Concomitant Diabetes Mellitus Research Articles

Dysglycemia in COVID-19 and Type 2 Diabetes Mellitus: Peculiarities of the Glycemic Profile in Hospitalized Patients and the Role of Steroid-Induced Disorders

There is a lack of data on the features of dysglycemia in hospitalized patients with COVID-19 and concomitant diabetes mellitus (DM) confirmed by continuous glucose monitoring (CGM). to study the glycemic profile in hospitalized patients with COVID-19 and type 2 diabetes mellitus by continuous glucose monitoring and the role of steroid therapy in dysglycemiadevelopment. We examined 21 patients with COVID-19 and DM 2 and 21 patients with DM 2 withoutCOVID-19(control group) using a professional 4-7-day CGM. We also compared two subgroups of patients with COVID-19 and DM 2: 1) patients received systemic glucocorticosteroids (GCS) during CGM and 2) patients in whomCGMwas performed after discontinuation of GCS. Compared with controls, patients with COVID-19 and DM2 had lesser values of glycemic «time in range» (32.7 ± 20.40vs 48.0 ± 15.60%, p = 0.026) andhigher parameters of mean glycemia (p <0.05) but similar proportion of patients with episodes of hypoglycemia (33.3% vs 38.1%, p = 0.75). Patients who received dexamethasone during CGM were characterized by higher hyperglycemia and the absence of episodes of hypoglycemia. In patients who hadCGM after dexamethasone discontinuation, hyperglycemia was less pronounced, but 60% of them had episodes of hypoglycemia, often nocturnal, clinically significant and not detected by routine methods. Patients with COVID-19 and DM 2had severe and persistent hyperglycemia but a third of them hadalso episodes of hypoglycemia. During therapy with dexamethasone, they had the most pronounced hyperglycemia without episodes of hypoglycemia. In patients who underwent CGM after discontinuation of dexamethasone, hyperglycemia was less pronounced but 60% of them have episodes of hypoglycemia, often nocturnal, clinically significant and not diagnosed by routine methods. It would be advisable to recommend at least a 5-6-fold study of the blood glucose level (with its obligatory assessment at night) even for stable patients with COVID-19 and DM 2after the end of GCS treatment.

The Role of Thyroid Disorders, Obesity, Diabetes Mellitus and Estrogen Exposure as Potential Modifiers for Pulmonary Hypertension.

Pulmonary hypertension (PH) is a progressive disorder characterized by a chronic in-crease in pulmonary arterial pressure, frequently resulting in right-sided heart failure and potentially death. Co-existing medical conditions are important factors in PH, since they not only result in the genesis of the disorder, but may also contribute to its progression. Various studies have assessed the impact of thyroid disorders and other endocrine conditions (namely estrogen exposure, obesity, and diabetes mellitus) on the progression of PH. The complex interactions that hormones may have with the cardiovascular system and pulmonary vascular bed can create several pathogenetic routes that could explain the effects of endocrine disorders on PH development and evolution. The aim of this review is to summarize current knowledge on the role of concomitant thyroid disorders, obesity, diabetes mellitus, and estrogen exposure as potential modifiers for PH, and especially for pulmonary arterial hypertension, and to discuss possible pathogenetic routes linking them with PH. This information could be valuable for practicing clinicians so as to better evaluate and/or treat concomitant endocrine conditions in the PH population.

Вплив багатокомпонентної терапії на діастолічну функцію лівого шлуночка в пацієнтів з резистентною артеріальною гіпертензією

The aim – to determine prognostic factors of improving left ventricular diastolic function (LV DF) in resistant hypertension (RH) patients (pts) treated with multicomponent antihypertensive therapy during three years.Materials and methods. 102 patients with true RH were included. Patients received triple fixed combination (blocker of the renin-angiotensin-aldosterone system / calcium antagonist / diuretic), to which has been added a fourth drug (spironolactone, eplerenone, moxonidine, torasemide or nebivolol). The state of LV DF was studied at the beginning and at the end of the study. Office and 24-h ambulatory blood pressure (BP) measurements, echocardiography, clinical characteristics, neurohumoral and proinflammatory status were assessed.Results and discussion. Impairment LV DF was detected in 75.5 % of pts. The first degree of LV diastolic dysfunction (DD) was observed in 63.7 %. The patients were divided into 2 groups: the first group included persons without initial impairment of LV DF (n=25), the second – pts with LV DD (n=77). Patients with LV DD were older, had a longer duration of hypertension, higher body mass index, 24-h urinary albumin excretion, office BP and 24-h ambulatory BP, more often (in 2 times) disorders of circadian BP rhythm and concomitant diabetes mellitus (DM). Left ventricular DD in 100 % of cases was associated with severe LV hypertrophy (LVH), increased plasma concentration of inflammatory proteins (CRP, fibrinogen), cytokines (IL-6, TNF-α), increased activity of leukocyte elastase, macrophage matrix metalloproteinase-12. The concentration in the blood of aldosterone, active renin, 24-h urinary excretion of metanephrines did not differ between the groups.Conclusions. Improvement and stabilization of LV DF occurred in parallel with regression of LVH (normalization of LVMI in 35.1 % of pts and significant decrease of LVMI in 64.9 %) against the background of decrease of BP and in the proportion of pts with disturbed circadian BP rhythm. The independent factors of the E/E’ ratio were the initial plasma concentrations of aldosterone (β=0.556; р=0.0001), glucose (β=0.366; р=0.0001), active renin (β=–0.223; р=0.004), 24-h urinary albumin excretion (β=0.188; р=0.016), age (β=0,192; р=0,023). The odds of an improvement in LV DF increased by 3.7 times, if the patient with RH had no DM, LVH regression occurred.

