Comorbidity In Diabetic Patients Research Articles

#2833 Charlson comorbidity index predicts early failure and overall survival of vascular access among diabetic dialysis patients.

Abstract Background and Aims Vascular access (VA) survival is a determinant factor in the morbidity and mortality of haemodialysis patients, directly influencing their quality of life. Some studies have described the influence of diabetes on the reduced survival of arteriovenous fistulas as an independent factor; however, the correlation between other comorbidities in diabetic patients with vascular access survival has been less well documented. Therefore, our aim is to describe the relationship between comorbidities in diabetic haemodialysis patients and arteriovenous fistula (AVF) patency. Method Descriptive, observational and retrospective study in prevalent patients included in a haemodialysis programme by consulting electronic records over a period of 35 months. Demographic variables; related to vascular access and primary and secondary patency of all accesses were included. The Charlson Comorbidity Index was used to categorise diabetic patients according to comorbidities. Kaplan Meyer survival curves were used to contrast the impact of comorbidities on the different patency. Results 22 patients, mean age 68.36 ± 10.9 years, 68.18% male, 31.82% female, Charlson index with a median of 6.5 (5 - 8), 95.45% had a native fistula, with humero-cephalic location being more frequent (72.72%) and predominance of the left upper arm (68.18%). The time required to reach an event in both primary patency and secondary patency in diabetic patients was longer in patients with a Charlson index less than or equal to 7, this being statistically significant (Log Rank Test (Mantel-Cox): primary patency p=0.022 and secondary patency p=0.032). Conclusion The Charlson Comorbidity Index in our population is a significant factor in arteriovenous fistula survival.

Implication of lncRNA MSTRG.81401 in Hippocampal Pyroptosis Induced by P2X7 Receptor in Type 2 Diabetic Rats with Neuropathic Pain Combined with Depression.

Major depressive disorder (MDD) is a common complication of diabetes and is often observed alongside diabetic neuropathic pain (DNP) as a comorbidity in diabetic patients. Long non-coding RNA (lncRNA) plays an important role in various pathophysiological processes. The P2X7 receptor is responsible for triggering inflammatory responses, such as pyroptosis, linked to pain and depression. The aim of this study was to investigate the effect of lncRNA MSTRG.81401 on hippocampal pyroptosis induced by the P2X7 receptor in diabetic rats with DNP combined with MDD (DNP + MDD). Our results showed that the expression of lncRNA MSTRG.81401 was significantly elevated in the hippocampus of DNP + MDD rats compared with the control group. Following the administration of shRNA targeting lncRNA MSTRG.81401, a notable elevation in mechanical and thermal pain thresholds was observed in rats with comorbid DNP and MDD. Additionally, significant improvements in depression-like behaviors were evident in the open-field test (OFT), sucrose preference test (SPT), and forced swim test (FST). In the DNP + MDD rats, elevated levels in hippocampal P2X7 receptor mRNA and protein were observed, along with increased co-expression of P2X7 and the astrocytic marker glial fibrillary acidic protein (GFAP). Meanwhile, in DNP + MDD rats, the heightened mRNA expression of NOD-like receptor protein 3 (NLRP3), apoptosis-associated speck-like protein (ASC), pyroptosis-related protein Gasdermin D (GSDMD), caspase-1, IL-1β, IL-18, and TNF-α was detected, in addition to increased serum levels of IL-1β, IL-18 and TNF-α. After shRNA treatment with lncRNA MSTRG.81401, the above abnormal changes in indicators for pyroptosis and inflammation were improved. Therefore, our study demonstrates that shRNA of lncRNA MSTRG.81401 can alleviate the pain and depression-like behaviors in diabetic rats associated with the comorbidity of DNP and MDD by inhibiting the hippocampal P2X7 receptor-mediated pyroptosis pathway and pro-inflammatory responses. This suggests that the P2X7R/NLRP3/caspase-1 implicated pyroptosis and inflammatory scenario may serve as a potential target for the management of comorbid DNP and MDD in diabetes.

