diabetestalk.net

Painful Diabetic Peripheral Neuropathy

Low Vitamin D Levels In Painful Diabetic Peripheral Neuropathy

Low Vitamin D Levels In Painful Diabetic Peripheral Neuropathy

Low Vitamin D Levels in Painful Diabetic Peripheral Neuropathy Lower vitamin D (25-hydroxyvitamin D) levels are found in patients with painful diabetic peripheral neuropathy (DPN) compared to those with painless DPN, patients with diabetes without any neuropathy, and healthy people, shows a study unique for its rigorous control for seasonal sunlight and physical activity. "This is the first time a study has corrected for these confounders [sunlight and physical activity]. The findings have major clinical significance because painful DPN is distressing and disabling," said lead author Solomon Tesfaye, MD, consultant endocrinologist at the Royal Hallamshire Hospital, Sheffield, UK, who discussed the findings with Medscape Medical News in an interview. Not only have previous studies failed to robustly control for seasonal sunlight exposure and physical activity, which have a significant impact on vitamin D levels, most have not differentiated between people with painful and painless DPN. In addition, these prior studies have lacked detailed assessment of peripheral neuropathy including measurement of skin intra-epidermal nerve density. "The finding is a big deal because it opens up a whole new area of research," asserted Tesfaye. "It's a very common disorder with 25% ofpatients with diabetes having neuropathic pain, many of whom are undiagnosed and suffering in silence because they believe it is just part of the aging process," he explained. He added that the small proof-of-principle study was a borne out of anecdotal findings that vitamin D supplements or injections given to patients with painful DPN improved their pain. The article was published online August 13 in Diabetic Medicine. Differentiating Between Painful and Painless DPN In total, 45 white Europeans with type Continue reading >>

Painful Diabetic Neuropathy: An Update

Painful Diabetic Neuropathy: An Update

2Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012 *Corresponding Author: Deptt of Endocrinology, PGIMER, Chandigarh-12, Phone: +919914209584, [email protected]_ikanip Received 2011 Aug 19; Revised 2011 Aug 30; Accepted 2011 Sep 5. Copyright 2011, Annals of Neurosciences This article has been cited by other articles in PMC. Diabetes, a silent killer, is a leading cause of neuropathy. Around 50% of diabetic patients develop peripheral neuropathy in 25 years. Painful diabetic neuropathy manifests as burning, excruciating, stabbing or intractable type of pain or presents with tingling or numbness. The pathophysiology of this condition is due to primarily metabolic and vascular factors. There is increase in sorbitol and fructose, glycated endproducts, reactive oxygen species and activation of protein kinase C in the diabetic state. All these factors lead to direct damage to the nerves. The first step in the management of painful diabetic neuropathy is a tight glycaemic control. Currently there is no drug which can halt or reverse the progression of the disease. Most of the therapies prevalent aim at providing symptomatic relief. Antidepressants like tricyclic antidepressants (TCAs) and selective norepinephrine reuptake inhibitors (SNRIs) have good efficacy in controlling the symptoms. Selective serotonin reuptake inhibitors have not shown the same consistent results. Anticonvulsants including pregabalin, gabapentin and lamotrigine have shown good results in the control of symptoms whereas same was not found with carbamazepine, oxcarbazepine and topiramate. Topical agents (capsaicin, topical nitrates and topical TCAs) and local anaesthetics have also been used with good results. Use of opioids and non steroidal anti- Continue reading >>

Painful Diabetic Peripheral Neuropathy Among Saudi Diabetic Patients Is Common But Under-recognized: Multicenter Cross-sectional Study At Primary Health Care Setting Algeffari Ma - J Fam Community Med

Painful Diabetic Peripheral Neuropathy Among Saudi Diabetic Patients Is Common But Under-recognized: Multicenter Cross-sectional Study At Primary Health Care Setting Algeffari Ma - J Fam Community Med

