Complications Of Type 2 Diabetes Mellitus Research Articles

Protective Role of Dietary Polyphenols in the Management and Treatment of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM), a serious metabolic disorder, is a worldwide health problem due to the alarming rise in prevalence and elevated morbidity and mortality. Chronic hyperglycemia, insulin resistance, and ineffective insulin effect and secretion are hallmarks of T2DM, leading to many serious secondary complications. These include, in particular, cardiovascular disorders, diabetic neuropathy, nephropathy and retinopathy, diabetic foot, osteoporosis, liver damage, susceptibility to infections and some cancers. Polyphenols such as flavonoids, phenolic acids, stilbenes, tannins, and lignans constitute an extensive and heterogeneous group of phytochemicals in fresh fruits, vegetables and their products. Various in vitro studies, animal model studies and available clinical trials revealed that flavonoids (e.g., quercetin, kaempferol, rutin, epicatechin, genistein, daidzein, anthocyanins), phenolic acids (e.g., chlorogenic, caffeic, ellagic, gallic acids, curcumin), stilbenes (e.g., resveratrol), tannins (e.g., procyanidin B2, seaweed phlorotannins), lignans (e.g., pinoresinol) have the ability to lower hyperglycemia, enhance insulin sensitivity and improve insulin secretion, scavenge reactive oxygen species, reduce chronic inflammation, modulate gut microbiota, and alleviate secondary complications of T2DM. The interaction between polyphenols and conventional antidiabetic drugs offers a promising strategy in the management and treatment of T2DM, especially in advanced disease stages. Synergistic effects of polyphenols with antidiabetic drugs have been documented, but also antagonistic interactions that may impair drug efficacy. Therefore, additional research is required to clarify mutual interactions in order to use the knowledge in clinical applications. Nevertheless, dietary polyphenols can be successfully applied as part of supportive treatment for T2DM, as they reduce both obvious clinical symptoms and secondary complications.

Predictive models and determinants of mortality among T2DM patients in a tertiary hospital in Ghana, how do machine learning techniques perform?

BackgroundThe increasing prevalence of type 2 diabetes mellitus (T2DM) in lower and middle – income countries call for preventive public health interventions. Studies from Africa including those from Ghana, consistently reveal high T2DM-related mortality rates. While previous research in the Ho municipality has primarily examined risk factors, comorbidity, and quality of life of T2DM patients, this study specifically investigated mortality predictors among these patients.MethodThe study was retrospective involving medical records of T2DM patients. Data extracted included mortality outcome (dead or alive), sociodemographic characteristics (age, sex, marital status, educational level, occupation and location), family history of diseases (diabetes, cardiovascular disease (CVD), or asthma), lifestyle (smoking and alcohol intake), comorbidities (such as skin infections, sickle cell disease, urinary tract infections, and pneumonia) and complications of diabetes (CVD, nephropathy, neuropathy, foot ulcers, and diabetic ketoacidosis) were analyzed using Stata version 16.0 and Python 3.6.1 programming language. Both descriptive and inferential statistics were done to describe and build predictive models respectively. The performance of machine learning (ML) techniques such as support vector machine (SVM), decision tree, k nearest neighbor (kNN), eXtreme Gradient Boosting (XGBoost) and logistic regression were evaluated using the best-fitting predictive model for T2DM mortality.ResultsOf the 328 participants, 183 (55.79%) were female, and the percentage of mortality was 11.28%. A 100% mortality was recorded among the T2DM patients with sepsis (p-value = 0.012). T2DM in-patients were 3.83 times as likely to die [AOR = 3.83; 95% CI: (1.53–9.61)] if they had nephropathy compared to T2DM in-patients without nephropathy (p-value = 0.004). The full model which included sociodemographic characteristics, family history, lifestyle variables and complications of T2DM had the best prediction of T2DM mortality outcome (ROC = 72.97%). The accuracy for (test and train datasets) were as follows: (90% and 90%), (100% and 100%), (90% and 90%), (90% and 88%) and (88% and 90%) respectively for the various ML classification techniques: logistic regression, Decision tree classifier, kNN classifier, SVM and XGBoost.ConclusionThis study found that all in-patients with sepsis died. Nephropathy was the identified significant predictor of T2DM mortality. Decision tree classifier provided the best classifying potential.

Higher Incidence of Diabetes in Asymptomatic Healthy Fatty Liver Patients of Bangladesh: Prompt Intervention can Avert Complications.

