for autonomic cardiac neuropathy. Regarding subclinical inflammation markers, patients with type 2 diabetes showed higher blood levels of inflammatory markers such as high-sensitivity C-reactive protein, proinflammatory cytokines IL-6, IL-18, soluble cell adhesion molecules and E-selectin and ICAM-1, than in type 1 diabetes patients. By contrast, the blood levels of adiponectin, an adipocyte-derived protein with multiple paracrine and endocrine activities (anti-inflammatory, insulin-sensitizing and proangiogenic effects) are higher in type 1 than in type 2 diabetic patients. This review provides new insights into the clinical differences in type 1 and 2 diabetes and provide future directions in this research field.

scholarly journals Minimal change disease associated with type 1 and type 2 diabetes mellitus

2012 ◽  
Vol 56 (5) ◽  
pp. 331-335 ◽  
Author(s):  
Miguel Moyses Neto ◽  
Gyl Eanes Barros Silva ◽  
Roberto S. Costa ◽  
Elen A. Romão ◽  
Osvaldo Merege Vieira Neto ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Complete Remission ◽  
Minimal Change Disease ◽  
Immunosuppressive Agents ◽  
Sudden Onset ◽  
Minimal Change ◽  
Diabetic Patients

A 19-year-old female with type 1 diabetes for four years, and a 73-year-old female with type 2 diabetes for twenty years developed sudden-onset nephrotic syndrome. Examination by light microscopy, immunofluorescence, and electron microscopy (in one case) identified minimal change disease (MCD) in both cases. There was a potential causative drug (meloxicam) for the 73-year-old patient. Both patients were treated with prednisone and responded with complete remission. The patient with type 1 diabetes showed complete remission without relapse, and the patient with type 2 diabetes had two relapses; complete remission was sustained after associated treatment with cyclophosphamide and prednisone. Both patients had two years of follow-up evaluation after remission. We discuss the outcomes of both patients and emphasize the role of kidney biopsy in diabetic patients with an atypical proteinuric clinical course, because patients with MCD clearly respond to corticotherapy alone or in conjunction with other immunosuppressive agents.

Insulin treatment for diabetes

2020 ◽  
Vol 13 (12) ◽  
pp. 739-746
Author(s):  
Mah Jabeen
Keyword(s):  
Type 2 Diabetes ◽  
General Practice ◽  
Type 1 Diabetes ◽  
Gestational Diabetes ◽  
Insulin Treatment ◽  
Diabetic Patients ◽  
New Era ◽  
Dominant Treatment

The first use of insulin in 1922 began a new era in the management and survival of patients with type 1 diabetes. Before 1922, patients with this condition were placed on a starvation diet and survived only a few months. Nearly a century later, insulin remains the dominant treatment for type 1 diabetes, is used in gestational diabetes and increasingly in type 2 diabetes. This article focuses on insulin treatment for adult diabetic patients in general practice. It will explore the effect of insulin and the role it has in diabetes, the preparations available, recommended regimens and some challenges with insulin treatment.

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

2009 ◽  
Vol 17 (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>

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

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Gareth Davies ◽  
Jeff Stephens ◽  
Sam Rice ◽  
James Chess
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Glucose Control ◽  
Health Board ◽  
Diabetes Diagnosis ◽  
Duration Of Diabetes ◽  
Cardiovascular Morbidity And Mortality

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.

scholarly journals Incidence of atrial fibrillation in patients with diabetes mellitus: effect of sex, age and type of diabetes in a nationwide analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Fauchier ◽  
A Bisson ◽  
G Fauchier ◽  
A Bodin ◽  
J Herbert ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Incidence Rates ◽  
Diabetic Patients ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background. There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age. Methods. All patients aged &gt; =18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes). Results. In 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. During 13.5 million person-years of follow-up, 327,012 patients with new-onset AF were identified. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27-1.37) in women vs. 1.12(1.08-1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16-1.19) in women vs. 1.10(1.09-1.12) in men for type 2 diabetes.  The adjusted HRs for women were significantly higher than the adjusted HRs for men as shown with the adjusted women-to-men ratios (adjusted WMR = adjusted HR women compared to adjusted HR men) = 1.18 (95%CI 1.12-1.24) for type 1 diabetes and 1.10 (95%CI 1.08-1.12) for type 2 diabetes. This phenomenon was seen across all ages in men and women with type 1 diabetes and progressively decreased with advancing age.  In type 2 diabetes, this phenomenon was seen after 50 years, increased until 60-65 years and then progressively decreased with advancing age. Conclusion. Although men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.

scholarly journals Shear Wave Elastography Reveals a High Prevalence of NAFLD-related Fibrosis Even in Type 1 Diabetes

2021 ◽  
Author(s):  
Gesine Meyer ◽  
Nina Dauth ◽  
Matthias Grimm ◽  
Eva Herrmann ◽  
Joerg Bojunga ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Shear Wave Elastography ◽  
Diabetic Patients ◽  
Alcoholic Fatty Liver ◽  
High Prevalence

Abstract Background The association between type 2 diabetes mellitus (T2DM) and advanced stages of non-alcoholic fatty liver disease is well known. Some studies indicate a relevant prevalence also in type 1 diabetes mellitus (T1DM), but so far there is only limited data. Objective To determine the prevalence of non-alcoholic fatty liver disease (NAFLD)-related liver fibrosis in individuals with T1DM and compare to those with type 2 diabetes. Methods Diabetic patients from a single diabetes care centre were screened for liver fibrosis by sonographic shear wave elastography (SWE). In addition, all patients received laboratory evaluation including non-alcoholic fatty liver fibrosis score and Fibrosis-4 Index. Results Three hundred and forty patients were included in the study, of these, 310 received SWE. Overall 254 patients (93 with type 1 and 161 with type 2 diabetes) had reliable measurements and were included in the final analysis. In patients with type 1 diabetes, the prevalence of NAFLD-related liver fibrosis was 16–21%, depending on the method of detection. Significant liver fibrosis was observed in 30–46% of patients with type 2 diabetes. Conclusions Our data revealed an unexpectedly high prevalence of NAFLD-related liver fibrosis in patients with type 1 diabetes. To our knowledge, this is one of the first studies using SWE to diagnose advanced NAFLD in type 1 diabetes in a non-preselected cohort. Considering the findings of our study, regular screening for hepatic complications must be recommended for all diabetic patients, even for those with type 1 diabetes.

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