The focus of this research study was to gain needed information on the older adult population in the United States who have diabetes. The research method was quantitative retrospective study of American diabetes obtained from the National Health Interview Survey database from 2001 through 2010. The study results confirmed more than one-third of the U.S. diabetics are aged 65 and older. More than 75% of the older diabetic population report clinical limitations or comorbidities. Based on surrogate markers of education, it appears the older diabetic cohort did receive more preventative care visits than did the older nondiabetic population; however, the difference was not robust. I found a slight negative trend between age and emergency room visits in the older diabetic population; in addition, there was a negative association between age and smoking in this population. There continues to be a need for scientific research in this population. Greater numbers need education and more clinical trials specific to the older diabetic should be encouraged.

Background: Type 2 diabetes has been found to be associated with cognitive impairments in planning, problem solving, organization, and working memory and also with an increased risk of dementia. Neurocognitive impairment may impact self-care and other health behaviours increasing the risk of poor health outcomes in this patient population. Detection of neurocognitive impairment in low and middle-income settings is challenging; there is a lack of validated screening tools suitable for local use in primary care and outpatient settings and access to formal neuropsychological testing services is limited. The inability to easily identify people with type 2 diabetes with neurocognitive impairments is constraining the development of context appropriate interventions to improve the care and outcomes in this sub-group of patients. Aim: The aim of the current analysis is to explore associations between neurocognitive function and measures of diabetes control (HbA1c, disease duration, type of blood glucose lowering treatment) at baseline in a population of people with type 2 diabetes participating in a clinical trial of treatment adherence support using SMS-text messages. Materials and Methods: Sms text Adherence suppoRt for type 2 Diabetes (StAR2D) is a randomised clinical trial testing if a system of SMS-text messages to support treatment adherence is more effective than usual care for controlling blood sugar among people with type 2 diabetes in sub-Sahara Africa (ISRCTN70768808). We have embedded neurocognitive assessment sub-studies into the Cape Town trial site. At baseline participants in the StAR2D trial complete a novel mobile-device based cognitive assessment, NeuroScreen, assisted by a field research assistant. The assessment contains 9 variants of tests found in the gold-standard neuropsychological test battery that have been adapted and normed for use in South Africa. It is available in English or isiXhosa. The assessment takes between 20 to 40 minutes depending on participant error rate. This cross-sectional analysis of baseline data uses linear and logistic regression models to explore associations between neurocognitive function and measures of diabetes control. Results: Six hundred participants eligible for enrolment in the StAR2D trial were recruited from the Cape Town trial site; 499 participants completed the baseline neurocognitive screening assessment (20 to 40 minutes to complete); 101 participants did not complete the assessment (commonly due to eyesight, hearing or motor difficulties e.g. hemiplegia due to previous stroke or technical difficulties.) We found differences in the scores in some but not all the neuropsychological tests. Using cut points suggested by an earlier validation study of NeuroScreen tool more than half of study participants would be scored as having at least mild neurocognitive impairment. HbA1c, duration of disease, type of blood glucose lowering treatment were not significantly associated with individual or overall neuropsychological test scores or odds of neurocognitive impairment. Conclusions: The prevalence of neurocognitive impairment may be substantial in this patient population. A novel tablet based neurocognitive screening tool was broadly feasible and acceptable to lay researchers and trial participants. There was no evidence that HbA1c, duration of disease, or type of blood glucose lowering treatment (oral agents alone or insulin containing regimens) was significantly associated with individual or overall neuropsychological test scores or odds of neurocognitive impairment. Validating this tool for this patient population and optimising its role in routine clinical care need further study.

Objectives Concurrent diabetic ketoacidosis (DKA) is highly prevalent in patients with hypertriglyceridemia-induced pancreatitis (HP). Diabetic ketoacidosis could potentially complicate the diagnosis, management, and prognosis of HP. This study aimed to directly compare the clinical course of HP with and without DKA and assess the outcomes of frequently used severity-prediction scores in such population. Methods We retrospectively analyzed 140 patients with HP; 37 patients (26.4%) had concurrent DKA. We compared epidemiologic characteristics, initial laboratory values, and clinical courses between the DKA and non-DKA groups. Bedside Index for Severity in Acute Pancreatitis score, Sequential Organ Failure Assessment score, Ranson criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Marshall score were calculated and compared between groups. Results We observed more acute kidney injury in the DKA group. Patients with DKA more likely required intensive care unit admission, received intravenous insulin, and were discharged on subcutaneous insulin. Ranson criteria and APACHE II score were significantly higher with DKA. Conclusions Concurrent DKA does not affect length of stay, in-hospital mortality, and readmission rate in patients with HP. Higher Ranson criteria and APACHE II score likely reflected derangement of clinical parameters secondary to DKA rather than true severity of pancreatitis in such population.