Depression in Diabetes: A Cross Sectional Survey among Patients Attending Diabetes Clinics

Background: Diabetes is a chronic disease that affects millions of people. Depression is reported to be a common comorbidity in diabetic patients. Depression in diabetic patients is associated with worse glycemic control, and increased risk of diabetes complications, including cardiovascular disease, neuropathy, and retinopathy Study design: It is a cross-sectional study conducted at Department of Medicine, Amna Inayat Medical College, Lahore for the duration of six months from April 2022 to September 2022. Material and Methods: The study included 150 diabetic patients who visited department of endocrinology and metabolism Services Hospital Lahore. There were 70 males and 80 females included in the study. 66 patients were in the range of 20-40 years and 84 were older than 40 years. 95 of them were illiterate while 55 were educated. Results: Total numbers of patients enrolled in this study were 150; among them 69 were type 1 diabetics while 81 had type 2 diabetes. Among type 1 diabetes 29 (42%) out of 69 patients were diagnosed with signs of depression whereas among type 2 diabetes the 40 (49%) patients were diagnosed with signs of clinical depression. It was found that there were 81 patients (54%) who were not diagnosed with any signs of clinical depression. Whereas 38 patients were suffering from mild form of depression. Conclusion: It was found that 46% of the diabetic patients suffered from depression. There were 54% diabetic patients that had no clinical signs of depression. There is a need to assess the signs of depression among diabetes patients. It can be an obstacle for the proper treatment of patient as such patients show non-adherence to their diabetes treatment because of poor mental health state. Keywords: Diabetes mellitus, depression and the blood glucose level

Type-1 diabetes mellitus down-regulated local cerebral glial fibrillary acidic protein expression in experimental toxoplasmosis.

Cerebral toxoplasmosis is an opportunistic infection, occurring mostly in immunosuppressed patients due to the reactivation of latent Toxoplasma cysts. The cerebral comorbidity in diabetic patients tends to intensify the burden of pathogenic infection within the brain. The aim of this work was to study the effect of cerebral toxoplasmosis in experimentally infected hyperglycemic mice, on histopathology and glial fibrillary acidic protein (GFAP) expression, compared to normoglycemic mice at different time intervals. Vasculopathy was exclusively observed in diabetic groups, with features of increased severity during Toxoplasma infection. Gliosis was observed in diabetic groups, while hyperactive astroglial activity was detected in normoglycemic groups, especially at 6weeks of infection. GFAP expression showed significant up-regulation in normoglycemic mice at 6weeks of infection (40.03 ± 1.41) afterwards, it decreased to 22.22 ± 3.14 at 12weeks which was statistically insignificant to the normal level, possibly indicating the successful Toxoplasma stage transformation (to bradyzoite), thereby limiting the infection within the brain. In hyperglycemic infected groups, GFAP was significantly down-regulated, in both acute and chronic phases of infection, most likely indicating failure of stage transformation and infection limitation. This may expose those vulnerable groups to the risk of dissemination, resulting in life-threatening diffuse encephalitis. The current study emphasized the importance of rapid diagnosis of Toxoplasma infection in diabetic subjects, and highlighted the value of using GFAP as a neurological indicator of disease progression in those comorbid cases.

Immunology of chronic low-grade inflammation: relationship with metabolic function.

Inflammation is part of the body's innate immune response and is an essential process that not only defends against harmful bacteria and pathogens but also plays a key role in the maintenance and repair of tissues. Under pathological conditions, there is bilateral crosstalk between immune regulation and aberrant metabolism resulting in persistent inflammation in the absence of infection. This phenomenon is referred to as sterile metabolic inflammation (metainflammation) and occurs if the initiating stimulus is not removed or if the resolution process is disrupted. Disruption of this tightly regulated immune response and its failure to resolve as is evident in metabolic disorders is not only associated with disease progression but also leads to immune senescence and should not be neglected in the clinical management of patients. This review gives an overview of the mechanisms underlying chronic metabolic inflammation, the aberrant metabolic activation of innate immune cells (neutrophils, macrophages, mast cells, dendritic cells), and its role in disease progression using obesity-diabetes as a prime example. Addressing the underlying subclinical metabolic inflammation in addition to achieving glucose control may contribute significantly towards therapeutic interventions aimed at preventing the onset of co-morbidities in diabetic patients.

