Adult T2DM Research Articles

Patient characteristics associated with improvement in glycemic control following addition of an oral antidiabetic drug to DPP-4 inhibitor monotherapy in Japanese patients with type 2 diabetes mellitus (JDDM 60).

The current study evaluated patient demographics and clinical characteristics that associated with HbA1c reduction following addition of one oral antidiabetic drug (OAD) to DPP4i monotherapy. A retrospective study was conducted using CoDiC database. Adult T2DM patients treated with sitagliptin monotherapy for ≥ 6months and adding one OAD were extracted. Association between patient characteristics at the time of add-on OAD and following HbA1c reduction was assessed. Of 444 included patients, mean age was 62years and 33% were female. All add-on OAD classes demonstrated further HbA1c reduction (p < 0.05). The majority received biguanide (BG; 61%) or sulfonylurea (SU; 25%) add-on therapy. BG and SU groups showed a significant association between higher baseline HbA1c categories and greater HbA1c reductions (BG: - 0.24 to - 1.75%, p < 0.0001; SU: - 0.15 to - 2.11%, p < 0.0001). Lower HDL-cholesterol/higher non-HDL-cholesterol (BG), male gender (SU), and lower SBP (SU) were associated with larger HbA1c reductions. The results for baseline HbA1c (BG and SU) and gender (SU) were also confirmed by multivariate analysis. The majority of Japanese T2DM patients on sitagliptin monotherapy who require an add-on OAD utilized BG or SU. There were 2 determinants of glycemic response: baseline HbA1c with BG and SU and gender with SU during add-on OAD therapy. The online version contains supplementary material available at 10.1007/s13340-021-00514-5.

CARDIOVASCULAR SCREENING IN ASYMPTOMATIC TYPE 1 DIABETES PATIENTS: PRELIMINARY RESULTS AND MODEL PROPOSAL FOR A COST-EFFECTIVENESS ANALYSIS

Abstract Objective: Background: Type 1 diabetes (T1DM) is an independent risk factor for cardiovascular disease (CVD), with patients being considered as a high or even very high risk group. However, routine screening for CVD in an asymptomatic T1DM population is currently not recommended. Moreover, the cost-effectiveness of such screening programs has been subject of debate. Objectives: Discuss results and perform a cost-effectiveness (CEA) and cost-utility (CUA) analysis of a CVD screening program (2013–2019) in a Belgian cohort of asymptomatic T1DM patients. Setting: Ghent University Hospital (Flanders, Belgium). Methods: Adult T1DM patients with a minimum disease duration (DD) of 10 years and without known macrovascular disease were enrolled in a CVD screening program, including: coronary artery calcium (CAC) scoring, cyclo-ergometry, transthoracic echocardiography, 24-hour Holter monitoring, and carotid ultrasound. A decision-analytic Markov model is applied to compare estimated costs and health outcomes (i.e. CVD events and quality-adjusted life years or QALYs) of the screening program vs. usual care (i.e. no screening). After screening, patients were categorised in five possible Markov states: (1) “No additionally increased risk” in case of no significant abnormalities being detected; (2) “Soft attention” in case of mild to moderate alterations or doubtful findings; (3) “Hard attention” if CAC &gt; P90 or absolute &gt; 400 Agatston score, i.e. subclinical high atherosclerotic burden; (4) “Unequivocally documented CVD on imaging” if presence of significant carotid plaque; and (5) “Documented clinical CVD” if patients were referred for coronary revascularization. The Markov model further includes stroke, myocardial infarction (MI) and death. Time horizon of the model is 10 years and a healthcare payer perspective will be applied. Results of the CEA will be expressed in incremental costs per event avoided (stroke and MI), and the CUA in incremental costs per QALY gained. Both one-way and probabilistic sensitivity analyses will be performed. To report on CUA, a willingness-to-pay threshold of €40 000 per QALY will be applied. Preliminary results: 97 patients (M/F: 61/36; age: 45 ± 10.0 years; DD: 24 ± 10.1 years; HbAc1: 7.7 ± 0.75%, BMI: 25 ± 3.0 kg/m2) were included. The CVD screening program yielded the following results: (1) “No additionally increased risk after screening”: n = 68/97 (70.1%); (2) “Soft attention”: n = 16/97 (16.5%); (3) “Hard attention”: n = 8/97 (8.2%); (4) “Unequivocally documented CVD on imaging”: n = 2/97 (2.1%); and (5) “Documented clinical CVD”: n = 3/97 (3.1%). Up to now, one event (MI) has occurred during follow-up (being a patient from group 1).

Use of Electronic Health (eHealth) Among Saudi Type 2 Diabetic Patients and Its Association With Their Diabetic Self-Management: A Cross-Sectional Study.

