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Examination of sleep disorders of 1023 type2 diabetic outpatients
Oral Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S40–S64
Diabetes Complications: Epidemiology and Biomarkers OL03-1 Examination of sleep disorders of 1023 type2 diabetic outpatients Akiko TESHIMA1 *, Junpei SHIKUMA1, Mamoru SAKURAI1, Ketchu YANAGI1, Rokurou ITOU1, Tomono TAKAHASHI1, Hiroyuki SAKAI1, Kazuo HARA1, Takashi MIWA1, Masato ODAWARA1. 1Tokyo Medical University Hospital, Japan Objective: Diabetic neuropathy can cause sleep disorders. Sleep disorders, meanwhile, increase insulin resistance, and affect leptin and ghrelin which enhance appetite. This study examined the relationship between diabetes mellitus (DM) and sleep disorders in type-2 DM (T2DM) patients, using a cross-sectional design. Methods: The participants in the study were 1033 Japanese outpatients with T2DM (age, 62.9 ± 13.1 years; M/F, 710/323 persons; DM duration, 16.3 ± 16.7 years; Hemoglobin A1c [HbA1c], 7.4 ± 1.3%) who visited our hospital in February 2014. We investigated sleep disorders, quality of life (QOL), and depression (assessed by the Pittsburgh Sleep Quality Index [PSQI], the Center for Epidemiologic Studies Depression Scale [CES-D], and the SF-8 Health Survey [SF-8]). We then compared the results with the data of 572 age- and sex-matched people from the general population without a diabetes history. Results: The mean PSQI score (cutoff ≥5.5) was 5.6 ± 3.3 (mean ± SD) in the participants, and 454 patients (44%) had PSQI scores of ≥5.5. Patients with a lower PSQI score tended to be obese. However, PSQI scores were not significantly correlated with glycemic control, diabetes duration, and insulin intake, respectively. In terms of CES-D (0–11 normal, 12–20 moderate, 21–36 severe), 929 patients (90%) were categorized as normal, 73 (7.1%) moderate, and 29 (2.9%) severe. PSQI scores and CES-D scores showed a positive correlation, whereas PSQI scores and SF-8 scores showed a negative correlation. In comparison with the non-diabetic population (n = 572), the diabetic group (n = 572) had significantly higher PSQI scores (5.7 ± 3.2 vs 5.2 ± 2.8) with significantly shorter sleep duration and lower sleep efficiency. Similarly, on SF-8, the diabetic group scored significantly lower in the Physical Functioning (PF), Role Physical (RP), Body Pain (BP), General Health (GH), and physical summary components. We observed no significant difference in CES-D scores between the two groups. Discussion: This study showed that many patients with T2DM suffer sleep disorders. Sleep quality is associated with depression and deteriorated QOL. While it is quite difficult to assume whether the diabetic patient has a sleep disorder through their patient characteristics, BMI – both the present and past maximum – had a correlation, pointing to the importance of noting patients’ body weight history. Sleep disorders should be widely recognized as a diabetic complication: intervention in the disorders can alleviate depression, and improve QOL and probably blood glucose control as well. OL03-2 Global and Chinese prevalence of diabetic foot Pengzi ZHANG1 *, Dalong ZHU1, Yan BI1. 1Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School, China Background: Diabetic foot is a severe public health issue worldwide and in China, and updating its epidemiologic characteristic is beneficial for future policy, prevention strategy and care management. However, there is a lack of studies to investigate the epidemiologic characteristics of diabetic foot. Here we performed a systematic review and meta-analysis to generate global and Chinese diabetic foot prevalence.
S45
Methods: In the systematic review and meta-analysis of global diabetic foot prevalence, we searched Pubmed, EMBASE, ISI Web of science and Cochrane and identified 67 studies. In the study of Chinese diabetic foot prevalence, we searched Pubmed, EMBASE, ISI Web of science, and Chinese databases: Chinese Biochemical Literature on Disc, Wanfang data resource and China National Knowledge Infrastructure database and included 39 studies. Random effects model metaanalysis was used to obtain the pooled prevalence of diabetic foot. Subgroup analysis and meta regression were also conducted to evaluate the sources of heterogeneity. Results: Global diabetic foot prevalence was 6.9% (95%CI: 5.9– 7.8%). North America had the highest prevalence (13.0%, 95% CI: 8.2–15.9%), and Oceania’s prevalence was the lowest (3.0%, 95%CI: 0.9–5.0%). The prevalence in Asia, Europe and Africa was 6.2% (95%CI: 5.2–7.2%), 5.7% (95%CI: 4.5–6.8%) and 8.8% (95%CI: 6.2–11.4%), respectively. Diabetic foot was more prevalent in males (4.5%, 95%CI: 3.7–5.2%) than in females (3.5%, 95%CI: 2.8–4.2%), and more prevalent in type 2 diabetes (9.4%, 95%CI: 6.4–12.4%) than type 1 diabetes (5.6%, 95%CI: 3.6– 7.6%). Patients with diabetic foot were older, with longer diabetic duration, higher HbA1c, larger percentage of smokers, hypertension and diabetic retinopathy as well as lower body mass index when compared with patients without diabetic foot. Chinese diabetic foot prevalence was 5.7% (95%CI: 4.9– 6.5%), which was higher in eastern region (6.9%, 95%CI: 5.6– 8.2%) than in western region (4.2%, 95%CI: 3.0–5.4%), and higher in males (6.6%, 95%CI: 2.1–11.2%) than in females (4.8%, 95%CI: 1.9–7.8%). Conclusion: We for the first time demonstrated that overall diabetic foot prevalence was 6.9% worldwide and 5.7% in China as well as its epidemiologic characteristics. Prevention of diabetic foot may include glycemic control and quit smoking. Our findings provide evidence for future policy making in diabetic foot, and thus alleviate the economic burden. OL03-3 Bilateral atrophy of extensor digitorum brevis muscle may be useful for diagnosis of diabetic polyneuropathy in Japanese diabetic men Hideyuki SASAKI1 *, Seigo KURISU1,2, Kenichi OGAWA1, Shohei KISHIMOTO1, Mika YAMANEKI1, Hiroto TANAKA1, Hiroto FURUTA2, Masahiro NISHI2, Kishio NANJO3, Takashi AKAMIZU2. 