Comorbid Type 2 Diabetes Mellitus Research Articles

Assessing the impact of comorbid type 2 diabetes mellitus on the disease burden of chronic hepatitis B virus infection and its complications in China from 2006 to 2030: a modeling study

BackgroundChina bears a high burden of both hepatitis B virus (HBV) infection and type 2 diabetes mellitus (T2DM). T2DM accelerates the progression of liver disease among individuals infected with HBV. This study aims to assess the excess disease burden caused by comorbid T2DM among HBV-infected individuals in China.MethodsWe estimated the disease burden of HBV and its complications in China from 2006 to 2030 using individual-based Markov models. The baseline population consisted of 93 million HBV-infected individuals derived from the 2006 National Serological Epidemiological Survey. We developed two models: one incorporated the impact of T2DM on the disease progression of HBV infection, while the other did not consider the impact of T2DM. By comparing the outcomes between these two models, we estimated the excess disease burden attributable to comorbid T2DM among HBV-infected individuals.ResultsThe incidence of severe HBV complications, including cirrhosis, hepatocellular carcinoma (HCC), and liver-related deaths, exhibited an increasing trend from 2006 to 2030 among the Chinese HBV-infected population. Comorbid T2DM increased the annual incidence and cumulative cases of severe HBV complications. From 2006 to 2022, comorbid T2DM caused 791,000 (11.41%), 244,000 (9.27%), 377,000 (8.78%), and 796,000 (12.19%) excess cases of compensated cirrhosis, decompensated cirrhosis, HCC, and liver-related deaths, respectively. From 2023 to 2030, comorbid T2DM is projected to result in an 8.69% excess in severe HBV complications and an 8.95% increase in liver-related deaths. Among individuals aged 60 and older at baseline, comorbid T2DM led to a 21.68% excess in severe HBV complications and a 28.70% increase in liver-related deaths from 2006 to 2022, with projections indicating a further 20.76% increase in severe HBV complications and an 18.31% rise in liver-related deaths over the next seven years.ConclusionsComorbid T2DM imposes a substantial disease burden on individuals with HBV infection in China. Healthcare providers and health policymakers should develop and implement tailored strategies for the effective management and control of T2DM in individuals with HBV infection.

Predictive value of serum TBA for 2-year MACEs in ACS patients undergoing PCI: a prospective cohort study

Bile acids play important roles in lipid metabolism and glucose homeostasis. Limited research exist on the association between serum total bile acid (TBA) levels and major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS), particularly those with comorbid type 2 diabetes mellitus (T2DM). This study was conducted to examine the relationship between baseline serum TBA level and T2DM status in patients with ACS after percutaneous coronary intervention (PCI) and to identify the predictive value of TBA levels for a 2-year risk of MACEs. 425 ACS patients underwent PCI were recruited and divided into three groups based on baseline serum TBA concentration. An analysis of the association between the T2DM status and baseline serum TBA levels was conducted using univariate linear regression and multivariate linear regression. The predictive relevance of serum TBA levels was evaluated using the receiver operating characteristic (ROC) curve and Cox regression. Kaplan–Meier curves were employed to analyze the differences among groups in predicting MACEs over a 2-year follow-up period. Baseline serum TBA levels were higher in ACS patients who were diagnosed with T2DM (the median 3.6 µmol/L) than those without T2DM (the median 3.0 µmol/L). T2DM status in ACS patients was positively correlated with baseline serum TBA concentrations (β: 1.7, 95% confidence interval [CI] 0.3–3.0), particularly in the male (β: 2.0, 95% CI 0.3–3.6) and 50–69-year-old (β: 2.5, 95% CI 0.6–4.4) populations. The areas under the ROC curve of baseline serum TBA levels predicted MACEs in ACS and ACS-T2DM patients following PCI were 0.649 (95% CI 0.595–0.703) and 0.783 (95% CI 0.685–0.881), respectively. Furthermore, Cox regression analysis showed that baseline serum TBA level was associated with the occurrence of MACEs in patients with ACS after PCI over a 2-year follow-up period, especially in those diagnosed with T2DM, whose baseline TBA concentration was lower than 10.0 µmol/L. ACS Patients with T2DM had higher serum TBA levels. TBA level at baseline was an independent predictor of MACEs in ACS patients who underwent PCI, especially with comorbid T2DM.

