Diagnosis Of Diabetes In Patients Research Articles

Survival benefit of metformin use according to cancer diagnosis in diabetic patients with metabolic syndrome

BackgroundMetabolic syndrome (MetSyn) is a disease cluster causing cardiovascular disease, cancer, and high mortality. Metformin is the most common antidiabetic agent inhibiting the tumorigenesis and insulin resistance of MetSyn. We describe the association between metformin intake and survival of patients with type 2 diabetes mellitus (T2DM) and MetSyn, according to the presence of cancer. MethodsWe analyzed the clinical characteristics and all-cause mortality of patients with T2DM and MetSyn using a 5-year dataset between January 1, 2009 and December 31, 2013 derived from the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). Cox proportional hazards regression models were used to investigate metformin effects adjusted for other potential confounding variables. ResultsAmong a total of 43,043 patients with both MetSyn and T2DM, 24,725 patients (57.4 %) received metformin regularly. Female sex, high income, regular exercise, and metformin use were good prognostic factors, whereas hypertension, current smoking, cancer, and diabetes medication (except metformin) were poor prognostic factors. After adjustment for possible confounding variables, metformin showed a significant effect on patient survival (hazard ratio [HR], 0.68; 95 % confidence interval [CI], 0.63–0.75; p < 0.001). The effect of metformin was pronounced on the group of patients with liver, lung, colorectal, or prostate cancers (HR, 0.57; CI, 0.46–0.70). ConclusionsMetformin intake may be related to favorable survival among patients with T2DM and MetSyn. The efficacy might be more remarkable in those with liver, lung, colorectal, and prostate cancers. The potential benefit of metformin in patients with these risk factors should be further investigated.

Current Opinion on Diagnosis of Peripheral Artery Disease in Diabetic Patients.

Peripheral arterial disease (PAD) prevalence and diabetes mellitus (DM) prevalence are continuously increasing worldwide. The strong relationship between DM and PAD is highlighted by recent evidence. PAD diagnosis in diabetic patients is very important, particularly in patients with diabetic foot disease (DFD); however, it is often made difficult by the characteristics of such diseases. Diagnosing PAD makes it possible to identify patients at a very high cardiovascular risk who require intensive treatment in terms of risk factor modification and medical therapy. The purpose of this review is to discuss the diagnostic methods that allow for a diagnosis of PAD in diabetic patients. Non-invasive tests that address PAD diagnosis will be discussed, such as the ankle-brachial index (ABI), toe pressure (TP), and transcutaneous oxygen pressure (TcPO2). Furthermore, imaging methods, such as duplex ultrasound (DUS), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), are described because they allow for diagnosing the anatomical localization and severity of artery stenosis or occlusion in PAD. Non-invasive tests will also be discussed in terms of their ability to assess foot perfusion. Foot perfusion assessment is crucial in the diagnosis of critical limb ischemia (CLI), the most advanced PAD stage, particularly in DFD patients. The impacts of PAD diagnosis and CLI identification in diabetic patients are clinically relevant to prevent amputation and mortality.

Diabetes Mellitus and Poor Glycemic Control Are Associated With a Higher Risk of Lumbar Spinal Stenosis: An Analysis of a Large Nationwide Database.

