Neuropsychiatric complications in diabetes mellitus
Authors:
Jana Švantnerová; Michal Minár
Authors‘ workplace:
II. neurologická klinika LF UK a UNB, Nemocnica akad. L. Dérera, Bratislava
Published in:
Forum Diab 2018; 7(3): 153-160
Category:
Review Article
Overview
Diabetes mellitus (DM) is a chronic disease with constantly increasing prevalence. In addition to the well known micro and macrovascular complications, patients with diabetes can develop also neuropsychiatric complications. Fear of hypoglycemia, depression and anxiety disorders have an unpleasant impact on the course of disease itself as well as on the other parts of patients´ lives. Therefore it is necessary to search for these kinds of complications and to be able to treat them correctly.
Key words:
anxiety disorders, depression, diabetes mellitus, fear of hypoglycemia
Sources
1. World Health Organisation (WHO). Fact sheets. Diabetes. 2017. Dostupné z WWW: <http://www.who.int/news-room/fact-sheets/detail/diabetes>.
2. International Diabetes Federation (IDF). International Diabetes Federation Atlas, 8th ed. 2017. Dostupné z WWW: <http://www.diabetesatlas.org/across-the-globe.html>.
3. World Health Organisation (WHO). Fact sheets. The top 10 causes of death. 2018. Dostupné z WWW: <http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death>.
4. Balhara Y. Diabetes and psychiatric disorders. Indian J Endocrinol Metab 2011; 15(4): 274. Dostupné z DOI: <http://dx.doi.org/10.4103/2230–8210.85579>.
5. Li C, Ford E, Zhao G et al. Undertreatment of Mental Health Problems in Adults With Diagnosed Diabetes and Serious Psychological Distress: The Behavioral Risk Factor Surveillance System, 2007. Diabetes Care 2010; 33(5): 1061–1064. Dostupné z DOI: <https://doi.org/10.2337/dc09–1515>.
6. Moulton CD, Pickup JC, Ismail K.The link between depression and diabetes: the search for shared mechanisms. Lancet Diabetes Endocrinol 2015; 3(6): 461–471. Dostupné z DOI: <https://doi.org/10.1016/S2213–8587(15)00134–5>.
7. Maia AC, Braga Ade A, Brouwers A et al. Prevalence of psychiatric disorders in patients with diabetes types 1 and 2. Compr Psychiatry 2012; 53(8): 1169–1173. Dostupné z DOI: <https://doi.org/10.1016/j.comppsych.2012.03.011>.
8. Li C, Ford ES, Zhao G et al. Association between diagnosed diabetes and serious psychological distress among U.S. adults: the Behavioral Risk Factor Surveillance System, 2007. Int J Public Health 2009; 54(S1): 43–51. Dostupné z DOI: <http://dx.doi.org/10.1007/s00038–009–0006–1>.
9. Chaudhry R, Mishra P, Mishra J et al. Psychiatric morbidity among diabetic patients: A hospital-based study. Ind Psychiatry J 2010; 19(1): 47. Dostupné z DOI: <http://dx.doi.org/10.4103/0972–6748.77637>.
10. Frier B. How hypoglycaemia can affect the life of a person with diabetes. Diabetes Metab Res Rev 2008; 24(2): 87–92. Dostupné z DOI: <http://dx.doi.org/10.1002/dmrr.796>.
11. [UK Hypoglycaemia Study Group]. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007; 50(6): 1140–1147. Dostupné z DOI: <https://dx.doi.org/10.1007/s00125–007–0599-y>.
12. Dobiáš V. Hypoglykémia, hyperglykémia. Via Practica 2004; 1(4): 226–227. Dostupné z WWW: <http://www.viapractica.sk/index.php?page=pdf_view&pdf_id=1731&magazine_id=1>.
13. Balijepalli C, Druyts E, Siliman G et al. Hypoglycemia: a review of definitions used in clinical trials evaluating antihyperglycemic drugs for diabetes. Clin Epidemiol 2017; 9: 291–296. Dostupné z DOI: <http://dx.doi.org/10.2147/CLEP.S129268>.
