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Skin lesions in diabetes mellitus: Prevalence and clinical correlations

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Abstract

With the aim to assess the prevalence and the main clinical correlations of skin lesions in diabetes mellitus, 457 diabetic subjects consecutively attending an outpatient clinic underwent a dermatological examination. Neurovascular foot lesions were excluded. Thirty-five of 64 IDDM patients (54%) had skin alterations mainly consisting of vitiligo (9% of all patients), psoriasis (9%) and eczema (8%). The most frequent skin lesions observed in 240/393 NIDDM subjects (61%) were represented by infections (20% of all patients) and diabetic dermopathy (12.5%), while other lesions were not common. NIDDM patients with skin infections had a worse metabolic control, and those with diabetic dermopathy had a greater prevalence of neuropathy and large vessel disease than patients without skin lesions. These data show that the prevalence of skin diseases in a large, unselected diabetic population is higher than expected and indicate that, in most cases, a careful dermatological examination and a better metabolic control are needed in order to improve quality of life in these patients.

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... It is generally asymptomatic. Lesions are typically common in the pretibial area; however, they can also develop in the thigh (2), trunk and lower abdominal region (2)(3)(4). Atrophic appearance and localization suggest a trauma origin (3,4). ...
... Lesions are typically common in the pretibial area; however, they can also develop in the thigh (2), trunk and lower abdominal region (2)(3)(4). Atrophic appearance and localization suggest a trauma origin (3,4). ...
... In addition, it is two times more frequent in men (1,4,7). There are also controversies about whether it is pathognomonic for diabetes mellitus because it is also seen in patients without diabetes (3,7). In this study, the relation of diabetic dermopathy with other complications of diabetes was investigated by comparing diabetic dermopathy patients with two control groups with and without hospitalization indication. ...
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Aim: Diabetic dermopathy is a skin disease, seen in patients with diabetes mellitus, characterized by atrophic scar and hyper-pigmented lesions. Recently, it was proposed that this disease might be associated with other microangiopathic complications of diabetes such as retinopathy, nephropathy, and polyneuropathy. In this study, patients with diabetic dermopathy were compared with two control groups to test the validity of these associations. Material and Methods: Twenty-three patients, who admitted to Dermatology Outpatient Clinic Health Sciences University Gazi Yaşargil Education and Research Hospital and diagnosed as diabetic dermopathy were included in the study. Twenty-three patients with well controlled diabetes mellitus (Control Group A) who treated as outpatients and 23 patients with diabetes mellitus who had poor general status and hospitalized by internal medicine department (Control Group B) were included as two control groups. Patients were evaluated in terms of retinopathy, nephropathy, neuropathy, heart attack history and diabetic foot ulcer. Results: In the study 82.6% (n:19) of patients were male and 17.4% (n:4) were female (female: male ratio 4.75:1). There was no significant relationship between fasting blood glucose and HbA1c elevation with retinopathy, neuropathy, polyneuropathy and diabetic foot. However, there was a significant relationship between fasting blood glucose levels and heart attack. Although heart attack history and diabetic foot was more common in the patient group and retinopathy, nephropathy and polyneuropathy was more frequent in the Control Group B, there was no significant difference between both groups. Conclusions: In conclusion, microangiopathic complications, heart attack and diabetic foot are not only common in the patient group with diabetic dermopathy but also in the Control Group B. Even though these complications were more common in these two groups, there was no significant difference between each and the other diabetic (Control Group A). Keywords: Diabetes mellitus; diabetic dermopathy; skin lesions; cutaneous manifestations.
... [2][3][4] It has been suggested that skin changes may be due to the effects of advanced glycation end products, oxidative stress and inflammation which leads to early skin aging, development of diabetic dermopathy, and scleroderma diabeticorum. [5] Similarly, skin lesions like acanthosis nigricans, acrochordons, and inflammatory dermatitis may result from hormonal influences, insulin resistance, imbalance growth factors and cytokines. [4,5] The aim of the study was to determine the prevalence and pattern of skin diseases in diabetic patients, to two occasions. ...
... [5] Similarly, skin lesions like acanthosis nigricans, acrochordons, and inflammatory dermatitis may result from hormonal influences, insulin resistance, imbalance growth factors and cytokines. [4,5] The aim of the study was to determine the prevalence and pattern of skin diseases in diabetic patients, to two occasions. Good control was fasting plasma glucose of <6 mmol/l and poor control was fasting plasma glucose of >6 mmol/l. ...
... On the other hand, some other skin changes observed in people living with diabetes are associated with infection. [4][5][6][7] Ninety-two (92%) of the subjects in this study had skin lesions. Previous studies have shown that 30-71% of diabetics have skin disorders. ...
Article
Background: Diabetes mellitus is one of the most common metabolic disorders with a rising prevalence. It cuts across all ages and socioeconomic status. Various skin lesions are frequently observed in diabetic patients. Aims: This study was carried out to determine the prevalence, pattern, and determinants of skin diseases in diabetic patients at the Barau Dikko Teaching Hospital, Kaduna, North West Nigeria. Materials and methods: One hundred consecutive diabetic patients attending the clinic were included in the study. Results: Many of the patients had more than one skin condition at a time. The most prevalent skin diseases were idiopathic guttate hypomelanosis which was seen in 61% of patients, infections from fungal, bacterial, and viral causes occurred in 30% of patients, other skin disorders were diabetic dermopathy seen in 17% of patients, palmoplantar hyperpigmentation was seen in 13% of patients, while pruritus occurred in 12% of patients and xerosis was seen in 10% of patients. Conclusion: Skin disorders are common among diabetic patients at Barau Dikko Teaching Hospital, Kaduna, North West Nigeria.
... Diabetes mellitus affects individuals of all ages and in all socio-economic segments of the population. 1 The International Diabetes Federation (IDF) estimates the total number of diabetic subjects to be around 40.9 million in India and this is further set to raise to 69.9 million by the year 2025. 2 Estimates by WHO suggest that the number of diabetic subjects would increase to 80 million by the year 2030 in India. 1 Skin lesions are frequently observed in diabetic patients and about 30% of diabetics have cutaneous disorders. 3 The skin is affected by the acute metabolic derangements and the chronic degenerative complications of diabetes. Although the mechanism for many diabetes-associated skin conditions remains unknown, the pathogenesis of others is linked to abnormal carbohydrate metabolism, other altered metabolic pathways, atherosclerosis, microangiopathy, neuron degeneration, and impaired host mechanisms. ...
... 4 Only a few epidemiologic studies have been done on the prevalence of skin disorders in patients with diabetes mellitus. 3,5 This study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from north coastal region of Andhra Pradesh. ...
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p class="abstract"> Background: Diabetes is the most common metabolic disorder with increased prevalence in developing countries like India. It affects almost all organs among which skin is affected by the acute metabolic derangments as well as by chronic degenerative complications. The aims were to study the pattern of cutaneous lesions in patients with diabetes mellitus and to determine the incidence of skin manifestations specific to and associated with diabetics. Methods: Hundred cases of diabetes mellitus with cutaneous manifestations attending skin outpatient department and other patients admitted in medical wards were included in the study. Results: The common skin disorders were cutaneous manifestations (67%), dermatosis more commonly associated with diabetes (36%), neuropathic and ischemic diabetic skin disease (11%). Conclusions: Most common cutaneous manifestation was cutaneous infections followed by dermatosis more commonly associated with diabetes. Among cutaneous infections fungal infections were more common followed by bacterial infections. Cutaneous infections were more common in patients with poor glycaemic control and the association was found to be statistically significant.</p
... Further, as the year of research moved forward, prevalence of skin lesions in diabetic patients in Iran again increases. In the studies conducted in Italy [11] and the US [12], 60% and more than 66% respectively of diabetic patients had skin signs and lesions. Prevalence of skin manifestations in diabetic patients in other countries of the world was as follows: Pakistan 82% [13], India 84% [14]. ...
... Zauważono także, że z czasem częstość występowania zmian skórnych u pacjentów z cukrzycą w Iranie wzrasta. W badaniach przeprowadzonych we Włoszech [11] i Stanach Zjednoczonych [12] zmiany skórne występowały odpowiednio u 60% i ponad 66% pacjentów diabetologicznych. W innych krajach świata odsetki te kształtują się na następującym poziomie: Pakistan 82% [13], Indie 84% [14]. ...
