Effect of remnant cholesterol on the onset of diabetes mellitus.

New onset of diabetes mellitus was noted as the commonest comorbidity in the COVID-19 pandemic, which contributed to a worse prognosis. Existing evidence showed that new-onset diabetes is associated with increased mortality compared to nondiabetic and known diabetic patients in the COVID-19 era. SARS-CoV-2 virus can worsen existing diabetes; at the same time, it can trigger new-onset diabetes that eventually worsens patient outcomes. Thus, this study is aimed at determining the prevalence and factors associated with new onset of diabetes mellitus among COVID-19 patients. Institution-based retrospective cross-sectional study design was conducted by reviewing 244 patient's records in the Addis Ababa COVID-19 care center. Descriptive statistics and binary logistic regression were used. During bivariate analysis, variables with p ≤ 0.25 were transferred into multivariate analysis. Adjusted odds ratios to determine the strength and presence of the association with a 95% confidence interval and p value ≤ 0.05 were considered, respectively. The mean age of the study participants was 53.2 years with (SD = 13.35). The study findings showed that 31.1% (CI: 25.4-37.4) of COVID-19 patients had new onset of diabetes mellitus; of those, 11.8% had type 1 and 88.2% had type 2 diabetes. Being male (aOR = 2.9; 95% CI: 1.2, 7.1), family history of hypertension (aOR = 3.7; 95% CI: 1.3, 10.5), obesity (aOR = 3.1; 95% CI: 1.01, 8.9), having pulmonary embolism (aOR = 0.2; 95% CI: 0.06, 0.04), and hyperkalemia (aOR = 9.3; 95% CI: 1.8, 47.3) showed statistically significant association with new onset of diabetes mellitus. A significant proportion of COVID-19 patients had been diagnosed with new onset of diabetes mellitus, and new-onset type 2 diabetes mellitus is the most common diabetes mellitus type. Being male, obesity, having a pulmonary embolism, family history of hypertension, and hyperkalemia were independently associated with new onset of diabetes mellitus among COVID-19 patients. Therefore, focused interventions need to be strengthened towards the identified factors.

