Combination Of Diabetes Mellitus Research Articles

Vasodilator reactive oxygen species ameliorate perturbed myocardial oxygen delivery in exercising swine with multiple comorbidities.

Multiple common cardiovascular comorbidities produce coronary microvascular dysfunction. We previously observed in swine that a combination of diabetes mellitus (DM), high fat diet (HFD) and chronic kidney disease (CKD) induced systemic inflammation, increased oxidative stress and produced coronary endothelial dysfunction, altering control of coronary microvascular tone via loss of NO bioavailability, which was associated with an increase in circulating endothelin (ET). In the present study, we tested the hypotheses that (1) ROS scavenging and (2) ETA+B-receptor blockade improve myocardial oxygen delivery in the same female swine model. Healthy female swine on normal pig chow served as controls (Normal). Five months after induction of DM (streptozotocin, 3 × 50mgkg-1 i.v.), hypercholesterolemia (HFD) and CKD (renal embolization), swine were chronically instrumented and studied at rest and during exercise. Sustained hyperglycemia, hypercholesterolemia and renal dysfunction were accompanied by systemic inflammation and oxidative stress. In vivo ROS scavenging (TEMPOL + MPG) reduced myocardial oxygen delivery in DM + HFD + CKD swine, suggestive of a vasodilator influence of endogenous ROS, while it had no effect in Normal swine. In vitro wire myography revealed a vasodilator role for hydrogen peroxide (H2O2) in isolated small coronary artery segments from DM + HFD + CKD, but not Normal swine. Increased catalase activity and ceramide production in left ventricular myocardial tissue of DM + HFD + CKD swine further suggest that increased H2O2 acts as vasodilator ROS in the coronary microvasculature. Despite elevated ET-1 plasma levels in DM + HFD + CKD swine, ETA+B blockade did not affect myocardial oxygen delivery in Normal or DM + HFD + CKD swine. In conclusion, loss of NO bioavailability due to 5 months exposure to multiple comorbidities is partially compensated by increased H2O2-mediated coronary vasodilation.

Factors associated to amputation in pyogenic flexor tenosynovitis in a tertiary referral center in Mexico

Background: Pyogenic flexor tenosynovitis is an aggressive closed-space infection, which affects the flexor tendon sheath of the hand with disabling sequelae. The purpose of this study is to describe the patient demographic characteristics and identify factors associated with amputation in pyogenic flexor tenosynovitis. Methods: In this retrospective single-center study, included all adult patients who presented to the emergency department from 2015 to 2021 with PFT of the hand. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, culture results, treatment strategies, and early complications. The factors influencing amputation were identified and analyzed. Results: A total of 59 patients with PFT diagnosis were included. Most of the population was found to be immunosuppressed (34 patients). Moreover, the most common comorbidities were the combination of diabetes mellitus and systemic arterial hypertension. The third right finger was the most frequently affected region. Almost all patients were hospitalized, intravenous antibiotics, and at least one additional surgical intervention was required in 16 cases. Amputation of the infected finger occurred in 6 patients, associated with different factors: reintervention, age over forty, presence of diabetes mellitus and chronic arterial hypertension, penetrating trauma, and presence of Enterococcus faecalis in culture. Conclusions: Rapid and aggressive treatment is required to prevent devastating complications such as amputation. Adequate identification of the disease and risk factors is critical for a successful result. E. faecalis represents the most common pathogen in this study, unlike the reported literature. Thus, broad-spectrum antibiotics and surgical intervention are required.

Reactive oxygen species mitigate perturbations in coronary microvascular tone in exercising swine with multiple risk factors

