Complications In Type 2 Diabetes Mellitus Patients Research Articles

Neutrophil/lymphocyte ratio and its association with cardiometabolic profile and prevalent chronic complications in type 2 diabetic patients in Douala General Hospital

Introduction: Neutrophil/lymphocyte ratio (NLR) is a simple and affordable marker of subclinical inflammation, reported to be associated with cardiac and non-cardiac disorders. We compared the distribution of NLR in type 2 diabetes mellitus (T2DM) patients and healthy subjects and assessed the association of NLR with glucose control, cardiometabolic parameters and prevalent chronic diabetic complications in T2DM patients receiving care at a tertiary health facility in Cameroon.

Hamilton rating scale for depression-24 (HAM-D24) as a novel predictor for diabetic microvascular complications in type 2 diabetes mellitus patients

The study was designed to investigate whether the hamilton rating scale for depression (24-items) (HAM-D24) can be used to predict the diabetic microvascular complications in type 2 diabetes mellitus (T2DM) patients. 288 hospitalized patients with T2DM were enrolled. Their diabetic microvascular complications including diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy and diabetic foot as well as demographic, clinical data, blood samples and echocardiography were documented. All the enrolled patients received HAM-D24 evaluation. The HAM-D24 score and incidence of depression in T2DM patients with each diabetic microvascular complication were significantly higher than those in T2DM patients without each diabetic microvascular complication. After the adjustment of use of insulin and hypoglycemic drug, duration of T2DM, mean platelet volume, creatinine, albumin, fasting glucose, glycosylated hemoglobin type A1C, left ventricular ejection fraction, respectively, HAM-D24 score was still significantly associated with diabetic microvascular complications (OR = 1.188–1.281, all P < 0.001). The AUC of HAM-D24 score for the prediction of diabetic microvascular complication was 0.832 (0.761–0.902). 15 points of HAM-D24 score was considered as the optimal cutoff with the sensitivity of 0.778 and specificity of 0.785. In summary, HAM-D24 score may be used as a novel predictor of diabetic microvascular complications in T2DM patients.

EFFICIENCY AND SAFETY OF THE ORAL HYPOGLYCAEMIC AGENTS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CARDIOVASCULAR DISEASES

Сахарный диабет является важной проблемой здравоохранения во всех странах мира. Наличие сахарного диабета 2-го типа (СД2) способствует развитию атеросклероза и повышает риск сердечно-сосудистых осложнений (ССО). Коррекция уровня гликемии служит важнейшим условием профилактики сосудистых осложнений у больных СД2. Возможности снижения риска ССО на фоне терапии пероральными сахароснижающими препаратами продолжают изучаться. В этом отношении перспективны представители инновационных классов пероральных сахароснижающих препаратов, в том числе ингибиторы дипептидилпептидазы-4.

Association of Traditional Chinese Medicine Therapy and the Risk of Vascular Complications in Patients With Type II Diabetes Mellitus: A Nationwide, Retrospective, Taiwanese-Registry, Cohort Study.

With an increasing use of traditional Chinese medicine (TCM) in type 2 diabetes mellitus (T2DM), evidence of long-term benefit with adjunctive TCM treatment is limited. This study investigated whether the concurrent TCM treatment reduces the risk of vascular complications in T2DM patients by using a large population from National Health Insurance Research Database (NHIRD).We identified 33,457 adult patients with newly diagnosed T2DM using anti-diabetic agents from a random sample of one million beneficiaries in the NHIRD between January 1, 2000 and December 31, 2011. We recruited 1049 TCM users (received TCM over 30 days with a diagnosis of T2DM) and randomly selected 4092 controls as the non-TCM cohort at a ratio of 1:4 frequency-matched by age, sex, hypertension, hyperlipidemia, and index year. We investigated the prescription pattern of TCM and conducted a Cox proportional hazards regression to calculate the hazard ratios (HRs) of stroke, chronic kidney diseases (CKD), and diabetic foot between the 2 cohorts.In the TCM cohort, the prescription pattern of TCM was different between insulin and noninsulin patients. The most common herbs were Dan-Shen (Radix Salviae Miltiorrhizae) in noninsulin group and Da-Huang (Radix et Rhizoma Rhei) in insulin group. The most common formulae were Liu-Wei-Di-Huang-Wan in noninsulin group and Yu-Quan-Wan in insulin group. Although no significant reduction in the hazard ratio of CKD and diabetic foot, the incidence rate of stroke was 7.19 per 1000 person-years in the TCM cohort and 10.66 per 1000 person-years in the control cohort, respectively. After adjustment of age, sex, hypertension, hyperlipidemia, and antidiabetes agent use (including sulfonylureas, α-glucosidase, metformin, meglitinide, thiazolidinediones, and insulin), TCM cohorts were found to have a 33% decreased risk of stroke (95% CI = 0.46–0.97; P < 0.05).This population-based retrospective study showed that the complementary TCM therapy might associate with the decreased risk of stroke in T2DM, suggesting TCM as an adjunctive therapy for T2DM to prevent subsequent stroke.

