Duration Of Diabetes Mellitus Research Articles

Depression and associated factors among patients with type 2 diabetic mellitus in Ethiopia: a cross sectional study

BackgroundDepression is a significant public health concern in both developed and developing countries. The burden of depression is particularly high among patients with chronic illnesses in developing countries, creating a dual challenge for both patients and the community. However, depression goes undiagnosed in 50%-75% of patients with chronic conditions such as diabetes mellitus. Additionally, there is limited information about the prevalence of depression among diabetic patients in Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of depression among type 2 diabetic patients in Ethiopia.MethodAn institution-based cross-sectional study was conducted on 376 randomly selected type 2 diabetic patients. Data were collected through face-to-face interviews and from patients’ follow-up records. The data were entered into EpiData version 4.6 and analyzed using STATA 14. Bivariable and multivariate logistic regression analyses were employed to identify associated factors. Variables with a p-value of less than 0.25 in the bivariable analysis were selected for multivariate logistic regression. Model fitness was assessed using Hosmer-Lemeshow’s test, and associations were reported using adjusted odds ratios with 95% confidence intervalsResultsIn this study, the prevalence of depression among type 2 diabetic patients was found to be 69.72% (95% CI: 64.75, 74.27). Three factors were significantly associated with depression in these patients: the duration of diabetes mellitus since diagnosis [AOR: 1.17; 95% CI (1.02, 1.34)], glycaemic control [AOR: 1.8; 95% CI (1.09, 3.01)] and cigarette smoking [AOR: 2.18; 95% CI (1.07, 4.46)].ConclusionThe prevalence of depression among type 2 diabetic patients was high. The Federal Ministry of Health, stakeholders, and the Ethiopian Diabetes Association should collaborate to reduce this burden. Mental health assessment and treatment should be integrated into chronic care follow-up services. Additionally, healthcare providers should closely monitor and counsel patients who smoke and those with poor glycemic control.

Empaglifozin modifies the arterial stiffness in type-2 diabetic patients: a preliminary report.

Abstract Background Sodium-glucose cotransporter-2 (SGLT2) inhibitors demonstrated beneficial effects on cardiovascular and renal events in patients with type 2 diabetes mellitus. The mechanisms underlying these effects are not fully elucidated. Aim of this study was to investigate whether empagliflozin is able to modify the arterial stiffness in type 2 diabetic patients. Methods Pulse wave velocity (PWV) and other parameters of arterial stiffness were assessed before and after adding empagliflozin to a traditional antidiabetic treatment in 16 consecutive T2DM outpatients folowed for 3 months. Arterial stiffness were evaluted using SphygmoCor ECEL measuring the pulse waveform of the arterial pulse moving from tha descending aorta to the femoral artery (PWV). Data obtained from the diabetic population has been compared to 16 T2DM outpatients not treated with SGLT2 inhibitors. Results In the two groups differences according gender distribution or duration of diabetes mellitus did not emerge. However the empagliflozin group was younger compared to controls (64.1±8.68 vs 74.45±8.13, P < 0.05). Empagliflozin treatment significantly decreased HbA1c after 12 weeks of treatment (7.9±0.78 vs 7.04±1.09%, P < 0.008.). After 12 weeks’ treatment, empagliflozin significantly improved PWV compared to controls not treated with SGLT2-i (ΔPWVV -0.68±1.1 vs 0.89±1,6 p <0.004, P = 0.0065 with age and HbA1c as covariates). Moreover body weight significantly decreased in the empagliflozin group (86.75±16.16 vs 81.71±16.5 kg, p =0.001) compared to controls (in whom remained unchanged) as long as BMI (30.48±5.4 versus 28.75±5.66 kg/m2, P < 0.002) compared to controls (in whom remained unchanged). Estimated glomerular filtration rate (eGFR) remained unchanged in the two groups during the study whereas urine Albumin to Creatinine ratio significantly improved using empagliflozin (17.8±46.8 vs 12.2±35.7 mg/mmol, P = 0.049). Conclusion In this ‘real clinical practice’ experience, the potential effect of empagliflozin treatment on arterial stiffness in T2DM patients was extensively investigated. Arterial stiffness was significantly decreased adding empaglifozin to the traditional treatment and this result has been obtained after 3-month. Significantly improvement in urine Albumin to Creatinine ratio might suggest an amelioration of endothelial function in those patients that could be involved in reducing arterial stiffness.

