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 Drug Utilization Evaluation of Anti-Diabetic Medication through Prescription Monitoring

2019 ◽  
Vol 7 (3) ◽  
pp. 75-77
Author(s):  
Sunaina Verma ◽  
Yogesh Joshi ◽  
Ankita Singh
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Drug Utilization ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Prescription Monitoring ◽  
Drug Utilization Evaluation ◽  
Diabetes Patients

Diabetes is a chronic and potentially disabling disease that represents an important public health and clinical concern. The study was designed to assess the drug utilization evaluation of anti-diabetic medications through prescription monitoring in a tertiary care hospital at capital city Dehradun in a northern state Uttarakhand. Prescriptions from patients of diabetes were selected for the study and data was collected from patients using a questionnaire format. All the necessary and relevant information will be collected from out-patient prescriptions, laboratory data reports and also by verbal communication with patients. Out of total 100 prescriptions of diabetic patients, it was found that gender wise distribution of diabetic patients was more in females (64%) as compared to males (36%). Among 100 patients, type 1 diabetes occurred in 16% patients and type 2 diabetes occurred in 84% patients. It was also analyzed that both type 1 and type 2 diabetes were mostly occurred in females. Among type 2 diabetes patients, Glimepiride were mostly prescribed in 42% patients, followed by Metformin in 22% patients and Gliclazide in 20% while in type 1 diabetes patients, Human Insulin were prescribed in 16% patients. Prescription analysis showed that maximum prescriptions (50%) contain two drugs per prescription while six drugs per prescription were shown by only 2% prescriptions. This study may provide further help to prescribers for improvement in current prescribing trends in the management of diabetes mellitus.    

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.

scholarly journals Hypoglycaemia and cardiac arrhythmias in diabetes

2020 ◽  
Vol 11 ◽  
pp. 204201882091180
Author(s):  
Andreas Andersen ◽  
Peter G. Jørgensen ◽  
Filip K. Knop ◽  
Tina Vilsbøll
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Cardiac Arrhythmias ◽  
Severe Hypoglycaemia ◽  
Qt Prolongation ◽  
Cardiac Autonomic Neuropathy ◽  
Consistent Finding ◽  
Dead In Bed Syndrome

Hypoglycaemia remains an inevitable risk in insulin-treated type 1 diabetes and type 2 diabetes and has been associated with multiple adverse outcomes. Whether hypoglycaemia is a cause of fatal cardiac arrhythmias in diabetes, or merely a marker of vulnerability, is still unknown. Since a pivotal report in 1991, hypoglycaemia has been suspected to induce cardiac arrhythmias in patients with type 1 diabetes, the so-called ‘dead-in-bed syndrome’. This suspicion has subsequently been supported by the coexistence of an increased mortality and a three-fold increase in severe hypoglycaemia in patients with type 2 diabetes receiving intensive glucose-lowering treatment in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Studies have investigated the association between hypoglycaemia-induced cardiac arrhythmias. In a rat-model, severe hypoglycaemia resulted in a specific pattern of cardiac arrhythmias including QT-prolongation, ventricular tachycardia, second- and third-degree AV block and ultimately cardiorespiratory arrest. In clinical studies of experimentally induced hypoglycaemia, QTc-prolongation, a risk factor of ventricular arrhythmias, is an almost consistent finding. The extent of QT-prolongation seems to be modified by several factors, including antecedent hypoglycaemia, diabetes duration and cardiac autonomic neuropathy. Observational studies indicate diurnal differences in the pattern of electrocardiographic alterations during hypoglycaemia with larger QTc-prolongations during daytime, whereas the risk of bradyarrhythmias may be increased during sleep. Daytime periods of hypoglycaemia are characterized by shorter duration, increased awareness and a larger increase in catecholamines. The counterregulatory response is reduced during nightly episodes of hypoglycaemia, resulting in prolonged periods of hypoglycaemia with multiple nadirs. An initial sympathetic activity at plasma glucose nadir is replaced by increased vagal activity, which results in bradycardia. Here, we provide an overview of the existing literature exploring potential mechanisms for hypoglycaemia-induced cardiac arrhythmias and studies linking hypoglycaemia to cardiac arrhythmias in patients with diabetes.

scholarly journals Cardiac autonomic neuropathy in type 1 and type 2 diabetes patients

BMC Neurology ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Anca Moţăţăianu ◽  
Smaranda Maier ◽  
Zoltan Bajko ◽  
Septimiu Voidazan ◽  
Rodica Bălaşa ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Autonomic Neuropathy ◽  
Cardiac Autonomic Neuropathy ◽  
Diabetes Patients

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 Bone Structure and Predictors of Fracture in Type 1 and Type 2 Diabetes

2016 ◽  
Vol 101 (3) ◽  
pp. 928-936 ◽  
Author(s):  
Jakob Starup-Linde ◽  
Simon Lykkeboe ◽  
Søren Gregersen ◽  
Ellen-Magrethe Hauge ◽  
Bente Lomholt Langdahl ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Bone Structure ◽  
Vertebral Fracture Assessment ◽  
Tissue Stiffness ◽  
Mineral Density ◽  
X Ray ◽  
Diabetes Patients

Abstract Context: Type 1 and type 2 diabetes mellitus are associated with an increased risk of fracture. Objective: The objective of the study was to compare the bone structure and density between type 1 and type 2 diabetes patients and to investigate fracture associations. Design: This was a cross-sectional study. Setting and Patients: Physician-diagnosed type 1 and type 2 diabetes patients were included from the outpatient clinics at two university hospitals participated in the study. Main Outcome Measures: Bone density and structure were assessed by dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Blood samples were collected for bone turnover markers. Prevalent vertebral fractures were assessed by vertebral fracture assessment and x-ray, and incident fractures were collected from The Danish National Hospital Discharge Register. Results: Bone mineral density (BMD) was higher in type 2 than type 1 diabetes patients at the hip, femur, and spine; however, only the hip differed in multivariate-adjusted models. Bone tissue stiffness at the tibia was increased in type 2 diabetes patients also in adjusted models. Sclerostin levels were inversely associated with fracture in type 1 diabetes patients. The patients with the highest tertile of sclerostin had an 81% decreased risk of a fracture compared with the lowest tertile. Conclusions: Type 1 and type 2 diabetes patients differ in BMD of the hip and tissue stiffness at the tibia. Sclerostin may be a marker independent of BMD to predict fractures in type 1 diabetes patients and thus potentially of clinical importance. Studies with longer follow-up are needed.

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 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.

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