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The aim of this study was to compare glucose measurements between fingertip and forearm using the blood glucose (BG) monitoring system One Touch Ultra (LifeScan), an electrochemical sensor that requires only a very small drop of blood (1 microL). Patients with type 1 or type 2 diabetes were identified in five outpatient diabetes clinics. Participants were requested to use the One Touch Ultra at home for 1 week for the measurement of BG levels from both sites. Patients filled in a questionnaire about their experience with testing blood samples from fingertip and forearm. The agreement between the measurements from the two sites was assessed using linear regression analysis, mean absolute relative error (MARE), the Bland-Altman method, and Error Grid Analysis (EGA). Overall, 112 patients were recruited, of whom 58% had type 1 diabetes. Linear regression analysis showed an intercept of 17.7, statistically different from 0 (p<0.0001). The slope was 0.956, and the Pearson correlation coefficient was 0.95. A MARE of 12.1% (SD=11.8%) was obtained, with a greater deviation of the forearm values from the fingertip ones in the hypoglycemic range (MARE=22.3%; SD=21.7%). The Bland-Altman bias plot showed a mean bias of 10.2 mg/dL (SD=23.1), with no correlation between mean difference and average BG levels (r=0.02). The EGA showed that 89.2% of the values fell in zone A, 10.4% in zone B, and 0.4% in zone C. The vast majority of patients (71%) declared that the collection of blood from the forearm caused no pain or less pain than the traditional site. Only 17% of the patients declared that it was impossible to obtain any blood from the forearm, while 63% reported with satisfaction that the quantity requested was small. At the end of the study period, 32% of the participants indicated the forearm as the preferred test site. Alternative site testing on the arm, with a BG meter that requires only a very small drop of blood, is feasible and reliable under routine clinical conditions. When testing with the express purpose of detecting hypoglycemia, the finger still remains the recommended test site.
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PMID:Alternative site blood glucose testing: a multicenter study. 1470 1

Type 2 diabetes has now reached epidemic proportions across the world and is the cause of substantial morbidity and mortality. Patients with diabetes suffer from their mircovascular complications of retinopathy (blindness), nephropathy (renal failure, dialysis), and neuropathy (neropathic pain, trophic ulcers). However, ultimately, the majority of diabetics will die from macrovascular cardiovascular disease. Not only does cardiovascular disease develop earlier in the presence of diabetes, mortality from cardiovascular disease is increased by a factor of two to three in persons with diabetes as compared with the general population. To reduce this increased risk, a multifactorial approach to the management of type 2 diabetes has been advocated. The American Diabetes Association recommends not only good glycemic control but also identification and aggressive treatment of associated cardiovascular risk factors, with more stringent target levels for lipids and blood pressure than those recommended for the general population. Studies have shown that an intensified and goal-oriented approach to the treatment of type 2 diabetes addressing tight glucose control, optimal lipid and blood pressure management and the use of antiplatelet agents like aspirin reduces cardiovascular events, as well as nephropathy, retinopathy, and neuropathy.
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PMID:Intense management of diabetes mellitus: role of glucose control and antiplatelet agents. 1505 50

Lower extremity ulcers are a common and challenging problem for people with diabetes and clinicians who provide their care. A qualitative study of seven patients with type 1 or type 2 diabetes who had leg and/or foot ulcers was conducted to enhance understanding of the patient's perspective of living with lower extremity ulcers and diabetes. Data were collected through in-depth interviews guided by the patients' descriptive priorities. Results indicated that patients experienced changes in their feet, pain and insomnia, fatigue and limited mobility, social isolation and loneliness, a restricted life, loss of control, and fear for the future. When treating a patient's leg or foot ulcer, clinicians need to consider patients' subjective feelings toward the various aspects of their life situations and the impact of their situation on their quality of life. Understanding the ramifications of lower extremity ulcers and diabetes on patients is important to the health professional's ability to provide support during the illness process.
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PMID:Living with diabetic foot ulcers: a life of fear, restrictions, and pain. 1512 12

Diabetic amyotrophy is a distinctive form of diabetic neuropathy usually characterized by the abrupt onset of pain and asymmetric proximal leg weakness and wasting. Involvement of the upper limbs is unusual, and prognosis is said to be good. We describe two patients, each with type II diabetes mellitus, who presented with diabetic amyotrophy progressing to severe quadriparesis. One patient remains severely disabled. The clinical spectrum of diabetic amyotrophy includes progression to severe quadriparesis.
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PMID:Diabetic amyotrophy progressing to severe quadriparesis. 1537 38

Bruns in 1890 was the first to recognize the main clinical features of 'diabetic amyotrophy'. The term itself was coined by Hugh Garland in 1955 when he reported 12 elderly patients with type 2 diabetes. The aetiology is controversial, and both ischaemic and metabolic hypotheses have been proposed. The current evidence, however, points to a vasculitic aetiology of ischaemia followed by axonal degeneration and demyelination. The main features of diabetic amyotrophy are weakness, wasting and pain, most commonly in the quadriceps muscle. Though the weakness starts on one side, it almost always spreads to the other side in an asymmetrical manner. Patients also complain of sensory symptoms in the thigh such as severe pain, dysaesthesiae and paraesthesiae. On examination, there is weakness in the involved muscles. Tendon jerks, especially the patellar, are absent. Extensor plantar responses may be elicited in some patients. The course of the disease is variable but good functional improvement can be expected in most patients though weakness, sensory symptoms and absent tendon jerks may persist. Some patients experience multiple episodes of the condition commencing mostly on the opposite side. Conservative treatment constitutes optimizing diabetic control along with active physiotherapy and analgesia. Recently, intravenous immunoglobulins have been found to produce dramatic improvement in both clinical and electrophysiological parameters in patients with diabetic polyradiculopathy.
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PMID:Diabetic amyotrophy: a brief review. 1537 63