ERYTHROPOIETIN SYNTESIS IN PATIENTS WITH CHRONIC HEART FAILURE DEPENDING ON COMORBID PATHOLOGY

Introduction. Decreased production of erythropoietin by the kidneys plays crucial role in the development of anemia in patients with chronic heart failure, especially on the background of comorbid diabetes mellitus type 2. In diabetic patients due to early damage of the kidney vessels and following erythropoietin deficiency anemia develops much earlier than clinically significant decrease of glomerular filtration rate.
 The aim of the study was to find out possible dependence of changes in the erythropoietinsynthesizing function of the kidneys on the degree of severity of anemic hypoxia in elderly and senile patients with chronic heart failure, including those with comorbid type 2 diabetes mellitus.
 Materials and methods. 120 patients with chronic heart failure of ischemic origin, type 2 diabetes mellitus and mild and moderate anemia were examined. Control group comprised 12 people with chronic heart failure without comorbid pathology. The examined groups were comparable in terms of gender and age, differing in the presence of comorbid diabetes mellitus and degree of severity of anemic syndrome. The level of erythropoietin in blood serum was determined by standard enzymelinked immunosorbent assay.
 Results. Type 2 diabetes mellitus in patients with chronic heart failure results in a significant decrease in erythropoietin production by 25 % compared to the control group (p<0,05). Comorbid to heart failure anemia leads to an increase in the level of erythropoietin by 74,4 % (р<0,05), and in the case of chronic heart failure and type 2 diabetes mellitus on the background of concomitant anemia – only by 39,5 % (р<0,05). As the severity of anemia in patients with chronic heart failure without diabetes progresses, the severity of the compensatory response of the kidneys to chronic anemic hypoxia is significantly higher than in patients with heart failure and comorbid type 2 diabetes.
 Conclusions. Diabetic nephropathy in patients with chronic heart failure and comorbid anemia leads to a significant deterioration of the erythropoietin-synthesizing function of the kidneys, complicating the course of both main and comorbid diseases.

Relationship between Age, Hypertension, and Type-2 Diabetes Mellitus in Benign Prostatic Hyperplasia Patients with Erectile Dysfunction

Based on epidemiological data, the incidence of ED and BPH increases with the same risk factors, such as age, metabolic disease, and others. Aim: This study aimed to determine the prevalence of ED and its relationship to age and the presence of hypertension (HT) and type-2 diabetes mellitus (T2DM) comorbid in BPH patients. This is a cross-sectional study conducted at RSUD Dr. Saiful Anwar and Hermina Hospital Tangku-banprahu Malang utilizes two questionnaires, including the translated version of The Interna-tional Index of Erectile Function (IIEF-5) and Erectile Hardness Score (EHS) in Indonesian. There were 44 research subjects with only 21 respondents to the IIEF-5 question-naire, while the EHS questionnaire was given to all subjects. The prevalence of ED was found to reach 100.0% at the age of 70-79 years through the IIEF-5 questionnaire and aged ³ 80 years through the EHS questionnaire. The prevalence of ED in BPH patients with HT was found to be higher than non-HT patients through both questionnaires. The prevalence of ED in BPH patients with T2DM was found to be higher through the IIEF-5 questionnaire and slight-ly lower through the EHS questionnaire than non-T2DM patients. Age had a significant rela-tionship with ED through the EHS questionnaire (p = 0.006), while no significant relationship was found through the IIEF-5 questionnaire (p = 1.000). HT and T2DM did not have a signif-icant relationship with ED (IIEF-5: p = 0.229 and 0.526; EHS: p = 0.518 and 1.000). The prevalence of ED in BPH patients increases with age and the presence of comorbid HT and T2DM. Even so, there was no significant relationship between HT and T2DM with ED in BPH patients. A significant relationship between age and ED was only found in the EHS questionnaire but not in the IIEF-5 questionnaire.

Effect modification of tumor necrosis factor-α on the kynurenine and serotonin pathways in major depressive disorder on type 2 diabetes mellitus.

Major depressive disorder (MDD) is strongly associated with type 2 diabetes mellitus (T2DM). The kynurenine and serotonin pathways, as well as chronic low-grade inflammation, are being considered potential links between them. MDD associated with T2DM is less responsive to treatment than that without T2DM; however, the underlying mechanism remains unknown. We aimed to investigate the effects of inflammatory cytokines on the kynurenine and serotonin pathways in patients with comorbid MDD and T2DM and those with only MDD. We recruited 13 patients with comorbid MDD and T2DM and 27 patients with onlyMDD. We measured interleukin-6 and tumor necrosis factor-α (TNF-α) levels as inflammatory cytokines and metabolites of the kynurenine pathway and examined the relationship between the two. TNF-α levels were significantly higher in patients with comorbid MDD and T2DM than in those with only MDD in univariate (p = 0.044) and multivariate (adjusted p = 0.036) analyses. TNF-α showed a statistically significant effect modification (interaction) with quinolinic acid/tryptophan and serotonin in patients from both groups (β = 1.029, adjusted p < 0.001; β = - 1.444, adjusted p = 0.047, respectively). Limitations attributed to the study design and number of samples may be present. All patients were Japanese with mild to moderate MDD; therefore, the generalizability of our findings may be limited. MDD with T2DM has more inflammatory depression components and activations of the kynurenine pathway by inflammatory cytokines than MDD without T2DM. Hence, administering antidepressants and anti-inflammatory drugs in combination may be more effective in patients with comorbid MDD and T2DM.

