Acute And Chronic Complications Of Diabetes Pdf

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Metrics details. This study assesses the impact of self-reported oral health on the likelihood of experiencing acute and chronic complications among a cohort of previously diagnosed diabetics. Self-reported oral health status was linked to health encounters in electronic medical records until March 31, Multinomial regression models determined the odds of the first acute or chronic complication after self-report of oral health status. Further research regarding the underlying causal mechanisms linking oral health and diabetes complications is needed.

Complications of diabetes: acute and chronic

Metrics details. This study assesses the impact of self-reported oral health on the likelihood of experiencing acute and chronic complications among a cohort of previously diagnosed diabetics. Self-reported oral health status was linked to health encounters in electronic medical records until March 31, Multinomial regression models determined the odds of the first acute or chronic complication after self-report of oral health status.

Further research regarding the underlying causal mechanisms linking oral health and diabetes complications is needed. Peer Review reports. Diabetes is a major public health concern in Canada and worldwide.

Characterized by hyperglycemia and the insufficient secretion or action of insulin, diabetes is a metabolic disorder that amplifies inflammatory immune responses resulting in diabetes complications [ 1 , 2 ].

The Canadian prevalence of diabetes currently sits at 3. Since the U. Periodontal disease is a chronic inflammatory condition characterized by the destruction of oral tissues supporting teeth [ 6 ]. Although periodontal disease is most commonly known as a complication of diabetes, the evidence indicates that the link between these two conditions may be bidirectional [ 7 , 8 ].

Initiated by microbial dysbiosis, periodontal disease produces a low grade host immune response that can stimulate systemic inflammation [ 9 , 10 ]. Specifically, the shift in symbiotic microbial communities of the periodontal tissues accounts for an exaggerated immune defense mechanism leading to the destruction of periodontal tissues [ 9 , 10 ]. In turn, among diabetics, hyperglycemia accounts for an alteration in cell function, defective neutrophil apoptosis, oxidative stress, and the excessive production of inflammatory mediators that exacerbate insulin resistance resulting in health complications [ 6 , 11 , 12 ].

A unified inflammatory mechanism between periodontal disease and diabetics is thought to impact diabetes health outcomes and complications [ 13 , 14 ]. Diabetes complications are classified as acute and chronic, and chronic complications are further classified as microvascular or macrovascular in nature [ 13 ].

Acute complications of diabetes include hyperglycemia and hypoglycemia, and chronic complications include cardiovascular diseases, kidney failure, retinopathy and neuropathy [ 13 ]. Diabetes complications with the highest prevalence and greatest cost to the Canadian health care system are predominantly chronic and include stroke, myocardial infarction, kidney failure, lower limb amputations and vision loss [ 3 , 15 ].

Although the biological mechanism of acute and chronic complications has been long debated, there is some consensus on the differences between them and the possibility of a continuum from acute to chronic [ 13 , 16 ]. Acute complications of diabetes have been characterized by changes in metabolic control, specifically hyperglycemia [ 13 , 17 ]. In contrast, chronic hyperglycemia is commonly assumed to be the central determinant in chronic diabetes complications.

However, insulin resistance and macrovascular damage are found to play a large role [ 13 , 17 ]. To quantify the periodontal impact on diabetic health, studies have explored the effect that periodontal treatment has on blood sugar levels and lipid profile markers [ 2 , 19 , 21 , 22 ]. The current evidence for periodontal treatment among diabetics also suggests that periodontal disease may play the role of a risk factor, as periodontal treatment was found to reduce blood sugar levels as well as cholesterol levels and high-density lipids [ 21 ].

Periodontal care has also been associated with reductions in health complications, hospital admissions and overall medical and pharmaceutical costs among diabetics [ 2 , 23 , 24 , 25 ].

However, there is no research using Canadian populations in relation to oral health and diabetes, and there is a paucity of population level evidence supporting the epidemiological association between oral and diabetes health generally [ 26 ].

A retrospective cohort study was designed to explore the odds of acute and chronic diabetes complications among Ontario residents self-reporting oral health status. Study participants were selected from a combined pool of respondents interviewed from the and —08 Canadian Community Health Survey CCHS [ 27 ]. The survey is administered by Statistics Canada and collects self-reported health information from Canadians over the age of 12, excluding those living on indigenous reserves, residing in institutions and full-time members of the Canadian armed forces [ 28 ].

Details regarding the CCHS methodology are documented elsewhere [ 28 ]. The study cohort was restricted to Ontario residents over the age of 40 with a validated diabetes diagnosis. As all residents of the province of Ontario are covered by a single payer insurance system, the Ontario Health Insurance Plan OHIP , health system encounters among these participants can be followed.