BackgroundType 2 diabetes mellitus (T2DM) is a prevalent, chronic, non-communicable disease that requires continuous multidisciplinary health care. Electronic health (eHealth) refers to “the transfer of health information resources and health care services using different electronic platforms.” This may have an effect on diabetes self-management (DSM).ObjectivesThis study aimed to identify the use of eHealth among patients with T2DM as well as its association with DSM.MethodAn analytical cross-sectional study was conducted online using a newly adapted three-part questionnaire using Google Forms through different social media platforms. A total of 2,228 adult Saudi T2DM patients from different provinces were selected based on the non-probability voluntary response sampling technique. The survey included demographic, clinical, and eHealth data, and diabetic self-care management.ResultsThe study results revealed an average DSM score of 5.2/10, and 74.1% were receiving diabetes care at primary health care centers. Of these, 87.1% used eHealth, mainly through Google (55.7%) and other social media (12.9%), and were satisfied with the quality of health care (70.4%). Moreover, 82% wanted to discuss the eHealth information with their physicians, but some (34.5%) had no online access to them. eHealth dependency was 44.2% and was associated with a lower mean DSM (5.6 vs. 5.3; p = 0.000) with significantly lower health care use (6.7 vs. 5.6; p = 0.000) and glucose management (4.7 vs. 4.0, p=0.000) compared to the independent group. The DSM total score was a significant predictor of eHealth dependency (OR: 1.022; 95% CI: 1.006-1.039; p = 0.007).ConclusionMost Saudi T2DM patients with an average DSM use different eHealth resources and are satisfied with their quality. Dependency to eHealth is significantly associated with lower DSM, especially for health care use and glucose management, a finding that could affect patient outcomes. Still, patients need to communicate with their physicians in person who should have different options for remote consultation, such as telemedicine, to support their patients.

Quality of life among type II diabetic patients attending the primary health centers of King Saud Medical City in Riyadh, Saudi Arabia.

Background/Aim:Type 2 diabetic patients (T2DM) have lower quality of life (QoL) compared to the general population. This study was conducted to determine QoL of T2DM patients and analyze factors that affect patients' QoL.Methods:We conducted this cross-sectional study in January to February of 2019 at several primary care health centers (PCHC) in Riyadh, Saudi Arabia. All adult T2DM patients were invited to participate in the study. We used the EQ-5D-3L and EQ VAS tools to determine the patients' health state and their self-rated overall health.Results:A total of 274 T2DM patients were surveyed, 149 (54.4%) were males. The mean age was 59.7 ± 10.4 years. Of the five EQ-5D-5L domains, self-care had the highest proportion that reported no problem (n = 183, 66.8%). The mobility domain had the highest proportion of reported severe problems (n = 37, 13.5%) and extreme problems (n = 7, 2.6%). Nineteen (6.9%) patients reported with a full state of health. The mean EQVAS was 65.9 ± 22.1, with only 24.1% reported as between 81–100%. Females, patients above 75 years old, those who are in the low socioeconomic income, unemployed, widow had lower EQ VAS.Conclusion:Males, with higher socioeconomic status, employed, married and younger patients experience better QoL compared to their counterparts. The overall health related QoL among our diabetic patients is low. These findings suggest improvement of health-related QoL, and more efforts should be invested in patient education particularly among patients who are in the low socioeconomic status, the elderly, females and the unemployed.

Effectiveness and safety of insulin glargine Gla-300 in insulin-naïve type 2 diabetes subjects in a real-life setting-the GOAL_RO trial.

BackgroundBasal insulin is the first choice for insulin initiation in type 2 diabetes (T2DM), with the second generation of basal insulin analogues having a lower risk of hypoglycemia compared to the first generation of basal insulins. The aim of our study was to assess on a large cohort of insulin-naïve T2DM subjects the effectiveness and safety of insulin glargine 300 U/mL (Gla-300) in a real-life setting.MethodsThis was a multicenter, prospective, non-interventional, 24 weeks, 3 visits (baseline, 3 and 6 months) trial performed in adult T2DM subjects not achieving glycemic target (HbA1c >7%) with prior oral or GLP-1 RA therapy. The study included 1,095 subjects (55.2% M/44.8% F) in 124 study sites. Mean (±SD) age was 61.1±8.5 years while mean duration of diabetes was 8.8±5.2 years. Mean BMI was 31.7±5.4 kg/m2 with 91.2% being overweight or obese. Baseline diabetes treatment included metformin (88.4% of subjects), sulphonylureas (75.4%), DPP-4i (16.7%) and GLP-1 RAs (8%). Comparison between quantitative variables was made with the paired sample t test.ResultsMean HbA1c at baseline was 9.8%±1.7% with a mean fasting plasma glucose (FBG) of 231.5±67.4 mg/dL. Mean HbA1c decreased to 7.7%±1.2% at 6 months with a mean change from baseline of −2.1% (P<0.001). Overall, 30.7% of subjects reached the HbA1c target of 7%. Final mean dose of Gla-300 was 0.4 IU/kg/day. Mean weight gain was 0.4 kg over 6 months. Adverse events (AEs) were reported by 11.1% of subjects with 2.3% reporting serious adverse events (SAEs). Overall, 4.4% of subjects reporting at least one event of symptomatic or confirmed hypoglycemia. Only 7 episodes of nocturnal and one of severe hypoglycemia were reported.ConclusionsIn conclusion, a significant 2.1% decrease of HbA1c was recorded after 6 months of treatment with Gla-300 with no unexpected safety signals, low risk of hypoglycemia and modest weight gain.

