Implication of Sex Differences in Visceral Fat for the Assessment of Incidence Risk of Type 2 Diabetes Mellitus

Comparing Primary Prevention Recommendations: A Focused Look at United States and European Guidelines on Dyslipidemia.

Diabetes mellitus and heart failure: insights from a toxic relationship

Objective To explore the related risk factors between adults with diabetes and cardiovascular disease risk.Methods Five hundred and fifty-seven patients whose age were over 20 years with diabetes mellitus were hospitalized in the First People's Hospital of Shangqiu from Jan.2008 to Dec.2013.According to the major risk factors of cardiovascular risk assessment,Framingham cardiac risk score was use to assess and stratify patients;and then graded as low risk group(＜ 10％),intermediate risk group(10％ to 20％) and the high risk group(＞ 20％).Predicted the next 10 years the probability of the risk of cardiovascular disease.Results Among 557 patients,275 cases were male and 282 cases were female,79 cases (14.18％) were type Ⅰ diabetes mellitus and 478 cases (85.82％) were type Ⅱ diabetes mellitus.Meanwhile,10 years the probability of the risk of cardiovascular disease showed that there were 103 cases of low risk group(18.5％),91 cases of intermediate risk group (16.3％),195 cases of high risk group (30.2％) and 168 cases of cardiovascular disease group who had cardiovascular disease (30.2％).(1) Characteristics of risk factors for cardiovascular disease of risk stratification:①There was high incidence of metabolic syndrome in patients with diabetes mellitus,which was up to 37.9％ even in low risk group and 60.5％ in high risk group.②The average age of high risk group was (63.5 ± 11.7) years old which was higher than the low risk group ((50.3 ± 15.4) years old).③Systolic pressure of high risk group was (143.4 ± 18.1) mmHg,higher than that of the low risk group ((125.7 ± 13.2) mmHg).④It was hard to control the blood pressure in high risk group,so as a few cases(32.3％) were up to the standard.⑤The incidence of chronic kidney disease in high risk group was 21.5％,which was significant higher than that in intermediate risk group(7.7％) and low risk group(7.8％).(2) In high risk groupn,type Ⅱ diabetes mellitus's incidence was 31.6％ which was higher than type Ⅰ diabetes mellitus's(16.4％).(3)In high risk group,the proportion of age range from 70 to 79 years old was up to 39.2％.Conclusion The overall risk of cardiovascular disease increases in patients with type Ⅱ diabetes.Metabolic factors may be the main risk.The risk assessment of diabetic patients will help to increase the intensity of treatment. Key words: Diabetes mellitus; Cardiovascular disease; Risk factors; Overall risk assessment; Framingham cardiac risk score

Accepting Living Kidney Donors with Preexisting Diabetes Mellitus: A Perspective on the Recent OPTN Policy Change-July 2022.

Diabetes mellitus (DM) is an important public health challenge [1 ].Different studies predicted that the frequency of diabetic patients will be increased to 642 million throughout the world by 2040 [2]. A notable percentage of diabetic patients are not aware of their disease (approximately 30% in Iran) [3]. Lag in the diagnosis of DM raises the expense of controlling disease and makes the prognosis poorer [4]. It is indicated the importance of diabetic risk assessment as a screening test for high risk populations. However, most of the screening methods to detect high risk people are invasive [5]. So, detecting population at high risk of developing DM by an easy way that can be applied by health care providers in the health centers may lead to preventive measures of public health magnitude [4]. Griffin et al developed a questionnaire according to the risk factors commonly collected in clinical practice and evaluated the characteristics of the questionnaire. They reported the positive predictive value of 11% for diabetes screening questionnaire in England and Wales [6].In Iran, primary health care providers in rural regions were named “Behvarz”. They were performed diabetes mellitus risk assessment as a screening program in health houses. They worked in “Health House,” which is the small health center in the rural areas of Iran. In the present study, we evaluated DM risk assessment positive predictive value (PPV) on the 30 years and older rural population. The PPV is the probability of the diabetes in a person with a positive risk assessment result ( ) [7]. A cross-sectional study was done in three villages of Bostanabad, one of East Azerbaijan ‘s cities in Iran. Three villages out of more than fifteen hundred villages in the Bostanabad were selected as considered concerns about arranging the population in the villages. In these three villages, Behvarzes performed screening activities for diabetes between March2019 to January2020. Screening for diabetes was regarded for all individuals older than 30 years of age living in chosen villages. Participants were interviewed and asked the presence of risk factors of DM. Risk factors contained family history of DM, overweight or obesity (BMI>25), already detected pre-diabetes. Among persons took part in screening test, those even with one risk factor were regarded positive and they as soon as were visited by a primary care physician for detection of individuals with unknown DM. The total population of the three villages, namely Saeid abad, Tikmedash and Kordkandy was 5137. More than half of them (57.62%) were more than 30years old in these villages. Out of 1305 people, who had at least one risk factor, 57 persons were diabetics. Accordingly, 57 was true positive .The value of1305 was the sum of true positive and false positive. Calculated positive predictive value was 4.36%. So, the positive predictive value of the risk factor assessment was low. In Conclusion, the ability of the risk factor assessment to predict individuals with DM was quite poor (96% of people with risk factors were not diabetic) and the risk assessment did not work well to identify at risk individuals

Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, which are based on systematic methods to evaluate and classify evidence, provide a foundation for the delivery of quality cardiovascular care. The ACC and AHA sponsor the development and publication of clinical practice guidelines without commercial support, and members volunteer their time to the writing and review efforts. Clinical practice guidelines provide recommendations applicable to patients with or at risk of developing cardiovascular disease (CVD). The focus is on medical practice in the United States, but these guidelines are relevant to patients throughout the world. Although guidelines may be used to inform regulatory or payer decisions, the intent is to improve quality of care and align with patients’ interests. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances, and should not replace clinical judgment. Recommendations for guideline-directed management and therapy, which encompasses clinical evaluation, diagnostic testing, and both pharmacological and procedural treatments, are effective only when followed by both practitioners and patients. Adherence to recommendations can be enhanced by shared decision-making between clinicians and patients, with patient engagement in selecting interventions on the basis of individual values, preferences, and associated conditions and comorbidities. The ACC/AHA Task Force on Clinical Practice Guidelines strives to ensure that the guideline writing committee both contains requisite expertise and is representative of the broader medical community by selecting experts from a broad array of backgrounds, representing different geographic regions, sexes, races, ethnicities, intellectual perspectives/biases, and scopes of clinical practice, and by inviting organizations and professional societies with related interests and expertise to participate as partners or collaborators. The ACC and AHA have rigorous policies and methods to ensure that documents are developed without bias or improper influence. The complete policy on relationships with industry and other entities (RWI) can be found online. Beginning in 2017, numerous modifications to the guidelines have been and continue to be implemented to make guidelines shorter and enhance “user friendliness.” Guidelines are written and presented in a modular knowledge chunk format, in which each chunk includes a table of recommendations, a brief synopsis, recommendation-specific supportive text and, when appropriate, flow diagrams or additional tables. Hyperlinked references are provided for each modular knowledge chunk to facilitate quick access and review. More structured guidelines–including word limits (“targets”) and a web guideline supplement for useful but noncritical tables and figures–are 2 such changes. This Preamble is an abbreviated version, with the detailed version available online. The reader is encouraged to consult the full-text guideline(P-1) for additional guidance and details, since the executive summary contains mainly the recommendations.

