Clinical Features Of Type Research Articles

367-P: Clinical Characteristics of Type 1 Diabetes and Severe Hypoglycemia in Adult Continuous Glucose Monitor Users

367-P: Clinical Characteristics of Type 1 Diabetes and Severe Hypoglycemia in Adult Continuous Glucose Monitor Users

A machine learning approach to predicting vascular calcification risk of type 2 diabetes: A retrospective study.

Recently, patients with type 2 diabetes mellitus (T2DM) have experienced a higher incidence and severer degree of vascular calcification (VC), which leads to an increase in the incidence and mortality of vascular complications in patients with T2DM. To construct and validate prediction models for the risk of VC in patients with T2DM. Twenty-three baseline demographic and clinical characteristics were extracted from the electronic medical record system. Tenclinical features were screened with least absolute shrinkage and selection operator method and were used to develop prediction models based on eight machine learning (ML) algorithms (k-nearest neighbor [k-NN], light gradient boosting machine, logistic regression [LR], multilayer perception [(MLP], Naive Bayes [NB], random forest [RF], support vector machine [SVM], XGBoost[XGB]). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, and precision. A total of 1407 and 352 patients were retrospectively collected in the training and test sets, respectively. Among the eight models, the AUC value in the NB model was higher than the other models (NB: 0.753, LGB: 0.719, LR: 0.749, MLP: 0.715, RF: 0.722, SVM: 0.689, XGB:0.707, p < .05 for all). The k-NN model achieved the highest sensitivity of 0.75 (95% confidence interval [CI]: 0.633-0.857), the MLP model achieved the highest accuracy of 0.81 (95%CI: 0.767-0.852) and specificity of 0.875 (95%CI: 0.836-0.912). This study developed a predictive model of VC based on MLand clinical features in type 2 diabetic patients. The NB model is a tool with potential to facilitate clinicians in identifying VC in high-risk patients.

Association of RPS26 gene polymorphism with different types of diabetes in Chinese individuals.

Different types of diabetes show distinct genetic characteristics, but the specific genetic susceptibility factors remain unclear. Our study aimed to explore the associations between the ribosomal protein S26 (RPS26) gene rs1131017 polymorphisms and susceptibility to type 1 diabetes mellitus, latent autoimmune diabetes in adults (LADA) and type 2 diabetes mellitus in the Chinese Han population, and their correlations with clinical features. Genotyping of the rs1131017 variant was carried out for 1,006 type 1 diabetes mellitus patients, 210 LADA patients, 642 type 2 diabetes mellitus patients and 2,099 control individuals. We found that the rs1131017 C allele was a risk locus for both type 1 diabetes mellitus and LADA (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.33-1.69, P < 0.001; OR 1.31, 95% CI 1.04-1.64, P = 0.021, respectively). Nevertheless, this association was not found for type 2 diabetes mellitus. Carrying the C allele genotype was associated with a lower postprandial C-peptide for type 1 diabetes mellitus (OR 1.41, 95% CI 1.11-1.80, P = 0.006) and lower fasting C-peptide for LADA (OR 1.55, 95% CI 1.01-2.38, P = 0.047). Interestingly, a lower GC frequency was noted for LADA than for type 1 diabetes mellitus, regardless of classification based on age at diagnosis, C-peptide or glutamic acid decarboxylase antibody positivity. The RPS26 polymorphism was associated with susceptibility and clinical characteristics of type 1 diabetes mellitus and LADA in the Chinese population, but was not related to type 2 diabetes mellitus. Thus, it might serve as a novel biomarker for particular types of diabetes.

The proteome and phosphoproteome of circulating extracellular vesicle-enriched preparations are associated with characteristic clinical features in type 1 diabetes.