Personality Traits, Metabolic Control and the Use of Insulin Pump Functions in Adults With Type 1 Diabetes: An Observational Single-Visit Study

IntroductionWhile a few studies have assessed the association between personality and metabolic outcomes in children and adolescents with type 1 diabetes (T1DM), there have been none in adults or in subjects treated with insulin pumps, and hypoglycaemic episodes have not been considered in these studies. The aim of this observational single-visit study was to assess the association between personality traits and metabolic control, hypoglycaemic episodes and insulin pump use in adult T1DM patients.MethodsData were obtained from 52 adults with T1DM treated in a tertiary care centre (no complications or comorbidities; aged 27 ± 8 years; diabetes duration of 12.8 ± 6.8 years; treated with insulin pumps for 6.3 ± 0.4 years). “Big Five” personality traits (neuroticism, extraversion, openness, agreeableness and conscientiousness) were assessed using the NEO-Five Factor Inventory questionnaire. Data on HbA1c, blood glucose levels, frequency of glucose testing, the number of hypoglycaemic episodes (< 3.9 mmol/l), basal and prandial insulin doses, and the number and types of boluses in the last 14 days were obtained from the insulin pumps and glucometers.ResultsThe mean levels of the assessed parameters were: HbA1c 7.2 ± 1.2% (55.0 ± 13.1 mmol/mol), episodes of hypoglycaemia 7.0 (3.00–9.75) and glucose tests per day 7.3 ± 3.9. All personality traits showed average intensity. None of the traits were associated with HbA1c, glycaemia, number of glucose tests, or number or kind of insulin boluses. Conscientiousness was the only factor associated with the incidence of hypoglycaemia in both univariate (r = + 0.46, p < 0.001) and multivariate (β = + 0.41, p < 0.001) analyses.ConclusionsDespite results reported for children and adolescents, personality traits of adult patients with T1DM were not essential for metabolic control assessed by HbA1c or for the use of insulin pump functions; however, higher conscientiousness may be related to more frequent hypoglycaemic episodes. Extrinsic factors should be searched as more relevant for metabolic control and proper use of very expensive insulin pump therapy.

Management Practice and Contributing Risk Factors for Chronic Complications Among Type 2 Diabetes Mellitus Adult Patients in Follow-Up at a Tertiary Care Teaching Hospital.

BackgroundDiabetes Mellitus is a complex, chronic disease that requires a coordinated management practice beyond blood glucose control. The disease causes chronic complications that affect the quality of the life of patients, place major pressure on the health-care system and cause a rise in diabetes-related mortality.ObjectiveTo determine the prevalence of chronic diabetes mellitus complications, related risk factors, and management practice among adult type 2 diabetes mellitus outpatients at Tikur Anbessa Specialized Hospital (TASH).MethodsA cross-sectional study design was carried out from July to September 2018. The pre-tested data abstraction format was used to gather demographic and clinical information. We also used a balance of weight measurement, upright placed meter for height measurement, waist circumference measurement meter and BP equipment. Statistical analysis was accomplished using Statistical Package for the Social Sciences (SPSS) 25® software. The significance level for statistics was set at p<0.05.ResultsIn this study, 320 patients were involved. Of these, about 57% were female and had a mean age of 58 ±11.2 years. About 85% of the study participants had comorbidity and 42.5% had complications. Hypertension and neuropathy were the most common comorbidity and complication, respectively. The usage of vascular preventive medication among study participants was 74.7% and 55.3% for statins and ASAs, respectively. Participants in the study who had disease duration of 5–10 years (AOR=3.50, 95% CI: 1.19–10.28) and fifteen and above (AOR= 3.59, 95% CI: 1.36–9.49) were at higher risk of diabetes complication as compared to less than five years.ConclusionThe prevalence of chronic complications was high among adult T2DM outpatients. The duration of disease and the number of medications used were the factors associated with chronic complications. The use of vascular preventive medications was low among study participants.