A large-scale retrospective case-control study. Examine diabetes as a risk factor for lumbar spinal stenosis (LSS) development and evaluate the impact of diabetes duration, glycemic control, and associated complications on this risk. Diabetes mellitus, a multiorgan disorder impacting various connective tissues, induces histological changes in spinal structures, particularly the ligamentum flavum. While clinical studies suggest a higher incidence of LSS in diabetic patients, substantial epidemiological research on the likelihood of LSS diagnosis in individuals with diabetes is scarce. Using nationwide data, a total of 49,576 patients diagnosed with LSS based on International Classification of Diseases-10 codes were matched with controls of the same number based on age and sex. Employing a multivariable logistic regression model, the study assessed for the association between spinal stenosis and diabetes, while adjusting for confounders. We found a higher likelihood of LSS diagnosis in diabetic patients [odds ratio (OR) 1.39, 95% CI: 1.36 - 1.43, P <0.001]. Those with hemoglobin A1c ≥7% and ≥1 diabetes-related complication also had an elevated likelihood (OR: 1.19, 95% CI: 1.08-1.31, P =0.001). Prolonged diabetes exposure increased the risk. Diabetes diagnosis reduced median survival by around 4.5 years for both stenosis and nonstenosis patients; spinal stenosis diagnosis alone minimally impacted survival. Relative to individuals diagnosed with diabetes mellitus at the age of 65 or older, the OR for developing LSS were 1.22 (95% CI: 1.18-1.27, P <0.001) when DM was diagnosed at 50 to 65 years old and 1.67 (95% CI: 1.56-1.79, P <0.001) for those under 50 years old. Multivariate analysis revealed a significantly increased risk of all-cause mortality in patients with DM and spinal stenosis (hazard ratio: 1.36, 95% CI: 1.29-1.44, P <0.001) and those with DM without stenosis (hazard ratio: 1.49, 95% CI: 1.41-1.57, P <0.001) compared with controls. Diabetic patients with prolonged disease, poor glycemic control, and diabetes-related complications face an elevated risk of developing LSS. Recognizing the reciprocal adverse relationship between these conditions is crucial in clinical practice and designing public health measures for managing both conditions. 4.

Expression and clinical association of MFG-E8 and TAM receptors in diabetic patients with different stages of microvascular complication: An experimental study.

Diabetic nephropathy (DN) is a major microvascular complication of diabetes mellitus that leads to end-stage renal disease. Hyperglycemia triggers apoptosis and kidney damage. Milk fat globule-epidermal growth factor 8 (MFG-E8) and TAM receptor tyrosine kinases, Tyro3, Axl, and Mer, are phagocytic receptors that mediate the clearance of apoptotic cells. This study aimed to identify the role of MFG-E8 and TAM receptors in the development of DN. A total of 146 patients with type 2 diabetes mellitus (T2DM), early stage DN, clinical DN and 48 healthy controls were employed to analyze the serum levels of MFG-E8, soluble Tyro3, Axl, Mer, and RAGE by enzyme-linked immunosorbent assay. The serum levels of CREA, hsCRP, CysC, and β2-microglobulin were measured by spectrophotometric analysis using a biochemical analyzer (AU5800). Our results showed that the serum levels of MFG-E8 were elevated in patients with T2DM compared with healthy controls; however, it decreased gradually in patients with DN with the severity of kidney injury, especially in the clinical DN group. Moreover, the levels of sTyro3, sAxl, and sMer were reduced in patients with T2DM and DN compared to healthy controls, particularly in patients with DN. The levels of MFG-E8, sTyro3, sAxl, and sMer were negatively correlated with UAER at 24 hours, CREA, hsCRP, CysC, β2-microglobulin, and RAGE, respectively. In addition, TAM receptors had significantly higher predictive and diagnostic values for early stage DN from T2DM than hsCRP, β2-microglobulin, and CysC, which are also predictive biomarkers of early stage DN from clinical DN. Decreased MFG-E8 and TAM receptor expression is associated with an increased risk of microvascular complications in patients with T2DM, which plays a critical role in the diagnosis of diabetic patients with microvascular complications, especially early stage DN, and in monitoring the development of DN.

Optimal glycated hemoglobin A1c value for prediabetes and diabetes in patients with pancreatic diseases.