There are no validated clinical or laboratory biomarkers to identify and differentiate endotypes of type 1 diabetes (T1D) or the risk of progression to chronic complications. Extracellular vesicles (EVs) have been studied as biomarkers in several different disease states but have not been well studied in T1D. As the initial step towards circulating biomarker identification in T1D, this pilot study aimed to provide an initial characterization of the proteomic and phosphoproteomic landscape of circulating EV-enriched preparations in participants with established T1D (N=10) and healthy normal volunteers (Controls) (N=7) (NCT03379792) carefully matched by age, race/ethnicity, sex, and BMI. EV-enriched preparations were obtained using EVtrap® technology. Proteins were identified and quantified by LC-MS analysis. Differential abundance and coexpression network (WGCNA), and pathway enrichment analyses were implemented. The detected proteins and phosphoproteins were enriched (75%) in exosomal proteins cataloged in the ExoCarta database. A total of 181 proteins and 8 phosphoproteins were differentially abundant in participants with T1D compared to controls, including some well-known EVproteins (i.e., CD63, RAB14, BSG, LAMP2, and EZR). Enrichment analyses of differentially abundant proteins and phosphoproteins of EV-enriched preparations identified associations with neutrophil, platelet, and immune response functions, as well as prion protein aggregation. Downregulated proteins were involved in MHC class II signaling and the regulation of monocyte differentiation. Potential key roles in T1D for C1q, plasminogen, IL6ST, CD40, HLA-DQB1, HLA-DRB1, CD74, NUCB1, and SAP, are highlighted. Remarkably, WGCNA uncovered two protein modules significantly associated with pancreas size, which may be implicated in the pathogenesis of T1D. Similarly, these modules showed significant enrichment for membrane compartments, processes associated with inflammation and the immune response, and regulation of viral processes, among others. This study demonstrates the potential of proteomic and phosphoproteomic signatures of EV-enriched preparations to provide insight into the pathobiology of T1D. The WGCNA analysis could be a powerful tool to discriminate signatures associated with different pathobiological components of the disease.

Correlation Between Clinical Features of Type 2 Diabetes Mellitus with CT Findings of Fatty Liver Patients

People with fatty liver disease are at major risk of liver cirrhosis and malignancies. This study aims to evaluate the correlation between fatty liver and diabetes features on computed tomography (CT) using Hounsfield units for the liver and spleen. The research was conducted in Jeddah Hospital’s Medical Imaging Department and CT scan department from March 2018 until March 2020. A total of 50 patients with diabetes were chosen randomly, with males (26) and females (24) ranging in age from 31 to 80 years old. Descriptive statistics of body mass index were recorded for the liver and the spleen; the main liver enzymes were Alanine aminotransferase (ALT), Gamma-glutamyltransferase (GGT), albumin, total bilirubin, and direct bilirubin, which were measured and analyzed using the Statistical Package for the Social Sciences program, version 23. We found a significant correlation of ALT and direct bilirubin with liver and spleen HU at p value &lt; 0.017 and &lt; 0.073, respectively; the mean and standard deviation for the other liver enzymes GGT, albumin, and total bilirubin in segment 3 of the left liver were 45.48 ± 7.077 HU, 45.00 ± 7.797 HU, 36.67 ± 5.776 HU, and 37.23 ± 4.885 HU, respectively. We concluded that fatty liver is associated with type 2 diabetes mellitus symptoms such as high ALT and direct bilirubin, with no significant association between GGT, albumin, total bilirubin, and liver and spleen HU.

Myocardial fat accumulation is associated with cardiac dysfunction in patients with type 2 diabetes, especially in elderly or female patients: a retrospective observational study

