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Access and quality of care for users with hypertension and diabetes mellitus

Access and quality of care for users with hypertension and diabetes mellitus

participation were important tools to change the supply of health services and actions, as well as the adherence and quality of care to users. The study of hypertension and diabetes was one of the central points to understand the need for interaction between professionals in the care of the user (MALTA, 2017, MALTA, MERHY 2017, SCHIMIDT et al, 2011). The contribution of a multidisciplinary team made the professionals involved advance in the complexity of the cases. Therefore, attention to hypertensive and diabetic users has become a shared responsibility of the entire team and the adequacy of the offerings to those who are targeted has been a challenge, since health policies that are primarily targeted at the most vulnerable populations (MALTA, 2017, SCHWAB, MOISÉS, KUSMA, 2014). In situations such as the one studied, the majority of users come from socio-cultural contexts that make it difficult to assimilate the benefits of attention models based on the idea of bonding, continuity of care, scheduling, and practices aimed at changing lifestyles (SCHWAB, MOISÉS, KUSMA, 2014). From this perspective, it can be inferred that multiple factors contribute to the difficult access of these users, among them we can highlight, the lack of community health agents and the high turnover of professionals, factors that interfere in access and quality of care in health services. APS (STRECK, GOMES, CARVALHO, SODER, WEILLER, DAMACENO, 2018). Another factor that interfered with the continuity of care was the lack of return with complementary exams and the non- adherence to the health promotion groups developed in the PHC unit. Therefore, it is important to maintain a dynamism in attending to users using the tools provided by the host, valuing the technical skills of each professional (BRAZIL, 2017). The study revealed that the adoption of instruments for the organization of care enabled the improvement of clinical practices and the continuity of care. Therefore, the follow-up mirror sheet allowed us to evaluate the profile of the users monitored, as well as their clinical conditions, degree of dependency and family situation, facilitating the active search of misconduct users. The use of the Framingham Score and renal risk scale by the Cockroft-Gault formula contributed to define the patients who need more attention from the health team, allowing the team to rethink the care and to establish a minimum space between the consultations, from of the indicators collected.
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Type 2 diabetes and psoriasis: links and risks

Type 2 diabetes and psoriasis: links and risks

increased risk of diabetes in PsA was partially explained by obesity and lifestyle factors (alcohol and smoking) and that PsA and PsO were associated with the risk of diabetes when adjusted for obesity and lifestyle factors. This sup- ports that the presence of PsA in patients with PsO mainly indicates a surplus of systemic inflammatory involvement, since autoimmune disorder prevalence, including T1D, does not differ between PsO and PsO + PsA patients. 36 Husted et

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Diabetes IN develOpment (DINO): the bio-psychosocial, family functioning and parental well-being of youth with type 1 diabetes: a longitudinal cohort study design

Diabetes IN develOpment (DINO): the bio-psychosocial, family functioning and parental well-being of youth with type 1 diabetes: a longitudinal cohort study design