Some articles suggest that using HbA1c alone for diabetes diagnosis is inappropriate. It requires considerable researches to explore the efficacy of HbA1c for diagnosing hyperglycemia in patients with pancreatic disease. This study analyzed 732 patients, comprising of 331 without pancreatic disease and 401 patients diagnosed with pancreatic diseases. All participants underwent the HbA1c assay and oral glucose tolerance test. Kappa coefficients were calculated to assess agreement between the HbA1c and glucose criteria. The receiver operating characteristic curve (ROC) was used to calculate the optimal HbA1c value. DeLong test was analyzed to compared the aera under curves (AUCs). There were 203 (61.3%) patients with NGT, 78 (23.6%) with prediabetes, and 50 (15.1%) with diabetes in patients without pancreatic diseases. In patients with pancreatic disease, 106 participants were diagnosed with NGT (36.4%), 125 with prediabetes (31.2%), and 130 with diabetes (32.4%). Patients with pancreatic disease exhibited elevated levels of bilirubin, transaminase enzymes, aspartate transaminase, high density lipoprotein cholesterol and total bile acid. The sensitivity and specificity of the HbA1c (6.5%) for diagnosing pancreatic diabetes were 60.8% (95% CI 52.3, 69.3) and 92.6% (95% CI 89.5, 95.7). In prediabetes, the sensitivity and specificity of HbA1c (5.7%) is 53.2% (44.3, 62.0) and 59.6 (51.5, 67.6). The optimal HbA1c value for diagnosing diabetes was 6.0% (AUC = 0.876, 95% CI 0.839, 0.906), with the sensitivity of 83.8% and the specificity of 76.8%. The optimal HbA1c value for the diagnosis of prediabetes was 5.8% (AUC = 0.617, 95% CI: 0.556, 0.675), with the corresponding sensitivity and specificity of 48.0% and 72.6% respectively. The combined tests (HbA1c, 6.0% or FPG, 7.0mmol/L) presented the sensitivity of 85.7% (95% CI 79.1, 91.3)and the specificity of 92.6% (95% CI 87.6, 97.3) in pancreatic diabetes. From our results, the recommended HbA1c by ADA criterion may not be sufficiently sensitive to diagnose hyperglycemia in pancreatic disease. The optimal value of 5.8% and 6.0% improved the accuracy for diagnosing prediabetes and diabetes and should be considered to be applied. Besides, we advocate the combination of HbA1c and FPG test for the diagnosis of diabetes in patients with pancreatic diseases.

A Highly Stable Graphene‐Based Metal Oxide Nano Enzyme with the Peroxidase‐Mimetic Activity for Equipment‐Free Diagnosis of Diabetic Patients

AbstractNanozymes are gaining attention as promising alternatives to natural enzymes due to their unique characteristics. In this study, CuO nanoparticles were decorated on three‐dimensional nitrogen‐doped graphene‐based frameworks (CuO/3D(N)GFs) were prepared through a facile hydrothermal process. The prepared nanocomposite was characterized using XRD, EDX, FTIR, and SEM to determine its structure, composition, and morphology. The CuO/3D(N)GFs showed excellent peroxidase mimetic activity, followed Michaelis‐Menten kinetics, and exhibited better kinetic parameters (Km and Vmax) for H2O2 substrate than the natural enzyme, making it a superior catalyst. A rapid and facile colorimetric platform was developed to diagnose diabetes with the naked eye by coupling the activities of the nanozyme and glucose oxidase. This technique can quantitatively measure the glucose with high precision in diabetic patients, with a linear range of 1–10 mM and good sensitivity/selectivity toward glucose. The highest peroxidase‐like activity of the nanozyme was observed at 30 °C, but it still retained over 60 % of its activity between 20–65 °C and showed long‐term storage stability. Therefore, the CuO/3D(N)GFs nanocomposite holds promise for catalysis, biosensing, and bioanalysis applications.

Frequency and characteristics of diabetes in lipodystrophies and insulin receptoropathies compared with type 1 and type 2: results from the multicenter DPV registry.

To investigate the frequency, treatment, and outcome of patients with diabetes due to severe insulin resistance syndromes (SIRS). Based on data from the multicenter prospective Diabetes Registry DPV, we analyzed diagnosis, treatment, and outcome of 636,777 patients with diabetes from 1995 to 2022. Diabetes due to SIRS was documented in 67 cases (62.7% females), 25 (37%) had lipodystrophies (LD) and 42 (63%) had congenital defects of insulin signaling. The relative frequency compared to type 1 diabetes (T1D) was about 1:2300. Median age at diabetes diagnosis in patients with SIRS was 14.8 years (interquartile range (IQR) 12.8-33.8). A total of 38 patients with SIRS (57%) received insulin and 34 (51%) other antidiabetics, mostly metformin. As high as 16% of patients with LD were treated with fibrates. Three out of eight patients with generalized LD (37.5%) were treated with metreleptin and one patient with Rabson-Mendenhall syndrome was treated with recombinant insulin-like growth factor 1. The median glycated hemoglobin level at follow-up was 7.1% (54 mmol/mol). Patients with LD had higher triglycerides than patients with T1D and T2D (P < 0.001 and P = 0.022, respectively), and also significantly higher liver enzymes and lower high-density lipoprotein cholesterol than patients with T1D (P < 0.001). Patients with insulin receptor disorders were significantly less likely to be treated with antihypertensive medication than patients with T2D (P = 0.042), despite having similar levels of hypertension. Diabetes due to SIRS is rarely diagnosed and should be suspected in lean children or young adults without classical T1D. Awareness of cardiovascular risk factors in these patients should be raised.