Renal function deterioration in adult patients with type-2 diabetes

BackgroundTo explore, in a large group of patients with type-2 diabetes (T2DM), renal function decline in terms of the slope of the estimated glomerular filtration rate (eGFR) over time, and to find out how classical risk factors, such as the presence of hypertension, dyslipidemia and microalbuminuria, affect the renal function.MethodsThe analysis included 32,492 adult T2DM patients from the DIVE/DPV registries who had serial eGFR determinations and information on the presence of microalbuminuria, hypertension and dyslipidemia available.ResultsPatients had a mean age of 66.3 years, 52.6% were male with a mean BMI of 31.7 kg/m2. The mean eGFR was 78.4 ± 21.4 mL/min/1.73m2. The results showed that the prevalence of renal function impairment understood as chronic kidney disease (CKD) is considerable (53.0%) in a population of patients with T2DM and has a high incidence rate of 6.6% within a year. Serial determinations of the eGFR are, however, infrequent (7.8% of all patients) and these patients are characterised by the presence of a high-risk profile for CKD, such as hypertension (88.1%) and dyslipidemia (66.1%). Over a three-year time period, 30.9% of the patients had an eGFR slope of -12 mL/min/1.73m2 or more; and more than a doubled proportion of patients with an eGFR < 30 mL/min/1.73 m2 (3.8% vs. 1.8%; p < 0.001). Hypertension and albuminuria contributed to renal function decline while dyslipidemia did not negatively affect the slope.ConclusionCKD is highly prevalent in patients with T2DM. Serial surveillance of the glomerular filtration rate is, however, not established in clinical practice, which would be necessary as indicated by a doubling of patients with an eGFR < 30 mL/min/1.73 m2 within 3 years. Moreover, the use of renin-angiotensin blocking agents was low, pointing at considerable room for improvement. Taken together we conclude that a closer surveillance of patients with diabetes based on the presence of further risk factors is mandatory combined with a mandatory prescription of RAS blocking agents once microalbuminuria and / or renal function deterioration develops.

MON-099 The Association Between C-Reactive Protein, Metabolic Syndrome, and Pre-Diabetes in Korean Children and Adolescents

Objective: Cardiovascular disease (CVD) is a leading cause of death worldwide, including in Korea. In adults, the risk for CVD is increased approximately three-fold in subjects with metabolic syndrome (MetS), and the hazard ratio for subjects with MetS has been reported as 1.37 for mortality from CVD after adjustment for other confounders. Furthermore, MetS in childhood predicts adult MetS and T2DM 25 to 30 years later. Because MetS is a state of chronic low-grade inflammation, measurements of the circulating levels of the inflammatory molecules might provide diagnostic and therapeutic approaches to modulate or alter disease progression. High sensitivity C-reactive protein (hsCRP), a biomarker of inflammation, has emerged as an independent predictor of CVD and T2DM development. The aim of this paper is to evaluate the association between hsCRP and MetS and its components in Korean children and adolescents. Methods: We performed a cross-sectional analysis using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2017. We analyzed the data of 1,247 subjects (633 males, 14.2 ± 2.7 years) from the KNHANES 2016–2017. MetS were defined by the modified NCEP-ATP III criteria. Results: Among the 1,247 subjects (mean age: 14.2 ± 2.7 years), the prevalence of MetS was 5.8% (7.0% in male subjects and 4.6% in female subjects; p = 0.070). The mean hsCRP level was 0.861 ± 1.567 mg/l (median and interquartile range: 0.370 and 0.430mg/l). Subjects with MetS had higher hsCRP levels than subjects without MetS (geometric mean: 1.08 vs. 0.46 mg/l, p < 0.001). The prevalence of MetS in the lowest, second, third, and highest hsCRP quartiles were 1.8%, 2.4%, 3.5%, and 15.2%, respectively. Compared to the lowest quartile, the odds ratio (OR) for having MetS in the highest quartile was 8.414 (3.272–21.638), adjusting for age and sex. The OR for having abdominal obesity and low HDL-C in the highest quartile were 9.657 (4.818–19.355) and 2.408 (1.286–4.510), adjusting for age, sex, and other components of the MetS. Additionally, the OR for having pre-diabetes (HbA1c ≥ 5.7%) in the highest quartile was 2.061 (1.097–3.870). Conclusion: Serum hsCRP level is positively associated with MetS and pre-diabetes in Korean children and adolescents.