Background: The association between pre-existing diabetes mellitus (DM) and subsequent increased incidence of breast cancer (BC), as well as worse survival after BC diagnosis, is well described. However, the reverse relationship of BC or metastases to development of new onset DM is unknown. Preclinical evidence suggests that increased bone destruction due to bone metastases or endocrine therapy impairs insulin secretion via TGFβ-mediated oxidation of the ryanodine receptor in pancreatic β- cells, predisposing patients to development of new onset DM. This analysis describes the prevalence and new onset of DM in metastatic BC compared to matched, unaffected controls and non-metastatic BC. Methods: This retrospective study collected data on women from the Indiana Network for Patient Care (INPC, a multi-health system electronic health record data warehouse), and the Indiana State Department of Health Cancer Registry from 2015 to 2017. Diagnosis of BC and metastases were established using ICD codes from INPC and confirmed in the cancer registry. DM was defined using a combination of ICD codes, diabetic medication prescriptions, and hemoglobin A1c >6.5%. Controls without BC were matched to all BC cases by birth year and race. The prevalence of DM before, or < 30 days after, BC diagnosis is described for non- cancer controls, all patients with BC, and subgroups without metastases, any metastases, and with bone metastases. In patients without evidence of DM prior to or < 30 days after BC diagnosis, the incidence of new onset DM was compared to matched controls over the same time period. The occurrence of new DM was evaluated both including and excluding the first 6 months after BC diagnosis to account for potential DM diagnosis simply due to medical attention. Prevalence and subsequent incidence of DM was compared between cases and controls using Pearson’s chi-square tests. Variables including demographics, comorbidities, BC treatment, A1c values, and DM treatments were also collected. Results: Any DM diagnosis, pre-existing DM, and new onset DM were higher in breast cancer cases compared to controls (Table). While pre-existing DM was similar between those with metastatic and non-metastatic DM (35.0% vs. 32.2%, p=0.22), new onset DM was higher in metastatic disease compared to non-metastatic BC (14.4% vs. 7.0%, p<0.001). Hemoglobin A1c was higher in those with metastatic disease, particularly those with bone metastases (8.8 vs 7.5, p<0.001). Conclusions: Diabetes is highly prevalent in this Indiana BC cohort. Incidence of new onset DM after BC is higher in those with metastatic BC compared to both controls and BC cases without metastatic disease. Hemoglobin A1c was highest in those with bone metastases, further supporting the hypothesis that bone turnover may influence insulin secretion and glucose metabolism. Additional investigation will analyze the influence of medications (chemo-, endocrine, and bone protective therapy) on development of DM. As more patients live longer with metastatic BC, identification and management of DM will be imperative given its impact on BC survival, treatment delivery, healthcare costs, and quality of life. ControlsBreast cancer (BC) casesAllNon-metAll metBone metNon-bone metTotal n10212102129760452236216Any DM, n (%)2464 (24.1)4406 (43.1)3823 (39.2)223 (49.3)111 (47.0)112 (51.9)p-value2<0.001<0.001<0.001<0.001<0.001Pre-existing DM1, n (%)2111 (20.1)3301 (32.2)3143 (32.2)158 (35.0)81 (34.3)77 (35.6)p-value2<0.001<0.001<0.001<0.001<0.001New DM after BC1, n (%)353 (3.5)745 (7.3)680 (7.0)65 (14.4)30 (12.7)35 (16.2)p-value2<0.001<0.001<0.001<0.001<0.001New DM > 6 months after BC1, n (%)336 (3.3)621 (6.1)565 (5.8)56 (12.4)27 (11.4)29 (13.4)p-value2<0.001<0.001<0.001<0.001<0.001HgbA1c in those with DM, Mean (SD)7.6 (1.6)7.6 (1.6)7.5 (1.6)8.3 (2.1)7.5 (1.6)8.8 (2.3)p-value21.00.001<0.0010.40<0.0011- For controls, values in relation to index date. 2 - p-values versus controls. Citation Format: Tarah Ballinger, Sarah El-Azab, Ziyue Liu, Theresa Guise, Erik Imel. High prevalence and incidence of new onset diabetes in metastatic breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-11.

New-onset diabetes in pancreatic cancer: A study in the primary care setting

ObjectiveTo evaluate (i) the prevalence and association of euthyroid sick syndrome (ESS) [decreased FT3 and/or FT4 and normal/decreased TSH] with severity indexes of type 1 diabetes mellitus (T1DM) onset such as diabetic ketoacidosis (DKA) and kidney damage [acute kidney injury (AKI) based on KDIGO criteria, acute tubular necrosis (ATN), renal tubular damage (RTD)], (ii) relationship between clinical/metabolic parameters at T1DM onset and thyroid hormones, and (iii) ESS as a prognostic indicator of delayed recovery from kidney damage.MethodsA total of 161 children with T1DM onset were included. RTD was defined by abnormal urinary beta-2-microglobulin and/or neutrophil gelatinase-associated lipocalin (NGAL) and/or tubular reabsorption of phosphate <85% and/or fractional excretion of Na>2%. ATN was defined by RTD+AKI.ResultsOf 161 participants, 60 (37.3%) presented ESS. It was more prevalent in case of more severe T1DM presentation both in terms of metabolic derangement (DKA) and kidney function impairment (AKI, RTD and ATN). Only ATN, however, was associated with ESS at adjusted analysis. FT3 inversely correlated with serum triglycerides and creatinine, and urinary calcium/creatinine ratio and NGAL. Participants with euthyroidism showed earlier recovery from AKI than those with ESS. ESS spontaneously disappeared.ConclusionsESS is associated with T1DM onset severity and spontaneously disappears. ESS delayed the recovery from AKI.ImpactThis is the first longitudinal study describing in detail the relationship between clinical/metabolic factors at type 1 diabetes mellitus (T1DM) onset and thyroid hormones, with particular attention to the relationship between diabetic ketoacidosis (DKA)-related kidney function impairment and euthyroid sick syndrome (ESS).Participants with more severe T1DM onset presentation both in terms of metabolic derangement and kidney function impairment had an increased prevalence of ESS.Children with ESS had a slower recovery from acute kidney injury compared with those without ESS.ESS spontaneously disappeared in all participants.