Prevalence of non-steroidal anti-inflammatory drugs (NSAIDs) use in patients with hypertensive crisis.

BackgoundOne of the known risk factors for hypertensive crisis (HTN‐C) is non‐steroidal anti‐inflammatory drugs (NSAIDs) which their adverse effects can lead to end‐organ damage such as gastrointestinal and cardiovascular issues.AimsData on the correlation between NSAIDs and HTN‐C are limited. In this study, we determined the prevalence of NSAID use among patients with HTN‐C.Materials & MethodsThis cross‐sectional study was conducted among patients primarily diagnosed with HTN‐C referred to Alzahra hospital, Shiraz, Iran from April 2015 to April 2020. Demographic data, as well as information regarding the past medical and drug history and laboratory findings, were gathered retrospectively. The history of NSAID use was also asked specifically. The collected data were analyzed by SPSS and the P‐value less than .05 was considered significant.ResultsA total of 257 patients with a mean age of 59.73 were enrolled in the study. Among them 62.6% were female and 137 patients (53.33%) used NSAIDs. Of all the patients 197 (76.7%), 71 (27.6%), and 46 (17.9%) suffered from concomitant hypertension (HTN), diabetes mellitus (DM), and ischemic heart disease (IHD) respectively. A significant relation was found between having each of the comorbidities and NSAIDs use among HTN‐C patients (P‐value <.0001). NSAIDs use was also significantly higher in older age (P‐value <.0001) and female gender (P‐value <.02). A high rate of NSAID use was seen among HTN‐C patients with a positive significant correlation to concomitant diseases, older age, and female gender.ConclusionThe Results of our study indicate that NSAIDs are frequently used among those with HTN‐C and considering the adverse effects of these medication our results further highlight the importance of monitoring and limiting NSAID use.

IMPACT OF PERCUTANEOUS CORONARY INTERVENTION ON PROTHROMBOGENIC POTENTIAL IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND DIABETES MELLITUS TYPE 2

The aim: Aim of study is to assess the influence of urgent reperfusion strategy on the levels of vWf, PAI-1 and sCD40L in patients with acute myocardial infarction (AMI) and concomitant diabetes mellitus type 2 (DM2). Materials and methods: 255 patients with acute myocardial infarction took part in the study, they were divided into four groups depending on the presence of concomitant diabetes mellitus type 2 and performed treatment: I group – 83 diabetic patients who were underwent urgent reperfusion therapy; II group – 60 diabetic patients who received standard anticoagulant therapy; III group – 65 non-diabetic patients who were underwent urgent reperfusion therapy; IV group – 47 non-diabetic patients who received standard anticoagulant therapy. The levels of von Willebrand factor, PAI-1 and sCD40L were determined by enzyme-linked immunosorbent assay. Statistical data were processed using the Mann–Whitney U-test, the Kruskal-Wallis H-test, quantitative variables were described by the following parameters: median (Me), 25th and 75th percentiles (Q1; Q3). Results: According to obtained data, we can conclude that patients with acute myocardial infarction and concomitant type 2 diabetes mellitus have higher levels of von Willebrand factor, PAI-1 and sCD40L compared to non-diabetic patients with AMI, which leads to the increasing of the platelets adhesion and aggregation and decreasing of fibrinolysis. Conclusions: Urgent restoration of blood supply in occluded artery contributed to a statistically significant reduction in levels of von Willebrand factor, PAI-1 and sCD40L levels in both diabetics and non-diabetic patients, reducing the risk of thromboembolic complications and thus improving the prognosis.

Diabetes mellitus lowers the chance of short-term urinary continence recovery in prostate cancer patients undergoing radical prostatectomy.

