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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The agreement between self-reported diseases in a questionnaire survey and data from medical records was assessed in a representative sample of Finnish men and women (n = 596) aged 45-73 years. The accumulated medical record information was abstracted from the records in the health centers and the central hospital in the study region. The agreement between the two information sources was substantial (kappa 0.73-0.80) for cardiovascular diseases as a group, hypertension, angina pectoris, myocardial infarction, and diabetes. The lowest agreement (kappa < 0.55) was found for lower back disorder, hip and knee arthrosis, and claudication. These results showed that the agreement between questionnaire data and medical records was good for well-known chronic diseases that have clear diagnostic criteria and are easily communicated to the patient. Conversely, the agreement was poor for diseases with nonestablished diagnostic criteria and a fluctuating course.
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PMID:Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. 912 3

Three middle-aged patients with diabetes sustained fractures of the acetabulum which were treated by open reduction and internal fixation. In each, rapid dissolution of the femoral head occurred with minimal discomfort, typical of a Charcot arthropathy. The patients had no other evidence of neuropathic arthropathy. Charcot changes may occur after high-energy trauma in patients with diabetes.
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PMID:Charcot arthropathy after acetabular fracture. 933 Oct 27

Two patients with longstanding insulin-dependent diabetes mellitus (IDDM) complicated by neuropathy, nephropathy and retinopathy leading to poor vision each developed a swollen and relatively painless foot. The previous day, both had been walking over uneven ground. At initial presentation, no X-ray was taken of the foot in case one and no action was taken over an undisplaced navicular fracture in case two. A few weeks later, a midfoot Charcot had developed in both cases. Poor vision may increase the risk of injury to the feet and may be an important risk factor for Charcot neuro-arthropathy. Plain radiographs are an important investigation for the swollen insensitive foot, even in the absence of pain.
Diabetes Res Clin Pract 1997 Oct
PMID:Poor vision as a contributory factor in diabetic neuro-arthropathy. 934 42

Scleroderma-like syndrome (SLS) may represent the earliest apparent diabetes complication in insulin-dependent diabetic (IDDM) patients. To evaluate the frequency of SLS and its association with other diabetes-related pathology in our diabetic population, we studied 153 (127 Jewish and 26 Arab) IDDM patients and 45 healthy age- and gender-matched controls (25 Jewish, 20 Arab). The mean age and diabetes duration of the patients were 14.09 +/- 5.1 years and 51 +/- 45 months, respectively. While no diabetes-related pathology was found in the controls, SLS was detected in 47% of all patients (skin, 31.4%; arthropathy, 37.9%; both, 22%), and nephropathy, neuropathy, and retinopathy were present in 10.5%, 5.2%, and 4.6%, respectively. Independent of age, SLS directly correlated with diabetes duration (p < 0.01) and with the presence of either nephropathy or neuropathy (p < 0.009 and p < 0.005, respectively). One or more features of systemic diabetic involvement were present in 22% of patients with SLS, compared to only 7.2% in patients without SLS (p < 0.009). When patients were analyzed according to ethnicity, the frequency of skin involvement and neuropathy were found to be higher among Arab patients, particularly males (p < 0.002 and p < 0.005, respectively), and detection of one was significantly associated with the presence of the other (p < 0.001). In conclusion, our results suggest that SLS is the most common diabetic complication among Jewish and Arab IDDM patients, and its presence may reflect an inherited tendency to develop other serious diabetic complications. Ethnicity (Arab) by itself, particularly when associated with male gender, seems to accelerate neurological and dermatological diabetic involvement.
J Diabetes Complications
PMID:Ethnicity and prevalence of scleroderma-like syndrome: a study of Arab and Jewish Israeli insulin-dependent diabetic children. 936 72