The final study sample was composed of individuals over the age of 40, who participated in the oral health component of the CCHS and had an ODD confirmed diagnosis of diabetes. Individuals were excluded if they could not be linked to electronic medical records, were OHIP-ineligible during the follow-up period, or if they did not report oral health status during survey administration. The final analytical sample consisted of participants, which represents a weighted sample of 1.

CCHS cycles and —08 were selected for the availability of oral health data for the province of Ontario [ 28 ]. Further description of oral health content from the CCHS is described elsewhere [ 28 ]. The primary outcome of this study was the first diabetes complication experienced by participants after the CCHS interview date. Complications were extracted from hospitalization and emergency department records. International Classification of Disease ICD-9 codes, were used to extract diabetes-specific complications from these data [ 30 ].

Acute complications included non-specific hypoglycemia and hyperglycemia; chronic complications included myocardial infarction, stroke, skin infections, amputation, dialysis, and retinopathy.

Following the CCHS interview, participants were classified in three categories comprising of those who did not experience any complication, those who experienced an acute complication and those who experienced a chronic complication. Age, BMI and duration of diabetes were continuous measures while all other covariates were categorical.

The duration of diabetes prior to interview date was used to consider the impact of a dated or early diabetes diagnosis. Co-morbidity at the interview date was assessed from CCHS questions regarding chronic diseases and participants were classified into two categories comprising of participants without any co-morbidity and participants with any of the following conditions: arthritis, chronic obstructive pulmonary disease COPD , heart disease and stroke. Health care visits was assessed by extracting OHIP codes for visits to a general practitioner or specialist.

Visits were classified into three categories, comprising of participants who visited their general practitioner, specialist or both general and specialist practitioners for diabetes management. Starting with baseline characteristics, all variables were assessed for their association with self-reported oral health. T-tests were used to express the means and standard deviations of continuous variables and Chi-squared tests were used to express the cross tabulated frequencies of categorical variables.

Bivariate analysis was conducted by the multi-categorical outcome. Oral health was the explanatory variable and covariates were included in the model if they were clinically significant or were associated with diabetes outcomes in existing literature. Bootstrapping sample weights provided by Statistics Canada were applied to the analysis to adjust for the complex nature of the CCHS survey design.

This generated inferable estimates for the Ontario population. All statistical analyses were performed using SAS version 9. A total of diabetics over the age of 40 were followed through electronic medical records at ICES.

Baseline characteristics of participants according to the diabetes outcome type are shown in Table 2. A majority of those who did not experience a complication were also male and self-reported higher income.

The study sample was predominantly composed of individuals self-identifying as white, living in urban areas and having a post-secondary education. A greater majority of those who experienced an acute or chronic complication reported having other chronic diseases as well as a higher BMI and a longer duration of diabetes prior to the interview date. The odds ratios shown in Table 3 depict the difference in the likelihood of an acute or chronic diabetes complication among study participants. Among covariates included in the multinomial model, age and income differences among participants were not significantly associated with the likelihood of acute and chronic complications.

As sex was not found to be associated with the study outcome in the bivariate analysis, it was included in the fully adjusted model as an interaction term. However, with every unit increase in age among males and females, there was no effect on the likelihood of acute or chronic complications versus no complications.

Trends are observed among education levels, self-reported general health, smoking and dental visits. For education levels, in comparison to those with a post-secondary education, those reporting having a secondary school diploma or less, had a higher likelihood of acute and chronic complications.

Fewer dental visits and current smoking showed similar trends in comparison to those who visited the dentist more than twice in the past year and those who never smoked, respectively. A trend among those consuming alcohol regularly and occasionally was associated with greater odds of acute complications only. Individuals identifying as an ethnic minority had higher odds for acute complications and lower odds for chronic complications.

Interestingly, those who were living in rural areas, in comparison to those in urban areas, had a higher likelihood for chronic than acute complications. For every unit increase in BMI, there was only a slight but insignificant increase in the odds for chronic complications in comparison to acute complications.

Those who reported having comorbidities prior to the interview date showed a similar trend leaning towards greater odds of chronic complications. However, those who had diabetes for a longer duration prior to the interview date were observed to have higher odds for acute complications than chronic complications. Those who were found to have had contact with only a general physician prior to any complication were at a lower likelihood of experiencing acute or chronic complications.

In contrast, those who only had contact with a specialist were at a higher risk. Those who had contact with both a general physician and specialist were considered the reference group. This is in line with studies that have found that diabetics with periodontal disease or those who do not receive periodontal treatment, incur higher medical costs and a greater number of hospitalizations, and supports the association between periodontal disease and chronic diabetes complications [ 24 , 25 , 34 , 35 , 36 , 37 ].