IntroductionThe aim of this article was to test the impact of diabetes mellitus (DM) on short-term urinary continence in patients undergoing radical prostatectomy (RP).Material and methodsWe relied on an institutional tertiary-care database to identify patients who underwent RP between 11/2018 and 02/2021 with data available on short-term urinary continence status (30–90 days post-surgery). Continence was defined as the usage of no or one safety-pad within 24 hours. Univariable and multivariable logistic regression models tested the correlation between DM and short-term continence. Covariates consisted of pathological T-stage, body mass index, prostate volume, surgical approach and nerve-sparing.ResultsOf 142 eligible patients, 15 (11%) patients exhibited concomitant DM. Patients diagnosed with DM exhibited lower continence rates at short-term follow-up compared to patients without DM (33 vs 63%, p = 0.03). In univariable and multivariable logistic regression models, DM was strongly associated with reduced chances of short-term urinary continence recovery (multivariable odds ratio [OR]: 0.26, 95%-CI: 0.07–0.86; p = 0.03). Furthermore, pathological T-stage (pT3/pT4) was additionally associated with reduced chance of urinary continence in logistic regression models (multivariable OR: 0.43, 95%-CI: 0.19–0.94; p = 0.04). Other covariables failed to reach statistical significance in multivariable logistic regression analyses predicting urinary continence.ConclusionsDM was associated with lower chances of short-term urinary continence recovery in a contemporary cohort of patients undergoing radical prostatectomy. Patients with DM should be preoperatively informed and intensified, postoperative pelvic floor training should be considered in this subgroup of RP patients.

Quality of life after myocardial re-vascularisation in patients with acute coronary syndrome during the coronavirus disease 2019 pandemic: a prospective observational study

Aim. To study the quality of life and how it is influenced by different factors in the long term after myocardial re-vascularisation in patients with coronary artery disease who had acute coronary syndrome during the coronavirus disease 2019 (COVID-19) pandemic.Methods. We examined 658 patients with coronary artery disease and acute coronary syndrome (mean age 66.4 ± 4.3 years). Percutaneous coronary intervention (600 patients) and coronary artery bypass grafting with cardio-pulmonary bypass (58 patients) were performed. Six months after myocardial re-vascularisation, we assessed patients' quality of life using the SF-36 questionnaire. We identified factors that affect the quality of life using multivariate regression analysis.Results. After myocardial revascularisation, the patients had a reduced overall indicator of physical health (&lt; 40 points). The overall indicator of psycho-emotional health was higher than physical (p &lt; 0.002) but did not exceed 50 points. We noted the adverse effect of COVID-19 (regardless of disease severity) on the assessment. Also, COVID-19 was associated with increased anxiety. A history of concomitant diabetes mellitus, obesity, stroke and percutaneous coronary intervention had a negative effect on the overall indicators of physical and mental health.Conclusion. Patients with coronary artery disease who had acute coronary syndrome after myocardial re-vascularisation are characterised by reduced indicators of physical and average indicators of mental health in the long term. COVID-19, regardless of disease severity, has a negative impact on patients' general state of health, social activity and emotional background. A history of diabetes mellitus, obesity, stroke and percutaneous coronary intervention adversely affects the physical and mental health indicators. Received 4 August 2021. Revised 31 August 2021. Accepted 1 September 2021. Funding: This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation (No. 121031300225-8). Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: O.V. Kamenskaya, V.V. LomivorotovData collection and analysis: A.S. KlinkovaStatistical analysis: A.S. KlinkovaDrafting the article: A.S. Klinkova, I.Yu. LoginovaCritical revision of the article: O.V. Kamenskaya, A.M. ChernyavskiyFinal approval of the version to be published: A.S. Klinkova, O.V. Kamenskaya, I.Yu. Loginova, A.M. Chernyavskiy, V.V. Lomivorotov

Evaluation of the impact of high-tone therapy on cognitive disorders and quality of life in the complex treatment of patients with comorbid pathology

Introduction. Comorbidity is an independent risk factor for mortality and significantly influences the prognosis and quality of life. Purpose: to evaluate the impact of high-tone HiTOP 4 touch therapy on cognitive disorders and quality of life in the complex treatment of patients with comorbid pathology. Methods: complex treatment of 2 groups of patients with inclusion in the basic treatment regimen of high-tone therapy was carried out - a total of 80 patients (men - 34, women - 46) aged 41 to 79 years old, group I - patients with hypertension and chronic cerebral ischemia (CСI) - 38 patients and group II - patients with hypertension, CСI and concomitant diabetes mellitus (DM) type 2 - 42 patients. The average age in group I was 61.5, in group II - 65.5. Group I received lisinopril and amlodipine in one tablet, group II received metformin in addition to the above therapy. Both groups received a course of 10 sessions of high-tone therapy using the device HiTOP 4 touch (Germany) according to the general method: 2 electrodes on the feet, 2 on the forearms and one on the neck-collar area. All the patients were assessed for their cognitive condition, degree of anxiety and depression, and estimated for quality of life before and after a course of high-tone therapy. In order to do this, we used valid assessment tests, such as the Montreal Cognitive Assessment Scale (MoCA), the Hospital Anxiety and Depression Scale (HADS), and the SF-36 Quality of Life Questionnaire. Results: the course of high-tone therapy for patients with hypertension and CCI led to improved quality of life, on all indicators of the SF-36 scale, except for pain intensity, increased cognitive functions by 3.52 points on the MoCA scale, reduced anxiety by 2.06 points and depression by 1.92 points on the HADS scale. The course of high-tone therapy for patients with CCI, hypertension and type 2 DM resulted in a significant improvement of 5 out of 8 quality of life indicators on the SF-36 scale, cognitive functions by 2.27 points on the MoCA scale and reduced anxiety by 4.3 points, and depression by 0.53 points on the HADS scale. Conclusion: the inclusion of high-tone therapy in the complex treatment of patients with comorbid pathology improves cognitive functions, reduces anxiety and depression, improves quality of life. Keywords: comorbid pathology, high-tone therapy, cognitive functions, anxiety, depression, quality of life,

Pharmacotherapy of diabetes mellitus in patients with heart failure - a nation-wide analysis of contemporary treatment.