PGI7 EVALUATION OF LIVER OUTCOMES RELATIVE TO USE OF GLP-1 RECEPTOR AGONISTS (GLP1A) AND/OR SGLT-2 INHIBITORS (SGLT2I) IN REAL-WORLD POPULATIONS DIAGNOSED WITH TYPE II DIABETES (T2DM) AND NASH/NAFLD OR AT RISK OF NASH

To assess effect of GLP1a and/or SGLT2i on development of advanced liver disease in T2DM patients with NASH/NAFLD or at risk of NASH. Data collected from a proprietary US EMR database were limited to adult T2DM (ICD10 E11. 9) patients diagnosed with NASH/NAFLD (ICD10 K76, 75.81) or with a risk profile of [Age >50 + ALT >30 U/L + BMI >30] and without viral hepatitis or evidence of alcohol abuse. Index date was the first calculable FIB4 between Jul 2015 to Jun 2017 with >1y history and >2y follow-up or to death. Advanced liver disease was defined as cirrhosis (compensated or decompensated), hepatocellular carcinoma, or liver transplant. All-cause death was not considered. Cox proportional models were used to determine hazard ratios (HR) between propensity-score (PS) matched groups. All multiple regression models used complete-case analysis and included treatment, MACE, FIB4, CVD, gender, age, race/ethnicity, and all covariates with p <0.200 by individual models. Of 30MM adult patients, 31323 met all study criteria and received SGLT2i and/or GLP1a at index (treated, 10%, 3208) or never received these therapies prior to or during follow up from index (not-treated, 90%, 28115). Mean follow up was 36.5 months. Advanced liver disease at index was significantly lower for the treated group (16%, 516/3208 v 29%, 8169/28115 not-treated, p<0.001). PS-matching of patients without advanced liver disease at index yielded 1720 pairs. Cox hazard ratios for developing advanced liver disease were favorable for treatment (0.74 [0.63-0.87] p<0.001) and unfavorable for FIB4 >2.67 (2.17 [1.59-2.96] p<0.001), MACE (2.32 [1.91-2.82], p<0.001), Age ≥75 (1.84 [1.91-2.82] p=0.005), and CVD (1.27 [1.07-1.52] p=0.007) at index. In T2DM patients with NASH/NAFLD or at risk of NASH, the risk of developing advanced liver disease was lower in patients treated with SGLT2i and/or GLP1a.

The effectiveness of insulin glargine 300 U/mL among type 2 diabetes patients: Analysis of a real-world data in Israel.

AimsRandomized controlled trials have shown that insulin glargine 300 U/mL (Gla‐300) has a more stable and prolonged glucose lowering effect among patients with type 2 diabetes (T2DM) compared to insulin glargine 100 U/mL (Gla‐100), resulting in a reduced risk of hypoglycaemia while maintaining a similar efficacy of lowering HbA1c. We aimed to investigate if the effectiveness of Gla‐300 is reproducible in real‐world settings.Material and methodsIn this retrospective cohort study, data from a large state‐mandated health organization were used to identify adult T2DM patients who were previously on insulin and initiated Gla‐300 therapy between 6/ 2016 and 12/2017. Changes in HbA1c levels, body weight and insulin dose were calculated from baseline period and over a follow‐up period of 180 days. Documented hypoglycaemia events were also explored.ResultsA total of 1797 patients were included in this study with a mean age of 64.2 (SD = ±11.0y), baseline HbA1c was 8.7 ± 1.6% and 42.5% were females. Among all patients with HbA1c measurement during follow‐up (n = 1508), HbA1c was significantly reduced by −0.6% (95% CI −0.6,−0.5; P < .001) from baseline, with a significant reduction in body weight (−0.4 kg; P = <.001).Additionally, a significant (P = .04) reduction of 40.5% in patients with hypoglycaemia events was recorded during follow‐up period, from 2.1% (n = 37) at the baseline period to 1.2% (n = 22).ConclusionsThis real‐world study supports evidence from RCTs regarding the effectiveness of Gla‐300 among T2DM patients by improving glycaemic control.

Abstract 44: Childhood Predictors of Type 2 Diabetes in Young Adulthood to Middle-age: The International Childhood Cardiovascular Cohort (i3c) Consortium

Introduction: Although childhood obesity is related to incident adult type 2 diabetes (T2DM), whether other childhood risk factors relate to T2DM is not clear and no childhood risk score has been established to help with prediction of T2DM. Methods: We examined childhood risk factors in The International Childhood Cardiovascular Cohort (i3C) Consortium with a goal of developing a risk score for predicting adult T2DM. The pooled datasets included childhood measurements during the 1970s to 1990s. Participants were re-contacted at mean age 40 yr and completed a health questionnaire including self-report of adult T2DM (occurrence age, medication use). Results: N = 4,425 i3C participants with measurements during ages 3-19 yr. 225 (5.1%) reported onset of T2DM between ages 20-55 (mean 38.4) years (82% reported use of a valid antidiabetic medication). After stepwise regression, age-sex standardized deviates (mean of all repeated measures during ages 3-19 yr) of body mass index (BMI), glucose and ln(insulin) were associated with incident T2DM; the unadjusted risk curves visibly steepened at about 0.75 standard deviates (Figure, top panel). In multivariable models, BMI, glucose and ln(insulin) in a single model were associated with adult T2DM after adjustment for sex, race, cohort, and individual mean childhood age and calendar year. Prediction of incident T2DM was directly related to the number of the three risk factors with levels above +0.75 standard deviates (0: 3.2% (96/2966), 1: 6.2% (63/1,012), 2: 14.3% (56/392), 3:18.2% (10/55); the corresponding adjusted HR (95%CI) for the counts were 1 (reference), 1.8 (1.3, 2.4), 4.7 (3.3, 6.5), and 6.7 (3.5, 13.1), respectively). The +0.75 standard deviates in natural units are given in the Figure (bottom panel), e.g. about 92 mg/dL for glucose at age 12-14. Conclusion: The study suggests that a childhood risk score composed of BMI, glucose and insulin is a strong predictor of adult T2DM. Provisionally suggested cutpoints are lower than currently defined normal.