Electronic nudge letters to increase influenza vaccination uptake in younger and middle-aged individuals with diabetes: a prespecified analysis of the NUDGE-FLU-CHRONIC trial

Abstract Background Despite evidence demonstrating that influenza vaccination is associated with reduced risk of adverse cardiovascular events and all-cause mortality, influenza vaccine uptake remains suboptimal in persons with diabetes mellitus (DM). Purpose In this prespecified analysis of the NUDGE-FLU-CHRONIC trial we assessed the effectiveness of electronically delivered nudges on influenza vaccine uptake according to DM status. Methods NUDGE-FLU-CHRONIC was a nationwide, randomized, pragmatic implementation trial among younger and middle-aged (18-64 years) Danish citizens with chronic disease during the 2023/2024 influenza season. All trial participants were eligible for a free influenza vaccination through the Danish governmental vaccine program. Participants were randomized in a 2.45:1:1:1:1:1:1 ratio to usual care (no electronic letter) or one of 6 different electronic nudge letters delivered on Sep 26, 2023. Baseline and outcome data were obtained using the Danish nationwide registries. The endpoint was receipt of a seasonal influenza vaccine on or before Jan 1, 2024. Results Of 299,881 NUDGE-FLU-CHRONIC participants, 57,666 (19.2%) had DM at baseline. Participants with DM had a median age of 51.6 years, 43.0% were female, median Hba1c of 53 mmol/mol, median DM duration of 10.0 years, and 51.2% were insulin dependent. During follow-up, 43.0% of those with DM vs. 34.6% of those without DM received the seasonal influenza vaccine (p<0.001). Any electronic letter vs. usual care was highly effective in increasing vaccine uptake in participants with DM at baseline (45.6% vs. 36.5%, difference: +9.1 percentage points [99.29%CI: 7.9-10.3], relative risk ratio [RR]: 1.42, 99.29%CI: [1.39-1.44]). However, DM status modified the effect of any electronic letter such that participants without DM at baseline experienced a slightly greater effect than those with DM (37.3% vs. 25.9%, difference: +12.3 percentage points [11.7-12.8], RR: 1.47 [1.45-1.50]; p-interaction <0.001). For each individual electronic nudge letter, the effect of the intervention was slightly lower in participants with DM compared to those without (Figure 1; all p-interaction < 0.015). When assessing DM subgroups, the effect of any electronic letter vs. usual care was greater in participants with DM and concomitant cardiovascular disease than in those without, greater in non-insulin treated than in insulin-treated individuals, and greater in those with shorter diabetes duration. Effectiveness of nudges were consistent across all other DM subgroups including HbA1c level (Figure 2). Conclusions Electronic nudge letters significantly boosted vaccine uptake in a broad range of individuals with DM, but the effect was slightly lower compared to those without DM. Future studies should test whether behaviorally designed nudges may positively influence other health behaviors in people with diabetes.

Proteinuria and the risk of incident atrial fibrillation according to diabetes stage in patients with diabetes: a nationwide population-based cohort study

Abstract Background Proteinuria and diabetes mellitus (DM) are established cardiovascular risk factors, both independently associated with an increased risk of atrial fibrillation (AF). Despite previous findings correlating proteinuria amount with incident AF, regardless of DM diagnosis, the nuanced association at different stages of DM warrants further investigation. Purpose This study aimed to delve into and compare the relationship between proteinuria amount and the risk of incident AF in patients across various stages of DM. Methods A cohort of 3,866,428 individuals without prior AF and type 1 DM, who underwent the 2009 health checkup provided by the National Health Insurance Service in Korea, were categorized into five DM stages: normal, prediabetes, new-onset DM, early DM (diagnosed < 5 years), and late DM (diagnosed ≥ 5 years). Proteinuria was graded using the urine dipstick test, ranging from negative to 3+ or more. AF incidence was tracked until December 31, 2020. Results The cohort, with an average age of 47.0 ± 13.9 years and 45.4% females, demonstrated escalating annual AF incidence rates from 1.90 to 6.45 per 1000 person-years across DM stages (p<0.001) (Figure). Similarly, the rates increased from 2.28 to 7.28 per 1000 person-years by proteinuria levels (p<0.001) (Figure). Adjusted Cox regression models revealed a heightened risk of incident AF associated with higher proteinuria amounts in all DM stages (adjusted hazard ratios for urine dipstick 3+ or more: 1.57, 1.76, 1.44, 2.32, and 2.23, respectively). Notably, the association between proteinuria and incident AF was more pronounced in individuals with early and late DM compared to those with prediabetes and new-onset DM (Figure). Conclusions At each DM stage, from prediabetes to late DM, a higher level of proteinuria corresponds to an increased risk of AF development. Furthermore, a stronger association was observed in patients with longer DM duration compared to those with prediabetes or new-onset DM. These findings underscore the significance of monitoring proteinuria levels across DM stages to assess AF risk comprehensively.

Association between plasma osteopontin level and mild cognitive impairment in patients with type 2 diabetes mellitus

