Prevalence and predictors of depression and anxiety in adult patients with type 1 diabetes in tertiary care setting

AIMS

To determine gender and age differences in the prevalence of depression and anxiety and their predictive factors in adult patients with type 1 diabetes (DM1).

METHODS

Random sample of DM1 adult patients from a tertiary care hospital cohort. To evaluate the presence of depression and anxiety, psychological evaluation was performed using structured clinical interview (MINI). For the specific evaluation of fear of hypoglycemia (FH), FH-15 questionnaire was used.

RESULTS

339 patients [51.6% male; 38.5 ± 12.9 years; HbA_1c 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.1 ± 12.0 years of DM1] met the inclusion criteria. Prevalence of depression, anxiety, and FH in men vs. women was as follows (%): depression: 15.4 vs. 33.5 (p < 0.05); anxiety: 13.7 vs. 26.2 (p < 0.05); and FH: 42.8 vs. 46.0 (p = NS). Among midlife female patients, prevalence of depression and anxiety was higher compared to male. Moreover, comorbid depressive and anxious symptoms were also higher in midlife female patients compared to age-matched male patients (3.5 vs. 14%, p < 0.05). Apart from age-related vulnerability, female gender, poor glycemic control, and microvascular and macrovascular complications were predictive factors for depressive and anxious symptomatology. Unawareness hypoglycemia and anxiety-prone personality were predictor factors for FH.

CONCLUSIONS

In adults with DM1, prevalence of depression and anxiety is higher in women. Midlife patients, in particular women, show a significantly higher prevalence of anxiety symptoms and comorbid depression and anxiety. The presence of secondary complications and sustained poor glycemic control should alert to the possibility of these mental disorders, especially in the most vulnerable age population; clinical, gender and age-related patterns could help to design more effective psychological assessment and support in adult patients with DM1.

Variability in the presence of the metabolic syndrome in Type 2 diabetic patients attending a diabetes clinic. Influences of age and gender

In this study, we have assessed age and gender-related influences on the presence of the metabolic syndrome (MS) and closely related variables in Type 2 diabetic patients attending a diabetes clinic. For this purpose, we have taken retrospective clinical and biochemical data from consecutive Type 2 diabetic patients (n = 291) and we have classified them by gender, age (with 55 and 70 years as cut-off levels) and having or not having the MS (using both the WHO and NCEP-ATP III MS definitions). A higher prevalence of adiposity and hypertension was present in the females. Males were characterized by higher uric acid and lower HDL-cholesterol and apoA(1) levels (two-way ANOVA considering jointly age and gender as main effects, P < 0.05 in every case). Overall the prevalence of NCEP-ATP III-defined MS was less frequent than WHO-defined MS (63.2% versus 81.1%, respectively). This difference was greater for males (42.1% versus 77.6%, respectively) than for females (75.5% versus 83.2% respectively). The kappa-coefficient for the concordance between both MS definitions was 0.46 for males and 0.72 for females in the first age band, 0.29 for males and 0.48 for females in the second age band and 0.24 for males and 0.51 for females in the third age band. Thus, this study reveals relevant differences in the application of WHO and NCEP-ATP III MS definitions in a clinic-based Type 2 diabetic population from Southern Spain. In addition, the data suggest that gender confers a specific influence upon some MS-associated features in Type 2 diabetic patients attending a diabetes clinic irrespective of age band.

Relationships of apolipoprotein B(100) with the metabolic syndrome in Type 2 diabetes mellitus

The current study assessed whether features of the metabolic syndrome are associated with higher apolipoprotein B(100) (apoB(100)) levels in people with Type 2 diabetes (n = 298) not taking lipid-lowering drugs. Body-mass index (BMI), waist:hip ratio (WHR), urinary albumin excretion rate, presence or absence of hypertension, uric acid levels, and apoB(100) levels were assessed. Both higher BMI and urinary albumin excretion rate were associated with higher apoB(100) levels (1.02 +/- 0.25 ( +/- S.D.) g/l in normal weight, 1.07 +/- 0.22 g/l in overweight and 1.14 +/- 0.25 g/l in obese individuals; P < 0.01; 1.09 +/- 0.23 g/l in normoalbuminuric patients, 1.06 +/- 0.22 g/l if urinary albumin excretion rate 20-50 microg/min and 1.17 +/- 0.27 g/l if urinary albumin excretion rate > 50 microg/min; P < 0.05). An association between the number of features of the metabolic syndrome and higher apoB(100) levels was found (1.03 +/- 0.22 g/l if no features, 1.08 +/- 0.25 g/l if one feature, 1.11 +/- 0.20 g/l if two features and 1.15 +/- 0.27 g/l if > 2 features; P for trend < 0.01). Thus apoB(100) levels show an association with the metabolic syndrome and, hypothetically, to insulin-insensitivity in Type 2 diabetes. BMI (but not WHR) and urinary albumin excretion rate accounted for most of the power of this relationship.