14. Leckie AM, Graham MK, Grant JB et al. Frequency, Severity, and Morbidity of Hypoglycemia Occurring in the Workplace in People With Insulin-Treated Diabetes. Diabetes Care 2005; 28(6), 1333–1338. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.28.6.1333>.
15. Pedersen-Bjergaard U, Pramming S, Heller SR et al. Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes Metab Res Rev 2004; 20(6): 479–486. Dostupné z DOI: < https://doi.org/10.1002/dmrr.482>.
16. Akram K, Pedersen-Bjergaard U, Carstensen B et al. Frequency and risk factors of severe hypoglycaemia in insulin-treated Type 2 diabetes: a cross-sectional survey. Diabet Med 2006; 23(7): 750–756. Dostupné z DOI: <https://doi.org/10.1111/j.1464–5491.2006.01880.x>.
17. Brod M, Christensen T, Thomsen TL et al. The Impact of Non-Severe Hypoglycemic Events on Work Productivity and Diabetes Management. Value Health 2011; 14(5): 665–671. Dostupné z DOI: <https://doi.org/10.1016/j.jval.2011.02.001>.
18. Wild D, von Maltzahn R, Brohan E et al. A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Educ Couns 2007; 68(1): 10–15. Dostupné z DOI: <https://doi.org/10.1016/j.pec.2007.05.003 >.
19. Martinka E, Polko J, Mokáň M. Manažment a liečba akútnych komplikácií diabetes mellitus. Metodický list Ústrednej komisie racionálnej farmakoterapie a liekovej politiky MZ SR 2006; 10(1–2): 1–8. Dostupné z WWW: <www.health.gov.sk/Zdroje?/Sources/dokumenty/ww2/casopis/ml/39_dm.pdf>.
20. Martín-Timón I, Del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes 2015; 6(7): 912. Dostupné z DOI: <http://dx.doi.org/10.4239/wjd.v6.i7.912>.
21. Borg WP, During MJ, Sherwin RS et al.Ventromedial hypothalamic lesions in rats suppress counterregulatory responses to hypoglycemia. J Clin Invest 1994; 93(4): 1677–1682. Dostupné z DOI: <http://dx.doi.org/10.1172/JCI117150>.
22. Page KA, Arora J, Qiu M et al. Small decrements in systemic glucose provoke increases in hypothalamic blood flow prior to the release of counterregulatory hormones. Diabetes 2009; 58(2): 448–452. Dostupné z DOI: <10.2337/db08–1224>.
23. Hwang JJ, Parikh L, Lacadie C et al. Hypoglycemia unawareness in type 1 diabetes suppresses brain responses to hypoglycemia. J Clin Invest 2018; 128(4): 1485–1495. Dostupné z DOI: <https://doi.org/10.1172/JCI97696>.
24. Green, L., Feher, M. and Catalan, J. Fears and phobias in people with diabetes. Diabetes/Metabolism Research and Reviews 2000; 16(4): 287–293. Dostupné z DOI: < https://doi.org/10.1002/1520–7560(2000)9999:9999<::AID-DMRR123>3.0.CO;2-T>.
25. Gjerløw E, Bjørgaas MR, Nielsen EW et al. Fear of Hypoglycemia in Women and Men With Type 1 Diabetes. Nurs Res 2014; 63(2): 143–149. Dostupné z DOI: <http://dx.doi.org/10.1097/NNR.0000000000000020>.
26. Sommerfield AJ, Deary IJ, McAulay V et al. Short-Term, Delayed, and Working Memory Are Impaired During Hypoglycemia in Individuals With Type 1 Diabetes. Diabetes Care 2003; 26(2): 390–396. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.26.2.390>.
27. Oyer DS. The Science of Hypoglycemia in Patients with Diabetes. Curr Diabetes Rev 2013; 9(3): 195–208. Dostupné z DOI: <http://dx.doi.org/10.2174/15733998113099990059>.