Lipid/Lipoprotein Abnormalities Among Adult Type 1 Diabetics in Nigeria

Background: Dyslipidemia abounds among diabetics. However, these are poorly characterized among patients with type 1 diabetes (T1DM). The current study determined the pattern of dyslipidemia and their relationship with glycemic status among adult T1DM subjects. Methods: This survey was conducted retrospectively among 346 newly-diagnosed/treatment-naïve T1DM adults attending outpatient units of a third-level hospital in Nigeria. Patients’ fasting plasma glucose and lipid parameters at the time of T1DM diagnosis were abstracted from their medical files. Lipid parameters included triglyceride (Tg), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Abstracted parameters were analyzed using descriptive and comparative statistics. Results: Of the 346 studied, 46.8% (n=162) were dyslipidemic (aged: 32.69±6.29) with female predominance (59.3%; p=0.018). Categorically, females predominated among isolated dyslipidemics while males predominated among the combined/mixed dyslipidemics. High plasma Tg concentration (n=142;87.7%) was the most common isolated dyslipidemia without male/female difference (p>0.05); seconded by low HDL-C (n=80;49.4%) with the females predominating (p<0.05). The most combined and mixed dyslipidemia was high plasma Tg/low HDL-C (total n=28, 17.3%; males n=16, 24.2% vs. females n=12, 12.5%; p=0.011) and high plasma Tg/high LDL-C/low-HDL-C (total n=30, 18.5%; males n=18, 27.3% vs. females n=12, 12.5%; p=0.001) concentrations, respectively with male predominance. The female dyslipidemics were younger with lower BMI, higher systolic blood pressure, glycemia, and mean plasma Tg levels (p<0.05). The overall dyslipidemics had poor glycemic status and their risk of dyslipidemia increases with worsening glycemia. Conclusion: Dyslipidemia was common and associated with poor glycemic status among the studied cohorts. This finding informs the need for more rigorous monitoring of dyslipidemia among T1DM subjects to reduce the risk of its complications.

Investigating the Role of Childhood Adiposity in the Development of Adult Type 2 Diabetes in a 64-year Follow-up Cohort: An Application of the Parametric G-formula Within an Agent-based Simulation Study.

The contribution of childhood obesity to adult type 2 diabetes (T2DM), not through adult adiposity, as well as the causal pathways through which childhood obesity increases adult T2DM risk are not well understood. This study investigated the contribution of childhood obesity to incident T2DM including pathways not through adult adiposity, and explored whether race modified this contribution. We used data from the Virtual Los Angeles Cohort, an agent-based longitudinal birth cohort composed of 98,230 simulated individuals born in 2009 and followed until age 65 years. We applied the parametric mediational g-formula to the causal mediation analysis investigating the impact of childhood obesity on the development of adult T2DM. The marginal adjusted odds ratio (aOR) for the total effect of childhood obesity on adult T2DM was 1.37 (95% CI = 1.32, 1.46). Nearly all the effect of childhood obesity on adult T2DM was mostly attributable to pathways other than through adult obesity; the aOR for the pure direct effect was 1.36 (95% CI = 1.31, 1.41). In all racial subpopulations, a similar 3% of the total effect of childhood obesity on adult T2DM was attributable to its effect on adult obesity. Childhood obesity remains a risk factor for adult T2DM separate from its effects on adult obesity. This study emphasizes the potential benefits of early interventions and illustrates that agent-based simulation models could serve as virtual laboratories for exploring mechanisms in obesity research.