Shock Wave Lithotripsy for Renal Stones Is Not Associated with Hypertension and Diabetes Mellitus

Objective Few reports have examined the association between "weight gain since the past combined with the presence of obesity" and diabetes mellitus (DM). Therefore, we longitudinally examined the influence of the combination of "weight gain of ≥10 kg since the age of 20 years" and the presence of obesity on the new onset of DM.Methods We identified 8,704 National Health Insurance enrollees in Habikino City, Osaka Prefecture, who underwent specific health checkups in 2013. After excluding those who had DM previously and those who were untraceable and had missing data, 5,708 participants were included in the analysis. The risk of the new onset of DM was classified into "no weight gain/non-obese," "no weight gain/obese," "weight gain/non-obese," and "weight gain/obese" groups. Weight gain and obesity were defined as gaining ≥10 kg since the age of 20 based on responses to a standard questionnaire from the Ministry of Health, Labour and Welfare and a BMI ≥25 kg/m2. A Cox proportional hazards model was used to examine the risk of the new onset of DM.Results Participants' mean age was 64.3 ± 7.9 years. During the mean follow-up period of 3.14 ± 1.13 years, 126 (6.0%) men and 133 (3.7%) women developed DM. The hazard ratios (95% confidence interval [CI]) for the new onset of DM were significantly higher in the weight gain/non-obese (1.77 [95% CI: 1.26-2.49]) and weight gain/obese groups (2.76 [95% CI: 2.05-3.72]), with the no weight gain/non-obese group as the reference group. By sex, the hazard ratio for men in the weight gain/obese group was 2.06 (95% CI: 1.34-3.18), whereas the hazard ratio was higher for women in the weight gain/obese (3.68 [95% CI: 2.44-5.53]) and weight gain/non-obese groups (2.19 [95% CI: 1.35-3.55]).Conclusion Weight gain was a risk factor for the development of DM in individuals without obesity. This factor was more pronounced in women, who had a higher risk of the new onset of DM if they had gained > 10 kg since the age of 20, even if their BMI was less than 25 kg/m2. The results suggest that those who fall into this category should receive lifestyle improvement guidance, even if they are not eligible for specific health guidance.

Status of the coronary arteries at necropsy in diabetes mellitus with onset after age 30 years: Analysis of 229 diabetic patients with and without clinicalevidence of coronary heart disease and comparison to 183 control subjects

It remains unknown whether diabetes mellitus (DM) is a risk factor for mild cognitive impairment (MCI). To investigate the association of DM with MCI using a population-based case-control design. Population-based case-control study. Academic research. Our study was conducted, among subjects aged 70 to 89 years on October 1, 2004, who were randomly selected from the Olmsted County (Minnesota) population. Main Outcome Measure We administered to all participants a neurologic examination, the Clinical Dementia Rating Scale, and a neuropsychological evaluation (including 9 tests in 4 cognitive domains) to diagnose normal cognition, MCI, or dementia. We assessed history of DM, DM treatment, and DM complications by interview, and we measured fasting blood glucose levels. History of DM was also confirmed using a medical records linkage system. We compared 329 subjects having MCI with 1640 subjects free of MCI and dementia. The frequency of DM was similar in subjects with MCI (20.1%) and in subjects without MCI (17.7%) (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.85-1.57). However, MCI was associated with onset of DM before age 65 years (OR, 2.20; 95% CI, 1.29-3.73), DM duration of 10 years or longer (OR, 1.76; 95% CI, 1.16-2.68), treatment with insulin (OR, 2.01; 95% CI, 1.22-3.31), and the presence of DM complications (OR, 1.80; 95% CI, 1.13-2.89) after adjustment for age, sex, and education. Analyses using alternative definitions of DM yielded consistent findings. These findings suggest an association of MCI with earlier onset, longer duration, and greater severity of DM.