BackgroundEctopic fat is fat that accumulates in or around specific organs or compartments of the body including myocardium. The clinical features of type 2 diabetes patients with high fat accumulation in the myocardium remain unknown. Moreover, little is known about the influence of myocardial fat accumulation in type 2 diabetes on coronary artery disease and cardiac dysfunction. We aimed to clarify the clinical features, including cardiac functions, of type 2 diabetes patients with myocardial fat accumulation.MethodsWe retrospectively enrolled type 2 diabetes patients who underwent ECG-gated coronary computed tomography angiography (CCTA) and abdominal computed tomography (CT) scan examinations within 1 year of CCTA from January 2000 to March 2021. High fat accumulation in the myocardium was defined as the low mean myocardial CT value of three regions of interest, and the associations between CT values and clinical characteristics or cardiac functions were assessed.ResultsIn total, 124 patients were enrolled (72 males and 52 females). The mean age was 66.6 years, the mean BMI was 26.2 kg/m2, the mean ejection fraction (EF) was 67.6%, and the mean myocardial CT value was 47.7 Hounsfield unit. A significant positive correlation was found between myocardial CT value and EF (r = 0.3644, p = 0.0004). The multiple regression analyses also showed that myocardial CT value was independently associated with EF (estimate, 0.304; 95% confidence interval (CI) 0.092 to 0.517; p = 0.0056). Myocardial CT value showed significant negative correlations with BMI, visceral fat area and subcutaneous fat area (r = − 0.1923, − 0.2654, and -0.3569, respectively, p < 0.05). In patients who were ≥ 65 years or female, myocardial CT value showed significant positive correlations with not only EF (r = 0.3542 and 0.4085, respectively, p < 0.01) but also early lateral annular tissue Doppler velocity (Lat e’) (r = 0.5148 and 0.5361, respectively, p < 0.05). The multiple regression analyses showed that myocardial CT value was independently associated with EF and Lat e’ in these subgroups (p < 0.05).ConclusionsPatients with type 2 diabetes, especially in elderly or female patients, who had more myocardial fat had more severe left ventricular systolic and diastolic dysfunctions. Reducing myocardial fat accumulation may be a therapeutic target for type 2 diabetes patients.

Overall Clinical Features of Type 2 Diabetes Mellitus With Respect to Gender.

Introduction Since patients with type 2 diabetes are frequently misdiagnosed, provided inappropriate management, orpoorly controlled, it is important to comprehend the wide range of clinical signs and symptoms associated with diabetes. Therefore, this study evaluated the overall clinical manifestations of patients with type 2 diabetes patients with respect to gender. Methods This was a multicenter, cross-sectional study that was conducted at various hospitals, using a non-probability sampling technique. The duration of the study was about six months, from January 1, 2022to June30, 2022. The study included 590 type 2 diabetes patients, ranging in age from 35 to 70 years. Age, gender, socioeconomic status, health status, co-morbidities, and diabetes symptoms were documented. A chi-square was applied to determine the association between overall symptoms associated with type 2 diabetes and gender. An independent t-test was applied to determine the significance level between means of demographic parameters. Results The study findings showed that out of 590 patients with diabetes, 310 (52.5%) were males and 280 (47.5%) were females. The male and female mean ages were 57.46±14.93 and 50.38±14.85 years, respectively, with a statistically significant gender difference (p<0.001). The prevalence of renal manifestation in type 2 patients with diabetes revealed a significant relationship (p<0.05) for both genders. The prevalence of ocular manifestations revealed a significant relationship with both genders (p<0.05) in terms of distortion and blurred vision. The prevalence of ocular manifestations revealed a significant relationship observed with both genders (p<0.05) in terms of shortness of breath, dyspnea severity, and severity of chest pain. Conclusion This study concluded that women with type 2 diabetes mellitus have a significantly higher frequency of muscular pain, urinary symptoms, neurological symptoms, and dermatological manifestations than men. In contrast, respiratory symptoms were significantly more pronounced in males than in females. The presence of comorbidities such as dyslipidemia significantly increased the probability of developing type 2 diabetes in both genders.

Blood Eosinophils for Prediction of Exacerbation in Preschool Children With Recurrent Wheezing

