Comorbid Type 2 Diabetes Mellitus Research Articles

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.

Incident Stroke and Its Influencing Factors in Patients With Type 2 Diabetes Mellitus and/or Hypertension: A Prospective Cohort Study.

ObjectiveTo understand the incidence of stroke in patients with type 2 diabetes mellitus (T2DM) and/or hypertension (HTN), and provide a basis for the prevention of stroke in these patients.MethodsA prospective cohort study was performed for adults with T2DM and/or HTN. The follow-up period was 1 year. The incidence and recurrence rate of stroke was calculated and a multivariate Cox proportional hazard was used to analyze influencing factors of stroke occurrence and recurrence in the follow-up of patients with T2DM and/or HTN.ResultsOf the 1,650 patients with T2DM and/or HTN, 1,213 patients had no history of stroke. After 1 year of follow-up, 147 new stroke cases occurred, and the incidence rate of stroke was 12.1%. Among the patients who had stroke history (413), there were 116 cases of stroke with a recurrence rate of 26.5%. Seven risk factors were independently associated with stroke occurrence among patients without stroke history, included smoking, abnormal total cholesterol abnormal low-density lipoprotein patients with comorbid T2DM with HTN, physical inactivity, carotid artery stenosis (CAS), and higher scores of National Institutes of Health Stroke Scale (NIHSS). Higher scores of NHISS and CAS were independent risk factors for the recurrence of stroke among patients with stroke history.ConclusionsPatients with T2DM and/or HTN have a higher rate of new stroke and recurrence after 1-year follow-up. Actively identifying the controllable risk factors, such as smoking and physical inactivity, will help reduce the risk of stroke and recurrence in patients with T2DM and HTN.

Mendelian randomization analysis of vitamin D in the secondary prevention of hypertensive-diabetic subjects: role of facilitating blood pressure control

BackgroundVitamin D (Vit-D) promotes vascular repair and its deficiency is closely linked to the development of type 2 diabetes mellitus (T2DM) and hypertension. Whether genetially predicted vitamin D status (serological 25-hydroxyvitamin D [25(OH)D]) confers secondary protection against cardiovascular diseases (CVD) among high-risk hypertensive-diabetic subjects was unknown.MethodsThis is a prospective, individual-data, two-sample Mendelian randomization study. We interrogated 12 prior GWAS-detected SNPs of comprehensive Vit-D mechanistic pathways using high-throughput exome chip analyses in a derivation subcohort (n = 1460) and constructed a genetic risk score (GRS) (rs2060793, rs4588, rs7041; F-statistic = 32, P < 0.001) for causal inference of comprehensive CVD hard clinical endpoints in an independent sample of hypertensive subjects (n = 3746) with prevailing co-morbid T2DM (79%) and serological 25(OH)D deficiency [< 20 ng/mL] 45%.ResultsAfter 55.6 ± 28.9 months, 561 (15%) combined CVD events including myocardial infarction, unstable angina, ischemic stroke, congestive heart failure, peripheral vascular disease, and cardiovascular death had occurred. Kaplan-Meier analysis showed that genetically predicted reduced vitamin D status was associated with reduced event-free survival from combined CVD events (log-rank = 13.5, P = 0.001). Multivariate-adjusted per-allele increase in GRS predicted reduced combined CVD events (HR = 0.90 [0.84 to 0.96], P = 0.002). Mendelian randomization indicates that increased Vit-D exposure, leveraged through each 1 ng/mL genetically instrumented rise of serum Vit-D, protects against combined CVD events (Wald’s estimate: OR = 0.86 [95%CI 0.75 to 0.95]), and myocardial infarction (OR = 0.76 [95%CI 0.60 to 0.90]). Furthermore, genetically predicted increase in Vit-D status ameliorates risk of deviation from achieving guideline-directed hypertension control (JNC-8: systolic target < 150 mmHg) (OR = 0.89 [95%CI 0.80 to 0.96]).ConclusionsGenetically predicted increase in Vit-D status [25(OH)D] may confer secondary protection against incident combined CVD events and myocardial infarction in a hypertensive-diabetic population where serological 25(OH)D deficiency is common, through facilitating blood pressure control.