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Diabetes is one of the most common chronic metabolic diseases [1]. According to a prediction by World Health Organization (WHO), the number of diabetic patients in 2025 will amount to 333 million adults. Meanwhile, predictions suggest that 4.4% of the citizens worldwide will have diabetes in 2030 [2]. These figures represent high prevalence of this disease in Iran [3]. The most important skin manifestation resulting from diabetes is incidence of infection. Poor control of diabetes results in incidence of different types of bacterial and fungal infections in patients. Staphylococcal pyodermas, candidiasis, erythrasma, and Epidermophytosis are among the common infections in diabetic patients [4]. In studies conducted in Iran, different values have been reported for the prevalence of skin lesions in diabetic patients. Prevalence of these manifestations in Tehran in 2016 (14), Arak [5], and Tabriz [6] has been reported to be 64%, 94.5%, and 16%, respectively, suggesting inconsistency of prevalence of skin manifestations, and does not show any overall skin lesions in diabetic patients in Iran. Accordingly, the question of this research is that: “what is the overall prevalence of skin lesions in diabetic patients in Iran?” This study has been performed as systematic review and meta-analysis, and it is a result of extracting the findings of studies performed on skin lesions in patients with diabetes in Iran. For this purpose, all papers published in both domestic and foreign journals within time range of March 2000 and October 2018 were included in the study. The databases that were searched included Magiran, SID, Medline (PubMed), Scopus, ScienceDirect, and Google Scholar. The search process in Persian databases including Magiran and SID as well as English databases including Scopus, ScienceDirect, Medline (PubMed), and Google Scholar was done using the keywords of blood glucose, diabetes, skin lesions, and their possible combinations. Furthermore, AND and OR operators were used in combination to gain a more comprehensive access to all papers. For this purpose, OR operator was used to search for synonym keywords such as blood glucose or hyperglycemia and skin lesions or cutaneous manifestations. On the other hand, AND operator was used between keywords (diabetes AND skin lesions). The criteria for entrance of papers into this study included Persian and English papers taken from cross-sectional studies about the prevalence and frequency of skin lesions in diabetic patients in Iran. Review studies, case studies, cohort, and interventional studies were excluded from the list of the papers. Based on assessment of the quality of the studied papers, a checklist of the information of the chosen papers including author’s name, title, year and place of conducting the study, sample size, and prevalence of skin lesions was prepared based on PRISMA 2009 (Figure.1) (Table 1). In each of the studies, the prevalence of skin lesions in patients with diabetes was obtained. Heterogeneity of studies was examined using I2 test. Considering the results obtained from I2 test (I2=97%) and great heterogeneity in the included studies, random effects model was used for combining the results of different studies with each other. The data were analyzed by CMA software. That total number of diabetic patients studied was 3085 within the age range of 13-84 years. Prevalence of skin lesions in patients with diabetes in Iran based on the meta-analysis was obtained as 67.2% (CI 95%:45.6-83.4%). The maximum and minimum prevalence of skin lesions in diabetic patients were observed in Arak and Tabriz with 96.5% (CI 95%: 92.6-96%) in 2015 [5] and with 16% (CI 95%: 13-19.5%) in 2006 [6], respectively. According to the results of the present study and having examined 3085 diabetic patients within the age range of 13-84 years, the overall prevalence of skin lesions in patients with diabetes in Iran based on meta-analysis is 67.2%. Further, as the year of research moved forward, prevalence of skin lesions in diabetic patients in Iran again increases. In the studies conducted in Italy [11] and the US [12], 60 and more than 66% respectively of diabetic patients had skin signs and lesions. Prevalence of skin manifestations in diabetic patients in other countries of the world was as follows: Pakistan 82% [13], India 84% [14]. Considering the high prevalence of skin lesions in patients with diabetes, health policy makers should take effective measures to raise awareness of diabetics about these complications. Further, considering the importance of the issue, the grounds should be provided to conduct observational and interventional studies about care, controlling, and preventive solutions.
... Males (55%) outnumbered females (45%) in our study, which is in agreement with studies done by Sawhney et al. 7 and Rao and Pai. 11 However, Romano et al., 12 Nigam and Pande, 9 Al Mutairi, 13 Mahajan et al., 8 and Bhat et al. 14 reported a higher incidence of dermatological manifestations in female diabetic patients. This may be due to the fewer number of females in our study. ...
... In the present study, 12, 21, 26, 25, 9, and 7% of patients had 1, 2, 3, 4, 5, and ≥ 6 cutaneous manifestations, respectively. While almost similar observations were made by Goyal et al. 20 in their study 20,20,12,16,14, and 2% of patients had 1, 2, 3, 4, 5, 6, and 7 cutaneous manifestations, respectively. ...
... 10 Vahoraet al. 12 have reported a lesser frequency of bacterial infections in such patients.The frequency of bacterial infections in type II Diabetes Mellitis was reported to be higher by Ahmedet al. 1 Few studies have also reported a varied frequency of bacterial infections in association with type II Diabetes Mellitis. [13][14][15] On the contrary, Galdeano F et al. 16 have reported a lower frequency of bacterial infections in a similar series of patients. Again it can be stated that the frequency of such findings can vary from one study to another depending upon the study design and setting. ...
... However, the relative frequency of these bacterial infections in diabetes mellitis can vary in different studies. [13][14][15][16] Cellulitis, carbuncle and furuncles were more frequent in a study from Sudan. 17 In a study from Sargodha, findings reported seem to be in agreement with our study. ...
... 8 In another report, among 457 diabetic subjects attending an outpatient clinic, 9% had vitiligo lesions. 16 Somorin and Krahn also found vitiligo to be associated with diabetes mellitus in 5% of cases, mostly in the form of type 2 diabetes. 17 In some other studies, a high prevalence of systemic complications has been reported in diabetic patients with cutaneous involvement compared with diabetics without cutaneous manifestations. ...
... 8 In another report, among 457 diabetic subjects attending an outpatient clinic, 9% had vitiligo lesions. 16 Somorin and Krahn also found vitiligo to be associated with diabetes mellitus in 5% of cases, mostly in the form of type 2 diabetes. 17 In some other studies, a high prevalence of systemic complications has been reported in diabetic patients with cutaneous involvement compared with diabetics without cutaneous manifestations. ...
... Therefore, screening and early detection of fungal infections in high-risk individuals، are critical for prevention of grave complications like foot amputation. In some diabetic patients, developing cutaneous lesions, and nail infections have been documented (9). More than 75% of DM patients are at risk for diabetic ulcers. ...
... 4 There are several studies in literature which gives a description of different complications of DM especially complications that occur in skin. [5][6][7][8][9][10][11] Few studies gives the association between complications of diabetes like retinopathy and dermatological lesion like diabetic dermopathy. 1 ² -18 Also, there are several studies in literature which gives the prevalence of DR in DM patients. 19-²³ Frequency of diabetic dermatological lesions in DR is not available in literature and it is difficult to know the exact nature of association between these two, though both are considered to be the complications of DM. ...
... Skin infections occurred more frequently with longer duration of the disease. These results were similar to a study done by Romano who studies 457 diabetic patients (16) . Allergic reactions to both oral hypoglycemic agents and parentally administered insulin occurred but were fortunately uncommon (17) . ...
Article
Abstract Objective:- To evaluate the incidence and types of cutaneous manifestations in diabetic patients in Iraq. Patients and methods:- One hundred diabetic patients attended the department of dermatology and venereology was evaluated. Sixty of them were male and 40 female. Sixty two percent of them had type I and 38% had type I diabetes mellitus I. Result: - Neuropathic cutaneous lesions were found in 32.43% of patients. Dryness of the skin and hair loss being the commonest. Vascular skin lesions were 14.86 %, diabetic dermopathy and necropiosis lipodica constitutes the highest percent. Cutaneous infections occurred in 20.7% weather bacterial or monilial infection. Drug eruptions were 10.36%, commonly complicate insulin therapy. Other miscellaneous skin lesions appeared in 21.62%. Purities were the commonest. Conclusion: - Diabetic skin manifestations are not uncommon in both types of diabetes mellitus.
... Uncontrolled diabetes leads to infections. Such infections are generally resistant to treatment [35]. Prevalence studies have shown that fungal infections are more common than bacterial infections [21]. ...
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BackgroudPrevalence of skin lesions among diabetic patients is a major health concern. Therefore, this systematic review and meta-analysis study was conducted to determine the prevalence of skin lesions in diabetic patients.Methods To identify and select relevant articles, the SID, MagIran, IranMedex, IranDoc, Google Scholar, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (WoS) databases were searched without a lower time limit and until April 2020. The random effects model was used to perform the analysis, and the heterogeneity of studies was assessed using the I2 index. Data were analyzed within the Comprehensive Meta-Analysis (Version 2) software.ResultsAfter evaluating the 22 final articles with a total sample size of 8406, the prevalence of skin lesions among diabetes patients were found as 70.3% (95% CI: 63–76.7%). Moreover, according to the meta-regression analysis, the effect of ‘sample size’ on th prevalence of skin lesions was significantly different in diabetes patients (p < 0.05).Conclusion The results of this study show that skin lesions are common in diabetes patients. Therefore, appropriate policies needs to be adopted to improve the situation and to monitor patients and outcomes at all levels.
... general, type two DM patients tend to develop more frequent cutaneous infections, whereas type one DM patients develop more autoimmune type of cutaneous lesions . [4][5] Hyperglycemia leads to nonenzymatic glycosylation (NEG) of various structural and regulatory proteins including collagen. NEG leads to formation of advanced glycosylation end products (AEG), which contribute to pathogenesis of disorders such as diabetic thick skin and limited joint mobility (LJM) . ...
