No abstract

Both diabetic peripheral neuropathy and peripheral arterial disease (PAD) cause foot ulcers and often result in non-traumatic amputations in patients with type 2 diabetes. This study aimed to evaluate the association between clinical variables, PAD, and subclinical diabetic small fiber peripheral neuropathy detected by abnormal thermal thresholds of the lower extremities in patients with type 2 diabetes.We investigated 725 consecutive patients with type 2 diabetes (male/female: 372/353; mean age, 67 ± 11 years) who did not have apparent cardiovascular disease (including coronary artery disease, arrhythmia, and stroke) and who underwent the quantitative sensory test for thermal (warm and cold) thresholds of the lower limbs and ankle-brachial index (ABI)/toe-brachial index (TBI) examinations in 2015. The analyses included glycated hemoglobin, estimated glomerular filtration rate, and other characteristics.In total, 539 (74.3%) patients showed an abnormality of at least 1 thermal threshold in their feet. All patients with an abnormal ABI (<0.9) had concurrent impaired thermal thresholds, and 93% (87/94) of patients with an abnormal TBI experienced abnormal thermal thresholds in the lower limbs. Age- and sex-adjusted TBI and estimated glomerular filtration rate were significantly correlated to abnormal thermal thresholds. In the multivariate analysis, fasting plasma glucose, and glycated hemoglobin were independently associated with abnormal thermal thresholds in the lower extremities.Subclinical thermal threshold abnormalities of the feet are significantly associated with PAD and nephropathy in patients who have type 2 diabetes without cardiovascular disease.

Introduction Although a number of researchers have considered the positive potential of Clinical Decision Support System (CDSS), they did not consider that patients' attitude which leads to active treatment strategies or HbA1c targets. Materials and Methods We adopted the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published to propose an HbA1c target and antidiabetic medication recommendation system for patients. Based on the antidiabetic medication profiles, which were presented by the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE), we use TOPSIS to calculate the ranking of antidiabetic medications. Results The endocrinologist set up ten virtual patients' medical data to evaluate a decision support system. The system indicates that the CDSS performs well and is useful to 87%, and the recommendation system is suitable for outpatients. The evaluation results of the antidiabetic medications show that the system has 85% satisfaction degree which can assist clinicians to manage T2DM while selecting antidiabetic medications. Conclusions In addition to aiding doctors' clinical diagnosis, the system not only can serve as a guide for specialty physicians but also can help nonspecialty doctors and young doctors with their drug prescriptions.