Severe obesity with co-morbidity such as diabetes mellitus, cardiac failure, obesity hypoventilation, degenerative bone diseases and increased incidence of malignancy give rise to shorter life expectancy and have an impact on quality of life. This results in higher costs of health care and work absence. Surgical procedures have become commonplace in the therapy of morbid obesity because of the infrequent success of medical treatment. We performed a horizontal gastroplasty by laparoscopic adjustable silicon gastric banding (LASGB) on 60 patients between 1. 11. 1995 and 28. 2. 1997. The average excess above normal weight was 62 kg, the median BMI (Body-Mass-Index) was 46.44 kg/m2. Fifty-nine procedures were performed by the laparoscopic method and one with an open technique. The average postoperative hospital stay was five days. Due to dorsal slipping or pouch enlargement the procedure had to be repeated on 6 patients (10%). The median loss of weight in the first three months was 14.78 kg, after six months 24.14 kg and after nine months 35.1 kg. Insulin treatment for three patients suffering diabetes mellitus could be discontinued-in addition blood sugar levels in six patients normalised. Two patients with obstructive sleep-apnea syndrome no longer needed a nocturnal Nasal-Continuous-Positive-Airway-Pressure-(nCPAP-)Therapy. To provide a better quality of life to this group of patients, the gastric banding is a suitable method for carefully evaluated and followed patients. In addition improved ability to work and reduction of health care costs due to co-morbidity and joint diseases have a positive economic impact.
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PMID:[Surgical therapy of morbid obesity: indications, technique of laparoscopic gastric banding and initial results]. 941 44

Although diabetes and peripheral neuropathy are perhaps the most important risk factors for neuropathic osteoarthropathy, we hypothesized that peak plantar pressures may also be higher in patients who have this condition. We are unaware of any reports in the medical literature that have specifically addressed this hypothesis. We obtained data from the medical records of 164 diabetic patients who had been managed in a multidisciplinary tertiary-care diabetic foot-specialty clinic. We then divided the patients into four groups: those who had acute Charcot arthropathy, those who had neuropathic ulceration, those who had neuropathy without ulceration, and those who had neither neuropathy nor ulceration. The peak plantar pressures were significantly higher in the patients who had acute Charcot arthropathy and those who had a neuropathic ulcer (p < 0.001 for both) compared with the pressures in those who had no history of arthropathy and those who had neuropathy without ulceration. With the numbers available, we could not detect a significant difference in the peak pressure between the affected and the unaffected foot in the patients who had Charcot arthropathy (mean [and standard deviation], 100+/-8.5 compared with 101+/-9.6 newtons per square centimeter; p > 0.05). However, the mean peak pressure was significantly higher on the ulcerated side than on the contralateral side in the patients who had a neuropathic ulcer (90+/-18.8 compared with 86+/-20.7 newtons per square centimeter; p < 0.02). Although the midfoot was the site of maximum involvement in all patients who had Charcot arthropathy, the peak plantar pressure was on the forefoot, suggesting that the forefoot may function as a lever, forcing collapse in the midfoot.
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PMID:Elevated peak plantar pressures in patients who have Charcot arthropathy. 987 50

A 54-year-old woman with insulin-dependent diabetes mellitus, diabetic neuropathy, neuropathic arthropathy of the feet and a plantar ulcer underwent plain radiography, which showed 2 clipped-off hypodermic needles, of which she had been unaware, in the soft tissue of one foot. This previously unreported complication is clinically instructive in that it demonstrates the importance of counselling patients about the protection of insensitive extremities. This case also has public health implications, suggesting as it does that the still-common practice of breaking hypodermic needles before disposal should be strongly discouraged.
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PMID:Hypodermic needles in the neuropathic foot of a patient with diabetes. 972 72