Recent research has employed different analytical techniques to estimate the impact of the various long-term complications of type 2 diabetes on health-related utility and health status. However, limited patient numbers or lack of variety of patient experience has limited their power to discriminate between separate complications and grades of severity. In this study alternative statistical model forms were compared to investigate the influence of various factors on self-assessed health status and calculated utility scores, including the presence and severity of complications, and type of diabetes therapy. Responses to the EuroQol EQ-5D questionnaire from 4641 patients with type 2 diabetes in 5 European countries were analysed. Simple multiple regression analysis was used to model both visual analogue scale (VAS) scores and time trade-off index scores (TTO). Also, two complex models were developed for TTO analysis using a structure suggested by the EuroQol calculation algorithm. Both VAS and TTO models achieved greater explanatory power than in earlier studies. Relative weightings for individual complications differed between VAS and TTO scales, reflecting the strong influence of loss of mobility and severe pain in the EuroQol algorithm. Insulin-based therapy was uniformly associated with a detrimental effect equivalent to an additional moderate complication. Evidence was found that TTO values are not responsive in cases where 3 or more multiple complications are present, and therefore may underestimate utility loss for patients most adversely affected by complex chronic diseases like diabetes.
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PMID:Modelling EuroQol health-related utility values for diabetic complications from CODE-2 data. 1538 66

A 46-year-old Japanese man with type 2 diabetes mellitus, whose only diabetic complication was simple retinopathy, developed acute painful neuropathy. This presented as paresthesia and hyperesthesia restricted to the abdomen. The patient's haemoglobin A(1c) had dropped from 12% to 7.5% within 5 months, following a rapid improvement in glycaemic control. On investigation, there were no indications of disease in the intraabdominal area. Nerve conduction studies were consistent with mild sensorimotor peripheral and autonomic neuropathy. The patient required medication (mexiletine, sulpiride and imipramine hydrochloride) to control the pain. Four months after presentation, the symptoms showed a dramatic improvement and the treatment for pain relief was discontinued without any recurrence of paresthesia or hyperesthesia in the patient's abdomen. This was a very unusual case of diabetic post-treatment painful neuropathy in which the prominent features were severe pain, paresthesia and hyperesthesia restricted to the abdomen.
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PMID:Acute painful neuropathy restricted to the abdomen following rapid glycaemic control in type 2 diabetes. 1545 90

Although people age at different rates, changes to the composition of the human body are a hallmark of aging. As a result of such changes, disease can present differently in a person over 65 years old than it would in a younger adult or child. This article identifies the critical indicators of underlying conditions, including changes in mental status, loss of function, decrease in appetite, dehydration, falls, pain, dizziness, and incontinence. It also describes the presentation of diseases common to older adults, including depression, infection, cardiac disease, gastrointestinal disorders, thyroid disease, and type 2 diabetes.
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PMID:Presentation of illness in older adults. 1549 36

An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma. Although the content and intensity of the programmes were affected by the objectives of management of the illness, the interventions differed substantially even within the three illnesses. When comparing across conditions, it is important to recognise the different objectives of the interventions and the complexity of the issues that they are attempting to tackle. For both diabetes and asthma, the objectives are concerned with the underlying control of the condition with clear strategies to achieve the desired outcome. By contrast, strategies to deal with symptoms of pain and the consequences of disability in arthritis can be more complex. The interventions that were efficacious provide some guidance as to the components needed in future programmes to achieve the best results. But to ensure that these results endure over time remains an important issue for self-management interventions.
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PMID:Self-management interventions for chronic illness. 1550 Aug 73

Diabetic polyneuropathy (DPN) is the most common complication of diabetes and may frequently be the presenting symptom in type 2 diabetes mellitus (T2DM). Metabolic syndrome and T2DM are associated with multiple metabolic toxicities. These substrate toxicities support the formation of reactive oxygen species (ROS), which are so damaging to cells, tissues and organs and play an important role in the development of multiple diabetic complications. The importance of redox stress (ROS) and their effect on the neuronal unit are discussed. There are at least 5 major pathways involved in the development of DPN: metabolic, vascular, immunologic-autoimmune, neurohormonal growth factor deficiency, and extracellular matrix neuronal unit remodeling. Each of these five pathways are reviewed and related to neural redox stress and the role of ROS. The identification of the toxic substrates (A-FLIGHT acronym), earlier diagnosis of T2DM at the stage of impaired glucose tolerance or impaired fasting glucose, and aggressive global risk reduction with the use of a simple RAAS acronym will assist the clinician in slowing the natural progressive history, and possibly preventing the complications associated with DPN. The pain, foot ulceration, limb loss, organ dysfunction, and the associated morbidity and financial burden all contribute to the need for a better understanding of DPN and the role of redox stress and global risk reduction.
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PMID:Neural redox stress and remodeling in metabolic syndrome, type 2 diabetes mellitus, and diabetic neuropathy. 1556 93


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