Family History of Type 2 Diabetes: Does Having a Diabetic Parent Increase the Risk?

BACKGROUND: It is well established that there is an important genetic predisposition for type 2 diabetes mellitus (T2DM). OBJECTIVE: To summarise available epidemiological data regarding T2DM transmission in various populations. METHOD: Narrative review. RESULTS: The estimated risk for the diagnosis of T2DM increases approximately by 2-4 times, when father, mother or both have this condition. Conversely, many T2DM patients have family members with DM. Studies have suggested that the likelihood of T2DM in the next generation is higher in the event of a diabetic mother than father. Both genetic factors, such as mitochondrial DNA mutations, and environmental components, such as intra-uterine environment, have been implicated in the higher maternal transmission of T2DM. Despite the above findings, some studies in populations with high frequency of T2DM have not corroborated the predominantly maternal transmission. Such works have shown either an excess paternal or an equal transmission of T2DM. CONCLUSION: It appears that potential biases in reporting family history data, especially between the various racial groups, have contributed to the controversy over the existence of excess maternal transmission of DM.

Hypoglycaemia requiring medical assistance in patients with diabetes: a prospective multicentre survey in tertiary hospitals.

AIM: Hypoglycaemia is considered a factor contributing to morbidity and mortality in patients with diabetes. The aim of the present study was to examine the frequency, clinical characteristics, predisposing factors and outcomes of iatrogenic hypoglycaemia requiring medical assistance. METHODS: Eight hospitals participated in this prospective survey of documented iatrogenic hypoglycaemia at their emergency departments. Cases with type 2 diabetes (T2D) were compared with a control group, consisting of patients visiting the outpatients' diabetes clinics of the same hospitals during the same time period. RESULTS: Median survey duration was 16.5 months, and 295 episodes of iatrogenic hypoglycaemia were recorded. Frequency varied across centres from 0.25 to 0.78 cases per 100 presenting patients. Most cases (90.8%) were observed in patients with T2D (mean age: 76.7±10.1 years), while 8.1% of events were recorded in patients with type 1 diabetes (mean age: 42.7±18.3 years). Total in-hospital mortality was 3.4%, and all involved patients with T2D. In T2D patients, advanced age (OR: 1.3 [1.20-1.45] for 5-year increase), use of sulphonylureas (OR: 4.0 [2.5-6.36]), use of insulin (OR: 2.35 [1.42-3.95]), lower estimated GFR (OR: 1.15 [1.07-1.23] at 10mL/min) and number of comorbidities (OR: 1.74 [1.34-2.27]) were each independently associated with hypoglycaemia requiring medical assistance. CONCLUSION: Hypoglycaemia requiring medical assistance in patients with diabetes is a moderately common condition seen in emergency departments and has a mortality rate of 3.4%. The majority of cases involve elderly individuals with T2D who are suffering from serious comorbidities and treated with insulin and/or sulphonylureas.

Knowledge regarding assessment of sepsis among Greek nurses.

The aim of the present survey was to evaluate nurses' knowledge regarding sepsis in Greece. A total of 835 registered nurses (125 males/710 females) from tertiary hospitals in Greece were interviewed from April 2008 to December 2009. All participants completed a self-completed questionnaire about assessment of sepsis (see Figure 1). Basic demographic information was recorded. The protocol and questionnaire were approved by the Ethics Committees of participating hospitals. The majority of the participants answered correctly regarding awareness of systemic inflammation - 83.5% regarding the role of temperature in the definition of systemic inflammation; 81.3% regarding the importance of white blood cell count; and 49.9% and 46.3% regarding the role of tachycardia and tachypnoea, respectively. The same pattern was observed regarding the answers about the assessment of sepsis - 79.4% of the nurses answered correctly about the role of blood pressure; 70.9% about the role of urine volume; and 43.5% about the importance of oxygen saturation. Finally, 57.2% of the participants confirmed that in practice they followed the current guidelines for the diagnosis and treatment of patients with sepsis. The study has established baseline data with which future studies can be compared.

Cardiovascular effects of glucagon-like peptide 1.

Glucagon-like peptide-1 (GLP-1) is involved in satiety control and glucose homeostasis. Besides, GLP-1 has cardiovascular effects. In experimental models, GLP-1 increases cardiac output and exerts a direct vasodilatory effect. In animals with dilated cardiomyopathy GLP-1 improves left ventricular performance. Human data demonstrated that GLP-1 reduces arterial blood pressure, improves endothelial function in individuals with diabetes and left ventricular function in patients with heart failure. Administration of GLP-1 increases ejection fraction in acute myocardial infraction and reduces ischemia-reperfusion myocardial injury. Although more research is needed, these data suggest that GLP-1 may be used with promising results in patients with heart failure, acute myocardial infarction and revascularization procedures in addition to the standard therapy.

In-hospital mortality in a tertiary referral hospital: causes of death and comparison between patients with and without diabetes.

