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Query: UMLS:C0011854 (type 1 diabetes)
 20,749 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

With the publication of the DCCT results in 1993, hope has been given to patients with type I diabetes that blindness, kidney failure, and neuropathies are not necessarily what awaits them. However, to assume that diabetes is simply a disease that can be controlled "if only the patient would be compliant" is an incredibly naive way to approach treatment. Practitioners need to be keenly aware of not only the complexities of intensive management of type I diabetes but perhaps more importantly the numerous psychological factors that determine whether treatment adherence will occur. Psychological issues such as patient perceptions of symptoms, fear, unawareness of symptoms because of autonomic dysregulation or cognitive decline, attitudes, and control issues need to be assessed. These issues can be assessed quite easily with questionnaires, scales, and interview schedules readily available to practitioners. Additionally, for those patients who may not be attuned to monitoring physiologic or cognitive cues, awareness training and other coping skills interventions are available that can be incorporated into existing diabetes education programs. A mutual effort by the patient and health-care provider team can lead to success in intensive management of IDDM.
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PMID:Psychological factors in intensive management of insulin-dependent diabetes mellitus. 896 35

Blind diabetic patients face particular difficulties in blood glucose self monitoring (BGSM). We investigated the quality of BGSM in blind and severely visually impaired diabetic patients and assessed the effects of training in BGSM using a blood glucose meter with voice edition of values and a modified test strip holder for easier placement of blood samples on the strip (One Touch II talk (OT II)). Twenty-six insulin-treated diabetic patients (23 IDDM and 3 NIDDM) participated. At baseline the quality of BGSM was checked in 14 patients who already regularly performed BGSM without external help. Thereafter all 26 patients received an extensive instruction in BGSM for blind patients. At re-examination, after a mean period of 41 days, the quality of BGSM performed by the patients without assistance was checked in three different blood samples. Blood glucose was measured in the same sample by a routine laboratory method. At baseline the mean absolute difference between BGSM and the reference method was -0.3 mmol l(-1) (range; +/- SD) (-7.7-4.8; +/- 2.6 mmol l(-1)); 74% of BGSM measurements deviated by more than 10% from the reference values and 43% by more than 20%. At follow-up all 26 patients reported daily BGSM without external help. The mean absolute difference between BGSM and the reference method was -0.1 (-2.7-2.8; +/- 0.9 mmol l(-1)); 25% of BGSM measurements deviated by more than 10 % from the laboratory reference values and 5% by more than 20%. The results of this study suggest that a substantial number of blind diabetic patients do not perform BGSM on their own at all and in those who do the reliability of the results is poor. However, after extensive instruction, the majority of blind diabetic patients should be able to perform BGSM and to obtain reliable results.
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PMID:Self monitoring of blood glucose in blind diabetic patients. 927 99

Wolfram syndrome is the association of diabetes mellitus and optic atrophy, also called DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy and deafness). Incomplete characterisation has caused diagnostic confusion; we therefore undertook a nation-wide cross-sectional case finding study. We identified 45 patients with Wolfram syndrome, median age 29 years. All patients fulfilled the ascertainment criteria (juvenile onset diabetes mellitus and optic atrophy). Optic atrophy presented in 38 patients with reduced visual acuity and colour vision defect (median age 11 years), progressing to visual acuity of 6/60 or less in 35 patients (median time 8 years, range 1-25 years). Visual field examinations recorded before acuity deteriorated showed central scotomas with peripheral constriction. Blind patients had absent pupillary reflexes. Horizontal nystagmus was seen in patients with other signs of cerebellar degeneration. There was no pigmentary retinal dystrophy; only 3 patients had background diabetic retinopathy, despite a median duration of diabetes of 24 years. Electroretinography was normal in 3 patients and showed reduced amplitude in 3 patients; visual evoked responses were abnormal (10/10 patients: reduced amplitude to both flash and pattern stimulation). Magnetic resonance imaging showed generalised brain atrophy with reduced signal from the optic nerves and chiasm. A postmortem brain specimen from one patient revealed atrophy of the optic nerves, chiasm, cerebellum and brainstem. We found no evidence of mitochondrial genome defects or rearrangements. This primary neurogenerative disorder presents with diabetes mellitus and progressive optic atrophy, probably due to pathology in the optic nerve.
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PMID:Optic atrophy in Wolfram (DIDMOAD) syndrome. 953 52