This study provides insights about the likelihood for complications among diabetics in Ontario, Canada. Over the last century, many hypotheses have been developed to explain the oral-systemic link, based on the microbial dysbiosis of periodontal disease [ 38 ].

Oral pathogens are thought to impact systemic health by either direct invasion or the indirect stimulation of immune-inflammatory responses [ 38 , 39 ]. The inconsistency of evidence on direct invasion lead scientists to find more support for the hypothesis of indirect invasion, which may explain the bidirectional impact of periodontal disease [ 36 , 38 , 39 ]. Although our study does not seek to support one hypothesis over the other, nor does it claim causation, the greater likelihood of chronic complications in this study may be explained by the proposition that indirectly exaggerated immune inflammatory responses link periodontal disease to diabetes [ 40 , 41 , 42 ].

The literature suggests that the basis of acute diabetes complications is metabolic imbalances and hyperglycemia [ 13 , 17 ]. Chronic complications are further characterized by insulin resistance that can lead to micro- and macrovascular damage [ 13 , 16 , 17 , 43 ].

Although clinical trials have explored the impact of periodontal treatment on the reduction of blood sugar levels, only a few have explored the reduction of lipid markers such as cholesterol, triglycerides and high-density lipids, which are important contributors of insulin resistance and are associated with greater chronic complications [ 44 , 45 , 46 , 47 , 48 ].

Some studies also support the use of BMI as a predictive measure for insulin resistance, however, BMI was not found to have a significant effect on either acute or chronic complications in this current study [ 49 ]. As insulin resistance may be the connecting factor for periodontal disease and chronic diabetes complications, further research into this component of the putative bidirectional link may provide insight into preventive measures.

At the public health level, for instance, where health outcomes, health expenditures and improved quality of life is of concern, this may provide support for concurrent demands for improvements in access to dental care in Canada and better management of diabetes, reductions in inefficient healthcare costs, such as physician and emergency department use for oral health-related complaints [ 50 , 51 ], and improvements to the quality of life of diabetics [ 52 ].

This study presents with several strengths. Primarily, it has been conducted at the population level, allowing for population-based inferences for diabetics over the age of Second is the use of a validated diabetes diagnosis, which contrasts most of the current literature [ 24 , 25 ]. In comparison with observational studies, our retrospective selection of participants and longitudinal follow-up allows for arguments beyond a simple association between self-reported oral health and diabetes complications.

The use of self-reported oral health also presents as a strength in this study. As self-reported oral health is multi-faceted in nature, representing the social, psychosocial, economic and cultural components of oral health, it presents as a convenient measure for exploring the diabetes health experience [ 53 , 54 , 55 ]. Notably, studies have found that self-reported oral health status is consistent with the clinical need for oral treatment [ 56 ].

Among diabetics, this measure can thus arguably be used to assess the odds of diabetes complications and provide a means to improve health literacy and expand the referral network for diabetics in need of dental care [ 57 ].

Despite these strengths, there are also important limitations to consider. Although self-reported oral health status can be an effective measure to predict oral health needs, it may not be a competent measure for clinical periodontitis [ 54 ]. The evidence shows that self-reported oral health can be highly specific but not sensitive [ 56 ].

Complications of Acute and Chronic Hyperglycemia

Diabetes mellitus DM , commonly known as diabetes , is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Diabetes is due to either the pancreas not producing enough insulin , or the cells of the body not responding properly to the insulin produced. Type 1 diabetes must be managed with insulin injections. The classic symptoms of untreated diabetes are unintended weight loss , polyuria increased urination , polydipsia increased thirst , and polyphagia increased hunger. Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurred vision , headache , fatigue , slow healing of cuts , and itchy skin.

Diabetes complications can be divided into two types: acute sudden and chronic long-term. This article discusses these complications and strategies to prevent the complications from occurring in the first place. Chronic complications are responsible for most illness and death associated with diabetes. Chronic complications usually appear after several years of elevated blood sugars hyperglycemia. Since patients with Type 2 diabetes may have elevated blood sugars for several years before being diagnosed, these patients may have signs of complications at the time of diagnosis. The typical cholesterol profile in patients with diabetes includes low HDL cholesterol and high triglycerides. The focus of treatment of high cholesterol in patients with diabetes is to lower the LDL cholesterol.


include diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, and hypoglycemia.


Diabetes: Preventing Complications

Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar glucose. Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel. The underlying cause of diabetes varies by type.

Objective: To explore the patterns and prevalence of complications of type 2 diabetes mellitus T2DM in Jazan region. A structured questionnaire was used for data collection, and the statistical analysis was performed using SPSS ver. Results: The prevalence of one or more complications due to T2DM was The prevalence of cardiovascular complications was found to be 7. The prevalence of retinopathy was estimated as

Over time, the surge and crash of dissolved glucose and insulin that occurs in diabetes can end up causing irreparable damage to many body organs and systems. Doctors refer to this as "end-organ damage" because it can effect nearly every organ system in the body:.

