Type 2 Diabetes Mellitus Cases Research Articles

Bayesian network analysis of factors influencing type 2 diabetes, coronary heart disease, and their comorbidities

ObjectiveBayesian network (BN) models were developed to explore the specific relationships between influencing factors and type 2 diabetes mellitus (T2DM), coronary heart disease (CAD), and their comorbidities. The aim was to predict disease occurrence and diagnose etiology using these models, thereby informing the development of effective prevention and control strategies for T2DM, CAD, and their comorbidities.MethodEmploying a case-control design, the study compared individuals with T2DM, CAD, and their comorbidities (case group) with healthy counterparts (control group). Univariate and multivariate Logistic regression analyses were conducted to identify disease-influencing factors. The BN structure was learned using the Tabu search algorithm, with parameter estimation achieved through maximum likelihood estimation. The predictive performance of the BN model was assessed using the confusion matrix, and Netica software was utilized for visual prediction and diagnosis.ResultThe study involved 3,824 participants, including 1,175 controls, 1,163 T2DM cases, 982 CAD cases, and 504 comorbidity cases. The BN model unveiled factors directly and indirectly impacting T2DM, such as age, region, education level, and family history (FH). Variables like exercise, LDL-C, TC, fruit, and sweet food intake exhibited direct effects, while smoking, alcohol consumption, occupation, heart rate, HDL-C, meat, and staple food intake had indirect effects. Similarly, for CAD, factors with direct and indirect effects included age, smoking, SBP, exercise, meat, and fruit intake, while sleeping time and heart rate showed direct effects. Regarding T2DM and CAD comorbidities, age, FBG, SBP, fruit, and sweet intake demonstrated both direct and indirect effects, whereas exercise and HDL-C exhibited direct effects, and region, education level, DBP, and TC showed indirect effects.ConclusionThe BN model constructed using the Tabu search algorithm showcased robust predictive performance, reliability, and applicability in forecasting disease probabilities for T2DM, CAD, and their comorbidities. These findings offer valuable insights for enhancing prevention and control strategies and exploring the application of BN in predicting and diagnosing chronic diseases.

Prevalence of and factors associated with suboptimal glycemic control among patients with type 2 diabetes mellitus attending public hospitals in the Greater Male’ Region, Maldives: a hospital-based cross-sectional study

BackgroundSuboptimal glycemic control of type 2 diabetes mellitus (T2DM) which is defined as having HbA1c greater than 7% is a major public health problem in several countries, including the Maldives. The study aimed to estimate the prevalence and determine factors associated with suboptimal glycemic control among T2DM patients.MethodsA hospital-based cross-sectional was applied to collect data from T2DM patients who attended public hospitals in the Greater Male’ Region, Maldives where were one of the highest reports of T2DM and suboptimal glycemic control cases in the country between January to March 2023 by a validated questionnaire and anthropometric measurements. Five (5) ml blood specimens were collected to measure the glycated hemoglobin (HbA1c) level. Univariable and multivariable logistic regressions were employed to determine factors associated with suboptimal glycemic control of T2DM at a significant level of α = 0.05.ResultsA total of 341 participants were recruited for the study: 65.7% were female, 42.5% were aged 40–60 years, and 42.2% were married. The overall prevalence of suboptimal glycemic control was 50.7%. Ten variables were found to be associated with suboptimal glycemic control in multivariable logistic regression. Those aged 40–60 years (AOR = 3.35, 95% CI = 1.78–6.30), being single (AOR = 2.53, 95% CI = 1.21–5.30), preparation of food using more than three tablespoons of cooking oil (AOR = 2.78, 95% CI = 1.46–5.28), preparation of food with more than three tablespoons of sugar (AOR = 2.55, 95% CI = 1.31–4.93), no exercise (AOR = 2.04, 95% CI = 1.15–3.61), DM diagnosed with more than twenty years prior (AOR = 2.59, 95% CI = 1.34–4.99), obese body mass index (BMI) (AOR = 3.82, 95% CI = 1.75–8.32), high total cholesterol (AOR = 2.43, 95% CI = 1.36–4.35), high triglycerides (AOR = 3.43, 95% CI = 1.93–6.11), and high-level stress (AOR = 2.97, 95% CI = 1.48–5.93) were having a greater odds of having suboptimal glycemic control than those who did not have these characteristics.ConclusionA large proportion of T2DM patients in the Greater Male’ Region fail to control their blood glucose. Effective public health interventions should be introduced, especially interventions focused on reducing cooking oil and sugar in daily cooking practices, encouraging regular exercise, and maintaining cholesterol levels, particularly for those diagnosed with diabetes mellitus for more than 20 years prior.