[Environmental evaluation near a fuel vendor within Parque Nacional Morrocoy, Venezuela. II: Water quality, sediments and biota]

This paper is the second part of a base line study carried out in the coastal region near a marine service station located in Morrocoy National Park, Venezuela. Results from a physical and chemical characterization of the water and sediments of four sites located around the service station are presented. The physical and chemical factors measured in water included: temperature, salinity, specific conductance, dissolved oxygen, saturation percentage of dissolved oxygen, pH, total suspended solids, transparency, oil and grease, total residual petroleum hydrocarbon, vanadium and lead, total coliform bacteria, and the presence of coliform bacteria. The factors measured in sediments include: granulometry, organic material, total carbonates, vanadium, lead, oil and grease, and total hydrocarbons. In addition, the amount of vanadium and lead in sample tissue from three species which are abundant and widely distributed in each site was measured in order to evaluate the potential of these species as bio-indicators. The water in the area where this study was conducted is shallow, warm, and thermally homogeneous, with high salinity and normal pH and dissolved oxygen, and supersaturated with oxygen in certain hours in sites adjacent to abundant underwater vegetation. The water is moderately turbid with a tendency towards less dissolved oxygen with increased depth. The estimated values of NMP/100 ml of the coliform fecal organisms is within legal limits even though the total number of water coliforms measured in Site 2 was ten times higher than in Site 1. This increase is associated with the proximity of Site 2 to an outflow of pre-treated sewage. The values of TRPH in the water collected from each site were low and very close to the detection limit (0.8/ml). Vanadium was not found, while lead was detected in 11 of the 12 samples. Compared to the values measured for Site 1, which was the local reference, only one sample had a concentration of three times the maximum baseline. The amount of lead found in all analyzed samples was acceptable, according to the standards set by the State of Washington (maximum value: 292 mg/kg), while the concentration of lead in the sediments around the supply dock were 1.5 to 3.4 times greater than the Dutch norm. It can be concluded that there is no evidence of an accumulation of Va or Pb in the species selected as bioindicators. An observation program is proposed in which variables similar to those measured for this characterization will be studied with some modifications. A more intense sampling of some variables is recommended (lead in water and sediments, total coliform and fecal matter in consecutive samples and in days following a high concentration of visitors) as is the elimination or minimization of other variables.

Adding metformin versus insulin dose increase in insulin-treated but poorly controlled Type 2 diabetes mellitus: an open-label randomized trial

To compare the effect of adding metformin to insulin therapy with a moderate increase in insulin dose alone in insulin-treated, poorly controlled Type 2 diabetic patients, 47 consecutive such patients (baseline daily dose >0.5 IU kg(-1) and HbA1c >8%) were openly randomized either to a combination of their previous insulin schedule plus metformin (2.55 g daily in three divided doses, n = 24) or to a moderate insulin dose increase (20% of baseline, n = 23). The patient status/biochemical profile was assessed at entry and at 4 months. Among those assigned to insulin + metformin, 18 took the drug. Upon an intention-to-treat basis, patients assigned to insulin dose increase had a statistically significant weight gain (1.16+/-1.9 vs 0.3+/-4.5 kg, p < 0.05). Patients assigned to the insulin + metformin regimen experienced a significantly greater fall in HbA1c (-1.87+/-2.16 vs 0.03+/-1.68%, p < 0.01), total cholesterol (-0.56+/-0.89 vs 0.14+/-0.72 mmol l(-1), p < 0.05) and LDL-cholesterol (-0.51+/-0.73 vs 0.19+/-0.6 mmol l(-1), p < 0.01). These data suggest that adding metformin to insulin in poorly controlled Type 2 DM patients offers an advantage in terms of glycaemic control and lipid plasma profile.

Relationships of C-peptide levels and the C-peptide/bloodsugar ratio with clinical/biochemical variables associated with insulin resistance in orally-treated, well-controlled type 2 diabetic patients

The aim of the present study was to evaluate the relationship of C-peptide and the C-peptide/bloodsugar ratio with clinical/biochemical variables presenting a well-known association with insulin resistance in NIDDM patients in acceptable control, obtained without the use of exogenous insulin. A total of 118 non insulin dependent diabetes mellitus (NIDDM) patients treated with diet/oral drugs and having a HbA(1c) level < 7.5% have been studied. Non-stimulated C-peptide levels (RIA) and the C-peptide/bloodsugar ratio have been determined and their relationships with the blood pressure status, blood pressure figures, estimates of adiposity, age, known duration of diabetes, current therapies, plasma lipids, glycaemic control, urinary albumin excretion rate, uric acid and creatinine have been ascertained. C-peptide levels were significantly (P < 0.05) correlated with systolic (r = 0.21) and diastolic blood pressure (r = 0.19), BMI (r = 0.21), high density lipoprotein (HDL) (r = -0.22), non-HDL-cholesterol (r = 0.23), apolipoprotein B (r = 0.29), log of triglycerides (r = 0.39) and uric acid (r = 0.35). The C-peptide/bloodsugar ratio had statistically significant correlations with known duration of diabetes (r = -0.23), diastolic blood pressure (r = 0.21), body mass index (BMI) (r = 0.22), log of triglycerides (r = 0.23) and uric acid (r = 0.36). Hypertensives had higher C-peptide levels than normotensives (1.04 +/- 0.04 versus 0.88 +/- 0.04 nmol/ml, respectively (mean +/- S.E.), P < 0.05) and this statistically significant difference remained after adjustment for age and known duration of diabetes. In well-controlled NIDDM patients not receiving exogenous insulin, both C-peptide levels and the C-peptide/bloodsugar ratio have statistically significant relationships with clinical/biochemical variables presenting a well-known association with insulin resistance.