Complications of Diabetes 2017

Hyperglycemia is due to a dysregulation in the complex mechanisms implicated in glucose homeostasis. Chronic hyperglycemia, as measured by hemoglobin A1c HbA1c , is a key risk factor for the development of microvascular and macrovascular complications, which in turn negatively influence the prognosis of patients with diabetes. Several studies have shown that acute hyperglycemia can add to the effect of chronic hyperglycemia in inducing tissue damage. Acute hyperglycemia can manifest as high fasting plasma glucose FPG or high postprandial plasma glucose PPG and can activate the same metabolic and hemodynamic pathways as chronic hyperglycemia. Glucose variability, as expressed by the intraday glucose fluctuations from peaks to nadirs, is another important parameter, which has emerged as an HbA1c-independent risk factor for the development of vascular complications, mainly in the context of type 2 diabetes. Treatments able to decrease HbA1c have been associated with positive effects in terms of reducing risk for the development and progression of complications. Further studies are required to clarify the impact of strategies more specifically targeting components of acute hyperglycemia, to improve outcomes in patients with diabetes.

Javascript is currently disabled in your browser. Several features of this site will not function whilst javascript is disabled. Received 10 February Published 20 April Volume Pages — Review by Single anonymous peer review. Editor who approved publication: Prof. Juei-Tang Cheng.

Он посмотрел на ее пальцы, но не увидел никакого кольца и перевел взгляд на сумку. Вот где кольцо! - подумал.  - В сумке. - и улыбнулся, едва сохраняя спокойствие. - Ты сочтешь это сумасшествием, - сказал Беккер, - но мне кажется, что у тебя есть кое-что, что мне очень. - Да? - Меган внезапно насторожилась.

References

Их компьютер через Интерпол засек имя Танкадо в регистратуре полиции Севильи. - От разрыва сердца? - усомнилась Сьюзан.  - Ему ведь всего тридцать лет. - Тридцать два, - уточнил Стратмор.  - У него был врожденный порок сердца. - Никогда об этом не слышала. - Так записано в его медицинской карточке.

 - Потом в его голосе зазвучали зловещие нотки.  - Но как только я узнаю, что вы следите за мной, я немедленно расскажу всю эту историю журналистам. Я расскажу, что Цифровая крепость - это большая липа, и отправлю на дно все ваше мерзкое ведомство. Стратмор мысленно взвешивал это предложение. Оно было простым и ясным. Сьюзан остается в живых, Цифровая крепость обретает черный ход.

Дело в людях. Они потеряли веру. Они стали параноиками. Они внезапно стали видеть врага в. И мы, те, кто близко к сердцу принимает интересы страны, оказались вынужденными бороться за наше право служить своей стране. Мы больше не миротворцы. Мы слухачи, стукачи, нарушители прав человека.

Скоро, подумал он, совсем. Как хищник, идущий по следам жертвы, Халохот отступил в заднюю часть собора, а оттуда пошел на сближение - прямо по центральному проходу. Ему не было нужды выискивать Беккера в толпе, выходящей из церкви: жертва в ловушке, все сложилось на редкость удачно.

Информация, которую он выдал. Если Стратмор получил от Следопыта информацию, значит, тот работал. Она оказалась бессмысленной, потому что он ввел задание в неверной последовательности, но ведь Следопыт работал.

 - Почему же вся переписка Северной Дакоты оказалась в твоем компьютере. - Я ведь тебе уже говорил! - взмолился Хейл, не обращая внимания на вой сирены.  - Я шпионил за Стратмором. Эти письма в моем компьютере скопированы с терминала Стратмора - это сообщения, которые КОМИНТ выкрал у Танкадо.

 Нет, вообще-то я… - Из туристического бюро. - Нет, я… - Слушайте, я знаю, зачем вы пришли! - Старик попытался сесть в кровати.  - Меня не удастся запугать. Я уже говорил это и могу повторить тысячу раз - Пьер Клушар описывает мир таким, каким его видит. Некоторые ваши туристические путеводители старательно скрывают правду, обещая бесплатный ночлег в городе, но Монреаль тайме не продается.

Немец схватил ее и нетерпеливо стянул с нее рубашку. Его толстые пальцы принялись методично, сантиметр за сантиметром, ощупывать ее тело.

1 Response
  1. Arnoldo C.

    Diabetes is widely recognized as an emerging epidemic that has a cumulative impact on almost every country, age group, and economy across the world.

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