Association between predicted fat mass, predicted lean mass, predicted percent fat and type 2 diabetes mellitus in Japanese adults: a retrospective study.

Type 2 diabetes mellitus (T2DM) is known to have obesity as a risk factor. Body mass index cannot distinguish between lean mass and fat mass. We aimed to examine the association between predicted fat mass, predicted lean mass, predicted percent fat and risk of T2DM in Japanese adults. We also explored whether these three new parameters could predict T2DM better than other obesity markers. This present study is a secondary data analysis. The study enrolled 20,944 Japanese individuals who participated in the NAGALA medical assessment program between 2004 and 2015. 15,453 participants who are eligible and have complete information were included to our analysis. Through the use of Kaplan-Meier curve, restricted cubic spline and univariate and multivariate Cox regression analysis, the relationship between predicted fat mass, predicted lean mass, predicted percent fat and T2DM risk was examined. The area under the curve method was used to assess the differences between these markers of obesity. A total of 373 cases of T2DM occurred over a median time of 5.4 years. In the male group, we found a U-shaped connection between predicted fat mass, predicted lean mass, and T2DM onset (p value, non-linearity < 0.05). A linear relationship was found between predicted percent fat and T2DM onset. The linear relationship was also found in the female group for predicted fat mass, and predicted percent fat. And for women, predicted lean mass was not an independent predictor. The area under the curve (AUC) for predicted fat mass, predicted lean mass, predicted percent fat in men was 0.673 (95%CI: 0.639 ~ 0.707), 0.598 (95%CI: 0.561 ~ 0.635), 0.715 (95%CI: 0.684 ~ 0.745), respectively. In males, WHtR was the strongest predictor (AUC 0.7151, 95%CI: 0.684 ~ 0.746), followed by predicted percent fat (AUC 0.7150, 95%CI: 0.684 ~ 0.745). In the females, WHtR was also the strongest predictor (AUC 0.758, 95%CI: 0.703 ~ 0.813), followed by body mass index (AUC 0.757, 95%CI: 0.704 ~ 0.811) and predicted percent fat (AUC 0.742, 95%CI: 0.687 ~ 0.798). Predicted fat mass, predicted lean mass, predicted percent fat were strongly connected with an increased risk for developing T2DM in Japanese, particularly in males. WHtR and predicted percent fat had a slightly better discrimination than other common obesity indicators in males. In the females, predicted fat mass and predicted percent fat were associated with T2DM risk, WHtR and body mass index had the slightly higher predictive power.

The Association Between the Triglyceride to High-Density Lipoprotein Cholesterol Ratio and the Incidence of Type 2 Diabetes Mellitus in the Japanese Population.

Abstract Aims: To explore whether the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) was independently associated with the risk of incident type 2 diabetes mellitus (T2DM) in a large Japanese cohort. Methods: A secondary analysis was performed using open-access data from a retrospective cohort study. A total of 12,716 eligible participants who had standard medical examinations at the Murakami Memorial Hospital were included in this study. New-onset T2DM was the main outcome during follow-up. The risk of T2DM based on the TG/HDL-C ratio was evaluated using Cox regression analysis and Kaplan-Meier analysis. Subgroup analysis was performed to understand further the significance of the TG/HDL-C ratio in particular populations. To assess the potential of the TG/HDL-C ratio for predicting T2DM, a receiver operating characteristic (ROC) analysis was performed. Results: One hundred fifty new-onset T2DM cases were observed during a median follow-up of 5.39 years. The incidence of T2DM increased with a rise in the TG/HDL-C ratio based on the Kaplan-Meier curves (P < 0.0001). After controlling for potential confounding variables, the TG/HDL-C ratio was positively related to incidence of T2DM (hazard ratio = 1.08, 95% confidence interval: 1.01-1.15, P = 0.0239). In subgroup analysis, those with a body mass index of ≥18.5 and <24 kg/m2 showed a significantly positive relationship. The area under the ROC curve for the TG/HDL-C ratio as a T2DM predictor was 0.684. The optimal TG/HDL-C ratio cutoff value for T2DM was 1.609, with a sensitivity of 54.7% and a specificity of 73.6%. Conclusion: The authors' results showed a significant relationship between the TG/HDL-C ratio and the incidence of T2DM in the Japanese population.