1Department of Medicine, Kihoku Hospital, Wakayama Medical University, 2First Department of Medicine, Wakayama Medical University, 3Wakayama Rosai Hospital, Japan Aims: We aimed to evaluate validity and reliability of observation of extensor digitorum brevis muscle (EDB). EDB atrophy for diagnosis of diabetic symmetric polyneuropathy (DPN). Firstly, we examined the relations between EDB atrophy and neurological findings in regional population-based Japanese subjects (Study I). Secondly, we investigated relations between EDB atrophy and quantitative neurological findings in the hospital-based diabetic patients (Study II). Methods: Study I. 548 non diabetic persons who received medical screening program were subjected. Subjective symptoms (numbness in toes and sole, pain and/or paresthesia in feet), quantitative vibratory perception at the tips of toe (QVP; using vibrometer Rion AU-02B), bilateral Achilles tendon reflexes (ATR) and EDB atrophy were evaluated. We judged EDB atrophy as positive when both EDB could not be identified by inspection and palpation. We also interviewed about Seiza habit (Japanese sit-down style with the buttocks on top of the ankles). Study II. In 193 diabetic patients, neurological examination as same as Study I were examined. Additional 8 objective nerve function tests were evaluated. Relationships among these findings were analyzed. Results: Study I. Prevalence (%) of EDB atrophy and Seiza habit in women (36, 73) were significantly higher than those in men
Diabetes Complications: Epidemiology and Biomarkers OL03-1 Examination of sleep disorders of 1023 type2 diabetic outpatients Akiko TESHIMA1 *, Junpei SHIKUMA1, Mamoru SAKURAI1, Ketchu YANAGI1, Rokurou ITOU1, Tomono TAKAHASHI1, Hiroyuki SAKAI1, Kazuo HARA1, Takashi MIWA1, Masato ODAWARA1. 1Tokyo Medical University Hospital, Japan Objective: Diabetic neuropathy can cause sleep disorders. Sleep disorders, meanwhile, increase insulin resistance, and affect leptin and ghrelin which enhance appetite. This study examined the relationship between diabetes mellitus (DM) and sleep disorders in type-2 DM (T2DM) patients, using a cross-sectional design. Methods: The participants in the study were 1033 Japanese outpatients with T2DM (age, 62.9 ± 13.1 years; M/F, 710/323 persons; DM duration, 16.3 ± 16.7 years; Hemoglobin A1c [HbA1c], 7.4 ± 1.3%) who visited our hospital in February 2014. We investigated sleep disorders, quality of life (QOL), and depression (assessed by the Pittsburgh Sleep Quality Index [PSQI], the Center for Epidemiologic Studies Depression Scale [CES-D], and the SF-8 Health Survey [SF-8]). We then compared the results with the data of 572 age- and sex-matched people from the general population without a diabetes history. Results: The mean PSQI score (cutoff ≥5.5) was 5.6 ± 3.3 (mean ± SD) in the participants, and 454 patients (44%) had PSQI scores of ≥5.5. Patients with a lower PSQI score tended to be obese. However, PSQI scores were not significantly correlated with glycemic control, diabetes duration, and insulin intake, respectively. In terms of CES-D (0–11 normal, 12–20 moderate, 21–36 severe), 929 patients (90%) were categorized as normal, 73 (7.1%) moderate, and 29 (2.9%) severe. PSQI scores and CES-D scores showed a positive correlation, whereas PSQI scores and SF-8 scores showed a negative correlation. In comparison with the non-diabetic population (n = 572), the diabetic group (n = 572) had significantly higher PSQI scores (5.7 ± 3.2 vs 5.2 ± 2.8) with significantly shorter sleep duration and lower sleep efficiency. Similarly, on SF-8, the diabetic group scored significantly lower in the Physical Functioning (PF), Role Physical (RP), Body Pain (BP), General Health (GH), and physical summary components. We observed no significant difference in CES-D scores between the two groups. Discussion: This study showed that many patients with T2DM suffer sleep disorders. Sleep quality is associated with depression and deteriorated QOL. While it is quite difficult to assume whether the diabetic patient has a sleep disorder through their patient characteristics, BMI – both the present and past maximum – had a correlation, pointing to the importance of noting patients’ body weight history. Sleep disorders should be widely recognized as a diabetic complication: intervention in the disorders can alleviate depression, and improve QOL and probably blood glucose control as well. OL03-2 Global and Chinese prevalence of diabetic foot Pengzi ZHANG1 *, Dalong ZHU1, Yan BI1. 1Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School, China Background: Diabetic foot is a severe public health issue worldwide and in China, and updating its epidemiologic characteristic is beneficial for future policy, prevention strategy and care management. However, there is a lack of studies to investigate the epidemiologic characteristics of diabetic foot. Here we performed a systematic review and meta-analysis to generate global and Chinese diabetic foot prevalence.