Although clinical features of type 2 inflammation have been associated with poorer longitudinal outcomes in preschool children with recurrent wheezing, it remains difficult to predict which children are at highest risk for poor outcomes during a routine clinical encounter. We tested the hypothesis that prespecified cut points of blood eosinophil counts would predict exacerbation and treatment response outcomes in preschool children with recurrent wheezing and that prediction could be improved with the addition of a second biomarker. Data from 3 clinical trials of 1,074 preschool children aged 12 to 71 months with recurrent wheezing were merged. The primary outcome was the occurrence of any exacerbation during follow-up. Secondary outcomes included the annualized rate of wheezing exacerbations and the occurrence of any exacerbation requiring hospitalization. Exploratory analyses focused on exacerbation outcomes, offline exhaled nitric oxide concentrations, and caregiver-reported asthma control scores after inhaled corticosteroid treatment initiation. Each blood eosinophil cut point was associated with increased odds of exacerbation, higher exacerbation rates, and greater hospitalization occurrence in preschool children with recurrent wheezing. However, outcome detection was improved in children with more elevated blood eosinophil counts. Addition of a second biomarker of type 2 inflammation improved outcome detection and was further associated with an improved response to initiation of daily inhaled corticosteroids in exploratory analyses. However, the specificity of blood eosinophils was poor. Although validation studies are warranted, blood eosinophil cut points may be useful for clinical assessment and future studies of exacerbation and treatment response in preschool children with recurrent wheezing.

Clinical features of type 1 and 2 refractory celiac disease: Results from a large cohort over a decade.

Refractory celiac disease (RCeD) is a rare complication of celiac disease (CeD) with a severe prognosis. We describe a cohort of patients with RCeD, their clinical and histological features at diagnosis, after therapy and at lymphoma onset, and the rate and causes of death over a 17-year follow-up. We retrospectively enrolled RCeD-I and RCeD-II patients attending our center between January 2002 and October 2019. Medical data were collected at diagnosis and during monitoring. Response to therapy, changes in RCeD molecular markers, number of hospitalizations, discharge diagnosis, and cause and date of death were evaluated. The control cohort consisted of 1015 responsive CeD patients. Compared with RCeD-I, RCeD-II more frequently exhibits diarrhea (83vs 64%), anemia (61vs 50%), hypoalbuminemia (70vs 21%), parenteral nutrition need (48vs 7%), ulcerative jejuno-ileitis (7vs 39%), and extended small intestinal atrophy (62vs 21%). One RCeD-I and six RCeD-II patients developed lymphoma. Ten RCeD-II patients died, four from lymphoma progression. Among RCeD-II patients, atrophy extension was the only parameter correlated with hypoalbuminemia and mortality. Clinical severity, response to therapy, and mortality differ between RCeD-I and RCeD-II. Atrophy extension, evaluated at capsule endoscopy, was associated with disease severity and mortality.

Increased HLA class II risk is associated with a more aggressive presentation of clinical type 1 diabetes.

To determine the association of HLA class II risk with the demographic and clinical characteristics of type 1 diabetes at diagnosis. We conducted a register-based retrospective cohort study of 4993 Finnish children (2169 girls) - diagnosed with type 1 diabetes under the age of 15 years in 2003-2016. The participants were divided into six risk groups based on their HLA DR/DQ genotype. Demographic characteristics, family history of type 1 diabetes and metabolic markers at the time of diagnosis were compared between the groups. In total, 4056/4993 children (81.2%) carried an HLA genotype associated with an increased risk of type 1 diabetes (risk groups 3-5), whereas 937/4993 children (18.8%) carried a HLA genotype conferring no or decreased disease risk. Children with higher HLA risk were younger at diagnosis (p < 0.001) and had a shorter duration of classical symptoms before diagnosis (p=0.016). Subjects in the high-risk group were more likely to have a family member affected by type 1 diabetes when compared to those in the neutral risk group (11.5% vs. 8.8%, p=0.05). Children with stronger HLA disease susceptibility are younger at their disease manifestation and have a shorter period of symptoms before diagnosis, suggesting that the HLA class II genes are associated with a more aggressive disease presentation.

