Diabetes Mellitus Individuals Research Articles

Impact of cardiorespiratory fitness and diabetes status on cardiovascular disease and all-cause mortality: An NHANES retrospective cohort study

High cardiorespiratory fitness (CRF) is associated with decreased mortality in people with pre-diabetes (pre-DM) and diabetes mellitus (DM); however, the degree to which CRF attenuates the risk of cardiovascular disease (CVD)-related and all-cause mortality is unclear. Study objectiveWe examined the impact of CRF status on CVD-related morbidity and all-cause mortality in non-DM, Pre-DM, and DM populations. Design and setting13,968 adults from the Third US National Health and Nutrition Examination Survey (NHANES III) were stratified into non-DM, pre-DM, or DM groups based on HbA1c levels. VO2Max was calculated using the Fitness Registry and Importance of Exercise: A National Database (FRIEND) equation. ParticipantsParticipants were categorized into tertiles of VO2Max; first VO2Max tertile was the lowest VO2Max and third VO2Max tertile was the highest. Main outcome measure(s)Cox regression was used to analyze the relationship between glycemic levels, VO2Max, and CVD-related and all-cause mortality. ResultsThose with DM in the highest fitness tertile had CVD (HR 0.13; 95 % CI 0.06, 0.27; p < 0.0001) and all cause (HR 0.28; 95 % CI 0.21, 0.38; p < 0.0001) mortality rates as low or lower than those with pre-DM (CVD HR 1.02; 95 % CI 0.78, 1.33 p < 0.892; all cause HR 0.96; 95 % CI 0.83, 1.12; p < 0.5496) or non-DM (CVD HR 0.65; 95 % CI 0.52, 0.80; p < 0.0001; all cause HR 0.61; 95 % CI 0.55, 0.68; p < 0.0001) at lower fitness levels. Regardless of DM status, there was lower all-cause mortality with higher CRF levels. ConclusionsHigher fitness levels in DM individuals are associated with total and CVD mortality rates as low or lower than those without DM with lower fitness.

Utilization of dental care and dentate status in diabetic and nondiabetic patients across US states: An analysis using the 2020 Behavioral Risk Factor Surveillance System.

This study examines the differences, by state, in dental care utilization and tooth retention between adults with and without diabetes mellitus (DM). We conducted a secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System, an annual, state-based, random telephone survey of noninstitutionalized US civilian adults. The predictor variable was DM status. The outcome variables were time since the last dental appointment and tooth loss. We utilized multiple multinomial logistic regression models followed by postestimation procedures to determine state-level adjusted proportions for dental visits within the last year and complete teeth retention among DM and non-DM adults. Among adults with DM, 60.0% reported dentist visits within a year of survey participation, while 53.6% had complete tooth retention. As education and income levels increased, dental attendance and tooth retention increased among adults with DM. Most Southern states had a higher prevalence of DM, a lower proportion of dentist visits, and worse tooth retention among DM adults. Nationally, DM individuals were 4.3 percentage points less likely to visit a dentist and were 7 percent less likely to have complete teeth retention than non-DM adults. Compared with the national average, 25/50 states had greater disparities in dental visits between DM and non-DM adults, and 27/50 states had greater disparities in tooth loss between DM and non-DM adults. State-level variations indicate geographical and dental coverage influences on DM and dental outcomes. There is a need for state-specific interventions to improve dental access and outcomes for adults with DM.

Survey on electrocardiography signal analysis and diabetes mellitus: unraveling the complexities and complications

Electrocardiography (ECG) is crucial in the medical field to assess cardiovascular diseases. ECG signal generates information, i.e., QRS complexes that imply the cardiac health of the human body. It is depicted in the form of a graph with voltage versus time interval. A distorted, inverted, lagged, small waveform implies an abnormality in a cardiac system. This study highlights the generation of an ECG signal, QRS complexes undertoned towards different diseases, event detection, and signal processing methods. It has become crucial to highlight the possibilities and advances that can be derived from an ECG signal. Throughout this study, an instance of diabetes mellitus (DM) is considered for creating concrete awareness and understanding of an ECG signal in DM. This study focuses on finding the correlation between ECG and DM. Detection of DM from ECG signal is also studied. The findings of this survey paper conclude that the correlation between DM individuals with cardiovascular complications has autonomic neuropathy, which may lead to myocardial infarction. It is also found that the QRS complex and its abnormalities are not specific to complications in DM. However, non-invasive detection of diabetes through ECG signals demonstrates future research potential.