Retrospective national sub-analysis of antidiabetic pharmacotherapy in patients with diabetes mellitus (DM) and heart failure (HF) based on data reported to the National Register of Paid Health Services in the Czech Republic between 2012-2018. In 2012, there were 75,022 patients with HF and DM (i.e. 42.5% of patients with HF), 6 years later 117,265 (i.e. 41.0% of HF patients in 2018). The most represented antidiabetic drug was metformin (45.6%). Of the insulins and analogues, glargine showed the largest positive trend (5.8% 2012; 14.8% 2018). Empagliflozin was the most prescribed SGLT-2 inhibitor (1.8% in 2018). A decrease in prescribing was observed for saxagliptin (0.5% 2012; 0.1% 2018) and for sulfonylurea derivates - gliclazide (13.0% 2012; 10.3% in 2018) and glimepiride (12.9% 2012; 9.0% 2018). Linagliptin was the most prescribed dipeptidyl peptidase inhibitor (0.7% 2012; 6.8% 2018). In the Czech Republic, between 2012 and 2008, there was an increase in prevalence of patients with heart failure and concomitant diabetes mellitus, their proportion being similar. In correspondence with other registries, metformin was used mostly. A positive trend was observed in prescription of DDP-4 and SGLT-2 inhibitors, while there was a significant decrease in patients taking sulfonylureas.

Epidemiology of intra-abdominal infiltrates and abscesses in patients with concomitant diseases and diabetes mellitus

The purpose ofthe work — to study the epidemiological factors in the development of primary and secondary intra-abdominal infiltrates, abscesses and fluid formations in patients with concomitant diseases and diabetes. Material and methods. In the clinic of the Department of Surgical Diseases No. 1, on the basis of the Center of Surgery of the Kiev City Clinical Hospital No. 1 from 2006 to 2019,218patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 male patients (49.08 %), 111 female patients (50.92 %). X-ray examination was performed in 112 (51.38 %) patients, computed tomography (CT) in 25 (11.48 %),ultrasound examination of the abdominal organs for 105 (4816 %) patients. Anterior abdominal wall thermometry was performed in 76 (34.86 %) patients. Resultsand discussion. Depending on the cause of the development of intra-abdominal infiltrates, abscesses and fluid formations, the patients were divided into 4 groups. Patients of the first, second and third groups had primary intra-abdominal complications, and in the fourth group patients had secondary postoperative complications. The first group included 74 (33.94 %) patients suffering from a complicated course of destructive appendicitis. The second group included 48 (22.02 %) patients suffering from perforated gastric ulcer and 12 duodenal ulcer. The third group included 69 (31.65 %) patients suffering from cholecystitis and various types of complications. The fourth group included 27 (12.39 %) patients who underwent urgent surgery due to strangulated hernias, adhesive obstruction. The study of the scales showed that: in 87 (39.91 %) the weight was within normal limits, and in 131 (60.09 %) patients were overweight and obese. It was found that 126 (57.80 %) patients wore glasses. Diseases of the cardiovascular system and arterial pressure disorders according to the data of case histories and anamnesis had 123 (56.42 %) patients. Diabetes was diagnosed in 38 (17.43 %) patients. Diseases of the musculoskeletal system were diagnosed in 27 (12.38 %) patients, and 48 (22.02 %) patients suffered from flat feet of various stages. Primary intra-abdominal complications(infiltrates and abscesses) were diagnosed in 191 (3.48 %) patients out of 5483 urgent hospitalizations and operations, of which 74 (1.35 %) with appendicitis, 69 (1.26 %), perforated gastric ulcer and 12 duodenal ulcer in 48 (0.87 %) patients. Secondary postoperative infiltrates, abscesses and fluid formations were found in 27 (18.12 %) of 149 patients who had undergone urgent abdominal surgery (adhesive obstruction, incarcerated and postoperative hernias, etc.), and in 29 (15.18 %) of 191 patients who underwent surgery for primary intra-abdominal complications of the underlying disease and urgent surgery. Diabetes mellitus was diagnosed in 38 (17.4 3%) patients, and therefore all patients who are hospitalized in an urgent and planned manner must undergo a comprehensive clinical and laboratory examination with the determination of blood sugar. The presence of established diabetes mellitus requires the consultation of an endocrinologist, and during the operation it is advisable and necessary to correct glycemic and volemic disorders, which continues until the restoration of vital functions and stabilization of the general condition of the patient. Intra-abdominal complications occurred on the background of concomitant diseases: overweight in 28.44 %, visual impairment in 57.80 %, diseases of the cardiovascular system and arterial pressure disorders in 56.42 %, diseases of the musculoskeletal system in 12.38 %, which indicates the need for an individual approach in the treatment of each patient.