Clinical features of type 1 and type 2 diabetes patients with suspected fungal foot infections: a single-center experience

Clinical features of type 1 and type 2 diabetes patients with suspected fungal foot infections: a single-center experience

1240-P: Real-World Demographics and Clinical Characteristics of Type 2 Diabetes Mellitus Patients in Ontario, Canada

Population-based studies of diabetes may be limited by sampling and capture. Our study utilizes the Ontario Diabetes Database, which captures all persons in Ontario, Canada with non-gestational diabetes. Based on sensitive and specific cohort definitions adults with T2DM were identified. Study objectives are to investigate: the demographic and the clinical characteristics of type 2 diabetes patients in Ontario, Canada over a time frame from Apr 1, 2002 to Sept 31, 2017. We also compare the demographics and clinical characteristics of T2DM patient populations from the cohorts to understand the impact T2DM definitions have on characterizing the disease. We identify 1,093,812 and 783,228 in the cohorts (Table 1) . In the sensitive and specific cohorts, the mean age of a patient with T2D is 64 to 65 years old and 52 to 54% are male, respectively. Roughly 56 to 64% of patients have a 1-year mean HbA1c of &amp;lt;7%, with ∼ 25 to 32% at 7.0%-8.5%, respectively. Overall, covariates of interest in our demographics and clinical characteristics analysis are similar for both cohorts. Our results show multiple comorbidities in this population; hypertension (∼ 77-79%) , dyslipidemia (∼55%) , chronic ischemic heart disease (∼28%) and angina (∼21%) . The comorbidities further illustrate a substantial proportion of T2DM patients suffer comorbid heart diseases. Disclosure R.L. Houlden: Advisory Panel; Novo Nordisk Canada Inc. Research Support; AstraZeneca. Speaker's Bureau; Abbott Diagnostics, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Medtronic, Novo Nordisk Canada Inc., Sanofi. S. Golden: Other Relationship; Novo Nordisk Canada Inc. W. Shi: Other Relationship; Novo Nordisk Canada Inc. A.A. Kukaswadia: Other Relationship; Novo Nordisk. A. Sharma: Other Relationship; Novo Nordisk Canada Inc. K. Quansah: Employee; Boehringer Ingelheim (Canada) Ltd., Novo Nordisk Canada Inc. A.R. Liu: Employee; Novo Nordisk A/S, Novo Nordisk Canada Inc.

Factors related to the risk of stroke in the population with type 2 diabetes: A protocol for systematic review and meta-analysis.

Background:Type 2 diabetes is an independent risk factor for stroke. The main role of the current study is to study the mechanism of stroke induced by diabetes, but there is no systematic summary of daily management and stroke prevention for patients with type 2 diabetes. In order to provide a more detailed stroke prevention program for patients with type 2 diabetes, we included in the study and looked forward to analyzing the risk factors that were more in line with the clinical characteristics of type 2 diabetes.Methods:We will search the following Chinese and English databases: PubMed, Web of science, Cochrane Library, Medline, and China National Knowledge Infrastructure database. All of the above electronic databases will be searched from inception to June 30, 2021. In addition, we will manually search for conference papers, ongoing experiments, and internal reports to supplement the studies retrieved via electronic search. We will use the STATA 16.0 provided by Cochrane Collaboration Network for statistical analysis.Results:The study will prove a collective view on the relationship between related factors and stroke in the type 2 diabetes population.Conclusion:We plan to submit this systematic review to a peer-reviewed journal.INPLASY registration number: INPLASY2021100046

Association of causes of type 2 diabetes mellitus and gestational diabetes with the clinical profile in the population of Khyber Pakhtunkhwa Pakistan

IntroductionThe current study is designed to assess the various risk factors, prevalence, and clinical characteristics of type 2 diabetes (among aged Pakistanis) and gestational diabetes (in pregnant women).Material and methodsThe statistical analysis of a cross-sectional survey included the data of 1479 adults, aged 18–75 years, living in urban and rural areas. Blood glucose was measured by an automatic clinical chemistry analyser. Diabetes was confirmed via an glycated hemoglobin (HbA1c) report from each patient’s file admitted in medical and surgical wards. Blood pressures were measured and recorded, and the medical history and prior illness data were collected by interviewing the patients and cross checked with their individual daily progress report.ResultsThe prevalence of type 2 diabetes mellitus in different age groups in urban and rural areas was 5.3%, among which 9.8% was found to be previously diagnosed type 2 diabetes mellitus and 7% was newly diagnosed type II diabetes, whereas the percentage of gestational diabetes was 1.36% of the total ratio (5.3%). Type 2 diabetes mellitus affected more women than men, which increased with age. Central obesity and hypertension were highly associated with type 2 diabetes mellitus occurrence. The prevalence of previously diagnosed type 2 diabetes mellitus with overweight or obesity was 68.4%, with central obesity 32.3%, and with hypertension 56.5%. A significant association (p = 0.005) was found between obesity, as a risk factor, gestational diabetes, and type 2 diabetes mellitus.ConclusionsThese results show that diabetes has reached high proportions, and comprehensive strategies are needed for the prevention and control of the problem of type II diabetes.

