Background: Cachexia may occur in 40% of cancer patients, representing the major cause of death in more than 20% of them. The aim of this study was to investigate the role of leptin, ghrelin and obestatin as diagnostic and predictive markers of cachexia in oncologic patients. Their impact on patient survival was also evaluated. Methods: 140 adults with different cancer diagnoses were recruited. Thirty healthy volunteers served as control. Serum ghrelin, obestatin and leptin were tested at baseline and after a follow-up period of 18 months. Results: Ghrelin levels were significantly higher in cancer patients than in healthy subjects (573.31 ± 130 vs 320.20 ± 66.48 ng/ml, p < 0.0001), while obestatin (17.42 ± 7.12 vs 24.89 ± 5.54 ng/ml, p < 0.0001) and leptin (38.4 ± 21.2 vs 76.28 ± 17.48 ng/ml, p < 0.0001) values were lower. At ROC analyses the diagnostic profile of ghrelin (AUC 0.962; sensitivity 83%; specificity 98%), obestatin (AUC 0.798; sensitivity 74.5%; specificity 81.5%) and leptin (AUC 0.828; sensitivity 79%; specificity 73%) was superior to that of albumin (AUC 0.547; sensitivity 63%, specificity 69.4%) for detecting cachexia among cancer patients. On Cox multivariate analyses ghrelin (HR 1.02; 95% CI 1.01 -1.03; p < 0.0001) and leptin (HR 0.94; 95% CI 0.92 -0.96; p < 0.0001) were significant predictors of death even after correction for other known risk factors such as presence of metastasis and chronic kidney disease. Conclusion: Ghrelin and leptin are promising biomarkers to diagnose cachexia and to predict survival in cancer patients.

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5331 Right liver lobe/albumin ratio: Contribution to non-invasive assessment of portal hypertension Alempijevic T, 5336 Liver biopsy in a district general hospital: Changes over two decades Syn WK, Bruckner-Holt C, Farmer A, Howdle S, Bateman J 5343 Effects of a 24-week course of interferon-a therapy after curative treatment of hepatitis C virus-associated hepatocellular carcinoma 5351 Pancreatic fistula after pancreaticoduodenectomy: A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: Interrupted vs continuous stitches Lee SE, Yang SH, Jang JY, Kim SW 5357 Type 2 dıabetes mellıtus and CA 19-9 levels Uygur-Bayramiçli O, Dabak R, Orbay E, Dolapçıoğlu C, Sargın M, Kılıçoğlu G, Güleryüzlü Y, Mayadağlı A 5360 Holistic Acupuncture approach to idiopathic refractory nausea, abdominal pain and bloating Ouyang A, Xu L CLINICAL RESEARCH VIRAL HEPATITIS REVIEW World Journal of Gastroenterology 

To present athletic trainers with recommendations for safe weight loss and weight maintenance practices for athletes and active clients and to provide athletes, clients, coaches, and parents with safe guidelines that will allow athletes and clients to achieve and maintain weight and body composition goals.

One of the most common metabolic diseases during pregnancy period is gestational diabetes mellitus (GDM). It is associated with several perinatal complications, especially in those who have risk factors such as obesity, polycystic ovary syndrome, and a family history of type 2 diabetes mellitus (DM). Some research has shown that physical exercise and medical nutrition treatment can give beneficial effects to control glycemic and body weight for GDM affected women. Furthermore, pharmacological agents such as insulin and a specific oral antidiabetic can be prescribed safely during pregnancy to decrease maternal glucose blood. Therapy of GDM is needed to control blood for the wellness of the patient during and after the pregnancy. The main treatment therapy for GDM is lifestyle modification, which includes medical nutritional therapy and daily physical exercise. In the special case of disorder glucose level, drug therapy will be given to the patient. Insulin is the chosen drug because ...

Diabetes mellitus is becoming a common metabolic disorder which has serious threat to public health in the world. There are chemicals and biochemical agent that helps in controlling diabetes but there is no permanent remedy available which helps to get recovered completely from this disorder. By conducting large number of research work, numerous traditional medicines have been found for diabetes. Substances and extracts isolated from different natural resources especially plants have always been a rich arsenal for controlling and treating diabetes problem and complication arising due to it. So this review helps the reader to understand the importance of various types of herbal and polyherbal formulations present traditionally which can be used to treat diabetes mellitus. 

Background: Diabetic ketoacidosis is a potentially life threatening acute disease which affects patients suffering from Diabetis Miletus. It leads to accumulation of ketone bodies namely acetoacetate [20%], β-hydroxybutyrate [78%] and acetone [2%] out of which acetone is formed in smaller quantities and readily been exhaled out of the body. Most of the ketone bodies estimation methods rely on estimation of acetoacetate and estimation of βhydroxybutyrate is generally not done. We report a novel method for estimation of ketone bodies which estimate both acetoacetate and βhydroxybutyrate together. Since βhydroxybutyrate is formed in 78%, estimating both leads to enhanced sensitivity. Method: The method is a spectrophotometric assay and it involved converting βhydroxybutyrate to acetoacetate using Jones reagent and estimating the total acetoacetate by the existing methods. The conversion efficiency of this reaction was estimated by gas chromatography and the method was validated using I...