The Footprint of Diabetes Mellitus on the Characteristics and Response to Anti-Tuberculous Therapy in Patients with Pulmonary Tuberculosis from Saudi Arabia.

BackgroundRight now, a tuberculosis (TB) and diabetes mellitus (DM) syndemic is re-emerging worldwide. Given the contradictory results of the impact of DM on the natural history of pulmonary TB (PTB), this study was undertaken to shed light on the precision of this hypothesis from a community with a substantial caseload of both diseases.MethodsThe present 5-year, retrospective, cohort study involved 487 (60.8% males, and 39.2% females) adult PTB patients (mean age 53.71 ± 15.78 years) selected from Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Kingdom of Saudi Arabia (KSA). The relevant patients’ clinical, radiological and microbiological data were extracted from the hospital medical and laboratory database.ResultsIn our study, the cumulative prevalence of DM among PTB subjects was 27.1%. Both diabetic and non-diabetic groups were matched with regard to gender (p = 0.46); however, diabetic patients were significantly older (p = 0.0001). Patients with concomitant DM displayed higher frequency of the classic clinical presentations of PTB and were 1.8 times more likely to have cavitary lesions on imaging studies (p = 0.012). Furthermore, diabetic patients showed higher initial sputum acid-fast bacillus (AFB) smear grade (p = 0.0001) and were more prone to have delayed culture conversion as compared to their non-diabetic counterparts (77.55 ± 37.74 versus 54.95 ± 27.67 days, respectively; p = 0.0001) which points out to less favorable treatment outcome.ConclusionDM showed an impact on different aspects of PTB. Accordingly, integrated bi-directional screening programs for both diseases in the KSA need to be implemented to upgrade health-care services of patients with dual diagnosis.

Abstract 9949: Characterising the Impact of Type Two Diabetes on the Phenotypic Expression of Hypertrophic Cardiomyopathy

Background: Hypertrophic cardiomyopathy (HCM) and type 2 diabetes mellitus (DM) are increasingly frequent comorbidities. DM is associated with worsened survival outcomes in HCM patients. HCM and DM, though differing in their etiologies, share features of alterations in myocardial energetics and perfusion. The mechanisms for this adverse prognostic association are incompletely understood but are likely to include the collective impact of DM and HCM on myocardial metabolism and perfusion. Objectives: We aimed to determine if cardiac energetics, measured as the phosphocreatine (PCr)/ATP ratio, and rest and adenosine stress myocardial blood flows (MBF) showed greater reductions in patients with concomitant HCM and DM (HCMDM) compared to isolated HCM or isolated DM using 31 Phosphorus magnetic resonance spectroscopy ( 31 P-MRS) and cardiovascular magnetic resonance (CMR). Methods: A total of 75 age and sex matched participants were recruited (20 HCMDM, 20 HCM, 20 DM and 15 controls). HCM groups were matched for HCM phenotype (8 with apical and 12 with asymmetric septal hypertrophy in both groups). DM groups were matched for diabetes treatment and HBA1c. Patients with a history of ischemic heart disease were excluded. Results: Table-1 shows clinical and CMR/ 31 P-MRS data.Left ventricular ejection fraction and mass index were similar in both HCM groups. Global longitudinal strain and left atrial function were significantly reduced in HCMDM compared to HCM. PCr/ATP was similarly reduced in HCMDM and DM groups compared to HCM and controls. Stress MBF was significantly reduced only in HCMDM group. Conclusions: The presence of diabetes as a comorbidity confers a more malignant phenotypic expression in HCM patients with greater reductions in myocardial energetics, contractile function, and perfusion. These phenotypic differences may account for the worsened clinical outcomes in HCM patients with concomitant DM. Table 1: Clinical Characteristics and CMR findings

Предиктори 5-річного виживання хворих із хронічною серцевою недостатністю зі зниженою фракцією викиду лівого шлуночка залежно від наявності в них цукрового діабету 2-го типу