Diabetes mellitus affects about 382 million people worldwide, and its prevalence is expected to increase to 592 million by the year 2035. [1] According to a recent World Health Organization (WHO) report, Saudi Arabia ranks as the second highest in the Middle East, and the seventh in the world for the rate of diabetes. [1] Diabetic neuropathy is one of the most common long-term complications of diabetes and is the main initiating factor for foot ulceration, Charcot neuroarthropathy, and lower-extremity amputation. [2] Diabetic neuropathy encompasses a variety of clinical and subclinical presentations. Painful diabetic peripheral neuropathy (PDPN) is a common type of diabetic neuropathy and is described as a superficial burning pain associated with other sensory symptoms affecting the feet and lower extremities. [3] , [4] , [5] The symptoms are typically characterized as prickling, burning pain like an electric shock with nocturnal exacerbation. Furthermore, PDPN not only causes pain but also associated with a high degree of functional impairment, an impairment of health-related quality of life and activities of daily living. [6] , [7] The prevalence of PDPN ranges from 10% to 20% of patients with diabetes and from 40% to 50% of those with diabetic neuropathies. [8] Studies conducted in the Middle East report higher rates of PDPN, ranging from 35% to 65%. [9] , [10] , [11] , [12] PDPN reportedly results in significantly higher health-care costs compared with costs for age- and sex-matched diabetic patients without PDPN. [8] , [13] The annual health-care costs in two separate databases were 24%38% higher even after adjusting for differences in comorbid medical conditions such as cardiovascular illness. [14] However, unlike other diabetic vascular complications including r Continue reading >>

Diabetic Peripheral Neuropathy (dpn)

Diabetic Peripheral Neuropathy (dpn)

* * * Please click on the video in order for it to start playing * * * The information contained in this video is made available with the understanding that ACPA is not engaged in rendering medical advice or recommendations. The content of this video is provided for informational purposes only. This information should not be used as a substitute for necessary consultations with a qualified health care professional to meet your individual needs. Always consult a medically trained professional with questions and concerns you have regarding your medical condition. No patient-physician or patient-nurse relationship is intended to be created by ACPA making this information available to you. * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * * * * Please click on the video in order for it to start playing * * * The information contained in this video is made available with the understanding that ACPA is not engaged in rendering medical advice or recommendations. The content of this video is provided for informational purposes only. This information should not be used as a substitute for necessary consultations with a qualified h Continue reading >>

Clinical Phenotype Of Diabetic Peripheral Neuropathy And Relation To Symptom Patterns: Cluster And Factor Analysis In Patients With Type 2 Diabetes In Korea

Clinical Phenotype Of Diabetic Peripheral Neuropathy And Relation To Symptom Patterns: Cluster And Factor Analysis In Patients With Type 2 Diabetes In Korea

Clinical Phenotype of Diabetic Peripheral Neuropathy and Relation to Symptom Patterns: Cluster and Factor Analysis in Patients with Type 2 Diabetes in Korea 1Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Republic of Korea 2Clinical Trial Center and Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea 3Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea 4Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea 5Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Republic of Korea 6Department of Internal Medicine Chonbuk National University Medical School, Research Institute of Clinical Medicine Chonbuk National University Hospital, Division of Endocrinology and Metabolism, Jeonju, Republic of Korea Correspondence should be addressed to Tae Sun Park ; [email protected] Received 3 May 2017; Revised 19 October 2017; Accepted 8 November 2017; Published 13 December 2017 Copyright 2017 Jong Chul Won et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Patients with diabetic peripheral neuropathy (DPN) is the most common complication. However, patients are usually suffering from not only diverse sensory deficit but also neuropathy-related discomforts. The aim of this study is to identify distinct groups of patients with DPN with respect to its clinical impacts on symptom patterns and comorbidities. Methods. A hierarchical clust Continue reading >>

Topical Menthol +/- Mannitol For Painful Diabetic Peripheral Neuropathy

Topical Menthol +/- Mannitol For Painful Diabetic Peripheral Neuropathy

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Topical Menthol +/- Mannitol for Painful Diabetic Peripheral Neuropathy The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT02728687 Information provided by (Responsible Party): Helene Bertrand, University of British Columbia Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Treatments for painful diabetic peripheral neuropathy (PDPN) are not very effective and have multiple side effects. To find out if a menthol cream alone or with added mannitol treats PDPN effectively, 90 participants with PDPN, after one month of observation, will receive randomly assigned menthol cream or the same cream with mannitol added for 3 months with a crossover for 3 additional months. At time 0, 1,4 and 7 months their BPI pain severity and interference scores, DN4 scores, cream % effectiveness and side effects will be compared. Purpose: to find out if a menthol cream containing mannitol is more effective than the same cream without mannitol in relieving painful diabetic peripheral neuropathy (PDPN). The test cream which will, at a later date, be marketed as QR cream contains Water, Mannitol, Propylene glycol, Isopropyl palmitate. Caprylic capric triglyceride, Ceteareth 20, Cetearyl alcohol, Glyceryl stearate, Polyethylene glycol 100 Stearate, Dimethicone, Octyldodecanol, Men Continue reading >>