New-onset diabetes mellitus (DM) may herald pancreatic cancer (PaC). We determined whether changes in body weight distinguished PaC-associated DM (PaCDM) from type 2 DM. Among Olmsted County residents, we identified 29 PaCDM and 43 type 2 DM subjects who had serial fasting blood glucose measurements, new-onset DM, and no cancer-specific symptoms at DM onset. We compared body weight (kg) and fasting blood glucose (mg/dL) at DM onset, 1 to 2 years before and at index date in the 2 groups. Fasting blood glucose values were similar before and at the onset of DM. Before onset of DM, PaCDM and type 2 DM subjects had similar body weight (P = 0.80). However, at onset of DM, 59% of PaCDM subjects lost weight versus 30% of type 2 DM subjects (P = 0.02). At onset of DM, 56% of type 2 DM subjects gained weight versus 31% of PaCDM subjects (P = 0.04). By index date, PaCDM subjects lost more weight than type 2 DM subjects did (8.3 ± 8.3 vs 0.8 ± 4.8 kg, P < 0.01). Although new-onset primary type 2 DM is typically associated with weight gain, weight loss frequently precedes onset of PaCDM. The paradoxical development of diabetes in the face of ongoing weight loss may be an important clue to understanding the pathogenesis of PaCDM.

The aim of the study is to investigate differences in clinical presentation, disease stage and survival of operable pancreatic cancer patients with new onset DM compared to long standing diabetes mellitus (DM) and non diabetics. A prospectively maintained pancreatic cancer surgery database of a tertiary care teaching hospital from January 2006 to August 2012 was reviewed. Only patients with a histological diagnosis of pancreatic carcinoma (PC) were included in final analysis. DM was defined as HbA1c >6.5% or any patient on anti-diabetic treatment regardless of HbA1c value. New onset DM was defined when diagnosed within two preceding years of surgery. Patients were stratified into two groups: DM and non DM. Among the DM patients, patients with new onset DM were further stratified and studied separately. Staging of PC was performed according to the 6(th) edition of AJCC. Survival of patients with PC was determined by reviewing medical records. Patients and their families were contacted if there was no existing follow-up. Eighty-six patients (n=55, 63.9% male) with a mean age of 62 years (range, 29-85 years) underwent pancreatic cancer surgery during the study period. Of the 86 patients, 30 (34%) had DM of which eight patients (9% overall) had new onset DM. DM patients tended to be older compared to non DM patients (67.8 vs. 58.5 years, P=0.0005). The majority of non DM patients were symptomatic (98.2%), and there was a tendency for DM group patients to be asymptomatic at presentation (13.3% vs. 1.8%, P=0.05). Abdominal pain was less common in DM patients compared to non DM patients (30% vs. 53.6%, P=0.04). The median duration of new onset DM prior to diagnosis of PC was 2 months (range, 1-23 months). There was a tendency for DM patients to present at an early stage (stage I and stage II) (P=0.08). There was no difference in survival (P=0.17) for new onset DM compared to long standing DM and non DM patients. DM patients tend to be older and are less likely to present with abdominal pain. Asymptomatic presentation and early stage disease tends to occur in DM patients. A larger sample size is required to determine if survival of new onset DM patients differs from long standing and non DM patients.