1290-P: A Rare Case of HNF1A-MODY

Introduction: Maturity onset diabetes of the young (MODY) is a monogenic nonimmune type of diabetes mellitus. It is rare and sometimes misdiagnosed as type 1 or type 2 diabetes (T2DM) . The age of onset is usually below 25 years. It is more common in the European population. Hepatocyte nuclear factor 1-alpha (HNF1A) is one of the most common mutations and is associated with cardiovascular and renal complications.1 Genetic testing in patients with strong hereditary factors results in definitive diagnosis and subsequent appropriate treatment.2 The aim of this report is to emphasize the importance of distinguishing MODY by considering the family history of diabetes and relative clinical features. Case presentation: A 58-year-old Filipino woman was diagnosed with T2DM at age 15. Her mother, 5 of 8 siblings and her daughter all had diabetes. They all died in the 2nd or 3rd decades of their life due to diabetes complications. Her grandfather was European. She has renal insufficiency, coronary heart disease and heart failure. Treatment included glimepiride 2 mg daily and sitagliptin 25 mg daily. The physical exam was unremarkable. Body mass index (BMI) was 21. GAD 65 antibody and Islet cell antibody were negative, C peptide: 3.6 ng/mL, blood sugar: 1mg/dL, HbA1c: 7.3%, creatinine: 2.15 mg/dL and GFR: 25 mL/min/1.73m2. A diagnosis of MODY was considered due to strong family history of diabetes, young age at the onset of diabetes and normal BMI. DNA sequencing demonstrated positive HNF1A mutation compatible with HNF1A-MODY. Due to post prandial hyperglycemia, glimepiride was replaced with pre-meal lispro. Conclusion: This is a rare case of HNF1A-MODY found in a Filipino patient. MODY should be included in the differential diagnosis of diabetic patients with an extensive family history of diabetes, young age of onset of diabetes and negative pancreatic antibodies. Early diagnosis with genetic profiling can guide therapy and hopefully decrease the vascular complications of long-term poor glycemic control. Disclosure S.Velayati: None. M.Shanik: Consultant; Bigfoot Biomedical, Inc., Proteomics International, Research Support; Better Therapeutics, Speaker's Bureau; Abbott, Boehringer Ingelheim International GmbH, Novo Nordisk, Xeris Pharmaceuticals, Inc. I.J.Romao: None.

Correlation Between Glycated Hemoglobin (HbA1c) and Post-Systolic Index Measured by Speckle-Tracking Echocardiography in Patients with Non-apparent Coronary Artery Disease.

Glycated hemoglobin (HbA1c) is a useful biomarker for the diagnosis of diabetes and also for determination of individuals with an increased risk of a severe disease. Some subtle changes in myocardial contractile function is measurable by post-systolic index (PSI) which is defined as late systolic shortening after aortic valve closure. The aim of our study was to determine the relationship between HbA1c and PSI in patients with non-apparent coronary artery disease (CAD) on angiograms. This study was a historical cohort study on 85 consecutive patients with a left ventricular ejection fraction ≥ 50% and non-apparent CAD on angiogram. Patients were divided into two groups based on their HbA1c levels, regardless of the diagnosis of diabetes in these patients, to patients with an HbA1c level of equal or higher than 5.7% and those with an HbA1c of less than 5.7%. A speckle-tracking echocardiography was performed for all patients and global longitudinal strain, PSI, left ventricular diameters, left atrial volume, pulsed-Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. PSI, E/e' ratio, and A wave were higher and e' velocity was lower in patients with HbA1c ≥ 5.7% than those with a level of < 5.7% (P value = 0.04, 0.001, 0.014, and 0.004, respectively). Other echocardiographic variables were not different between two groups. Multiple linear regression analysis showed the association between HbA1c and PSI was independent of other demographic, biochemical, and echocardiographic variables (B = 35.674, 95% CI 10.741-60.606, P value = 0.006). Our study showed PSI is more pronounced in individuals with an HbA1c > 5.7% than those with a lower value in the absence of CAD. Because PSI is an important indicator of adverse outcome and increased mortality, these data can underline the importance of an abnormal HbA1c level and its association with subtle cardiac dysfunction, irrespective of the diagnosis of diabetes in patients with non-apparent CAD.