The number of Americans with diabetes mellitus has increased 50% since 1983 to 16 million. An interesting and startling factor is that only half of these diabetics are aware they have the disease. Diabetes mellitus can lead to blindness, heart disease, stroke, nerve damage, kidney failure, and periodontal disease. It is the fourth leading cause of death in the United States. A metabolic disorder affecting insulin metabolism and associated blood glucose intolerance regulation, diabetes may be classified by the following categories: type I-insulin dependent diabetes mellitus which is commonly found in children and adolescents and type II-non-insulin-dependent or adult-onset diabetes which occurs in patients over forty and is associated with obesity. The dental hygienist's role in education, prevention, and therapeutics has expanded to detection and recognition of oral manifestations of diabetes. The dental hygienist may be the first to recognize the presence of the disease. This article aims to acquaint the dental hygienist with the clinical picture of a dental patient with diabetes mellitus.
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PMID:A dental hygiene perspective in the detection of diabetes mellitus. 959 74

Treatment of diabetic complications consumes health care resources. Intensive therapy was shown by the Diabetes Control and Complications Trial (DCCT) to avert complications. Economic analyses and models have been used to evaluate the cost-effectiveness of intensive therapy for people with type 1 and type 2 diabetes. An economic analysis of the DCCT estimated the cost of intensive therapy to be two to three times greater than that of conventional therapy. In contrast, an economic model predicts that intensive therapy, as compared with conventional therapy, could reduce blindness from 34 to 20% or by 41%, end-stage renal disease from 24 to 7% or by 71%, and lower-extremity amputations from 7 to 4% or by 43%. Although intensive therapy is more expensive, when the costs of complications are factored in, it becomes cost-effective for treatment of type 1 diabetes. Similarly, a model to evaluate the cost-effectiveness of intensive therapy for people with type 2 diabetes found that the lifetime costs of general and diabetes-related medical care would be approximately two times greater. However, the reduction in lifetime costs of complications, which would produce substantial reductions in costs of treatment, largely offsets the difference. Intensive therapy for type 1 and type 2 diabetes may be more expensive than conventional therapy, but from an economic perspective, it is comparable in cost to pharmacological therapies for people with hypertension and hypercholesterolemia. From a health system viewpoint, intensive therapy represents a fruitful long-term financial investment.
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PMID:The effects of treatment on the direct costs of diabetes. 985 Apr 82

Literature review shows that in the African Sub-Sahara, prevalence of diabetic retinopathy is between 15 and 52%, the main age being the fifties (between 45.5 and 53.25 years in our cases); after 5 years of diabetes evolution (8.45 +/- 6.93 years in our cases) men being two to three fold more affected than women; non insulin dependent diabetes representing 77% and insulin dependent diabetes 23%. The type of retinopathy is usually mixed, both edematous and ischemic (88% being non proliferative). Retinopathy concerned mainly non obese, non insulin dependent diabetics in our cases. Risk factors are poor glycemic control and arterial hypertension. Diabetes duration was the sole and most evident risk factor. Diabetes duration was 5.28 +/- 5.28 years when retina was normal and reached 8.58 +/- 5.33 years for Stage II and 12.8 +/- 6.31 years for retinopathy Stage III and 16.75 +/- 7.25 years for retinopathy Stage IV. These factors, delayed diagnosis and diabetes progression in Africa justify improvement of diabetes care by multidisciplinary team to prevent blindness.
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PMID:[Diabetic retinopathy in Dakar and review of African literature: epidemiologic elements]. 1101 Dec 27