Diabetic cardiomyopathy: An update on its pathophysiology with specific emphasis on epigenetics modifications besides treatment - A systematic review

Diabetes mellitus (DM) represents a significant lifestyle disease. Of the types of DM, type 2 DM aids maximum in the development of cardiovascular disease (CVD) along with diabetic cardiomyopathy (DbCM), which is correlated with significant mortality along with comorbidity in diabetic patients. DbCM is a non-canonical cardiac illness that exhibits cardiac remodelling occurs when there is DM but not when there is any concomitant conditions like hypertension, valve disease, or coronary artery disease (CAD). DbCM is linked to altered mitochondrial structure and function, as well as aberrant cardiac metabolism. Additional physiological and pathological signaling mechanisms include inflammation, oxidative stress (OS), and others; besides, in the diabetic environment, there are various cardiomyopathy-inducing factors such as reactive oxygen species (ROS)-modulated OS, hyperglycemic situations, cytokines-modulated These mediators induce inflammatory responses, cell death, including apoptosis, pyroptosis, and autophagy, as well as the epigenetic control of abnormal molecular pathways. The last 10-years have demonstrated the importance of miRNAs and long non-coding RNAs (lncRNAs) in controlling key biological processes such cell death, mitochondrial dysfunction, and electrical remodelling. Cardiomyopathy is a significant event regarding cardiac remodeling event in DbCM. Considerable proof exists regarding the part of epigenetics in diabetic correlated cell demise. Epigenetic controlling modes like histone alterations, DNA methylation, and miRNA along with lncRNAs control cardiac cell demise in the diabetic environment. Akin to that, other modes such as mitochondrial impairment and OS are controlled by miRNA along with lncRNAs. Finding these modes has given provision of generation of innovative therapy approaches for DbCM. miRNAs along with lncRNAs have illustrated translational capacity in the form of Besides treatment options, There are other DbCM-specific diagnostic and prognostic biomarkers available. HDACs were further shown to have a crucial role in controlling the pathogenesis of DbCM.

Prevalence of Depression among Patients of Type 2 Diabetes Mellitus without Overt Complications and Its Association with Glycemic Control in a Tertiary Care Center in India – A Cross-sectional Study

Abstract Background: The prevalence of type 2 diabetes is on the rise worldwide posing a serious threat to public health. In India, it has increased from 3.3% to 19% in urban and 2.4% to 15% in rural areas from 1972 to 2019. Depression is a major contributor to disability-adjusted life years (DALYs) and common comorbidity in diabetic patients. Studies show a bidirectional relationship between depression and diabetes. However, there is a dearth of evidence on the relationship between depressive symptoms and diabetes mellitus. Aim: This study aims to estimate the occurrence of depression in type 2 diabetic patients and to find the association between depression and glycemic control in a tertiary care center in Tamil Nadu, India. Materials and Methods: A cross-sectional study was done among type 2 diabetes mellitus patients of 18–65 years of age. Hemoglobin A1C levels were collected, and the Patient Health Questionnaire-9 (PHQ-9) was administered for screening depression. If PHQ ≥10, the Mini-international Neuropsychiatric Interview (MINI) was done to confirm the diagnosis of depression. The severity was assessed using the Hamilton Depression Rating Scale, and the Diabetes Self-Management Questionnaire was used to assess their self-management behaviors. Results: One hundred and fourteen patients (male = 36, female = 78) were screened for depression, and the diagnosis was confirmed with MINI. Twenty-six patients scored ≥10 scores, of which 8 (7%) met the criteria for moderate depression and 18 (15.8%) for mild depression. Eighty-eight (77.2%) had no depression. The characteristics significantly associated with depression were female gender, poor glycemic control, and systemic hypertension. Conclusion: There are clear evidence in the literature for an increased prevalence of depression in diabetic patients resulting in poorer prognosis. This study demonstrated the association of poor glycemic control with depression. Early diagnosis and multidisciplinary treatment approach addressing both disorders would help improve the global health burden by reducing mortality and DALYs.