Article
BACKGROUND: Diabetes is most common endocrine disorder with increasing prevalence worldwide. Every organs system is affected by it albeit at different pace. This study was carried out with the aim of studying cutaneous manifestation of diabetes mellitus. METHODS- 200 cases of diabetes mellitus with cutaneous manifestations attending out patient department of dermatology were included in the study. RESULTS - The common skin disorders were cutaneous infections (53.5%), acanthosis nigricans (10.5%), generalized pruritus (10.5%),skintags (9.5%). CONCLUSION - most common dermatological manifestations were cutaneous infections.
... An increased adhesion for pathogens is observed in the In the present study, around 50% of patients had more than one skin lesion. The prevalence of skin lesions in diabetic patients mentioned in other local studies is 68% and 96% reflecting a wide variation in the frequencies of skin manifestations, either 15,16 infectious or non-infectious, in our population. This study indicated that female patients o u t n u m b e r e d t h e i r m a l e c o u n t e r p a r t s , encompassing 56% of the study's population. ...
... Lesions are more common in patients with microangiopathic diabetic complications such as retinopathy. 7 The diagnosis of DD is primarily clinical; however, if biopsied, lesions show epidermal atrophy, dilated blood vessels in the superficial dermis, and mild perivascular lymphocytic infiltrate. DD resembles stasis dermatitis histologically, therefore, clinical correlation is required to distinguish between the two diagnoses. ...
Article
Through multiple complex mechanisms, the endocrine system plays a vital regulatory role in virtually every organ system including the skin. Cutaneous lesions may be seen incidentally in patients with endocrine disorders. Alternatively, certain skin conditions are seen exclusively in the setting of endocrine disorders and may rarely be the first clinical symptom of the underlying endocrinopathy. Although clinical examination is often sufficient, a tissue biopsy may still be needed to arrive at or confirm the diagnosis and to direct therapy. In many cases, the cutaneous condition might improve or resolve completely after treatment of the underlying endocrine disorder. In this review, we summarize the most common skin conditions associated with endocrine disorders, uncovering their relationship to the underlying endocrinopathy, demonstrating their clinicopathologic presentation, and highlighting their typical modalities of treatment.
... An increased adhesion for pathogens is observed in the In the present study, around 50% of patients had more than one skin lesion. The prevalence of skin lesions in diabetic patients mentioned in other local studies is 68% and 96% reflecting a wide variation in the frequencies of skin manifestations, either 15,16 infectious or non-infectious, in our population. This study indicated that female patients o u t n u m b e r e d t h e i r m a l e c o u n t e r p a r t s , encompassing 56% of the study's population. ...
... Skin manifestations are more common in insulin-dependent diabetes mellitus than in the insulinindependent variant (Box 1). As the majority of dermatoses occur in both types of diabetes, the most useful classification from the practical point of view is as follows: (1) cutaneous manifestation specific to diabetes; (2) compatible dermatoses not specific to diabetes; (3) skin infection associated with diabetes; and (4) skin manifestation due to anti-diabetic therapy (6 ...
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Context: Diabetes is considered a major health problem, mainly due to its various debilitating complications including blindness, renal failure, heart attack, stroke, limb amputation,and even death in millions of patients per year. Skin manifestations of diabetes are common in every day clinical practice but often remain neglected. This review aims to highlight the pathogenetic mechanisms and clinical picture of skin conditions associated with diabetes mellitus. Evidence Acquisition: The skin manifestations of diabetes mellitus are related to blood glucose levels. Initially, glycemia affects skin homeostasis by inhibiting keratinocyte proliferation and phagocytosis and inducing endothelial cell apoptosis, while in later stages, the involvement of the peripheral nervous system and vascular changes (micro and macroangiopathy) become the leading pathogenetic factors. Results: There are different classifications of skin changes in diabetes, depending on the frequency, the onset, or the type of diabetes. The most convenient classification from the practical point of view subdivides cutaneous manifestations into four categories: (A) cutaneous manifestation specific to diabetes; (B) compatible dermatoses not only specific to diabetes; (C) skin infection associated with diabetes; and (D) skin manifestation due to antidiabetic therapy. Conclusions: Diabetes mellitus is associated with a wide range of dermatological disorders. Their recognition is important for the early diagnosis of diabetes and therefore might be helpful to reduce the complication rates
... No patient with itch was reported. Romano et al. [28] in 1997 studied heterogeneous population of 477 patients with DM, of which 64 patients had T1D. Patients with T1D were mostly adolescents and young adults with mean age 22 ± 8 years, and mean diabetes duration of 10 ± 4 years. ...
Article
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Introduction: Type 1 diabetes (T1D) is reported to be one of the most common medical conditions in school-age youth and is ranked third in the prevalence of pediatric conditions. Only a few studies have investigated the occurrence of itch in diabetes mellitus, reporting conflicting data. The purpose of this study was to investigate the prevalence of itch in T1D to provide itch characteristics and to explore the potential underlying causes. Methods: This prospective study evaluated itch among 100 children with T1D. Itch intensity was assessed with the Numerical Rating Scale (NRS) and the 4-Item Itch Questionnaire (4IIQ). The Children's Dermatology Life Quality Index (CDLQI) was implemented to assess the quality of life issues. Various clinical features and factors influencing itch were also examined. Skin dryness was evaluated clinically by non-invasive assessment of epidermis moisturizing. Results: Itch occurred in 22% of children with T1D with the mean maximal intensity of 5.9 ± 3.0 points in NRS and 6.7 ± 3.5 points in 4IIQ (median, 5.5 points). In the majority of patients, the itch was limited to a few regions of the body; usually, the upper limbs (68.2%) were affected, followed by the lower limbs (50%) and the trunk (31.8%). Clinically examined skin xerosis was significantly more advanced in children with itch compared with those without itch (p < 0.01). The mean CDLQI score in the itchy group was 4.0 ± 4.7 points (median, 2.5 points), indicating a small impairment of quality of life. The intensity of itch (both NRS last 3 days and NRS last 24 h) correlated positively with life quality impairment (R = 0.7; p = 0.015 and R = 0.8, p = 0.002, respectively). Conclusions: Our study found itch as a moderately frequent symptom in children with T1D; however, itch presence and intensity may relevantly debilitate quality of life among subjects. We suggest that dryness of the skin may play a role in the pathogenesis of itch in this population.
... Диабетический буллез (диабетический пузырь, bullosis diabeticorum, diabetic bullae) -дерматоз, встречающийся у больных диабетом и характеризующийся высыпанием субэпидермальных пузырей, локализующихся чаще всего на передних поверхностях голеней [6]. В современной литературе описания сочетаний дерматопатий с другими осложнениями СД крайне редки, а упоминания о комбинации распространенной ДНОАП и диабетического буллеза нам не встретились. ...
Article
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Diabetic neuroosteoarthropathy (Charcots osteoarthropathy, DNAP, Charcots foot) is a common complication of diabetic neuropathy, which can be easily diagnosed in clinical practice and usually is corrected without leading to severe deformation of the affected joint in case of timely and adequate treatment. We present the result of long-term clinical observation of a patient with early development of complications of type 2 diabetes mellitus, diabetic dermatopathy, common DNOAP with damage to the joints of the feet, ankles, knees and elbows. A feature of the described clinical case is the prevalence of osteoarticular disorders with seizure of atypical diabetes zones knee and elbow joints, the defeat of which is more characteristic of other diseases (such as collagenoses and syphilis), as well as a combination of DNOAP with diabetic dermatopathy. It seems that the causes of such a common arthropathic process lie in the long course of diabetic neuropathy, which debuted long before the diagnosis of type 2 diabetes, as well as the development and progression of this patient in the last decade of observing diabetic nephropathy and associated secondary hyperparathyroidism. In the modern literature, descriptions of combinations of dermatopathies with other complications of diabetes mellitus are extremely rare, and references to a combination of common DNAP and diabetic bullosis have not been found.
... At least one in three diabetic people develop cutaneous manifestations in the course of the disease [4][5][6] . Cutaneous symptoms are observed following the development of diabetes or the signs may appear after several years 4,7,8 . ...
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Background: Diabetes is an important metabolic disease with myriad manifestations and complications, affecting many people. Cutaneous infections impact numerous diabetic patients. Among different bacterial infections in diabetic patients, the infections caused by mycobacteria other than Mycobacterium tuberculosis (MOTT) eventuate in complications owing to the paucity of accurate detection methods. Methods: The articles reporting nontuberculous mycobacteria (NTM) in cutaneous infections of diabetic patients, published until the end of 2017 were assessed in the present research. Results: The organisms reported from cutaneous infections of diabetic patients are Mycobacterium chelonae, Mycobacterium abscessus, Mycobacterium immunogenum, Mycobacterium kansasii and Mycobacterium fortuitum. Conclusion: NTM infection, along with prolonged disease cycle, decelerates the healing process in diabetic patients. Considering NTM during infection diagnosis, along with other possible opportunistic bacteria, conduces to accelerating the treatment process. In most cases, clarithromycin and erythromycin have been reported as effective alternatives for the treatment of diabetic patients.