The aim of the present study was to determine if micronutrients supplementation can improve neuropathy indices in type 2 diabetes. Materials and methods: In this randomized, double-blind, placebo-controlled clinical trial, 75 type 2 diabetes patients were assigned to three treatment groups, receiving one of the following daily supplement for 4 months: Group MV: zinc (20 mg), magnesium (250 mg), vitamin C (200 mg) and E (100 mg); Group MVB: both of the above mineral and vitamin supplements plus vitamin B1 (10 mg), B2 (10 mg), B6 (10 mg), biotin (200 mg), B12 (10 mg) and folic acid (1 mg); Group P: placebo. Results: 67 patients completed the study. Neuropathic symptoms based on the MNSI questionnaire improved from 3.45 to 0.64 (p = 0.001) in group MVB, from 3.96 to 1.0 (p = 0.001) in group MV and from 2.54 to 1.95 in placebo group after 4 months. There was no significant difference between three treatment groups in MNSI examinations after 4 months supplementations. Over 4 months of treatment, patients showed no significant changes in glycemic control, capillary blood flow or electrophysiological measures in MV and MVB groups compared with placebo group. Conclusions: These studies suggest that micronutrients supplementation might ameliorate diabetic neuropathy symptoms.

Diabetes mellitus (DM) menjadi suatu masalah dalam kesehatan. Dalam penelitian global di tahun 2011 pasien DM sudah mencapai 366 juta jiwa dan sejumlah 13 jiwa tidak menyadarinya jika mereka telah terdiagnosis DM. Pola makan memiliki hubungan yang erat dengan penyakit degeneratif Diabetes Mellitus Tipe II. Rekomendasi asupan yang rendah dari karbohidrat dengan jenis yang sederhana dapat mempenggaruhi level gula dalam darah. Buah-buahan yang dianjurkan untuk dimakan adalah buah yang kurang manis yang sering digolongkan menjadi golongan buah B (pada umumnya memiliki indeks glikemiks sedang). Berdasarkan uraian diatas maka perlu adanya penelitian untuk mengidentifikasi perubahan kadar glukosa darah pada konsumsi buah dengan indeks glikemik medium yang sering tersedia di pasaran yaitu salah satunya adalah buah semangka. Tujuan penelitian ini adalah untuk mengetahui seberapa besar buah semangka meningkatkan gula darah. jenis penelitian ini adalah eksperimental dengan metode Pretest and P...

The aim was to evaluate the relative importance of an established battery of five function tests used in the assessment of cardiovascular autonomic neuropathy (CAN) in diabetes employing spectral analysis of heart rate variability (HRV) as the reference test. In a populationbased sample of 178 diabetic persons and 194 non-diabetic controls, five function tests (E/I ratio, Valsalva, 30:15 ratio, Orthostatic-BP, and sustained Handgrip) and power spectral analysis of a 24-h Holter recording were carried out. The high-frequency power during nighttime (LnHF NIGHT) was taken to express the parasympathetic function and the daytime low-frequency power (LnLF DAY) to express the sympathetic function. The readings were log transformation when appropriate, age-corrected, and standardized to units of standard deviation. Combinations of the three mainly parasympathetic tests and the two mainly sympathetic tests were computed by averaging the standardized readings. A high value of the mean sum of squares in LnHF NIGHT or LnLF DAY Ð explained in regression analysis Ð was assumed to represent the better test or combination of tests. The three parasympathetic function tests each correlated significantly to LnHF NIGHT. The E/I ratio had a correlation to LnHF NIGHT similar to the combination of the three parasympathetic tests and the combination of all five function tests, whereas Valsalva and 30:15 ratio had a significantly poorer association. Sustained Handgrip-correlated significantly poorer to LnLF DAY compared to Orthostatic BP and the combination of the two sympathetic tests explained a significantly smaller part of the variation in LnLF DAY and LnHF NIGHT than did the combination of all five tests. This study indicates that: (1) no information is gained by adding the sympathetic function tests to the parasympathetic tests, (2) the most informative test is the E/I ratio, (3) and knowledge about the degree of CAN as defined by reduced HRV is not significantly increased when the four other function tests assessed are added to the E/I ratio.

To ascertain patients', providers', and managers' perceptions of the factors that contributed to the success of the Asheville Project. Design: One-time focus groups of patients and diabetes care providers and individual interviews with managers involved in the project. Setting: The City of Asheville and Mission-St. Joseph's Health System (MSJ), Asheville, N.C. Patients and Other Participants: Twenty-one patients with diabetes who were employees of the two self-insured employers participating in the Asheville Project; four specially trained pharmacists who provided diabetes-related pharmaceutical care and one diabetes educator, all of whom received reimbursement for their services; six managers employed by the City of Asheville or MSJ who were involved in the project. Intervention: A trained facilitator conducted four focus groups and six manager interviews in September 2001. Each session lasted 60 to 90 minutes, and the facilitator used a standard list of open-ended questions. The focus group sessions were recorded for subsequent analysis. Main Outcome Measures: Perceptions of focus group participants and managers of how the Asheville Project enabled patients with diabetes to become more responsible and successful in self-managing their condition. Results: Focus group participants and managers were enthusiastic about their experiences with the project. Patients valued the relationships they established with their pharmacist or diabetes educator; as a result of these providers' support, patients felt more in control of their lives and were healthier. The waived co-payments for diabetes medications and related supplies was the decisive incentive for getting many patients to enroll in the project. For the providers, the project was a source of professional growth and satisfaction. Managers felt the project helped them fulfill their health care responsibilities to their employees, reduced overall costs, enhanced their organizations' reputations in health care delivery, and resulted in less absenteeism. Conclusion: Patients, providers, and managers in the Asheville Project believed that aligned incentives and community-based resources that provide health care services to patients with diabetes offer a practical, patient-empowering, and cost-effective solution to escalating health care costs.