The aim – to determine the predictors of 5-year survival of patients with CHF and reduced LV EF depending on the presence of type 2 diabetes mellitus.Materials and methods. 490 case histories of patients in the period from 2011 to 2018 with CHF, 40–80 years of age (median – 64 years), II–IV NYHA functional class, LVEF ≤ 40 % were analyzed. For the analysis of all patients with CHF and reduced LV EF were divided into two groups: Group I included 338 (69 %) patients without diabetes mellitus type 2, group II consisted of 152 (31 %) patients diagnosed with diabetes mellitus type 2. To measure the values ​​of the independent predictors, we calculated the value of the odds ratio (OR) with a 95 % confidence interval. To determine predictors of mortality/survival of the studied patients, was calculated the Хі-square criterion. Additionally, we calculated the estimate of the frequency difference between the groups, the odds ratio, the confidence interval for the odds ratio, the Pearson correlation coefficient r, for all the calculated characteristics we determined the probability of error of the first kind p. As a result, we formed a final table of indicators-predictors of mortality/survival of patients with CHF with reduced LV EF with and without diabetes mellitus type 2 for which there is a statistical relationship between mortality / survival and the studied indicator.Results and discussion. In patients without diabetes, many indicators are associated with the prognosis of long-term survival. These include hemodynamic parameters (heart rate, the left atrium size (LV) and indexed left ventricular (LV) volumes, LV myocardial mass index, right ventricular size (RV) and LV ejection fraction, renal function parameters (microalbuminuria (UIA), glomerular filtration rate (GFR), urea nitrogen), systemic inflammatory marker (C-reactive protein (CRP)), markers of systemic oxidative stress (myeloperoxidase, citrulline, uric acid) and antioxidant defence – SOD, as well as the N-terminal fragment of the precursor of natriuretic peptide (NT-proBNP), flow-dependent vasodilatory response (FDVR), high-density lipoprotein cholesterol (HDL), insulin and the relative content of lymphocytes in the blood. Patients with diabetes had significantly fewer such predictors: in addition to parameters of intracardiac hemodynamics and heart modeling, other significant predictors of 5-year survival were daily UIA level, CRP, SOD, HDL, insulin and the lymphocyte level.Conclusions. Quantitative predictors of poor 5-year survival prognosis among patients with CHF and reduced LV EF with and without concomitant diabetes mellitus type 2 are parameters of heart remodeling, LV systolic function-EF, UIA level, antioxidant stress marker (SOD), HDL level, blood lymphocytes and the level of circulating insulin. Patients without diabetes are characterized by a wider range of poor long-term survival predictors, which include indicators of renal nitrogen function, markers of systemic oxidative stress (myeloperoxidase, citrulline, uric acid), flow-dependent vasodilatory response and circulating NT-proBNP. The determined quantitative predictors can be used in algorithms of individual prediction of the course of CHF and reduced LV EF, which should be created separately for patients with and without concomitant diabetes mellitus type 2

СРАВНИТЕЛЬНОЕ ИЗУЧЕНИЕ ВЛИЯНИЯ ИНСУЛИНОЗАВИСИМОГО САХАРНОГО ДИАБЕТА 2-ГО ТИПА, ОТЯГОЩЕННОЙ НАСЛЕДСТВЕННОСТИ И КУРЕНИЯ НА ТЯЖЕСТЬ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА

Introduction. The presence of high-risk factors such as hereditary burdening, tobacco smoking, and diabetes mellitus significantly worsen the prognosis in potentially healthy individuals by increasing the incidence of coronary heart disease. Aim. To study the separate influence of insulin-dependent diabetes mellitus type 2, heredity and smoking on the severity and course of coronary heart disease. Material and methods. One hundred patients with coronary heart disease were enrolled in the study. The patients were divided according to the presence of the following high-risk factors: heredity, tobacco smoking, and insulin-dependent type 2 diabetes mellitus. The patients were examined at the beginning and 1 year after treatment. The results of echocardiography and electrocardiography were analyzed at the beginning of follow-up and one year later. The severity of coronary artery lesions was assessed using SYNTAX score analysis of coronarography protocols. The number of Q and QS waves on electrocardiogram, increased size and decreased left ventricular ejection fraction were also considered as criteria of coronary heart disease severity. The obtained data were processed using IBM Statistics SPSS-26 program. The differences were considered statistically significant at p&lt;0,05. Results and discussion. Patients with diabetes mellitus were more susceptible to aortocoronary bypass grafting, whereas coronary angioplasty was performed more frequently in patients with heredity (p&lt;0,05). Coronary vessels were more affected in diabetic patients and in tobacco smokers compared with patients with a burdened heredity [(20,4±2,7) points (21,9±1,39) and (12,9±1,8) points, respectively]. Severe heart failure prevailed among patients with concomitant diabetes mellitus. After one year, all patients had a reduction of clinical symptoms of angina and heart failure. The efficacy of medical treatment of angina in patients with heredity was lower compared to other groups. Conclusion. In patients with a history of diabetes mellitus development of coronary heart disease is manifested by severe myocardial and coronary lesions, which increases the risk of coronary artery bypass grafting. Despite this, patients with diabetes mellitus lend themselves well to drug treatment. The tobacco smoking group is not inferior to the diabetes mellitus group by the severity of heart and coronary artery lesions and is well amenable to drug therapy. The last place in the severity of coronary heart disease is occupied by patients with a hereditary burden, although they are more prone to acute coronary syndrome.