Diagnostic utility of BNP, corin and furin as biomarkers for cardiovascular complications in type 2 diabetes mellitus patients

Context: The number of patients with type 2 diabetes mellitus (T2DM) is progressively increasing, and diabetic cardiovascular complications have become a public health problem. Brain or B-type natriuretic peptide (BNP) is a cardiac hormone synthesized as a pre-pro-peptide. pro-BNP is produced by cleaving the signal peptide then two proprotein convertases, corin and furin cleave pro-BNP to form a biologically active hormone. Two corin single nucleotide polymorphisms (SNPs) have been reported to alter corin protein conformation and impair its biological activity.Objective: We aimed to investigate the potential role of corin and furin in comparison to BNP as biomarkers for predicting cardiovascular complications in T2DM patients. The association of corin gene SNPs with corin levels was also examined.Methods: Seventy-five subjects were recruited in this study, including 25 T2DM patients with complications, 25 T2DM patients without complications as well as 25 healthy subjects. Plasma BNP, corin and furin levels were measured using enzyme-linked immunosorbent assays. Two corin SNPs were genotyped using allele specific oligonucleotide-polymerase chain reaction.Results: Both furin and BNP were found to be more sensitive than corin (80% versus 56%, p = 0.008), whereas furin showed higher specificity when compared to BNP (96% versus 84%, p = 0.041) and corin (96% versus 64%, p < 0.0001) in predicting cardiovascular complications in T2DM patients. Corin SNPs are not associated with corin levels, neither in the entire study cohort nor in the subgroup of T2DM patients with cardiovascular complications (p > 0.05).Conclusions: Furin may be useful, either alone or in combination with other biomarkers, for cardiovascular risk stratification assessment in T2DM patients.

The MCP-1 Gene A-2518G Polymorphism Confers an Increased Risk of Vascular Complications in Type 2 Diabetes Mellitus Patients

We aimed to evaluate the correlation of the monocyte chemoattractant protein 1 (MCP-1) A-2518G polymorphism with type 2 diabetes mellitus (T2DM) and vascular complications in T2DM, to aid in understanding its role in pathogenesis. A total of 150 T2DM patients and 50 healthy controls (group A) were enrolled. The T2DM patients were divided into three groups based on the absence of complications (group B) presence of microvascular disease (group C) or macrovascular disease (group D). DNA of all enrolled subjects was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for the MCP-1 A-2518G polymorphism. Serum MCP-1 levels were measured by an enzyme-linked immunosorbent assay (ELISA). Participants in group D had increased serum MCP-1 levels relative to group B, group C, and group A (all p<0.01). Compared with group A, the frequencies of the MCP-1 A-2518G G/G genotype and G allele were significantly higher in group C and group D (all p<0.05). In contrast to group B, group C had higher frequencies of the G/G genotype and G allele, while group D had higher G allele frequencies (all p<0.05). Logistic regression analysis showed that lower body-mass index (BMI) and free cholesterol (FC), as well as higher high-density lipoprotein cholesterol (HDL-C) levels may be the protective factors for T2DM, while higher levels of triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and G/G genotype frequency were independent risk factors for T2DM. Our data indicates a correlation between the MCP-1 A-2518G polymorphism with macrovascular complications in T2DM patients; lower BMI and FC, as well as higher HDL-C levels may be the protective factors for T2DM, while higher levels of TG, LDL-C, and G/G genotype frequency were independent risk factors for T2DM.