THE ASSESSMENT OF MICRO AND MACRO VASCULAR COMPLICATIONS IN PEOPLE WITH SYSTEMIC HYPERTENSION ASSOCIATING UNCONTROLLED TYPE 2 DIABETES

Objective: to assess the percentage of complications in patients with systemic hypertension associating uncontrolled type 2 diabetes Design and method: SH diabetic patients (SH for more than 8 years) with T2DM duration at least 5 years. SH was diagnosed previous to DM. The subjects were assessed between January 2016 and end October 2018 in a cross sectional study. All the patients were evaluated by clinical examination (including exam for polyneuropathy), paraclinical exams (HbA1c in the last 3 months, fasting plasma glucose - FPG, glomerular filtration rate), cardio and ophthalmological examination (ECG, echocardiography, ocular fundus). Results: 166 adult T2DM patients, 46% male, mean age 59.2 years, mean duration of T2DM 7.6(3.9) years, mean duration of SH 9.3 years. average HbA1c 8.5 %, FPG: 224.9 mg/dl were included. Patients were treated for DM with metformin (88.5%), sulphonilureas (81%), and alpha glucosidase inhibitors (9.4%) in monotherapy or combination. The blood pressure was well controlled in all patients. The microvascular complication of these T2DM patients were: retinopathy in 18.5% of the patients, chronic kidney diseases (declining glomerular filtration rate) in 10.8% and neuropathy (defined as distal symmetrical polyneuropathy) in 57.4%. 10.6% of the patients had previous stroke, 9.4% previous myocardial infarction, 42.9% ischemic heart disease (ECG changes in almost 64% of them), 9.8% heart failure, and 16.4% peripheral arterial disease. Conclusions: : It is well known that most of the complications in diabetes arise from damages to small blood vessels and narrowing of large arteries (atherosclerosis) due to chronic hyperglycemia and hypoglycemic episodes. Our study confirm the observation that microvascular complications affect more diabetic patients than macrovascular complications. The most frequent microvascular complication was polyneuropathy due to neuronal damage cause by vasa vasorum injury. It is absolutely necessary to screen more often these patients and to maintain their glycemic control on long term, avoiding also hypoglycemic episodes.

Genotypic and Allelic Distribution of Polymorphic Variants of Gene SLC47A1 Leu125Phe (rs77474263) and Gly64Asp (rs77630697) and Their Association to the Clinical Response to Metformin in Adult Pakistani T2DM Patients

Genotypic and Allelic Distribution of Polymorphic Variants of Gene SLC47A1 Leu125Phe (rs77474263) and Gly64Asp (rs77630697) and Their Association to the Clinical Response to Metformin in Adult Pakistani T2DM Patients

Associations of renal function with diabetic retinopathy and visual impairment in type 2 diabetes: A multicenter nationwide cross-sectional study.

BACKGROUNDDiabetic retinopathy (DR) separately has been noted as a major public health problem worldwide as well. Currently, many studies have demonstrated an association between diabetic nephropathy and DR in type 1 diabetes mellitus (T1DM) patients, but this association is less strong in T2DM. The evidence for an association between renal function and DR and visual impairment among T2DM patients is limited, particularly in the Asian population.AIMTo assess the association between glomerular filtration rate (GFR) and DR, severe DR, and severe visual impairment among T2DM patients in Thailand.METHODSWe conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. GFR was categorized into ≥ 90, 60-89, 30-59 and < 30 mL/min/1.73 m2. The association between GFR and DR, severe DR, and severe visual impairment were assessed using multivariate logistic regression.RESULTSA total of 13192 T2DM patients with available GFR were included in the analysis. The mean GFR was 66.9 ± 25.8 mL/min/1.73 m2. The prevalence of DR, proliferative DR, diabetic macular edema, and severe visual impairment were 12.4%, 1.8%, 0.2%, and 2.1%, respectively. Patients with GFR of 60-89, 30-59 and < 30 mL/min/1.73 m2 were significantly associated with increased DR and severe DR when compared with patients with GFR of ≥ 90 mL/min/1.73 m2. In addition, increased severe visual impairment was associated with GFR 30-59 and < 30 mL/min/1.73 m2.CONCLUSIONDecreased GFR was independently associated with increased DR, severe DR, and severe visual impairment. GFR should be monitored in diabetic patients for DR awareness and prevention.

Life Course Socioeconomic Position, Allostatic Load, and Incidence of Type 2 Diabetes among African American Adults: The Jackson Heart Study, 2000-04 to 2012.

We examined whether life course socioeconomic position (SEP) was associated with incidence of type 2 diabetes (t2DM) among African Americans. Secondary analysis of data from the Jackson Heart Study, 2000-04 to 2012, using Cox proportional hazard regression to estimate hazard ratios (HR) with 95% CI for t2DM incidence by measures of life course SEP. Sample of 4,012 nondiabetic adults aged 25-84 years at baseline. Incident t2DM identified by self-report, hemoglobin A1c ≥6.5%, fasting plasma glucose ≥126 mg/dL, or use of diabetes medication. During 7.9 years of follow-up, 486 participants developed t2DM (incidence rate 15.2/1000 person-years, 95% CI: 13.9-16.6). Among women, but not men, childhood SEP was inversely associated with t2DM incidence (HR=.97, 95% CI: .94-.99) but was no longer associated with adjustment for adult SEP or t2DM risk factors. Upward SEP mobility increased the hazard for t2DM incidence (adjusted HR=1.52, 95% CI: 1.05-2.21) among women only. Life course allostatic load (AL) did not explain the SEP-t2DM association in either sex. Childhood SEP and upward social mobility may influence t2DM incidence in African American women but not in men.