Objective: To analyze the influencing factors of type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI), and to explore the association between plasma osteopontin (OPN) levels and MCI. Methods: A retrospective analysis was conducted on the clinical data of 254 patients with T2DM admitted to Zhongda Hospital Affiliated to Southeast University from October 2021 to May 2023. The patients were divided into MCI group (n=106) and normal cognitive function control group (n=148) according to whether they had MCI. Clinical data were collected, cognitive function was assessed using neurological scales and plasma OPN levels were measured by enzyme linked immunosorbent assay. A multivariate logistic regression model was applied to analyze the influencing factors of MCI in T2DM patients. Interaction terms between gender, age, body mass index (BMI), and OPN were established to verify their significance levels. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of OPN for MCI in T2DM patients. The mediation model of OPN-FPG-montreal cognitive assessment(MoCA) was constructed with fasting plasma glucose (FPG) as the mediating variable to test the mediating effect, and the mediating effect percentage was calculated. Results: A total of 254 patients were included, including 162 males and 92 females, with an average age of (61.5±7.5) years old. Compared with the control group, the patients in MCI group were older[63.0(59.0, 69.0) years vs 60.0(54.2, 66.8) years], had a greater proportion of females [(43.4%(46/106) vs 31.1%(46/148)], shorter years of education[12(9, 12) years vs 12(9,15) years], longer duration of diabetes[15.0(8.0, 20.0) years vs 10.0(5.0, 15.0) years], and higher levels of FPG[7.78(6.07, 10.23) mmol/L vs 6.86(5.36, 8.59) mmol/L], insulin resistance index[2.93(2.47, 3.98) vs 2.79(2.27, 3.25)], glycated hemoglobin (HbA1c) [9.24%(7.89%, 10.96%) vs 7.97%(7.00%, 9.45%)], total cholesterol(TC)[(4.51±1.17) mmol/L vs (4.19±0.99) mmol/L], and OPN [11.30(8.68, 12.84) ng/ml vs 9.69(7.82, 11.74) ng/ml] (all P<0.05). The scores of various neuropsychological tests in MCI patients were lower than those in control group with normal cognitive function (all P<0.05). Spearman correlation analysis showed that age(r=-0.212), duration of diabetes mellitus(r=-0.156), duration of hypertension(r=-0.132), FPG(r=-0.207), insulin resistance index(r=-0.171), HbA1c(r=-0.271), OPN(r=-0.238), and total cholesterol (r=-0.125) were negatively correlated with MoCA scores, whereas years of education(r=0.285) were positively correlated with MoCA scores(all P<0.05). Multifactorial logistic regression analysis showed that age, years of education, duration of diabetes mellitus, HbA1c, TC and OPN levels were the influencing factors of T2DM patients with MCI, and the risk of MCI increased by 15% for every 1 ng/ml increase in OPN (OR=1.15, 95%CI: 1.021-1.295, P=0.021), and the relationship was not affected by age, gender and BMI(The interaction effects are all P>0.05). The area under the curve (AUC) of the working curve of subjects with OPN predicting combined MCI in patients with T2DM was 0.612 (95%CI: 0.541-0.682), and the AUC was 0.702 (95%CI: 0.638-0.767) after the combination of HbA1c and OPN. The results of the mediated effect model showed that FPG partially mediated the correlation between OPN and MoCA in T2DM patients, and the mediated effect accounted for 11.34% of the total effect. Conclusions: Plasma OPN level is associated with MCI in patients with T2DM,and the higher the OPN level, the higher the risk of T2DM patients developing MCI.

Characterizing cognitive phenotypes and clinical correlates in type 2 diabetes using fuzzy clustering and decision tree analysis

Cognitive impairment is frequently seen in patients with type 2 diabetes (T2DM), ranging from mild impairment to dementia. However, our knowledge of the specific profiles and risk factors for these different levels of impairment is limited. In this study involving 152 patients with T2DM, cognitive function was assessed using the Montreal Cognitive Assessment test. The Fuzzy C-means clustering algorithm was utilized to group individuals with similar cognitive characteristics. The study evaluated how well clinical parameters could classify characteristics of clusters using the Classification and Regression Trees algorithm. ROC analysis was then used to assess the classification success. Three distinct cognitive clusters were identified. Cluster 1 had the poorest cognitive performance and was characterized by more women, lower education levels, and lower levels of iron, hemoglobin, and creatine. Cluster 3, the amnestic cluster, was distinguished by low TSH levels. The decision tree model highlighted several parameters, including education level, hemoglobin, duration of diabetes mellitus (DM), iron, TSH, gender, family history of diabetes, and microalbumin/creatinine ratio, as significantly affecting the distinction of cognitive clusters. Diabetes-associated cognitive impairment stems from multifaceted pathophysiological mechanisms influenced by complex risk factors, resulting in diverse types of cognitive deficits.

Scoring and validation of a simple model for predicting diabetic retinopathy in patients with type 2 diabetes based on a meta-analysis approach of 21 cohorts

Aim To develop and validate a model for predicting diabetic retinopathy (DR) in patients with type 2 diabetes. Methods All risk factors with statistical significance in the DR prediction model were scored by their weights. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve, Kaplan–Meier curve, calibration curve and decision curve analysis. The prediction model was externally validated using a validation cohort from a Chinese hospital. Results In this meta-analysis, 21 cohorts involving 184,737 patients with type 2 diabetes were examined. Sex, smoking, diabetes mellitus (DM) duration, albuminuria, glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and TG were identified to be statistically significant. Thus, they were all included in the model and scored according to their weights (maximum score: 35.0). The model was validated using an external cohort with median follow-up time of 32 months. At a critical value of 16.0, the AUC value, sensitivity and specificity of the validation cohort are 0.772 ((95% confidence interval (95%CI): 0.740–0.803), p < .01), 0.715 and 0.775, respectively. The calibration curve lied close to the ideal diagonal line. Furthermore, the decision curve analysis demonstrated that the model had notably higher net benefits. The external validation results proved the reliability of the risk prediction model. Conclusions The simple DR prediction model developed has good overall calibration and discrimination performance. It can be used as a simple tool to detect patients at high risk of DR.