Profile of the bile acid FXR-FGF15 pathway in the glucolipid metabolism disorder of diabetic mice suffering from chronic stress.

Imbalances in bile acid (BA) synthesis and metabolism are involved in the onset of diabetes and depression in humans and rodents. However, the role of BAs and the farnesoid X receptor (FXR)/fibroblast growth factor (FGF) 15 signaling pathway in the development of diabetes and depression is still largely unknown. Therefore, we investigated the potential molecular mechanisms of BAs that may be associated with glucolipid metabolism disorders in diabetic mice subjected to chronic stress. The type 2 diabetes mellitus (T2DM) mouse model was induced by feeding mice a high-fat diet and administering an intraperitoneal injection of streptozotocin (STZ). The chronic unpredictable mild stress (CUMS) procedure was performed by introducing a series of mild stressors. Forty mice were randomly divided into the regular chow feeding group and the high-fat diet feeding group. After two weeks of feeding, the mice were randomly divided into four groups: the Control group, CUMS group, T2DM group, and T2DM+CUMS group. The T2DM group and T2DM+CUMS group received an intraperitoneal injection of STZ to induce the T2DM model. The CUMS and T2DM+CUMS groups were exposed to CUMS to induce depressive-like phenotypes. Blood and tissue samples were obtained for pertinent analysis and detection. Compared with the T2DM mice, T2DM+CUMS mice had higher blood glucose and lipid levels, insulin resistance, inflammation of the liver and pancreas, impaired liver function, and increased total bile acids. These changes were accompanied by attenuated FXR signaling. Chronic stress was found to attenuate FXR expression and its downstream target, FGF15, in the ileum when compared with the T2DM group. FXR may play a role in the diabetic disorder of glucolipid metabolism when aggravated by chronic stress. FXR and its downstream target, FGF15, may be therapeutic targets for treating comorbid T2DM and depression.

Analisis Drug Related Problems dan Pengaruhnya terhadap Pengendalian Glukosa Darah pada Pasien Covid-19 dengan Komorbiditas Diabetes Melitus Tipe 2

This study aims to anayze the effect of drug related problems (DRPs) on glycemic control in COVID-19 patients with comorbid diabetes mellitus type 2. This research is a cross-sectiona study using retrospective data obtained from secondary data from the medica records of Covid-19 patients. with type 2 diabetes mellitus. The research location was at Jati Padang Hospita. The sample consisted of 76 medica records with total sampling method. Data collected using PCNE V9.00 were then tested using the Wilcoxon test comparing initia GDS in hospita with GDS at the end of patient discharge, the Chisquare test which correlated changes in GDS with patient clinica outcomes and the Spearman test which linked changes in GDS with DRPs, characteristics of Covid-19 patients with diabetes mellitus predominant age 46-55 years (30.3%), predominant sex mae (51.3%), length of stay 6-10 days (64.5%), profile of drug use that is often used antivira, antibiotics, vitamins and supplements, symptomatic and antidiabetic (100%). The most common comorbidities were hypertension (60.4%), the incidence of DRPs (92.1%), the most common fina GDS was hyperglycemia (≥ 200 mg/dL) (65.8%). 58 patients were discharged with a negative sample (76.3%). The results of the Wilcoxon test on blood glucose showed differences in blood glucose at the beginning and at the end. The results of the Chi-square test between changes in blood glucose and the patient's clinica outcome (p&gt;0.05) showed that there was no significant relationship between changes in blood glucose levels and the patient's clinica outcome. Spearmen's correlation test results (p&gt;0.05) showed a significant relationship between DRPs and changes in patient's blood glucose. The correlation between the incidence of DRPS and blood glucose (0.169) shows a weak relationship. It can be interpreted that DRPs do not realy affect changes in blood glucose in patients at Jati Padang Hospital.&#x0D; &#x0D;

Help-seeking during 1-year follow-up in Chinese patients diagnosed with type 2 diabetes mellitus comorbid major depressive disorder.