... At least one in three diabetic people develop cutaneous manifestations in the course of the disease 4-6 . Cutaneous symptoms are observed following the development of diabetes or the signs may appear after several years 4,7,8 . ...
Article
Background: Diabetes is an important metabolic disease with myriad manifestations and complications, affecting many people. Cutaneous infections impact numerous diabetic patients. Among different bacterial infections in diabetic patients, the infections caused by mycobacteria other than Mycobacterium tuberculosis (MOTT) eventuate in complications owing to the paucity of accurate detection methods. Methods: The articles reporting nontuberculous mycobacteria (NTM) in cutaneous infections of diabetic patients, published until the end of 2017 were assessed in the present research. Results: The organisms reported from cutaneous infections of diabetic patients are Mycobacterium chelonae, Mycobacterium abscessus, Mycobacterium immunogenum, Mycobacterium kansasii and Mycobacterium fortuitum. Conclusion: NTM infection, along with prolonged disease cycle, decelerates the healing process in diabetic patients. Considering NTM during infection diagnosis, along with other possible opportunistic bacteria, conduces to accelerating the treatment process. In most cases, clarithromycin and erythromycin have been reported as effective alternatives for the treatment of diabetic patients.
... One of the complications of longstanding diabetes is lesions of the skin. Around 30% of the patients suffering from diabetes are estimated to have skin lesions in some form 8 . Dermatological manifestations in DM are mainly due to four causes. ...
Article
Introduction: Diabetes mellitus (DM) is a common metabolic disorder and is significant for its ability to adverse effect of various organs. Skin manifestations in this condition are due to metabolic derangements, chronic complications and infections, which are commonly observed after developing clinical diabetes mellitus, but may also precede the disease. Aim: The aim of this study was to understand dermatological manifestations in diabetes mellitus relation with demographic parameters. Materials and Methods: It was a hospital based cross sectional study carried out among 80 randomly selected diabetic patients with/without skin lesions. Patients were then asked for their willingness to participate in the study. Skin examination was carried out and skin lesions were identified. All data was recorded in the pre-designed, pre-tested, and semi-structured questionnaire developed for the study. Data was analyzed using SPSS version 26. Frequencies and percentages were calculated for the necessary data. Result: : Mean age of the subjects was 51.0±13.2 years, minimum age 25 and maximum 80 years. It was observed that, out of 80 patients, 52 (65.0%) were aged between 41–60 years. 52 (65%) were female and 28(35%) were male patients. 46(57.5%) were housewives and 16(20.0%) were service holders, 10(12.5%) were farmers and other 8(10%). 41(51.2%) from middle class, 38(47.5%) from lower class and 1(1.3%) were from upper class. 61.2% patients came from rural area and 38.8% patients from urban area. The mean duration of diabetes mellitus was 6.6±5.1 years, 42.5% patients duration had 5-10 years followed by 36.3% below 5 years and 21.3% patients had DM more than 10 years. Out of 80 patients, a total of 39(48.8%) DM patients had skin manifestations and 41(51.2%) had no skin manifestations. Among 39 DM patients with skin disease, 19(48.7%) having a single, while 8(25.5%) had two and 13(30.8%) patients had three or more skin lesions. 22(56.4%) patients found diabetic dermopathy, diabetic foot ulcer 12(30.8%), fungal infections 9(23.1%), bullous lesions 7(17.9%), diabetic foot gangrene 5(12.8%), lypodystrophy 5(12.8%), pruritus 5(12.8%), xerosis 5(12.8%) cases, scleredema 3(7.7%), ichthyosis 2(5.1%) and bacterial infections 2(5.1%). Age, sex, educational level, socioeconomic status, residence found no significant association (p>0.05), but duration of diabetes mellitus was significantly associated with the presence of dermatological manifestations (p=0.001). Conclusion: The spectrum of skin manifestations due to DM in this study population is similar to that in other parts of the world. Diabetic dermopathy, Pruritus and fungal infections are the most common cutaneous manifestations in DM patients. The presence of skin manifestations can highlighten the suspicion for DM enabling early diagnosis and management and thereby can be helpful for preventing complications. Medicine Today 2022 Vol.34(2): 145-149
... Se postula que los pacientes diabéticos tipo 2 con mal control metabólico desarrollan con más frecuencia infecciones cutáneas, mientras que aquellos con DM1 padecen frecuentemente lesiones cutáneas del tipo autoinmune, como alopecia areata, vitiligo y liquen plano [8][9] . ...
Article
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La diabetes mellitus (DM) de larga evolución con mal control metabólico puede producir permanentes e irreversibles cambios funcionales y daños en órganos y tejidos produciendo, de este modo, complicaciones que principalmente resultan de anormalidades bioquímicas, estructurales y funcionales. Se ha asociado de forma causal el pobre control glucémico y el desarrollo y progresión de complicaciones microvasculares (retinopatía, nefropatía y neuropatía); en virtud de las complicaciones en la microvasculatura, cualquier sistema u órgano puede ser afectado y la piel no es la excepción.
... Furthermore, all patients received general information on the selftreatment of diabetes, including dietary measures, regular exercise, and continuous care of legs and feet to prevent recurrence or any other complications such as foot ulcers or wounds, skin infection, abscess, and gangrene. 21 Laser Therapy Protocol Prior to each treatment session of LLLT, the dressing was removed and the lesions were cleaned with saline to remove creams or ointments and any discharge or debris. ...
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Introduction: Diabetic dermopathy (DD) is the most common cutaneous diabetes marker. Few studies have targeted DD using low-level laser therapy (LLLT). This pilot study aimed to evaluate the effect of LLLT on DD in patients with type 2 diabetes (T2D). Methods: 12 patients with T2D (9 men, 3 women) and bilateral DD were enrolled in this placebo-controlled pilot study, and their ages ranged 50-65 years. One side was subjected to LLLT, three sessions weekly for one month (LLLT side), while the other side received the same treatment protocol with a laser device switched off as a placebo (placebo side). All patients were instructed to receive skincare for both sides, such as debridement, antibiotic creams, and dressings with betadine solution. The diameter of DD lesion and the cutaneous blood flow of the knees and ankles sites were assessed before and after one month at the end of the intervention. Results: At the baseline, no significant differences existed between LLLT and placebo sides in the DD and skin blood flow at the knee and ankle sites (P > 0.05). Post-intervention, a significant improvement occurred in DD diameter and the skin blood flow of the knee and ankle sites in the LLLT side (P < 0.05), while the placebo side showed a significant improvement only in DD diameter (P < 0.05) and non-significant changes in skin blood flow (P > 0.05). Comparing both sides, all measures significantly favored LLLT. Conclusion: The findings of this study indicate that LLLT has beneficial effects on decreasing DD in T2D patients. Also, it was approved that the short term of LLLT is a safe modality to control DD in T2D patients.
... In some diabetic patients, developing cutaneous lesions and nail infections has been documented. [6] More than 75% of DM patients are at risk for diabetic ulcers. Diabetic foot ulcer is one of the most important complications in diabetic patients. ...
... Most documented studies have shown the incidence of cutaneous disorders associated with diabetes to be [8,9] between 30 and 71%. In our study, the most common six skin disorders among uncontrolled diabetics were: Skin infections (55.36%), diabetic foot ulcers (25%), pruritus (7.4%), diabetic bullae (5.36%), and acanthosis nigricans and skin tags -(3.57%) respectively. ...
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Introduction: Diabetes is a leading chronic disease in world and number of cases are significantly increasing each year in India also. Out of many associated conditions, skin involvement in diabetes also needs to be evaluated. We conducted this study to study relation between the sugar control and skin manifestations in diabetic patients. Methodology: We studied total 100 diabetic patients visiting our dermatology OPD over a period of 1 year from January to December 2020. All skin diseases in diabetic patients were studied. We studied association of these diseases with sugar control in our study participants. Results: Mean age of our study participants was 63.48 ± 18.12 years, Majority of the males were from the age group of 61 and above, 34 (62.96%) while majority of the females were from the age group of 41-60 years 25 (54.35%). Majority of the patients had diabetes for 5-10 years (52%) followed by more than 10 years (36%) and less than 5 years in 24% cases. Out of 100 participants, 44% had controlled diabetes while rest 56% had uncontrolled diabetes with HbA1c > 6. We observed a significant difference in skin manifestations of controlled and uncontrolled sugars in diabetic patients. (p = 0.007). Conclusion: From this study, we conclude that the skin is involved in diabetes quite often. Early diagnosis and treatment of skin manifestations in diabetic patients is important to reduce unwanted morbidity and further complications in the diabetic patients.
... In some diabetic patients, developing cutaneous lesions and nail infections has been documented. [6] More than 75% of DM patients are at risk for diabetic ulcers. Diabetic foot ulcer is one of the most important complications in diabetic patients. ...