The prognostic significance of fibroblast growth factor-23 in predicting complications of type 2 diabetes mellitus, especially when associated with obesity

type 2 Diabetes Mellitus (T2DM) is considered a global health problem with an exceptionally high economic burden not only for families but also for countries overall. In 90-95% of T2DM cases, varying degrees of obesity are observed. One aspect contributing to complications in T2DM involves musculoskeletal system impairment, specifically alterations in bone mineral density (BMD), indicative of bone architecture disruption, leading to secondary osteoporotic conditions. Fibroblast growth factors (FGFs), known for their regulatory influence on metabolism, are identified as mechanisms activated in T2DM. Within this group, fibroblast growth factor 23 (FGF-23) is acknowledged. In individuals with T2DM and excess weight or obesity, conditions conducive to increased FGF-23 synthesis are established, contributing to disturbances in mineral metabolism. Therefore, our study aimed to investigate the content and role of FGF-23 in the development of secondary osteoporosis in T2DM patients with concurrent obesity. A total of 103 patients with type 2 diabetes were involved, with 83 cases featuring elevated body weight or obesity (main group). To assess the impact of obesity on FGF-23 changes, a comparison group of 20 T2DM patients with normal body weight (NBW) was formed. The average age of patients with comorbid conditions was 43±4.6 years, and for those with isolated T2DM, it was 44.1±2.1 years. The average duration of T2DM across groups ranged from 1 to 13 years (6.7±2.4 years on average). Control FGF-23 values were obtained from a group of 20 practically healthy individuals of similar age and gender. The diagnosis of T2DM was confirmed according to the Unified Medical Assistance Protocol "Diabetes Mellitus" (Order of the Ministry of Health of Ukraine dated December 21, 2012, No. 1118). Thus, all examined T2DM patients were in the subcompensation stage with a moderate degree of disease severity. The presence and severity of obesity were assessed according to the International Diabetes Federation (IDF, 2005) criteria based on the body mass index (BMI) calculation using the Ketle formula. In the examination of 83 T2DM patients with obesity, a probable increase in fibroblast growth factor 23 (FGF-23) in serum was determined, correlating with osteoporotic changes in dual-energy X-ray absorptiometry. Therefore, FGF-23 can be utilized as a marker for bone mineral density status and control of treatment measures.

Visit to visit transition in TXNIP gene methylation and the risk of type 2 diabetes mellitus: a nested case-control study.

Our study aimed to investigate the association between the transition of the TXNIP gene methylation level and the risk of incident type 2 diabetes mellitus (T2DM). This study included 263 incident cases of T2DM and 263 matched non-T2DM participants. According to the methylation levels of five loci (CpG1-5; chr1:145441102-145442001) on the TXNIP gene, the participants were classified into four transition groups: maintained low, low to high, high to low, and maintained high methylation levels. Compared with individuals whose methylation level of CpG2-5 at the TXNIP gene was maintained low, individuals with maintained high methylation levels showed a 61-87% reduction in T2DM risk (66% for CpG2 [OR: 0.34, 95% CI: 0.14, 0.80]; 77% for CpG3 [OR: 0.23, 95% CI: 0.07, 0.78]; 87% for CpG4 [OR: 0.13, 95% CI: 0.03, 0.56]; and 61% for CpG5 [OR: 0.39, 95% CI: 0.16, 0.92]). Maintained high methylation levels of four loci of the TXNIP gene are associated with a reduction of T2DM incident risk in the current study. Our study suggests that preserving hypermethylation levels of the TXNIP gene may hold promise as a potential preventive measure against the onset of T2DM.

Effect of rs10440833 polymorphism in the CDKAL1 gene on insulin secretion in type 2 diabetes patients

In the present generation, type 2 diabetes mellitus (T2DM) has become a common disease with the same trend in the Saudi Arabia due to many factors. Apart from environmental factors, genetic factors are also playing the major role. In this context, this study has design to screen a polymorphism related to T2DM and which was not studied yet in the Saudi Arabia and this study was designed by selecting rs10440833 polymorphism in CDKAL1 gene. The aim of this study was to execute the genetic association with rs1044883 polymorphism in the CDKAL1 gene in Saudi patients diseased with T2DM. In this study, 60 T2DM patients and 60 controls were selected and genotyping was carried with PCR-RFLP analysis using ACIL restriction enzyme. The obtained data was calculated with SPSS software and the tables were generated. The current study results confirmed, that some of the clinical parameters significantly differ between T2DM cases and control subejcts (p < 0.05). Genotype and allele frequencies showed negative association (p > 0.05). However, both regression and ANOVA analysis was also showed negative association (p > 0.05). In conclusion, the rs10440833 polymorphism is not associated in the Saudi Arabian T2DM patients and this polymorphism has no role.

Increased severity of presentation signs in children with newly diagnosed Type 1 Diabetes during the COVID-19 pandemic: A tertiary center experience.