The strong association between type 2 diabetes mellitus (T2DM) and fatty liver is well known, and its nomenclature has even recently changed to metabolic dysfunction-associated steatotic liver disease (MASLD). Healthy MASLD patients are frequently overlooked and maltreated, especially in Bangladesh. In this present study, we tried to correlate T2DM burden in apparently healthy, incidentally diagnosed fatty liver patients on ultrasound. This cross-sectional study was done in Sheikh Hasina Medical College Hospital, Tangail, Bangladesh, from August 2022 to February 2023. A total of 92 patients with ultrasonological evidence of grade II fatty change in the liver were included and evaluated. Known T2DM, hypothyroidism, consumption of alcohol, HBV or HCV infection, Wilson's disease, autoimmune liver disease, hemochromatosis, and any other chronic liver or kidney disease patients were excluded. The patients were then assessed for the presence and absence of T2DM using OGTT (2 hours 75 gm glucose ≥ 11.1 mmol/L) and/or HbA1c (≥6.5%) as diagnostic criteria. Data was analyzed by SPSS, version 23. Out of 92 patients, 48 were male and 44 were female. A total of 50 patients (54.3%) were newly diagnosed with T2DM. Statistically significant differences were seen in the T2DM group and non-DM group for AST (50.33 IU vs 36.53 IU) and TG (270 mg/dL vs 189 mg/dL). Although no noteworthy differences were evident in mean age (41 years vs 38 years), ALT (58.9 IU vs 60.23 IU), and BMI (28.85 vs 29.29). In the present study, more than 54% of patients with grade II fatty liver were newly diagnosed with T2DM. They would later present with more advanced T2DM and related complications. Although a larger study is needed, physicians and healthcare workers in Bangladesh should be more concerned about treating MASLD patients with early diagnosis of T2DM, recommending prompt lifestyle interventions, and prescribing drugs if necessary. Gani ABMS, Mahmood AA, Alam AFMS, et al. Higher Incidence of Diabetes in Asymptomatic Healthy Fatty Liver Patients of Bangladesh: Prompt Intervention can Avert Complications. Euroasian J Hepato-Gastroenterol 2024;14(2):172-175.

Integrating Sglt-2 Inhibitors into the Clinical Management of Type 2 Diabetes Mellitus and Chronic Kidney Disease: Current Evidence and Future Outlook

Objective and Background: The prevalence of type 2 diabetes mellitus (T2DM) is steadily increasing globally. A significant complication of T2DM is diabetic kidney disease, which contributes to increased morbidity and mortality. Sodium-Glucose Co-Transporter-2 (SGLT-2) inhibitors are a class of oral antidiabetic agents that effectively lower blood glucose levels and provide protective benefits for kidney health. Methods: A comprehensive review of studies was conducted focusing on the use of SGLT-2 inhibitors in patients with T2DM, including those with chronic kidney disease (CKD), defined as a glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m², or urine albumin/creatinine ratio ≥ 30 mg alb/g creatinine. The studies evaluated clinical outcomes such as cardiovascular events, kidney disease progression, and mortality. Results: Research findings demonstrate that SGLT-2 inhibitors significantly reduce the risk of hospitalization due to heart failure, myocardial infarction, and stroke. Additionally, these medications lower the incidence of cardiovascular-related and all-cause mortality. Renal-specific benefits include slowing the progression of albuminuria, reducing the decline in GFR, lowering the need for renal replacement therapy, and decreasing kidney-related deaths.

Single-cell view and a novel protective macrophage subset in perivascular adipose tissue in T2DM

BackgroundVasculopathy underlies diabetic complications, with perivascular adipose tissue (PVAT) playing crucial roles in its development. However, the changes in the cellular composition and function of PVAT, including the specific cell subsets and mechanisms implicated in type 2 diabetes mellitus (T2DM) vasculopathy, remain unclear.MethodsTo address the above issues, we performed single-cell RNA sequencing on the stromal vascular fraction (SVF) of PVAT from normal and T2DM rats. Then, various bioinformatics tools and functional experiments were used to investigate the characteristic changes in the cellular profile of diabetic PVAT SVF, their implications, and the underlying mechanisms.ResultsOur study reveals the single-cell landscape of the SVF of PVAT, demonstrating its considerable heterogeneity and significant alterations in T2DM, including an enhanced inflammatory response and elevated proportions of macrophages and natural killer (NK) cells. Moreover, macrophages are critical hubs for cross-talk among various cell populations. Notably, we identified a decreased Pdpn+ macrophage subpopulation in the PVAT of T2DM rats and confirmed this in mice and humans. In vitro and in vivo studies demonstrated that Pdpn+ macrophages alleviated insulin resistance and modulated adipokine/cytokine expression in adipocytes via the Pla2g2d-DHA/EPA-GPR120 pathway. This subset also enhances the function of vascular endothelial and smooth muscle cells, inhibits vascular inflammation and oxidative stress, and improves vasodilatory function, thereby protecting blood vessels.ConclusionPdpn+ macrophages exhibit significant vascular protective effects by alleviating insulin resistance and modulating adipokine/cytokine expression in PVAT adipocytes. This macrophage subtype may therefore play pivotal roles in mitigating vascular complications in T2DM. Our findings also underscore the critical role of immune-metabolic cross-talk in maintaining tissue homeostasis.Graphical