A high body mass index (BMI) is associated with the onset of diabetes mellitus (DM). However, evidence regarding the association between changes in BMI and DM onset is limited, and the effect of annual BMI (kg/m2/year) change on DM onset is unknown. Therefore, we assessed the effects of changes in BMI and annual BMI on DM onset. We enrolled 13,949 participants aged 21-81 years who underwent an annual health checkup at least twice between April 2003 and March 2021 and examined the effect of BMI change and annual BMI change on DM onset. In total, 462 individuals newly developed DM. Compared with a BMI change of -0.25-<0.25, univariate and multivariate analyses-adjusted for age, sex, BMI, systolic blood pressure, creatinine, total cholesterol, triglycerides, alanine aminotransferase, hemoglobin A1c, and family history of DM-showed that a BMI change <-2 was associated with a lower risk, while 2 ≤ BMI change < 4 and 4 ≤ BMI change were associated with a higher risk of DM onset. In contrast, compared with -0.05 ≤ BMI change per year < 0.05, univariate and multivariate analyses showed a significant association between DM onset and 0.3 ≤ BMI change per year. In the age-stratified analysis, these associations were significant among younger and middle-aged participants but not in older adults. In conclusion, changes in BMI affect DM onset. Therefore, clinicians can prevent DM onset by providing guidance based on BMI and focusing on a ≥2 increase in BMI and a ≥0.3 increase per year of BMI in young and middle-aged individuals.

Type 2 diabetes mellitus(DM) is a progressive disease and the rate of progression from non-diabetes to DM varies considerably between individuals, ranging from a few months to many years. It is important to understand the mechanisms underlying the progression of diabetes. In the present study, a high-resolution metabolomics(HRM) analysis was performed to detect potential biomarkers and pathways regulating the mode of onset by comparing subjects who developed and did not develop type2 DM at the second year in a 3-year prospective cohort study. Metabolic profiles correlated with progression to DM were examined. The subjects (n=98) were classified into four groups: Control (did not develop DM for 3 years), DM (diagnosed with DM at the start of the study), DM onset at the third year and DM onset at the second year. The focus was on the comparison of serum samples of the DM groups with onset at the second and third year from the first year, where these two groups had not developed DM, yet. Analyses involved sample examination using liquid chromatography-mass spectrometry-based HRM and multivariate statistical analysis of the data. Metabolic differences were identified across all analyses with the affected pathways involved in metabolism associated with steroid biosynthesis and bile acid biosynthesis. In the first year, higher levels of cholesterol {mass-to charge ratio (m/z)369.35, (M+H-H2O)+}, 25-hydroxycholesterol [m/z403.36, (M+H)+], 3α,7α-dihydroxy-5β-cholestane [m/z443.33, (M+K)+], 4α-methylzymosterol-4-carboxylate [m/z425.34, (M+H‑H2O)+], and lower levels of 24,25-dihydrolanosterol [m/z429.40, (M+H)+] were evident in the group with DM onset at the second year compared with those in the group with DM onset at the third year. These results, with a focus on the cholesterol biosynthesis pathway, point to important aspects in the development of DM and may aid in the development of more effective means of treatment and prevention.

Background: Statin drugs are using all over the world for the treatment of hypercholesterolemia. There is hypothesis that post menopausal women who used statin drugs long time can develop the onset of type 2 diabetes mellitus because statin drugs inhibit the signal transduction of insulin by inhibiting oxidative phosphorylation resulting in decrease secretion of insulin leads to hyperglycemia. The aim of this study to estimate the effects of statin drugs on blood glucose level and HbA!c% in post menopausal women.&#x0D; Methodology: This case comparative study was done at LUMHS Jamshoro. The sampling was done by Non Probability method. Total number of150 subjects were divided in 2 group’s i.e group A (Control group) &amp; group B (Case study group). The fasting glucose level was measured by glucose oxidase method while HbA1c% &amp; serum cholesterol levels were determined by Kit method by using auto analyzer. The statistical analysis was done by SPSS 21 by applying ANOVA test for multiple variants. &#x0D; Results: The mean with S.D fasting blood glucose levels in control group was 78± 9.05 mg/dl while in case study group it was 134 ± 12.15mg/dl (p &lt;0.05), HbA1c% levels in control group was 5.3 ± 1.1% while in case study group it was 7.4 ± 1.3% (p&lt;0.05) and serum cholesterol in control group was 157± 9.75 mg/dl while in case study group it was 195 ± 8.78 mg/dl (p&lt;0.05) was significantly (P&lt;0.05). The glycemic index &amp; fasting blood glucose levels significantly observed elevated in post menopausal women who were use statin drugs since last three years&#x0D; Conclusion: This study concluded that there was significant relation of statin drugs on increasing of blood glucose levels so they can induce the onset of Type-2 Diabetes Mellitus.