Previous research has revealed a bidirectional relationship between type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD). A very limited proportion of patients with T2DM comorbid MDD received adequate psychiatric intervention. This study investigated the help-seeking behaviors of patients with T2DM comorbid with MDD during one-year follow-up. At a medical center in China, a cohort of outpatients with T2DM were assessed and diagnosed for comorbid depression at baseline and after one year. The Mini International Neuropsychiatric Interview was used to diagnose MDD, while The Patient Health Questionnaire-9 (PHQ-9) and The Hamilton Depression Scale 17-item (HAMD-17) were used for depression assessment. Mental health help-seeking behaviors of patients during follow-up period were also evaluated. Out of the 203 patients with T2DM at baseline, 114 (56.2%) completed the follow-up. The prevalence of MDD in participants with T2DM was 12.8% at baseline and 22.8% at follow-up. Patients who completed the follow-up had a lower baseline PHQ-9 score (test statistic -2.068, p=0.039), HAMD-17 score (test statistic -2.285, p=0.022) than those who did not complete the follow-up. A total of 26 patients had comorbid MDD during the follow-up period, among which 8 patients (30.8%) voluntarily visited psychiatric clinics, while others did not seek assistance. The level of HbA1c at follow-up was higher in patients who sought help than in those who did not (8.1 ± 1.8% vs. 7.0 ± 0.7%), although the difference was not statistically significant. Voluntary psychiatric help-seeking for Chinese patients with comorbid T2DM and MDD is uncommon. It is crucial to increase awareness of depression among patients and healthcare professionals alike.

FRI084 The Impact Of COVID-19 On Comorbid Beliefs And Adherence To Self-Management Behaviors Among Breast Cancer Survivors With Type 2 Diabetes

Abstract Disclosure: S. Lambert: None. J.E. Itty: None. L. Guerra: None. M. Goel: None. J.J. Lin: None. Y.T. Harris: None. Introduction: During the first year of the Covid-19 pandemic, anxiety and depression rates increased substantially worldwide. Anxiety and depression can affect self-efficacy and health-related beliefs as well as diabetes self-management behaviors (DSMBs) such as diet, exercise, and medication adherence, which are crucial for glycemic control and preventing complications. Both Type 2 diabetes mellitus (T2DM) and breast cancer pose an increased risk of complications from Covid, which could exacerbate pandemic-related distress in patients with T2DM and a history of breast cancer. We compared diabetes beliefs and adherence to DSMBs in breast cancer survivors with T2DM, before Covid-19 versus during the first Covid-19 surge. Hypothesis: Patients will experience a change in diabetes beliefs and adherence to DSMBs in the setting of the Covid-19 pandemic. Methods: Eligible patients included women ≥ 55 years, diagnosed with Stage 0-IIIA breast cancer in the past 15 years, who had completed chemotherapy and/or were prescribed hormonal therapy, had pre-existing T2DM treated with ≥ 1 oral medication, and had been enrolled in an ongoing study of disease beliefs and cognition in breast cancer survivors with comorbid T2DM. We included patients with a baseline visit prior to Covid and a six-month follow up visit between March - September 2020. We assessed diabetes beliefs with the Illness Perception Questionnaire (IPQ) and DSMB adherence with the Summary of Diabetes Self Care Activities (SDSCA) questionnaire. Self-reported adherence to diabetes medication was assessed with the Medication Adherence Rating Scale (MARS). Signed rank tests were used to compare disease beliefs and DSMB adherence before versus during the first Covid-19 wave. Results: 26 patients completed baseline interviews prior to Covid and a six-month follow up visit during the first Covid-19 surge (mean age: 65 years; 27% White, 35% Black, 11% Asian/Pacific Islander, 27% unanswered). Diabetes beliefs did not differ significantly before versus during Covid (p &amp;gt; 0.05 for all IPQ scales), nor did adherence to DSMBs including diet (days/week following a healthful eating plan: p = 0.87), exercise (days participating in a specific exercise: p = 0.40), and glucose monitoring (days checking blood sugar the number of times recommended: p = 0.84). No significant differences were seen in medication adherence (p = 0.698). Conclusion: In this small sample of breast cancer survivors with T2DM there appears to be no change in diabetes beliefs or DSMB adherence during the first Covid surge compared to baseline. These findings raise the possibility that individual patient factors play a greater role in adherence and disease beliefs than pandemic-related distress. Future analyses will expand the sample size and explore whether the extent to which the Covid-19 pandemic impacted patients moderates their disease beliefs and self-management. Presentation: Friday, June 16, 2023

Prognostic significance of catestatin in patients with primary hypertension and type 2 diabetes mellitus

The aim of this study was to determine predictors of cardiovascular complications of arterial hypertension (AH) and type 2 diabetes mellitus (T2DM) and investigate the prognostic potential of catestatin (CST) and relaxin-2 (RLN-2) in this patient population. Materials and methods. The research was performed in accordance with all ethical principles of the Declaration of Helsinki. All study participants signed a written informed consent. This study involved 106 patients with primary hypertension and 30 healthy volunteers. 55 hypertensive patients had comorbid T2DM. Plasma CST and RLN-2 levels were measured by an enzyme-linked immunosorbent assay. Major adverse cardiovascular events (MACE) were collected during 12-month follow-up via telephone interviews at visits in months 3, 6, 9, and 12. The end points of this study were acute myocardial infarction, ischemic stroke, acute heart failure and cardiac death. Statistical data analysis was performed using the SPSS 25.0 statistical software. Results. 13 end-points were registered in patients with AH during the 12-month follow-up period, but the difference in frequency of MACE occurrence between patients with AH and T2DM and hypertensive patients without T2DM was insignificant (p=0.181). The Cox proportional hazard model indicated CST (p=0.01), but not RLN-2 (p=0.20), as an independent predictor of MACE in hypertensive patients. Age (p=0.01), AH duration (p=0.03), presence of T2DM (p=0.03), HOMA-IR index (p=0.02), insulin (p=0.02) and uric acid levels (p=0.02) were also established as independent factors of end-points occurrence. Conclusions. CST is an independent factor for predicting cardiovascular complications of AH, which allows us to consider it as a prognostic biomarker in patients with AH, especially hypertensive patients with comorbidity T2DM