Analysis of Racial and Regional Disparities in Sudden Cardiac Death Related Mortality, Trends in Patients with Type 2 Diabetes Mellitus: 1999-2020.

Subnormal glycemic control, as is seen in Type 2 Diabetes Mellitus (T2DM), has been established as a risk factor of sudden cardiac death (SCD) due to the microvascular complications of T2DM affecting the heart's conduction system, instigating arrhythmias. With increasing incidence of SCD in diabetics in the U.S., the racial and rural-urban disparities remain less well-established. This paper examines the difference in mortality trends when stratified by these two demographics.CDC WONDER database was queried from 1999-2020 to obtain SCD related mortality trends data in diabetics. Age-adjusted mortality rates (AAMR) per 100,000 were obtained using the U.S. population in 2000 as the standard. Joinpoint regression was employed to ascertain differences in interracial trends & rural vs urban cities.12,545 diabetics suffered from sudden cardiac death in the past 2 decades, with West Virginia (AAMR: 0.37) and Tennessee (AAMR: 0.38) recording the highest rates. Overall AAMR upturned from 1999 (AAMR: 0.14) to 2020 (AAMR: 0.22). Mortality rates were higher in the African Americans (AAMR: 0.21 [0.19,0.22]; AAPC: 2.2 [0.56,4.27]) than Whites: (AAMR: 0.17 [0.16,0.17]; AAPC: 2.3 [1.3,3.78]), AAPC declined for Hispanics (AAPC: -0.62 [-4.7,3.6]). Midwest (AAMR: 0.22 [0.21,0.23]) had the highest rates, followed by South (AAMR: 0.16 [0.16,0.17]), Northeast (AAMR: 0.14 [0.1,0.18]) and West (AAMR: 0.09 [0.09,0.1]). AAMR in rural counties (AAMR: 0.32 [0.31,0.34]; AAPC: 3.6 [2.6,5.2]) was 3.5 times higher than in large metropolitans (AAMR: 0.09 [0.09,0.1]; AAPC: 1.9 [0.8,3.5]).Racial disparity alongside three-fold higher AAMRs in rural counties require robust mechanisms of healthcare delivery to impoverished regions and entities.

GLP-1 Receptor Agonists and Diabetic Kidney Disease: A Game Charger in the Field?

Kidney disease is a public health epidemic affecting 10% of the population worldwide with a constantly rising incidence, and it is an important contributor to morbidity and mortality. Type 2 diabetes mellitus (T2DM) is a chronic complex condition with a rising incidence worldwide. T2DM remains the principal cause of chronic kidney disease (CKD), which is related to a high risk for cardiovascular (CV) events, end-stage kidney disease (ESKD), and, overall, considerable morbidity and mortality. In the past few decades, various therapeutic treatments have targeted the culprit pathways for slowing CKD progression, with partial success. Thus, despite new advances in patients' treatment, progressive loss of kidney function or death from T2DM and CKD complications compel new therapeutic pathways. Renin-angiotensin-aldosterone-system-blocking agents have been the only treatment until recently. On top of this, sodium-glucose co-transporter 2 inhibitors along with finerenone showed an impressive ability to reduce the progression of kidney disease and cardiovascular events in diabetic patients with CKD. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) can play a special role and could be a game changer in this field. The latest FLOW trial confirmed multiple favorable clinical effects on renal, cardiovascular, and survival outcomes among high-risk patients treated with semaglutide and supports a significant therapeutic role for GLP-1RAs in this population, although larger-scale evaluation of their risks is needed, given their increasing use.

Abstract 4117397: SGLT2i And Cardio-Renal Outcomes In Type 2 Diabetes Mellitus: A Systematic Review And Meta Analysis.