The way the family of T1D youth functions is important, both as determinant and consequent of poor diabetes control. A negotiating parent–child environment is beneficial for children with diabetes. In addition, shared responsibility for diabetes management tasks is shown to be associated with better psychological health, self-care behavior and metabolic control [51–53]. A lack of col- laboration between children and parents can result in conflicts which are often associated with poor glycemic control and QoL [54, 55], however, this seems to be re- lated to ethnicity [56]. Shared responsibility regarding diabetes tasks between parents and adolescents (rather than complete/sudden transfer of parental control) for diabetes management may serve as a way to achieve au- tonomy for self-care. Youth with an inordinate self-care autonomy relative to their psychological maturity are at greater risk of poor treatment adherence, worse diabetic control and more hospitalizations [57]. Inconsistencies regarding competence and independence between par- ents and children with T1D is associated with poorer diabetes outcomes [58]. Furthermore, the better parents are able to adopt youth’s perspectives the better the gly- cemic control [59]. Recent research reveals that parental involvement [60] in diabetes care and greater overall parental support [61] are associated with better health [60] and service use [61], and greater parental motiv- ation is related to child’s healthier diet [62]. These find- ings highlight the importance of parenting practices. One of the major tasks for parents is to be responsive to adolescents’ needs for increasing responsibility and deci- sion making power while at the same time maintaining a high level of cohesiveness in the family. However, paren- tal well-being influences the way this task proceeds. Re- cent research reveals that parents with T1D children were more anxious and perceived less family cohesion than the parents of healthy youth [63]. The diagnosis, hypoglycemic events, as well as the chronic nature of diabetes and its demands all contribute to anxiety and depressive symptoms in parents [64, 65]. Importantly, worse parental well-being is shown to be associated with poorer glycemic control of the children [66, 67] and ma- ternal depression is found to be associated with acute hospitalization [68]. Of interest is how family function- ing and parental well-being influences adolescents’ dia- betes outcomes and development, and how parental well-being influences youths’ diabetes and psychosocial outcomes.
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Assessment of Knowledge and Attitude towards Diabetes Mellitus among Type 2 Diabetes Patients Attending Biryogo Health Centre.

Assessment of Knowledge and Attitude towards Diabetes Mellitus among Type 2 Diabetes Patients Attending Biryogo Health Centre.

According to Rwanda Diabetic Association the prevalence of diabetes in Rwanda is about 3.16% of the population with 1,918 diabetes related deaths per year. [6] Biryogo health center started following up the patients living with diabetes mellitus since 2008 where it has a big number of patients with diabetes who are on follow up on appointments accordingly with a total number of 250 patients with diabetes. [7] At Biryogo health center there is no documented study that has assessed the knowledge and attitude towards patients with diabetes Mellitus type 2 about diabetes. Thus, this study aimed to assess the knowledge and attitude towards diabetes mellitus type 2 for patients with diabetes type two attending Biryogo health centre.
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Knowledge, attitude and practice of diabetes mellitus and diabetic retinopathy in rural population of Karnataka

Knowledge, attitude and practice of diabetes mellitus and diabetic retinopathy in rural population of Karnataka

programmes have to be implemented. The morbidities caused by ocular complication of diabetes has placed this disease as the 4th leading cause of blindness worldwide. (Tumosa, 2008) There are 4 million cases of blindness due to diabetic retinopathy. (Vision 2020) (Belfort, 2010) If diabetic retinopathy is detected early the blindness caused by it can be prevented. Creation of awareness about diabetic retinopathy by diabetic patients could help in the early detection, management and prevention of this complication. (Mohammed and Waziri 2009) The information about level of awareness in a population helps in formulating a prevention programme for diabetes. (Badrudin et al., 2002) Previously done studies on knowledge, attitude and practice (KAP) studies have supported the need for greater awareness of prevention, diagnosis, risk factor control and disease management (Demaio et al., 2013; Rani et al., 2008; Zaman et al., 2012; Norris et al., 2001; Al-Maskari et al., 2013; Mazzuca et al., 1986) and most studies are related to diabetes have focused on people with diagnosed diabetes mellitus or newly diagnosed diabetes mellitus attending urban clinics or hospitals. (Demaio et al., 2013; Rani et al., 2008; Al- Maskari et al., 2013) However, there is a paucity of evidence amongst the general community specifically in rural and remote areas. The aim of the study is to report the KAP (Knowledge, attitude and practice) study of Diabetes mellitus and Diabetic retinopathy among patients and attendants of patients visiting hospital in rural Karnataka.
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Gestational diabetes and the neonate: challenges and solutions

Gestational diabetes and the neonate: challenges and solutions

guidelines continue to recommend screening only of high- risk women (raised body mass index, previous macrosomic infant, previous GDM, first degree relative with diabetes, family origin with high prevalence of diabetes). In the United States, the “two-step” National Institutes of Health (NIH) nonfasting one-hour 50 g glucose load test (GLT) at 24–28 weeks, followed by a fasting 100 g OGTT for those who test positive, remains an alternative option to the IADPSG “one-step” OGTT. 14 The Australasian Diabetes in