OBSERVATIONAL STUDY REGARDING RISK FACTORS AND COMORBITITES FOR CHRONIC KIDNEY DISEASE IN DIABETES MELLITUS PATIENTS FROM BIHOR COUNTY

Introduction. Chronic kidney disease is a common comorbidity in diabetes mellitus type 2 patients because of presence of numerous risk factors such as obesity, hypertension, hyperglycemia and dyslipidemia. Material and methods. Our retrospective, observational study included 300 patients with type 2 diabetes mellitus from Bihor County and had the purpose to establish a clinical profile and to determine the risk factors associated with this pathology. Results. The prevalence of CKD was 75.67%. Older age, worse glucose control, presence of diabetic polyneuropathy and diabetic retinopathy, higher weight, past history of cardiovascular events, the presence of metabolic syndrome and hyperuricemia were associated with the presence of CKD. Conclusion. The clinical characteristics of type 2 diabetes mellitus patients with CKD is significantly worse compared with the population without CKD.

Latent Autoimmune Diabetes of Adults (LADA) Is Likely to Represent a Mixed Population of Autoimmune (Type 1) and Nonautoimmune (Type 2) Diabetes.

Latent autoimmune diabetes of adults (LADA) is typically defined as a new diabetes diagnosis after 35 years of age, presenting with clinical features of type 2 diabetes, in whom a type 1 diabetes-associated islet autoantibody is detected. Identifying autoimmune diabetes is important since the prognosis and optimal therapy differ. However, the existing LADA definition identifies a group with clinical and genetic features intermediate between typical type 1 and type 2 diabetes. It is unclear whether this is due to 1) true autoimmune diabetes with a milder phenotype at older onset ages that initially appears similar to type 2 diabetes but later requires insulin, 2) a disease syndrome where the pathophysiologies of type 1 and type 2 diabetes are both present in each patient, or 3) a heterogeneous group resulting from difficulties in classification. Herein, we suggest that difficulties in classification are a major component resulting from defining LADA using a diagnostic test-islet autoantibody measurement-with imperfect specificity applied in low-prevalence populations. This yields a heterogeneous group of true positives (autoimmune type 1 diabetes) and false positives (nonautoimmune type 2 diabetes). For clinicians, this means that islet autoantibody testing should not be undertaken in patients who do not have clinical features suggestive of autoimmune diabetes: in an adult without clinical features of type 1 diabetes, it is likely that a single positive antibody will represent a false-positive result. This is in contrast to patients with features suggestive of type 1 diabetes, where false-positive results will be rare. For researchers, this means that current definitions of LADA are not appropriate for the study of autoimmune diabetes in later life. Approaches that increase test specificity, or prior likelihood of autoimmune diabetes, are needed to avoid inclusion of participants who have nonautoimmune (type 2) diabetes. Improved classification will allow improved assignment of prognosis and therapy as well as an improved cohort in which to analyze and better understand the detailed pathophysiological components acting at onset and during disease progression in late-onset autoimmune diabetes.

Histological validation of a type 1 diabetes clinical diagnostic model for classification of diabetes.