Overweight and obesity in type1 diabetes equal those of the general population.

SummaryBackgroundThe obesity epidemic might affect patients with type 1 diabetes (T1DM), historically described as lean and insulin-sensitive subjects. Insulin resistance in T1DM might increase diabetic complications, especially cardiovascular disease. Therefore, the body mass index (BMI) in T1DM patients was analyzed in comparison to the general population. Furthermore, the impact of increased BMI on glycemic control and metabolic alterations was assessed.MethodsBody mass index was compared overall and among four different age groups between adult T1DM (n = 186), treated in the outpatient clinic between 2014 and 2016, and 15,771 individuals from the general population who took part at an Austrian health survey. Furthermore, parameters of glycemic control, lipid state, blood pressure and additional medication were compared between T1DM with a BMI under or above 27.5 kg/m2.ResultsPatients with T1DM had significantly higher BMI values than general population (25.9 ± 4.2 kg/m2 vs. 25.3 ± 4.5 kg/m2; p = 0.027), controlling for age group; however, prevalence of overweight (39.8% vs. 33.1%) and obesity (14% vs. 13.8%) was not significantly different. Within the 4 age groups only T1DM patients between 30 years and 49 years old had significantly higher BMI values compared to the general population (mean difference 1.9 kg/m2; 95% confidence interval, CI: 0.96–2.83 kg/m2). In T1DM, a BMI ≥27.5 kg/m2 was associated with increased rates of hypertension, dyslipidemia, microalbuminuria, and increased insulin demand, whereas glycemic control was not affected.ConclusionsIn contrast to common descriptions T1DM patients have a higher BMI compared to the general population. Rates of overweight and obesity in T1DM equal those of the general population. Therefore, it is concluded that the obesity epidemic has reached T1DM patients and “double diabetes” might be an entity to consider.

Efficacy and safety of evogliptin versus sitagliptin as add on to metformin alone in a combined russian-korean population. Evo-combi trial

Background: Dipeptidyl-peptidase-4 inhibitors (iDPP-4) are pathogenically targeted drugs for diabetes mellitus type 2 (T2DM). Evogliptin is a new member of iDPP-4 class. The drug has the longest half-elimination period among the class, and its efficacy and safety as monotherapy have been already studied in placebo-controlled randomized clinical trials.&#x0D; Aims: To study efficacy and safety of evogliptin as compared to sitagliptin in T2DM patients with unsatisfying glycemic control with metformin monotherapy via a multinational double blind randomized controlled trial. To compare the study results in Russian and Korean subpopulations.&#x0D; Materials and methods: We used a combined Russian-Korean database (1:4) of EVO-COMBI trial. 281 adult T2DM patients administered metformin alone (at least 1000 mg/day) were randomized 1:1 to add on evogliptin (142 patients) or sitagliptin (139 patients) for 24 weeks once daily. The primary endpoint was change in glycated hemoglobin (HbA1c) level at Week 24 as compared to baseline. Non-inferiority was concluded if the upper limit of the 2-sided 95% confidence interval for the HbA1c difference between treatments was 0.35 %. Subgroup analysis for between-subpopulation difference in treatment effect was also conducted.&#x0D; Results: The mean between-group difference was 0.03 % [95 % CI: -0.14; 0.19 %], that confirms non-inferiority of evogliptin (mean HbA1c decrease -0.58 0.70 %, p0.001) to sitagliptin (mean HbA1c decrease -0.61 0.66 %, p0.001). Evogliptin and sitagliptin both tend to be more effective in South Korean subpopulation in terms of fasting plasma glucose lowering (p=0.030), however HbA1c decrease in subpopulations was comparable (p=0.657). Both drugs were well tolerated in both subpopulations. Adverse effects were associated mostly with gastrointestinal disorders, and the frequency was comparable between treatment groups (p0.05). Gastrointestinal adverse effects were registered more often in Korean patients (p=0.014). There were no severe hypoglycemia. Frequency of mild hypoglycemia was comparable between evogliptin and sitagliptin (0.7 % and 5.2 %, respectively, p=0.365).&#x0D; Conclusions: Evogliptin 5 mg/day is non-inferior to sitagliptin 100 mg/day in T2DM patients with unsatisfying glycemic control with metformin monotherapy. Safety profile is also comparable. Efficacy-safety profile of evogliptin is comparable in Russian and South Korean subpopulations.