Background: Diabetes Mellitus (DM) significantly impacts global health through cardiovascular and renal complications. SGLT2 inhibitors (SGLT2i) have emerged as beneficial for cardiovascular outcomes in Type 2 Diabetes Mellitus (T2DM). However, only few studies report outcomes related to renal function. Aim: This study aims to analyse the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. Methods: A systematic review and meta-analysis, following PRISMA-2020 guidelines was conducted. We evaluated the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. We included randomized controlled trials(RCT) and post hoc analyses that compared SGLT2i with placebo, focusing on cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalizations, and renal outcomes such as the progression of albuminuria and the decline of eGFR. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI). Results: We identified 2753 studies, registered in PubMed(=788), Embase(n=538), WoS(n=369), Scopus(n=908), and Cochrane(n=150). We included 11 studies 6 RCT and 7 Post Hoc Analysis, sample size of 50.653 patients. Meta-analysis showed that SGLT2i improve cardiovascular outcomes such as reduced cardiovascular mortality (RR 0.84 [95% CI 0.73–0.97] p=0.02), heart failure hospitalizations (RR 0.65 [95%CI 0.54–0.77]p<0.00001), and their composites outcomes. Furthermore, renal outcomes with SGLT2i significantly improve Urinary Albumin-to-Creatinine Ratio (RR1.10 [95%CI 1.03–1.18]p=0.004), Improvement of the decline of the eGFR (RR1.08 [95%CI 1.04–1.11] p<0.00001) and progression of albuminuria (RR 0.69[95%CI 0.66–0.72]p<0.00001). Slower Doubling of serum creatinine (RR 0.71 [95% CI 0.61–0.82] p<0.00001), end-stage kidney disease (RR 0.66 [95% CI 0.53–0.83] p=0.0003). Reduced Acute Kidney Injury (RR 0.72 [95% CI 0.58–0.89] p=0.002) and renal impairment (RR 0.57 [95% CI 0.34–0.95] p=0.03). Regarding death from renal causes, we identified a 46% relative reduction in the risk in SGLT2i group, although was not statistically significant (RR 0.54 [95% CI: 0.23, 1.27] p=0.16). The observed heterogeneity across studies calls for careful application of these results to individual patients. Conclusion: SGLT2i confers notable advantages in managing cardiorenal complications in T2DM, demonstrating a reduction in cardiovascular mortality and heart failure hospitalizations and offering a nephroprotective effect.

The Role of Insulin Within the Socio-Psycho-Biological Framework in Type 2 Diabetes-A Perspective from Psychoneuroimmunology.

The interplay between socio-psychological factors and biological systems is pivotal in defining human health and disease, particularly in chronic non-communicable diseases. Recent advancements in psychoneuroimmunology and mitochondrial psychobiology have emphasized the significance of psychological factors as critical determinants of disease onset, progression, recurrence, and severity. These insights align with evolutionary biology, psychology, and psychiatry, highlighting the inherent social nature of humans. This study proposes a theory that expands insulin's role beyond traditional metabolic functions, incorporating it into the Mitochondrial Information Processing System (MIPS) and exploring it from an evolutionary medicine perspective to explore its function in processing psychological and social factors into biological responses. This narrative review comprises data from preclinical animal studies, longitudinal cohort studies, cross-sectional studies, machine learning analyses, and randomized controlled trials, and investigates the role of insulin in health and disease. The result is a proposal for a theoretical framework of insulin as a social substance within the socio-psycho-biological framework, emphasizing its extensive roles in health and disease. Type 2 Diabetes Mellitus (T2DM) with musculoskeletal disorders and neurodegeneration exemplifies this narrative. We suggest further research towards a comprehensive treatment protocol meeting evolutionary expectations, where incorporating psychosocial interventions plays an essential role. By supporting the concept of 'insulin resilience' and suggesting the use of heart rate variability to assess insulin resilience, we aim to provide an integrative approach to managing insulin levels and monitoring the effectiveness of interventions. This integrative strategy addresses broader socio-psychological factors, ultimately improving health outcomes for individuals with T2DM and musculoskeletal complications and neurodegeneration while providing new insights into the interplay between socio-psychological factors and biological systems in chronic diseases.

The Jiangsu Biobank for the Prevention and Control of Diabetes (JBPCD) in China.