Diabetic Cardiomyopathy: An Update on Its Pathophysiology With Specific Emphasis on Epigenetics Modifications Besides Treatment – A Systematic Review

Diabetes mellitus (DM) represents a significant lifestyle disease. Of the types of DM, type 2 DM aids maximum in the development of cardiovascular disease (CVD) along with diabetic cardiomyopathy (DbCM), which is correlated with significant mortality along with comorbidity in diabetic patients. DbCM is a non-canonical cardiac illness that exhibits cardiac remodelling occurs when there is DM but not when there is any concomitant conditions like hypertension, valve disease, or coronary artery disease (CAD). DbCM is linked to altered mitochondrial structure and function, as well as aberrant cardiac metabolism. Additional physiological and pathological signaling mechanisms include inflammation, oxidative stress (OS), and others; besides, in the diabetic environment, there are various cardiomyopathy-inducing factors such as reactive oxygen species (ROS)-modulated OS, hyperglycemic situations, cytokines-modulated These mediators induce inflammatory responses, cell death, including apoptosis, pyroptosis, and autophagy, as well as the epigenetic control of abnormal molecular pathways. The last ten years have demonstrated the importance of miRNAs and long noncoding RNAs (lncRNAs) in controlling key biological processes such cell death, mitochondrial dysfunction, and electrical remodelling. Cardiomyopathy is a significant event regarding cardiac remodeling event in DbCM. Considerable proof exists regarding the part of epigenetics in diabetic correlated cell demise. Epigenetic controlling modes like histone alterations, DNA methylation, and miRNA along with lncRNAs control cardiac cell demise in the diabetic environment. Akin to that, other modes such as mitochondrial impairment and OS are controlled by miRNA along with lncRNAs. Finding these modes has given provision of generation of innovative therapy approaches for DbCM. miRNAs along with lncRNAs have illustrated translational capacity in the form of Besides treatment options, There are other DbCM-specific diagnostic and prognostic biomarkers available. HDACs were further shown to have a crucial role in controlling the pathogenesis of DbCM.

Evaluation of Levels of Urea and Creatinine, Comorbidity and Socioeconomic Status in Diabetic Patients

Nephropathy occurs in 10±40% of patients who have Type I (insulin-dependent) diabetes mellitus [1±3]. The development of diabetic nephropathy cannot be explained by poor glycaemic control alone. Objectives: To determine the frequency, association of diabetes with gender, correlation of diabetes duration with urea and creatinine, co morbidity, socioeconomic status renal disease in diabetic patients. Methods: The study was carried out in Mayo Hospital. A total of 100 patients were included in this study from 1st November 2019 to 31st January 2020. Blood samples were collected from diabetic people for chemical analysis to determine the protein and Urea Creatinine Ratio (UCR). RFTs was done to calculate the urea/creatinine values and their ratios. Statistical analysis was performed by using SPSS software version 13. Results: The ratio of male and female diabetic patients was 60:40. Mean age of male diabetic patients was 53.67 years and of female diabetic patients was 50.42 years. Frequency of renal diseases in diabetic patients was 55%. A significant p-value was obtained from the correlation of duration of diabetes (yrs) with urea and creatinine (mg%). Frequency of co-morbidity in all diabetic patients was measured and the highest frequency was of heart diseases. Conclusions: We conclude that diabetes is the single main and leading cause of renal diseases. It is clear that diabetic kidney disease is becoming a problem in Pakistan. As long as the duration of diabetes increases there will be more chances of renal disease so the proper diagnose at time and management is very necessary.

Incremental Healthcare Resource Utilization and Expenditures Associated with Cardiovascular Diseases in Patients with Diabetes: A Cross-Sectional Study.

Background: Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients.Methods: In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively.Results: A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non-CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all P<0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all P<0.001).Conclusion: CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients.