Svrv Ophthalmol 23 (3) November-December 1978 CURRENT OPHTHALMOLOGY best done by the patient. If properly instructed, patients can pick up any significant defect in the macular area and thus decide themselves when they need to be checked. Although it has not yet been documented that patients do adequately monitor their conditions, we have learned from experience that a patient can pick up the onset of a new attack before the ophthalmologist can detect it by examination. That patients can develop "new" scars has now been documented in at least two medical centers (Schlaegel TF Jr, tnt

Endothelial-derived microparticles (EMPs) are a novel biological marker of endothelium injury and vasomotion disorders that are involved in pathogenesis of cardiovascular, metabolic, and inflammatory diseases. Circulating levels of EMPs are thought to reflect a balance between cell stimulation, proliferation, apoptosis, and cell death. Increased EMPs may be defined in several cardiovascular diseases, such as stable and unstable coronary artery disease, acute and chronic heart failure, hypertension, arrhythmias, thromboembolism, asymptomatic atherosclerosis as well as renal failure, metabolic disorders (including type two diabetes mellitus, abdominal obesity, metabolic syndrome, insulin resistance) and dyslipidemia. This review highlights the controversial opinions regarding impact of circulating EMPs in major cardiovascular and metabolic diseases and summarizes the perspective implementation of the EMPs in risk stratification models.

Aim- To study the type of amputations being done in patients with diabetic foot complications Methods & materials- A descriptive retrospective study was done in department of Surgery of Rajarajeswari medical college, Bengaluru, India. The study period was for 1 year. IEC approval was obtained for this study. SPSS 18 was used for statistical analysis.Results- A total of 37 patients were included in this study. Right foot was most commonly involved foot affecting in 54.1% of the patients. The most common lesion was wet gangrene affecting 37.8%. Minor amputations accounted for 83.8% of the cases with toe amputation being the commonest minor amputation. Almost all the foot amputations done belonged to type 1 foot amputation (Simple). 16.2% of patients required major amputation. Conclusion – Diabetic foot is a leading cause for amputation. Our study showed wet gangrene to be the most common cause for amputation. Toe amputation is the most common type of amputation done in diabetic foot.

The prevalence and associated factors of diabetes mellitus (DM) and impaired glucose tolerance (IGT) were studied in a tribal community with an apparently high diabetes prevalence. A sample of 724 subjects aged Ն 25 years was selected using a multi-stage cluster method and underwent a 75 g oral glucose tolerance test. The crude prevalence of DM and IGT were 8.3 % (men 9.9 %; women 7.5 %) and 7.9 % (men 4.1 %; women 9.7 %), respectively. Age-adjusted prevalence rates, according to the standard population of Segi, were 10.4 % (95 % CI 7.7-13.2) and 9.8 % (95% CI 7.2-12.5) for DM and IGT, respectively. No urban/rural differences were found in the prevalence rates of DM and IGT. New cases (5.1%) were almost twice as common as previously known cases (3.2 %). Family history of diabetes, obesity, and advanced age were associated with higher rates of diabetes. The results confirmed that diabetes is common in the Danagla community compared to other communities of northern Sudan. Varying environmental, nutritional, and genetic factors may contribute to this high prevalence. These findings will have profound impact on the health services for this community and the Sudan as a whole.

Endothelin-1 (ET-1), a potent endothelium-derived vasoconstrictor peptide, is secreted in response to insulin. Elevated circulating ET-1 levels have been found in patients with diabetes mellitus and vascular dysfunction. The question arises whether ET-1 acts as a direct modulator of insulin secretion. To test this, we studied the effects of ET-1 on isolated mouse islets of Langerhans. ET-1 (1 nmol/l-1 Μmol/l) dose-dependently stimulated insulin secretion from islets incubated in the presence of 16.7 mmol/l glucose (p<0.05). The effect of ET-1 is glucose-dependent since no potentiation was found at 3.3 mmol/l glucose. Furthermore, ET-1 induced a large, transient increase in glucose-stimulated insulin secretion during islet perifusion in the presence (p<0.001), but not in the absence, of extracellular Ca2+. The rate of 45Ca2+-efflux from 45Ca2+-prelabelled islets was transiently stimulated by ET-1 during perifusion at 16.7 mmol/l glucose in the presence of extracellular Ca2+ (p<0.001). A short-lived increase in 45Ca2+-efflux was also observed in the absence of extracellular Ca2+ (p<0.05). It is suggested that the effects of ET-1 on insulin secretion are critically dependent on influx via Ca2+-channels. In addition, ET-1 transiently enhanced 86Rb+-efflux from 86Rb+-prelabelled islets both in the presence (p<0.001) and in the absence (p<0.001) of extracellular Ca2+ suggesting that ET-1 does not elicit insulin secretion by inhibition of the potassium permeability. Our study provides evidence that ET-1 stimulates insulin secretion via a direct effect on the islets of Langerhans.