The Jiangsu Biobank for the Prevention and Control of Diabetes (JBPCD) is a community-based prospective cohort study initiated in Jiangsu province, to examine the burden of complications associated with type 2 diabetes mellitus (T2DM). This study aims to better understand the incidence, risk factors, and long-term outcomes of T2DM complications to inform prevention and control strategies. From October 2013 to July 2014, 20,053 T2DM patients (7,862 males and 12,191 females) were recruited from Suzhou city and Huai'an city. Baseline data were collected through questionnaire survey, physical examination and biochemical testing, with blood samples stored in a biobank. The follow-up focused on the incidence and mortality related to T2DM complications, linked to national and local medical datasets. Between August 2019 and October 2020, the repeated assessments were completed for 13,973 participants, including questionnaire, physical examination and repeated blood collection. The study identified 1,479 new cancer cases and 3,324 cardiovascular disease cases, with an overall mortality rate of 25.66 per 1,000 person-years. JBPCD welcomes research collaborations and data access requests via email. Currently, there are no plans to provide cohort data for free public access, but specific proposals for further collaboration are welcome. For further information and collaboration, please email [jswuming@vip.sina.com] and [sc@njmu.edu.cn].

The Potential of Neuregulin 4 as a Novel Biomarker and Therapeutic Agent for Vascular Complications in Type 2 Diabetes Mellitus.

Neuregulin 4 (Nrg4), a novel adipokine produced primarily by brown adipose tissue (BAT), has beenfunctionallycharacterized to exert beneficial effects on modulating energy homeostasis and glucolipid metabolism, and is closely associatedwith the development and progressionof obesity and obesity-associated metabolic diseases, such as type 2 diabetes mellitus (T2DM) and cardiovascular diseases. Recently, there has been a growing focus on the relationship between circulating Nrg4 levels and T2DM-related vascular complications. In this review, we discussed the known and potential roles of Nrg4 in various physiological and pathological processes, and its association with vascular complications in T2DM, in the aim of finding a potential biomarker recommended for the clinical diagnosis, prognosis and follow-up of T2DM patients at high risk of developing vascular complications as well as providing new therapeutic approaches.

Unveiling the Predictive Model for Macrovascular Complications in Type 2 Diabetes Mellitus: microRNAs Expression, Lipid Profile, and Oxidative Stress Markers.

To assay new circulating markers related to macrovascular complications (MVC) in type 2 diabetes mellitus (T2DM), we carried out a descriptive cross-sectional study. We recruited 30 controls (CG), 34 patients with T2DM (DG), and 28 patients with T2DM and vascular complications (DG+C); among them, 22 presented MVC. Peripheral blood was used to determine redox status (superoxide dismutase, SOD; catalase, CAT; glutathione reductase, GRd; glutathione peroxidase, GPx; glucose-6-phosphate dehydrogenase, G6PD) and markers of oxidative damage (advanced oxidation protein products, AOPP; lipid peroxidation, LPO), nitrite levels in plasma (NOx). Inflammatory markers (IL-1β, IL-6, IL-10, IL-18, MCP-1, TNF-α) and the relative expression of c-miRNAs were analyzed. The real-time PCR results showed that the expressions of miR-155-5p, miR-21-5p, miR-146a-3p, and miR-210-3p were significantly higher in the DG group compared to the CG. The DG+C group presented statistically relevant differences with CG for four miRs: the increased expression of miR-484-5p, miR-21-5p, and miR-210-3p, and decreased expression of miR-126a-3p. Moreover, miR-126a-3p was significantly less expressed in DG+C compared to DG. The application of binary logistic regression analysis and construction of receiving operator characteristic curves (ROC) revealed two models with high predictive values for vascular complications presence: (1) HbAc1, creatinine, total cholesterol (TC), LPO, GPx, SOD, miR-126, miR-484 (Exp(B) = 0.926, chi2 = 34.093, p < 0.001; AUC = 0.913). (2) HbAc1, creatinine, TC, IL-6, LPO, miR-126, miR-484 (Exp(B) = 0.958, Chi2 = 33.863, p < 0.001; AUC = 0.938). Moreover, our data demonstrated that gender, TC, GPx, CAT, and miR-484 were associated with MVC and exhibited higher predictive values (Exp(B) = 0.528, p = 0.024, Chi2 = 28.214, AUC = 0.904) than classical variables (Exp(B) 0.462, p = 0.007, Chi2 = 18.814, AUC = 0.850). miR-126, miR-484, IL-6, SOD, CAT, and GPx participate in vascular damage development in the studied diabetic population and should be considered for future studies.

Clinical Profile and Risk Factors for Complication of Type 2 Diabetes Mellitus at the National Referral Hospital, Bhutan: A Descriptive Cross-Sectional Study.