Assessing the level of infectious and inflammatory factors in acute ischemic stroke in diabetic and non-diabetic patients

Introduction. Stroke is one of the principal leading causes of death globally. In 2005, stroke cause approximate 5.7 million death, 87% of deaths was in low and middle-income countries. Recently period, collecting evidence indicated that inflammation and atherosclerosis play important roles in stroke evolution. Material and method. In this prospective longitudinal observational study including 340 patients with acute ischemic stroke with / without diabetes mellitus we analyzed as main criteria infectious factors, inflammatory factors and biochemical factors. The patients were divided into 2 groups: 101 diabetic patients (study group) and 239 non-diabetic patients (control group), were we analyzed as main criteria infectious factors (cytomegalovirus IgG plasma level, cytomegalovirus IgM plasma level, Helicobacter pylori IgG plasma level), inflammatory factors (leucocyte, C-reactive protein) and biochemical (plasma level of fibrinogen). Results. Cytomegalovirus-IgG levels are lower in diabetic versus non-diabetic patients with an arithmetic mean of 1170 AU/ml (95% CI 862.4169 to 1477.8326) versus 1398 AU/ml (95% CI 1169.6839 to 1627,2042) but this difference, although it exists, is not statistically significant p = 0.123. The cytomegalovirus-IgM level is lower in diabetic versus non-diabetic patients a statistically significant difference, p 0.001. The Helicobacter IgG level is lower in diabetic patients with a mean value of 1.0763 U/ml with a 95% CI from 0.8141 to 1.3386 versus non-diabetics with an average of 1.3943 U/ml with a CI of 95% from 1.1963 to 1.5923, but this difference, although there, is not statistically significant, p = 0.07.The number of leukocytes diagnosed in diabetic patients is lower than that of people without diabetes (p = 0.0001). The level of C-reactive protein at diagnosis of diabetic patients is lower (an average value of 3.0207mg/dl with a 95% CI of 0.9726 to 5.0688) than in people who do not suffer from diabetes (arithmetic mean of 5.8218 mg/dl with a 95% CI of 0.5894 to 11.0542), but this difference is not statistically significant. The serum level of fibrinogen at the diagnosis of diabetic patients is lower, with a mean value of 399.4 mg/dl with a 95% CI of 327.7993 to 471.0749, than that of people without diabetes, with an arithmetic mean of 653.8 mg/dl, with a 95% CI of 497.8700 to 809.8647, the difference being statistically significant, p = 0.041. Conclusions. Inflammatory markers such as leukocyte levels at intake, C-reactive protein (CRP), and fibrinogen levels showed lower levels at admission in diabetic patients versus non-diabetic patients. There is no statistically significant difference between diabetic vs. non-diabetic patients regarding cytomegalovirus IgG levels, referring to cytomegalovirus IgM level is lower in diabetic versus non-diabetic patients with significant statistically difference. The Helicobacter IgG level is lower in diabetic patients versus non-diabetics patients.

Effect of Blood Lipid Test in Clinical Diagnosis of Diabetic Patients

Effect of Blood Lipid Test in Clinical Diagnosis of Diabetic Patients

MON-LB126 A Benign and Favorable Diagnosis: Glycogen Hepatopathy Causing Transient Transaminitis During Diabetic Ketoacidosis in Type 1 Diabetes Mellitus