Abstract Background Multiple cardiovascular risk factors, such as diabetes mellitus (DM), chronic kidney disease (CKD) and dyslipidemia are known to induce inflammation and microvascular dysfunction contributing to impaired myocardial perfusion. We previously observed that a combination of DM, high fat diet (HFD) and CKD produced an increase in coronary microvascular tone in awake swine, resulting in perturbations in myocardial O2 balance. The increased microvascular tone was mediated by an impaired NO bioavailability and was accompanied by increased myocardial levels of reactive oxygen species (ROS) and increased circulating levels of endothelin (ET). Hypothesis: In the present study in swine, we tested the hypothesis that ROS scavenging and ET receptor blockade reduce coronary microvascular tone, improving myocardial O2 delivery and O2 balance in swine with DM+HFD+CKD. Methods DM (streptozotocin), HFD and CKD (renal artery embolization) were induced in 13 female swine (DM+HFD+CKD), while 11 healthy female swine on normal pig chow served as controls (Normal). After 6 months, the effects of ROS scavenging and ET receptor blockade on coronary microvascular tone were studied at rest and during graded treadmill exercise. Results 6 months of sustained hyperglycemia (18.1±1.0 in DM+HFD+CKD vs 8.5±0.6 mmol/l in Normal), hypercholesterolemia (12.3±2.0 vs 1.7±0.1 mmol/l) and renal dysfunction (plasma creatinine: 165±7 vs 119±3 µmol/l) were accompanied by systemic inflammation (TNF 52±5 vs 25±6 pg/ml), elevated ET plasma levels, (36±2 vs 29±2 pg/ml), and oxidative stress (myocardial PGF2a 12.9±0.8 vs 10.2±0.5 pg/mg protein, all P<0.05 by t-test). Surprisingly, in vivo ROS scavenging (TEMPOL+MPG) reduced myocardial O2 delivery (forcing an increased myocardial O2 extraction) in DM+HFD+CKD swine, indicative of a coronary microvascular constrictor response to ROS scavenging, implying a ROS-mediated vasodilator influence (Fig. A, B). In vitro experiments, using catalase in coronary small arteries, suggested a vasodilator role for hydrogen peroxide (H2O2) in DM+HFD+CKD but not in Normal swine. A switch from NO towards to H2O2 in the regulation of coronary microvascular tone was further supported by an increase in ceramide production (138±34 vs 45±4 nmol/ml, P<0.05) and increased activity of catalase in the myocardium (44±3 vs 31±4 nmol/min/mg, P<0.05) of DM+HFD+CKD vs Normal swine. Despite elevated ET plasma levels in DM+HFD+CKD swine, combined ETA/ETB receptor blockade with tezosentan did not affect myocardial O2 balance in either Normal or DM+HFD+CKD swine (Fig C, D). Conclusion In swine, 6 months exposure to multiple risk factors resulted in increased oxidative stress that paradoxically acted to mitigate perturbations in coronary microvascular tone via an H2O2-mediated coronary vasodilator influence. Despite an increase in circulating ET levels, we found no evidence for an increased ET-1 mediated coronary vasoconstrictor influence.

Long-Term Survival Prediction Model for Elderly Community Members Using a Deep Learning Method.

In an aging society, maintaining healthy aging, preventing death, and enabling a continuation of economic activities are crucial. This study sought to develop a model for predicting survival times among community-dwelling older individuals using a deep learning method, and to identify the level of influence of various risk factors on the survival period, so that older individuals can manage their own health. This study used the Korean National Health Insurance Service claims data. We observed community-dwelling older people, aged 66 years, for 11 years and developed a survival time prediction model. Of the 189,697 individuals enrolled at baseline, 180,235 (95.0%) survived from 2009 to 2019, while 9462 (5.0%) died. Using deep-learning-based models (C statistics = 0.7011), we identified various factors impacting survival: Charlson's comorbidity index; the frailty index; long-term care benefit grade; disability grade; income level; a combination of diabetes mellitus, hypertension, and dyslipidemia; sex; smoking status; and alcohol consumption habits. In particular, Charlson's comorbidity index (SHAP value: 0.0445) and frailty index (SHAP value: 0.0443) were strong predictors of survival time. Prediction models may help researchers to identify potentially modifiable risk factors that may affect survival.

Prevalence and major risk factors of non-communicable diseases: a machine learning based cross-sectional study

The aim: The study aimed to determine the prevalence of several non-communicable diseases (NCD) and analyze risk factors among adult patients seeking nutritional guidance in Dhaka, Bangladesh.
 Participants: 146 hospitalized adults of both genders aged 18-93 participated in this cross-sectional research.
 Methods: We collected the demographic and vital information from 146 hospitalized patients in Dhaka, Bangladesh. We checked the physical and vital parameters, including blood sugar, serum creatinine, blood pressure, and the presence or absence of major non-communicable diseases. Then we used descriptive statistical approaches to explore the NCDs prevalence based on gender and age group. Afterwards, the relationship between different NCD pairs with their combined effects was analyzed using different hypothesis testing at a 95 % confidence level. Finally, the random forest and XGBoost machine learning algorithms are used to predict the comorbidity among the patients with the underlying responsible factors.
 Result: Our study observed the relationships between gender, age groups, obesity, and NCDs (DM, CKD, IBS, CVD, CRD, thyroid). The most frequently reported NCD was cardiovascular issues (CVD), which was present in 83.56 % of all participants. CVD was more common in male participants. Consequently, male participants had a higher blood pressure distribution than females. Diabetes mellitus (DM), on the other hand, did not have a gender-based inclination. Both CVD and DM had an age-based progression. Our study showed that chronic respiratory illness was more frequent in middle-aged participants than in younger or elderly individuals. Based on the data, every one in five hospitalized patients was obese. We analyzed the comorbidities and found that 31.5 % of the population has only one NCD, 30.1 % has two NCDs, and 38.3 % has more than two NCDs. Besides, 86.25 % of all diabetic patients had cardiovascular issues. All thyroid patients in our study had CVD. Using a t-test, we found a relationship between CKD and thyroid (p-value 0.061). Males under 35 years have a statistically significant relationship between thyroid and chronic respiratory diseases (p-value 0.018). We also found an association between DM and CKD among patients over 65 (p-value 0.038). Moreover, there has been a statistically significant relationship between CKD and Thyroid (P<0.05) for those below 35 and 35-65. We used a two-way ANOVA test to find the statistically significant interaction of heart issues and chronic respiratory illness in combination with diabetes. The combination of DM and RTI also affected CKD in male patients over 65 years old. Among machine learning algorithms, XGBoost produced the highest accuracy, 69.7 %, in comorbidity detection. Random forest feature importance detected age, weight and waist-hip ratio as the major risk factors behind the comorbidity.
 Conclusion: The prevalence study helps to identify the future risks and most vulnerable groups. By initiating and implementing control plans based on the prevalence study, it is possible to reduce the burden of NCDs on the elderly and middle-aged population of Bangladesh.