The additive effect of essential hypertension on coronary artery plaques in type 2 diabetes mellitus patients: a coronary computed tomography angiography study

BackgroundThe effect of comorbid hypertension and type 2 diabetes mellitus (T2DM) on coronary artery plaques examined by coronary computed tomography angiography (CCTA) is not fully understood. We aimed to comprehensively assess whether comorbid hypertension and T2DM influence coronary artery plaques using CCTA.Materials and methodsA total of 1100 T2DM patients, namely, 277 normotensive [T2DM(HTN−)] and 823 hypertensive [T2DM(HTN +)] individuals, and 1048 normotensive patients without T2DM (control group) who had coronary plaques detected on CCTA were retrospectively enrolled. Plaque type, coronary stenosis, diseased vessels, the segment involvement score (SIS) and the segment stenosis score (SSS) based on CCTA data were evaluated and compared among the groups.ResultsCompared with patients in the control group, the patients in the T2DM(HTN−) and T2DM(HTN +) groups had more partially calcified plaques, noncalcified plaques, segments with obstructive stenosis, and diseased vessels, and a higher SIS and SSS (all P values < 0.001). Compared with the control group, T2DM(HTN +) patients had increased odds of having any calcified and any noncalcified plaque [odds ratio (OR) = 1.669 and 1.278, respectively; both P values < 0.001]; both the T2DM(HTN-) and T2DM(HTN +) groups had increased odds of having any partially calcified plaque (OR = 1.514 and 2.323; P = 0.005 and P < 0.001, respectively), obstructive coronary artery disease (CAD) (OR = 1.629 and 1.992; P = 0.001 and P < 0.001, respectively), multivessel disease (OR = 1.892 and 3.372; both P-values < 0.001), an SIS > 3 (OR = 2.233 and 3.769; both P values < 0.001) and an SSS > 5 (OR = 2.057 and 3.580; both P values < 0.001). Compared to T2DM(HTN−) patients, T2DM(HTN +) patients had an increased risk of any partially calcified plaque (OR = 1.561; P = 0.005), multivessel disease (OR = 1.867; P < 0.001), an SIS > 3 (OR = 1.647; P = 0.001) and an SSS > 5 (OR = 1.625; P = 0.001).ConclusionT2DM is related to the presence of partially calcified plaques, obstructive CAD, and more extensive coronary artery plaques. Comorbid hypertension and diabetes further increase the risk of partially calcified plaques, and more extensive coronary artery plaques.

Diagnostic Overview of COVID-19 Patients with Comorbid Type 2 Diabetes Mellitus at Royal Prima General Hospital Medan in 2020

COVID-19 is a disease caused by infection with a coronavirus known as SARS-CoV-2. COVID-19 patients with diabetes have a poor prognosis and thus have a shorter life expectancy than those without diabetes. This is because COVID-19 causes severe lung dysfunction and inflammation. The purpose of the study is to find out the description of diagnostic of COVID-19 patients with comorbid diabetes mellitus type 2 at Royal Prima general hospital Medan in 2020. The case study design method is descriptive with a retrospective approach, the sample size of 63 patient medical records is taken by purposive sampling, a complete medical record and analyzed with descriptive statistics. Most patients were aged more than 50 years old (66.7%) and female (50.8%). With symptoms of fever (84.1%), cough (87.3%), shortness of breath (87.3%), headache (28.6%), diarrhea (9.5%), nausea (42.9%), abdominal pain (31.7%), loss of smell (20.6%). The longest hospitalization time (11-20 days) (46%). It can be concluded that the most age is &gt; 50 years, the most gender is female and the most clinical symptoms are cough and shortness of breath.