Background: Transient transaminitis is a rarely discussed complication of uncontrolled diabetes mellitus (DM). Known as glycogenic hepatopathy (GH), it is belived to be caused by build-up of glycogen in hepatocytes. Recognized as benign and reversible, GH is associated with hepatomegaly (>90% cases) and primarily seen in patients with type 1 DM during periods of inadequate hyperglycemic control. Differential diagnoses include glycogen storage diseases, nonalcoholic fatty liver disease, hepatosclerosis, autoimmune hepatitis, hemochromatosis, Wilson disease, and acute viral hepatitis.1 Case Report: A 26-year-old African American female with type 1 DM and sickle cell presented on multiple occasions to the emergency department with abdominal pain associated with nausea, vomiting and diarrhea. Initial labs consistently included glucose levels >600 mg/dL (70-105 mg/dL), elevated anion gap ranging 20-40s mEq/L (5-15 mEq), and severe metabolic acidosis reflective of diabetic ketoacidosis (DKA). Labs were also significant for repeated mild transaminitis despite adequate fluid hydration.After several admissions, we observed a distinct pattern of mild transaminitis that directly fluctuated with her levels of blood glucose. With some minor lag, the patient’s liver enzymes normalized when her glucose levels normalized and DKA resolved.Further work-up ruled out more common etiologies of liver injury. Multiple abdominal ultrasounds and CT scans showed a normal sized liver without obvious structural abnormalities. Labs were significant for negative hepatitis B and hepatitis C; several negative anti-smooth muscle, anti-nuclear antibody, centromere antibody, and liver kidney microsomal type 1 antibody; normal levels of ceruloplasmin and alpha 1 anti-trypsin; low iron levels 23 ug/dL (60-180 ug/dL); borderline low IgG 627 mg/dL (700-1600 mg/dL).We hypothesized that the patient likely had GH by exclusion of other liver pathologies and given the context of transient transaminitis during DKA. Conclusion: GH is a benign and favorable diagnosis in diabetic patients with elevated transaminases.1 Given the small number of cases of GH reported, there is a need to record and analyze more patients with likely GH in order to better understand the condition. Appropriate clinician awareness of GH can also eliminate the need for time consuming and costly workup.

Performance Impact of Genetic Operators in a Hybrid GA-KNN Algorithm

Diabetes is a chronic disease caused by a deficiency of insulin that is prevalent around the world. Although doctors diagnose diabetes by testing glucose levels in the blood, they cannot determine whether a person is diabetic on this basis alone. Classification algorithms are an immensely helpful approach to accurately predicting diabetes. Merging two algorithms like the K-Nearest Neighbor (K-NN) Algorithm and the Genetic Algorithm (GA) can enhance prediction even more. Choosing an optimal ratio of crossover and mutation is one of the common obstacles faced by GA researchers. This paper proposes a model that combines K-NN and GA with Adaptive Parameter Control to help medical practitioners confirm their diagnosis of diabetes in patients. The UCI Pima Indian Diabetes Dataset is deployed on the Anaconda python platform. The mean accuracy of the proposed model is 0.84102, which is 1% better than the best result in the literature review.

Flow Density in Optical Coherence Tomography Angiography is Useful for Retinopathy Diagnosis in Diabetic Patients

Our study evaluated the diagnostic capability of flow density (FD) in OCT angiography (OCTA) for diabetic retinopathy (DR) detection in diabetic patients. We studied 93 eyes of 68 diabetic patients who underwent OCTA (36 and 57 eyes without and with DR, respectively). Retinal capillary FD of a 2.6 × 2.6 mm2 area and four divided areas at the superficial (SCP) and deep capillary plexus (DCP) were measured. Predictions were evaluated using the area under the receiver operating characteristic curve (AUC). The diagnostic capabilities of the FDs in discriminating between eyes without DR and eyes with total or early DR were compared. Furthermore, predictions with foveal avascular zone (FAZ) area, hemoglobin A1c (HbA1c), and DM duration were also compared with FD. Prediction using FD AUC in the temporal side in the DCP (0.83) was the highest and significantly better than all other AUCs examined (P < 0.05), including discriminating between eyes without DR and with early DR (P < 0.01). Prediction using this particular AUC was also significantly better than that by FAZ area and HbA1c (P < 0.001 and <0.001, respectively). Area-divided FD in OCTA may be valuable for diagnosing retinopathy in diabetic patients.