Painful Diabetic Neuropathy

Painful Diabetic Neuropathy

Painful diabetic neuropathy is pain arising as a direct consequence of abnormalities of the somatosensory system in diabetic patients and predominantly affects the feet and legs. Risk factors for development of diabetic peripheral neuropathy include duration of disease, poor glycaemic control, hypertension, hyperlipidaemia, and smoking, but the specific risk factors for painful neuropathy are less clear. Patients often find it difficult to clearly describe the pain—up to 40% have never received treatment. Treatment follows the NICE guidance pathway, with duloxetine and tricyclic antidepressants considered to be first-line agents, but also includes modification of the risk factors for development of neuropathy. Around 347 million people worldwide are estimated to have diabetes mellitus, making it one of the most common chronic diseases. It is associated with considerable morbidity and mortality because of the primary disease and also secondary complications. The incidence has almost doubled in the last three decades in parallel with an increasing trend in ageing and also in obesity worldwide.1 It has a huge impact on quality of life, health resources, and economy. Diabetic neuropathy is the most common long-term complication of the condition and a leading cause of neuropathy in the developed world.2 Both duration of diabetes and degree of glycaemic control are important predictive factors for the development of neuropathy.3 The prevalence of diabetic neuropathy varies considerably among clinical studies because of differences in the study population, design, and diagnostic criteria. Prevalence increases predictably with the duration of diabetes from 10% at diagnosis to as much as 53% after 25 yr of diabetes.4 There is also a proportional increase with age. It is estima Continue reading >>

Peripheral Neuropathy And Diabetes

Peripheral Neuropathy And Diabetes

Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It leads to numbness, loss of sensation, and sometimes pain in your feet, legs, or hands. It is the most common complication of diabetes. About 60% to 70% of all people with diabetes will eventually develop peripheral neuropathy, although not all suffer pain. Yet this nerve damage is not inevitable. Studies have shown that people with diabetes can reduce their risk of developing nerve damage by keeping their blood sugar levels as close to normal as possible. What causes peripheral neuropathy? Chronically high blood sugar levels damage nerves not only in your extremities but also in other parts of your body. These damaged nerves cannot effectively carry messages between the brain and other parts of the body. This means you may not feel heat, cold, or pain in your feet, legs, or hands. If you get a cut or sore on your foot, you may not know it, which is why it's so important to inspect your feet daily. If a shoe doesn't fit properly, you could even develop a foot ulcer and not know it. The consequences can be life-threatening. An infection that won't heal because of poor blood flow causes risk for developing ulcers and can lead to amputation, even death. This nerve damage shows itself differently in each person. Some people feel tingling, then later feel pain. Other people lose the feeling in fingers and toes; they have numbness. These changes happen slowly over a period of years, so you might not even notice it. Because the changes are subtle and happen as people get older, people tend to ignore the signs of nerve damage, thinking it's just part of getting older. But there are treatments that can help slow the progression of this condition and limit the damage. Talk to your doctors Continue reading >>

Diabetic Neuropathy

Diabetic Neuropathy

Diabetic neuropathies are nerve damaging disorders associated with diabetes mellitus. These conditions are thought to result from a diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum) in addition to macrovascular conditions that can accumulate in diabetic neuropathy. Relatively common conditions which may be associated with diabetic neuropathy include third, fourth, or sixth cranial nerve palsy[1]; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy. Signs and symptoms[edit] Illustration depicting areas affected by diabetic neuropathy Diabetic neuropathy affects all peripheral nerves including sensory neurons, motor neurons, but rarely affects the autonomic nervous system. Therefore, diabetic neuropathy can affect all organs and systems, as all are innervated. There are several distinct syndromes based on the organ systems and members affected, but these are by no means exclusive. A patient can have sensorimotor and autonomic neuropathy or any other combination. Signs and symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years. Symptoms may include the following: Trouble with balance Numbness and tingling of extremities Dysesthesia (abnormal sensation to a body part) Diarrhea Erectile dysfunction Urinary incontinence (loss of bladder control) Facial, mouth and eyelid drooping Vision changes Dizziness Muscle weakness Difficulty swallowing Speech impairment Fasciculation (muscle contractions) Anorgasmia Retrograde ejaculation (in males) Burning or electric pain Pathogenesis[edit] The following factors are thought to be involved in the development of dia Continue reading >>