Alternative ways to correct poor glucose metabolism in patient with diabetes mellitus

There is an annual increase in the incidence of diabetes recorded worldwide. The existing measures of prevention and multimodal treatment of the disease have not yet brought the desired results. A promising field is bariatric (metabolic) operations used in obese patients, which also improve glucose metabolism in the case of concomitant diabetes mellitus of both types 1 and 2. At the same time, there is a certain contradiction and understatement regarding the mechanisms that lead to remission of diabetes mellitus, regardless of weight loss. One of the anatomical effects of bariatric procedures is the accelerated release of nutrients into the distal segment of the small intestine, which leads to stimulation of enteroendocrine cells and increased secretion of incretins (GLP-1, PYY, etc.). The experiment investigates these mechanisms by the operation of ileal transposition. Further study of the ileal transposition effects using different models of type 1 and type 2 diabetes, accompanied both with and without obesity, may contribute to a more detailed understanding of the triggering and supporting mechanisms of increasing glucose tolerance in the struggle against this disease.

EVALUATION OF NEUTROPHIL-LYMPHOCYTE RATIO IN DIABETES AND CORONARY ARTERY DISEASE: A CASE CONTROL STUDY FROM INDIA

IntroductionSystemic inflammation leads to the development of both type 2 diabetes mellitus (DM) and coronary artery disease (CAD). MethodologyA case-control study of 120 participants was conducted in a tertiary-care center in Northern India. Study participants comprised four groups; 30 healthy controls, 30 patients with DM, 30 with CAD, and 30 with concomitant DM and CAD. Groups were age and sex-matched. CAD was diagnosed by coronary angiography when ≥ one lesion with >50% stenosis was present. Anthropometric measurements, complete hemogram, neutrophil-lymphocyte ratio (NLR), HbA1c, lipid profile, highly-sensitive C-Reactive Protein (CRP), and uric acid levels were measured. ResultsThe mean age was 61.26 ± 7.61, and 80 (66.6%) were male. Multinomial logistic regression analysis was used to determine the association of different parameters with disease. After adjusting for other parameters including body-mass index, HbA1c levels, lipid profile, hsCRP, and uric acid, NLR was an independent predictor of DM vs. Controls (Odds Ratio) 3.802 [1.457-9.917], CAD vs. Controls 9.807 [3.556-27.050], and Both vs. Controls 13.448 [4/725-38.279]. Uric acid was not a significant predictor. hsCRP was an independent predictor of only concomitant CAD and DM vs. Controls 1.558 [1.053-2.303]. A clear stepwise increase in NLR was observed across the four groups: lowest among healthy controls, followed by the DM group, CAD group, and the highest among those with CAD and DM. ConclusionNLR is an easily accessible and inexpensive inflammatory parameter. Appropriate cut-offs of NLR may be beneficial as screening tools for DM, CAD or both.

Diabetes mellitus as a risk factor for aortic stenosis: from new mechanisms to clinical implications.

Aortic stenosis (AS) is a progressive disease, with no pharmacological treatment. The prevalence of diabetes mellitus (DM) among AS patients is higher than in the general population. DM significantly increases the risk of AS development and the rate of its progression from mild to severe. However, the mechanism of the interaction between AS and DM is not fully understood. Limited data regarding the influence of hyperglycemia on valvular calcification are available while understanding the cross-talk between them is pivotal in designing an effective therapeutic approach to prevent or at least retard AS development and/or progression in DM patients. Analysis of aortic stenotic valves revealed that increased accumulation of advanced glycoxidation end products (AGEs) was associated with enhanced valvular oxidative stress, inflammation, expression of coagulation factors and markers of calcification. Moreover, AGEs valvular expression correlated with AS severity. Interestingly, in diabetic AS patients, valvular inflammation correlated only with long-term glycemic control parameters, i.e. glycated hemoglobin and fructosamine but not with serum glucose levels. It has been demonstrated that transcatheter aortic valve replacement (TAVI) is beneficial for AS patients also with concomitant DM and safer as compared to surgical aortic valve replacement (SAVR). Moreover, new antidiabetic drugs, such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors, targeting inhibition of AGEs-mediated oxidative stress, have been proposed to reduce the risk of AS development in DM patients. This review aimed to comprehensively discuss the impact of DM on AS and its potential therapeutic implications.

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery.

Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.

Effect of type 2 diabetes mellitus and mutations of the cyp2c19 gene on the platelets functional activity of patients with ischemic heart heart disease