Cortisol awakening response in bipolar patients with comorbid type 2 diabetes mellitus

Objectives Bipolar disorder (BD) is frequently associated with type 2 diabetes mellitus (T2DM). The functioning of the hypothalamic-pituitary-adrenal (HPA) axis has been never investigated in BD with respect to the glucose metabolic status. Therefore, we assessed the cortisol awakening response (CAR) in bipolar patients with or without comorbid T2DM. Methods Twenty euglycemic bipolar patients [12 males and eight females; mean age (±SD): 47.4 ± 14.4 years; mean (±SD) duration of illness: 18.3 ± 12.1 years], 16 BD patients with T2DM [11 males and five females; mean age (±SD): 63.6 ± 12.8 years; mean (±SD) duration of bipolar illness: 17.1 ± 10.8 years; mean (±SD) duration of T2DM: 5.2 ± 5.3 years], 18 healthy subjects [seven males and 11 females; mean age (±SD): 45.0 ± 12.1 years] and 12 non-psychiatric subjects with T2DM [eight males and four females; mean age (±SD): 56.7 ± 11.2 years; mean (±SD) duration of T2DM: 5.2 ± 3.5 years] were recruited. Saliva cortisol was measured at awakening and after 15, 30, and 60 min. Results With respect to both healthy controls and controls with T2DM, euglycemic and diabetic BD patients exhibited a CAR occurring at significantly lower levels. No significant difference emerged in the CAR between the two groups of bipolar patients. Controls with T2DM had an overall post-awakening cortisol production significantly higher than healthy controls. Conclusions Our results show that the CAR of patients with BD is reduced in terms of overall cortisol production but normal in terms of cortisol reactivity independently from the occurrence of comorbid T2DM. The dampened CAR points to a tuning down of the functioning of the HPA axis. in both euglycemic and diabetic BD patients, which may be a factor of vulnerability, since a preserved HPA axis functioning is essential to deal with stressors, which may precipitate affective episodes.

Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink.

Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions. To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions. This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively. There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year. Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.

Association of cardiovascular biomarkers with myocardial and coronary imaging characteristics in patients having acute myocardial infarction and type 2 diabetes mellitus

Aim. To assess the dynamic changes and clinical significance of biomarkers of inflammatory processes in patients with acute myocardial infarction (MI) with/ or without type 2 diabetes mellitus (T2DM) and primary percutaneous coronary intervention (pPCI) at various stages of treatment.Methods. 96 patients with acute MI after pPCI were examined. The level of inflammation markers was measured 4 times: before pPCI (first day from admission to the hospital), on the third day, 7–10 days (before discharge from the hospital) and 40–45 days after pPCI.Results. All groups of patients with MI showed an increase in the plasma activity of biomarkers of inflammatory processes. After pPCI for 40–45 days, there is a significant difference in the concentration of biomarkers, depending on the comorbid T2DM presence. Strong associations were found between cardiovascular biomarkers and post-MI cardiac remodeling and coronary atherosclerosis progression.Conclusion. The assessment of the levels of biomarkers of inflammatory processes may have additional clinical value in estimating the course of MI, including patients with T2DM at the postinfarction stages.

The effects of antidiabetic agents on heart failure.

In the Netherlands, approximately 250,000 people are living with heart failure. About one-third of them have comorbid diabetes mellitus type 2. Until recently, the effects of antidiabetic agents on heart failure were largely unknown. This changed after an observed increased risk of heart failure and ischaemic heart disease associated with thiazolidinediones that prompted the requirement for cardiovascular outcome trials for new glucose-lowering drugs. In the past decade, three new classes of antidiabetic agents have become available (i.e. dipeptidyl peptidase‑4 inhibitors, glucagon-like peptide‑1 receptor agonists and sodium-glucose cotransporter‑2 (SGLT2) inhibitors). Although the first two classes demonstrated no beneficial effects on heart failure compared to placebo in patients with diabetes mellitus type 2, SGLT2 inhibitors significantly and consistently lowered the risk of incident and worsening heart failure. Two recent trials indicated that these favourable effects were also present in non-diabetic patients with heart failure with reduced ejection fraction, resulting in significantly lower risks of hospitalisation for heart failure and presumably also cardiovascular and all-cause mortality. SGLT2 inhibitors have been shown to be benefit on top of recommended heart failure therapy including sacubitril/valsartan and may also prove beneficial for heart failure with preserved ejection fraction. In this review, we discuss the effects of antidiabetic agents on heart failure.