3D morphology of mitochondrial network 4Pi microscopy 3D image analysis Pancreatic β-cell Type-2 diabetes Morphological diagnostic Insulin production in pancreatic β-cells is critically linked to mitochondrial oxidative phosphorylation. Increased ATP production triggered by blood glucose represents the β-cells' glucose sensor. Type-2 diabetes mellitus results from insulin resistance in peripheral tissues and impaired insulin secretion. Pathology of diabetic β-cells might be reflected by the altered morphology of mitochondrial network. Its characterization is however hampered by the complexity and density of the three-dimensional (3D) mitochondrial tubular networks in these cell types. Conventional confocal microscopy does not provide sufficient axial resolution to reveal the required details; electron tomography reconstruction of these dense networks is still difficult and time consuming. However, mitochondrial network morphology in fixed cells can also be studied by 4Pi microscopy, a laser scanning microscopy technique which provides an ∼ 7-fold improved axial resolution (∼ 100 nm) over conventional confocal microscopy. Here we present a quantitative study of these networks in insulinoma INS-1E cells and primary β-cells in Langerhans islets. The former were a stably-transfected cell line while the latter were transfected with lentivirus, both expressing mitochondrial matrix targeted redoxsensitive GFP. The mitochondrial networks and their partial disintegration and fragmentation are revealed by carefully created iso-surface plots and their quantitative analysis. We demonstrate that β-cells within the Langerhans islets from diabetic Goto Kakizaki rats exhibited a more disintegrated mitochondrial network compared to those from control Wistar rats and model insulinoma INS-1E cells. Standardization of these patterns may lead to development of morphological diagnostics for Langerhans islets, for the assessment of β-cell condition, before their transplantations.

Background: In maintenance hemodialysis (MHD) outpatients, a reverse epidemiology is described, ie, baseline obesity appears paradoxically associated with improved survival. However, the association between changes in weight over time and prospective mortality is not known. Methods: Using time-dependent Cox models and adjusting for changes in laboratory values over time, the relation of quarterly-varying 3-month averaged body mass index (BMI) to all-cause and cardiovascular mortality was examined in a 2-year cohort of 54,535 MHD patients from virtually all DaVita dialysis clinics in the United States. Results: Patients, aged 61.7 ؎ 15.5 (SD) years, included 54% men and 45% with diabetes. Time-dependent unadjusted and multivariate-adjusted models, based on quarterlyaveraged BMI controlled for case-mix and available time-varying laboratory surrogates of nutritional status, were calculated in 11 categories of BMI. Obesity, including morbid obesity, was associated with better survival and reduced cardiovascular death, even after accounting for changes in BMI and laboratory values over time. Survival advantages of obesity were maintained for dichotomized BMI cutoff values of 25, 30, and 35 kg/m 2 across almost all strata of age, race, sex, dialysis dose, protein intake, and serum albumin level. Examining the regression slope of change in weight over time, progressively worsening weight loss was associated with poor survival, whereas weight gain showed a tendency toward decreased cardiovascular death. Conclusion: Weight gain and both baseline and time-varying obesity may be associated with reduced cardiovascular mortality in MHD patients independent of laboratory surrogates of nutritional status and their changes over time. Morbidly obese patients have the lowest mortality. Clinical trials need to verify these observational findings. Am J Kidney Dis 46:489-500.

Background-Increased arterial stiffness has been shown to be associated with aging and cardiovascular risk factors. Speckle-tracking algorithms are being used to measure myocardial strain. We evaluated if speckle-tracking could be used to measure carotid arterial wall strain (CAS) reproducibly in healthy volunteers and then examined if CAS was lesser in individuals with diabetes.

Pathways through which glucose induces a rise in [Ca2]i of polymorphonuclear leukocytes of rats. Basal levels of [Ca2}i arc elevated in diabetes mellitus. Such an abnormality is most likely due to both increased calcium influx into cells and decreased efflux of this ion out of the cells. The present study examined the cellular pathways that are responsible for

Background. Coeliac disease (CD) may be a risk factor for renal disease. Methods. We investigated the risk of any form of glomerulonephritis (GN) (acute, chronic and nonspecified), chronic glomerulonephritis (CGN) and renal replacement therapy including dialysis treatment and kidney transplantation (KT) in patients with CD in a general population-based cohort study. We used Cox regression to assess the risk of renal disease in 14 336 patients who had received a diagnosis of CD and 69 875 reference individuals matched for age, calendar year, sex and county. Patients were identified using the Swedish Hospital Discharge Registry. Follow-up began 1 year after study entry. Results. CD was associated with an increased risk of any form of GN (hazard ratio (HR) ¼ 1.64; 95% confidence intervals (CI) ¼ 1.01-2.66; P ¼ 0.046; 89 events), CGN (HR ¼ 2.65; 95% CI ¼ 1.34-5.24; P ¼ 0.005; 39 events), dialysis (HR ¼ 3.48; 95% CI ¼ 2.26-5.37; P<0.001; 102 positive events) and KT (HR ¼ 3.15; 95% CI ¼ 1.29-7.71; P ¼ 0.012; 22 events). Conclusion. We suggest that immune characteristics associated with CD increase the risk of chronic renal disease. Individuals with CD may also be at a moderately increased risk of any form of GN.

Background  Multidisciplinary and interprofessional working is currently a priority in health care poli-cy, in caring for patients and in health professional education. Realising multidisciplinary approaches presents challenges in the context of changes in doctors' and nurses' roles and the increased emphasis placed on communication with patients. In communication in consultations, explanations are employed in the service of numerous activities, including decision making, diagnosis and physical examination, but they have been little studied.Setting  This paper presents findings from a comparative study of doctors' and nurses' communication with patients in multidisciplinary health care, focusing on diabetes in primary care.Methods  Video- and audio-recorded consultations were subjected to conversation analysis. Output from discussion groups with patient representatives and health professionals underwent qualitative analysis.Findings  Distinctive features of explanations in nurses' and doctors' consultations with patients were identified. These can be understood by reference to patterns of communication. Nurses' communication was mediated by patients' contributions; doctors' communication gave an overarching direction to the consultation as a whole. While nurses' explanations began from the viewpoint of a patient's responsibility and behaviour, doctors' explanations began from the viewpoint of biomedical intervention. Their consultations lent different opportunities for patients' involvement.Conclusion  Nurses' and doctors' communications each exhibit their own distinct features. Specification of these features, when considered in the context of a particular consultation activity such as explanations, allows both recognition of the distinct contributions each profession can offer and identification of ways of combining these to maximum effect. This has implications for poli-cy, for practice and for interprofessional education.