Predicting Diabetes Mellitus with Machine Learning Techniques

This study addresses the challenge of accurately identifying diabetes mellitus in individuals. Utilizing accessible online and real-world diagnostic data, we employ machine learning models, including Support Vector Machine, Random Forest, Naïve Bayes, eXtreme Gradient Boosting, and Deep Neural Network, on the PIMA Indian Diabetes and NHANES 1999-2016 datasets. Rigorous data pre-processing steps were conducted, handling null values, outliers, and imbalanced data together with data normalization. Our results reveal that the RF model achieves a 79% accuracy for binary classification on the PIMA Indian Diabetes dataset, using a 60:40 train-test split with BORUTA selected features. Meanwhile, the XGBoost model excels on the NHANES 1999-2016 dataset, achieving 92% accuracy for binary and 91% for multiclass classification respectively.

Early detection of peripheral neuropathy and its correlation with retinopathy and HbA1c levels in type 2 diabetes mellitus patients

Screening of asymptomatic diabetes mellitus (DM) patients may reduce future complications. Despite having diabetic peripheral neuropathy (DPN), about 50% of type 2 diabetes mellitus (type 2 DM) patients are asymptomatic. If diabetic neuropathy is diagnosed early, the annual cost of treating diabetic neuropathy and associated complications can be decreased. The study objectives are to identify peripheral neuropathy at an early stage and to correlate peripheral neuropathy with diabetic retinopathy and HbA1c (glycated haemoglobin) in asymptomatic type 2 DM patients.: A cross-sectional analytical study was done during July and August 2022 using consecutive sampling on 105 patients who attended the General Medicine out-patient dept (OPD) at Pondicherry Institute of Medical Sciences and the Primary Health Centre (PHC) Kalapet in Puducherry, India. Patients over 18 years old with type 2 DM, who were asymptomatic for peripheral neuropathy, and had their HbA1c levels checked within the last two months were included. Patients have undergone Michigan Neuropathy Screening Instrument (MNSI) examination, biothesiometer and monofilament testing for neuropathy and Fundus examination for retinopathy. The average age of the study participants was 54.7±11.4 yrs, and they had a male-female ratio of 6:4. The retinopathy was present in 18.1% (95% CI:11.9-26.5). The prevalence of DPN by MNSI examination was 3.8% (95% CI:1.5-9.4), monofilament testing was 21.0% (95% CI:14.3-29.7) and biothesiometer was 98.1% (95% CI:93.3-99.5). A statistically significant association between DPN measured by a biothesiometer and HbA1c (p&amp;#60;0.05). There was no significant correlation between DR and HbA1c and between DPN measured by monofilament and HbA1c (p&amp;#62;0.05).The objective assessment by the biothesiometer is the best tool for detecting peripheral neuropathy at an early stage in asymptomatic type 2 DM individuals than monofilament testing.

Low CD4+ T Cell count among HIV-seronegative Type 2 Diabetes Mellitus patients in Ilorin metropolis

Background and aims: Diabetes Mellitus (DM) is a metabolic disorder that manifests as chronic hyperglycemia accompanied by a dysfunctional metabolism of carbohydrates, lipids, and proteins. Several studies have earlier pointed out several complications associated with the disease and in particular, the sufferer’s susceptibility to various infectious diseases. We therefore sought to investigate the adaptive immune status of the condition, as represented by the assessment of CD4+ T cell count among DM patients. Method: Seventy-six type 2 DM patients were recruited for the study. Thirty (30) age and sex-matched, non-diabetic individuals were enrolled as negative controls. Their fasting blood sugar (FBS), HbA1c, and CD4 count were assayed using standardized procedures. The demographic and clinical data of the studied group and controls were compared with respect to age, sex, BMI, FBS, HbA1c, and CD4+ T cell counts. Result: The mean concentration of glucose (7.82 ± 2.58) and the percentage concentration of HBA1c (8.21 ± 2.31) were significantly higher in DM individuals as against the control (3.67 ± 0.66) (p = 0.0001) and (5.20 ± 0.48) (p = 0.0001) respectively. The CD4+ cell count was also significantly lower in DM subjects (843.58 ± 297.6) when compared with the control (1067.9 ±195.4) (p = 0.035). Conclusion: A significant reduction in CD4+ T cell level was noted among diabetic patients in our study, which could be a contributing factor for aggravating some of the associated complications in DM, especially those that involve susceptibility to infectious diseases. We found out that having Hb-AA is associated with normal or elevated CD4+ T cells in DM patients; whereas having the Hb-AS variant increases the chance of a low CD4+ T cell count. Assessment of CD4+ T cell count should be included as part of periodic investigations in DM patients, especially for those with unresolved complications, in spite of treatment.