Achievement of partial combined control of major diabetes targets in primary care correlates with development of chronic complications in T2DM patients—A real life data

AimsStrict long term glucose, cholesterol and blood pressure control is advocated in type 2 Diabetes Mellitus (T2DM) patients. It is not known whether combined partial goals’ achievement affects development of chronic complications. MethodsWe evaluated the relative ability or failure of 5369 T2DM ambulatory patients to achieve and maintain control of blood pressure, glycaemia and cholesterol for 3 consecutive years. Correlation between the extent of combined goal achievement, and development of chronic complications was determined. ResultsOnly 9 patients (0.17%) fully achieved and none completely failed to achieve all strict goals. Therefore, patients were characterized as either partial achievers (PA) (n=699) or partial non achievers (PNA) (n=322). As compared to PA patients, PNA patients were significantly younger, single, and demonstrated a higher female and Arab ethnicity dominance. PNA patients had higher BMI, received more insulin treatment and consumed more hospital services. The incidence of microvascular complications during 3 years was significantly increased in PNA patients. ConclusionsA negligible number of primary care patients completely and persistently achieve or fail to achieve combined control of major diabetes targets. Partial achievement of these targets correlates with specific patients’ characteristics and incidence of chronic micro-vascular complications.

Effects of different nutrition intervention on alimentary tract reconstruction in knowledge and practice nutrition and efficacies of patients with type 2 diabetes mellitus

A total of 206 patients of type 2 diabetes mellitus (T2DM) were assigned into the trial group (n=156) and the control group (n=50) according to whether real object-based diabetic diet was provided. Traditional nutritional education for both groups during hospitalization. The patients in the trial group received a real object-based diabetic diet guided by a nutritionist who adjusted feeding regimens and skills before and after operation. The control group had a free access to a normal diet. The patient understanding of knowledge, attitude and practice (KAP) was examined by nutrition surveys. And their postoperative nutrition states and complications were assessed by questionnaires during a 6-month follow-up. The total average score of cognitive divided was 93.4±7.5, the average score of diet therapy knowledge 13.8±1.6 and the average scores of attitude and practice 9.6±1.9 and 32.2±3.9. Significant differences existed between two groups (P<0.05). The incidence rates of hypoglycemia, hyperglycemia and gastrointestinal obstruction were lower than the control group (P<0.05, P<0.01). It suggested that real object-based diabetic diet guidance plus traditional nutrition education could improve the KAP level and may lower the incidence of postoperative complications in T2DM patients with gastric bypass. Key words: Diet therapy; Diabetes mellitus, type 2

Macrovascular complication phenotypes in type 2 diabetic patients

BackgroundMacrovascular diseases (MVD) in type 2 diabetes mellitus (T2DM) are often considered all together, without discriminating the areas involved. The aim of our study was to analyse MVD prevalence in a large population of T2DM patients by dividing the cases into subgroups according to MVD sites (NMVD, no MVD; NSCS, non-significant carotid stenosis; CBVD, cerebrovascular disease; CAD, coronary artery disease; PAD, peripheral artery disease; PVD, polyvascular disease) and studying the anthropometric, clinical and laboratory parameters in each group.MethodsA diabetic outpatient cohort (n = 1199) was retrospectively studied. Demographic, clinical and laboratory parameters were included in analyses. A thorough cardiovascular history as documented by previous medical records (including medical and hospital records) and vascular laboratory studies (including standardised electrocardiogram, echocardiogram, provocative tests for cardiac ischaemia, ankle/brachial index, duplex ultrasonography of the carotid and lower limbs and, in selected cases, computed tomography angiography, carotid and peripheral arteriography and evaluation of transcutaneous oxygen pressure), was collected for all of the patients. Standardised procedures were used to assess microvascular complications as well as metabolic syndrome (Mets).ResultsThe unadjusted MVD prevalence was 46.4% among the participants. The majority of patients with MVD were in the PVD group. In the multivariate analysis, age, male sex and diabetes duration were independent risk factors for PAD and PVD (P < 0.01). A low HDL-C value was an independent risk factor in the CAD and PVD groups (P = 0.03). Very high frequencies of MetS were observed in the PAD and PVD groups (94.9 and 95.7% respectively). The most MetS diagnostic criteria were recorded among members of the CAD group (all or all-1 criteria were present in 73% of patients). The average age in the CAD group (64.5 y) was comparable to that of the NMVD group. Microvascular complications were more frequent in the PAD and PVD patients.ConclusionPhenotypic heterogeneity is associated with different macrovascular complications in T2DM patients. These findings might have clinical implications for developing diagnostic and therapeutic strategies targeting type 2 diabetes.