Impact of Coexisting Risk Factors on Outcomes in Patients with Acute Coronary Syndrome: A Real-World Analysis Using the Taiwan Chang Gung Research Database.

BACKGROUND Diabetes mellitus (DM), chronic kidney disease (CKD), and advanced age are associated with poor outcomes in patients with acute coronary syndrome (ACS). This real-world study utilized data from the Taiwan Chang Gung Research Database (CGRD) to compare outcomes in ACS patients with DM, CKD, and the elderly. MATERIAL AND METHODS The study enrolled 28,613 ACS patients diagnosed based on CGRD medical records between January 2005 and December 2019. Baseline characteristics and clinical outcomes were compared among groups based on patient characteristics. RESULTS Within the ACS cohort, 42.1% had DM, 48.2% had CKD, and 33.6% were elderly. Among them, 10.7% (3,070) were elderly patients with both DM and CKD. Elderly patients with DM and CKD had significantly higher risks of gastrointestinal bleeding (hazard ratio=11.32), cardiovascular events (HR=7.29), and all-cause mortality (HR=8.59). Patients with three or at least two of these risk factors had a 2.20-2.99-fold increased risk of recurrent ACS during the three-year follow-up period. CONCLUSIONS Patients with the combination of DM, CKD, and advanced age (elderly) experienced an 11.32-fold increased risk of gastrointestinal bleeding, 7.29-fold increased risk of cardiovascular events, and 8.59-fold increased risk of all-cause mortality compared to those without these risk factors. Furthermore, patients with two or more of these risk factors had a 2- to 3-fold increased risk of recurrent ACS. These findings emphasize the importance of managing multiple risk factors in ACS patients to improve outcomes.

Understanding the Burden of Kidney Failure in Trinidad and Tobago: A Review of the Epidemiological Data From a Regional Center.

Objective The aim of this study was to determine the incidence of new patients requiring renal replacement therapy and to gather data on sex, age, ethnicity, mortality, and causes of kidney failure in Trinidad and Tobago in comparison with the rest of the world. Method Electronic data were gathered for new patients initiating dialysis between January 1, 2016, and December 31, 2017, including the date of dialysis initiation, age, gender, ethnicity, diagnosis, dialysis access and modality, and outcome at three months and the end of the year. The data were analyzed using simple descriptive statistics via Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results Over a two-year period, 265 new patients underwent renal replacement therapy, of which 51.7% were 50-69 years of age, 53.9% were male, 46% were female, 67.9% were Afro-Trinidadian, and 38.1% had a combination of diabetes mellitus and hypertension as the cause of kidney failure. The incidence rates of treated end-stage renal disease (ESRD) globally in 2016 and 2017 were 306 and 224 per million population, respectively, and mortality for both years was 32% and 32.1%, respectively. Conclusion Our study showed that Trinidad and Tobago has one of the highest incidences of patients initiating renal replacement therapy and mortality rates.

Reactive Oxygen Species Mitigate Perturbations in Coronary Microvascular Tone in Exercising Swine with Multiple Risk Factors