Association between cardiovascular disease risk and incident type 2 diabetes mellitus in individuals with prediabetes: A retrospective cohort study

AimsIn this study, we aimed to evaluate the impact of overall cardiovascular disease (CVD) risk on the development of incident T2DM in patients with prediabetes. MethodsWe retrospectively enrolled 5,908 subjects with prediabetes who underwent health check-ups at the Asan Medical Center. CVD risk was estimated using the Framingham Risk Score (FRS). We compared moderate- to high-risk groups with low-risk controls based on the FRS. Cox proportional hazards regressions were conducted to estimate the time-to-develop incident T2DM. ResultsAmong the 5908 subjects with prediabetes, 3031 (51.8 %) were identified to have either moderate or high CVD risk scores. During a median follow-up of 5.2 years, 278 (9.2 %) patients from the moderate- to high-risk group and 171 (5.9 %) from the low-risk group were diagnosed with T2DM. The covariate-adjusted hazard ratio for the incident T2DM was 1.30 (95 % CI, 1.06–1.60, p = 0.011) in the moderate- to high-risk group compared to the low-risk controls. ConclusionAmong patients with prediabetes, those with high CVD risk were more likely to develop incident T2DM, as determined by the FRS. CVD risk factors should be properly evaluated and managed in individuals with prediabetes to reduce the risk of both incident T2DM and associated cardiovascular complications.

&lt;i&gt;Falciparum&lt;/i&gt; malaria is associated with risk markers of type 2 diabetes mellitus in individuals with or without COVID-19 exposure

Background: Scientific information on the impact of malaria on the risk of developing type 2 diabetes mellitus (T2DM) after recovery from the coronavirus disease 2019 (COVID-19) is limited in the Ghanaian context. The purpose of this study was to examine the association between selected risk markers of T2DM in falciparum malaria patients post-COVID-19 or not at a tertiary hospital in Ghana.&#x0D; Methodology: This was a descriptive cross-sectional comparative study of 38-recovered COVID-19 adult participants with malaria and 40 unexposed COVID-19 adults with malaria at the Tamale Teaching Hospital, Ghana. Demographic, anthropometric and levels of glucose, insulin, C-reactive protein and lipid profiles were measured in the two groups of participants under fasting conditions. Parasitaemia was assessed microscopically but insulin resistance and beta-cell function were assessed by the homeostatic model.&#x0D; Results: The COVID-19 exposed participants were older (p=0.035) with lower parasitaemia (p=0.025) but higher mean levels of insulin, insulin resistance, and beta-cell function compared with their unexposed counterparts (p&lt;0.05). Parasitaemia correlated positively with a number of the measured indices of diabetogenic risk markers in the COVID-19 exposed group only, and predicted (Adjusted R2=0.751; p=0.031) by beta-cell function, C-reactive protein and triglycerides with the model explaining about 75% of the observed variation. Parasitaemia could only be predicted (Adjusted R2=0.245; p=0.002) by C-reactive protein with the model explaining just about a quarter of the observed variation in the COVID-19 unexposed group. Insulin resistance and sub-optimal beta-cell function were detected in both groups of participants.&#x0D; Conclusion: Falciparum malaria is associated with risk markers for development of T2DM irrespective of COVID-19 exposure. Insulin resistance, inflammation and sub-optimal beta-cell secretory function may drive the risk. The observed diabetogenic risk is higher in the recovered COVID-19 participants.&#x0D; &#x0D; French title: Le paludisme à falciparum est associé à des marqueurs de risque de diabète sucré de type 2 chez les individusavec ou sans exposition au COVID-19&#x0D; &#x0D; Contexte: Les informations scientifiques sur l'impact du paludisme sur le risque de développer un diabète sucré de type 2 (DT2) après la guérison de la maladie à coronavirus 2019 (COVID-19) sont limitées dans le contexte ghanéen. Le but de cette étude était d'examiner l'association entre certains marqueurs de risque de DT2 chez les patients atteints de paludisme à falciparum après le COVID-19 ou non dans un hôpital tertiaire du Ghana.&#x0D; Méthodologie: Il s'agissait d'une étude comparative transversale descriptive portant sur 38 participants dultes atteints de COVID-19 guéris et atteints de paludisme et 40 adultes COVID-19 non exposés atteints de paludisme à l'hôpital universitaire de Tamale, au Ghana. Les niveaux démographiques, anthropométriques et de glucose, d'insuline, de protéine c-réactive et le profil lipidique ont été mesurés dans les deux groupes de participants à jeun. La parasitaémie a été évaluée au microscope, mais la résistance à l'insuline et la fonction des cellules bêta ont été évaluées par le modèle homéostatique.&#x0D; Résultats: Les participants exposés au COVID-19 étaient plus âgés (p=0,035) avec une parasitémie plus faible (p=0,025) mais des niveaux moyens d'insuline, de résistance à l'insuline et de fonction des cellules bêta plus élevés que leurs homologues non exposés (p&lt;0,05). La parasitaémie était corrélée positivement avec un certain nombre d'indices mesurés de marqueurs de risque diabétogène dans le groupe exposé au COVID-19 uniquement et prédite (R2 ajusté=0,751; p=0,031) par la fonction des cellules bêta, la protéine C-réactive et les triglycérides avec le modèle expliquant environ 75% de la variation observée. La parasitaémie ne pouvait être prédite (R2 ajusté=0,245; p=0,002) que par la protéine C-réactive, le modèle expliquant à peine environ un quart de la variation observée dans le groupe non exposé au COVID-19. Une résistance à l’insuline et une fonction sous-optimale des cellules bêta ont été détectées dans les deux groupes de participants.&#x0D; Conclusion: Le paludisme à falciparum est associé à des marqueurs de risque de développement du DT2, quelle que soit l'exposition au COVID-19. La résistance à l’insuline, l’inflammation et la fonction sécrétoire sousoptimale des cellules bêta peuvent entraîner ce risque. Le risque diabétogène observé est plus élevé chez les participants guéris du COVID-19.