Urinary albumin excretion rate and cardiovascular disease in Spaniard type 2 diabetic patients

To assess the prevalence of urinary albumin excretion abnormalities and their associations with cardiovascular disease or its classical risk factors in type 2 diabetes mellitus, 1348 clinic-proceeding patients have been studied retrospectively. The overnight urinary albumin excretion rate, blood pressure, smoking, ophthalmic and cardiovascular status, current therapies, estimates of glycemic control, plasma lipids, serum creatinine and uric acid have been ascertained. 767 (56.8%) patients were found normoalbuminuric, 461 (34.1%) microalbuminuric and 120 (8.9%) macroalbuminuric. In bivariate analyses, the urinary albumin excretion rate had statistically significant (P < 0.05) relationships with age, duration of diabetes, male sex, waist-to-hip ratio, systolic and diastolic pressure, coronary heart disease, cerebrovascular disease, peripheral vascular disease, hypertension, antihypertensive therapy, laser-treated retinopathy, kind of treatment, smoking habit, fasting glycaemia, HbA1c, creatinine, uric acid, triglycerides, high density lipoprotein (HDL)-cholesterol and apolipoprotein B. Borderline statistically significant (P < 0.1) relationships were found with hypolipidaemic therapy, insulin dose, non-HDL-cholesterol, apolipoprotein A1 and lipoprotein (a). In a multivariate stepwise logistic regression model, HbA1c, hypertension, male sex, age, diastolic blood pressure, coronary heart disease and body-mass index were sequentially selected as variables independently associated with microalbuminuria. Serum creatinine, HbA1c, male sex and hypertension were sequentially selected as independently associated with macroalbuminuria. Micro and macroalbuminuria are frequent abnormalities associated with poorly controlled and complicated disease, with overt cardiovascular disease and its classical risk factors as well as with the male sex.

Lack of association of lipoprotein (a) with coronary heart disease in Spaniard type 2 diabetic patients

We tried to elucidate the possible relationship between lipoprotein (a) levels and coronary heart disease by assessing the presence of lipoprotein (a) covariates in NIDDM. We selected 41 type 2 diabetic patients with coronary heart disease and 82 type 2 diabetic patients free from cardiovascular disease. They were adjusted for age, sex and duration of diabetes. Routine chemical analysis was carried out using standard procedures, HbA1c by HPLC and lipoprotein (a) and urinary albumin excretion rate by immunonephelometry. No difference has been found in lipoprotein (a) levels between both groups of patients (18 [144.25] mg/dl in cases vs. 23 [197.25] mg/dl in controls (median [range]), Mann Whitney U-test, P > 0.1). No association has been found between coronary heart disease and lipoprotein (a) levels greater than 30 mg/dl (Pearson's chi 2, P > 0.1). Significant and independent linear relationships have been found between the square root of lipoprotein (a) levels, serum creatinine and total cholesterol (multiple r2: 0.15, P < 0.001). Patients treated with insulin had greater square root of lipoprotein (a) levels, even after adjusting for serum creatinine and total cholesterol (5.87 +/- 0.35 vs. 4.76 +/- 0.36 (mean +/- S.E.), ANCOVA, P < 0.05). These data do not show an association between symptomatic coronary heart disease and lipoprotein (a) in NIDDM. Significant and independent relationships have been found between this variable and serum creatinine, total cholesterol and insulin therapy.

Electrophoretic studies on blood and tissue proteins of normal and regenerating Ampullarius glaucus (Gastropoda)

Changes in blood and soluble tissue proteins of the snail Ampullarius glaucus were studied by acrylamide gel and cellulose acetate electrophoresis in normal snails and those undergoing shell regeneration. Normal blood regularly has five bands (cellulose acetate). A sixth band was present in 19% of normal and 77% of regenerating snails. Two new protein bands appeared in the mantle during regeneration (acrylamide gel), and these corresponded to two bands of the normal hepatopancreas. The hepatopancreas showed no change in the number of protein bands during regeneration. Total blood calcium and total blood protein were not significantly altered during regeneration. The crystal type of both normal and regenerated shell was aragonite.