INTRODUCTION: Subjects with type 2 diabetes mellitus (T2DM) have increased morbidity and mortality mainly due to macrovascular complications. In addition, diabetic patients show increased in-hospital admissions in comparison with nondiabetic patients. However, in-hospital mortality data for patients with T2DM are not available in our country. The aim of the present study was to examine mortality rates in diabetic compared to nondiabetic patients admitted to a tertiary hospital during a 10-year period (1998-2007). MATERIAL AND METHODS: We performed a retrospective analysis of mortality rates in patients with and without T2DM hospitalised in a tertiary care hospital during the years 1998-2007. Demographic characteristics, medical history and outcome were collected from the patients' medical records. Patients with type 1 diabetes were excluded from the analysis. RESULTS: A total of 16 125 patients' records were studied (14 005 without diabetes and 2 120 with T2DM). In the total sample, 1 467 (9.1%) deaths were recorded. Mortality rates were higher in the diabetic than in the nondiabetic patients (11.2% versus 8.7%, respectively, p<0.001). Age of death did not differ between diabetic and nondiabetic patients (age+/-SD: 77.1+/-9.5 vs. 77.6+/-16.3 years, p=0.73). Median length of hospital stay was higher in the diabetic than in the nondiabetic patients (p=0.03). Mortality was higher in the diabetic in comparison with the nondiabetic females (59.9% vs. 52.7%, respectively, p=0.04), while no gender difference was found in males. Cerebrovascular disease was the commonest cause of death in both diabetic and nondiabetic patients (41.6% vs. 30.3%, p=0.001), followed by infections (23.1% vs. 21.7%, respectively, p=0.62). Death rates from malignancies were more common in the nondiabetic in comparison with the diabetic patients (18.8% vs. 4.2%, p<0.001). No significant differences were observed between the two study groups regarding mortality caused by cardiovascular events and chronic renal failure. CONCLUSION: The present study showed that diabetic patients and especially females had increased in-hospital mortality compared with nondiabetic patients. Cerebrovascular disease and infections were the more common cause of death in both groups.

Matrix metalloproteinases and cardiovascular diseases.

Matrix metalloproteinases (MMPs) are extracellular enzymes that are important in many physiologic and pathologic processes. Their activity is regulated mainly by tissue inhibitors of metalloproteinases (TIMPs). MMPs expression is related with the classical cardiovascular risk factors as well as with inflammation. They play a central role in atherosclerosis, plaque formation, platelet aggregation, acute coronary syndrome, restenosis, aortic aneurysms and peripheral vascular disease. Many studies have shown that commonly prescribed antihypertensive medications, glitazones and statins may influence MMPs activity. The aim of the review is to present literature data on the role of MMPs and their inhibitors in cardiovascular disease.

Prevalence trends for myocardial infarction and conventional risk factors among Greek adults (2002-06).

AIM: To examine trends in the prevalence of myocardial infarction (MI) and conventional risk factors in Greek adults between 2002 and 2006. DESIGN: Repeated cross-sectional study. METHODS: Self-reported data from surveys given in Salamis during two election days in 2002 and 2006 were analysed. The same sampling method and procedures were used on both surveys. The study sample included 2805 and 3478 subjects (> or =20 years) in 2002 and 2006, respectively, with similar age and sex distribution to the target population. RESULTS: The prevalence of MI increased from 4.1% (men, 6.3%; women, 1.9%) in 2002 to 4.8% (men, 7.3%; women, 2.2%) in 2006 (P = 0.18). At the same time, prevalence rates of major risk factors were as follows: diabetes increased from 8.7% to 10.3% (P = 0.037), hypertension from 20.1% to 25.7% (P < 0.001) and hypercholesterolemia (cholesterol >240 mg/dl or the use of cholesterol-lowering medication) increased from 17.5% to 22.3% (P < 0.001). Prevalence of current smokers in 2002 (defined as persons who smoked > or =5 cigarettes/day) was 37.0% and in 2006 (defined as those who smoked > or =1 cigarettes/day) was 40.1%. Logistic regression analysis showed that the aforementioned risk factors were significantly associated with MI in both surveys; the factor that showed the greatest magnitude of association with MI was hypercholesterolemia, followed by diabetes, hypertension and smoking. CONCLUSION: These findings show that, in the Greek population, prevalence of MI continues to rise (at approximately 4% per year). This trend seems to be driven by a persistently high prevalence of smoking and the rapidly increasing burden of diabetes, hypertension and hypercholesterolemia.

Errors in death certificates in a rural area of Greece.

INTRODUCTION: A death certificate is the formal document in which a physician records the time, cause and circumstances under which the death of an individual has occurred. Morbidity and mortality statistics are mainly based on the analysis of these certificates, and inaccuracies in the detail may lead to biased estimation in several epidemiological parameters. The aim of this study was to examine the quality of cause of death in death certificates in a rural area of Greece, and to identify factors that may be associated with inaccuracies in the completion of these death certificates. METHODS: All death certificates archived in the municipality of Tritaia during the period 1999-2006 were examined. Statistical analysis was performed by comparing the proportions of the unpaired case. The state of independence among the various variables was investigated by considering the class of discrete graphical models. RESULTS: In total, 516 death certificates were examined; 5.6% (29/516) were excluded because of insufficient demographic data. The remaining 487 death certificates were analyzed with the following findings: 51.5% were for males and 48.5% females (median age 82 years, range 5-103 years; and 83 years, range 0-104, respectively); and 39.4% (192/487) were correctly completed. In 168 the mechanism of death was given; in 72 multiple causal sequences were given; in 22 a single/not precise cause was given; and in 33 a single causal sequence with incorrect order was given. In all, 20.1% were completed by a physician of the regional health centre. Gender was not associated with the presence of error (p = 0.352). Errors were present in 63.8% (270/423) of the death certificates in deceased individuals > or =60 years and in 39.1% (25/64) of the death certificates in individuals < or =59 years (p<0.001). In 19.7% of the erroneously completed death certificates, the certifier was a physician working in primary health care. The presence of errors in death certificates decreased from 74.6% in 1999 to 51.8% in 2006 (p = 0.004). CONCLUSIONS: Giving the mechanism instead of the cause of death was the most frequent type of error. A statistically significant increase in the presence of errors was observed as the age of the descendent increased. During these 8 years, there has been a statistically significant decrease in errors. However, efforts should be made by trainers and physicians in order to improve the accuracy of the information in death certificates. If this is accomplished, cause-of-death statistics will be more accurate and so enable better health planning.