Therapeutic strategy in patients with long-lasting essential hypertension with comorbid type 2 diabetes mellitus and obesity

Background: Presently the level of blood pressure (BP) control is extremely unsatisfactory in hypertensive patients throughout the world. The aim of our study was to find the optimal drug therapy for patients with hard-to-treat essential hypertension (EH) associated with type 2 diabetes mellitus (T2DM) and obesity, namely the comparison of strategies of fixed and non-fixed combination. Material and methods: Eighty-seven patients with EH, T2DM and obesity were enrolled into the study. Two groups were formed: the 1st group — 41 patients received antihypertensive therapy in the form of unfixed combination of drugs (“multi-pill”) perindopril, indapamide and amlodipine; the 2nd — 46 patients, who received the same drugs, but in a fixed-dose combination (“single pill”). Results: A favorable treatment result was found for fixed-dose combination of antihypertensive drugs, with significant reduction in the frequency of visits to the doctor: relative risk (RR) — 1.27 (95% CI: 1.01‒1.61), p = 0.045, and odds ratio (OR) — 3.10 (95% CI: 1.05‒9.13), p = 0.04. That indicates that patients on fixed-dose combination were less likely to visit a doctor with complaints. Patients on single-pill therapy were less likely to get to progression (worsening) group in contrast to multi-pill non-fixed combination: RR — 1.37 (95% CI: 1.02‒1.84), p = 0.03; OR — 2.91 (95% CI: 1.12‒7.59), p = 0.03. Conclusion: The single-pill triple combination has significant advantage compared to multi-pill regimen in hard-totreat hypertensive patients with comorbid T2DM and obesity. Fixed-dose triple combination leads to significantly faster achievement of blood pressure control.

Schizophrenic patients with type 2 diabetes: An 8-year population-based observational study.

This paper presents a realistic evaluation of the prevalence of type 2 diabetes mellitus (T2DM) among Polish schizophrenic patients who have sought treatment through the Polish National Health Fund in the years 2010-2017. Data from the National Health Fund database was used and T2DM and schizophrenia groups were defined according to International Classification of Diseases (ICD-10) codes. Demographic data were collected from the web page of Statistics Poland (GUS). The annual prevalence of T2DM and schizophrenia was estimated, and the age groups were categorised into eight sets. The incidence of schizophrenia in T2DM patients in the years 2010-2017 was measured, including relative risk and 95% confidence interval (95% CI). The incidence of T2DM has been assessed in various subtypes of schizophrenia. In the eight years of follow-up study, 1,481,642 patients with schizophrenia were included, of which 185,205 were also diagnosed with T2DM. This accounted for 12.50% of all patients with schizophrenia. The trend of comorbid schizophrenia (F20) and T2DM (E11) in the general population of patients with schizophrenia, who sought treatment through the National Health Fund, was relatively stable in the years 2010-2017. The relative risk of T2DM in those with schizophrenia was 8.33 (95% CI 8.23-8.43) in 2017. Taking actions to enable the detection of diabetes in patients with concomitant schizophrenia is well-grounded, although these actions should be gender-dependent. There is also a need to take adequate actions to improve the efficiency of diabetological care among patients with schizophrenia.