e15192 Background: ADT is a mainstay treatment in pts with PC and is supposedly associated to an unfavorable metabolic and cardiovascular profile. Recently, a meta-analysis of randomized controlled trials (RCT) found no association between ADT and increased risk of CVE (JAMA 2011). However, no conclusive data were available about ADT association with metabolic changes and adverse CVE or DM because of pts selection in RCT. Therefore, we performed a meta-analysis of adjusted observational results in order to look for DM and CVE onset in an ADT unselected population. Methods: Medline, Cochrane Library and Biomed Central were searched for articles addressing adverse events related to ADT in patients with PC. Selection criteria were: not RCT, pts assigned to ADT or not, adjusted risk of CVE and DM according to ADT. Exclusion criteria were: duplicate publication, comparison of two different strategies of ADT (different drugs or duration). Cardiovascular death was the primary endpoint; non-fatal myocardial infarction (MI), stroke/transient ischemic attack (TIA) and new DM onset were secondary endpoints. Random effects model with generic inverse variance weighting was used to estimate adjusted risks as odds ratios (OR) with 99% confidence interval (CI). Results: We selected 12/2100 screened studies. We included 208643 pts of which 102177 received ADT. At a follow up of 5 years (4-7.5), ADT did not result as an independent risk factor for cardiovascular death (OR= 1.04; 99% CI= 0.94-1.14). No increased risk of MI (OR= 1.13; CI= 0.86-1.48) or of stroke/TIA (OR= 1.11; CI= 0.78-1.57) were detected. Incident DM was more frequent among ADT pts (OR= 1.32; CI= 1.14-1-53). Even in 7205 pts with previous CVE (2450 received ADT), ADT was not associated with an increased risk of overall death (OR= 1.23; CI= 0.87-1.75). Meta-regression analysis showed no significant interactions between duration of ADT and cardiovascular death or incident DM. Conclusions: In non-selected pts,ADT appears to increase the risk of incident DM, but not of CVE or stroke/TIA. Moreover, overall mortality is not increased in pts with a history of CVE.

Introduction &amp; Objective: Primary liver cancer (PLC) is a major global health concern, with diabetes mellitus (DM) identified as a potential risk factor. Our study aimed to evaluate the temporal association between the onset of DM and the risk of developing PLC. Methods: A retrospective cohort study was conducted, encompassing a sample of 89,243 Chinese adults free from any previous diagnoses of cancer or DM. Incidence rates of new-onset DM and PLC were recorded over a median follow-up of 14.04 years. Data from biennial health assessments between 2006 and 2020 were analyzed using Cox proportional hazards models, adjusting for demographics and lifestyle factors. Results: Of the participants, 13,225 developed incident DM. Those with new-onset DM exhibited a higher risk of PLC within the first five years post-diagnosis (HR 3.09), which declined over time (Figure). HBsAg-positive individuals with recent-onset DM faced an even higher risk (HR 4.30). Subgroup analysis identified males, non-obese, current drinkers, and smokers as high-risk groups for PLC among those with new-onset DM. Conclusion: The onset of DM is associated with a heightened risk of PLC, especially within the first five years following diagnosis, particularly for those with concurrent HBsAg positivity. Our findings highlight the need for vigilant PLC screening in newly diagnosed diabetic patients. Disclosure X. Qi: None. Y. Li: None. S. Zhang: None. C. Liu: None. S. Wang: None. J. Gao: None.