Plasma catestatin levels are related to metabolic parameters in patients with essential hypertension and type 2 diabetes mellitus.

Catestatin (CST) is a pleiotropic peptide with cardioprotective and metabolic effects. CST is involved in the pathogenesis of both arterial hypertension (AH) and type 2 diabetes mellitus (T2DM), which are the risk factors of cardiovascular diseases. In this study, we aimed to investigate the plasma CST levels in hypertensive patients, especially with T2DM, as well as compare those with healthy volunteers, and explore the relationship between CST levels and clinical, anthropometric and laboratory parameters. 106 Hypertensive patients, 55 of which had comorbidity T2DM, and 30 healthy volunteers were enrolled in the study. All subjects underwent clinical examination, including vital signs and anthropometric data assessment, medical history interview, and blood sample collection. Plasma CST levels were measured by an enzyme-linked immunosorbent assay (ELISA), using a commercial diagnostic kit. The plasma CST levels were significantly lower in hypertensive patients (N = 106) compared with healthy subjects (N = 30) (5.02 ± 1.09 vs. 6.64 ± 0.72; p < 0.001). Furthermore, hypertensive patients with T2DM (N = 55) have significantly reduced CST levels in comparison with those without T2DM (N = 51) (4.47 ± 1.16 vs. 5.61 ± 0.61; p < 0.001). CST significantly correlated with anthropometric characteristics, in particular, weight (r = -0.344; p < 0.001), BMI (r = -0.42; p < 0.001), neck (r = -0.358; p < 0.001), waist (r = -0.487; p < 0.001), hip (r = -0.312; p < 0.001), wrist circumferences (r = -0.264; p = 0.002), and waist-to-hip ratio (r = -0.395; p < 0.001). Due to its antihypertensive effect, CST has significant associations with systolic BP (r = -0.475; p < 0.001) and duration of AH (r = -0.26; p = 0.007). CST also has an inverse relationship with insulin (r = -0.382; p < 0.001), glucose (r = -0.45; p < 0.001), index HOMA-IR (r = -0.481; p < 0.001) and HbA1c (r = -0.525; p < 0.001), that indicate its involvement in T2DM development. Besides, CST has significant correlations with uric acid levels (r = -0.412; p < 0.001) as well as lipid parameters, especially HDL-C (r = 0.480; p < 0.001), VLDL-C (r = -0.238; p = 0.005), TG (r = -0.4; p < 0.001), non-HDL-C/HDL-C (r = -0.499; p < 0.001). Multiple linear regression analysis indicated BMI (β = -0.22; p = 0.007), AH duration (β = -0.25; p = 0.008), HbA1c (β = -0.43; p = 0.019) and HDL-C levels (β = 0.27; p = 0.001) as independent predictors of CST levels. The hypertensive patients have significantly decreased CST levels that are even more reduced in the presence of comorbid T2DM. The established correlations with anthropometric and laboratory parameters indicate not only antihypertensive but also metabolic effects of CST. Our results suggest the probable role of CST in the pathophysiology of cardiometabolic diseases and the development of cardiovascular complications.

Reduced SARS-CoV-2 mRNA vaccine immunogenicity and protection in mice with diet-induced obesity and insulin resistance

Obesity and type 2 diabetes mellitus (T2DM) are associated with an increased risk of severe outcomes from infectious diseases, including coronavirus disease 2019. These conditions are also associated with distinct responses to immunization, including an impaired response to widely used severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines. We sought to establish a connection between reduced immunization efficacy via modeling the effects of metabolic diseases on vaccine immunogenicity that is essential for the development of more effective vaccines for this distinct vulnerable population. A murine model of diet-induced obesity and insulin resistance was used to model the effects of comorbid T2DM and obesity on vaccine immunogenicity and protection. Mice fed a high-fat diet (HFD) developed obesity, hyperinsulinemia, and glucose intolerance. Relative to mice fed a normal diet, HFD mice vaccinated with a SARS-CoV-2 mRNA vaccine exhibited significantly lower anti-spike IgG titers, predominantly in the IgG2c subclass, associated with a lower type 1 response, along with a 3.83-fold decrease in neutralizing titers. Furthermore, enhanced vaccine-induced spike-specific CD8+ T-cell activation and protection from lung infection against SARS-CoV-2 challenge were seen only in mice fed a normal diet but not in HFD mice. The study demonstrated impaired immunity following SARS-CoV-2 mRNA immunization in a murine model of comorbid T2DM and obesity, supporting the need for further research into the basis for impaired anti-SARS-CoV-2 immunity in T2DM and investigation of novel approaches to enhance vaccine immunogenicity among those with metabolic diseases.

Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India.

Medication adherence is a crucial component in the management of elderly with co-morbid chronic conditions. Hence, this study aimed to investigate the determinants of medication non-adherence among rural elderly with co-morbid chronic conditions of hypertension (HTN) and type 2 diabetes mellitus (T2DM) in India. This cross-sectional study adopted the probability proportional to size (PPS) sampling technique to find the determinants of medication non-adherence among elderly residing in rural coverage areas of five randomly selected primary health centres (PHC) in Udupi district, Karnataka, India. A total of 360 elderly (72 samples from each cluster) who met the inclusion criteria and consented were interviewed using predesigned prevalidated and standardized or reliable tools. The data were coded and entered in SPSS version 16.0 and analyzed using both descriptive and inferential statistics. The study found that 55.6% (n=200) of rural elderly with co-morbid conditions HTN and T2DM were non-adherent to their medications and established Spearman correlation coefficient rank (r) value between undesirable person-related factors (r=-0.444); good family support (including financial support) (r=0.185); poor accessibility to healthcare facility (r=-0.209); detrimental medication-related factors including high cost of medication (r=-0.237) were found to be significant at 0.05 level of confidence (p < 0.05). Further, the study depicted that the chi-square test (χ2) was identified to be significantly associated (p<0.05) with a variable such as education, knowledge, number of illnesses and impairments, vision, memory, and physical impairments. Medication adherence could be improved among rural elderly with co-morbid conditions by identifying and addressing the determinants at the earliest. Further, it is vital to identify the suitable intervention program to address these avoidable problems.

Enzalutamide vs abiraterone in patients with prostate cancer with and without type 2 diabetes mellitus.

5066 Background: Estimations are that 8-18% of newly diagnosed cancer patients have Type 2 Diabetes Mellitus (T2DM). Current guidelines offer no clarification on the choice of therapy for prostate cancer (PCa) patients with T2DM. Since the comorbid PCa—T2DM population is increasing and these patients face unique challenges from adverse events requiring acute care utilization (ACU) it is important to ascertain which medication poses less of a threat of adverse events. The objective of this study was to describe the SEER-Medicare T2DM-PCa population in terms of those with and without complications and determine if T2DM influences ACU and PCa medication choice. Methods: We identified men with primary PCa treated with abiraterone (ABI, 2011) or enzalutamide (ENZ, 2012) with comorbid T2DM using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1999-2019). Patients with a missing date of diagnosis, those diagnosed at death, having HMO or no continuous A and B coverage 12 months before diagnosis and 6 months continuous part D coverage before starting treatment as well as 6 months following treatment or until death were excluded. T2DM was identified using ICD-9 and ICD-10 codes. ACU was calculated utilizing the CMS Research Data Assistance Center definition focusing on emergency room visits resulting in in-patent hospitalization during the 6 months following treatment initiation. Differences in emergency room in-patient visits were evaluated using negative binomial models adjusted for age, race, SEER region, marital status, state-buyin, education, income, and modified Charlson Comorbidity Index (excluding T2DM). Results: The sample of 11,163 men included 61.8% treated with ABI and 38.2% with ENZ. We identified 3,044 (27.3%) men with T2DM, of which, 59.1% were treated with ABI and 40.8% with ENZ. Compared to those without T2DM those with T2DM had more ACU, regardless of medication, with a higher rate in the ABI than ENZ group, see table. Among diabetics, those with complications related to T2DM compared to those without also experienced a higher rate of ACU. The rate of ACU was 43% higher among those treated with ABI compared to ENZ (IRR 1.43; 95% CI 1.28, 1.61). Overall mortality (15.7% vs 10.1%, p&lt;0.01) and PCa-specific mortality (8.2% vs 5.3%, p&lt;0.01) were worse in those with T2DM treated with ABI compared to ENZ. Conclusions: Outcomes for PCA patients with T2DM are worse than for those without. ACU is higher in men treated with ABI compared to ENZ regardless of T2DM status. Given the worse outcomes for comorbid T2DM patients, further study to evaluate comorbidity management in this population is warranted. [Table: see text]

Glucagon-like peptide-1 receptor agonists as a disease-modifying therapy for knee osteoarthritis mediated by weight loss: findings from the Shanghai Osteoarthritis Cohort

ObjectiveObesity is a risk factor for knee osteoarthritis (KOA) development and progression. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are indicated for type 2 diabetes mellitus (T2DM) and obesity. However, whether KOA...