Arterial Wall Elasticity Measured Using the Phased Tracking Method and Atherosclerotic Risk Factors in Patients with Type 2 Diabetes

The aim of this study was to investigate the relationship between atherosclerotic manifestations and brachial and radial arterial wall elasticity (AWE) measured using the phased tracking method in patients with type 2 diabetes mellitus (T2DM). This study included T2DM patients (n= 220, mean age 59 years) without a history of stroke or coronary artery disease. The brachial AWE, radial AWE, carotid mean intima-media thickness (IMT), max-IMT and flow-mediated vasodilation (FMD) were measured. The patients were classified according to the number of atherosclerotic risk factors, including obesity, dyslipidemia and hypertension. Group 1 included T2DM patients only, group 2 included patients with two risk factors, group 3 included patients with three risk factors and group 4 included patients with four risk factors. The patients were also divided into two groups according to microangiopathic complications, including retinopathy and nephropathy. The between-group differences were analyzed. The brachial AWE (548, 697, 755 and 771 kPa for groups 1, 2, 3 and 4, respectively) and radial AWE (532, 637, 717 and 782 kPa for groups 1, 2, 3 and 4, respectively) significantly increased in association with an increasing number of risk factors. The brachial AWE and radial AWE were significantly higher in the patients with microangiopathic complications than in those without microangiopathic complications (brachial AWE 797 and 694 kPa and radial AWE 780 and 660 kPa, respectively). Receiver operating characteristic curve analyses revealed that, for brachial AWE and radial AWE, the area under the curve was equal to the max-IMT and higher than the mean-IMT and FMD. Upper limb AWE measurement can reflect the degree of atherosclerosis risk overload and may be useful for evaluating vascular complications in T2DM patients.

Estimation of oxidative status in lymphocytes of type2 diabetes mellitus patients

Introduction: Diabetes mellitus (DM) is a group of metabolic disorders which opens the door for many diseases leading to various complications like neuropathy, nephropathy and retinopathy. Type 2 diabetes mellitus (T2DM) is associated with elevated level of oxidative stress, which is one of the most important factors responsible for the development of chronic complications of this disease. Antioxidants like reduced glutathione (GSH), superoxide dismutase (SOD) and catalase protects cells against oxidative damage. Our present study suggests that hyperglycemia induced oxidative stress leads to various complications in T2DM patients. Here we investigated oxidative stress markers in lymphocytes of healthy control and diabetes mellitus patients. In the present study, 40 patients with T2DM (group A), aged 35-65 years and 30 healthy individuals (group B) of the same age group were included. Lymphocytes were isolated by using ficoll hypaque from heparinised blood obtained from all the participants in this study. Lymphocyte SOD, Catalase, Glutathione and MDA were estimated by using an ELISA reader. SOD activity was higher in group B (98.97 ± 8.01) as compared with group A (49.71 ± 5.85);whereas catalase (61.50 ± 8.79 vs 76.33 ± 6.80) and glutathione (44.22 ± 6.85 vs 63.61 ± 8.89) amount was reduced in the same group as compared with healthy control. Lipid peroxidation was higher in group B (13.43 ± 3.99) as compared with healthy control (9.89 ± 2.59). Hyperglycemia induces the oxidative stress condition inside the lymphocytes which stimulates cell death for various cells including lymphocytes. Our data collectively confirm a significant decrease in lymphocyte GSH and catalase activity as well as an increase in activity of SOD and MDA reflecting elevated oxidative stress in the diabetic state.