Globally, diabetes mellitus is a major public health concern affecting 10.5% of the population. Nearly 90% of these people have Type 2 diabetes mellitus (T2DM). In Bhutan, T2DM is prevalent in 5.6% of the population, and around 60% are unaware of their diagnosis of diabetes. There is no baseline information on the rate and the risk factors for complications of diabetes in Bhutan. The study assessed the clinical profile and the risk factors for complications of T2DM at the Jigme Dorji Wangchuk (JDW) National Referral Hospital, Bhutan. A descriptive cross-sectional study was conducted at the JDW National Referral Hospital, Bhutan, from January to December 2019. Patients with T2DM attending diabetic clinics were included in the study. Demographic variables and metabolic profiles were recorded using a standard pro forma. Descriptive statistics were used to express the results. The association of clinical profiles with the microvascular complication was assessed using multivariate logistic analysis with statistical significance at p < 0.05. There were 292 patients with T2DM during the study period. The rate of microvascular complication is around 25% in T2DM. Among the complications, diabetic retinopathy occurred in over 51%, followed by neuropathy (29.7%) and nephropathy (18.9%). Over 1/3rd of patients had a duration of diabetes over 10 years with a mean duration of 6.3 (5.4) years, and around 44% (127/292) of them had poor glycemic control (HbA1C ≥ 7%). The age ≥ 60 years and the duration of diabetes ≥ 10 years were independent risk factors for microvascular complications in T2DM patients. Regular exercise prevents retinopathy (OR 0.4, 95%CI 0.2-0.9, p = 0.026). There is a microvascular complication in 1 in 4 of type 2 diabetic patients. Age over 60 years and a duration of diabetes of more than 10 years are independent risk factors for microvascular complications, and regular exercise is preventive for microvascular complications.

The effect of MIND diet on sleep status, anxiety, depression, and cardiometabolic indices in obese diabetic women with insomnia: study protocol for a randomized controlled clinical trial {1}

BackgroundThe Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is a plant-based and anti-inflammatory diet that has the ability to protect and manage cardiovascular and nervous system diseases. Regarding that insomnia and cardiovascular problems are x`common in type 2 diabetes mellitus (T2DM), the present study will assess the effectiveness of the MIND dietary pattern on sleep quality, cardiometabolic indicators, and other psychological indicators.MethodsForty-four overweight/obese T2DM women with insomnia, aged 30–65 years, will voluntarily participate in this randomized controlled trial and will be randomized to receive either a MIND low-calorie diet (MLCD) or a low-calorie diet (LCD) over a 3-month period. Before and after the study, sleep quality, some biochemical and cardiometabolic indices, cortisol, brain-derived neurotrophic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP), and oxidative stress indicators will be assessed.DiscussionThe use of dietary interventions in the management of T2DM complications is practical and safe. This research seeks to investigate the capacity of the MIND diet in the management of insomnia and cardiovascular problems of DM. It is expected that the results of this research will provide new perspectives on using an ideal dietary regimen to treat these health conditions.Trial registrationIRCT20181111041611N8. Registered on August 7, 2023. https://www.irct.ir/trial/71772

7604 Examining Disparities in Diabetes Control and Complications: A Comparative Study of Type 2 Diabetes Mellitus Patients in Rural and Urban Saudi Arabia

Abstract Disclosure: S.F. Alqifari: None. O. Alkomi: None. P. Amirthalingam: None. T. Alrasheed: None. M. Muqresh: None. H. Hamad: None. A. Khojah: None. N. Alshehri: None. B. Alhunayhani: None. B. AbuAlhasan: None. N. Alajlan: None. S. Alatawi: None. N. Alsabeelah: None. A. Wasel: None. A. Alqifari: None. Background: The escalating global prevalence of diabetes is also mirrored in Saudi Arabia. Approximately one in four individuals in the country is diagnosed with diabetes, as reported by the World Health Organization (WHO). The Ministry of Health has taken steps to address the needs of patients with diabetes by creating more than 20 specialized diabetes care centers in various regions throughout Saudi Arabia. However, disparities in access and utilization of primary healthcare facilities persist between rural and urban provinces within the country. Highlighting these disparities would bridge healthcare gaps between rural and urban areas to enhance diabetes management, ensure better access to specialized care, and improve the overall well-being of individuals living with Type 2 Diabetes Mellitus (T2DM) in Saudi Arabia. Objectives: This study aims to examine disparities in diabetes control and complications in patients with T2DM in rural and urban Saudi Arabia. Methods: This is an observational retrospective study conducted from November 2022 until May 2023, we collected data from 13 diabetes care centers across Saudi Arabia to assess diabetes control and complications of T2DM among patients who received their care in rural and urban Saudi Arabia. Results: Among 709 patients residing in rural and urban areas, rural area patients' recent HbA1c readings were generally within the range of 7-8%. Among these patients, around 2.6% had a history of heart disease, and 6.08% had experienced cerebrovascular events. Limb numbness was reported by 44.34% of subjects, 47.82% experienced vision complications, and renal impairment was observed in 10.43% of the participants. Additionally, among male patients, 26.41% suffered from erectile dysfunction. Remarkably, 21% of the rural patients reported having been hospitalized due to diabetes complications at least once in the past 12 months. Conclusion: The study findings emphasize the importance of considering regional disparities and socio-environmental factors when managing diabetes and its complications. Additional research is needed to understand the underlying causes and develop targeted interventions for improved diabetes care in rural and urban populations in Saudi Arabia. Presentation: 6/2/2024