28. Wu FL, Juang JH, Yeh MC. The dilemma of diabetic patients living with hypoglycaemia. J Clin Nurs 2011; 20(15–16): 2277–2285. Dostupné z DOI: <https://doi.org/10.1111/j.1365–2702.2011.03725.x >.
29. Leiter L, Yale JF, Chiasson JL et al. Assessment of the Impact of Fear of Hypoglycemic Episodes on Glycemic and Hypoglycemia Management. CJD 2005; 29(3): 1–7. Dostupné z WWW: <https://www.researchgate.net/publication/238784539_Assessment_of_the_Impact_of_Fear_of_Hypoglycemic_Episodes_on_Glycemic_and_Hypoglycemia_Management>.
30. Hansen MV, Pedersen-Bjergaard U, Heller SR et al. Frequency and motives of blood glucose self-monitoring in type 1 diabetes. Diabetes Res Clin Pract 2009; 85(2): 183–188. Dostupné z DOI: <https://doi.org/10.1016/j.diabres.2009.04.022>.
31. Hajós TR, Polonsky WH, Pouwer F et al. Toward Defining a Cutoff Score for Elevated Fear of Hypoglycemia on the Hypoglycemia Fear Survey Worry Subscale in Patients With Type 2 Diabetes. Diabetes Care 2014; 37(1): 102–108. Dostupné z DOI: <http://dx.doi.org/10.2337/dc13–0971>.
32. Lam AYR, Xin X, Tan WB et al. Psychometric validation of the Hypoglycemia Fear Survey-II (HFS-II) in Singapore. BMJ Open Diabetes Res Care 2017; 5(1): e000329. Dostupné z DOI: <http://dx.doi.org/10.1136/bmjdrc-2016–000329>.
33. Graue M, Iversen M, Wentzel-Larsen T et al. Assessing fear of hypoglycemia among adults with type 1 diabetes – psychometric properties of the Norwegian version of the Hypoglycemia Fear Survey II questionnaire. Norsk Epidemiologi 2013; 23(1): 75–81. Dostupné z DOI: <http://dx.doi.org/10.5324/nje.v23i1.1605>.
34. Anderbro T, Amsberg S, Adamson U et al. Fear of hypoglycaemia in adults with Type 1 diabetes. Diabet Med 2010; 27(10): 1151–1158. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464–5491.2010.03078.x>.
35. Gonder-Frederick LA, Fisher CD, Ritterband LM et al. Predictors of fear of hypoglycemia in adolescents with type 1 diabetes and their parents. Pediatr Diabetes 2006; 7(4): 215–222. Dostupné z DOI: <https://doi.org/10.1111/j.1399–5448.2006.00182.x>.
36. Patton SR, Dolan LM, Henry R et al. Fear of Hypoglycemia in Parents of Young Children with Type 1 Diabetes Mellitus. J Clin Psychol Med Settings 2008; 15(3): 252–259. Dostupné z DOI: <http://dx.doi.org/10.1007/s10880–008–9123-x>.
37. Davis SN, Fowler S, Costa F. Hypoglycemic counterregulatory responses differ between men and women with type 1 diabetes. Diabetes 2000; 49(1): 65–72. Dostupné z DOI: <https://doi.org/10.2337/diabetes.49.1.65>.
38. Jørgensen HV, Pedersen-Bjergaard U, Rasmussen AK et al. The Impact of Severe Hypoglycemia and Impaired Awareness of Hypoglycemia on Relatives of Patients With Type 1 Diabetes. Diabetes Care 2003; 26(4): 1106–1109. Dostupné z DOI: <https://doi.org/10.2337/diacare.26.4.1106>.
39. Lawton J, Rankin D, Elliott J et al. Experiences, Views, and Support Needs of Family Members of People With Hypoglycemia Unawareness. Diabetes Care 2014; 37(1): 109–115. Dostupné z DOI: <https://doi.org/10.2337/dc13–1154>.