Peroneal Nerve Entrapment in Diabetes Mellitus.

This narrative mini-review discusses the association between peroneal nerve entrapment (PEN) and diabetes mellitus (DM). Generally, PEN is not a common cause of peripheral neuropathy in DM. Poor glycaemic control and DM duration are powerful risk factors for PEN. Underlying mechanisms involve neurodegeneration and entrapment of the peroneal nerve. Patients tend to present with chronic leg pain, gradual foot drop, steppage gait, or weakness of ankle dorsiflexion. Electrodiagnostic and imaging studies are very useful in diagnosis to determine the level at which entrapment occurs. Treatment varies based on the aetiology and severity of symptoms. It is initially conservative. Surgical nerve decompression management is required when entrapment is refractory to non-operative options.

Diabetes Mellitus Duration and Glycemic Control as Predictors of Diabetic Kidney Disease Progression: Evidence from 2019-2021 Korean National Health and Nutrition Examination Survey

Diabetes Mellitus Duration and Glycemic Control as Predictors of Diabetic Kidney Disease Progression: Evidence from 2019-2021 Korean National Health and Nutrition Examination Survey

BARRIERS TO INITIATE INSULIN THERAPY AND ITS ASSOCIATION WITH DURATION OF DIABETES MELITIS AND DEMOGRAPHIC FACTORS IN UNCONTROLLED TYPE 2 DIABETIC PATIENTS, A CROSS SECTIONAL STUDY

Objectives: To determine different barriers to initiate insulin therapy and association of duration of diabetes mellitus and demographic factors with barriers in initiation of insulin therapy in Uncontrolled type 2 diabetic patients.Materials and Methods: We conducted a cross sectional study conducted among patients with type 2 diabetic patients presenting to endocrinology outpatient clinics in two Tertiary care hospitals of Peshawar ie. Khyber Teaching hospital and hayatabad medical complex Peshawar. The duration of study was 03 months after approval of synopsis. The sample size was 257.The study population was selected by consecutive non probability sampling technique. The data was collected by pre designed questionnaire. All the included patients were interviewed on pre designed questionnaire. Data was processed in SPSS version 22.Results: In study we found that patients face different barriers to initiate insulin therapy. In our study, side effects of insulin was the barrier for 97(37.7%) of the patient, difficulty in carrying insulin was barrier for 128(49.8%) patients , dose adjustment of insulin was barrier for 90(35%) patients, fear if insulin needle was barrier for 89 (34.6%) patients, self administration of insulin was barrier for 98(38.1%) patients , affordability of insulin was barrier accounting for 114(44%) patients , frightened about insulin therapy by someone was barrier for116 (45.1%) patients. The association between economic status of patient and the barrier that they are frightened by someone was statistically significant. Chi-square test was also run between duration of diabetes with all barriers in which one association was found nearly signifi cant i.e. the association of duration of diabetes with difficulty in carrying insulin with the p value of 0.064.Conclusion: The most common barrier in insulin therapy initiation of patients in the study was difficulty in carrying insulin. We found that there is near to signifi cant association between duration of diabetes and difficulty in carrying insulin. There is significant association between economic status of patient and frightened by someone. The lower the economic status the more frightened about Insulin use.

Risk factor analysis and establishment of a predictive model for complications of elderly advanced gastric cancer with Clavien-Dindo classification ≥ II grade

BackgroundThe occurrence of complications following radical gastrectomy for gastric cancer significantly impacts patients’ quality of life. Elderly patients are susceptible to postoperative complications. This study seeks to investigate the risk factors associated with Clavien-Dindo ≥IIgrade complications following radical gastrectomy for advanced gastric cancer in elderly patients, develop a nomogram risk prediction model, and validate its accuracy.MethodsRetrospective collection of clinical and pathological data was conducted on 442 elderly patients with advanced gastric cancer who underwent radical gastrectomy at Shaanxi Provincial People’s Hospital from January 2015 to December 2020. They were randomly divided into a training set (n = 310) and a validation set (n = 132) in a 7:3 ratio. The severity of postoperative complications was graded using the Clavien-Dindo classification system, resulting in two complication groups: Clavien-Dindo <II group (n = 229) and Clavien-Dindo ≥II group (n = 81). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors affecting the occurrence of Clavien-Dindo ≥II grade complications, and a predictive model was established based on the results. The model was then validated using the validation set.ResultsAmong the 442 patients included in the study, 121 cases (27.38%) experienced postoperative complications, with 111 cases (25.11%) classified as Clavien-Dindo ≥II grade complications. Multivariable logistic analysis revealed that the Prognostic Nutritional Index (PNI), surgical duration, age, and history of Diabetes mellitus were independent risk factors for the occurrence of Clavien-Dindo ≥IIgrade complications in elderly patients with advanced gastric cancer after surgery (P < 0.05). The nomogram model constructed based on these factors demonstrated good discriminative ability, as indicated by the area under the Receiver Operating Characteristic (ROC) curve. Calibration plots showed that the predicted probability of gastric cancer lymph node metastasis using the nomogram model was well aligned with actual outcomes. Decision curve analysis indicated the clinical utility of the nomogram model across a wide range of thresholds, demonstrating its practicality and potential for clinical benefit.ConclusionThis study identified Prognostic Nutritional Index (PNI), surgical duration, age, and history of Diabetes mellitus as risk factors for the occurrence of Clavien-Dindo ≥ II grade complications in elderly patients with advanced gastric cancer after surgery. Based on these four risk factors, a nomogram risk prediction model was constructed. This model can be used to personalize the prediction of the risk of Clavien-Dindo ≥ II grade complications occurring after surgery in elderly patients with advanced gastric cancer.