Abstract Goal To establish sensitivity to clopidogrel in carriers of various G681A alleles of the CYP2C19 gene on the basis of a comprehensive assessment of platelet hemostasis. Materials and methods We examined 120 patients with various forms of coronary heart disease (CHD), including: 60 patients with acute coronary syndrome (ACS), 60 patients with chronic coronary syndrome (CCS). All patients were treated with clopidogrel. Results Genotyping of patients revealed that 73.3% of the examined cohorts of patients with ACS and 86.4% of patients with CCS were dominated by the native genotype G/G. In the cohort of patients with ACS, the degree of spontaneous platelet aggregation (SPA) among patients with G/A-A/A genotype exceeded the control values by 4.6 times (p&amp;lt;0.001). When compared with the corresponding indicator in patients with G/G genotype, it was found that the presence of a mutated A-allele had no significant effect on the increase in SPA (OR=2,450; 95% CI: 0.462–12.982; p=0.480). The degree and rate of arachidonic acid (AA)-induced platelet aggregation was significantly lower than the control values in all subgroups, but did not differ between subgroups of patients with different polymorphisms (OR=0.625; 95% CI: 0.065–6.090; p=0.912). Studying the degree and rate of ADP-induced platelet aggregation did not reveal statistically significant changes either in comparison with the control group or in the intergroup analysis. There was also no significant association between CYP2C19 gene polymorphisms and the degree of ADP aggregation (OR=0.795; 95% CI: 0.216–2.928; p=0.983). In patients with stable CHD, despite the use of clopidogrel in all patients, the level of SPA was significantly higher than the control values and depended on the polymorphism of the CYP2C19 gene. To evaluate the effect of diabetes on the effectiveness of inhibition of platelet functional activity by clopidogrel in carriers of different allelic variants of the CYP2C19 gene, we compared the G/G and G/A-A/A genotypes. The group of isolated coronary heart disease consisted of 48 patients with G/G genotype (80%) and 12 patients with mutated A-allele (20%). Patients with pathology of carbohydrate metabolism were distributed as follows: 47 patients had G/G genotype (78%), and 13 - G/A-A/A (22%). It was found that when carrying the G/A-A/A genotype, the intergroup difference was 72.6% (57.65 [49.34; 67.8] vs. 33.4 [32.47; 37.99], p&amp;lt;0.01). The chance of encountering a high degree of ADP-induced aggregation among carriers of the A-allele of the CYP2C19 gene with diabetes was almost 17 times significantly higher than the group of patients with isolated coronary heart disease (OR=16,667 (2,273–122,218), p=0.009). Conclusion The data obtained in our study showed that the patients with CHD and concomitant diabetes mellitus who had a mutated A-allele CYP2C19 gene was less sensitive to clopidogrel, which was manifested in a higher degree of ADP-induced platelet aggregation. Funding Acknowledgement Type of funding sources: None.

Ticagrelor monotherapy after percutaneous coronary intervention in patients with concomitant diabetes mellitus and chronic kidney disease: a TWILIGHT substudy

Abstract Background Diabetes mellitus (DM) and chronic kidney disease (CKD) are established risk factors for cardiovascular events, with patients presenting both conditions being at extremely high risk. P2Y12 inhibitor monotherapy with ticagrelor after a short course of dual antiplatelet therapy has emerged as a bleeding avoidance strategy for high-risk patients undergoing percutaneous coronary intervention (PCI). Purpose To investigate ischemic and bleeding outcomes associated with ticagrelor monotherapy versus ticagrelor plus aspirin according to the presence or absence of CKD and DM. Methods The TWILIGHT trial enrolled patients undergoing PCI with a drug-eluting stent who fulfilled at least one clinical and one angiographic high-risk criterion. Both DM and CKD (estimated glomerular filtration rate &amp;lt;60 mL/min/1.73m2) were clinical study entry criteria. Following 3 months of ticagrelor plus aspirin, patients who had been adherent to treatment and free from major adverse events were randomly assigned to either aspirin or placebo in addition to ticagrelor for 1 year. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The key secondary endpoint was the composite of all-cause death, myocardial infarction, or stroke. Net adverse clinical events (NACE) were defined as BARC type 3 or 5 bleeding, all-cause death, myocardial infarction, or stroke. Results Of the 6273 patients included in the analysis, 8.0% had both CKD and DM (DM+/CKD+), 8.9% had CKD only (DM-/CKD+), 29.0% had DM only (DM+/CKD-), and 52.1% had neither CKD nor DM (DM-/CKD-). At 1-year follow-up, there was a progressive increase in the rates of bleeding and ischemic events according to DM and CKD status (Figure 1). Ticagrelor plus placebo reduced the primary bleeding endpoint as compared with ticagrelor plus aspirin across all study groups, including DM+/CKD+ patients (4.7% vs. 8.7%; HR 0.52, 95% CI 0.25–1.07), with no evidence of heterogeneity (p-interaction=0.68). Similar treatment effects of ticagrelor monotherapy were observed for major BARC type 3 or 5 bleeding (p-interaction=0.17), with DM+/CKD+ patients showing the greatest absolute risk reduction (0.9% vs. 5.1%; HR 0.16, 95% CI 0.04–0.72). The key secondary endpoint was not significantly different between treatment arms across study groups, with the exception of a reduced risk in DM+/CKD- patients receiving ticagrelor monotherapy (p-interaction=0.033). A similar pattern in the DM+/CKD- group was observed for NACE (p-interaction=0.030) (Figure 2). Conclusions Among high-risk patients undergoing PCI, ticagrelor monotherapy reduced the risk of clinically relevant and major bleeding without a significant increase in ischemic events as compared with ticagrelor plus aspirin, irrespective of the presence of DM and CKD. Furthermore, ticagrelor monotherapy seemed to be associated with a more favourable net benefit in patients with DM without CKD. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator-initiated grant from AstraZeneca Figure 1. Event rates according to DM/CKD statusFigure 2. Effects of ticagrelor monotherapy