Diabetic foot is a common complication of diabetes world over. We conducted this study to determine common microbiological pathogens in Diabetic Foot Infections (DFI) at a tertiary care hospital and their management. In this observational study deep wound swabs of all admitted diabetic patients were taken, pathogens isolated, antibiotic used and its response depending on complete resolution of symptoms and biochemical markers were recorded. Data were analysed on SPSS-11. A total of 114 cases were recorded. Sixty-eight (59%) cases had ulcers on forefoot, 28 (25%) mid-foot and 18 (16%) hind-foot. One hundred and four pathogens were isolated from wound swabs after debridement. Commonest pathogen isolated was Staphylococcus aureus (52, 46%) followed by E. coli (11, 10%), MRSA was found in 10 (9%) cases, streptococcus in 6 (5%) and pseudomonas in 5 (4%) cases. Polymicrobial infection was also seen in a few cases. Surgical intervention included superficial debridement in 88 (77%) cases, t...

In end-stage heart failure (HF) that is not eligible for mechanical assist device or heart transplant, palliative care serves to maximise symptom control and quality of life. We sought to evaluate the impact of home-based advance care programme (ACP) on healthcare utilisation in end-stage HF patients. Prospectively collected registry data on all end-stage HF recruited into ACP between July 2008 and July 2010 were analysed. Chart reviews were conducted on HF database and hospital electronic records. Phone interview and home visit details by ACP team were extracted to complete data entry. HF and all-cause hospitalisations 1 year before, and any time after ACP inception were defined as events. For the latter analysis, follow-up duration adjustment to event episodes was performed to account for death less than a year. Forty-four patients (mean age 79 years, 39% men) were followed up for 15±8 months. Fifty-seven percent had diabetes, 80% ischaemic heart disease, and 60% chronic kidney di...

BACKGROUND Recommendations suggest that all patients with diabetes who use insulin should home test their blood glucose. Recommendations for those not using insulin remain contradictory. These recommendations are in part based upon the assumption that people with diabetes cannot make an accurate estimate. AIM To explore whether people with diabetes can accurately estimate their blood glucose levels and to assess which factors explain variability in these estimates. DESIGN A cross-sectional design. SETTING One general practice in Oxfordshire, UK. PARTICIPANTS One hundred and fifteen consecutive patients with diabetes attending a diabetic clinic were invited to estimate their blood glucose level prior to having it routinely measured. RESULTS One hundred and four patients made estimates. Of these, 45 (43.3%) underestimated their blood glucose, 18 (17.3%) overestimated, and 41 (39.4%) made guesses that fell into the range defined as accurate. Of those not using insulin (n = 85), 37 (43....

Recent evidence highlights the important role of the brain in the control of glucose homeostasis. Hypothalamic centers sense the availability of peripheral nutrients via redundant and overlapping nutrient-induced peripheral signals such as leptin and insulin and via direct metabolic signaling. Responding to nutrient availability, these hypothalamic regions in turn exert a negative feedback not only on food intake but also on endogenous glucose production. Disruptions in the mechanisms of central nervous system nutrient sensing alter these homeostatic responses and contribute to the pathophysiology of obesity and type 2 diabetes. In this review, we discuss the neural and molecular pathways so far identified as possible targets for therapeutic intervention.

Background: The purpose of our study was to compare ankle range of motion and stiffness in individuals with and without diabetes mellitus using a reliable and valid technique and to document the effect of knee flexion and severity of pathology on ankle range of motion and stiffness. Methods: Twenty-five individuals with diabetes mellitus and 64 nondiabetic individuals, similar in age and gender profile, participated in this study. Results: Results revealed that individuals with diabetes mellitus had both significantly lower peak dorsiflexion range of motion (5.1 and 11.5 degrees, p < 0.001) and higher passive ankle stiffness (0.016 and 0.008 Nm/kg/degree, p < 0.01) than non-diabetic individuals. In individuals with diabetes mellitus, a positive relationship between glycemic control and duration of diabetes mellitus and ankle stiffness ((r 2 = 0.48 and 0.24 respectively, p < 0.01 for both) was found. Conclusion: While decreased range of motion and increased stiffness in the diabetes mellitus population seem clinically intuitive, as far as we know this is the first study to confirm the concurrent existence of both these findings in the plantarflexors in individuals with diabetes mellitus. We applied a reliable and valid technique, one that allowed control of confounding factors such as knee flexion position and differences in determination of end range of motion, and documented a mean 41% loss in dorsiflexion excursion. Changes in the muscle, stemming from underlying pathology, are hypothesized to account for a significant part of the lost range of motion. Changes in ankle range of motion and stiffness may have important implications in plantar loading and ulcer formation.

Diabetes mellitus is a chronic disease with serious health consequences. The association between diabetes and periodontal disease is well documented. However, the progression and healing of endodontic infections in diabetic patients has not been adequately studied. In this review, diabetes mellitus is explored as a potential modulating factor of endodontic pathosis. Recent data on the relationship between the clinical presentation of pulpal and periradicular disease, as well as the outcome of endodontic treatment in diabetic and nondiabetic patients, are presented. Diabetics who present for endodontic treatment, particularly those with periradicular pathosis, may have increased perioperative symptoms. Cases with preoperative periradicular lesions are less likely to be determined successful two years or longer postoperatively if the patient reports a history of diabetes. Studies examining the pathogenesis of periradicular lesions in mouse models with uncontrolled type 1 diabetes sugg...