Insulin Resistance in Patients with Essential Hypertension Using Homeostatic Model Assessment

Introduction: Insulin resistance has a strong relationship with the incidence of type II diabetes. It also has a direct relationship with other risk factors of diabetes, which together are known as metabolic syndrome. The aim of this study was to investigate the relationship between insulin resistance and hypertension.Materials and Methods: In this historical cohort study, 90 patients were divided into three different groups: those without hypertension, those with controlled hypertension, and those with uncontrolled hypertension. Systolic and diastolic blood pressure, body mass index, and laboratory test results such as cholesterol, triglycerides, low- density lipoprotein, high-density lipoprotein, fasting plasma glucose, and fasting plasma insulin were compared among the three groups. Data were analyzed with t-tests and the analysis of variance test, which were performed using statistical package for the social sciences version 20 software.Results: Age and sex were the same among the three groups; however, BMI, systolic blood pressure, and diastolic blood pressure in the uncontrolled-hypertension group were higher than in the controlled-hypertension and without-hypertension groups (P&lt;0.05). Lipid profile (P&lt;0.05), creatinine (P=0.77), and uric acid (P=0.233) were not significantly different among the groups, although fasting plasma insulin (P=0.012) and homeostatic model assessment of insulin resistance (P=0.038) were significantly higher in the uncontrolled-hypertension group than in the other groups.Conclusion: Homeostasis model assessment of insulin resistance in patients with uncontrolled hypertension was higher than in patients with controlled hypertension and those without hypertension. Therefore, homeostatic model assessment of insulin resistance can be used as a predictive clinical test for the early diagnosis of diabetes in patients with uncontrolled hypertension.

Utility and Limitations of Glycated Hemoglobin (HbA1c) in Patients with Liver Cirrhosis as Compared with Oral Glucose Tolerance Test for Diagnosis of Diabetes.

IntroductionTo study the utility of glycated hemoglobin (HbA1c) in the diagnosis of diabetes in patients with cirrhosis as compared to the gold standard oral glucose tolerance test (OGTT) and to see the effect of anemia and severity of cirrhosis on its performance.MethodsIndividuals (n = 100) with an established diagnosis of liver cirrhosis were recruited. The OGTT was performed as described by the World Health Organization (WHO). The severity of cirrhosis was calculated using the Child–Turcotte–Pugh (CTP) score. The severity of anemia was defined according to WHO criteria. The utility of HbA1c was compared against the OGTT results. Test sensitivity and specificity were used to describe the diagnostic accuracy of HbA1c.ResultsA total of 100 subjects aged 46.9 ± 9.1 years (mean ± standard deviation) participated in the study, of whom 65% were recruited from out patient department of our hospital. The overall sensitivity and specificity of a HbA1c level of ≥ 6.5% for the diagnosis of diabetes in patients with cirrhosis was 77.1% (95% CI 59.9, 89.6) and 90.8% (95% CI 81.0, 96.5), respectively. The positive and negative predictive values were 81.8% (95% CI 67.3, 90.8) and 88.1% (95% CI 80.0, 93.2), respectively. The area under the curve was 0.85 (95% CI 0.75–0.94). The sensitivity of HbA1c for diagnosing diabetes in outpatients was 87.0% (95% CI 66.4, 97.2) and was better than that for diagnosing diabetes in hospitalized patients (58.3%; 95% CI 27.7, 84.8). The sensitivity of HbA1c for diagnosing diabetes was poor in patients with moderate to severe anemia. The difference in sensitivity and specificity was not statistically different for CTP classes A, B and C. The prevalence of diabetes as defined by American Diabetes Association OGTT criteria was 35% (95% CI 25.7–45.2%).ConclusionsTaking OGTT as the gold standard, the sensitivity of HbA1c for diagnosing diabetes is good when used in outpatients with cirrhosis. However, the sensitivity of HbA1c decreases when it is used for hospitalized patients, suggesting that it is not a good test for diagnosis of diabetes in such cases. It also performs poorly if the patient has moderate to severe anemia.

Periodontitis and diabetes: A bidirectional, cyclical relationship - A brief review

Diabetes mellitus and periodontitis have been said to have a bidirectional cyclical relationship, with diabetes leading to oral disease, and periodontitis, in turn, exacerbating hyperglycemia. Periodontitis is recognized as the sixth major complication of diabetes, having increased prevalence and severity in patients with diabetes. Early diagnosis of diabetes in patients with periodontitis can lead to the prevention of major morbidity and mortality associated with the disease. Therapy for diabetes may also lead to the improvement of periodontitis. In this review, we are presenting the current knowledge of the interplay and interaction between these two entities and the available data regarding treatment of the two entities together.