Multiple cardiovascular risk factors, such as diabetes mellitus (DM), chronic kidney disease (CKD) and dyslipidemia are known to induce inflammation and microvascular dysfunction contributing to impaired myocardial perfusion. We previously observed that a combination of DM, high fat diet (HFD) and CKD produced an increase in coronary microvascular tone in awake swine, resulting in perturbations in myocardial O 2 balance. The increased microvascular tone was mediated by an impaired NO bioavailability and was accompanied by increased myocardial levels of reactive oxygen species (ROS) and increased circulating levels of endothelin (ET). In the present study in swine, we tested the hypothesis that ROS scavenging and ET receptor blockade reduce coronary microvascular tone, improving myocardial O 2 delivery and O 2 balance in swine with DM+HFD+CKD. DM (streptozotocin), HFD and CKD (renal artery embolization) were induced in 13 female swine (DM+HFD+CKD), while 11 healthy female swine on normal pig chow served as controls (Normal). After 6 months, the effects of ROS scavenging and ET receptor blockade on coronary microvascular tone were studied at rest and during graded treadmill exercise. 6 months of sustained hyperglycemia (18.1±1.0 in DM+HFD+CKD vs 8.5±0.6 mmol/l in Normal), hypercholesterolemia (12.3±2.0 vs 1.7±0.1 mmol/l) and renal dysfunction (plasma creatinine: 165±7 vs 119±3 μmol/l) were accompanied by systemic inflammation (TNF 52±5 vs 25±6 pg/ml), elevated ET plasma levels, (36±2 vs 29±2 pg/ml), and oxidative stress (myocardial PGF2α 12.9±0.8 vs 10.2±0.5 pg/mg protein, all P<0.05 by t-test). Surprisingly, i n vivo ROS scavenging (TEMPOL+MPG) reduced myocardial O 2 delivery (forcing an increased myocardial O 2 extraction) in DM+HFD+CKD swine, indicative of a coronary microvascular constrictor response to ROS scavenging, implying a ROS-mediated vasodilator influence. In vitro experiments, using catalase in coronary small arteries, suggested a vasodilator role for hydrogen peroxide (H 2 O 2 ) in DM+HFD+CKD but not in Normal swine. A switch from NO towards to H 2 O 2 in the regulation of coronary microvascular tone was further supported by an increase in ceramide production (138±34 vs 45±4 nmol/ml, P<0.05) and increased activity of catalase in the myocardium (44±3 vs 31±4 nmol/min/mg, P<0.05) of DM+HFD+CKD vs Normal swine. Despite elevated ET plasma levels in DM+HFD+CKD swine, combined ET A /ET B receptor blockade with tezosentan did not affect myocardial O 2 balance in either Normal or DM+HFD+CKD swine. Conclusion: In swine, 6 months exposure to multiple risk factors resulted in increased oxidative stress that paradoxically acted to mitigate perturbations in coronary microvascular tone via an H 2 O 2 -mediated coronary vasodilator influence. Despite an increase in circulating ET levels, we found no evidence for an increased ET mediated coronary vasoconstrictor influence. Funding: Grants 2017B018 ARENA-PRIME and 2020B008 RECONNEXT This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Clinical and laboratory COVID-19 features in hospitalized patients with concomitant diabetes mellitus type 2: A retrospective study

<b>Objective:</b> To investigate the prevalence of diabetes mellitus in comorbidity structures and its effect on the clinical course in hospitalized COVID-19 patients in south region of Kazakhstan.<br /> <b>Material and methods:</b> A retrospective analysis of data from 918 patients with COVID-19 treated at the City Clinical Infectious Diseases Hospital was carried out. Pearson's Chi-square test and Student's t-test were conducted.<br /> <b>Results:</b> In Kazakhstan, diabetes mellitus occupies the second position in the structure of comorbidities in patients with COVID-19 with a share of 20%. Diabetes mellitus in patients most often occurs in combination with cardiovascular diseases and arterial hypertension (20.3% and 16.3%, respectively). Combination of diabetes mellitus, arterial hypertension and other diseases was detected in 72.4% of patients. Combination of diabetes mellitus, cardiovascular and other diseases was detected in 32.5%.<br /> In diabetes mellitus patients, COVID-19 was more severe, the hospital stay was longer, and patients over 60 years of age suffered. These patients had a combination of diabetes mellitus with arterial hypertension, obesity, and cardiovascular diseases. Hyperglycemia, elevated blood pressure, rapid breathing, and low saturation were more common for these patients.<br /> <b>Conclusion:</b> Diabetes mellitus ranks second in the structure of comorbidities in COVID-19 in the south region of Kazakhstan and is characterized by a combination with cardiovascular diseases, arterial hypertension and obesity. In patients with diabetes, COVID-19 is more severe, which affects the length of stay in the hospital, the mortality rate and the need for transfer to the Intensive Care Unit.

Serum Procalcitonin Level and Comorbidity in Covid-19 Patients in UAE

Background: Most COVID-19 patients experience a mild form of the disease, but there is a certain percentage of patients who progress to a very severe disease state that requires intensive care and invasive ventilation. In order to ensure better patient management and improved outcomes, early identification of patients who may be at a higher risk of severe infection can play an important role. The aim of this study was to assess the association between the mean procalcitonin (PCT) level and comorbidity in hospitalized patients with COVID-19. Methods and Results: A total of 231 COVID-19-positive patients aged between 20 and 82 years (170[73.6 %] males and 61[26.4%] females) were included in this study. Serum PCT was accessed by procalcitonin assay using the Beckman Coulter UniCel DxI 800 instrument. Eighty-seven (37.7%) patients had no chronic disease, while 144(62.3%) had comorbidities: hypertension (37[16.0%]), diabetes mellitus (44[19.0%]), a combination of diabetes mellitus with hypertension (32[13.9%]), asthma (6[2.6%]), hyperlipidemia (4[1.7%]), renal disease (1[0.4%]), and COPD (1[0.4%]). COVID-19 patients with diabetes in combination with hypertension had a statistically greater PCT level than COVID-19 patients without comorbidities (P=0.0273). However, there were no statistically significant differences in the mean PCT level between different age categories (P=0 .7390). The serum PCT measurement could evaluate the prognosis of the disease in some COVID-19 patients.