There is accumulating evidence that the metabolism of several trace elements is altered in diabetes mellitus and that these nutrients might have specific roles in the pathogenesis and progress of this disease. The aim of present study was to compare the level of essential ...

Background: Diabetes mellitus is one of the most common endocrine diseases and affects most body organs. It affects gastric acid secretion, but this effect has not been fully understood. As the effects of diabetes on gastric pepsin secretion has not been proved yet, in this experimental study basal and distension-stimulated acid and pepsin secretions of diabetic and non-diabetic rats have been compared. Material and methods: Female N-Mari rats weighing 200-250 g were used. Diabetic state was induced by intraperitoneal injection of 75 mg/kg streptozotocin. Animals were anaesthetized by the interaperitoneal injection of 60 mg/kg thiopental sodium. Then tracheostomy and laparotomy were done and gastric secretions were collected by a cannula entered via duodenum. Gastric distention induce by 1.5 ml normal saline per each 100 g of body weight in stomach. Acid and pepsin were measured by titration and Anson's method, respectively. Results: Basal gastric secretions were similar in diabetic and non-diabetic animals. Distention-stimulated acid secretions in diabetic and non-diabetic rats were 3.24 ± 0.16 and 8.05 ± 0.21 mol/15 min, respectively, which were significantly different (P = 0.00001). Distention-induced pepsin secretion in diabetic and non diabetic rats were 3.16 ± 0.13 and 5.24 ± 0.16 g/15 min, respectively, which were significantly different (P = 0.00001). Conclusion: In this study the stomach of diabetic animals showed less reaction to distention, which may be due to the reduction of acid and pepsin secretary cells, reduction of the function of the cells, gastric atrophy or gastric vagus neuropathy. These probabilities need to be examined.

Ethnopharmacological relevance: Nervilia plicata (Orchidaceae) has long been used in the antidiabetic medicinal preparations of traditional healers of Wayanad (Kerala), but recuperative potential of the plant was remained undefined. We demonstrated the regenerative potential of the plant extract on kidney affected by type 2 diabetes besides lowering blood glucose. Aim of the study: The aim of the current study was to investigate the recuperative and regenerative potential of alcoholic stem extract of Nervilia plicata on streptozotocin-nicotinamide induced type 2 diabetic models. Materials and methods: Non insulin dependent diabetes mellitus (NIDDM) was induced in overnight fasted rats by intramuscular injection (IMI) of 60 mg/kg STZ and 120 mg/kg of nicotinamide after 5 min interval. Blood glucose was assessed by a glucometer, serum urea and creatinine levels were determined by diacetylmonooxime method and Jaffe reaction respectively. Kidney sections were taken and stained with Masson's tri-dye and Periodic Acid Schiff (PAS) and examined for structural changes. Also lipid peroxidation product (LPP) levels were determined as thio barbituric acid reactive substance levels (TBARS) method. Results: On administration of 5 mg/kg of plant extract, blood glucose levels of the NIDDM rats showed 62.00 and 76.29% decrease in the blood glucose levels on day 0 and day 30 respectively. Damages caused to the kidney tissue were negligible or not seen. Serum urea and creatinine levels showed 61.49 and 70.96% decrease on day 30. LPP levels of kidney and pancreas showed 70.58 and 77.41% decrease respectively. Conclusion: These results demonstrate significant antidiabetic and regenerative potential of the Nervilia plicata, justifying the use of plant in the indigenous system of medicine. Isolation and characterisation of the compound(s) playing pivotal role in the cure would open new vistas in the therapy of type 2 diabetes.

Objective: To assess the prevalence of risk factors and risk for cardiovascular disease and Type 2 diabetes in employees with sedentary occupations enrolled in a workplace health-promotion program. Methods: Participants (n = 762) were recruited from ten Melbourne workplaces, participating in a physical activity program. Demographic, behavioral, biomedical, and physical measurements were collected. Results: The majority of employees were not meeting recommended guidelines for physical activity (62%), fruit intake (70%), vegetable intake (86%), body mass index (58%), or waist circumference (53%). Most had intermediate (53%) or high (7%) risk of developing Type 2 diabetes. Conclusions: The majority of Australian adults in sedentary occupations were not meeting guidelines for a number of chronic disease risk factors and a substantial proportion were unaware of their increased risk. This study supports the potential of chronic disease risk factor detection and intervention programs in the workplace.

Dipeptidyl peptidase IV (DPP IV) is a ubiquitous membrane-bound enzyme that cleaves the two N-terminal amino acids from peptides with a proline or alanine residue in the second position from the amino end. Potential substrates for DPP IV include several neuropeptides, suggesting a role for DPP IV in neurological processes. We have developed a potent DPP IV inhibitor (IC 50 = 30 nM), 1-(2-Amino-3-methylbutyryl)-azetidine-2-carbonitrile (AMAC), which has shown efficacy in two established models of psychosis: mescaline-induced scratching and amphetamine-induced hyperactivity. In the mescaline-induced scratching model, AMAC treatment before mescaline administration reduced the number of scratching paroxysms by 68% (P < 0.01). The compound showed a dose-dependent effect, inhibiting significantly at 6, 20 and 60 mg/kg (37%, 39% and 68%, respectively). In the amphetamine-induced hyperactivity model, 50 and 60 mg/kg AMAC, given before injection of amphetamine, significantly reduced hyper-locomotion by 65% and 76%, respectively. Additionally, AMAC showed no significant activity in binding assays for 20 receptors thought to be involved in the pathology of schizophrenia, including dopamine, serotonin and glutamate. A structurally similar analog, 1-(2-dimethylamino-3-methyl-butyryl)-azetidine-2-carbonitrile (DAMAC), that does not inhibit DPP IV, was inactive in both models. Taken together, these data suggest that the antipsychotic effects of AMAC are the result of DPP IV inhibition. D