Objective To investigate the clinical application value in the risk assessment of diabetic retinopathy using a receiver operating characteristic curve and discriminant analysis.Methods This was a cross-sectional study.The outcomes of correlated clinical and biochemical examinations were obtained in 250 cases with type 2 diabetes mellitus (100 cases with retinopathy and 150 cases without retinopathy as the control).Standard measurements were obtained with an ophthalmoscope and fundus fluorescein angiography.A receiver operating characteristic (ROC) curve was used to assess their value in the diagnosis of diabetic retinopathy and formulate a diagnostic discrimination model with Bayes's discriminant analysis.The correlated indexes of diabetic retinopathy were endothelin-1,vascular endothelial growth factor,magnesium,correlation indexes from renal and pancreas function,hemorheology indexes,and blood fat.Results ROC analysis showed that the diagnostic reliability of ET-1 was the best indicator in the mild stages of NPDR and PDR (AUCmild NPDR=0.742,AUCPDR=0.857); the diagnostic reliability of urinary albumin was the best indicator in the moderate and severe stages of NPDR (AUCmoderate and severe NPDR=0.742). The samples rechecked by the model showed a coincidence rate of 96.4％ in the mild stage of NPDR,and 100％ in the moderate and severe stages of NPDR and PDR.Conclusion The diagnostic discrimination model may be used to screen and monitor the high-risk group with diabetic retinopathy in type 2 diabetes mellitus. Key words: Diabetic retinopathy ; Receiver operating characteristic analysis ; Discriminant analysis ; Risk assessment

Objective To investigate the application of EZSCAN to assess the diabetes risk for pilots. Methods Data of the people examined in Air Force General Hospital were retrospectively studied. The diabetes cases were screened out. Eighty seven pilots who were without diabetes were selected as pilots group. Control group included 49 normal people. The EZSCAN test results, as well as blood sugar, lipid and blood uric acid of 2 groups were compared. Results The diabetes risk detected by EZSCAN had significant difference between pilots group and control group (χ2=17.171, P<0.01). Diabetes risk in control group was higher than that in pilots group (χ2=15.374, P<0.01). Triglyceride level in non-diabetes risk pilots was lower than that in control group (P<0.01). Blood uric acid in high diabetes risk pilots was lower than that in control group (P<0.01). Age were significantly correlated with the detection of diabetes risk in pilots group (F=10.935, P<0.01). The risk of having diabetes was increased with age. Conclusions EZSCAN system could be used in the diabetes risk assessment for pilots and has certain effect on pilot′s health assessment. Key words: Diabetes mellitus; Risk assessment; Physical examination; Pilots

ATP III recognizes that detection of cholesterol disorders and other coronary heart disease (CHD) risk factors occurs primarily through clinical case finding. Risk factors can be detected and evaluated as part of a person's work-up for any medical problem. Alternatively, public screening programs can identify risk factors, provided that affected individuals are appropriately referred for physician attention. The identification of cholesterol disorders in the setting of a medical examination has the advantage that other cardiovascular risk factors—including prior CHD, PVD, stroke, age, gender, family history, cigarette smoking, high blood pressure, diabetes mellitus, obesity, physical inactivity—co-morbidities, and other factors can be assessed and considered prior to treatment. At the time of physician evaluation, the person's overall risk status is assessed. Thus, detection and evaluation of cholesterol and lipoprotein problems should proceed in parallel with risk assessment for CHD. The approach to both is described below. The guiding principle of ATP III is that the intensity of LDL-lowering therapy should be adjusted to the individual's absolute risk for CHD. In applying this principle, ATP III maintains that both short-term (≤10-year) and long-term (> 10-year) risk must be taken into consideration. Thus, treatment guidelines are designed to incorporate risk reduction for both short-term and long-term risk (composite risk). ATP III identifies three categories of risk for CHD that modify goals and modalities of LDL-lowering therapy: established CHD and CHD risk equivalents, multiple (2+) risk factors, and 0-1 risk factor (Table III.1-1). View this table: Table III.1-1. Categories of Risk for Coronary Heart Disease (CHD) ### a. Identification of persons with CHD and CHD risk equivalents Coronary heart disease . Persons with CHD are at very high risk for future CHD events (10-year risk >20 percent). Several clinical patterns constitute a diagnosis of CHD; these include history of acute myocardial infarction, evidence of silent myocardial infarction or myocardial ischemia, history of unstable angina and stable angina pectoris, and history …

Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S50 The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVD); improve the management of people who have these diseases through professional education and research; and develop guidelines, standards, and policies that promote optimal patient care and cardiovascular health. Toward these objectives, the ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute (NHLBI) and stakeholder and professional organizations to develop …

This Month in Gastroenterology

Serum visfatin in relation to visceral fat, obesity, and type 2 diabetes mellitus in Asian Indians