Urinary cyclophilin A as an early marker of chronic kidney disease with underlying type 2 diabetes

Cyclophilin A (CypA) is a novel renal inflammation biomarker, with levels altered in various diseases, particularly in patients with diabetes mellitus (DM) and kidney damage. This study aimed to investigate the correlation between urinary cyclophilin A (uCypA) and chronic kidney disease (CKD) conditions with and without type 2 diabetes mellitus (T2DM) using an in-house enzyme-linked immunoassay (ELISA) method. A uCypA strip-test prototype was also developed. An indirect ELISA was performed to determine the uCypA levels. A 0.48 µg/mL uCypA cutoff differentiated healthy patients from those with early-stage CKD (stages I and II). The uCypA levels were significantly increased in patients with progression of renal deterioration, especially in the T2DM with late-stage CKD group, compared to the control group. Fasting blood sugar (FBS), estimated glomerular filtration rate (eGFR), albumin/creatinine ratio, and metformin use were associated with uCypA levels. Multinomial logistic regression analysis revealed an association between uCypA levels and T2DM diagnosed for over five years and early-stage CKD. This finding shows that uCypA could be used as a biomarker for distinguishing early-stage CKD as well as T2DM complications, which is beneficial for patients to be aware of their health status and change their behavior to slow kidney deterioration.

Potential roles for eNOS and NrF₂ /HO-1 signaling in the ameliorative effect of lixisenatide on diabetes-induced kidney injury in rats and its amplification by ticagrelor co-administration.

Antioxidant and anti-inflammatory effects of lixisenatide (LX) and ticagrelor (TC) have been previously identified in type 2 diabetes mellitus (T2DM). Diabetic nephropathy is one of the major complications of T2DM. In the current study, we examined the potential protective effects of LX and TC on experimentally induced diabetic nephropathy in T2DM rats and their possible molecular mechanisms. To examine this possibility, rats were fed a high-fat diet (HFD) for 12 weeks, followed by a single injection of 35 mg/kg streptozotocin (STZ) to induce T2DM. 10 μg/kg LX and 25 mg/kg TC were given alone or in combination to T2DM rats for 4 weeks. The kidney examination of T2DM rats showed clear deterioration. T2DM rats exhibited significantly higher body weight, blood glucose, hemostatic model assessment for insulin resistance (HOMA-IR), blood urea nitrogen (BUN), serum creatinine, kidney reactive oxygen species (ROS), nuclear factor-κ B (NF-κ B), and transforming growth factor-β (TGF-β ), and significantly lower serum insulin, urine creatinine, creatinine clearance (CRCL), kidney superoxide dismutase (SOD), glutathione reduced (GSH), nuclear factor erythroid 2 (NrF₂ ), heme oxygenase-1 (HO-1), and endothelial nitric oxide synthase (eNOS) when compared to control rats. Single treatment with LX or TC showed obvious ameliorative effects on kidney complications in T2DM rats, with more ameliorative effects with the combined administration of both drugs. Conclusion: Our investigation found that both LX and TC could significantly ameliorate the development of diabetic nephropathy via stimulating NrF₂ /HO-1 antioxidant pathway in addition to increasing eNOS and decreasing NF-κ B renal tissue concentrations, and these effects were markedly augmented by their combined administration.