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Background: Diabetic patients are more susceptible to cutaneous fungal infections. The higher blood sugar levels cause increasing the cutaneous fungal infections in these patients. The main objective of this study was to find the frequency of fungal infections among cutaneous lesions of diabetic patients and to investigate azole antifungal agent susceptibility of the isolates. Materials and Methods: In this study, type 1diabetes (n = 78) and type 2 diabetes (n = 44) comprised 47 cases (38.5%) with diabetic foot ulcers and 75 cases (61.5%) with skin and nail lesions were studied. Fungal infection was confirmed by direct examination and culture methods. Antifungal susceptibility testing by broth microdilution method was performed according to the CLSI M27‑A and M38‑A references. Results: Out of 122 diabetic patients, thirty (24.5%) were affected with fungal infections. Frequency of fungal infection was 19.1% in patients with diabetic foot ulcer and 28% of patients with skin and nail lesions. Candida albicans and Aspergillus flavus were the most common species isolated from thirty patients with fungal infection, respectively. Susceptibility testing carried out on 18 representative isolates (13 C. albicans, five C. glabrata) revealed that 12 isolates (10 C. albicans and two C. glabrata isolates) (66.6%) were resistant (minimum inhibitory concentration [MIC] ≥64 mg/ml) to fluconazole (FCZ). Likewise, eight isolates (80%) of Aspergillus spp. were resistant (MIC ≥4 mg/ml), to itraconazole. Conclusion: Our finding expands current knowledge about the frequency of fungal infections in diabetic patients. We noted the high prevalence of FCZ‑resistant Candida spp., particularly in diabetic foot ulcers. More attention is important in diabetic centers about this neglected issue. Keywords: Diabetes, diabetic foot ulcer, fluconazole, itraconazole
... Around 30% of the patients suffering from diabetes are estimated to have skin lesions in some form. 2 These are mainly of four types. First is directly due to diabetes. ...
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p class="abstract"> Background: Though extensive data is available on diabetes and its systemic manifestations, research about the skin lesions in those afflicted with diabetes is scarce. The aim of this study was to understand dermatological manifestations in diabetes. Methods: A hospital based cross sectional study was carried out among 100 randomly selected diabetic patients afflicted with skin lesions due to diabetes. Results: Out of 73 patients having cutaneous infections, 71.2% were having fungal infections. Out of 18 having bacterial infections, 38.9% were having furuncles. Out of 52 having fungal infections, 63.5% were having dermatophytosis. Out of 14 cases of candidal infections, the most common was intertrigo in 35.7%. Out of 33 cases of dermatophytosis, T. cruris was the most common in 54.5%. Out of 82 patients in whom we suspected dermatoses strongly associated with diabetes, the most common condition was pruritus in 36.6% of the cases. Conclusions: Bacterial skin infections and dermatophytosis were the most common diabetic dermatological lesions in the present study.</p
... For many diabetics, the development of skin lesions into wounds is often an insidious process. Even slight trauma or pressure from impaired proprioception can lead to chronic, non-healing wounds and ulcers [16]. Conditions associated with insulin resistance include acanthosis nigricans, acrochordons, and diabetic dermopathy. ...
Article
Diabetes mellitus (DM) is one of the most common chronic diseases in the United States. It is characterized by increased patient morbidity and mortality due to the many complications that can arise. Certain dermatological findings can be indicative of poorly controlled DM and can be a useful clue to further management. Persons experiencing homelessness (PEH) with DM often have higher rates of diabetic complications than the general diabetic population. Medical providers caring for PEH in the setting of limited resources should carefully evaluate cutaneous disease as a potential indicator of underlying illness. This physical manifestation of illness can serve to guide the next appropriate steps in management. A 41-year-old unsheltered male with an extensive medical history of hypertension, seizures, chronic diarrhea, and cocaine use was seen at a "foot-washing" medical outreach event. He presented with fevers, chills, and multiple painless right lower extremity ulcerated lesions of unspecified origin. A finger-stick glucose measurement was found to be 650 mg/dL. After immediate administration of 10 units of insulin, he was transported immediately to the emergency department and admitted. His month-long hospital course was complicated and involved the amputation of multiple toes. Preemptive outreach and management could have prevented the marked deterioration of his disease and represents the importance of outreach and regular follow-up with the PEH community.
... In some diabetic patients, developing cutaneous lesions and nail infections has been documented. [6] More than 75% of DM patients are at risk for diabetic ulcers. Diabetic foot ulcer is one of the most important complications in diabetic patients. ...
... and fibroblasts (3.21±0.31%) looked significantly very optimistic (p<0.05), a group of cells of young connective tissue in the form of fibroblasts, fibroblasts, fibrous fibres were discovered (Hong et al., 2014;Cosson et al., 2006;Romano et al., 1998). All this confirmed the presence of a reparative potential in the wound, and the cytological picture corresponded to the inflammatory or inflammatory-regenerative type. ...
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Diabetes mellitus is currently characterised by a high progressive prevalence of patients. The purpose of this study is to evaluate the clinical, functional, and morphological parameters of purulonecrotic foci healing in diabetic foot syndrome (DFS) using programmable sanitation technologies. The patients were randomised into two groups. In the comparison group (n=51), patients received conventional local treatment after surgery. In the main group (n=55), after surgical treatment, the wound was sutured, and in the postsurgical period, programmable sanitation was conducted using the AMP-01 device. The cytological smears of the main group identified a higher rate of cellular reactions in the wound. There was a 1.3-fold reduction in the duration of hospitalisation, the number of purulent complications was significantly less (p=0.014). It was possible to preserve the supporting function of the foot in patients of the main group in a larger percentage of cases (p=0.023). There was a statistically significant increase in the frequency of high amputations in the comparison group (p=0.026). As a result, the effectiveness of the use of programmable sanitation technologies for purulent lesions of the diabetic foot has been proven.
... With non-insulin-dependent DM, the most frequent skin lesions were infectious dermatoses and diabetic dermatoses, psoriasis, pruritus, xerosis, lichen, and cutaneous complications of DM treatment, and some other skin lesions were also observed. [24] There are 47 kinds of skin diseases or symptoms that were comorbid with T2DM patients in this study. The most frequent skin lesions were infectious dermatoses (onychomycosis, tinea pedis, bacterial infections, wart, etc), disturbances of pigmentation (hyperpigmentation, vitiligo, freckle, post-inflammatory pigmentation, etc), and there are eight kinds of skin diseases or symptoms with prevalence >10%. ...
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Background: The prevalence of skin diseases and diabetes mellitus (DM) are prominent around the world. The current scope of knowledge regarding the prevalence of skin diseases and comorbidities with type 2 DM (T2DM) is limited, leading to limited recognition of the correlations between skin diseases and T2DM. Methods: We collected 383 subjects from the Da Qing Diabetes Study during the period from July 9th to September 1st, 2016. The subjects were categorized into three groups: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. The prevalence and clinical characteristics of skin diseases were recorded and investigated. Results: In this cross-sectional study, 383 individuals with ages ranging from 53 to 89-year-old were recruited. The overall prevalence of skin diseases was 93.5%, and 75.7% of individuals had two or more kinds of skin diseases. Additionally, there were 47 kinds of comorbid skin diseases in patients with T2DM, of which eight kinds of skin diseases had a prevalence >10%. The prevalence of skin diseases in NGT, IGT, and T2DM groups were 93.3%, 91.5%, and 96.6%, respectively; stratified analysis by categories showed a statistically significant difference in "disturbances of pigmentation" and "neurological and psychogenic dermatoses". The duration of T2DM also significantly associated with the prevalence of "disturbances of pigmentation" and "neurological and psychogenic dermatoses". Subsequently, the prevalence of "disturbances of pigmentation" was higher in males than females in NGT (P < 0.01) and T2DM (P < 0.01) groups. In addition, the difference in the prevalence of "disturbances of pigmentation" was also significant in NGT and T2DM groups (P < 0.01). Conclusions: There was a high prevalence of skin diseases in the Da Qing Diabetes Study. To address the skin diseases in the Da Qing Diabetes Study, increased awareness and intervention measures should be implemented.
... Diabetes mellitus is a common endocrinological disorder and affects individuals of all ages. Skin manifestations are frequently observed in [1] diabetic patients and 30% of diabetics have cutaneous disorders . ...
Article
Background: Aim:Skin involvement in Diabetes mellitus is very common and occurs in 43-66% of diabetics. To study the cutaneous manifestation in patients with diabetes mellitus attending Dermatology OPD at Saveetha Medical College. Seventy-ve patients withMethod: diabetes mellitus and having skin problem at Saveetha Medical College were included in this study. Clinical details regarding age, sex, duration of diabetes, mode of treatment for diabetes and detailed dermatological examination were done in all the patients. Patients having skin changes secondary to pregnancy were excluded in this study. An informed consent was taken from all the patients. The most common cutaneousResults: manifestations observed in our study were infections (87%) followed by acanthosis nigricans (42.6%) and skin tags (29.3%). EarlyConclusion: detection of skin manifestations in diabetes mellitus is important as to avoid or properly manage the complications and to prevent disability.