Estimation of oxidative status in lymphocytes of type2 diabetes mellitus patients

AbstractIntroduction: Diabetes mellitus (DM) is a group of metabolic disorders which opens the door for many diseases leading to various complications like neuropathy, nephropathy and retinopathy. Type 2 diabetes mellitus (T2DM) is associated with elevated level of oxidative stress, which is one of the most important factors responsible for the development of chronic complications of this disease. Antioxidants like reduced glutathione (GSH), superoxide dismutase (SOD) and catalase protects cells against oxidative damage. Purpose: Our present study suggests that hyperglycemia induced oxidative stress leads to various complications in T2DM patients. Here we investigated oxidative stress markers in lymphocytes of healthy control and diabetes mellitus patients. Methods: In the present study, 40 patients with T2DM (group A), aged 35-65 years and 30 healthy individuals (group B) of the same age group were included. Lymphocytes were isolated by using ficoll hypaque from heparinised blood obtained from all the participants in this study. Lymphocyte SOD, Catalase, Glutathione and MDA were estimated by using an ELISA reader. Results: SOD activity was higher in group B (98.97 ± 8.01) as compared with group A (49.71 ± 5.85);whereas catalase (61.50 ± 8.79 vs 76.33 ± 6.80) and glutathione (44.22 ± 6.85 vs 63.61 ± 8.89) amount was reduced in the same group as compared with healthy control. Lipid peroxidation was higher in group B (13.43 ± 3.99) as compared with healthy control (9.89 ± 2.59). Conclusions: Hyperglycemia induces the oxidative stress condition inside the lymphocytes which stimulates cell death for various cells including lymphocytes. Our data collectively confirm a significant decrease in lymphocyte GSH and catalase activity as well as an increase in activity of SOD and MDA reflecting elevated oxidative stress in the diabetic state.

The influence of homocysteine levels on endothelial function and their relation with microvascular complications in T2DM patients without macrovascular disease

The aim of this study was to investigate the influence of homocysteine (hcy) levels on endothelial function by the method of brachial artery ultrasonography and their relation with microvascular complications in type 2 diabetes mellitus (T2DM) patients without macrovascular disease. Fifty-nine T2DM patients with a mean age of 53.4+/-8.6 years and diabetes duration of 8.1+/-6.2 years and 16 healthy controls with a mean age of 47+/-14.5 years were included in the study. Endothelialdependent and endothelium-independent flow-mediated dilatation (FMD) were evaluated via brachial artery ultrasonography. Fasting plasma glucose (FPG), glycosylated haemoglobin (A1c), lipid profile, hcy, B12 and folic acid levels were measured. Diabetic patients and control group individuals were compared with regard to the laboratory values and brachial artery vascular reactivity. Factors influencing endothelium-dependent FMD were investigated with linear regression analysis. Age, gender, body mass index, lipid profiles and hcy levels were similar in both groups (p>0.05). Endothelium-dependent FMD percentages were significantly lower in diabetics than in the control group (7.7+/-5.9 vs. 11.7+/-7.1%, p<0.05). Endothelial-independent FMD percentage was similar for both groups (p>0.05). The upper limit of the reference hcy value was found to be 12.6 micromol/l in the control group. In the diabetic group, hcy levels were high in 33 patients and normal in 26 patients. No difference was detected between the patients with high hcy levels and those with a normal level with regard to endothelium-dependent and endothelium-independent FMD values (p>0.05). Mean hcy levels were 16+/-1.7 and 13.3+/-4.3 micromol/l in T2DM patients with microvascular complication and those with no microvascular complication, respectively (p<0.05). Regression analysis revealed that the main factors influencing the endothelial-dependent FMD were FPG, total cholesterol (TC), triglycerides (TG) and high-density lipoprotein (HDL-C) levels (p<0.05, p=0.05, p=0.05, p=0.02, respectively). Hcy, folic acid and B12 values did not influence endothelium-dependent FMD (p>0.05). Diabetes duration and A1c levels were close to being significant although they did not reach statistical significance (p=0.07 and p=0.08 respectively). Hcy levels have no effect on endothelium-dependent and endothelium-independent FMD in T2DM patients without macrovascular complications. The influence of classical atherogenic factors (such as FPG, TC, TG and HDL-C levels) on endothelium functions, detected with endothelium-dependent FMD, is greater.