MODERN CONCEPTION OF TREATING PURULENT INFLAMMATORY DISEASES OF FACE AND NECK IN PATIENTS WITH DIABETES MELLITUS

The issue of surgical treatment of purulent infection in people suffering from diabetes mellitus is becoming increasingly important that can be explained by a significant growth of diabetes worldwide. The combination of diabetes mellitus and surgical infection forms a closed vicious circle, in which the infection negatively affects metabolic processes, increasing insulin insufficiency and acidosis, while metabolic and microcirculation disorders worsen the course of reparative processes in the lesion. A lack of insulin in patients with diabetes mellitus results in the disorganization of carbohydrate metabolism that is manifested by hyperglycemia, glycosuria, a decrease in the content of glycogen in tissues and, first of all, in the liver. Liver dysfunction, in turn, leads to water-salt and protein metabolisms changes. The impairment of protein metabolism is manifested in a decrease in its synthesis and an increase in its breakdown. As a result, the formation of glucose from amino acids becomes more intensive. The accumulation of ketone bodies and acetone under an almost complete inability to synthesize fats leads to ketoacidosis.
 The goal of this work is to analyze the treatment outcomes of patients with diabetes mellitus who had various purulent and inflammatory diseases of the maxillofacial area. The treatment of purulent wounds in the patients with diabetes mellitus requires the participation of an endocrinologist to control criteria, which can objectively reflect the course of the wound healing including cytological examination of wound impressions, morphological examination of wound tissues, determination of indicators of tissue homeostasis in the lesion. The use of the methods described above, as well as the scope and direction of therapy in each specific case should be based on the teach approach to this comorbidity.
 Noteworthy, the course of purulent and inflammatory diseases of the maxillofacial area under diabetes mellitus is peculiar and atypical, often leading to the development of formidable complications and even death. Effective treatment of foci of inflammation under decompensated diabetes is a hard task. Special attention should be paid to the study of the etiopathogenetic mechanisms of the development of purulent-inflammatory diseases of the maxillofacial area in patients with diabetes mellitus and to the development of new treatment algorithms. Close cooperation of maxillofacial surgeons and endocrinologists will help preserve life quality and life expectance of the patients with diabetes mellitus.

ПАТОФИЗИОЛОГИЧЕСКАЯ РОЛЬ ОСТЕОПРОТЕГЕРИНА ПРИ АТЕРОСКЛЕРОЗЕ И САХАРНОМ ДИАБЕТЕ

Diabetes mellitus is rightly called non-infectious epidemic of the 21st century. At the same time, cardiovascular diseases still remain the leading cause of death in the world. A combination of diabetes mellitus and peripheral arterial disease increases the risk of the lower limb loss and death many times over. There are many concepts concerning the mechanism of development of these diseases. In recent years, there is more and more data evidencing the similarity of the processes of atherosclerosis and osteoporosis development. The connecting link between these processes may be osteoprotegerin (OPG). Information has been obtained on osteoprotegerin as an antiresorptive factor participating in the RANKL-RANK-OPG system. Under pathophysiological conditions, OPG is expressed in the vascular wall, including being found at different stages of atherosclerotic plaque formation. The RANKL-RANK-OPG signaling pathway is involved in the process of bone tissue remodeling. The mechanisms of atherosclerosis and osteoporosis development are similar; nevertheless, they require further study.

Individualized Biological Age as a Predictor of Disease: Korean Genome and Epidemiology Study (KoGES) Cohort.

Chronological age (CA) predicts health status but its impact on health varies with anthropometry, socioeconomic status (SES), and lifestyle behaviors. Biological age (BA) is, therefore, considered a more precise predictor of health status. We aimed to develop a BA prediction model from self-assessed risk factors and validate it as an indicator for predicting the risk of chronic disease. A total of 101,980 healthy participants from the Korean Genome and Epidemiology Study were included in this study. BA was computed based on body measurements, SES, lifestyle behaviors, and presence of comorbidities using elastic net regression analysis. The effects of BA on diabetes mellitus (DM), hypertension (HT), combination of DM and HT, and chronic kidney disease were analyzed using Cox proportional hazards regression. A younger BA was associated with a lower risk of DM (HR = 0.63, 95% CI: 0.55–0.72), hypertension (HR = 0.74, 95% CI: 0.68–0.81), and combination of DM and HT (HR = 0.65, 95% CI: 0.47–0.91). The largest risk of disease was seen in those with a BA higher than their CA. A consistent association was also observed within the 5-year follow-up. BA, therefore, is an effective tool for detecting high-risk groups and preventing further risk of chronic diseases through individual and population-level interventions.