... e skin of diabetic patients is known to be susceptible to damage and does not heal easily following an injury. Diabetic skin lesions are related to diabetic vascular disease, neuropathy, cell dysfunction, and abnormal cytokine secretion; however, the specific mechanism for their formation remains unknown [1,2]. us, evaluation of the molecular mechanism leading to the development of diabetic skin ulcers and the determination of appropriate interventions are of great significance for the diagnosis and effective treatment of this condition. ...
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The effects of Dendrobium polysaccharides (PDC) on the functions of human skin fibroblasts (HSFs) and expression of matrix metalloproteinase-2 under high-glucose conditions and exploration of the underlying mechanism remain unclear. We used the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) analysis and flow cytometry to evaluate the cell viability and apoptosis. The collagen levels were determined by the Sircol™ Collagen Assay. Real-time quantitative polymerase chain reaction (RT-PCR) was used to detect the expression of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase inhibitor (TIMP-2) mRNA. We found the following: (1) under the high-glucose condition, the HSF cell viability, the expression of TIMP-2 mRNA, and the collagen levels were reduced, while the apoptosis rate and the expression of MMP-2 mRNA increased (P
... The frequency of cutaneous impairment in diabetic patients has been reported to range from 30.0% to 91.2%, but its pathogenesis has yet to be elucidated [35][36][37]. Although diabetic foot cutaneous symptoms may not be life-threatening, they may seriously affect the quality of life and serve as external markers for extracutaneous complications, which are strongly associated with DPN [38][39][40]. ...
Article
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Background: Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4-10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were "glycated hemoglobin" OR "HbA1c" AND "diabetic neuropathies" AND "Foot". Results: A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. Conclusions: This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.
... Also, Diabetic dermopathy and HbA1C were found unrelated or in other words, variable improvement of lesions was found on glycaemic control. 7,26 Due to a lack of clarity of pathogenesis, no measure has proven effective in treating these lesions. Cosmetic camouflage can disguise the lesions. ...
Article
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Diabetic dermopathy is a cutaneous manifestation commonly seen in diabetes patients and was initially described by Melin in 1964. These lesions are well-demarcated, hyperpigmented macules or papules with atrophic depression and were commonly sighted on shins of the tibia with bilateral asymmetrical distribution and rarely seen on arms, thighs and abdomen. The incidence of DD ranges from 0.2 to 55%. It has been frequently associated with microangiopathic complications of diabetes such as nephropathy, retinopathy and polyneuropathy. Although the exact mechanism of occurrence is unknown, it may be related to impaired wound healing due to decreased blood flow, local thermal trauma or local subcutaneous nerve degeneration. Diagnosis is made by clinical examination and the differential diagnosis includes stasis dermatitis, early lesion of necrobiosis lipoidica and purpuric dermatitis. Prevention of dermopathy lesions includes optimized glucose control. No active treatment is recommended or proven effective and DD is known to resolve on its own as time passes. Modified collagen and high glycerine-based lotion have shown marked improvement in skin color changes due to diabetic dermopathy. Diabetic dermopathy is known to have a strong association with microangiopathic complications; the presence of such lesions must raise strong suspicion and prompt investigation for severe underlying pathology. Enhanced scrutinized glycemic control in diabetic dermatopathy patients can even lead to abatement in further progression to microvascular complications and improved long-term patient outcomes.
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Background: Diabetic dermopathy consists of small, round, brown atrophic skin lesions that occur on the shins of patients with diabetes. Its proper diagnosis is essential for proper management. Objective: The present study has been undertaken to study the complications, signs, symptoms, prevention and cure of dermopathy caused by diabetes. Material and Methods: Dermopathy was studied in brief with the help of literature available in the form of articles, various databases, medical news, etc. Result: Proper diagnosis and cure are necessary at early stages to prevent future complications associated with it. Conclusion: Diabetic dermopathy requires no treatment, but may be a surrogate for more serious complications of diabetes, which require investigation and management.
Article
Os indivíduos portadores de Diabetes Mellitus (DM) são no geral caracterizados como pacientes mais susceptíveis a complicações infecciosas, devido ao seu estado de imunossupressão, como processos bacterianos, virais e fúngicos. Dentre as fúngicas, destacam-se a Mucormicose Rinocerebral. O objetivo desse trabalho é discutir sobre a infecção por fungos Mucormicose e sua evolução em pacientes imunodeprimidos, como os diabéticos. O presente estudo foi realizado através de uma revisão de literatura, com base em artigos publicados em meio eletrônico nas bases de dados do PubMed, Medline e Scielo, utilizando os seguintes descritores: diabetes mellitus, imunossupressão e mucormicose. O paciente descompensando com cetoacidose diabética é o que frequentemente culmina no aparecimento da mucormicose. Ela pode se manifestar em diversos sítios como pulmão, trato gastrointestinal, sistema nervoso central, porém a forma mais comum de apresentação é a rinocerebral. Para iniciar a terapêutica do quadro, devemos realizar o controle da doença de base, Diabetes Mellitus, normalizando os níveis glicêmicos. É imperioso que os diabéticos tenham aderência ao tratamento correto, visto que suas complicações fomentam a suscetibilidade a diversas infeções. Reforçar a educação em saúde é um dos métodos que podem auxiliar a reduzir a alta prevalência de complicações em indivíduos diabéticos. Dessa forma, os portadores serão incentivados a cuidar de si e controlar essa condição, garantindo uma melhor qualidade de vida.
Chapter
This chapter presents a comprehensive review of the skin with emphasis on the ankle-foot region. All aspects of the skin (anatomical layers, blood supply, and innervation) are revisited. The pathogenesis and prevalence of skin diseases associated with diabetes are analyzed. Skin ulcerations seen in Charcot neuroarthropathy (diabetic foot) are revised. Examples of skin ulcerations are provided as they are visualized on MR images.
Chapter
Paediatric endocrine disease may result in changes of the skin, hair, nails and mucosa. Cutaneous signs of congenital and acquired hypothyroidism include xerosis, thickening and doughy appearance of the skin, and brittleness of the hair. Hyperthyroidism with goiter often have skin changes which include facial flushing, hyperhidrosis and warm, moist skin. Increased serum cortisol can cause facial plethora, broad and purple striae, acne, acanthosis nigricans and skin thinning. Hyperpigmentation is seen with adrenal insufficiency. Androgen excess can present with weight gain, pubic and facial hair growth, acne, body odour and muscular habitus. Gynaecomastia is associated with hyperoestrogenism. Wrinkling of skin especially around the eyes and mouth can be seen in hypopituitarism, whereas gigantism/acromegaly is associated with hyperpituitarism. Hypoparathyroidism can result in dry skin, alopecia and brittle nails. Primary hyperparathyroidism can cause dehydration with skin tenting, prolonged capillary refill time and dry mucous membranes.
Article
En la diabetes, sin considerar el pie diabético, las afecciones cutáneas son frecuentes y afectan al 50-70% de los pacientes. La mayor parte de ellas son de origen infeccioso. Se distinguen tres tipos de dermatosis: las que requieren sistemáticamente un estudio en busca de diabetes, las que pueden asociarse a la diabetes y las que constituyen una complicación de una diabetes ya conocida. Las del primer tipo, como la necrobiosis lipoídica, el granuloma anular, la acantosis nigricans o el engrosamiento cutáneo digital en empedrado, son poco frecuentes en la población general y más comunes en los pacientes diabéticos. Por lo tanto, en estos casos, está justificado buscar de forma sistemática una diabetes asociada. Otras dermatosis son corrientes en la población general y serían más frecuentes en los pacientes diabéticos, como sucede con el vitíligo, la capilaritis purpúrica y pigmentaria, la eritrosis facial y la xerosis cutánea. Ninguna de estas afecciones es un marcador de gravedad, a excepción de la capilaritis purpúrica y pigmentaria, que, según un estudio, podría ser un marcador de complicaciones macrovasculares y microvasculares, sobre todo en la diabetes de tipo 2. Las complicaciones cutáneas crónicas de la diabetes se presentan en pacientes de larga evolución. Una de las más graves es el mal perforante plantar, que se debe a complicaciones microangiopáticas, asociadas o no a una arteriopatía obliterante de los grandes vasos. Algunas complicaciones, como la esclerosis de las extremidades con rigidez articular, parecen correlacionarse con la microangiopatía. Las complicaciones cutáneas agudas de la diabetes están sobre todo representadas por las infecciones micóticas cutáneas y/o mucosas, más frecuentes en los pacientes diabéticos y que se asocian particularmente a un control metabólico deficiente. Las infecciones bacterianas no parecen ser más frecuentes en la diabetes, pero serían más resistentes a los tratamientos y tendrían un peor pronóstico. Las reacciones cutáneas a los tratamientos de la diabetes son mucho menos frecuentes. Las erupciones tras la administración de sulfonamidas hipoglucemiantes se producen en el 1% de los pacientes. Desde que se utilizan insulinas humanas recombinantes, las reacciones cutáneas a la insulina son muy inusuales y afectan a menos del 1% de los pacientes. Estas manifestaciones alérgicas suelen ser locales, en los puntos de inyección, pero también se han comunicado reacciones sistémicas inmediatas.