Burden of comorbidities among diabetic patients in Latur, India

BackgroundDiabetes ailment is a route of the multi-morbidity's ailments. In Maharashtra state, Latur district have a higher proportion of diabetics. According to DLHS-4 (2012-013) and NFHS-4 (2015-016) blood sugar >140 mg/dl is around 14% and 17% respectively in Latur. Hence, study was undertaken to find out the burden of comorbidities among diabetes persons and its determinants. Materials and methodsThis study used house listing method for self-reported diabetic person. Multistage stratified sampling technique was used to collect data. Two sub-divisions have selected in Latur districts. Three villages and three CEB randomly selected based on prevalence of diabetes among social strata in each sub-division of Latur. Furthermore, data was collected from 505 self-reported diabetic patients of 413 household during May to October 2017 and analysed by bivariate and multivariate techniques. ResultsThe prevalence of major comorbidities was blood pressure (28.5%), cardiovascular diseases (19.5%), retinopathy (21.8%) and rheumatism (24.4%). Health risk factors were blood sugar level, overweight, substance use and non-exercised, which shown more likely to develop the morbidities among diabetic patients. ConclusionsIncrease of number of comorbidities in diabetic patients indicates lack of awareness of causes and consequences of diabetes. Hence, there is needs awareness program about diabetes prevention and management through health education, disease management programmes, trained peers, community health workers and community-based programmes.

Dose-response effect of prebiotic ingestion (\u03b2-glucans isolated from Saccharomyces cerevisiae) in diabetic rats with periodontal disease

BackgroundPeriodontal disease is one of the most frequent comorbidities in diabetic patients and can contribute to poor blood glucose control.ObjectiveTo evaluate the effects of ingesting different doses of beta-glucans (BG) isolated from Saccharomyces cerevisiae on alveolar bone loss (ABL) and inflammatory/metabolic parameters in normal and diabetic rats with ligature-induced periodontal disease (PD).DesignSixty male rats were assigned into two groups: non-diabetic or diabetic (i.p. 70 mg/kg streptozotocin) with PD. Then, groups were subdivided into five subgroups according BG doses: 0 mg/Kg; 10 mg/Kg; 20 mg/Kg; 40 mg/Kg or 80 mg/Kg. Animals received BG for 28 days and ligatures were placed on lower first molars during the last 14 days.ResultsABL of diabetic and non-diabetic animals receiving BG 40 mg/kg (1.33 ± 0.03 mm and 0.77 ± 0.07 mm, respectively) and 80 mg/kg (1.26 ± 0.07 mm and 0.78 ± 0.05 mm, respectively) doses was lower (p < 0.05) in comparison to respective controls (1.59 ± 0.11 mm and 0.90 mm ±0.08). COX-2 (Control: 1.66 ± 0.12; 40 mg/kg: 1.13 ± 0.07; 80 mg/kg: 0.92 ± 0.18) and RANKL expressions (Control: 1.74 ± 0.34; 40 mg/kg: 1.03 ± 0.29 ;80 mg/kg: 0.75 ± 0.21), together with the RANKL/OPG ratio (Control: 1.17 ± 0.08; 40 mg/kg: 0.67 ± 0.09; 80 mg/kg: 0.63 ± 0.28) were attenuated above the same dose (p < 0.05). BG did not influence (p > 0.05) metabolic parameters in non-diabetic rats. In diabetic animals, doses above 40 mg/kg reduced IL-1β (Control: 387 ± 66; 40 mg/kg: 309 ± 27; 80 mg/kg: 300 ± 14) and TNF-α (Control: 229 ± 19; 40 mg/kg: 128 ± 53; 80 mg/kg: 71 ± 25), blood glucose levels (Control: 402 ± 49; 40 mg/kg: 334 ± 32; 80 mg/kg: 287 ± 56), total cholesterol (Control: 124 ± 8; 40 mg/kg: 120 ± 10; 80 mg/kg: 108 ± 9), LDL-c + VLDL-c (Control: 106 ± 8; 40 mg/kg: 103 ± 10; 80 mg/kg: 87 ± 10) and triacylglycerols (Control: 508 ± 90; 40 mg/kg: 301 ± 40; 80 mg/kg: 208 ± 61), whereas increased HDL-c (Control: 18 ± 0.5; 40 mg/kg: 19 ± 1; 80 mg/kg: 21 ± 1) (p < 0.05). Optimal dose needed to reduce ABL was higher in diabetic animals with PD.ConclusionsBG ingestion reduced ABL and improved inflammatory profile in a dose-dependent manner. Best effects were achieved with doses above 40 mg/kg.