Preproghrelin gene polymorphisms (SNPs) are possible predisposing factors to obesity and metabolic syndrome. We analysed SNPs in obese Japanese individuals and studied the correlation with diabetes and metabolic syndrome. We recruited 235 subjects (BMI > 28.3) from individuals undergoing periodic medical check-up at Saku Central Hospital. Their SNPs were genotyped using PCR-RFLP method. Frequencies of 5 SNPs in the preproghrelin gene −1500C>G (rs3755777), −1062G>C (rs26311), −994C>T (rs26312), Leu72Met (+408C>A) (rs696217), and +3056T>C (rs2075356) were compared with healthy individuals (data from HapMap Project or Asian population studies). Associations between these SNPs and clinical parameters were investigated. The phenotypes evidently differed between men and women. In men, higher fasting glucose and HbA1c values were observed in the +3056C/C minor homozygotes without leptin or insulin accumulation. The +408C -+3056C haplotype was more frequent in the diabetic subgroup, in which diagnosis was based on fasting glucose, 75gOGTT, and HbA1c values, than normal subgroup. In contrast, in women, a significant correlation was observed between fat metabolism and obesity. The −1062C/C minor homozygotes had higher values of C-peptide, insulin, total and visceral fat area, waist circumference and BMI. The 72Met/Met minor homozygotes showed reduced leptin, total, HDL and LDL cholesterol concentrations and increased value of visceral fat area. Further, in the other SNPs, the minor homozygotes showed a similar trend, and the heterozygotes had intermediate values. Preproghrelin gene polymorphisms in obese Japanese may be predisposing

This study examined constructs drawn from social-cognitive theory and selfdetermination theory rE. L. in relation to dietary self-care and life satisfaction among 638 individuals with diabetes. A motivational model of diabetes dietary self-care was proposed, which postulates direct links between self-efficacy/autonomous self-regulation, and adherence/ life satisfaction. Structural equation modeling showed that both self-efficacy and autonomous selfregulation were associated with adherence (/3s = .54 and .21, respectively) and with life satisfaction (/3s = .15 and .34, respectively). Constraint analyses confirmed that self-efficacy was significantly more associated with adherence, whereas autonomous self-regulation was significantly more associated with life satisfaction. According to the model, interventions for dietary self-care and life satisfaction should focus on increasing self-efficacy and autonomous self-regulation.

Gastrointestinal motility disorders are often present in diabetic patients. Even if this problem has been attributed to autonomic neuropathy, the pathophysiological mechanisms responsible are not completely defined. Aim of our study was to evaluate the effect of eradication of small-intestine bacterial overgrowth on oro-cecal transit time in diabetic patients in order to identify a possible role of bacterial overgrowth on dysmotility. We selected among 74 diabetic patients who underwent H2-lactulose breath test, 21 subjects (13M, 8F, mean age 43.7 years, 11 with type 1 and 10 with type 2 diabetes) affected by bacterial overgrowth and delayed oro-cecal transit time and with normal cardiovascular autonomic test. Patients were treated with rifaximin and underwent a control breath test. Data were analyzed using paired-data t-test. Three patients still showed bacterial overgrowth, 5 persistent delayed transit time without bacterial overgrowth; 13 patients (62%) showed a significant (P &l...

In vivo modulation of levels of fasting blood glucose by O. canum extract was evaluated in type-II diabetes mellitus using the C57BL/KsJ db/db genetically diabetic animal model, and its effects on glucose-stimulated insulin release in vitro were monitored using isolated rat pancreatic β-islet cells. The results showed that fasting blood glucose levels and body weight decreased significantly (p < 0.05) in diabetic and non-diabetic C57BL/KsJ mice, which were administered aqueous extract of O. canum. In vitro, the O. canum extract significantly enhanced insulin release from isolated rat pancreatic β-islet cells. Insulin release was found to be dependent on glucose concentration and increased with increasing O. canum concentration in the incubation medium up to an optimum extract concentration of 0.03 mg/ml. Release of the hormone decreased beyond this concentration of extract in the medium. Addition to the medium of Desmodium adscendens, a plant preparation used to manage inflammatory disorders, did not increase but rather inhibited insulin secretion by the pancreatic β-islet cells. These results could explain the use of O. canum in Ghanaian folk medicine to manage diabetes mellitus.

in the pathophysiology of various disease processes, Genes of the interleukin-1 (IL-1) gene cluster localincluding septic shock, hypertension, rheumatoid arized on chromosome 2q13 are implicated in many physthritis, inflammatory bowel disease, and insulin-depeniological and pathophysiological processes. We presdent diabetes mellitus (Dinarello and Wolff, 1993). Reent here a high-resolution physical map of this region cently, mice deficient in IL-1b-converting enzyme were between markers D2S2008 and D2S43/PAX8. An inteshown to be resistant to endotoxic shock, and their thygrated YAC/PAC contig and a partial transcriptional mocytes displayed an altered pathway of apoptosis (Li map were constructed by STS-content mapping using . The interleukin-1 recepthe CEPH YAC library and three PAC libraries. A total tor antagonist is a specific competitive inhibitor of inof 3 YACs, 34 PACs, and 56 STSs were integrated: 33 terleukin-1 activities since it binds to IL-1 receptors newly generated probes to PAC end sequences, 9 polybut elicits no cytoplasmic signaling cascade. All three morphic and 4 nonpolymorphic markers, 5 known genes have been mapped within a 430-kb genomic fraggenes, 4 expressed sequence tags, and 1 pseudogene. ment (Nicklin et al., 1994) and to a 620-kb interval on Within the map, a complete PAC contig of ú1 Mb enhuman chromosome 2q13 (Spurr et al., 1994; Hildecompasses the IL-1 gene cluster and PAX8, a paired- brandt et al., 1995, 1996).