Chapter
Skin manifestations of diabetes mellitus are frequent. Symptoms vary from mild cosmetic concerns to disabling conditions. The skin signs are not always recognized though they can be a presenting symptom of diabetes mellitus or a marker of advanced disease. In this chapter different skin manifestations and their pathogenesis are discussed, some of them are more specific for type 1 diabetes mellitus, others for type 2, or both. Cutaneous side effects of medications used to treat diabetes mellitus are discussed as well. Several clinical and histopathological images are included.
Article
Previous studies showed that the activation of Wnt signaling reduced high glucose (HG)-mediated fibroblast damage, but the molecular basis for this phenomenon remains elusive. This study aimed to analyze the level of phosphorylation of GSK3β Ser⁹ (pGSK3β Ser⁹) during HG damage. Moreover, the phosphomimic form of pGSK3β Ser9 was expressed to analyze its effect on cell migration via the phosphorylation of Ikaros. The results revealed that HG treatment significantly reduced the pGSK3β Ser⁹ level. The overexpression of GSK3β Ser⁹D and GSK3β Ser⁹A accelerated and inhibited fibroblast cell migration, respectively. P110α knockdown or treatment with SP600125, an inhibitor of JNK, also reduced the pGSK3β Ser⁹ level under HG condition. Treatment with SP600125 inhibited the migration of fibroblasts, but not in GSK3β Ser⁹D–expressing cells. Further, yeast two-hybrid screening and biochemical analysis identified that GSK3β interacted and phosphorylated Ikaros at Ser³⁹¹. Besides, GSK3β Ser⁹D, but not GSK3β Ser⁹A, activated Ikaros Ser³⁹¹ phosphorylation. Expressing Ikaros or β-catenin significantly promoted cell migration, suggesting that GSK3β modulated cell migration partially via the activation of Ikaros besides β-catenin signaling under HG condition. The expression of the phosphomimic form of Ikaros Ser³⁹¹D resulted in a significant increase in the extent of cell migration compared with Ikaros under HG condition. Moreover, the Ikaros Ser³⁹¹D DNA-binding affinity toward the ANXA4 promoter increased, and ANXA4 suppression promoted cell migration. In conclusion, the results of this study provided a new regulatory mechanism by which GSK3β negatively regulated human skin fibroblast cell migration.
Chapter
Metabolic syndrome (MetS) has emerged as a new epidemic not only in adults but also in children and adolescents. It comprises a cluster of cardiovascular risk factors such as hypertension, visceral obesity, dyslipidaemia and altered glucose metabolism, i.e. glucose intolerance. Visceral obesity and insulin resistance (IR), together with latent inflammation, represent the core pathophysiology. Anthropomorphic and – less easy to measure and compare in young age groups – laboratory parameters are used for diagnosis. Similar to other systemic diseases, skin signs and conditions can provide diagnostic clues to the risk factors of the MetS. (Pseudo‐)acanthosis nigricans, fibroma pendulans and striae distensae are significantly associated with obesity, insulin resistance and diabetes. Obesity and diabetes mellitus promote cutaneous infections, such as erysipelas and intertrigo. Skin signs due to hyperandrogenaemia such as acne vulgaris, hirsutism and androgenetic alopecia develop in young females and may be associated with obesity and/or polycystic ovary syndrome (PCOS). Hidradenitis suppurativa is associated with overweight and obesity in both genders. Psoriasis worsens in obese children and young adults, mainly due to the release of proinflammatory cytokines from fat tissue. The association between body mass index and severity of psoriasis has been demonstrated in several cohorts. The high prevalence of the MetS among psoriasis patients is already discernible among paediatric psoriasis patients, as several risk factors of the MetS can be demonstrated in this patient group. Recently, neonatal obesity has been described to be associated with an increased risk of atopic dermatitis (AD) in infancy.
Article
Diabetes mellitus is a significant worldwide health concern and cutaneous manifestations are common. This review describes characteristic skin findings of diabetes, general skin findings related to diabetes, and findings related to diabetes treatment with a focus on clinical presentation, diagnosis, pathophysiology, epidemiology, and treatment. As the prevalence of diabetes continues to rise, cutaneous manifestations of diabetes mellitus likely will be encountered more frequently by physicians in all disciplines including dermatologists and primary care physicians. Accordingly, knowledge regarding the prevention, diagnosis, and management of cutaneous manifestations is an important aspect in the care of patients with diabetes.
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Background and Design: Type 1 diabetes mellitus (T1DM) can cause significant changes in the skin. However, there are limited studies examining the skin findings in children with T1DM. The objective of this study is to determine the frequency of skin lesions in children with T1DM. Additionally, this study also evaluates the relationship of skin lesions with disease duration and hemoglobin A1c (HbA1c) levels. Materials and Methods: This cross-sectional study enrolled 65 children with T1DM and 78 age- and sex-matched healthy children. Importantly, detailed skin examinations of the cases were conducted. Results: The mean age at the onset of disease was 7.1±3.7 years, and the mean duration of T1DM was 45.9±40.4 months. The mean level of HbA1c in children with T1DM was determined as 8.0±1.6%. In total, 9 (13.8%) of the patients were using insulin infusion pump, whereas 56 of them were using multiple insulin injections therapy. At least one skin lesion related to insulin treatment was recorded in 54 patients (83%). Bruises (50.8%), lipohypertrophy (44.6%), and post-inflammatory hyperpigmentation (26.2%) were among the most observed skin reactions related to the insulin treatment. However, hypopigmented scar was the most frequently observed skin reaction related to the insulin treatment among the patients using insulin infusion pump (5/9, 55%). Only xerosis and rubeosis faciei diabeticorum were found to be significantly higher in the T1DM group, as compared to healthy controls. Xerosis was observed in 19 (29%) patients with DM and 8 (10.2%) healthy controls, whereas rubeosis faciei was observed in 6 (9.2%) patients with DM and 1 (1.3%) healthy control. Although not statistically significant, it was found that the disease duration was longer and HbA1c levels were higher in T1DM patients with rubeosis faciei or xerosis. Conclusion: We believe that significant benefits can be provided for the management and prevention of skin findings in children with T1DM through the training of the patients and caregivers as well as by increasing the awareness of physicians.
Article
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Diabetic complications of the skin regarding skin structure have been well documented and researched, notably in relation to wound healing. Recently it has also been discovered that dermis thickness may also be reduced in type 2 diabetic patients. Peripheral damage in diabetes has been attributed to inflammation, as well as hyperglycaemia resulting from insulin resistance. However, this has not been investigated specifically in relation to dermis thickness. This study used mouse models with a range of obesity, insulin resistance and diabetic states to investigate the extent of reduction in dermis thickness that results from these conditions and to elucidate the correlation of dermis thickness with both biomarkers of insulin resistance and whole-body and local proinflammatory cytokine levels, which can both directly damage tissues and be the causative factor of the insulin resistance. The results suggest that the reduced dermis thickness observed in type 2 diabetes is likely a result of hyperglycaemia resulting from insulin resistance rather than the increased proinflammatory milieu resulting from insulin resistance and obesity.
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Factors associated with oral candidiasis in 51 diabetics were examined. The prevalence of oral yeast infection was 49 (n = 25)%. The association with diabetic control, as measured by fasting blood glucose concentration, urinary glucose concentration, and glycosylated haemoglobin, with the presence of yeast was analysed in the 51 diabetic patients. Glycosylated haemoglobin above 12% was strongly associated with oral yeast infection (odds ratio = 13.00) (p less than 0.001), while fasting blood and urinary glucose concentrations were not. The risk of oral candidiasis among diabetics wearing dentures was significantly higher than among dentate diabetics (odds ratio = 4.78). After controlling for the effect of denture wearing, glycosylated haemoglobin greater than 12% remained highly predictive of oral yeast infection, particularly among diabetics without dentures.
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The prevalence of neuropathy, a common complication of diabetes, was determined in diabetic patients recruited from 109 outpatient diabetes clinics in Italy. Neuropathy was diagnosed using the Diabetic Neuropathy Index (DNI), a standardized examination developed for use in the outpatient setting. A total of 8,757 diabetic patients were studied, 51.2% men and 48.8% women, with average and median ages of 56 and 58 years, respectively. Of the 8,757 patients, 32.3% had neuropathy, defined as a positive score of > 2 points on the DNI. A total of 2,033 (49.6% men and 50.4% women) were administered the Diabetic Neuropathy Score (DNS), the second component of the screening program, by a neurologist. This component consists of a quantitative neurological examination and nerve conduction studies that together provide a summated score. A total of 335 patients (16.5%) were not neuropathic, and 395 (19.4%) had borderline, 453 (22.3%) mild, 592 (29.1%) moderate, and 258 (12.7%) severe neuropathy. The concordance between a positive score on the DNI and a DNS indicating neuropathy was 83.5%. The severity of neuropathy increased with both age and disease duration. Of patients with neuropathy, 64.1% had an average age between 58 and 59 years with a disease duration between 12.4 +/- 8.4 years (mild neuropathy) and 15.6 +/- 9.7 years (severe neuropathy). Neuropathy is a common complication of diabetes and, in this study, was present in 32.3% of all patients. An increased awareness of the high prevalence of neuropathy can lead to early therapeutic intervention and possible prevention of later neuropathic complications, such as infection and foot ulcers.