During a 10-year period, 237 patients (129 women, 108 men) with a diagnosis of neuropathic (Charcot) arthropathy of the foot and ankle were treated in a tertiary care university hospital medical center. During this period, 115 of the patients (48.5%) were treated nonoperatively as outpatients with local skin and nail care, accommodative shoe wear, and custom foot orthoses. A total of 120 (50.6%) underwent 143 operations. Surgery included 21 major limb amputations, 29 ankle fusions, 26 hindfoot fusions, 23 exostectomies, and 23 debridements for osteomyelitis. It is widely accepted that patients with diabetes are at risk for developing foot ulcers, which can lead to lower extremity amputation. Within the population of diabetic patients, it is widely accepted that patients with neuropathic (Charcot) arthropathy of the foot and ankle have one of the highest likelihoods of having to undergo lower extremity amputation. The current emphasis in care of the foot of a diabetic patient involves a multidisciplinary team approach combining patient education, skin and nail care, and accommodative shoe wear. As data from prophylactic programs become available, resource allocation and cost of care can be compared with this benchmark baseline. This benchmark analysis can be used by those who are responsible for allocating resources and projecting healthcare costs for this "high utilization"/high risk patient population.
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PMID:Benchmark analysis of diabetic patients with neuropathic (Charcot) foot deformity. 1050 83

Hemochromatosis is a recessive disorder of iron metabolism characterized by progressive iron loading of parenchymal organs, which accounts for clinical complications such as cirrhosis, diabetes mellitus, cardiopathy, endocrine dysfunctions and arthropathy. Clinical complications, which usually develop after the third or fourth decade of life, can be fatal but may be prevented by phlebotomy if iron excess is detected at a very early stage. The hemochromatosis gene (HFE), located 4.5 megabases telomeric to the HLA-A locus, encodes an HLA class I like protein and two missense mutations, C282Y and H63D in complete disequilibrium have been identified within this gene. Due to its high frequency in the general population, the involvement of H63D in the pathogenesis of the disease remains controversial, and it might correspond to a minor mutation. Conversely, the C282Y mutation is tightly linked to the disease, as it accounts for 80 to 100% of the hemochromatosis cases in Northern Europe. The lower frequency observed, in the patients, in Italy and South of France led to imagine either the implication of other mutations or of other genes. The C282Y mutation is absent in Asia and Africa and is present in the general population with a decreasing gradient of frequency from Northern to Southern Europe. The prevalence of the disease was usually estimated to be 3% but the observed frequency of the C282Y homozygotes is 5% in our breton population raising the question of the penetrance of the disease, and consequently the use of the genotypic test for its systematic screening. As HFE encodes a membrane protein similar to HLA class I protein, its contribution to iron overload is not obvious. The normal protein is predicted to to be expressed at the cell surface in association with beta 2-microglobulin, a localization for which C282Y is critical as it disrupts this association. This protein has also been shown to form a stable complex with the transferrin receptor leading to a decreased affinity for transferrin. A better knowledge of its function will help to decipher iron and different metal-ions metabolism. Although the exact role of the HFE protein is unknown, the genotypic test allows the clinicians to ascertain their diagnosis and genetic counselling.
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PMID:[Molecular genetics of hemochromatosis]. 1052 Apr 11

The outcome of bacterial arthritis is generally poor: the mortality is 10-15% and there is loss of joint function in 25-50% of the survivors. Adverse prognostic factors are advanced age, a pre-existent joint disease and an infection of a prosthetic joint. The incidence of bacterial arthritis is low: 2-6 per 100,000 persons per year. Risk factors are advanced age, a joint disease--especially rheumatoid arthritis--diabetes mellitus and presence of a prosthetic joint. Situations that can lead to bacterial arthritis are mainly skin infections of the feet and only rarely invasive medical or dental procedures. Because of the severity of the disease, antibiotic prophylaxis of haematogenous bacterial arthritis in patients with prosthetic joints is advocated in guidelines. However, because of the rarity of the disease it is unclear whether the advantages of prophylaxis outweigh the disadvantages of the large-scale use of antibiotics, such as side effects, costs and increased resistance of bacteria. In a decision analysis of a large group of patients with joint diseases, antibiotic treatment of skin infections appeared to be (cost-)effective in the prevention of haematogenous bacterial arthritis, mainly in high-risk patients. On the other hand, prophylaxis around medical or dental procedures was not (cost-)effective, except possibly in a small group of patients with increased risk.
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PMID:[Antibiotic prophylaxis of hematogenous bacterial arthritis]. 1052 83


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