Symptoms Of Diabetic Peripheral Neuropathy

Symptoms Of Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy is a condition caused by long-term high blood sugar levels, which causes nerve damage. Some people will not have any symptoms. But for others symptoms may be debilitating. Between 60 and 70 percent of people with diabetes have some form of neuropathy, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Peripheral neuropathy, the most common form of diabetic neuropathy, affects the legs, feet, toes, hands, and arms. Many people do not know that they have diabetes. People unaware of their diabetes may not know what’s causing some of the unusual sensations they’re experiencing. Nerve damage is the result of high levels of blood glucose over long periods of time. It isn’t entirely clear why high glucose levels damage nerves. A number of factors may play a role in nerve fiber damage. One possible component is the intricate interplay between the blood vessels and nerves, according to the Mayo Clinic. Other factors include high blood pressure and cholesterol levels and nerve inflammation. Diabetic peripheral neuropathy usually first appears in the feet and legs, and may occur in the hands and arms later. A common symptom of diabetic peripheral neuropathy is numbness. Sometimes you may be unable to feel your feet while walking. Other times, your hands or feet will tingle or burn. Or it may feel like you’re wearing a sock or glove when you’re not. Sometimes you may experience sudden, sharp pains that feel like an electrical current. Other times, you may feel cramping, like when you’re grasping something like a piece of silverware. You also may sometimes unintentionally drop items you’re holding as a result of diabetic peripheral neuropathy. Walking with a wobbly motion or even losing your balance can res Continue reading >>

Perspectives On The Impact Of Painful Diabetic Peripheral Neuropathy In A Multicultural Population

Perspectives On The Impact Of Painful Diabetic Peripheral Neuropathy In A Multicultural Population

Since few studies have characterized painful diabetic peripheral neuropathy (pDPN) symptoms in multicultural populations, this study fielded a survey to better understand pDPN and its impact in African-American, Caucasian, and Hispanic populations. Kelton fielded a survey by phone or Internet, in English or Spanish, among adults with pDPN symptoms in the United States between August and October 2015; African-Americans and Hispanics were oversampled to achieve at least 500 subjects for each group. Patients were required to have been diagnosed with pDPN or score 3 on ID Pain validated screening tool. The survey elicited information on pDPN symptoms and interactions with healthcare providers (HCPs), and included the Brief Pain Inventory and pain-specific Work Productivity and Assessment Questionnaire (WPAI:SHP). Respondents included 823 Caucasians, 525 African-Americans, and 537 Hispanics; approximately half of African-Americans and Hispanics were <40years of age, vs 12% of Caucasians. Pain was less likely to be rated moderate or severe by African-Americans (65%) and Hispanics (49%) relative to Caucasians (87%; p < 0.05). African-Americans and Hispanics were less likely than Caucasians to report experiencing specific pDPN sensory symptoms. Significantly fewer African-Americans and Hispanics reported receiving a pDPN diagnosis relative to Caucasians (p < 0.05), and higher proportions of African-Americans and Hispanics reported difficulty communicating with their HCP (p < 0.05). WPAI:SHP activity impairment was lower in Hispanics (43%) relative to African-Americans (53%) and Caucasian (56%; p < 0.05). Multicultural patients reported differences in pDPN symptoms and pain relative to Caucasians, and fewer received a pDPN diagnosis. While further evaluation is needed to unders Continue reading >>

Painful Diabetic Neuropathy

Painful Diabetic Neuropathy

Advantage of novel drugs over old drugs? Neuropathic pain exerts a substantial impact on quality of life, particularly by causing considerable interference in sleep, daily activities, and enjoyment of life. Chronic neuropathic pain is present in 13–26% of diabetic patients (1–4). In a recent survey from Augsburg, Germany, the prevalence of painful polyneuropathy was found to be 13.3% in diabetic subjects, 8.7% in individuals with impaired glucose tolerance, 4.2% in individuals with impaired fasting glucose, and 1.2% in individuals with normal glucose tolerance (3). Independent factors significantly associated with diabetic painful neuropathy (DPN) were age, weight, and peripheral arterial disease. Pain is a subjective symptom of major clinical importance, since it is often this complaint that motivates patients to seek health care. However, in a survey from the U.K., only 65% of diabetic patients received treatment for their neuropathic pain, although 96% had reported the pain to their physician. Pain treatment consisted of antidepressants in 43.5% of cases, anticonvulsants in 17.4%, opiates in 39%, and alternative treatments in 30% (combinations possible). Whereas 77% of the patients reported persistent pain over 5 years, 23% were pain free over at least 1 year (1). Thus, neuropathic pain persists in the majority of diabetic patients over periods of several years. MANIFESTATIONS OF PAINFUL NEUROPATHY Chronic DPN with persistent or episodic pain that typically may worsen at night, and improve during walking, is localized predominantly in the feet. The pain is often described as a deep-seated ache, but there may be superimposed lancination, or it may be of burning thermal quality. In a clinical survey including 105 patients with DPN, the following locations of pain w Continue reading >>

Painful Diabetic Peripheral Neuropathy: Presentations, Mechanisms, And Exercise Therapy