Misclassification of diabetes is common due to an overlap in the clinical features of type 1 and type 2 diabetes. Combined diagnostic models incorporating clinical and biomarker information have recently been developed that can aid classification, but they have not been validated using pancreatic pathology. We evaluated a clinical diagnostic model against histologically defined type 1 diabetes. We classified cases from the Network for Pancreatic Organ donors with Diabetes (nPOD) biobank as type 1 (n=111) or non-type 1 (n=42) diabetes using histopathology. Type 1 diabetes was defined by lobular loss of insulin-containing islets along with multiple insulin-deficient islets. We assessed the discriminative performance of previously described type 1 diabetes diagnostic models, based on clinical features (age at diagnosis, BMI) and biomarker data [autoantibodies, type 1 diabetes genetic risk score (T1D-GRS)], and singular features for identifying type 1 diabetes by the area under the curve of the receiver operator characteristic (AUC-ROC). Diagnostic models validated well against histologically defined type 1 diabetes. The model combining clinical features, islet autoantibodies and T1D-GRS was strongly discriminative of type 1 diabetes, and performed better than clinical features alone (AUC-ROC 0.97 vs. 0.95; P=0.03). Histological classification of type 1 diabetes was concordant with serum C-peptide [median <17pmol/l (limit of detection) vs. 1037pmol/l in non-type 1 diabetes; P<0.0001]. Our study provides robust histological evidence that a clinical diagnostic model, combining clinical features and biomarkers, could improve diabetes classification. Our study also provides reassurance that a C-peptide-based definition of type 1 diabetes is an appropriate surrogate outcome that can be used in large clinical studies where histological definition is impossible. Parts of this study were presented in abstract form at the Network for Pancreatic Organ Donors Conference, Florida, USA, 19-22 February 2019 and Diabetes UK Professional Conference, Liverpool, UK, 6-8 March 2019.

Long-Term Prognosis of Patients with Myocardial Infarction Type 1 and Type 2 with and without Involvement of Coronary Vasospasm.

While prognoses in relation to myocardial infarction (MI) type have been elucidated in past reports, the results were not consistent, perhaps due to occurrence of Type 2 MI with CVS and its mortality. The Japanese registry of acute Myocardial Infarction diagnosed by Universal Definition (J-MINUET) is a prospective multicenter registry in Japan. In contrast to thromboembolic event-related Type 1 myocardial infarction (MI), clinical features of Type 2 MI, including coronary vasospasm (CVS), are varied due to the heterogeneous nature of its development. To elucidate the MI type-related all-cause mortality, 2989 consecutive patients with AMI were stratified as Type 1 MI, Type 2 MI with CVS, and Type 2 MI with non-CVS. Most patients (n = 2834; 94.8%) were classified as Type 1 MI and 155 patients (5.2%) were classified as Type 2 MI. Of the Type 2 MI patients, 87 (56% of Type 2 MI) were diagnosed as MI with CVS. Although the 3-year mortality was comparable between Type 1 and Type 2 MI patients, significant differences were observed between Type 2 MI with CVS and with non-CVS (3.4% and 22.1%, p < 0.001). Among Japanese patients with AMI, mortality rates between Type 1 MI and Type 2 MI are comparable, but further stratification of Type 2 MI (with or without CVS) may be useful in predicting the prognosis of patients with Type 2 MI.

Safety and efficacy of oral semaglutide versus dulaglutide in Japanese patients with type 2 diabetes (PIONEER 10): an open-label, randomised, active-controlled, phase 3a trial