Diabetic ketoacidosis (DKA) is an important complication of Type 1 Diabetes Mellitus (T1DM) which is worsened when the diagnosis of T1DM is delayed. The aim of this study was to evaluate the presentation patterns, severity, autoantibody status and seasonal variability of newly diagnosed T1DM patients during the pandemic period of two years compared to those in the pre-pandemic period. In this single tertiary center retrospective cohort study newly diagnosed T1DM patients were grouped as pre-pandemic and pandemic period. Age, gender, the month of diagnosis, hemoglobinA1c (HbA1c), venous blood gas parameters, duration of symptoms, glutamic-acid-decarboxylase-antibody (anti GAD), islet-cell antibody (ICA) and insulin autoantibody (IAA) levels were recorded. The data obtained were compared between the groups. Number of patients presenting with DKA was significantly higher during the pandemic period (92 (65.7%) vs. 62 (40.8%) patients, p<0.001). In terms of clinical severity of DKA, pH, and HCO3 levels were lower during the pandemic period (p<0.001), while the number of patients presenting with severe DKA was significantly higher during the pandemic period (41 (44.6%) vs. 17 (27.4%) patients, p=0.031). ICA positivity was significantly higher in patients admitted during the pandemic period (47 (36.4%) vs. 21 patients (16.9%), p<0.001), especially in the second year of the pandemic (p<0.001). Anti GAD-ICA co-positivity was significantly higher in patients admitted during the pandemic period and also in second year of the pandemic (p<0.001). DKA rates increased in newly diagnosed T1DM cases during the pandemic. Despite the relaxation of bans, the second year of the pandemic also saw increased rates of DKA and severe DKA compared to the pre-pandemic period. The significantly increased ICA positivity in the pandemic may support the effects of COVID-19 on autoimmune T1DM.

Trajectories of social isolation and loneliness and the risk of incident type 2 diabetes mellitus across genetic risk score

AimThis study aimed to investigate the association of social isolation, loneliness, and their trajectory with the risk of developing type 2 diabetes mellitus (T2DM) across genetic risk. MethodsWe included 439,337 participants (mean age 56.3 ± 8.1 years) enrolled in the UK Biobank study who were followed up until May 31, 2021. Social isolation and loneliness were self-reported and were further categorized into never, transient, incident, and persistent patterns. ResultsDuring a median follow-up of 12.7 years, 15,258 incident T2DM cases were documented. Social isolation (versus no social isolation: hazard ratio (HR) 95 % confidence interval (CI) 1.04 [1.00;1.09]) and loneliness (versus no loneliness: 1.26 [1.19;1.34]) were associated with an increased T2DM risk, independent of the genetic risk for T2DM. The interactions existed between social isolation and loneliness (Pinteraction < 0.05); the increased T2DM risk associated with social isolation was only significant among participants without loneliness. In the longitudinal analysis, only persistent social isolation (versus never social isolation: 1.22 [1.02;1.45]) was associated with an increased T2DM risk, whereas incident loneliness (versus never loneliness: 1.95 [1.40;2.71]) and persistent loneliness (2.00 [1.31;3.04]) were associated with higher T2DM risks. ConclusionSocial isolation and loneliness, especially their persistent pattern, were independently associated with an increased incident T2DM risk, irrespective of an individual's genetic risk. Loneliness modified the association between social isolation and incident T2DM.

Association between Parvovirus B19 and thyroid/celiac autoantibodies among T1DM pediatric patients.

In recent years, an overwhelming association between Pediatric Type 1 Diabetes Mellitus (T1DM) and autoimmune diseases has been largely reported. The current study was designed to determine a possible association between autoimmune thyroiditis (AIT), celiac disease (CD) - associated autoantibodies, and Parvovirus B19 infection among pediatric T1DM cases in the southwestern region of Saudi Arabia. Blood samples from age groups 1-18 years attending the Diabetic Clinic were collected over a period of 12 months. Serum anti-thyroid peroxidase (TPO), anti-thyroglobulin (TG), anti-tissue transglutaminase immunoglobulin A (TG-IgA), endomysial IgA (EMA-IgA), Parvovirus B19-IgG and IgM antibodies were detected by standard methods. The results showed the prevalence of autoantibodies against thyroid and CD among pediatric T1DM patients to be 44 (25%) and 25 (14.4%), respectively. The prevalence of antibodies against B19 was 70 (40%). Further determination of the prevalence of Parvovirus B19-IgG antibodies and thyroid antibodies among T1DM pediatric patients revealed that there was a significant association between them with a p<0.0491. The prevalence of autoantibodies against the thyroid was higher among the seropositive Parvovirus B19 children with T1DM. A positive association between the prevalence of autoantibodies against thyroid disease and the increase in the duration of diabetes was also noted. Hence, periodic screening of T1DM patients for B19 antibodies and autoantibodies for thyroid is crucial.