Особливості перебігу цукрового діабету 2-го типу у поєднанні з гіпотиреозом

Вступ. Останні десятиліття характеризуються значним збільшенням частоти захворювань органів ендокринної системи зі зміною структури, насамперед випадків поліендокринопатій, особливе місце серед яких займають поєднання цукрового діабету (ЦД) і тиреопатій. Збільшення частоти поєднання ЦД 2-го типу з гіпотиреозом впливає на особливості клінічного перебігу такої патології, залишається актуальною проблемою сучасної медичної науки. Мета дослідження: вивчення частоти гіпотиреозу у хворих на ЦД 2-го типу та встановлення клінічних особливостей перебігу ЦД 2-го типу у поєднанні з гіпотиреозом. Матеріали і методи. Проведено обстеження 179 хворих на ЦД у поєднанні з первинним гіпотиреозом, у тому числі 64 хворих на ЦД 1-го типу і 115 хворих на ЦД 2-го типу. Групу порівняння становили 62 хворі на ЦД без гіпотиреозу (з них 27 — із ЦД 1-го типу, 35 — із ЦД 2-го типу). Функціональний стан щитоподібної залози (ЩЗ) оцінювали за допомогою визначення базальних концентрацій тиреотропного гормона і вільної фракції тироксину. Результати. Встановлено, що пацієнти із ЦД 2-го типу та гіпотиреозом належали до більш старшої вікової категорії, ніж пацієнти з ЦД 1-го типу та гіпотиреозом. Так, вік пацієнтів у групі хворих на ЦД 1-го типу з гіпотиреозом становив 35,3 ± 9,5 року та у групі хворих на ЦД 2-го типу з гіпотиреозом — 47,6 ± 11,0 року. В усіх групах хворих відсоток жінок був значно вищим за чоловіків. Виявлено вірогідні відмінності щодо показника амплітуди глікемії — його збільшення у хворих на ЦД 1-го типу з гіпотиреозом. При поєднанні ЦД 2-го типу з гіпотиреозом показники ліпідного обміну були вищими, ніж при ЦД 2-го типу без тиреоїдної патології. Це підтверджує вплив гіпотиреозу на ліпідний обмін та обумовлює підвищення ризику прогресування серцево-судинних ускладнень за наявності двох захворювань. Висновки. Серед обстежених хворих гіпотиреоз траплявся у 2,4 раза частіше при ЦД 2-го типу, ніж при ЦД 1-го типу, що свідчить про більше число чинників ризику розвитку супутньої автоімунної патології за умов метаболічних порушень при ЦД 2-го типу. Інсулінорезистентність та гіперінсулінемія, що відзначаються при ЦД 2-го типу, сприяють проліферативним процесам, у тому числі й у тканині ЩЗ, а більш старший вік хворих на ЦД 2-го типу сприяє прогресуванню інволютивних змін і подальшому розвитку гіпофункції ЩЗ. Рекомендується обов’язкове комплексне обстеження хворих на ЦД 2-го типу щодо наявності супутньої тиреоїдної патології.

Mucormycosis in COVID-19 patients: predisposing factors, prevention and management.

India is considered the diabetes capital of the world and has the highest burden of mucormycosis. Bacterial, viral and fungal co-infections are increasingly being reported in severe acute respiratory syndrome virus 2 (SARSCoV-2) infected patients. India is one of the worst affected countries during the second wave of the COVID-19 pandemic. This combination of diabetes mellitus, COVID-19 and mucormycosis has led to the drastic upsurge of COVID-19-associated mucormycosis (CAM) in India. Immunosuppression, iron disequilibrium, endothelial injury, ketoacidosis and hypoxia are some of the other COVID-19-related risk factors for CAM. There has been an increase in the proportion of mucormycosis affecting paranasal sinuses and central nervous system (CNS) in CAM compared to pre-COVID-19 literature due to the SARSCoV-2-related pathophysiological mechanisms, complications and treatment strategies. CAM is a medical and surgical emergency, and it can present with non-specific symptoms and signs initially resulting in diagnostic delay. High index of suspicion and regular screening for features of CAM are of paramount importance to prevent lethal consequences. Rapid action with a tripod approach consisting of withdrawal of immunomodulators, early antifungal therapy and extensive surgical debridement is considered the best possible treatment model. We review the published data to give a detailed account of the predisposing factors and their mechanisms, diagnostic work-up, treatment modalities and prevention strategies of CAM with special emphasis on CNS mucormycosis.