Medicated-related burden and adherence in patients with co-morbid type 2 diabetes mellitus and hypertension

BackgroundMedication adherence is an integral component in the management of patients with co-morbid type 2 diabetes mellitus (T2DM) and hypertension. However due to their combined conditions, there is likelihood of polypharmacy and medication-related burden, which could negatively impact adherence to therapy. This study aimed to assess the perceived medication-related burden among patients with co-morbid T2DM and hypertension and to evaluate the association between the perceived burden and adherence to medication therapy. MethodsA cross-sectional study was conducted among adult patients with co-morbid T2DM and hypertension attending a primary health facility. The living with medicines questionnaire and the medication adherence report scale were used to assess extent of medication-related burden and adherence respectively. Binary logistic regression model was used to estimate the adjusted odds and their corresponding 95% confidence interval for medication-related burden and adherence outcomes. All observed categorical variables were considered for the multivariable binary logistic regression model. ResultsThe total number of participants was 329 with a median age of 57.5 ± 13.2 years. The median score for the overall burden was 99 (IQR: 93–113), and this significantly varied by sex (p = 0.012), monthly income (p = 0.025), monthly expenditure on medications (p = 0.012), frequency of daily dose of medications (p = 0.020) and family history of T2DM (p < 0.001). About 30.7% and 36.8% of participants reported moderate/high burden and medication adherence respectively. Uncontrolled diastolic blood pressure (AOR: 2.46, 95% CI: 1.20–5.05, p = 0.014), high glucose (AOR: 4.24, 95% CI: 2.13–8.46, p < 0.001) and no family history of T2DM (AOR: 2.14, 95% CI: 1.14–4.02, p = 0.026) were associated with moderate/high medication burden. Uncontrolled diastolic blood pressure (AOR: 0.48, 95% CI: 0.25–0.94, p = 0.031), at least 5 years since hypertension diagnosis (AOR: 0.55, 95% CI: 0.30–0.99, p = 0.045) and moderate/high medication-related burden (AOR: 0.33, 95% CI: 0.16–0.69, p = 0.003) were associated with lower odds of medication adherence. ConclusionThese findings suggest that to improve the preventive and optimal care of patients with T2DM and hypertension, interventions that aim to reduce medication-related burden and morbidity are recommended. The study proposes that health stakeholders such as clinicians, pharmacists, and policy makers, develop multidisciplinary clinical and pharmaceutical care interventions to include provision of counselling to patients on adherence. In addition, developing policies and sensitization activities on deprescribing and fixed-dose drug combinations aimed at reducing medication-related burden, while promoting better adherence, blood pressure and blood glucose outcomes are recommended.

Predictors, Disparities, and Facility-Level Variation: SGLT2 Inhibitor Prescription Among US Veterans With CKD

Sodium/glucose cotransporter 2 (SGLT2) inhibitors are recommended for type 2 diabetes mellitus (T2DM) in patients with chronic kidney disease (CKD) or atherosclerotic cardiovascular disease (ASCVD). We evaluated factors associated with SGLT2 inhibitor prescription, disparities by race and sex, and facility-level variation in prescription patterns. Retrospective cohort. A national sample of US veterans with comorbid T2DM, CKD, and ASCVD with a primary care visit between January 1 and December 31,2020. Race, sex, and individual Veterans Affairs (VA) location. SGLT2 inhibitor prescription. Multivariable logistic regression assessed associations of race and sex with SGLT2 inhibitor prescription. Facility-level variation in SGLT2i prescription was quantified by median rate ratios (MRR), which express the likelihood that 2 randomly selected facilities differ in their use of SGLT2 inhibitor among similar patients. Of 174,443 patients with CKD, T2DM, and ASCVD, 20,024 (11.5%) were prescribed an SGLT2 inhibitor. Lower odds of SGLT2 inhibitor prescription were seen in Black or African American patients compared with White patients (OR, 0.87 [95% CI, 0.83-0.91]) and among women compared with men (OR, 0.59 [95% CI 0.52-0.67]). The adjusted MRR for SGLT2 inhibitor prescription was 1.58 (95% CI 1.48-1.67) in the total cohort, indicating an unexplained 58% variation in treatment between VA facilities, independent of patient and facility characteristics. Facility-level variation was evaluated among Black or African American patients (MRR, 1.55 [95% CI 1.41-1.68]), White patients (MRR, 1.57 [95% CI 1.47-1.66]), women (MRR, 1.40 [95% CI 1.28-1.51]), and men (MRR, 1.57 [95% CI 1.48-1.67]). Albuminuria was not assessed. Prescription for SGLT2 inhibitors was low among likely eligible patients, with evident disparities by sex and race and between individual VA facilities. Efforts are needed to study and address the reasons for these disparities to improve equitable adoption of these important medications.