Cardiovascular disease (CVD) and type 2 diabetes are two major public health challenges. There is strong evidence that both conditions are predictable and preventable. Accurate identification of individuals at higher risk of CVD and type 2 diabetes is critical for the most effective and efficient prevention of these conditions, as it ensures preventive resources are focused on those who are most likely to benefit. Firstly, using baseline data from the nation-wide, population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study, this thesis examined how well the current Australian Pharmaceutical Benefits Scheme eligibility criteria for subsidy of lipid-lowering drugs identified individuals who were at high risk of developing CVD events according to the current national guidelines; and whether an anthropometric index can be used as an ancillary measure to help identify individuals with a high absolute cardiovascular risk estimate. Secondly, a validated risk prediction tool for future CVD mortality was developed based on recalibration of the SCORE (Systematic COronary Risk Evaluation) risk chart using Australian national mortality data and the major CVD risk factor profiles from eight Australian population-based surveys. Since diabetes is a major and independent risk factor for CVD, this thesis was expanded to include the prediction of risk of diabetes by analysing data from the two waves of the AusDiab study. Relevant work entailed development and validation of a self-completed, non-invasive Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK); and investigation of four different screening strategies to maximise efficiency of screening for people with a high risk of future diabetes and those with prevalent undiagnosed diabetes. The study found that: i) 11.0% of all Australian men and 3.6% of women aged 30-74 years old with neither CVD nor diabetes were found to be at high absolute CVD risk, and less than 20% of these high-risk individuals were being treated with lipid-lowering agents. Conversely many individuals eligible for statins subsidy were estimated to be at relatively low risk; ii) measurement of waist-to-hip ratio could be used as an ancillary measure to help identify individuals who are likely to have an increased absolute cardiovascular risk estimate; iii) an Australian risk prediction chart for CVD mortality was generated and validated, and offers an easy and simple approach to assessing 10-year risk of CVD death; iv) the AUSDRISK provides a valid and reliable method to estimate the 5-year risk of developing type 2 diabetes and is also able to identify asymptomatic individuals who are likely to have prevalent undiagnosed diabetes in cross-sectional settings; v) a sequential risk stratification strategy, using AUSDRISK then a second score incorporating fasting glucose, would maximise efficiency of type 2 diabetes screening and inform appropriate intervention. In conclusion, this work provides two validated tools for predicting risk of CVD mortality and incident type 2 diabetes, respectively. These tools will help improve strategies for detection of individuals at high risk of CVD or diabetes to ensure they might receive adequate prevention and treatment. The overall findings will help inform national health strategies and clinical practice related to the prevention and management of CVD and type 2 diabetes in Australia.

Abdominal fat distribution and insulin resistance in Indian women with polycystic ovarian syndrome

Although several environmental factors, including a high-calorie diet and physical inactivity, influence the development of type 2 diabetes mellitus, genetic factors have been shown to contribute to individual susceptibility to this condition. The purpose of the present study was to identify gene polymorphisms that confer susceptibility or resistance to type 2 diabetes mellitus, and thereby to contribute to assessment of the genetic risk for this condition. The study population comprised 5259 unrelated Japanese individuals (2980 men, 2279 women), including 1640 subjects with type 2 diabetes mellitus (1071 men, 569 women) and 3619 controls (1909 men, 1710 women). The genotypes for 94 polymorphisms of 67 genes were determined with a method that combines the polymerase chain reaction and sequence-specific oligonucleotide probes with suspension array technology. Evaluation of genotype distributions by the chi-square test revealed that the 13989-->G (Ile118Val) polymorphism of the cytochrome P450, subfamily IIIA, polypeptide 4 gene (CYP3A4) was significantly (false discovery rate, 0.000009) associated with the prevalence of type 2 diabetes mellitus. Multivariable logistic regression analysis with adjustment for age and sex also revealed that the 13989-->G (Ile118Val) polymorphism of CYP3A4 was significantly (P=0.00002) associated with the prevalence of type 2 diabetes mellitus, with the AG genotype being protective against this condition. Genotyping for CYP3A4 may thus prove informative for assessment of the genetic risk for type 2 diabetes mellitus.