The review of several diabetes epidemiological studies confirms that diabetes is one of the most prevalent non-communicable diseases globally, and it is the fourth or fifth leading cause of death in most developed countries. Diabetes prevalence ranges from nearly 0% in New Guinea to 50% in the Indians of Arizona. No modifiable risk factors have been clearly established in persons with type 1 diabetes, but major environmental determinants have been suggested. Impaired glucose tolerance, gestational diabetes, insulin resistance, obesity and lack of physical activity have been consistently identified as risk factors for type 2 diabetes. The prevalence of diabetes increases with age, but a sex-specific tendency has not been consistent. In addition, the prevalence of diabetes is higher in African-Americans and Hispanics when compared to other ethnic groups. Diabetes affects almost all organs of the body and is the leading cause of blindness and amputations of legs, imposing both clinical and economic costs to patients and society.
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PMID:The public health burden of diabetes: a comprehensive review. 1156 71

The majority of diabetic dogs appear to have a form of type 1 diabetes analogous to the latent autoimmune diabetes of adults (LADA) in humans. Evidence of acute or chronic pancreatitis occurs in about 40% of diabetic dogs. Blindness caused by cataract formation eventually occurs in the majority of diabetic dogs and is not dependent on glycemic control. Insulin is the mainstay of therapy for diabetic dogs, and a conservative approach to insulin therapy is crucial. Most diabetic dogs require twice-daily dosing with lente or NPH insulin to adequately control their clinical signs. The diet fed should primarily be palatable and nutritionally balanced. Improved glycemic control may be achieved in some dogs if the diet contains increased insoluble fiber.
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PMID:Management of canine diabetes. 1157 Jan 30

Diabetes affects millions of people worldwide. The most common variants are type 1 diabetes with autoimmune destruction of the pancreatic beta-cells and type 2 diabetes with peripheral insulin resistance and beta-cell dysfunction. In spite of tremendous research, current pharmacological regimens are still sub-optimal for adequate blood glucose control. As a consequence, patients with diabetes are at significant risk for development of serious long-term complications, such as blindness and kidney disease. This review will discuss present and future strategies for the treatment of type 2 diabetes with a focus on the more recently recognized problems of beta-cell dysfunction and loss. The treatment strategies presented include promotion of beta-cell proliferation and differentiation by glucagon-like peptide 1 receptor agonists.
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PMID:Current and future treatment strategies for type 2 diabetes: the beta-cell as a therapeutic target. 1176 59

Visual impairment and blindness are major complications of diabetes and are regarded as the most serious disability by most of patients. The purpose of the study was to determine the incidence and prevalence due to diabetes-induced visual disability in 1991-1999 in the former Cracow voivodeship with population of 1,245,047 inhabitants. A register of visual disability was established using independent sources of information. On the end of 1999 the register had included 122 diabetics with visual disability--66 women (54.1%) and 56 men (45.9%). The patients with type 2 diabetes predominated--92 subjects (75.4%). The remaining 30 patients (24.6%) had type 1 diabetes. Grade 1 visual disability was diagnosed in 82 subjects (67.2%) whereas grade 2 visual disability in 40 patients (32.8%). Grade 1 visual disability was defined as visual acuity in a better eye < 0.05 and visual field narrowing < 20%. The criteria of grade 2 were visual acuity after correction in a better eye 0.05-0.1 and visual field narrowing 20-30%. According to the register of the Cracow Branch of the Polish Association of the Blind diabetics made up 6.2% of all visual disability cases. In 1991-1999 the incidence of visual disability due to diabetes did not increase significantly. The mean incidence rate was 0.9/100,000 population. However, there was a significant increasing trend in prevalence with mean annual increase of 0.24/100,000 population (95% CI 0.17-0.31/100,000).
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PMID:[Visual disability due to diabetes in Cracow voivodeship]. 1192 95


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