Abstract 17639: Association of Retinal Microvascular Changes With Incidence and Progression of Coronary Artery Calcium Score in Individuals With vs Without Diabetes Mellitus; Data From the Multi-Ethnic Study of Atherosclerosis

Introduction: Retinopathy (RP) is a microvascular complication of diabetes mellitus (DM); however, it is also increasingly recognized in persons without DM. Microvascular disease may play a prominent role in coronary heart disease (CHD) development. We performed this study to evaluate the association of grades of RP with incidence of CAC (Coronary Artery Calcium) among those with zero CAC at baseline. Hypothesis: We performed this study to evaluate the association of grades of RP with incidence of CAC among those with zero CAC at baseline and to Identify the association of grades of MA and RP with progression of CAC among those with positive CAC at baseline. Methods: We included 5709 subjects with and without DM from the Multi-Ethnic Study of Atherosclerosis (MESA), who had retinal photos and CAC score available. We analyzed the association of grades of RP with incidence and progression of CAC among subjects with and without DM with zero CAC and positive CAC at baseline from robust regression models. The grades of RP were defined as: no retinopathy, minimal non-proliferative R (NPR) (level 14 -20), early to moderate NPR (level 31-41) and severe NPR or proliferative RP (level 51-80). Results: Among those with zero CAC, in the diabetic group, early to moderate (95% CI [1.2, 2]) and severe (95% CI [1.3, 3]) NPR had significantly higher incident CAC risk than the non-retinopathy group. Among those with positive CAC at baseline, in the diabetic group, the early to moderate NPR group had higher CAC progression than the non-retinopathy group. (95% CI [-146, 228]). In the non-diabetic group, the minimal NPR group had significantly higher CAC progression than the non-retinopathy group (95% CI [1.8, 52.7]). Conclusions: In conclusion, after adjustment for major CHD risk factors, RP with any severity was associated with incident CAC in DM individuals, however only early to moderate NPDR was associated with CAC progression in them.

Serum Tsukushi Level Is Associated With the Severity of Liver Fibrosis Independent of Type 2 Diabetes.