COVID-19 Severity and Comorbidities in Diabetic Patients

Background: This study aimed to investigate the demographic factors, comorbidities, and laboratory results of diabetic patients with coronavirus disease 2019 (COVID-19) severity. Materials and Methods: This cross-sectional study enrolled 171 diabetic patients with COVID-19 admitted based on chest CT scan findings to the COVID-19 ward of Shahid Mohammadi Hospital in Hormozgan, Iran from 1 March to 1 June, 2020. Reverse-transcriptase polymerase chain reaction (RT-PCR) test was performed, and the patients were divided into three groups (mild, moderate, and severe) based on the severity of disease. Then we investigated the demographic factors, comorbidities, and laboratory results of diabetic patients with severe COVID-19 severity. Results: Regarding comorbidities, there was no significant difference between the three groups. Moreover, there was a significantly lower lymphocyte count in the severe group compared to moderate and mild groups (P = 0.001). We showed the increase in blood urea nitrogen (BUN) and creatinine to be significantly associated with increased disease severity (P = 0.001 and P = 0.009, respectively). We also showed a significant difference in aspartate aminotransferase (AST) levels between different groups of patients (P = 0.002) with a higher level of AST in the severe group (P = 0.020). Lactate dehydrogenase (LDH) and troponin were also significantly associated with an increase in COVID-19 severity in patients with diabetes (P = 0.013 and P = 0.002, respectively). Conclusion: There was a significant association between disease severity and BUN, creatinine, AST, LDH, and troponin levels in diabetic patients with COVID-19. There was no significant association between different groups regarding severity of disease and comorbidities.

Bixin attenuates mechanical allodynia, anxious and depressive-like behaviors associated with experimental diabetes counteracting oxidative stress and glycated hemoglobin

Neuropathic pain, depression, and anxiety are common comorbidities in diabetic patients, whose pathophysiology involves hyperglycemia-induced increased oxidative stress. Bixin (BIX), an apocarotenoid extracted from the seeds of Bixa orellana, has been used in traditional medicine to treat diabetes and has been recognized by its antioxidant profile. We aimed to investigate the effect of the BIX over the mechanical allodynia, depressive, and anxious-like behaviors associated with experimental diabetes, along with its involved mechanisms. Streptozotocin-induced diabetic rats were treated for 17 days (starting 14 days after diabetes induction) with the corresponding vehicle, BIX (10, 30 or 90 mg/kg; p.o), or INS (6 IU; s.c.). Mechanical allodynia, depressive, and anxious-like behavior were assessed by electronic Von Frey, forced swimming, and elevated plus-maze tests, respectively. Locomotor activity was assessed by the open field test. Blood glycated hemoglobin (HbA1) and the levels of lipid peroxidation (LPO) and reduced glutathione (GSH) were evaluated on the hippocampus, pre-frontal cortex, lumbar spinal cord, and sciatic nerve. Diabetic animals developed mechanical allodynia, depressive and anxious-like behavior, increased plasma HbA1, increased LPO, and decreased GSH levels in tissues analyzed. Repeated BIX-treatment (at all tested doses) significantly attenuated mechanical allodynia, the depressive (30 and 90 mg/kg) and, anxious-like behaviors (all doses) in diabetic rats, without changing the locomotor performance. BIX (at all tested doses) restored the oxidative parameters in tissues analyzed and reduced the plasma HbA1. Thereby, bixin may represent an alternative for the treatment of comorbidities associated with diabetes, counteracting oxidative stress and plasma HbA1.

Growth Differentiation Factor 15 As a Composite Diabetic Cardiovascular Disease Indicator Including Heart Failure: A Systematic Review and Meta-Analysis