Pre-Existing Knowledge and Self-Reported Barriers to uptake Eye Care among Type-1 Diabetic Patients attending a City Diabetic Hospital at Southern Bangladesh

Purpose: To find out the knowledge about diabetic complication of eye &amp; the barriers to uptake of diabetic eye care among Type-1 diabetic patients. Method: This is a hospital based observational case series of 100 cases of Type-1 Diabetes Mellitus (DM1). Demographic data, knowledge about diabetic complication of eye, self reported barriers to uptake diabetes eye health service were collected by face-to-face interview. Interview was done on a formulated questionnaire including pre-existing knowledge about diabetes related ocular problems and factors act as a barrier to receive eye care. All DM1 patients attending in a city diabetic hospital during one year (from October 2017 to September 2018) period were included. Written consent was taken. Patients refuse to give consent &amp; aged more than 30 years were excluded. Results: The mean age of participants was (17.09 ± 3.92) years with range 6 to 23 years and 57% of them were female. About 59 % subjects were students. Around 50% of the respondent had knowledge about the adverse effect of diabetes on eyes, among them only 6% had knowledge about retina problems and 3% knew that blindness may happen. Only 32% of study population gave answer about the reason behind not seeking diabetic eye care and the most common (12%) answer was “not feeling necessity of eye care”. Conclusion: DM1 patients are more prone to systemic and ocular morbidity. The main reasons for not getting eye care services was lacks of awareness. Increase awareness building program can bring them to the eye health service which will very important to reduce diabetic ocular morbidity of young people who have long life in front of them.

Metformin-dolutegravir interaction leads to metformin-associated lactic acidosis: A case report

Metformin, a biguanide, is considered the standard first-line drug for managing type 2 diabetes mellitus (T2DM) patients owing to its safety profile. Despite having a highly safe profile, it is capable of causing serious adverse effects. Biguanides decrease gluconeogenesis from alanine, pyruvate, and lactate, which may result in lactic acidosis. The risk is high in patients with polypharmacy or comorbidities. This is a case of a 48-year-old Indian female with a known case of human immunodeficiency virus (HIV), T2DM, hypothyroidism, and hypertension who presented to the hospital with progressive right-sided weakness for the past 10 days along with transit loss of vision. The patient was diagnosed with multiple central nervous system tuberculomas, for which antitubercular treatment and dexamethasone were started. The patient was on a tenofovir, lamivudine, and dolutegravir regimen for HIV. The patient was started on metformin for sugar control, which led to metformin-associated lactic acidosis. A drug interaction between dolutegravir and metformin was attributed to this. The patient improved after metformin was replaced with glipizide, and lactate levels returned to normal. Lactic acidosis is a rare side effect of metformin. However, the risk of lactic acidosis is high when another drug interferes with metformin pharmacokinetics. Proper assessment and evaluation of potential drug–drug interactions is crucial to assure safe and effective therapy.

Review on the screening of urine glucose for early diagnosis of type 2 diabetes mellitus in school children and adolescents with obesity in Hong Kong.

Obesity and type 2 diabetes mellitus (T2DM) are growing health concerns. Since 2005, Student Health Service (SHS) and Hong Kong Paediatric Society formulated a protocol on urine glucose screening (UGS) for early diagnosis of T2DM in students with obesity in Hong Kong. This study reviews students with T2DM captured by this screening program and compare the data with the Hong Kong Children Diabetes Registry (HKCDR) database, to see if the UGS program facilitates early diagnosis of T2DM. Students between the ages of 10-18 years old with age- and sex-specific body mass index (BMI) >97th percentile who attended SHS between the school years from 2005/06 to 2017/18 were recruited for UGS. Those tested positive for random urine glucose underwent diagnostic testing for T2DM according to ADA guidelines. Demographic data and investigatory results from UGS and HKCDR within the same time period were compared. A total of 216,526 students completed UGS in the said period; 415 (0.19 %) students were tested positive for urine glucose of which 121 students were diagnosed with T2DM. UGS picked up 23 % of the newly diagnosed T2DM cases. When compared to the HKCDR database, students diagnosed via UGS were significantly younger, less obese, and had fewer diabetic related complications. The negative predictive value of UGS is high and can effectively rule out T2DM. Urine glucose screening is an inexpensive and simple test that allows for early diagnosis of T2DM among obese school students. Other methods including POCT HbA1c can be explored to improve program effectiveness.