Tsukushi (TSK) is a recently identified hepatokine, and we aimed to investigate the association between systemic TSK and the severity of nonalcoholic fatty liver disease (NAFLD) in subjects with and without type 2 diabetes mellitus (DM). Three hundred ninety-three DM and 289 without DM individuals were recruited for transient elastography assessment to determine liver steatosis and fibrosis. Serum TSK was measured by ELISA. The presence of NAFLD was defined as controlled attenuation parameter ≥ 248 dB/m. NAFLD was present in 276 (70.2%) and 129 (44.6%) subjects with and without DM respectively, and they had higher serum TSK levels than those without NAFLD [DM group: 91.0 ng/mL (61.7-133.8) vs 82.5 (60.9-118.5), P < .01 respectively; without DM group: 97.1 ng/mL (69.3-148.6) vs 80.8 (53.4-111.6) respectively, P < .01]. Univariate analysis showed that serum TSK significantly correlated with the degree of steatosis and fibrosis both in subjects with and without DM. On multivariable regression analysis, only liver stiffness and estimated glomerular filtration rate were significant determinants of TSK level, and the relationship was independent of diabetes and serum adiponectin. Out of 405 subjects with NAFLD, 49 had either advanced fibrosis or cirrhosis. The area under receiver operating characteristic curve of serum TSK to indicate advanced fibrosis or cirrhosis was 0.70 (95% CI .62-.77), which was significantly better than that of fibrosis-4 index, 0.64 (95% CI .55-.72), P < .05. Serum TSK levels were increased in subjects with NAFLD and reflected the severity of liver fibrosis.

Sonographic Assessment of Intima-Media Thickness of Carotid Arteries in Hypertensive and Diabetic Volunteers

Objective: Diabetes mellitus (DM) and hypertension are among the most common causes of arteriosclerotic diseases. Intima-media thickness is usually increased with arterial diseases and an increase in carotid intima-media thickness (cIMT) is associated with the presence and extent of coronary artery disease (CAD). This study was designed to sonographically compare the cIMT in hypertensive and DM patient volunteers. Materials and Methods: A case-control stratified study was conducted at Lahore imaging center. Patients were invited to the study had to more than 30 years of age, DM, and hypertension. Individuals from the same age group without hypertension and DM were invited as study controls. Patients with an endarterectomy, or other arterial interventional procedure, as well as a previous history of cardiovascular disease and stroke, were excluded. Results: The mean cIMT, within the right carotid artery was 0.53 mm for the control group, 0.69 mm for the DM group, 0.67 mm for the hypertensive group, and 0.98 mm for the DM and hypertensive patients. The mean cIMT of the left carotid artery was 0.56 mm for the control group, 0.7 mm for DM group, 0.68 mm for hypertensive group, and 1.01 mm for the DM and hypertensive patients. Conclusion: There was a significant difference between the mean cIMT among DM and non-DM individuals. The control group and the DM or hypertension group also differed significantly. However, a more significant difference was found in the mean cIMT within the common carotid artery of control group as well as those with both DM and hypertension.

New erythrocyte parameters derived from the Coulter principle relate with red blood cell properties-A pilot study in diabetes mellitus.

In routine hematological instruments, blood cells are counted and sized by monitoring the impedance signals induced during their passage through a Coulter orifice. However, only signals associated with centered paths in the aperture are considered for analysis, while the rejected measurements, caused by near-wall trajectories, can provide additional information on red blood cells (RBC), as recent publications suggest. To assess usefulness of two new parameters in describing alterations in RBC properties, we performed a pilot study to compare blood samples from patients with diabetes mellitus (DM), frequent pathological condition associated with impairment in RBC deformability, versus controls. A total of 345 blood samples were analyzed: 225 in the DM group and 120 in the control group. A diagram of [Formula: see text] and [Formula: see text], the two new parameters derived from the analysis of impedancemetry pulses, was used to compare distribution of RBC subpopulations between groups. To discriminate RBC from DM and control individuals, based on our multiparametric analysis, we built a score from variables derived from [Formula: see text] matrix which showed good performances: area under the receiving operating characteristic curve 0.948 (0.920-0.970), p<0.0001; best discriminating value: negative predictive value 94.7%, positive predictive value was 78.4%. These results seem promising to approach RBC alterations in routine laboratory practice. The related potential clinically relevant outcomes remain to be investigated.

The Effects of Sacubitril/Valsartan Compared to Olmesartan on the Blood Pressure and Glucolipid Metabolism in DM Patients with Primary Hypertension.