40. [Anxiety and Depression Association of America (ADAA)]. Facts & Statistics. 2018. Dostupné z WWW: <https://adaa.org/about-adaa/press-room/facts-statistics>.
41. Collins MM, Corcoran P, Perry IJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med 2009; 26(2): 153–161. Dostupné z DOI: <https://doi.org/10.1111/j.1464–5491.2008.02648.x>.
42. Anderson RJ, Freedland KE, Clouse RE et al. The Prevalence of Comorbid Depression in Adults With Diabetes: A meta-analysis. Diabetes Care 2001; 24(6): 1069–1078. Dostupné z DOI: <https://doi.org/10.2337/diacare.24.6.1069>.
43. Renn BN, Feliciano L, Segal DL. The bidirectional relationship of depression and diabetes: A systematic review. Clin Psychol Rev 2011; 31(8): 1239–1246. Dostupné z DOI: <https://doi.org/10.1016/j.cpr.2011.08.001>.
44. Nouwen A, Winkley K, Twisk J et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia 2010; 53(12): 2480–2486. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–010–1874-x>.
45. Golden SH, Lazo M, Carnethon M et al. Examining a Bidirectional Association Between Depressive Symptoms and Diabetes. JAMA 2008; 299(23): 2751. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.299.23.2751>.
46. Knol MJ, Twisk JW, Beekman AT et al. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia 2006; 49(5): 837–845. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–006–0159-x>.
47. Mezuk B, Eaton W, Golden S. Depression and Type 2 Diabetes Over the Lifespan: A Meta-Analysis: Response to Nouwen, Lloyd, and Pouwer. Diabetes Care 2009; 32(5): e57. Dostupné z DOI: <https://doi.org/10.2337/dc08–0985>.
48. Kivimäki M, Hamer M, Batty GD et al. Antidepressant Medication Use, Weight Gain, and Risk of Type 2 Diabetes: A population-based study. Diabetes Care 2010; 33(12): 2611–2616. Dostupné z DOI: <http://dx.doi.org/10.2337/dc10–1187>.
49. Mc Sharry J, Bishop FL, Moss-Morris R et al. ‘The chicken and egg thing’: Cognitive representations and self-management of multimorbidity in people with diabetes and depression. Psychol Health 2013; 28(1): 103–119. Dostupné z DOI: <http://dx.doi.org/10.1080/08870446.2012.716438>.
50. Lustman PJ, Anderson RJ, Freedland K Eet al. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000; 23(7): 934–942. Dostupné z DOI: <https://doi.org/10.2337/diacare.23.7.934>.
51. de Groot M1, Anderson R, Freedland KE et al. Association of Depression and Diabetes Complications: A Meta-Analysis. Psychosom Med 2001; 63(4): 619–630. Dostupné z DOI: <http://dx.doi.org/10.1097/00006842–200107000–00015>.
52. Katon WJ, Rutter C, Simon G et al. The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes. Diabetes Care 2005; 28(11): 2668–2672. Dostupné z DOI: <https://doi.org/10.2337/diacare.28.11.2668>.
53. Lin EH, Katon W, Von Korff M et al. Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care. Diabetes Care 2004; 27(9): 2154–2160. Dostupné z DOI: <https://doi.org/10.2337/diacare.27.9.2154>.
54. Egede LE, Grubaugh AL, Ellis C .The effect of major depression on preventive care and quality of life among adults with diabetes. Gen Hosp Psychiatry 2010; 32(6): 563–569. Dostupné z DOI: <https://doi.org/10.1016/j.genhosppsych.2010.08.002>.
55. Katon WJ, Lin EH, Russo J et al. Cardiac risk factors in patients with diabetes mellitus and major depression. J Gen Intern Med 2004; 19(12): 1192–1199. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1525–1497.2004.30405.x>.