CLINICAL CHARACTERISTICS OF PATIENTS WITH CHRONIC HEART FAILURE AND TYPE 2 DIABETES MELLITUS WHO REQUIRE IMPLANTATION OF PERMANENT PACEMAKER

In recent decades, there has been a rise of chronic heart failure mortality. Among the huge range of modern methods of this pathology treatment, the cardioresynchronizing therapy stands out, it allows the improvement of the patient's heart function, reduces clinical signs of the disease, improves well−being, as well as diminishes morbidity and mortality. The use of this method in the patients with a comorbid pathology, i.e. in those with chronic heart failure and type 2 diabetes, deserves a special attention. In order to determine the clinical characteristics of the patients who required a pacemaker implantation, we examined 203 patients who had reasonable indications for this in accordance with the ACC / ANA and ESC current recommendations. Another important criterion for inclusion into the group of implantation was considered to be the presence of comorbid Diabetes mellitus type 2. The gender and age characteristics of the surveyed population were dominated by elderly male patients. The presence of concomitant cardiovascular pathology depending on the age of patients was analyzed, which showed mostly hypertension of stage 2−3, a constant atrial fibrillation. In structure of comorbid pathology the somatic diseases, including type 2 Diabetes mellitus prevailed. Electrostimulators were implanted into the examined cohort of patients, among which 132 devices worked in DDD mode, 71 of the installed stimulators had the DDDR mode. The research results concluded that the implantation of a pacemaker became a necessary procedure for elderly patients, mostly men, with a high prevalence of cardiovascular (coronary heart disease, hypertension, persistent atrial fibrillation) and somatic pathology in the form of type 2 Diabetes mellitus. Key words: chronic heart failure, type 2 diabetes mellitus, pacemaker implantation, clinical features, gender and age characteristics.

Exploring the effect of type 2 diabetes on brain structure and cerebral perfusion in patients with early Alzheimer’s disease

AbstractBackgroundPast research has shown that Alzheimer’s Disease (AD) can have a significant detrimental effect on the cerebrovascular system. Previous work has also indicated that type 2 diabetes mellitus (T2DM), along with being a risk factor for AD, shares certain similarities with AD in terms of the mechanisms affecting the cerebrovascular system. Hence, comorbid T2DM in AD could cause additional cardiovascular burden that may cause further damage to brain structure and function than that seen in AD.MethodThe current study compares 54 patients across the AD spectrum with and without T2DM (with 27 patients in each group). Voxel based morphometry was used to determine volumetric differences in grey matter using T1‐weighted magnetic resonance images. To assess whether these volumetric differences were associated with a reduction in cerebral blood flow, arterial spin labelling (ASL) was used to measure cerebral perfusion.ResultsPatients with T2DM had smaller grey matter volume compared to patients without T2DM in the anterior caudate nucleus and posterior cerebellum in the right hemisphere. Perfusion deficits mirrored the regional volumetric abnormalities, along with additional hypoperfusion observed in the right parahippocampal gyrus. These differences were also associated with deficits in cognitive function.ConclusionsMicrovascular and macrovascular complications seen in the AD patients with comorbid T2DM could therefore contribute toward the negative effects exerted on cerebral perfusion that could potentially contribute toward the structural deficits observed. Furthermore, the right lateralised effects seen in the present study could arise due to the characteristic trajectory of the arteries supplying the brain. With the increasing prevalence of cardiovascular risk factors such as T2DM combined with the rise in numbers of people living with AD, the additional cardiovascular burden caused by such risk factors may be a crucial tipping point toward conversion to AD dementia from prodromal stages. This is one of the first studies to show that the additional cerebrovascular burden resulting from comorbid T2DM in AD can result in worse structural and perfusion deficits using multi‐modal neuroimaging and that these deficits can be associated with clinical presentations.