S45
Methods: In the systematic review and meta-analysis of global diabetic foot prevalence, we searched Pubmed, EMBASE, ISI Web of science and Cochrane and identified 67 studies. In the study of Chinese diabetic foot prevalence, we searched Pubmed, EMBASE, ISI Web of science, and Chinese databases: Chinese Biochemical Literature on Disc, Wanfang data resource and China National Knowledge Infrastructure database and included 39 studies. Random effects model metaanalysis was used to obtain the pooled prevalence of diabetic foot. Subgroup analysis and meta regression were also conducted to evaluate the sources of heterogeneity. Results: Global diabetic foot prevalence was 6.9% (95%CI: 5.9– 7.8%). North America had the highest prevalence (13.0%, 95% CI: 8.2–15.9%), and Oceania’s prevalence was the lowest (3.0%, 95%CI: 0.9–5.0%). The prevalence in Asia, Europe and Africa was 6.2% (95%CI: 5.2–7.2%), 5.7% (95%CI: 4.5–6.8%) and 8.8% (95%CI: 6.2–11.4%), respectively. Diabetic foot was more prevalent in males (4.5%, 95%CI: 3.7–5.2%) than in females (3.5%, 95%CI: 2.8–4.2%), and more prevalent in type 2 diabetes (9.4%, 95%CI: 6.4–12.4%) than type 1 diabetes (5.6%, 95%CI: 3.6– 7.6%). Patients with diabetic foot were older, with longer diabetic duration, higher HbA1c, larger percentage of smokers, hypertension and diabetic retinopathy as well as lower body mass index when compared with patients without diabetic foot. Chinese diabetic foot prevalence was 5.7% (95%CI: 4.9– 6.5%), which was higher in eastern region (6.9%, 95%CI: 5.6– 8.2%) than in western region (4.2%, 95%CI: 3.0–5.4%), and higher in males (6.6%, 95%CI: 2.1–11.2%) than in females (4.8%, 95%CI: 1.9–7.8%). Conclusion: We for the first time demonstrated that overall diabetic foot prevalence was 6.9% worldwide and 5.7% in China as well as its epidemiologic characteristics. Prevention of diabetic foot may include glycemic control and quit smoking. Our findings provide evidence for future policy making in diabetic foot, and thus alleviate the economic burden. OL03-3 Bilateral atrophy of extensor digitorum brevis muscle may be useful for diagnosis of diabetic polyneuropathy in Japanese diabetic men Hideyuki SASAKI1 *, Seigo KURISU1,2, Kenichi OGAWA1, Shohei KISHIMOTO1, Mika YAMANEKI1, Hiroto TANAKA1, Hiroto FURUTA2, Masahiro NISHI2, Kishio NANJO3, Takashi AKAMIZU2. 1Department of Medicine, Kihoku Hospital, Wakayama Medical University, 2First Department of Medicine, Wakayama Medical University, 3Wakayama Rosai Hospital, Japan Aims: We aimed to evaluate validity and reliability of observation of extensor digitorum brevis muscle (EDB). EDB atrophy for diagnosis of diabetic symmetric polyneuropathy (DPN). Firstly, we examined the relations between EDB atrophy and neurological findings in regional population-based Japanese subjects (Study I). Secondly, we investigated relations between EDB atrophy and quantitative neurological findings in the hospital-based diabetic patients (Study II). Methods: Study I. 548 non diabetic persons who received medical screening program were subjected. Subjective symptoms (numbness in toes and sole, pain and/or paresthesia in feet), quantitative vibratory perception at the tips of toe (QVP; using vibrometer Rion AU-02B), bilateral Achilles tendon reflexes (ATR) and EDB atrophy were evaluated. We judged EDB atrophy as positive when both EDB could not be identified by inspection and palpation. We also interviewed about Seiza habit (Japanese sit-down style with the buttocks on top of the ankles). Study II. In 193 diabetic patients, neurological examination as same as Study I were examined. Additional 8 objective nerve function tests were evaluated. Relationships among these findings were analyzed. Results: Study I. Prevalence (%) of EDB atrophy and Seiza habit in women (36, 73) were significantly higher than those in men