Physiological Targets for the Treatment of Diabetic Encephalopathy

Diabetes mellitus is a chronic degenerative disease responsible for hyperglycemic episodes through insulin secretion deficiency or cellular resistance. Clinical diagnosis in diabetic patients established that this disease affects the CNS, damaging the brain and impairing cognition, and thus establishing a clinical diabetic condition named diabetic encephalopathy. Despite the physiological mechanisms responsible for the development diabetic encephalopathy are still unclear, an excessive formation of reactive oxygen species, an alteration of acetylcholinesterase activity, and a reduction of growth factor levels, may be related with the pathogenesis of this condition. Pharmacological treatments with natural compounds have been proven useful to treat and cure a wide variety of diseases through their antioxidant actions. This study built a compendium of chemical compounds used for the treatment of diabetic encephalopathy demonstrating the most important physiological targets that future drugs should aim for, reviewing them. As previously suspected, antioxidants and acetylcholinesterase inhibitors were useful to prevent memory loss in streptozotocin-induced animals. In addition, growth factors showed an improvement of memory in diabetic rodents. Most studies focused on antioxidant compounds despite cross studies researched both antioxidants and acetylcholinesterase activities. Therefore, it could be suggested that future studies regarding treatments for diabetic encephalopathy should focus on the antioxidant profile and acetylcholinesterase, since they seem to play pivotal roles in cognitive impairment in diabetes. No less important, studies with growth factors are also important physiological targets for treating the diabetic encephalopathy.

51 The prevalence of diabetes mellitus in patients with multivessel disease undergoing PCI and CABG before and after the freedom trial. Have the trial findings impacted practice

<h3>Aims</h3> The FREEDOM trial published in 2012 found coronary artery bypass grafting (CABG) to be superior to percutaneous coronary intervention (PCI) in reducing rates of death and myocardial infarction in patients with diabetes mellitus (DM) and multi-vessel coronary artery disease (CAD) undergoing revascularisation. The aim of this study was to evaluate practice in a tertiary Irish Cardiothoracic centre regarding revascularisation in diabetic patients and to assess if the findings of the FREEDOM trial impacted treatment patterns. <h3>Methods</h3> This was an observational study in which all cases undergoing PCI and CABG in Cork University Hospital (CUH) for the years 2008 and 2013 were retrospectively reviewed. Data on the extent of CAD and the procedure details were collected. The prevalence of diabetes mellitus was calculated. CABG and PCI rates for diabetic patients with multi-vessel CAD were compared for the years 2008 and 2013. <h3>Findings</h3> A total of 1609 patients were included in this study. 783 patients underwent revascularisation in 2008 and 826 in 2013. The prevalence of diabetes undergoing revascularisation was 19% (n = 152) in 2008 and 25% (n = 203) in 2013. The number of diabetic patients undergoing two or more vessel revascularisation was 60% (n = 91) in 2008 and 47% (n = 96) in 2013. The proportion of diabetic patients with multivessel disease undergoing PCI was 33% (n = 30) in 2008 and 15% (n = 15) in 2013. The proportion of this population undergoing CABG was 67% (n = 61) in 2008 and 84% (n = 81) in 2013. <h3>Conclusion</h3> The diagnosis of diabetes in patients undergoing revascularisation in Cork University Hospital was seen more frequently in 2013 than 2008. The proportion of patients with diabetes mellitus with multivessel disease undergoing PCI in 2008 was relatively low but decreased further to a very small proportion in 2013. These findings suggest an impact on clinical practice of the FREEDOM trial and subsequent guidelines on Myocardial Revascularisation issued by the European Society of Cardiology.

Diabetes myonecrosis – A rare complication

We report a patient with very rare complication of poorly controlled diabetes. Diabetes myonecrosis is a self-limiting condition with unclear pathogenesis and it most commonly affects the quadriceps muscle. Physicians should consider this diagnosis in diabetic patients presenting with sudden onset, non-traumatic muscular pain.