Given the beneficial effects of sacubitril/valsartan on blood pressure generally, this study investigates its antihypertension effects in diabetes mellitus (DM) patients with primary hypertension specifically, and the effect of sacubitril/valsartan on glycolipid metabolism. We conducted a randomized, open-label, active-controlled study to compare the antihypertension effects of sacubitril/valsartan in DM individuals with primary hypertension. The primary end point was reduction in mean systolic blood pressure (SBP) from baseline with sacubitril/valsartan vs. olmesartan at week 8. The secondary endpoints included the changes in diastolic blood pressure (DBP), daytime SBP/DBP, nighttime SBP/DBP, BP achievement (office sitting BP < 130/80mmHg), and lipid profile. The trial was registered with chictr.org.cn (ChiCTR2200066428) on Dec 22, 2022. A total of 124 patients were included in the final analysis. SBP decreased to a greater extent in the sacubitril/valsartan group from baseline to 8weeks [between-treatment difference: 3.51mm Hg, 95% confidence interval (95% CI) 0.41 to 6.62mm Hg, P = 0.03]. Furthermore, more patients achieved the blood pressure goal with sacubitril/valasartan (74.60% vs. 54.70%, P = 0.03). Multiple logistical regression analysis showed that sacubitril/valsartan was associated with BP achievement [odds ratio (OR) 0.33, 95% CI 0.14-0.73, P = 0.007], but the difference in SBP, DBP, day time SBP/DBP, and night time SBP/DBP reduction did not approach statistical significance. HbA1C1, total cholesterol, and low-density lipoprotein-cholesterol were lower than baseline in both groups (P < 0.05); however, there was no difference in the effects on glucose and lipid metabolism from sacubitril/valsartan compared to olmesartan. Sacubitril/valsartan not only provided superior BP reduction compared to olmesartan, it did so without adverse effects on glycemic control and lipid parameters in DM patients with primary hypertension.

Isolated Systolic Hypertension among Diabetes Mellitus Subjects; a national cross-sectional study in Indonesia

Isolated systolic hypertension (ISH) reflects atherosclerosis. Studies reported hypertension prevalence among diabetes mellitus (DM); however, limited studies provided community prevalence. The present study aimed to explore ISH prevalence among DM in Indonesia. This study obtained data from the 2018 Indonesia Basic Health Survey. The DM category was determined by fasting plasma glucose (PG) level ≥126 mg/dL or 2 hours postprandial and random PG level ≥200 mg/dL or previously diagnosed by a doctor. ISH is categorized if systolic blood pressure is≥140 mmHg and diastolic blood pressure is 90 mmHg. This study also explored the subject’s determinants, i.e., compliance, demography, and lipid profile. A Chi-square and Binary logistic regression were used to determine the association. The study included 3,911 DM individuals and disclosed the prevalence of ISH at 17.5%. ≥65 years old (OR=13.61 95%CI: 3.297-19.365) and 45-64 years old OR=4.59 95%CI: 3.297-6.383)), high HDL-cholesterol (OR=0.77; 95%CI: 0.626-0.936), and longer DM duration (OR=2.89; 95%CI: 2.405-3.474), all together were related to the ISH. Subjects with the oldest age category, i.e., ≥65 years old, had the highest OR. Older DM individuals with low HDL-C and longer DM duration were related to the ISH, suggesting lipid profile treatments, mainly the HDL-C, is a pivotal effort to delay ISH.

Relationship between Diabetes Mellitus and Serum Lathosterol and Campesterol Levels: The CACHE Study DM Analysis.

Risk of cardiovascular disease is increased in patients with diabetes mellitus (DM). Cholesterol metabolism (hepatic synthesis and intestinal absorption) is known to be associated with cardiovascular risk. Next, we examined the association of DM with cholesterol absorption/synthesis. The CACHE Consortium, which is comprised of 13 research groups in Japan possessing data of lathosterol (Latho, synthesis marker) and campesterol (Campe, absorption marker) measured by gas chromatography, compiled the clinical data using the REDCap system. Among the 3597 records, data from 2944 individuals were used for several analyses including this study. This study analyzed data from eligible 2182 individuals including 830 patients with DM; 42.2% were female, median age was 59 years, and median HbA1c of patients with DM was 7.0%. There was no difference in Latho between DM and non-DM individuals. Campe and Campe/Latho ratio were significantly lower in DM individuals than in non-DM individuals. When the associations of glycemic control markers with these markers were analyzed with multivariable-adjusted regression model using restricted cubic splines, Campe and Campe/Latho ratio showed inverse associations with glucose levels and HbA1c. However, Latho showed an inverted U-shaped association with plasma glucose, whereas Latho showed a U-shaped association with HbA1c. These associations remained even after excluding statin and/or ezetimibe users. We demonstrated that DM and hyperglycemia were independent factors for lower cholesterol absorption marker levels regardless of statin/ezetimibe use.