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Association of maternal diabetes/glycosuria and pre-pregnancy body mass index with offspring indicators of non-alcoholic fatty liver disease

Association of maternal diabetes/glycosuria and pre-pregnancy body mass index with offspring indicators of non-alcoholic fatty liver disease

It has been estimated that up to half of gestational dia- betes cases are attributable to pre-pregnancy overweight and obesity [28] and in a systematic review and meta- analysis it was calculated that for one unit increase in pre- pregnancy BMI the risk of gestational diabetes increased by 0.92 % (95 % CI: 0.73,1.10 %) [29]. Here, the association of maternal pregnancy diabetes/glycosuria and NAFLD remained even after adjusting for potential confounding by maternal pre-pregnancy BMI and after accounting for birthweight and offspring concurrent adiposity. Similarly, adjusting for maternal early pregnancy BMI in the afore- mentioned sibling study did not account for the higher BMI of young men exposed to diabetes in utero compared to their unexposed brothers [26]. This suggests that familial adiposity, whether due to shared genetics or behaviour, is not a main or only driver of the association between Table 2 Multivariable associations of maternal diabetes/
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Transition from pre-diabetes to diabetes and predictors of risk in Mexican-Americans

Transition from pre-diabetes to diabetes and predictors of risk in Mexican-Americans

subjects who did not transition from pre-diabetes to diabetes met minimum recommendations for moderate and vigorous physical activity of ≥ 600 MET-minutes/week compared with their counterparts at enrollment (33% versus 16%; P= 0.03) (Table 1). The lack of association was likely because these factors are not significant determinants of developing diabetes from pre-diabetes. Alcohol and smoking are not generally identified as risk factors for diabetes and our study was no exception. The question of diet is more complex, but we utilize a standardized method of diet measurement and none of its components nor the instrument as a whole was associated with developing diabetes. Overall, the transition from pre-diabetes states to type 2 diabetes is characterized by a vicious cycle that includes severe deleterious effects
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Quality of life and type 1 diabetes: a study assessing patients’ perceptions and self-management needs

Quality of life and type 1 diabetes: a study assessing patients’ perceptions and self-management needs

more patient-centered. People with T1D have to cope with many factors that affect everyday disease management. The study of quality of life (QoL) in these patients is somewhat different from other populations, since T1D requires a high degree of patient involvement and frequent decision making (frequent glucose monitoring, insulin injection and dose adjustment, carbohydrate estimation, planning of therapeutic adjustments to physical activity, etc). Indeed, an Australian guideline on the assessment of diabetes education programs recommended the inclusion of not only knowledge-based evaluations but also self-management, QoL, and psychological well-being. 6
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History of breastfeeding in children and adolescents with diabetes mellitus type 1

History of breastfeeding in children and adolescents with diabetes mellitus type 1

The results of this research show that the mean age was 13.1 years old and there was a predominance of females. The early weaning was evidenced in the study since most of the subjects were not exclusively breastfed until the sixth month. It was also observed that food was introduced to children early, such as cow's milk, processed milk, fruits and juices, soda, sweets such as candies and sandwich cookies, which may have contributed to the onset of type 1 diabetes mellitus. Thus, it is realized that exclusive breastfeeding is a safe, economical and emotionally satisfying way to feed babies, as it provides protection for these children against prevalent diseases. There is no doubt that this discussion will be able to equip health professionals to promote breastfeeding, since as they encourage, accompany, assist and mainly guide the mother- father-family group in the implementation of exclusive breastfeeding until the sixth month, contributing to increased breastfeeding rates, mobilizing health professionals and authorities for actions that prevent early weaning.
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A study on complications of diabetes mellitus and its management measures