Introduction Recent studies suggested that growth differentiation factor 15 (GDF-15) may indicate heart failure and a constellation of cardiovascular co-morbidities in diabetic patients. Whereas N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) is a cardiac-specific biomarker, GDF-15 is non-tissue-specific and may be a useful marker of global cardiovascular disease (CVD) burden, particularly in diabetes. In this systematic review and meta-analysis, we summarized the effects of elevated GDF-15 on the composite outcome of cardiovascular disease, events, and/or death in diabetic patients. Methods MEDLINE, EMBASE, CINAHL and Cochrane Library were queried for articles published from inception until February 2020. Longitudinal studies that reported data about the relationship between GDF-15 levels and CVD outcomes in diabetic patients were included. Pooled hazard ratios (HRs) for mortality were calculated and presented with 95% confidence intervals (CIs). Prespecified I2 threshold values of 25%, 50%, and 75% were used to indicate low, moderate, and high levels of heterogeneity, respectively. The risk of bias in the included studies was evaluated according to the criteria established by the Cochrane collaboration. Publication bias was assessed using funnel plot analysis. Results Seven studies with a total 15,805 diabetic patients were included (Fig. 1). The median follow-up ranged from 1.5 to 7.9 years. Pooled effect estimate suggested that elevated GDF-15 levels at baseline was associated with an increased risk for composite CVD-related outcome(s) (per standard deviation (SD) increase in log(GDF-15): HR 1.26, 95% CI 1.12-1.42, P = 0.0001, I2 for heterogeneity 85%, n = 15,651 patients) (Fig. 2a). When an unadjusted study was excluded, the pooled effect estimate remained statistically significant, with improvement in heterogeneity (per SD increase in log(GDF-15): HR 1.16, 95% CI 1.11-1.20, P Conclusion Findings from this systematic review and meta-analysis suggest that elevated GDF-15 levels are associated with increased risk for incident cardiovascular endpoint(s) including acute cardiovascular events, heart failure and/or all-cause death in diabetic patients.

Two-weeks treatment with cannabidiol improves biophysical and behavioral deficits associated with experimental type-1 diabetes

The prevalence rates of depression and anxiety are at least two times higher in diabetic patients, increasing morbidity and mortality. Cannabidiol (CBD) has been identified as a therapeutic agent viable to treat diverse psychiatric disorders. Thus, this study aimed to investigate the effect of CBD treatment (once a day for 14 days starting two weeks after diabetes induction; at doses of 0, 3, 10 or 30 mg/kg, i.p.) on depression- and anxiety-like behaviors associated with experimental diabetes induced by streptozotocin (60 mg/kg; i.p.) in rats. Levels of plasma insulin, blood glucose, and weight gain were evaluated in all experimental groups, including a positive control group treated with imipramine. The rats were tested in the modified forced swimming test (mFST) and elevated plus maze (EPM) test. Besides, the levels of serotonin (5-HT), noradrenaline (NA) and dopamine (DA) in two emotion-related brain regions, the prefrontal cortex (PFC) and hippocampus (HIP) were evaluated using high-pressure liquid chromatography. Our results showed that CBD treatment (only at the higher dose of 30 mg/kg) reduced the exaggerated depressive- and anxiogenic-like behaviors of diabetic (DBT) rats, which may be associated with altered 5-HT, NA and/or DA levels observed in the PFC and HIP. Treatment with CBD (higher dose) also induced a significant increase in weight gain and the insulin levels (and consequently reduced glycemia) in DBT rats. The long-term CBD effects gave rise to novel therapeutic strategies to limit the physiological and neurobehavioral deficits in DBT rats. This approach provided evidence that CBD can be useful for treating psychiatry comorbidities in diabetic patients.

Glifozines and cardiorenal outcomes.

Diabetes mellitus, with its complications, is one of the major health problems in economically developed countries and its prevalence is constantly increasing. Kidneys and heart involvement represent main comorbidities in diabetic patients often leading to organ failure. The treatments available until a few years ago are often associated with hypoglycemia, weight gain, gastro-intestinal disorders and other side effects together with serious adverse effects on renal function. The new frontiers of diabetic cardionephropathy treatment are mainly focused on delay of heart and renal failure both on diabetic and nondiabetic patients ad it was shown by last data reports. In the following review, we will focus on Gliflozins, one of the newest classes of hypoglycemic drugs that have shown to hold peculiar pharmacological properties in managing cardiac and renal complications.