New glucose-lowering medications need to be investigated in east Asian populations, as the clinical characteristics of type 2 diabetes differ between western and east Asian patients. The PIONEER 10 study aimed to evaluate the safety and efficacy of oral semaglutide versus dulaglutide in Japanese patients with type 2 diabetes. PIONEER 10 was an open-label, randomised, active-controlled, phase 3a trial done at 36 sites (clinics and university hospitals) in Japan. Patients aged 20 years and older with uncontrolled type 2 diabetes were randomly assigned (2:2:2:1) to receive once-daily oral semaglutide 3 mg, 7 mg, or 14 mg, or once-weekly subcutaneous dulaglutide 0·75 mg for 52 weeks, as an add-on to their background medication. The primary endpoint was the number of treatment-emergent adverse events over 57 weeks. Supportive secondary endpoints (not controlled for multiplicity) included mean change from baseline in HbA1c and bodyweight at 52 weeks. This trial is registered with ClinicalTrials.gov, NCT03015220. Between Jan 10, and May 30, 2017, 492 patients were screened and 458 were randomly assigned to oral semaglutide 3 mg (n=131), 7 mg (n=132), or 14 mg (n=130), or dulaglutide 0·75 mg (n=65). 448 (98%) patients completed the trial. Adverse events occurred in 101 (77%) of 131 patients with oral semaglutide 3 mg, 106 (80%) of 132 with oral semaglutide 7 mg, 111 (85%) of 130 with oral semaglutide 14 mg, and 53 (82%) of 65 with dulaglutide. The most common adverse events were infections and gastrointestinal events. Gastrointestinal adverse events (mostly mild and transient constipation and nausea) occurred in a dose-dependent manner with oral semaglutide. Adverse events led to premature treatment discontinuation in four (3%) of 131 patients receiving oral semaglutide 3 mg, eight (6%) of 132 receiving oral semaglutide 7 mg, eight (6%) of 130 receiving oral semaglutide 14 mg, and two (3%) of 65 receiving dulaglutide. No deaths or severe hypoglycaemic events were reported. Based on the treatment policy estimand (ie, regardless of study drug discontinuation or rescue medication use), estimated mean reductions in HbA1c from baseline (8·3%) to week 52 were -0·9 percentage points (SE 0·1) with oral semaglutide 3 mg, -1·4 percentage points (0·1) with oral semaglutide 7 mg, -1·7 percentage points (0·1) with oral semaglutide 14 mg, and -1·4 percentage points (0·1) with dulaglutide (estimated treatment difference -0·3% [95% CI -0·6 to -0·1] for oral semaglutide 14 mg vs dulaglutide; p=0·0170). Estimated mean changes in bodyweight from baseline (72·1 kg) to week 52 were 0·0 kg (SE 0·3) with oral semaglutide 3 mg, -0·9 kg (0·3) with oral semaglutide 7 mg, -1·6 kg (0·3) with oral semaglutide 14 mg, and 1·0 kg (0·4) with dulaglutide (estimated treatment difference -2·6 kg [95% CI -3·5 to -1·6] for oral semaglutide 14 mg vs dulaglutide; p<0·0001). Oral semaglutide was well tolerated in Japanese patients with type 2 diabetes. Once-daily oral semaglutide significantly reduced HbA1c (14 mg dose) and bodyweight (7 mg and 14 mg doses) versus weekly subcutaneous dulaglutide 0·75 mg by week 52. Novo Nordisk.

Polymorphisms of the NLRC4 Gene are Associated with the Onset Age, Positive Rate of GADA and 2-h Postprandial C-Peptide in Patients with Type 1 Diabetes.

PurposeThe purpose of this study was to clarify the association between the NLRC4 gene and the susceptibility and clinical characteristics of type 1 diabetes (T1D) in a Chinese Han population.Patients and MethodsA case-control study was performed in a Chinese Han population including 510 classical T1D patients and 531 healthy controls. rs212704 and rs385076 of the NLRC4 gene were genotyped by MassARRAY. The frequency distributions of alleles and genotypes of polymorphisms in the NLRC4 gene were compared by logistic regression and the chi-square test. The relationships between the polymorphisms of the NLRC4 gene and various clinical characteristics were analyzed by Kruskal–Wallis one-way ANOVA. The statistical power was calculated by Quanto software.Results1) rs385076 of the NLRC4 gene was significantly correlated with the onset age of T1D patients and the positive rate of GADA. The relationship between rs212704 and 2-h postprandial C-peptide was statistically significant. 2) There was no significant difference in the frequency distributions of the genotypes and alleles of rs212704 and rs385076 between T1D patients and controls. 3) rs212704 and rs385076 were not correlated with T1D susceptibility under different genetic models.Conclusionrs212704 was associated with 2-h postprandial C-peptide, while rs385076 of the NLRC4 gene was associated with the onset age and positive rate of GADA in patients with T1D.