CD36 gene variant rs1761667(G/A) as a biomarker in obese type 2 diabetes mellitus cases

BackgroundSeveral reports discussed a connection between CD36 genotypes associated with obesity, influencing the development of Type 2 diabetes mellitus (T2DM). Therefore, this study examines the prognostic value of CD36 polymorphism rs1761667 (G/A) in individuals with obese T2DM. The investigation also explores the correlation between this genetic variation and the clinical/biochemical parameters of the subjects.MethodsBlood samples of a total of 475 subjects from north India were collected from the outpatient unit (OPD), Department of Medicine, KGMU, Lucknow as per inclusion/exclusion criteria. Anthropometric details of study subjects were recorded and biochemical parameters were estimated in 250 T2DM cases, 75 obese T2DM cases, and 150 controls. The CD36 gene variant rs1761667 (G/A) was subject to genotypic analysis using the polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) method, utilizing specific primers and HhaI enzyme. All statistical analysis was done using SPSS (ver. 21.0) and Prism (5.01) software.ResultsFasting plasma glucose (FPG), systolic blood pressure (SBP), post-prandial glucose (PPG) were significant in T2DM subjects. Lipid profile such as Total Cholesterol (TC), Low-Density Lipoprotein (LDL) and Very Low-Density Lipoprotein (VLDL) were also found significantly associated with obese T2DM cases. GA and AA genotypes of rs1761667 (G/A) showed significant associations in obese T2DM cases. The GA genotype demonstrated a considerable association (P < 0.001) with a 2.77-fold increased susceptibility to the high risk of T2DM. The AA genotype was found to be significantly associated (P = 0.008) with 2.94-fold higher risk of T2DM in obesity while 9.33 folds significant risk of developing obesity in T2DM cases.ConclusionsThe risk of obesity in T2DM cases can be assessed by genotyping the CD36 genetic variant rs1761667 (G/A). However, raised FPG, PPG, TC, LDL, and VLDL showed poor prognosis in obese T2DM cases. CD36 gene variant can be proposed as a prognostic biomarker for risk prediction of T2DM and obesity, while anthro-biochemical risk factors as preventive biomarker.

Social isolation, loneliness, and the risk of incident type 2 diabetes mellitus by glycemic status

AimThe modifying effect of prediabetic status on the association of social isolation and loneliness with the risk of type 2 diabetes mellitus (T2DM) remains uncertain. We aimed to explore whether prediabetic status modifies the association of social isolation and loneliness with incident T2DM. Methods358,951 participants with random blood glucose < 11.1 mmol/l, hemoglobin A1c < 6.5 % and without diagnosis of diabetes from the UK Biobank were included. Prediabetes was defined by hemoglobin A1c level at 5.7–6.4 %. Social isolation and loneliness were assessed using self-reported questionnaires. The study outcome was incident T2DM. ResultsDuring a median follow-up of 12.5 years, 13,213 (3.7 %) incident T2DM cases were documented. Social isolation and loneliness in subjects with normoglycemia (adjusted HR [95 %CI]: social isolation: 1.14 [1.07;1.23]; loneliness: 1.33 [1.20;1.47]) were more strongly associated with increased risk of T2DM than in those with prediabetes (adjusted HR [95 %CI]: social isolation: 0.97 [0.91;1.03]; loneliness: 1.04 [0.95;1.13]) (Both P for interaction < 0.001). Among individuals with prediabetes, alcoholic consumption (30.9 %), household income (23.3 %), healthy sleep (17.1 %), loneliness (14.9 %), and physical activity (12.6 %) mediated most of the variance in the association between social isolation and incident T2DM, while body mass index (17.9 %) and healthy sleep (17.6 %) mediated most of the variance in the association between loneliness and incident T2DM. ConclusionSocial isolation and loneliness were independently associated with a higher risk of T2DM among individuals without prediabetes. Among those with prediabetes, the association of social isolation and loneliness with incident T2DM were mainly mediated by some socioeconomic and lifestyle factors.

Exposure to PM2.5 and its five constituents is associated with the incidence of type 2 diabetes mellitus: a prospective cohort study in northwest China.