Background: The International Diabetes Federation estimates that the number of adults with diabetes in Africa will increase by 98% by the year 2030. The importance of diabetic retinopathy as a cause of blindness has increased because of longevity and a decline in the other preventable causes of blindness in developing countries. Retinopathy diagnosed early, followed closely, and treated timeously with retinal laser therapy, prevents blinding retinopathy. The objective of the study is to determine the prevalence of Diabetic Retinopathy, its determinants and the acceptability as well as accessibility of the screening service by patients. Methods: The study is a cross-sectional study conducted at Gaborone diabetic retinopathy screening clinic. Convenience sampling was used where every eligible patient that arrived for DR screening and had consented was included in the study. Basic descriptive statistics of the study sample were reported and a multivariate analysis was performed with DR as the outcome of interest. Results: A total of 220 participants attended the clinic between 12th of January and 6th of February 2015. The mean age of the participants was 55.96 (p=0.32) years and females comprised the majority 65.45% (n= 144, p=0.33)) of participants. A fifth of the participants (n=43, p=0.67) felt they had poor knowledge of diabetes and 25.91% (n=57, p=0.96) stated they did not understand the purpose of screening. Only 63.64% (n=140, p=0.46) reported to always being compliant with their medication and compliance did not differ significantly between those who had retinopathy and those who did not. Traditional medicine use was reported in 16.36% of the participants (n=36, p=0.33). Diabetic Retinopathy was found in 31.82% (n=70) of the population and of those, 3 participants (1.36%) had referable DR. Maculopathy was found in 21.82% (n=48) of participants. Increasing household number and years living with DM were the only variables found to have a significant association with development of diabetic retinopathy. Conclusion: The prevalence of diabetic retinopathy has increased in our population compared to previous studies. The number of Diabetics attending the DR screening service in Gaborone has also increased but continuous diabetes health education cannot be over emphasized. Incorporation of local cultural values into the overall management of the disease is the best way to increase patient compliance.

Diabetes is a disease characterized by high blood glucose levels that result from a defect in the body’s inability to produce or utilize insulin. This disease increases the risk of long-term health problems and affects multiple organ systems; one complication being diabetic retinopathy (DR) that causes changes in the blood vessels of the retina. Diabetic retinopathy is the leading cause of blindness in the working age population. Early events in the pathogenesis of diabetic retinopathy are characterized by retinal vascular cell loss and excess retinal capillary leakage. Studies have shown that the retinal vascular cell loss occurs by programmed cell death while excess permeability develops at least in part through compromised tight junctions. Studies, including those from our laboratory, have also established that high glucose or diabetes reduces a specific protein, Cx43, found in intercellular communication channels or gap junctions, and contributes to the development of programmed cell death. It is currently unknown if there is an association between high glucose- or diabetes-induced Cx43 downregulation and excess permeability. Importantly, previous studies have shown that reduced Cx43 can promote excess permeability, but the mechanism underlying this phenomenon is not well understood. In this study, the effects of reduced Cx43 expression on proteins involved in cell-cell adhesion, or tight junctions, was examined. Specifically, experimentally induced Cx43 downregulation by a gene silencing technique affected the expression of tight junction proteins (ZO-1, occludin, claudin-5) in rat retinal endothelial cells. ZO-1 and occludin protein levels were decreased while claudin-5 levels were increased. In addition, permeability was increased when Cx43 was downregulated. These observations suggest that expression levels of Cx43 regulate barrier characteristics by influencing the expression of tight junction proteins. Findings from this study provide an insight into how high glucose-induced Cx43 downregulation compromises endothelial barrier characteristics through modulation of tight junction proteins. / 2031-01-01

Thesis (Ph.D.)--Baylor University, 2006. / Includes bibliographical references (p. 88-90).

To investigate the possibility that chronic diabetes mellitus was related to specific neuropsychological deficits, cognitive functioning was measured in subjects with diabetic retinopathy (without secondary disabilities), and in subjects classified as normal blind adults (also without secondary disabilities). The scores for the two groups were then compared.

Magister Chirurgiae Dentium (MChD) / Diabetes Mellitus (DM) is a well-known risk factor for Periodontal disease. Research has established that the prevalence of Periodontal disease is directly related to the glycaemic control of DM in adults and only a few research studies explore this prevalence in diabetic children and adolescents in South Africa. The aim of this study is to determine the periodontal health status of diabetic patients which include children and adolescents attending the Paediatric Diabetic Clinic at Tygerberg Hospital and compare periodontal status with diabetic control. cross-sectional study was employed to determine periodontal status and data relating to the HbA1c% level, the type and duration of DM, the body mass index (BMI) percentile, age, sex, and puberty and treatment regimens were collected from patient records and entered into data collection sheets.

No description available.

No description available.