A synergistic effect of variability in estimated glomerular filtration rate with chronic kidney disease on all-cause mortality prediction in patients with type 2 diabetes: a retrospective cohort study

BackgroundThe combination of diabetes mellitus (DM) and chronic kidney disease (CKD) is associated with a high risk of mortality. Annual assessment of the estimated glomerular filtration rate (eGFR) is recommended for patients with DM. We investigated the effect of variability in annual eGFR values on all-cause mortality in patients with type 2 DM.MethodsIn this retrospective cohort study, we enrolled patients with eGFR data between 01 Aug 2017 and 31 July 2018. We defined the index eGFR as the first available eGFR value within the enrollment year and collected additional annual eGFR data from the previous three years. A total of 3592 patients with type 2 DM were enrolled, including 959 patients with CKD (index eGFR < 60 mL/min/1.73 m2) and 2633 patients without CKD. We assessed eGFR variability by using the standard deviation (SD) of the three annual eGFR and index eGFR values. We divided patients into subgroups according to the median SD of their annual eGFR (7.62 mL/min/1.73 m2). The primary endpoint was all-cause mortality after the index eGFR was assessed.ResultsDuring a median follow-up of 19 months (interquartile range: 18‒20 months), 127 (3.5%) deaths occurred among all 3592 enrolled patients. The highest mortality risk was observed in the high SD with CKD group, with a hazard ratio (HR) of 2.382 [95% confidence interval (CI) 1.346‒4.215] in comparison to the low SD without CKD group after adjusting for the associated factors. In patients without CKD, a high SD was an independent risk factor for mortality (HR = 2.105, 95% CI 1.256‒3.528). According to the C-index, the mortality prediction ability was better for the index eGFR + SD model than for the index eGFR alone model (0.671 vs. 0.629, P < 0.001).ConclusionThere was a synergistic effect of eGFR variability with single-measured eGFR for the prediction of mortality in patients with type 2 DM. The SD of the annual eGFR values was also an independent predictor of mortality in patients with an eGFR > 60 mL/min/1.73 m2.

Current Perspectives of Periodontal Disease (PD) and Diabetes Mellitus (DM)

Combination of diabetes mellitus (DM) and periodontal disease (PD) has been a problem. Diabetic cases with PD showed elevated odds ratio (OR) compared to those without PD, where retinopathy 2.8-8.7, nephropathy 1.9-8.5, neuropathy 3.2-6.6, cardiovascular complications 1.3-17.7, and mortality 2.3-8.5. Medical and dental staffs always manage to check DM and PD.

HIGH RENAL RESISTANCE INDICES AND HIGH PULSE PRESSURE MAY LIMIT NEPHROPROTECTIVE EFFICACY OF RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Objective: The combination of diabetes mellitus (DM) and resistant hypertension (RHTN) is associated with an increased risk of development and progression of chronic kidney disease (CKD). It has been shown that renal denervation have nephroprotective efficacy by slowing the decline in renal function in some patients. The aim of the study was to identify factors limiting the nephroprotective effect of renal denervation in patients with RHTN and DM. Design and method: Twenty seven patients with RHTN and type 2 DM were included in single-arm prospective interventional study (protocol number NCT01499810 on ClinicalTrial.gov) (mean age 61.6 ± 7.3 years, mean office (systolic/diastolic) blood pressure (BP) 171.8 ± 21.9/87.7 ± 17.7mmHg, mean eGFR 72.1 ± 19.9 ml/min/1.73 m2, HbA1c 6.3 ± 1.1%, 7 patients (26%) with stage 3 CKD, 8 men). All patients were underwent to ambulatory 24-hour BP, renal Doppler ultrasound and assessment of eGFR (CKD-EPI formula) at baseline and 3 years follow-up. The patients were advised not to change their medication regimen during the study. Nineteen patients completed 3 years of follow-up. The renal outcomes were 1) a decrease in eGFR = &gt; 30% from baseline; 2) decrease in eGFR &gt; 5 ml/min/1.73 m2/year; 3) their combination. Results: There was a significant decrease in mean 24-hour BP (SBP/DBP) (-14.3 ± 20.6 / -7.7 ± 10.6 mmHg, P = 0.02 /0.04). Six patients (32%) had renal outcomes at 3 years follow-up (5 pts (26%) with both outcomes, 5 patients (26%) had a decrease in eGFR = &gt; 30% from baseline and 5 patients had a decrease in eGFR &gt; 5 mL/min/1.73 m2/year). At baseline, patients with renal outcomes compared with patients without them had higher values of both 24-hour pulse BP (90.3 ± 7.1 vs 73.1 ± 12.5 mmHg, p = 0.007) and its variability (15.6 ± 2.6 versus 11.7 ± 3.0 mmHg, p = 0.01), as well as a higher mean value of renal resistive indices (RI) (RI in the trunk 0.79 ± 0.04 vs0.71 ± 0.06, p = 0.007; RI in segmental arteries 0.75 ± 0.08 vs 0.66 ± 0.08, p = 0.04). Conclusions: Our data indicate that a high value of pulse blood pressure and its variability, as well as high indices of renal resistance, can limit the nephroprotective efficacy of renal denervation, possibly due to chronic intrarenal barotrauma and irreversible changes in the kidneys.