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This study examines whether an aldose reductase inhibitor (statil, ICI) can enhance neutrophil oxidative killing by diabetic neutrophils. We have examined a radiometric assay of phagocytosis and killing of Candida albicans by neutrophils from 20 controls and 20 subjects with insulin-dependent diabetes under various in vitro glucose concentrations. Glucose was present at 5, 10 and 20 mM in the presence and absence of statil (11 microM). Phagocytosis was unaffected by raised glucose levels in controls and in diabetic subjects. Killing by the diabetic cells was inhibited by increasing concentrations of glucose, killing was 18.9 +/- 2.0, 16.9 +/- 2.4 and 14.8 +/- 2.0% (mean +/- s.e.m.) at 5, 10 and 20 mM glucose, respectively (P less than 0.05). With the addition of statil under the same conditions killing improved to 19.3 +/- 2.0, 23.2 +/- 2.2 and 23.6 +/- 2.4 (P less than 0.01), these values were similar to the controls (P greater than 0.01). We conclude therefore that aldose reductase inhibition restores oxidative killing to normal.
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A reduction in the bulk of the extensor digitorum brevis muscle (EDB) may be a sign of diabetic neuropathy. We devised a semi-quantitative scale (normal, reduced or absent) for assessing the bulk of the EDB muscle, and judged it to be a sign of neuropathy in 375 of 395 diabetic patients aged 15-50 years in the county of Umeå, 79% of whom had Type 1 diabetes mellitus (DM), and in 100 healthy controls. Reduced or absent EDB was significantly more common in patients with Type 1 and Type 2 DM than in controls (44 and 48 vs. 12%; P less than 0.001). In patients with Type 1 DM, reduced or absent EDB was significantly correlated with age, longer duration of DM, smoking, dry feet, and foot ulcers, but not with fallen forefoot arch, hammer toes or callosities. Reduced or absent EDB was also associated with skin and nail lesions, including Melin's shin spots, purpura and yellow toenails, but not with necrobiosis. Sensory thresholds for vibration, perception and pain were all significantly elevated in Type 1 diabetic patients with impaired EDB, compared to Type 1 diabetics with normal EDB. In controls, impaired EDB was only significantly correlated with smoking. We conclude that the EDB test is easy to perform, and may be used to screen for neuropathy in Type 1 diabetic patients.
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The skin is one of the major organ systems involved in diabetes. Certain changes occur inevitably in this disease, and are undoubtedly the cause of many of the skin disorders seen in patients with diabetes. Other skin disorders are related to common disease processes, and still others are simply unexplained statistical observation.
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Neutrophil phagocytosis and killing of Candida albicans were examined using a radiometric assay in 25 patients with insulin-dependent diabetes and 17 controls under various in vitro metabolic conditions. Glucose was present at 5, 10 and 50 mM, beta-hydroxybutyrate at 1, 5 and 20 mM and glucose with beta-hydroxybutyrate in combinations of 10 with 5 and 50 with 20 mM, respectively. Phagocytosis occurred at similar levels in diabetics and controls at all the glucose and beta-hydroxybutyrate concentrations used. The ability to neutrophils from diabetics to kill candida was inhibited by increased concentrations of glucose and beta-hydroxybutyrate, both independently and in combination. Candida killing (mean +/- s.e.) was 20 +/- 2.4, 19 +/- 2.3 and 13 +/- 2.7% at glucose concentrations of 5, 10 and 50 mM; and 20 +/- 3.4, 20 +/- 3 and 13 +/- 3% at beta-hydroxybutyrate concentrations of 1, 5 and 20 mM, respectively, and in glucose and beta-hydroxybutyrate combinations of 10 with 5 and 50 with 20 mM was 20 +/- 2.8 and 10 +/- 2.8%, respectively. Inhibition was not observed with control neutrophils. These data indicate that although phagocytosis occurs at similar levels in diabetics and controls, killing of candida by the diabetic neutrophil is impaired under conditions of hyperglycaemia and ketosis. The biochemical basis for this effect is discussed.
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A study of non-infective skin associations of diabetes mellitus was conducted on 100 consecutive outpatient diabetics over a 3-month period. 10 were insulin-dependent diabetics (IDDM), 24 insulin-requiring and 66 non-insulin dependent diabetics (NIDDM). A total skin evaluation was done for each patient with skin biopsy whenever appropriate. Twenty-three patients had diabetic dermopathy; the frequency of retinopathy in this group (39.1%) is significantly higher than that without diabetic dermopathy (6.9%) (p less than 0.001). There were 20 instances of cutaneous complications of therapy; 10 had insulin lipodystrophy (29.4% of 34 insulin users). Twelve patients, 8 of whom were overweight, had acanthosis nigricans. There were 6 Indians among them and all the patients had NIDDM. Eight had xanthelasma. Vitiligo occurred in 3.3% of those with NIDDM. Classical scleredema diabeticorum and cheiroarthropathy occurred in 2% of patients. One patient had atypical granuloma annulare. There was a higher incidence of xanthelasma in our study compared with studies done previously. Insulin lipodystrophy and acanthosis nigricans in the absence of classically described syndromes of insulin resistance seem to be fairly common phenomena and merit further investigation locally.
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Endocrinologic disorders occasionally manifest themselves by their associated or induced cutaneous abnormalities. In some instances the initial and most prominent complaints of the patient are related to alterations in the skin, and thus the dermatologist will at times be the first physician consulted. In this article we describe the cutaneous lesions that occur in patients with acromegaly, hypopituitarism, hypothyroidism, hyperthyroidism, diabetes mellitus, glucagonomas, hypercalcemia, hypoparathyroidism, and fibrous dysplasia. In addition, we also discuss the role of the skin in vitamin D metabolism. Whenever possible and where known, we have attempted to point out the pathophysiologic mechanisms that account for the cutaneous changes.
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Diabetes mellitus is a common condition, and persons who have this ailment are commonly encountered by dermatologists and primary care physicians. Because glucose attaches to long-lived proteins, it may have a profound effect on the tertiary structure of the protein. Chronic hyperglycemia may be responsible for the pathogenesis of many diabetic complications. It has been suggested that increased cross-linking of collagen in diabetic patients is responsible for the fact that their skin is generally thicker than that of nondiabetics. Advanced glycosylation end-products are probably responsible for yellowing of skin and nails. Increased viscosity of blood caused by stiff red blood cell membranes results in engorgement of the postcapillary venules in the papillary dermis, which is detected as erythema of the face or as periungual erythema. It is suggested that these skin changes may eventually be used as a reflection of the patient's current (as well as past) metabolic status.
Article
Diabetes mellitus (DM) is a heterogeneous group of disorders characterized by a high serum glucose level and by disturbances of carbohydrate and lipid metabolism. It is estimated that 11 million persons in the United States have DM, 90% of whom have non-insulin-dependent DM. At least 30% of persons with diabetes have some type of cutaneous involvement during the course of their chronic disease. This review classifies the cutaneous findings in DM into four categories: (1) skin diseases with strong to weak association with DM; (2) cutaneous infections; (3) cutaneous manifestations of diabetic complications; and (4) skin reactions to diabetic treatment. Each of these categories is reviewed as well as the pathophysiology of the normal and diabetic basement membrane for a better understanding of the cutaneous manifestations of DM.
Article
Information now available about the prevalence and incidence of coronary heart disease is seriously deficient because of the lack of standardized and objective methods of collection, tabulation, interpretation, and reporting of survey data. Chief reliance in the objective diagnosis of coronary heart disease rests on the electrocardiogram, a crucial tool in population studies. A classification system for the electrocardiogram in epidemiologic studies has been developed, tested, and herein presented. It is adapted to the usual clinical reading technics of the electrocardiographer. It embodies criteria widely employed and of diagnostic and prognostic import, but no stipulations about interpretation are made. The system permits more valid comparisons of data on heart disease between populations. It is susceptible to modern methods of data processing.
Diabetes Mellitus, Technical Re-port Series 727, World Health Organization
  • Who
  • Study
  • Group
WHO Study Group, Diabetes Mellitus, Technical Re-port Series 727, World Health Organization, Geneva, 1985.
Skin disorders associated with diabetes mel-litus Ellenberg and Rifkin's Diabetes Mellitus, Theory and Practice, El-sevier
  • J E Jelinek
J.E. Jelinek, Skin disorders associated with diabetes mel-litus, in: H. Rifkin, D. Porte (Eds.), Ellenberg and Rifkin's Diabetes Mellitus, Theory and Practice, El-sevier, New York, NY, 1990, pp. 838 – 849.
Non-infective skin associations of diabetes mellitus
  • Vijuyusingam
Ellenberg and Rifkin's Diabetes Mellitus
  • J E Jelinek