A study on complications of diabetes mellitus and its management measures

The present study was aimed to assess awareness regarding diabetic complications through well designed questionnaires which included blood sugar levels, eating habits, physical activities and awareness questions. This study was designed to determine retinopathy, neuropathy, nephropathy, hypertension, hypoglycaemia, heart diseases, etc. The study was conducted on diabetic population including 150 subjects, of which 68 were males and 82 females, designed on 16 questions and responses were evaluated. The study revealed that 91% male subjects knew what type of diabetes they were diagnosed with and the rest 9% didn’t know it. 78% of female subjects also knew what type of diabetes they were diagnosed with unlike the remaining 22%. When asked how long they were suffering from diabetes 15% reported they were suffering from 0-1 year, 19% from 1-3 years, 15% were suffering from 3-6 years and the left 50% were suffering from more than 6 years. Coming to females 13% were suffering from 0-1 years, 18% from 1-3 years, 24% from 3-6 years and 45% from more than 6 years. It was also found that 63% of males were checking their sugar levels regularly and the rest 37% weren’t. Coming to female reports 65% of them were checking their sugar levels regularly
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Periodontitis and gestational diabetes mellitus: a case control study

Periodontitis and gestational diabetes mellitus: a case control study

The incidence of a major malformation in an infant whose mother is GDM is 4.8%, in contrast to 1-3% with no history of diabetes ( Jeanne, 2002 ). In addition, long-term complications of GDM to the offspring include an increased risk of glucose intolerance, diabetes and obesity ( American Diabetes Association, 2004 ). Maternal complications associated with GDM include hypertension, preeclampsia and an increased risk of cesarean delivery ( Schmidt, 2011 ). Therefore, diagnosis of GDM plays an important role to take up an intervention that improves insulin sensitivity, which may further help in prevention of these fetal as well as the maternal complications ( Seely, 2003 ). In addition, women with a history of GDM have an increased risk of developing diabetes after pregnancy compared to the general population, with a conversion rate of up to 3% per year ( Cianni, 2003 ). Periodontal disease is caused by bacteria present in dental plaque, especially the gram-negative rods, e.g. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tanerella forsythus ( Haffajee, 1994 ). These pathogens, particularly P. gingivalis have the ability to invade the deep vascular endothelium within the periodontium ( Chun, 2005 ).
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Association between serum ferritin and type 2 diabetes mellitus

Association between serum ferritin and type 2 diabetes mellitus

0.83± 0.18mg/dl. Serum cholesterol have a mean value of 210± 64.48mg/dl in case group and that of control was 159.38±18.23mg/dl. The current study shows mean serum ferritin level was 197.36±113.45ng/ml in diabetic group and that of control was 48.87±16.36 ng/ml. Serum ferritin levels shows a good positive correlation with HbA1c with r=0.916 and p value <0.001. The correlative studies of ferritin with duration of diabetes shows a positive correlation with r=0.975 and p=0.000.When considering the correlation of ferritin with FBS and PPBS, shows r=0.569,p=0.000 and r=0.885,p=0.000, respectively. Ferritin have a positive correlation with creatinine, r=0.830,p=0.000 and also with cholesterol, r=0.856,p=0.000.The present findings demonstrate the imbalance in levels of serum ferritin levels among patients with Type 2 Diabetes in comparison to controls. These changes may play an important role in the pathogenesis of Type 2 DM by the involvement of oxidative damages to the pancreatic beta cells.
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Experiences of gestational diabetes and gestational diabetes care: a focus group and interview study

Experiences of gestational diabetes and gestational diabetes care: a focus group and interview study

Societal expectations of reproductive asceticism, as de- scribed, can lead to judgements and criticism. This is ex- acerbated in GDM, where women are stigmatised for their ‘choice’ to be overweight [21]. Research shows that there is general stigma against people with T2DM and those who are obese [42, 55]. When the ‘public fetus’ is seen to be affected by the woman’s individual choice, the stigma is intensified, which can lead to feelings of guilt, depression and negative self-beliefs. This, coupled with the trauma of the GDM experience and little acknow- ledgment of the woman’s individual worth can only in- tensify the difficulties women face addressing lifestyle choices for themselves after birth. Therefore, in spite of being able to achieve excellent clinical outcomes for the baby in the short term, the current UK model of GDM care (coupled with societal influences) may be at the cost of poor psychological and longer-term clinical outcomes for the woman, who may not re-engage with addressing her future diabetes risk.
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Quick guide to type 2 diabetes self-management education: creating an interdisciplinary diabetes management team