Цукровий діабет і хронічний коронарний синдром

Хронічний коронарний синдром (ХКС) характеризується розвитком епізодів ішемії внаслідок дисбалансу між потребами та кровопостачанням міокарда. Зазвичай такі епізоди провокуються фізичними або емоційними навантаженнями чи іншими стресовими ситуаціями, проте можуть виникати й спонтанно. Класичним проявом ішемії міокарда є напади стенокардії. У деяких випадках захворювання певний час може бути безсимптомним і дебютувати одразу гострим коронарним синдромом. ХКС може мати довготривалий доклінічний період на тлі підтвердженого коронарного атеросклерозу. В огляді проведений аналіз літературних джерел, присвячених сучасному стану проблеми цукрового діабету (ЦД) і ХКС. Зокрема, аналізуються питання, пов’язані з особливостями оцінки ризику, основних чинників, що зумовлюють дуже високий ризик атеросклеротичних серцево-судинних захворювань, класифікацією, основними характеристиками ХКС та його особливостями при ЦД, діагностикою ХКС (дозоване фізичне навантаження (велоергометрія, тредміл-тест) або стрес-тести, однофотонна емісійна комп’ютерна томографія, стрес-ехокардіографія; стрес-магнітно-резонансна томографія, позитронно-емісійна томографія із застосуванням радіоактивних маркерів). Аналізуються питання консервативної терапії ХКС на тлі ЦД (призначення антиагрегантів, блокаторів β-адренорецепторів, блокаторів кальцієвих каналів, нітратів, інгібіторів ангіотензинперетворювального ферменту, міокардіальних цитопротекторів, статинів). Лікування пацієнта з поєднанням ЦД і ХКС буде успішним лише в тому випадку, якщо призначено адекватну, безпечну в плані гіпоглікемій і можливих серцево-судинних ризиків цукрознижувальну терапію, з одного боку, і метаболічно нейтральну антиангінальну терапію— з іншого. Без сумніву, необхідно звернути увагу на корекцію факторів ризику ССЗ, АГ і ХСН.

1553-P: Combination of Diabetes Mellitus and Lack of Habitual Physical Activity Is a Risk Factor for Functional Disability in Japanese

Declining healthy life expectancy due to functional disability is relevant and urgent not only because of its association with decreased quality of life but also for its enormous socioeconomic impact. Thus, we analyzed a population-based retrospective cohort study including 9,673 community dwelling Japanese adults (4,420, men) aged 39-98 years in 2012-2017. Functional disability was defined as a condition meeting Japan’s new long-term care insurance certification requirements for the need of assistance in the activities of daily living whether by caregivers or assistive devices. Cox proportional hazards regression model identified variables related to functional disability. Median follow-up was 3.7 years. During the study period, 165 disabilities occurred in the overall study population. Multivariate analysis showed that diabetes (hazard ratio [HR] 1.74 (95% CI: 1.12-2.68)), no physical activity habit (HR 1.83 (1.27-2.65)), and low BMI category (18.5 kg/m2 &amp;gt;) (HR 1.63 (1.02-2.63)) presented increased risks for disability. The prevalence ratio of 0, 1, 2, 3 and 4 conditions (diabetes, hypertension, dyslipidemia, and physical activity habits) was 12.8%, 40.0%, 32.6%, 12.9 and 1.7%, respectively. HR for disability increased with the number of risk factors (HR of individuals with 1, 2, 3 and 4 conditions, 1.34 (0.71-2.52), 1.95 (1.04-3.63), 2.11 (1.07-4.15), and 3.96 (1.59-9.99) vs. individuals with none of those conditions as a ref.). HR for disability among diabetes patients with and without a physical activity habit was 1.68 (0.70-4.04) and 3.19 (1.79-5.70), respectively, compared to individuals without diabetes with a physical activity habit. This shows that the combination of diabetes and lack of habitual physical activity is predictive of functional disability in Japanese. Habitual physical activity attenuates the risk of functional disability in patients with diabetes. Disclosure K. Fujihara: None. M.H. Yamada: None. Y. Matsubayashi: None. M. Kitazawa: None. M. Kaneko: None. M. Yamamoto: None. Y. Yaguchi: None. T. Yahiro: None. S. Kodama: None. K. Kato: None. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. Funding Japan Society for the Promotion of Science (18K17897)