Low estimated glomerular filtration rate and proteinuria among adult diabetic patients in a tertiary hospital in Eastern Uganda - a cross-sectional study

BackgroundChronic kidney disease (CKD) is one of the most common complications of diabetes mellitus (DM). Diabetes mellitus contributes to about 66% of CKD cases globally. CKD results in increased morbidity and mortality and advanced stages often require kidney replacement therapy that is unaffordable for the majority of the patients. Developing countries have scanty data regarding CKD burden in diabetic patients.ObjectivesThis study aimed at determining the prevalence of low estimated glomerular filtration rate (eGFR) and proteinuria and associated clinical and socio-demographic factors among adult diabetic patients attending the diabetic clinic of Mbale Regional Referral Hospital (MRRH).MethodsA cross-sectional study was conducted at the adult diabetic clinic of MRRH in Eastern Uganda. A total of 374 adult diabetic patients were enrolled. A urine sample for urine albumin creatinine ratio (UACR) determination and a venous blood sample for measurement of serum creatinine were obtained from each participant. The eGFR was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and CKD was staged according to the Kidney Disease Improving Global Outcomes (KDIGO) classification.ResultsA total of 318 (85%) participants had an eGFR of ≤ 60 mL/min/1.73m2, UACR of ≥ 30g/g, or both. Only 6.1% were aware. Age, duration of DM, hypertension, and dyslipidemia were associated with low eGFR and proteinuria.ConclusionThere is a high prevalence of low eGFR and proteinuria among DM patients, 85% of the participants had these markers of CKD and the majority of them were undiagnosed. Over half of the DM patients had an eGFR consistent with advanced CKD. Strengthening routine screening for CKD biomarkers and equipping DM clinics with more diagnostic resources is recommended.

Ultrasonographic estimation of kidney size in adult Bangladeshi population without known renal disease: a preliminary report

Background: The kidney size of a patient is a valuable diagnostic parameter in clinical practice. Renal size varies with age, gender, body mass index (BMI), pregnancy, race and co-morbid conditions like diabetes mellitus (DM) and hypertension (HTN). Measurements of renal dimensions can be carried out by using different modern techniques like ultrasonography (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI). Out of these modalities USG is choice because of its simplicity, inexpensive, easily available, non-invasive and easy reproducibility. There is no established nomogram for renal size in the Bangladeshi population. Aim of the study was to determine the ultrasonographic renal size in adult Bangladeshi population with no known renal disease and to correlate renal size with age, gender and BMI. In addition, we assess whether hypertension and diabetes mellitus affect renal size. Methods: This cross-sectional study was done in BIRDEM General Hospital and included 55 patients with age &gt;18 years over 6 month period. Study population were not known to have renal disease documented by urine routine microscopy, spot urine for albumin creatinine ratio (ACR), serum creatinine and USG. Their body weight, height and BMI were calculated along with duration of DM and HTN. Analysis was done for differences due to age, gender and laterality. The correlation of renal dimensions with anthropometric parameters were also done. Results: A total of 55 patients were analyzed. There were 19 (34.5%) male and 36 (65.5%) female. The mean age was 46±.10 years. There mean weight, height and BMI were 61 ± 11 kg, 1.54±.069 meter, 25.7 ± 4.8 kg/m2 respectively. In total population 34.5% (19) were diabetic and 32.5% (18) were hypertensive. The means of length, width and parenchymal thickness (PT) of right kidneys (RK) were 10.1 ± 0.87, 4.2 ± 0.67 and 1.4± 0.32 cm respectively. The means of length, width and PT of left kidneys (LK) were 10.3 ± 0.89, 4.5 ± 0.49 and 1.5 ± 0.32 cm respectively. Measurements were significantly higher in LK than those of RK respectively (p=.003, p&lt;.001 and p=.041). There were significant differences in kidney length and PT between sex and age. There were also significant differences in kidney length and PT between subjects of higher BMI, long duration of DM and HTN. The correlation between renal length and weight showed a positive correlation (r = 0.16, p &lt; 0.023). Conclusion: The variation of parameters of both kidneys varies on gender, age, obesity, comorbidity like DM &amp; HTN and with their duration. Length of both kidneys depends on body weight. Further study needed with large samples. BIRDEM Med J 2024; 14(3): 151-157

Major cardiovascular and neurological events among diabetic patients with severe hypoglycaemia at a tertiary care hospital in Bangladesh