Prevalence of obesity among type 2 diabetes mellitus patients in urban areas of Belagavi

BACKGROUND: Diabetes is a major disease burden in India, and we are home to the second largest number of diabetes cases in the world with currently over 72 million cases of diabetes. The reported prevalence of obesity in type 2 diabetes mellitus (T2DM) was 60%–90%. Obesity and overweight pose a major risk for chronic diseases and are considered to be a strong risk factor for the development of T2DM. AIMS: The aim of the study was to determine the prevalence of obesity among T2DM patients. MATERIALS AND METHODS: This community-based cross-sectional study was conducted among T2DM patients residing in areas under Ashok Nagar and Rukmini Nagar Urban Health Centres, Belagavi. Three hundred and eighty T2DM patients were included in the study over a period of 1 year (January 1–December 31, 2017). Predesigned and pretested questionnaire was used to collect sociodemographic profile, and patient's height and weight were measured, and body mass index (BMI) was calculated and categorized based on Asian population. STATISTICAL ANALYSIS USED: Statistical analysis was done using the Chi-square test for categorical variables. P RESULTS: The prevalence of generalized obesity (GO), abdominal obesity (AO), and combined obesity (CO) among T2DM patients were 58.68%, 81.84%, and 53.42%, respectively. Multiple logistic regression analysis showed that female gender and hypertension were significantly associated with GO, AO, and CO. Physical inactivity and hyperglycemic state were significantly associated with AO and CO but not with GO. The duration of T2DM was significantly associated with AO but not with GO and CO. CONCLUSIONS: Our study concluded that obesity is a highly prevalent comorbidity in diabetic patients. AO appears to be a better indicator of diabetic risk than BMI. The combination of a low-calorie diet, increased physical activity, and behavioral therapy as the first-line intervention for weight loss should be stressed for the effective management of T2DM.

Prevalence of psychiatric comorbidities in diabetic patients who are candidates for therapy with SGLT2 inhibitors: clinical and metabolic characteristics

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Prevalence and association of co-morbidities in diabetic patients along with prescription patterns in Delhi-NCT, India

BackgroundDiabetes is rising at an alarming rate in India and the national capital forms a significant part of the nation's diabetic population. The metabolic disorder is no more a disease specific to the rich countries but has also markedly spread its roots in middle-income countries. ObjectiveTo ascertain the prevalence of associated co-morbidities in the diabetic population of Delhi, a metropolitan city in India. Moreover, this study was conducted to help with adding information to the limited shreds of evidence of diabetes prevalence in Delhi along with the usually preferred therapies. Materials and methodsA cross-sectional, observational, survey-based study was conducted on people (n = 798) of different age groups (18 years and above) belonging to different regions of Delhi. All subjects were enrolled after obtaining oral consent. Detailed information about clinical, demographic and metabolic profiles was obtained with the help of a pre-structured, open-ended questionnaire. The data were analyzed, and the correlation between diabetes and several other fields was drawn. ResultsOut of the 798 diabetic patients 458 (57.39%) were males and 340 (42.60%) were females. The presence of diabetes was higher in the age group of 50–60 years irrespective of the gender. Co-morbidities54.13% of patients suffered with additional co-morbidities which is significantly high. The associated co-morbidities found in the survey included Hypertension, Hypothyroidism, Dyslipidemia, Obesity, Coronary Artery Diseases etc. About 30.57% of patients suffered from hypertension making it the most commonly associated co-morbidity. The other diseases included hypothyroidism (11.52%), Dyslipidemia (10.27%), Obesity (9.27%) etc. MedicationMajority of patients i.e about 60.65% received oral hypoglycemic agents (including patients receiving both insulin and oral hypoglycemic agents). About 19.92% of patients were prescribed with insulin. 14.16% of patients were found to be following diet control and yoga with about 3.13% more females the males. A small percentage of patients (5.25%) were also following alternative systems (Ayurvedic/Unani/Homeopathic) of treatment. Overall, amongst oral hypoglycemic agents, the combination of metformin and DPP4 inhibitors (Vildagliptin, Sitagliptin) was being prescribed majorly i.e 16.41%. ConclusionThe number of diabetic population is high in Delhi. It was evident that a significant percentage of diabetic patients suffered from additional diseases that may lead to worsening of the health conditions. Thus, there is an urgent need to educate and spread awareness amongst the masses about the potential benefits of lifestyle modifications like the incorporation of a healthy diet and physical activities. Additionally, continuous and regular tests should be taken to avoid further complications.