Clinical Outcomes of Antiviral Therapy on Comorbid and non-Comorbid T2-DM COVID-19 Patients at Rasidin Hospital

Patients with comorbidity is vulnerable to being attacked by COVID-19. Diabetes mellitus comorbid patients have experience of higher severity viral infections than those without diabetes mellitus. The objective of the research was to evaluate the impact of Type 2 Diabetes Mellitus (T2-DM) comorbidity and antiviral therapy on the clinical outcome of COVID-19 patients. The study was performed following a cross sectional design from April 2020 to March 2021 at Hospital dr Rasidin Padang. Data were collected retrospectively from the patient's medical record. Treatment and clinical outcomes of patients were analyzed using the Kruskal Wallis, Mann-Withney U Test, Repeated Measured ANOVA, and Friedman Test. Results showed that the respiratory rate on T2-DM comorbid and non-comorbid patients were 20.58±0.25 and 20.15±0.08 times/minutes, respectively (p&lt;0.05). While, oxygen saturation was 97.95±0.16 and 98.38±0.06%, respectively (p&lt;0.05). Patient’s length of stay after the treatment of oseltamivir and favipiravir on non-comorbid COVID-19 patients were 14.76±0.861 and 9.96±0.488 days, respectively (p&lt;0.01). While on comorbid patients were 16.00 ±3.17 and 10.47±0.77, respectively (p&lt;0.01). Comorbidity had a significantly impacted on the patient's respiratory rate and oxygen saturation. The use of oseltamivir and favipiravir had a highly significant different on the LOS of comorbid and non-comorbid patients.

IMPACT OF BEHAVIORAL ACTIVATION ON COMORBID DEPRESSION AND TYPE 2 DIABETES IN LOW-INCOME ADULTS

Abstract Older age is a significant risk factor for type 2 diabetes mellitus (T2DM), and depression risk increases with comorbid illnesses such as T2DM. Older adults with depression have increased risk of developing somatic symptoms and decreased interest in activities, which impacts diabetes self-care. This makes depression an important target for treatment alongside T2DM. Behavioral activation (BA) is a therapeutic intervention shown to be effective in the treatment of moderate to severe depression. The current study examined the utility of brief BA treatment (once weekly for 4 weeks) across older adults aged 60-80, middle-aged adults aged 45-59, and younger adults aged 18-44. Fifty-six adults with diabetes participated in an in-home diabetes management program with BA to treat depression in low-income adults. Participants completed weekly measures of well-being and depressive symptoms. Two mixed-subjects analyses of variance (3 x 2 ANOVAs) found that BA was significantly effective at improving subjective well-being, F (1, 53) = 38.24, p &amp;lt; .001, ηp2 = .42, and reducing depressive symptoms, F (1, 38) = 27.25, p &amp;lt; .001, ηp2 = .42, but found no interaction effects between either age group and well-being or depressive symptoms (p = .173 and .302, respectively). Results indicate that BA is effective for treating depression in adults with comorbid T2DM regardless of age, making it a useful therapeutic tool for both the high number of older adults with T2DM and their younger counterparts. Further research should examine other outcomes (diabetes management) to evaluate the full extent of BA’s effectiveness.

Acute Ischemic Stroke Comorbid with Type 2 Diabetes: Long-Term Prognosis Determinants in a 36-Month Prospective Study for Personalized Medicine.

Ischemic stroke (IS) is often comorbid with type 2 diabetes mellitus (T2DM) wherein the determinants of long-term outcomes, beyond the acute stroke phase, are not adequately known. This study identified the determinants of long-term outcomes for diabetic IS patients through a prospective nested case-control study in 624 patients treated with conservative measures (38.60% females, mean age: 63.85 years). After 36-month follow-up, 117 (18.8%) patients with poor outcome were enrolled in the case group. The poor outcome was defined with a modified Rankin Scale (mRS) score ≥3. Meanwhile, 374 (59.9%) patients with good outcome, defined as (mRS score <3), were included in the control group. Patients who died (n = 32) or lost to follow-up (n = 101) were excluded in analysis. Poor prognostic outcome was positively associated with (1) the pulse rate at admission, (2) diastolic blood pressure (DBP), and (3) fasting blood glucose (FBG) during follow-up, whereas physical activity and lipid-lowering treatment during follow-up were negatively associated. Importantly, a forecasting model with these indicators distinguished the patients with good versus poor outcomes with 70.1% sensitivity and 73.5% specificity. Health care professionals and laboratory medicine scholars may want to monitor an increase in DBP and FBG during follow-up, as well as physical activity and lipid-lowering treatment, in relationship to the prognosis of IS with comorbid T2DM after conservative therapies. The proposed predictive model for personalized/precision medicine requires field testing in independent studies, and might help risk stratification with theranostic tests for patients with acute IS who also have a diagnosis of T2DM.