Background: Cardiovascular disease (CVD) is a major cause of death and disability among people with diabetes mellitus (DM). Hypoglycemia is a potential risk factor to augment life threatening CVD. This study intended to find out impact of severe hypoglycemia in adverse cardiovascular and neurological events among patients with DM. Methods: This cross-sectional study was conducted among diabetic patients with severe hypoglycemia (plasma glucose &lt;70 mg/dl or 3.9 mmol/l) admitted in BIRDEM General Hospital from March 2014 to April 2015. Patients were categorized into two groups depending on blood glucose values (group A &lt;2.8 and group B e”2.8) for analytical purpose. Major cardiac events including acute myocardial infarction (MI), non ST elevated MI or arrhythmia were observed along with neurological outcome including acute stroke, hypoglycemic encephalopathy and convulsion by both relevant clinical examinations and investigations as appropriate. Data were collected at discharge or death if any. Results: Among the 311 patients, 62% were in the age group of 51 to 60 years with mean age 49.02 years. Mean duration of DM was 8.5 (±5.4) years and in 85.5% cases HbA1c was e”7%. Majority was on insulin (79.41%); predominantly on premixed (33.5%) and self mixed (35.7%) regime. Meal related factors (p &lt;0.001) e.g., delayed or missed meal, insulin related factors (p&lt;0.001) e.g., miscalculation, overdosing were significant predisposing factors for developing hypoglycemia. Multivariate analysis revealed frequency of hypoglycemia was more in diabetic nephropathy (p&lt;0.01), chronic liver disease (p=0.01), gastroparesis (p=0.01), cognitive impairment (p&lt;0.001), established CVD (p=0.02) and adrenal insufficiency (p&lt;0.01). Nocturnal hypoglycemia (33.80% ) and hypoglycemic unawareness (44.23%) was also observed among the participants. Cardiovascular events were found in 98 (31.55%) individuals which included any form of arrhythmia (p=0.02), non ST elevated MI (p=0.08) and ST elevated MI (p&lt;0.008). Among the neurological events (n=67, 21.54%), hypoglycemic encephalopathy (p&lt;0.02) and acute stroke (p=0.01) were significant. Seizure happened in 15 individuals (p=0.53). Nine patients died (death rate 2.89%). Predominant cause of death was acute MI (6, 66%) and hypoglycemic encephalopathy (3, 33.33%). Conclusion: The major finding of this study suggest that severe hypoglycemia is strongly associated with fatal cardiovascular and neurological events including MI, acute stroke and hypoglycemic encephalopathy in diabetic patients predominantly treated with insulin. Mortality was found in 2.89% participants. Co morbidities including renal disease, liver disease, gastroparesis, cognitive impairment increased the vulnerability of developing severe hypoglycemia. In most of the cases, lifestyle factors are the precipitating causes of hypoglycemia, which are readily recognizable and easily modifiable. Therefore, appropriate diabetic education and periodic reevaluation of patient’s knowledge, attitude and practice towards hypoglycemia is of utmost importance to prevent this common but life-threatening complication. BIRDEM Med J 2024; 14(3): 118-123

Evaluation of Interleukin-6 Levels in Patients with Type 2 Diabetes Mellitus

Background: It has been suggested that inflammatory processes play an important role in the pathogenesis of type 2 diabetes. Individuals who develop type 2 diabetes show signs of low-grade inflammation years before disease onset. This low-grade inflammation has been assumed to be implicated in the pathogenetic mechanisms that cause type 2 Diabetes Mellitus. Inflammatory mediators such as the IL-6 family of cytokines have been proposed to be involved in the events that lead to type 2 diabetes. IL-6 has immunoregulatory actions been proposed to affect glucose homeostasis and metabolism directly and indirectly by action on skeletal muscle cells, adipocytes, hepatocytes, pancreatic b-cells and neuroendocrine cells. Many studies have suggested the role of IL-6 in the pathogenesis of type 2 diabetes mellitus. However, no references have been observed in Bangladesh regarding IL-6 and its association with type 2 diabetes mellitus. It thus may highlight the importance of low-grade inflammation in the pathophysiology of type 2 diabetes mellitus. The purpose of this study was to evaluate type 2 diabetes patients' levels of interleukin-6. Materials and methods: A hospital-based cross-sectional observational study was carried out in the Department of Biochemistry Chittagong Medical College, Department of Endocrinology of Chittagong Medical College Hospital and Chattogram Diabetic Hospital. One hundred (100) type 2 diabetes mellitus patient was included in the study by nonprobability consecutive sampling. Important variables in this study were serum IL-6, BMI, waist circumference and duration of Diabetes Mellitus. Results: The mean serum IL-6 level was 10.08±0.39 pg/ml in patients with type 2 Diabetes Mellitus. Serum IL-6 was positively correlated (r 0.33, p &lt;0.01) with waist circumference and duration of diabetes mellitus (r 0.26, p &lt;0.05). The mean IL-6 was significantly different between BMI groups (F (2,97) =5.39, p=0.006) and was higher in the obese group (10.52±4.00) compared to the overweight and normal BMI (6.78±1.95) and overweight (8.08±3.15) group. Conclusion: It can be concluded that type 2 diabetes mellitus patients had increased serum levels of IL-6. It can give an insight into the possible role of sub clinical inflammation among patients with type 2 Diabetes Mellitus. IAHS Medical Journal Volume 6(2) December 2023; 53-57