56. Xie J, Deng W. Psychosocial intervention for patients with type 2 diabetes mellitus and comorbid depression: a meta-analysis of randomized controlled trials. Neuropsychiatr Dis Treat 2017; 13: 2681–2690. Dostupné z DOI: <https://doi.org/10.2147/NDT.S116465>.
57. Champaneri S, Wand GS, Malhotra SS et al. Biological Basis of Depression in Adults with Diabetes. Current Diabetes Reports 2010; 10(6): 396–405. Dostupné z DOI: <http://dx.doi.org/10.1007/s11892–010–0148–9>.
58. Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Ann N Y Acad Sci 2016; 1391(1): 20–34. Dostupné z DOI: <http://dx.doi.org/10.1111/nyas.13217>.
59. Anagnostis P, Athyros VG, Tziomalos K et al. Clinical review: The Pathogenetic Role of Cortisol in the Metabolic Syndrome: A Hypothesis. J Clin Endocrinol Metab 2009; 94(8): 2692–2701. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2009–0370>.
60. Pivonello R, Isidori AM, De Martino MC et al. Complications of Cushing‘s syndrome: state of the art. Lancet Diabetes Endocrinol 2016; 4(7): 611–629. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(16)00086–3>.
61. Mommersteeg PM, Herr R, Zijlstra WP et al. Higher levels of psychological distress are associated with a higher risk of incident diabetes during 18 year follow-up: results from the British household panel survey. BMC Public Health 2012; 12: 1109. Dostupné z DOI: <https://doi.org/10.1186/1471–2458–12–1109>.
62. Kumar A, Gupta R, Thomas A et al. Focal Subcortical Biophysical Abnormalities in Patients Diagnosed With Type 2 Diabetes and Depression. Arch Gen Psychiatry 2009; 66(3): 324. Dostupné z DOI: <http://dx.doi.org/10.1001/archgenpsychiatry.2008.548>.
63. Ajilore O, Haroon E, Kumaran S et al. Measurement of Brain Metabolites in Patients with type 2 Diabetes and Major Depression Using Proton Magnetic Resonance Spectroscopy. Neuropsychopharmacology 2006; 32(6): 1224–1231. Dostupné z DOI: <http://dx.doi.org/10.1038/sj.npp.1301248>.
64. Kumar A, Haroon E, Darwin C et al. Gray matter prefrontal changes in type 2 diabetes detected using MRI. J Magn Reson Imaging 2008; 27(1): 14–19. Dostupné z DOI: <https://doi.org/10.1002/jmri.21224>.
65. Rustad JK, Musselman DL, Nemeroff CB. The relationship of depression and diabetes: Pathophysiological and treatment implications. Psychoneuroendocrinology 2011; 36(9): 1276–1286. Dostupné na DOI: <https://doi.org/10.1016/j.psyneuen.2011.03.005>.
66. Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005; 15(4): 357–376. Dostupné z DOI: <https://doi.org/10.1016/j.euroneuro.2005.04.012>.
67. World Health Organization (WHO) Mental Health. Fact sheets. 2018. Dostupné z WWW: <http://www.who.int/mental_health/advocacy/en/#Factsheets>.
68. Grigsby AB, Anderson RJ, Freedland KE et al. Prevalence of anxiety in adults with diabetes. J Psychosom Res 2002; 53(6): 1053–1060. Dostupné z DOI: <https://doi.org/10.1016/S0022–3999(02)00417–8>.
69. Fisher L, Skaff MM, Mullan JTet al. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabet Med 2008; 25(9): 1096–1101. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464–5491.2008.02533.x>.
70. Berlin I, Bisserbe JC, Eiber R et al. Phobic Symptoms, Particularly the Fear of Blood and Injury, Are Associated With Poor Glycemic Control in Type I Diabetic Adults. Diabetes Care 1997; 20(2): 176–178. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.20.2.176>.
