الفهرس 
Over view of Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Summary
iabetes mellitus is a metabolic disorder of multiple etiologies characterized by the presence of hyperglycemia with disturbance of carbohydrate, fat and protein metabolism. Most common types of DM are: Type I DM which is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. Type II DM which is the most common form of diabetes caused by insulin resistance, a condition in which the body’s muscle, fat, and liver cells do not use insulin effectively.
Diabetes mellitus is a serious condition with potentially devastating complications that affects all age groups worldwide. In 2012, the International Diabetes Federation (IDF) estimated that 371 million people had diabetes. This number is projected to rise to 552 million (or 1 in 10 adults) by 2030, which equals to 3 new cases per second.
During the last years, the co-morbidity of mental disorders with chronic health conditions has emerged as a topic of considerable clinical and policy interest. Diabetes is considered one of the most psychologically demanding of the chronic medical illnesses because it requires strict daily management of the treatment by the patients themselves.
Diabetes mellitus as well as psychiatric disorders are common. These may occur with one another and/or one may worsen the other. Psychiatric disorders are at least twice as common in patients with diabetes compared to the general
population. However, many of them are under recognized and under treated. People with mental disorders have several risk factors that are likely to influence diabetes outcomes.
According to evidences, the association between these conditions is bi-directional. The presence of psychiatric co-morbidity can result in difficult clinical courses, depression negatively affects quality of life, treatment outcome and medication adherence of patients with DM. On the other hand, poor diabetes control might cause or exacerbate depression via direct effects on brain functions or indirectly through complications, functional impairment, or decreased quality of life. The incidence of depression in persons with diabetes seems to be associated with female gender, low socio-economic status, family history, obesity, smoking habits, physical activity and sedentary life.
Among the many additional complications which coincide with DM anxiety, tension, dysthymia and stress are most commonly under-detected. This is despite the fact that a growing body of literature has reported that patients with diabetes are almost twice as likely to suffer from these psychiatric disorders as the general population. Also, such symptoms were associated with poor glycaemic control, diabetes complications, worsened prognosis and quality of life.
Quality of life itself is a subjective construct which varies with the population studied. It is generally conceptualized as a multi-dimensional construct made up of a number of independent
domains including physical health, psychological well-being, social relationships, functional roles and subjective sense of life satisfaction.
Quality of life, along with more traditional physiologic measures of health status, has been recognized increasingly as a useful criterion for evaluating medical outcome. (WHO) defines health as ”A state of complete physical, mental, and social well-being not merely the absence of disease? It follows that the measurement of health and the effects of health care must include not only an indication of changes in the frequency and severity of diseases but also an estimation of well being and this can be assessed by measuring the improvement in the quality of life related to health care.
Therefore, the main focus of our study is to estimate rate of psychiatric morbidity among diabetic patients comparing their quality of the lives and illustrating risk factors in order to be early identified and managed.
We hypothesize that type I diabetes mellitus might have more psychiatric morbidity than type II presumably due to longer duration or different medications and that patients with diabetes mellitus and associated psychiatric disorders will have poorer quality of life. We also hypothesize that the most common psychiatric disorders will be anxiety and depression as they are most frequently found in other literature.
Our work was a cross sectional study included 60 adult subjects who present with DM without known psychiatric disease to general internal medicine outpatient clinics of Kobry El Koba military hospital and health insurance hospital at Nasr city regarding the psychiatric morbidity and their quality of life.
Our results showed that the majority of the sample was females, married and over half of them were highly educated and 96.6% of the study group was working.
Regarding the diabetes mellitus control, it was better among type I DM group in comparison to type II (43.3%vs 36.7%) with no statistically significant difference between them. There was also no statistically significant difference between both groups regarding mean of quality of life score
There was no statistical significant difference between type I and type II diabetes mellitus patients regarding the psychiatric diagnoses. The most common primary psychiatric diagnoses of type I DM group were anxiety disorders (22.2%) followed by depressive disorders (15%), The most frequent primary psychiatric diagnoses of type II DM group were depressive disorders (22.2%) and anxiety disorders (22.2%) while the most common co-morbid psychiatric diagnoses in the group of type I DM patients were Adjustment disorder (30%) followed by Hypochondriasis (13.3%) and lastly, Dysthymia (10%). In the type II DM group, 30% of patients had adjustment disorder and 23.3% had hypochondriasis and 10% had dysthymia.
A statistical significant difference was found between diabetes mellitus control and psychiatric diagnoses in both groups, poorly controlled DM had more frequent positive psychiatric diagnoses than controlled ones.
Statistically significant inverse correlation was found between QOL score and HBA1C levels among type I DM. On the other hand we found no significant correlation with other variables as age and education. Meanwhile, a statistically significant inverse correlation between QOL score and random blood sugar level was found in both groups of DM with no significant correlation with other variables.
We also found that the independent predictors of depression, anxiety and poor QOL included three factors, female sex, positive family history and diabetes control. It showed that diabetic control was statistically significant. This implies that the significant independent predictors of depression, anxiety and poor QOL among different independent variables are DM control.