Comparison of Thyroid Function Tests Among Type 2 Diabetes Patients With and Without Diabetic Nephropathy and Controls.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with hyperglycemia and impaired insulin function. Diabetic nephropathy (DN) is a common complication of T2DM, characterized by progressive kidney damage. Thyroid dysfunction, particularly hypothyroidism, has been increasingly recognised as a significant factor influencing the progression of DN. To compare thyroid function tests in patients with T2DM with and without diabetic nephropathy and non-diabetic controls, and to assess the role of thyroid dysfunction in DN progression. A hospital-based cross-sectional study was conducted among 225 participants. Patients were divided into three groups: T2DM with DN, T2DM without DN, and controls, with 75 participants in each group. Data collection included demographic details, comorbidities, and clinical assessments such as blood pressure, thyroid function tests, urinary albumin levels, glycated hemoglobin (HbA1c), renal function tests, serum electrolytes, and estimated glomerular filtration rate (eGFR). Statistical analyses were conducted using SPSS version 20.0 (IBM Corp., Armonk, NY, USA). Results:The most common DN stage among T2DM patients was stage 4 (29, 38.7%), followed by stages 2 and 5 (19, 25.3%each). The T2DM with DN (47, 62.7%) group had a higher prevalence of overweight and obesity compared to the T2DM without DN group (38, 51.5%) and controls (24, 32%) (p value<0.001). Abnormal cardiovascular, respiratory, and abdominal examinations were most prevalent in the T2DM with DN group. Hypothyroidism was more prevalent in both T2DM groups (14, 18.7% each) compared to controls (2, 2.7%) (p value<0.004). Conclusion:Our findings strengthen the evidence of an important link between T2DM and thyroid disorders. The high prevalence of thyroid dysfunction among T2DM patients highlights the critical need for routine screening and integrated management of both conditions to enhance patient outcomes.

Association between Mediterranean diet adherence and peripheral artery disease in type 2 diabetes mellitus: An observational study

IntroductionTo evaluate the relationship between adherence to the Mediterranean diet (MD) and periphereal artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM). MethodsAn observational sectional study was conducted with 174 patients diagnosed with T2DM, of which 78 patients had PAD. A patient was considered to have PAD if they obtained an ankle-brachial index (ABI) < 0.9 and/or absence of both distal pulses in one of the two feet. Data on sociodemographic and anthropometric variables, physical activity, smoking habits, biochemical blood parameters, and comorbidities were recorded. Good adherence to the MD was considered with a score ≥ 9 in MEDAS-14. Vascular factors independently associated with adherence to the MD in patients with T2DM were identified through multivariate logistic regression analysis. ResultsABI, DFU, intermittent claudication and pedal pulse absence correlated with MD adherence. DFU, intermittent claudication and posterior tibial pulse absence were associated with the final score obtained in the MEDAS-14. Nut consumption, white meat preference and sautéed dish intake were associated with PAD presence. Multivariate analysis linked MD adherence to sex (OR = 0.044, 95 % CI 0.003–0619), age (OR = 0.139, 95 % CI 0.029–0.666), duration of T2DM (OR = 7.383, 95 % CI 1.523–35.779) and age at diagnosis of T2DM (OR = 6082, 95 % IC 1.415–26.136), as well as the presence of DFU (OR = 0.000, 95 % IC 0.000–0.370) and intermittent claudication (OR = 0.004, 95 % IC 0.000–0.534). ConclusionsAdherence to the MD is associated with a reduction in vascular complications in T2DM, highlighting its potential as a dietary intervention strategy.

Role of Circulating Biomarkers in Diabetic Cardiomyopathy.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder that has alarmingly increased in incidence in recent decades. One of the most serious complications of T2DM is diabetic cardiomyopathy (DCM), an often underrecognized yet severe condition that is a leading cause of mortality among diabetic patients. In the early stages of DCM, patients typically show no symptoms and maintain normal systolic and diastolic left ventricle function, making early detection challenging. Currently available clinical markers are often not specific enough to detect the early stage of DCM. Conventional biomarkers of cardiac mechanical stress and injury, such as natriuretic peptides (NPs) and cardiac troponin I (cTnI), have shown limited predictive value for patients with T2DM. NPs have proven efficacy in detecting diastolic dysfunction in diabetic patients when used alongside 2D echocardiography, but their utility as biomarkers is limited to symptomatic individuals. While cTnI is a reliable indicator of general cardiac damage, it is not specific to cardiac injury caused by high glucose levels or T2DM. This underscores the need for research into biomarkers that can enable early diagnosis and management of DCM to reduce mortality rates. Promising novel biomarkers that showed good performance in detecting diastolic dysfunction or heart failure in diabetic patients include galectin-3, ST2, FGF-21, IGFBP-7, GDF-15, and TGF-β. This review summarizes the current understanding of DCM biomarkers, aiming to generate new ideas for the early recognition and treatment of DCM by exploring related pathophysiological mechanisms.