Role of hypercortisolemia in the comorbid course of coronary artery disease, diabetes mellitus type 2 and anemia

The results of the investigation are components of the scientific-research work “Features of the comorbid course of the diseases of internal organs: risk factors, mechanisms of the progression and comorbidity, pharmacotherapy”. №0114U002475. The aim of the study – investigation of dynamics of cortisol synthesis changes in patients of older age groups with coronary artery disease (CAD) with comorbid diabetes mellitus type 2 (DM) and anemic syndrome (AS). Material and methods. Blood cortisol level was measured in 40 old and senile CAD patients with comorbid DM and AS of different degrees of severity. Control group consisted of 12 patients with CAD without comorbidities that were not significantly different by gender and age from patients of research groups. Possible effects of telmisartan on the degree of chronic hypoxia were also investigated. Results. In patients of old and senile age with CAD and comorbid AS, same as in case of CAD and AS on the background of DM, activation of the cortisol synthesis is observed, likely in response to hypoxia as a stress factor in anemia. The degree of severity of the detected changes was different depending on the degree of anemia severity. There was no normalization of cortisol content in blood in any of the major experimental groups regardless the prescribed treatment with ACE inhibitors or telmisartan. Conclusion. In patients with CAD, same in the case of a comorbid course of CAD and DM, an increase of cortisol secretion in response to anemic hypoxia was observed. As the degree of severity of the AS progressed, gradual decreasing of cortisol blood level was detected. Reduction of the intensity of stress-limiting systems in the organism by telmisartan prescription may help to eliminate the adverse effects of hypercortisolemia on the progression of coronary artery disease, especially on the background of comorbid diabetes mellitus type 2 and anemia.

Factors influencing functional outcomes following open reduction internal fixation of acetabular fractures.

Recent large series of patient-reported outcomes after acetabulum fracture are limited, and potentially modifiable risk factors may be unidentified. The goal of this study was to describe patient and injury factors which negatively influence functional outcomes following operative management of acetabular fractures. 699 patients with acetabular fractures were treated with open reduction and internal fixation (ORIF). Musculoskeletal Function Assessment (MFA) questionnaire was completed after a minimum 12 months post-injury by 283 adults. MFA scores range from 1 to 100 and higher scores represent greater dysfunction. Factors were assessed for potential association with MFA scores, and univariate and multiple linear regression analyses were performed. Survey respondents were more severely injured than non-respondents, with more chest injury (38% vs 22%, p<0.001) and higher Injury Severity Score (19.3 vs 16.8, p=0.003). Patients were 69% male with mean age 44.0 years. Approximately one-third were smokers (31%), while 14% had comorbid diabetes mellitus type II. The majority of injuries occurred during a motor vehicle collision (65%); low-energy mechanisms were rare (4.2%). The most common fracture pattern was isolated posterior wall (23%), followed by transverse/posterior wall (21%). Heterotopic ossification (HO) was noted in 22%: Brooker 1: 29.5%, 2: 23.0%, 3: 32.8%, and 4: 14.8%. Tobacco use (β=18.4, p<0.001), obesity (β=0.39, p=0.009), diabetes (β=8.2, p=0.029), post-traumatic arthrosis (PTA) (β=5.94 p=0.035), and increasing HO severity (β=8.93, p<0.001) were independently associated with worse MFA scores. Tobacco use had the strongest association, followed by the severity of HO. In a large series of patient-reported functional outcomes following fixation of acetabular fractures, tobacco use, obesity, comorbid diabetes, PTA, and HO were associated with worse MFA scores. Further study to mitigate HO should be considered. III.

Progress of research on the relations between bipolar disorder and type 2 diabetes mellitus

Both risks of type 2 diabetes mellitus (T2DM) in patients with bipolar disorder (BD) and of BD in patients with T2DM are both significantly higher than the general population, indicating the two disorders may share the common pathogenesis. Patients with BD and co-morbid T2DM behave poorly on managing their own behavior on health, thus increased risks of outcomes on related complications, disability and mortality. The article reviewed the epidemiologic features, health hazards, relations and possible mechanisms between BD and T2DM. Strategies and measures on intervention of BD and T2DM were also involved in the text to improve the awareness and research ability of the researchers.