Studies have demonstrated that fine particulate matter (PM2.5) is an underlying risk factor for type 2 diabetes mellitus (T2DM), but evidence exploring the relationship between PM2.5 chemical components and T2DM was extremely limited, to investigate the effects of long-term exposure to PM2.5 and its five constituents (sulfate [SO42-], nitrate [NO3-], ammonium [NH4+]), organic matter [OM] and black carbon [BC]) on incidence of T2DM. Based on the "Jinchang Cohort" platform, a total of 19,884 participants were selected for analysis. Daily average concentrations of pollutants were gained from Tracking Air Pollution in China (TAP). Cox proportional hazards regression models were utilized to estimate the hazard ratios (HR) and 95% confidence interval (CI) in single-pollutant models, restricted cubic splines functions were used to examine the dose-response relationships, and quantile g-computation (QgC) was applied to evaluate the combined effect of PM2.5 compositions on T2DM. Stratification analysis was also considered. A total of 791 developed new cases of T2DM were observed during a follow-up period of 45254.16 person-years. The concentrations of PM2.5, NO3-, NH4+, OM and BC were significantly associated with incidence of T2DM (P-trend < 0.05), with the HRs in the highest quartiles of 2.16 (95% CI 1.79, 2.62), 1.43 (95% CI 1.16, 1.75), 1.75 (95% CI 1.45, 2.11), 1.31 (95% CI 1.08, 1.59) and 1.79 (95% CI 1.46, 2.21), respectively. Findings of QgC model showed a noticeably positive joint effect of one quartile increase in PM2.5 constituents on increased T2DM morbidity (HR 1.27, 95% CI 1.09, 1.49), and BC (32.7%) contributed the most to the overall effect. The drinkers, workers and subjects with hypertension, obesity, higher physical activity, and lower education and income were generally more susceptible to PM2.5 components hazards. Long-term exposure to PM2.5 and its components (i.e., NO3-, NH4+, OM, BC) was positively correlated with T2DM incidence. Moreover, BC may be the most responsible for the association between PM2.5 constituents and T2DM. In the future, more epidemiological and experimental studies are needed to identify the link and potential biological mechanisms.

Investigating the Impact of ENPP1 Gene's K121Q (RS1044498) Polymorphism in Type 2 Diabetes via an Updated Meta-Analysis

Type 2 Diabetes Mellitus (T2DM) occurs due to a complex relationship of genetic, environmental, and physiological factors, encompassing insufficient pancreatic insulin synthesis, peripheral insulin resistance, and diverse molecular pathways. The transmembrane glycoprotein ectonucleotide pyrophosphatase phosphodiesterase 1 (ENPP1) plays a role in insulin regulation, with the K121Q (rs1044498) variant on the ENPP1 gene being a subject of extensive study due to its potential association with T2DM. To comprehensively evaluate this relationship, a meta-analysis was conducted, pooling data from 48 studies retrieved from databases such as PubMed, Google Scholar, Science Direct, and Medline. The analysis, performed using Review Manager Version 5.4.1 and Stata version 14.1, included a total of 24,979 T2DM cases and 33,005 controls. Employing fixed-effects or random-effects models, the combined Odds Ratio (OR) and 95% Confidence Intervals (CIs) were calculated to quantify the connection's magnitude. In the overall population, all genotypic models revealed a statistically noteworthy connotation between ENPP1 and T2DM (P &lt; 0.05). Notably, the homozygous model exhibited an OR of 1.53 (95% CI = 1.23-1.90, P = 0.0001), while the heterozygous, dominant, recessive, and allelic models showed ORs of 1.22 (95% CI = 1.08-1.37, P = 0.001), 1.15 (95% CI = 1.11-1.41, P = 0.0003), 1.38 (95% CI = 1.17-1.64, P = 0.0002), and 1.22 (95% CI = 1.10-1.36, P = 0.0003), correspondingly. Subgroup analysis by population indicated no significant correlation between the K121Q polymorphism and T2DM in the African population, while a noteworthy association was detected in both Asian and Caucasian populations, with the heterozygous model lacking significance in the latter. Despite no evidence of publication bias, a notable amount of residual heterogeneity among studies was identified. Sensitivity analysis established the steadiness and dependability of the meta-analysis findings, underscoring the complex nature of the ENPP1 gene's involvement in T2DM across diverse populations.

Psychotic Disorders and the Risk of Type 2 Diabetes Mellitus, Atherosclerotic Cardiovascular Diseases, and All-Cause Mortality: A Population-Based Matched Cohort Study.