Painful Diabetic Peripheral Neuropathy: Presentations, Mechanisms, And Exercise Therapy

Painful Diabetic Peripheral Neuropathy: Presentations, Mechanisms, and Exercise Therapy 1Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, USA 2Department of Neurology, University of Kansas Medical Center, USA *Corresponding author: Patricia M Kluding, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City KS, USA, Tel: (913) 588-6918; Fax: (913) 588-9428, [email protected] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The publisher's final edited version of this article is available at J Diabetes Metab See other articles in PMC that cite the published article. Diabetic peripheral neuropathy (DPN) is a frequent complication of diabetes and a major cause of morbidity and increased mortality. It is typically characterized by significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Painful diabetic neuropathy (P-DPN) is a common phenotype of DPN that affects up to one-third of the general diabetic population. P-DPN has been shown to be associated with significant reductions in overall quality of life, increased levels of anxiety and depression, sleep impairment, and greater gait variability. The purpose of this review is to examine proposed mechanisms of P-DPN, summarize current treatment regimen, and assess exercise as a potential therapy for P-PDN. Although exercise has been shown to be an effective therapeutic modality for diabetes, its specific effects on DPN and especially the painful phenotype have not been Continue reading >>

Treating Painful Diabetic Peripheral Neuropathy With Electroacupuncture

Treating Painful Diabetic Peripheral Neuropathy With Electroacupuncture

Treating Painful Diabetic Peripheral Neuropathy With Electroacupuncture Treating Painful Diabetic Peripheral Neuropathy With Electroacupuncture Adverse events reported were related to treatment with electroacupuncture According to a study published in Diabetes Care, electroacupuncture treatment effectively reduces pain and improves sleep disturbance and quality of life in patients with painful diabetic peripheral neuropathy. To determine the safety and efficacy of electroacupuncture for the management of painful diabetic peripheral neuropathy, researchers conducted a multicenter, assessor-blinded trial in which 126 patients with type 2 diabetes and a history of at least 6 months of painful diabetic peripheral neuropathy were randomly assigned to either an intervention or a control group. Those in the intervention group received electroacupuncture treatment with a mixed current of 2 Hz/120 Hz at 12 acupuncture points twice per week for 8 weeks. Both groups received education on diet and lifestyle modification and were allowed to take rescue medication, but no other analgesics. There were no significant differences between groups in baseline characteristics. Primary outcomes were pain intensity score and proportion of responders, which researchers defined as participants who achieved at least a 50% reduction of pain intensity on 8-week follow-up. For pain intensity scores, patients in the intervention group improved significantly more than those in the control group (P =.0136). Among intervention participants, 9 were responders (15.52%) compared with 3 (6.25%) in the control group (P =.2176). In addition to pain reduction, the intervention group demonstrated significantly greater improvement on the short-form McGill Pain Questionnaire, sleep interference scores, and the Continue reading >>

Painful Diabetic Peripheral Neuropathy Linked To Low Vitamin D Level

Painful Diabetic Peripheral Neuropathy Linked To Low Vitamin D Level

Painful diabetic peripheral neuropathy linked to low vitamin D level Please provide your email address to receive an email when new articles are posted on this topic. Receive an email when new articles are posted on this topic. Patients with type 2 diabetes and painful diabetic peripheral neuropathy had significantly lower 25-hydroxyvitamin D levels compared with healthy volunteers and patients with type 2 diabetes without neuropathy or with painless neuropathy, according to data published in Diabetic Medicine. A number of recent studies have reported reduced vitamin D levels in diabetic peripheral neuropathy, although many of these did not assess major confounding factors, including seasonal sunlight exposure and daily activity, Solomon Tesfaye, MB ChB, MD, FRCP, consultant physician/endocrinologist at Sheffield Teaching Hospitals and honorary professor of diabetic medicine at the University of Sheffield, and colleagues wrote in the study background. There is some evidence, although not consistent, that vitamin D supplementation improves painful neuropathic symptoms, suggesting that vitamin D may have a role in the pathogenesis of painful diabetic peripheral neuropathy. Our study was designed to address these limitations. Researchers evaluated data from 59 people, including 14 healthy volunteers, 14 patients with type 2 diabetes without neuropathy, 14 patients with type 2 diabetes and painless diabetic peripheral neuropathy, and 17 patients with type 2 diabetes and painful diabetic peripheral neuropathy. Researchers recruited patients from the Sheffield Teaching Hospitals NHS Foundation Trust diabetes database and outpatient clinics from August 2013 to September 2014. Patients with diabetic peripheral neuropathy had higher BMI (P = .02) and were older (P = .009) than Continue reading >>

More in diabetes