71. Pitsavos C, Panagiotakos DB, Papageorgiou C et al. Anxiety in relation to inflammation and coagulation markers, among healthy adults: The ATTICA Study. Atherosclerosis 2006; 185(2): 320–326. Dostupné z DOI: <http://dx.doi.org/10.1016/j.atherosclerosis.2005.06.001>.
72. Farvid MS, Qi L, Hu FB et al. Phobic anxiety symptom scores and incidence of type 2 diabetes in US men and women. Brain Behav Immun 2014; 36: 176–182. Dostupné z DOI: <http://dx.doi.org/10.1016/j.bbi.2013.10.025>.
73. Mirza S, Hossain M, Mathews C et al. Type 2-diabetes is associated with elevated levels of TNF-alpha, IL-6 and adiponectin and low levels of leptin in a population of Mexican Americans: A cross-sectional study. Cytokine 2012; 57(1): 136–142. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cyto.2011.09.029>.
74. Pečeňák J. Klasifikácia v psychiatrii. Univerzita Komenského Bratislava: Bratislava 2014. ISBN 978–80–223–3662–8.
75. Ludman E, Katon W, Russo J et al. Panic episodes among patients with diabetes. Gen Hosp Psychiatry 2006; 28(6): 475–481. Dostupné z DOI: <http://dx.doi.org/10.1016/j.genhosppsych.2006.08.004>.
76. Smith KJ, Deschênes SS, Schmitz N. Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta-analysis. Diabet Med 2018; 35(6): 677–693. Dostupné z DOI: <https://doi.org/10.1111/dme.13606>.
77. Demmer RT, Gelb S, Suglia SF et al. Sex Differences in the Association Between Depression, Anxiety, and Type 2 Diabetes Mellitus. Psychosom Med 2015; 77(4): 467–477. Dostupné z DOI: <http://dx.doi.org/10.1097/psy.0000000000000169>.
78. Edwards L, Mezuk B. Anxiety and risk of type 2 diabetes: Evidence from the Baltimore Epidemiologic Catchment Area Study. J Psychosom Res 2012; 73(6): 418–423. Dostupné z DOI: <https://doi.org/10.1016/j.jpsychores.2012.09.018>.
79. Steudte S, Stalder T, Dettenborn L et al. Decreased hair cortisol concentrations in generalised anxiety disorder. Psychiatry Research 2011; 186(2–3): 310–314. Dostupné z DOI: <http://dx.doi.org/10.1016/j.psychres.2010.09.002>.
80. Hasan S, Clavarino A, Dingle K et al. Diabetes Mellitus and the Risk of Depressive and Anxiety Disorders in Australian Women: A Longitudinal Study. J Womens Health (Larchmt) 2015; 24(11): 889–898. Dostupné z DOI: <http://dx.doi.org/10.1089/jwh.2015.5210>.
81. Smith K, Béland M, Clyde M. et al. Association of diabetes with anxiety: A systematic review and meta-analysis. J Psychosom Res 2013; 74(2): 89–99. Dostupné z DOI: <https://doi.org/10.1016/j.jpsychores.2012.11.013>.
82. Anderson R, Grigsby A, Freedland K et al. Anxiety and Poor Glycemic Control: A Meta-Analytic Review of the Literature. Int J Psychiatry Med 2002; 32(3): 235–247. Dostupné z DOI: <http://dx.doi.org/10.2190/klgd-4h8d-4ryl-twq8>.
83. Smith K, Schmitz N. Association of Depression and Anxiety Symptoms With Functional Disability and Disability Days in a Community Sample With Type 2 Diabetes. Psychosomatics 2014; 55(6): 659–667. Dostupné z DOI: <http://dx.doi.org/10.1016/j.psym.2014.05.015>.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
![Issue 3](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image/663be842dfb9bb98956664c399b64f3d.jpeg)
2018 Issue 3
Most read in this issue
- Polyneuropathies in patients with diabetes mellitus
- Balance disorders in the presence of diabetes mellitus
- Proximal diabetic amyotrophy: case reports
- Cardiac autonomic neuropathy as serious complication of diabetes mellitus