Quick guide to type 2 diabetes self-management education: creating an interdisciplinary diabetes management team

This guide covers the 3 main topics of DSME: nutrition educa- tion, exercise, and medications (Figure 1). The goals of the first 15-minute visit are to give a basic understanding of diabetes, the patient’s type of diabetes, basic carbohydrate counting, and normal glucose levels before and after meals. The goals of the second 15-minute visit are to explain the importance of exercise, hypoglycemia, and hyperglycemia and thereafter guide them what to do during low- and high-blood-sugar level conditions. In the third 15-minute visit, a review of the home-based glucose monitoring log and the food log is conducted, and thereafter, questions are answered and recommendations are provided.
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Effect of ageing on diabetes mellitus and hypertension

Effect of ageing on diabetes mellitus and hypertension

Ageing is associated with an increasing prevalence of hypertension and metabolic abnormalities such as hyper insulinaemia, insulin resistance, altered glucose tolerance and/or frank noninsulin-dependent diabetes mellitus (NIDDM) Harris, et al., 1987. Systolic blood pressure (SBP) increases throughout life, while diastolic blood pressure (DBP) rises much more modestly with age, increasing until 55 to 60 years and then declining after 70 elsayed shokr 2016 and Harris, et al., 1987. In the Fra- mingham Heart Study, SBP increased about 25 mmHg in men and 35 mmHg in women between the fourth and eighth decades [Kannel, Jarret]. Isolated systolic hypertension was present in 11.7 % of patients over 60 years of age enrolled in the Systolic Hypertension in the Elderly Program (SHEP) Kannel et al., 1991, Jarret et al., 1978 and Elsayed shokr, 2015 and 2016. The effect of aging on blood glucose showed that high significant increase on blood glucose with increasing aging. Also, there were significant increases in blood elements (Na, K, Cl and Ca) in the population that increase in aging than young one. Arterial hypertension and “nor- mal” ageing, in the absence of hypertension, have many similar effects on the cardiovascular system. Thus, increased arterial stiffness, increased peripheral vascular resistance and increased left ventricular mass are common in hypertensive patients and healthy nor- motensive elderly subjects. Etiologic factors in age- related hypertension include vascular structural chan- ges, such as increased rigidity and decreased compliance of the aorta, hyalin degeneration within the media of precapillary arterioles, and atherosclero- tic effects of baroreceptor sensitivity. Other important factors involved in rising blood pressure with age are a decreased ability to handle sodium, a tendency to accumulate calcium and reduce magnesium content in the cell, increased sympathetic nervous system acti- vity, and a decreased vascular beta-adrenenergic vaso- dilatation function, which leaves alpha-adrenergic re- ceptor vasoconstriction unopposed in response to elevated norepinephrine levels Kannel et al., 1976 Monnier et al., 1986. Since an in- crease in blood pressure is not inexorable, and not present in developing countries, cultural factors such as diet, decreased exercise, stress and obesity probably contribute
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Diabetes and chronic ailments- An analytical and comparative study

Diabetes and chronic ailments- An analytical and comparative study

Though, Diabetes mellitus is not completely curable but, it is controllable to a great extent. So, you need to have thorough diabetes information to manage this it successfully. The control of diabetes mostly depends on the patient and it is his/her responsibility to take care of their diet, exercise and medication. Advances in diabetes research have led to better ways of controlling diabetes and treating its complications. As long as the individual lives in a stress free environment and has control on his life style and habits, the disease will not affect any other organ or organ system of the body.
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Role of metabolism of hdl and its subtypes in occurrence of diabetes in off springs of patients with type 2 diabetes mellitus