Basic principles of treatment and follow-up of children with acute odontogenic infection and insulin-dependent diabetes mellitus

The purpose of the study is to substantiate the basic principles of treatment and clinical dental observation of children with acute odontogenic inflammatory disease and insulin-dependent diabetes mellitus as an accompanying disease. Material and methods. A medical examination was conducted for 213 children who were treated at the St. Petersburg city children’s hospital of K.A. Raukhus of. The dental status of children with insulin-dependent diabetes mellitus and children of the control group without concomitant diseases was assessed using the Fedorov-Volodkina index, the KPU index and analysis of the caries intensity according to the T.F. Vinogradova table, periodontal conditions according to the PMA index (papillary-marginal-alveolar). The state of microhemocirculation of periodontal tissues was also assessed using Doppler ultrasound and the use of a reflex cold test. In children diagnosed with “Acute odontogenic osteomyelitis of the jaws,” laboratory blood parameters, the composition of the microbial flora of wound discharge, and the length of hospitalization were studied. Results. Based on the data obtained, an algorithm for treatment and dispensary dental observation of children with diabetes was presented. The detection of diabetes mellitus in children of any age should be accompanied by increased attention to the dental health of these patients. If teeth affected by caries are identified during a preventive examination, immediate treatment is required. It is necessary to ensure constant follow-up of the child by an endocrinologist. Doppler examination of the microhemocirculatory bed vessels of the mucosa of the alveolar process of the jaw revealed that an adequate response to a reflex cold test was detected only in the control group patients, those who do not have insulin-dependent diabetes mellitus. With the development of acute odontogenic osteomyelitis of the jaw in children suffering from insulin-dependent diabetes mellitus, hospitalization is necessary when the first clinical symptoms of the inflammatory process appear. Immediately after hospitalization and immediate surgical sanitation of a purulent focus of infection in the oral cavity, drug therapy should be started: antibacterial, infusion, symptomatic, as well as insulin therapy. The results of this study are especially relevant in the treatment of children with a duration of insulin-dependent diabetes mellitus of more than 5 years and a decompensated course of endocrine disease. Conclusions. The results of the study allowed us to expand our understanding of the impact of diabetes on the oral health of children, to establish risk factors for the development of acute odontogenic osteomyelitis of the jaws in children of different age categories with insulin-dependent diabetes mellitus, as well as the characteristics of the course of odontogenic osteomyelitis of the jaws in each of the cases. Based on the identified features, the principles of diagnosis and treatment of acute odontogenic osteomyelitis of the jaws in children with insulin-dependent diabetes mellitus have been formulated.

Multiplex analysis of post-Covid cardiorenal complications in patients with type 1 and type 2 diabetes mellitus according to the mobile diagnostic and treatment center (Diamobil)

BACKGROUND: Patients with diabetes mellitus (DM) are at risk for a higher incidence and severity of COVID-19, as well as its adverse outcomes, including post-Covid syndrome.AIM: to assess the incidence of cardiorenal complications in patients with type 1 and type 2 diabetes (T1DM/T2DM) who have had COVID-19, and to analyze the structure and severity of disorders according to examination data at the Diamobil mobile medical diagnostic and treatment center.MATERIALS AND METHODS: a cohort of T1DM and T2DM patients examined in Diamobil (n=318), with a confirmed anamnesis of COVID-19 (n=236). The time interval between COVID-19 and the visit to Diamobil was 8.7/8.2 months for T1DM/T2DM. The parameters of the last visit before COVID-19 recorded in the Federal Register of Diabetes (FRD) were used as initial data.RESULTS: Clinical characteristics of patients with T1DM/T2DM: age — 49.2/64.5 years, duration of DM — 22/11 years, proportion of women — 64/73%, respectively. After analysis the data from visits before and after COVID-19 there weren’t statistically significant differences in HbA1c levels for both types of DM (before 9.0/8.3%; after 8.4/8.2%, respectively), there was the intensification of glucose lowering therapy (the proportion of patients with T2DM on 2 and 3 component therapy increased by 4.3% and 1.6%, the proportion of patients on insulin therapy by 16%). After COVID-19, there was a statistically significant decrease in glomerular filtration rate (GFR) in T1DM from 88.1 to 62 ml/min/1.73 m2; with T2DM from 74.7 to 54.1 ml/min/1.73 m2. When assessing acute diabetic complications, there was an increase in the frequency of coma in T1DM by 1.5 times, severe hypoglycemia in T1DM by 3 times, and in T2DM by 1.7 times. Analysis of the frequency of cardiorenal complications before and after COVID-19 showed a total increase of 8.5% in T1DM, by 13.2% in T2DM, of which myocardial infarction, ischemic heart disease, and CHF increased in T1DM in the range from 1.5 to 5 times, with T2DM by 1.3 times, the frequency of CKD with T1DM by 1.5 times, with T2DM by 5.6 times.CONCLUSION: There was a decline of kidney filtration function (decrease in GFR) and an increase in the frequency of cardiovascular complications in both types of diabetes in post-Covid period while patients achieved a stable HbA1c levels by intensifying therapy during the COVID-19 infection. This fact reflects combined damage to the kidney and cardiovascular system as a part of the post-Covid syndrome and determines a key set of measures for the development of preventive strategies.

