Neurophysiological changes in neurologically asymptomatic hypothyroid patients: a prospective cohort study.

This is a prospective cohort study on neurologically asymptomatic patients with primary hypothyroidism. It was conducted to evaluate the frequency and pattern of neurophysiological changes in this group of patients. Twenty-three subjects were included over a period of 2(1/2) years. Neurophysiological evaluation included nerve conduction studies (NCS) of median, ulnar, and peroneal motor nerves as well as median palmar and ulnar and sural sensory responses. Electromyography of deltoid, first dorsal interosseous, vastus lateralis, and tibialis anterior muscles was performed with concentric needle electrodes in which duration, amplitude, and stability of motor unit action potentials, recruitment, and interference pattern were evaluated. NCS showed that 52% of the patients had some abnormality, predominantly of the motor demyelinating pattern, as evidenced by prolonged F-wave and distal latencies with normal amplitudes in most affected nerves. Thirty percent of patients had median mononeuropathy consistent with carpal tunnel syndrome. Nondisfigurative myopathic changes in the form of myopathic motor unit action potentials without spontaneous activity were seen in 74% of the patients, most commonly in deltoid (70%). Frequencies of involvement of other muscles were 39% in the vastus lateralis muscle, 26% in tibialis anterior muscle, and 9% in the first dorsal interosseous muscle. We conclude that electromyographic/NCS changes commonly exist in treated, neurologically asymptomatic patients with hypothyroidism and are most frequently myopathic. Median neuropathy is the most common nerve abnormality. Other nerves are involved, with a higher tendency for motor nerve demyelination. We speculate that some neuromuscular changes secondary to hypothyroidism persist after treatment and that motor nerve abnormalities are less likely to be symptomatic than sensory nerve changes in these patients.

Stage of change of 6 health-related behaviors among patients with type 2 diabetes.

AIMS: Assessing patients' current stage of change toward 6 healthy behaviors related to diabetes control. Behaviors studied were smoking cessation (2) regular exercise; (3) consuming 5 servings or more of fruits and vegetables; (4) decreasing intake of refined sugar; (5) reducing saturated fat; and (6) self monitoring of blood glucose (SMBG). METHODS: Stage of change (SOC) for several diabetes control-related behaviors was assessed for 737 patients with type 2 diabetes using a staging algorithm. Socio-demographic data were collected by a structured interview-based questionnaire. RESULTS: There was high degree of readiness toward consuming diets with less saturated fat and simple sugar. Very low degree of readiness was reported for self-monitoring of blood glucose on a regular bases and for practicing physical exercise. Half of the participants (50.9%) were in the precontemplation stage for consuming ≥5 servings of fruits and vegetables every day. Significant correlations were obtained between the degree of readiness for several behaviors (p<0.01). Age, gender, income and education were all related to the stage of change of the studied behaviors (p<0.01). CONCLUSIONS: Patients with diabetes in Jordan are still in the pre-action stages for practicing exercise, consuming 5 servings or more of fruit and vegetable, and self-monitoring of blood glucose. The current finding suggests a need for nutritional education and interventions to raise awareness of lifestyle factors influencing glycemic control among diabetics.

Food insecurity is related to glycemic control deterioration in patients with type 2 diabetes.

BACKGROUND & AIMS: Poor glycemic control has been shown to play a major role in the development and progression of diabetes complications. This cross-sectional study tested the hypothesis that food insecurity may deteriorate glycemic control in patients with type 2 diabetes. The objectives of this study were to assess the prevalence of food insecurity among type 2 diabetics in a major hospital that serves the area of northern Jordan, and to investigate its relation to glycemic control. METHODS: A sample of 843 patients diagnosed with type 2 diabetes participated in the study. Socioeconomic and health data were collected by interview-based questionnaire. Weight and height were measured by a trained nutritionist. Dietary assessment was done using food frequency questionnaire. Dietary data were processed using food processor software. Food insecurity was assessed by the short form of the U.S. food security survey module. Glycemic control was assessed by measuring glycosyated hemoglobin (HbA1c). Statistical procedures used to analyze the data were chi-square, and post-hoc analysis of variance. RESULTS: About 22% of the tested sample were food secure (FS); 51% were moderately food insecure (MFIS); and 27% were severely food insecure (SFIS). Higher BMI was associated with SFIS patients. After adjusting for age, gender, income, education, and duration of diabetes, body mass index, and caloric consumption; moderate and severe food insecurity were associated with poor glycemic control (p = 0.04). CONCLUSION: food insecurity may be associated with glycemic control deterioration in patients with type 2 diabetes.

Elevated glycosylated hemoglobin is associated with subclinical neuropathy in neurologically asymptomatic diabetic patients: a prospective study.

The association between poorly controlled diabetes and higher risk of polyneuropathy is well established. The American Diabetes Association recommends that glycosylated hemoglobin (HbA1c) should be less than 7%. Most previous studies, which reported HbA1c correlation with polyneuropathy, used higher HbA1c cut points and focused on neurologically symptomatic patients. This study evaluated the correlation of HbA1c levels, using the 7% cut point, with abnormal nerve conduction studies in diabetic patients in the subclinical stage of polyneuropathy. Fifty neurologically asymptomatic diabetic patients were included. HbA1c was measured at time of inclusion and 3 months later followed by nerve conduction studies. Univariate and multivariate analyses with logistic regression models were used to study the association of different patient characteristics with abnormal nerve conduction studies. Fifteen women and 35 men were studied. Half of patients had elevated HbA1c and half had HbA1c <7%. Twenty-six patients (52%) had subclinical neuropathy (18 men, 8 women). In multivariate analysis, HbA1c was the most important factor predicting higher risk of subclinical neuropathy [adjusted odds ratio 10.71 (2.49, 46.01), P < 0.005]. Therefore, nerve conduction studies abnormalities commonly exist in diabetic patients in the subclinical stages of polyneuropathy, and are highly correlated to HbA1c levels. Therapies for diabetic neuropathy should target the early stages of the disease.