Role of metabolism of hdl and its subtypes in occurrence of diabetes in off springs of patients with type 2 diabetes mellitus

The purpose of this study was to estimate and analyze HDL and its subclasses in off springs of patients with Type 2 Diabetes Mellitus. Previous relevant studies have revealed that patients with Diabetes have usually low HDL as well has higher TG as compared to non-diabetics (Syvanne et al., 1995). These low HDL levels in Diabetics have been successfully linked with a high risk of Coronary Heart Disease CHD (Laakso, 1997). Several studies reveal a diminished HDL2 levels in patients with Type 2 DM (Bakogianni et al., 2001; Pérez-Méndez et al., 2007). A study done on healthy Japanese individuals suggested higher levels of HDL2 than Table 2. Concentrations of HDL, HDL2 and HDL3 in cases
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Anthropometrical indicators and social variables among enderly with hypertension  and diabetes

Anthropometrical indicators and social variables among enderly with hypertension and diabetes

This study aimed at assessing the anthropometrical indicators and social variables among elderly with hypertension and diabetes. It is a transversal, descriptive research with a quantitative approach, carried out in two municipalities in Southwestern Bahia, Brazil, provided with a sample of 180 interviewees. The statistical analysis was carried out by means of the Chi-Squared test. One identified that 65% of the sample hat hypertension diagnosis and 18.3% of diabetes diagnosis. One evidenced significant statistical difference among illiterate hypertensive elderly with the anthropometrical variables body fat, body mass index, waist circumference and abdominal circumference (p≤ 0.05). Hypertensive elderly who do not work and do not practice any physical activity with the anthropometrical variables body fat, body mass index, waist circumference and abdominal circumference (p≤ 0.05). Married hypertensive elderly with the variables body fat, waist circumference and abdominal circumference (p≤ 0.05). Among diabetic elderly, there was only significant statistical difference among the elderly who do not work and do not practice any physical activity with the variable body fat (p≤ 0.05). However, one evidenced that social- demographic factors may interfere in the anthropometrical variables, and such factors, when associated with the aging phenomenon, may trigger the increase of morbi-mortality of this population by Non-Communicable Chronic Diseases.
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Association between anthropometrical indicators and lifestyle habits of people with diabetes mellitus and neuropathic symptoms

Association between anthropometrical indicators and lifestyle habits of people with diabetes mellitus and neuropathic symptoms

any individual, with diagnosis of DM must be tracked for risk factors for this complication’s development (Rocha;Zanetti; Santos, 2009; Boulton, 2012). The DNS average was higher on people with protective sensibility on the sole of the feet with low or moderate alteration. Studies on South, mid-west and Northeast of Brazil identified that the sensibility loss is related to the emergence of diabetic neuropathies, in addition to determine that on individuals with loss of protective sensibility on the sole of the feet, there is twelve times more chances of developing neuropathies (Dutra et al., 2018; Ferreira; Torre, 2013, Brinati et al., 2017). Therefore, it is worth to highlight the urge of constantly educate people with diabetes about the risks, care and implications to their feet, because of their lower sensibility, aiming to avoid any type of trauma, being mechanic, chemical or thermal, using proper shoes. The evaluation of patients with DM in relation to the risk of developing ulceration on their feet via DNS, constitutes one of the main directives to prevent complications such as diabetic foot, a reason why the nurses must get familiar with this practice and incorporate them to their routine, specially at the context of primary care (Lucoveis et al., 2018). At the nursing inquiry these professionals must precisely identify people with DM that shows neuropathic symptoms, in addition to accomplish a detailed feet evaluation, as a prevention strategy (Boulton et al., 2010). The current study has a few limitations, such as: reduced sample number, moreover, given the age profile it is possible that some answers from the instruments may had been underestimated in relation to the real symptomatology condition. Therefore, one suggests that new researches study the associations explored on this manuscript with other microvascular disorders, such as diabetic retinopathy and chronic renal disease, in addition to diabetic neuropathy.
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