TB infection in adults with diabetes mellitus in Uganda.

BACKGROUND: The diabetes mellitus (DM) and TB dual epidemic is growing in sub-Saharan Africa (SSA), yet the underlying mechanisms of increased TB risk in DM are incompletely understood. We determined the prevalence and factors associated with TB infection (TBI) among DM patients at a tertiary hospital outpatient clinic in Uganda.METHODS: Eligible consenting adults were recruited for this cross-sectional study at an outpatient diabetes clinic using systematic random sampling. Data were collected using a pre-tested case report form. TBI was defined as a positive QuantiFERON® Gold Plus test (QFT-Plus) result. Factors associated with TBI were determined using modified Poisson regression analysis in Stata BE v.16.0.RESULTS: Among the 185 study participants, over two thirds were female and 87.6% (n = 162) were receiving metformin therapy. More than two thirds (143/185) had poor glycaemic control. TBI prevalence was 57.8% (107/185). Concurrent calcium channel blocker (adjusted prevalence ratio [aPR] 1.33, 95% CI 1.05-1.69) and pregabalin therapies (aPR 1.45, 95% CI 1.15-1.84) were independently associated with TBI.CONCLUSIONS: DM individuals on calcium channel blocker and pregabalin therapies should be routinely screened for TBI. Further studies should investigate the mechanisms of commonly used drugs for TBI in patients with DM in Uganda.

Prevalence and Risk Factors of Isolated Systolic Hypertension among Diabetes Mellitus Subjects; a national cross-sectional study in Indonesia

Isolated systolic hypertension (ISH) reflects atherosclerosis. Studies reported hypertension prevalence among diabetes mellitus (DM); however, limited studies provided community prevalence. Present study aimed to explore ISH prevalence among DM in Indonesia. This study obtained data from the 2018 Indonesian basic health survey. The DM category was determined by fasting plasma glucose (PG) level ≥126 mg/dL or 2-hours postprandial and random PG level ≥200 mg/dL or previously diagnosed by a doctor. ISH is categorized if systolic blood pressure is≥140 mmHg and diastolic blood pressure is 90 mmHg. This study also explored the subject's determinants, i.e., compliance, demography, and lipid profile. A Chi-square and Binary logistic regression were used to determine the association. The study included 3,911 DM individuals and disclosed the prevalence of ISH 17.5%. ≥65 years old (OR=13.61 95%CI: 3.297-19.365) and 45-64 years old OR=4.59 95%CI: 3.297-6.383)), high HDL-cholesterol (OR=0.77; 95%CI: 0.626-0.936), and longer DM duration (OR=2.89; 95%CI: 2.405-3.474), all together were related to the ISH. Subjects with the oldest age category, i.e., ≥65 years old, had the highest OR. Older DM individuals with low HDL-C and longer DM duration were related to the ISH, suggesting lipid profile treatments, mainly the HDL-C, is a pivotal effort to delay ISH.

Is skin autofluorescence a novel non-invasive marker in diabetes? A systematic review and meta-analysis of case-control studies.

The advanced glycation end product (AGE) is produced from the nonenzymatic reaction between glucose and macromolecules by aging. Accumulation of AGE causes functional and structural changes in body proteins that lead to impairment of tissue protein functions. We aimed to validate AGE measurement by skin autofluorescence (SAF) in diabetes mellitus (DM) compared to the nondiabetes population. We searched the PubMed, Cochrane, and Scopus databases from their inception till September 18, 2022, for casecontrol studies measuring AGE by SAF. Nonhuman studies, as well as review articles, study proposals, editorials, case reports, or congress posters, were excluded. We used a random effects model to assess the standard mean difference (MD) of age, body mass index (BMI), HbA1c, and SAF between diabetes and nondiabetes individuals. Higher SAF in DM patients indicated more accumulation of AGE compared with the nondiabetic population. Furthermore, HbA1c was considerably higher in DM patients. The MD of age, male gender, and BMI were significantly different between the DM individuals, compared with nondiabetic subjects, which can lead to altered SAF level and AGE production. There was a remarkable heterogeneity between diabetes and nondiabetes when measuring age, gender, and BMI, as well as HbA1c and SAF level. This study could not confirm the validity of SAF as a surrogate marker in diabetes patients. Interestingly, metabolic load and high BMI can increase SAF, considerably. Altogether, SAF could be helpful in the future as a marker for metabolic syndrome or diabetes.