The effects of psychotic disorders on cardiometabolic diseases and premature death need to be determined in Asian populations. In this population-based matched cohort study, the Korean National Health Insurance Service database (2002 to 2018) was used. The risk of type 2 diabetes mellitus (T2DM), acute myocardial infarction (AMI), ischemic stroke, composite of all cardiometabolic diseases, and all-cause death during follow-up was compared between individuals with psychotic disorders treated with antipsychotics (n=48,162) and 1:1 matched controls without psychiatric disorders among adults without cardiometabolic diseases before or within 3 months after baseline. In this cohort, 53,683 composite cases of all cardiometabolic diseases (during median 7.38 years), 899 AMI, and 1,216 ischemic stroke cases (during median 14.14 years), 7,686 T2DM cases (during median 13.26 years), and 7,092 deaths (during median 14.23 years) occurred. The risk of all outcomes was higher in subjects with psychotic disorders than matched controls (adjusted hazard ratios [95% confidence intervals]: 1.522 [1.446 to 1.602] for T2DM; 1.455 [1.251 to 1.693] for AMI; 1.568 [1.373 to 1.790] for ischemic stroke; 1.595 [1.565 to 1.626] for composite of all cardiometabolic diseases; and 2.747 [2.599 to 2.904] for all-cause mortality) during follow-up. Similar patterns of associations were maintained in subgroup analyses but more prominent in younger individuals (P for interaction <0.0001) when categorized as those aged 18-39, 40-64, or ≥65 years. Patients with psychotic disorders treated with antipsychotics were associated with increased risk of premature allcause mortality and cardiometabolic outcomes in an Asian population. This relationship was more pronounced in younger individuals, especially aged 18 to 39 years.

A cross-sectional comparative assessment of diabetic autonomic neuropathy using heart rate variability and galvanic skin response – Effect of disease progression

Background: Type 2 diabetes mellitus (T2DM) poses a significant health-care challenge and is a primary contributor to both mortality and morbidity. Diabetic autonomic neuropathy (DAN) is a frequently occurring complication associated with diabetes mellitus. Autonomic nerve damage leading to cardiac autonomic dysfunction and peripheral sympathetic neuropathy can lead to changes in heart rate variability (HRV) and galvanic skin resistance (GSR), respectively. Aims and Objectives: The study was designed and done to evaluate the impact of T2DM on HRV and GSR for assessing DAN. Materials and Methods: A total of 100 individuals diagnosed with T2DM (cases) and 100 healthy individuals (controls) participated in this study. Physio Pac (PC-2004) was used to record the necessary data. Statistical analysis was performed using the non-parametric Mann–Whitney test to see the comparison of the cases and controls. In addition, to measure the statistical relationship between the duration of the disease and the HRV and GSR parameters, Spearman’s rank correlation coefficient was utilized. The study received approval from the Ethical and Research Committee at the Government Medical College, Patiala. Results: Significant statistical differences were observed between the cases and controls in all time domain measures, as well as GSR and the majority of frequency domain measures of HRV. The correlation analysis revealed a strong association between the duration of T2DM and a decrease in HRV as well as an increase in GSR. Conclusion: The findings from the present study provide evidence that T2DM has an impact on HRV, which suggests the presence of cardiac autonomic neuropathy among diabetic patients, leading to an increased risk of cardiovascular morbidity. In addition, the study indicates that reduced sudomotor function, as assessed by Galvanic Skin Resistance (GSR), serves as a predictive measure for autonomic neuropathy. Therefore, these tests can serve as valuable tools in facilitating the assessment of DAN.

Risk of Type 1 Diabetes Mellitus in Patients with Atopic Dermatitis: A Nationwide Population-Based Cohort Study

Introduction: Atopic dermatitis (AD) is a disease frequently occurring in children. The immune response is characterized by T-helper (Th)-2-dependent inflammation. Type 1 diabetes mellitus (T1DM) is an autoimmune disease that destroys pancreatic islet beta cells. In contrast, it is mainly mediated by a Th-1-dependent response. An inverted association has been hypothesized between T1DM and AD since Th1 and Th2 responses are mutually inhibitory. Methods: Data was retrieved from a nationwide healthcare database in Taiwan. A logistic regression model was used to evaluate the association of T1DM in patients with AD within a year. A Cox proportional hazards analysis was used to evaluate the subsequent risk of developing T1DM 1 year after AD diagnosis. Results: We identified 396,461 patients with AD and 1,585,844 age- and sex-matched controls. During the first year of follow-up, after adjusting variates, the association between T1DM and AD showed no statistical differences (odds ratio: 1.40; 95% confidence interval [CI]: 0.83–2.38, p = 0.207). After excluding those T1DM cases within 1 year of AD diagnosis and those with a follow-up duration of less than 1 year, AD did not significantly increase the risk of T1DM (hazard ratio [HR]: 1.02; 95% CI, 0.83–1.25, p = 0.843). Conclusions: Our study revealed that there was no significant association between AD and T1DM in the first year after AD diagnosis, and there was no increased risk of T1DM in AD patients in the average 5-year follow-up in our study.