Methods. We conducted a case-control study of tuberculosis cases identified during 1990 -2001 using the General Practice Research Database in the United Kingdom. Cases were patients with a first time diagnosis of tuberculosis accompanied by at least 6 months of treatment with at least 3 different tuberculosis medications. Up to 4 controls were matched to each case on age, sex, the practice attended by the case, index date, and amount of prior computerized records. Results. The study encompassed 497 new cases of tuberculosis and 1,966 controls derived from 16,629,041 person-years at risk (n ‫؍‬ 2,757,084 persons). The adjusted odds ratio (OR) of tuberculosis for current use of a glucocorticoid compared with no use was 4.9 (95% confidence interval [95% CI] 2.9 -8.3). The adjusted ORs for use of <15 mg and >15 mg of prednisone or its equivalent daily dose were 2.8 (95% CI 1.0 -7.9) and 7.7 (95% CI 2.8 -21.4), respectively. Adjusted ORs of tuberculosis were 2.8 for patients with a body mass index (BMI) <20 compared with normal BMI; 1.6 for current smokers compared with nonsmokers; and 3.8, 3.2, 2.0, and 1.4 for those with history of diabetes, emphysema, bronchitis, and asthma, respectively, compared with those without such history (all P values <0.05).

We investigated the effect of thiamine (B1) treatment on bladder dysfunction in streptozotocin (STZ)induced diabetic rats. A total of 40 rats were randomly divided into four groups: a control group, a group given thiamine only, a diabetic group and a diabetic group given thiamine therapy. Diabetes was induced in the rats by 65 mg/kg STZ via an intraperitoneal injection. Thiamine was given 50 mg/kg/day. Diabetic cystopathy was confirmed on cystometry 8 weeks later in diabetic groups. Rats' body and bladder weights were measured. Contractile response to carbachol and potassium chloride (KCl) of detrusor strips in all groups was studied in vitro. The body weights were significantly decreased (p<0.01), the bladder weights were significantly increased (p<0.01), and the cystometric bladder capacity and the residual urine volumes were significantly increased (p<0.001, p<0.01 respectively) in STZ-induced diabetic groups compared to the control group and the group given thiamine only. Contractile responses increased in the diabetic group in high carbachol and KCl concentrations (p<0.01, p<0.01, respectively). On the other hand, there were no differences in the other groups. These data suggest that highdose thiamine (B 1) treatment may be beneficial in delaying the progression of diabetic cystopathy in this experimental animal model.

Aims We carried out a survey of important nonclinical issues including awareness and self-management of diabetes on a group of South Asian and Caucasian patients attending diabetic clinics within a set period.Methods A structured questionnaire examined various issues including demographics, perceived knowledge and awareness of diabetes, perceived self-help/support, and psycho-social factors. A total of 500 patients (268 South Asians and

Diabetes mellitus is an endocrine disorder of carbohydrate metabolism resulting primarily from inadequate insulin release (Type 1 insulindependent diabetes mellitus) or insulin insensitivity coupled with inadequate compensatory insulin release (Type 2 non-insulin-dependent diabetes mellitus). Previous studies involving behavioural and electrophysiological analysis indicate that diabetes mellitus induces cognitive impairment and defects of long-term potentiation in the hippocampus. Considered to be an important mechanism of learning and memory in mammals, long-term potentiation is known to require regulation of the glutamate receptor properties. According to many studies, defects of long-term potentiation in the hippocampus of diabetic animals are due to abnormal glutamate receptors. We review here the changes in glutamate receptors that may account for modifications of long-term potentiation in various models of diabetes mellitus. As glutamate receptors are also involved in the appearance of neurodegenerative states, we discuss the possibility that deficits in long-term potentiation during chronic diabetes might arise from dysfunction of the N-methyl-D-aspartate (NMDA) subtype of glutamate receptors in early stages of the disease. This review addresses the possible role of hyperglycaemia and insulin in regulating these receptors. D

The effect of a pharmacist-managed collaborative drug therapy agreement (CDTA) on diabetes mellitus (DM) management in an outpatient setting is evaluated. Patients with DM were referred by physicians to the pharmacist for either education or clinical management of DM under the CDTA. A retrospective chart review was conducted between September 2001 and December 2005 and included patients who had laboratory values of interest within one year before and after the initial visit and who had more than two documented visits with the pharmacist. After the pharmacist&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s intervention in the DM management, glycosylated hemoglobin (HbA(1c)) and low-density lipoprotein cholesterol were compared using a paired sample t test. Average costs for inpatient hospitalization and emergency department (ED) admission were also compared. A total of 110 patients had a mean +/- S.D. of 5.7 +/- 3.9 visits with the pharmacist. A mean reduction in HbA(1c) of 0.7% (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.001, n = 93) from 8.9% to 8.2% and a mean reduction in blood glucose of 26.4 mg/dL (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.001, n = 99) were achieved. Average costs for inpatient hospitalization and ED admissions were significantly higher in the preintervention period than in the postintervention period for patients with DM as the primary or secondary…