Discovering a trans-omics biomarker signature that predisposes high risk diabetic patients to diabetic kidney disease

Diabetic kidney disease is the leading cause of end-stage kidney disease worldwide; however, the integration of high-dimensional trans-omics data to predict this diabetic complication is rare. We develop artificial intelligence (AI)-assisted models using machine learning algorithms to identify a biomarker signature that predisposes high risk patients with diabetes mellitus (DM) to diabetic kidney disease based on clinical information, untargeted metabolomics, targeted lipidomics and genome-wide single nucleotide polymorphism (SNP) datasets. This involves 618 individuals who are split into training and testing cohorts of 557 and 61 subjects, respectively. Three models are developed. In model 1, the top 20 features selected by AI give an accuracy rate of 0.83 and an area under curve (AUC) of 0.89 when differentiating DM and non-DM individuals. In model 2, among DM patients, a biomarker signature of 10 AI-selected features gives an accuracy rate of 0.70 and an AUC of 0.76 when identifying subjects at high risk of renal impairment. In model 3, among non-DM patients, a biomarker signature of 25 AI-selected features gives an accuracy rate of 0.82 and an AUC of 0.76 when pinpointing subjects at high risk of chronic kidney disease. In addition, the performance of the three models is rigorously verified using an independent validation cohort. Intriguingly, analysis of the protein–protein interaction network of the genes containing the identified SNPs (RPTOR, CLPTM1L, ALDH1L1, LY6D, PCDH9, B3GNTL1, CDS1, ADCYAP and FAM53A) reveals that, at the molecular level, there seems to be interconnected factors that have an effect on the progression of renal impairment among DM patients. In conclusion, our findings reveal the potential of employing machine learning algorithms to augment traditional methods and our findings suggest what molecular mechanisms may underlie the complex interaction between DM and chronic kidney disease. Moreover, the development of our AI-assisted models will improve precision when diagnosing renal impairment in predisposed patients, both DM and non-DM. Finally, a large prospective cohort study is needed to validate the clinical utility and mechanistic implications of these biomarker signatures.

Need for improving immunization status and preventive care in diabetes mellitus patients.

The incidence and the comorbidities, such as infectious diseases (e.g. pneumonia or influenza) of diabetes mellitus are increasing. Therefore, the purpose of this study is to investigate immunization status and preventive care in diabetes mellitus patients. Two groups from the Austrian health interview survey 2014 were identified, acohort of diabetes mellitus (DM) individuals (n = 678) and anon-diabetes mellitus (non-DM) cohort (n = 15,093). The frequencies of doctors' visits, preventive care and immunization status were compared. Furthermore, the study population was divided by age (> 50years, < 50years) and differences between > 50years old DM with < 50years old DM and the > 50years old DM and > 50years old Non-DM cohort were investigated. In the DM cohort ahigher frequency of influenza immunization (13.3% vs. 7.1%, p < 0.001), doctor visits (89.4% vs. 75.4%, p < 0.001), and preventive care, such as colonoscopy (11.2% vs. 6.8%, p < 0.001) and hemoccult tests (32.6% vs. 22.1%, p < 0.001) was observed. Even though older DM individuals have ahigher risk for complications, the > 50 years DM cohort has similar frequencies of colonoscopy, hemoccult test and immunization against influenza and TBE (tick-borne encephalitis) compared to > 50 years Non-DM. Although the > 50 years old DM cohort had ahigher frequency of doctors' visits, they still had lower frequencies of mammography and dentists' visits compared to > 50 years old Non-DM. In comparison to the < 50 years old DM cohort, the > 50 years DM cohort was related to lower intact immunization status of tetanus, diphtheria, Polio and TBE. Still a higher frequency of intact immunization of pneumococcus, influenza and doctors' visits in the > 50years old DM cohort compared to the < 50years old DM cohort can be reported. Preventive care and immunization status in the DM cohort just differ slightly from the general cohort but still should be improved.