Etiopathogenetic features of bone metabolism in patients with diabetes mellitus and Charcot foot

Diabetic neuropathy is one of the most common diabetes mellitus complications associated with mediocalcinosis of the lower extremities, a significant decrease in feet bone mineral density, and a high incidence of cardiovascular disease. In most cases, calcium-phosphorus metabolism changes occur in patients with diabetic neuroarthropathy, or Charcot foot, when we can observe feet local osteoporosis, which in 90% of cases associated with a vessel’s calcification of the lower extremities in the majority of diabetes population. A large number of studies presented literature have demonstrated that patients with Charcot foot can have accelerated bone metabolism and increased bone resorption. Patients with Charcot foot often have crucial abnormalities in the calcium-phosphorus parameters, bone metabolism, and levels of vitamin D and its metabolites. In addition, the duration of diabetes mellitus, the degree of its compensation widely affects the development of its micro- and macrovascular complications, which could also accelerate the development of mineral and bone disorders in these types of patients. Multifactorial pathogenesis of these disorders complicates the management of patients with a long and complicated course of diabetes mellitus. This review discusses the peculiarities of vitamin D metabolism, the importance of timely diagnosis in phosphorus-calcium disorders, and the specifics of therapy in these patients. Special attention is paid to the timely diagnosis of the Charcot’s foots acute stage based on the bone marrow edema by MRI evaluation and the possibility of reducing the immobilization period.

Meibomian Gland Dysfunction and Dropout in Diabetic Patients with Non-Proliferative Diabetic Retinopathy.

This study aims to compare meibomian gland (MG) dropout and MG dysfunction (MGD) between patients with diabetes mellitus (DM) with moderate-severe non-proliferative diabetic retinopathy (NPDR) and patients with no diabetes (NDM). This prospective, transversal, age, and gender-matched case-control study included 98 DM and 106 NDM eyes. Dry eye disease (DED) and MGD evaluations were performed, including meibography (Keratograph 5M®). The objective MG dropout percentage was obtained by analyzing meibography images with ImageJ software (v. 1.52o, National Institutes of Health, Bethesda, MD, USA) and was subsequently graded with Arita's meiboscore. The DM duration was 18 ± 9 years. The mean meiboscore (3.8 ± 0.8 vs. 3.4 ± 1.0, p = 0.001), meiboscore severity (p = 0.016), and MG dropout (45.1 ± 0.1% vs. 39.0 ± 0.4%, p < 0.001) were greater in DM than in NDM. All patients showed MG dropout (meiboscore > 1). Lower eyelids showed greater MG dropout in both groups. A correlation with age (r = 0.178, p = 0.014) and no correlations with DM duration or gender (p > 0.005) were observed. Patients with diabetes showed greater corneal staining (1.7 ± 1.3 vs. 0.9 ± 1.1; p < 0.001), reduced corneal sensitivity (5.4 ± 1.1 vs. 5.9 ± 0.4; p < 0.001), lower MG expressibility (3. 9 ± 1.6 vs. 4.4 ± 2.1; p = 0.017), and worse meibum quality (1.9 ± 0.8 vs. 1.7 ± 0.5; p = 0.019). Tear breakup time, osmolarity, MMP-9, Schirmer, and the Ocular Surface Disease Index showed no significant differences. In conclusion, patients with DM with NPDR have greater MG dropout and meiboscore, as well as more severe MGD and DED parameters than persons with NDM.

Skin disorders in patients with type 2 diabetes mellitus in Khartoum Dermatology and Venereology Teaching Hospital

Background: Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose, which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn't make enough insulin. About 1 in 11 adults worldwide now have diabetes mellitus (DM), 90% of whom have type 2 DM (T2DM). One of the most common manifestations of diabetes are skin complications, such as dryness of the skin, bacterial and fungal infections. Objectives were to study the frequency and pattern of skin disorders in patients with T2DM at Khartoum dermatology and venereology teaching hospital (KDVTH) in Khartoum, Sudan during August 2016 to December 2016. Methods: This was prospective, observation descriptive, cross-sectional hospital-based study used a quantities method. A total convenient sample technique enrolled 100 points during the study period. Results: One hundred diabetic patients (64% male and 36% female) were included in the study. The age group varies between (25 and &gt;70 years), the commonest cutaneous manifestations were xerosis which was found in 45 patients (45%), fungal infection found in 36 patients (36%). Serum HbA1c level was done for each case. Conclusions: The study concluded that the most prevalent cutaneous diseases among patients were xerosis fungal infection, eczema, bacterial infections, and scabies respectively. A significant relationship between duration of DM and level of HB A1C and the presence of cutaneous manifestations was observed.