Diabetes Mellitus Subjects Research Articles

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.

High-Throughput Microfluidic Extraction of Platelet-free Plasma for MicroRNA and Extracellular Vesicle Analysis.

Cell-free RNAs and extracellular vesicles (EVs) are valuable biomarkers in liquid biopsies, but they are prone to preanalytical variabilities such as nonstandardized centrifugation or ex vivo blood degradation. Herein, we report a high-throughput and label-free inertial microfluidic device (ExoArc) for isolation of platelet-free plasma from blood for RNA and EV analysis. Unlike conventional inertial microfluidic devices widely used for cell sorting, a submicrometer size cutoff (500 nm) was achieved which completely removed all leukocytes, RBCs, platelets, and cellular debris based on differential lateral migration induced by Dean vortices. The single-step operation also reduced platelet-associated miRNAs (∼2-fold) compared to centrifugation. We clinically validated ExoArc for plasma miRNA profiling (39 samples) and identified a 7-miRNA panel that detects non-small cell lung cancer with ∼90% sensitivity. ExoArc was also coupled with size exclusion chromatography (SEC) to isolate EVs within 50 min with ∼10-fold higher yield than ultracentrifugation. As a proof-of-concept for EV-based transcriptomics analysis, we performed miRNA analysis in healthy and type 2 diabetes mellitus (T2DM) subjects (n = 3 per group) by coupling ExoArc and ExoArc+SEC with quantitative polymerase chain reaction (RT-qPCR) assay. Among 293 miRNAs detected, plasmas and EVs showed distinct differentially expressed miRNAs in T2DM subjects. We further demonstrated automated in-line EV sorting from low volume culture media for continuous EV monitoring. Overall, the developed ExoArc offers a convenient centrifugation-free workflow to automate plasma and EV isolation for point-of-care diagnostics and quality control in EV manufacturing.

7-year follow-up atherosclerotic plaque progression in patients with antiphospholipid syndrome versus diabetes mellitus and healthy controls.

Patients with antiphospholipid syndrome (APS) carry a substantial burden of cardiovascular disease and subclinical atherosclerosis. We aimed to assess a 7-year follow-up atherosclerotic plaque progression in APS patients vs diabetes mellitus (DM) and healthy controls (HC). Eighty-six patients with thrombotic APS, 86 with DM and 86 HC (all age- and sex-matched) who underwent a baseline ultrasound of carotid and femoral arteries were invited for a 7-year follow-up ultrasonography examination. We compared atherosclerosis progression among the three groups and examined determinants of plaque progression in APS patients. Sixty-four APS patients (75% females, 43.8% with primary APS), 58 patients with DM and 66 HC were included in the 7-year ultrasound re-evaluation. New plaque was detected in 51.6%, 36.2% and 25.8% of APS, DM and HC subjects, respectively. After adjusting for traditional cardiovascular risk factors (CVRFs) and baseline plaque presence, APS patients showed a 3-fold (OR = 3.07, p= 0.007) higher risk for atherosclerosis progression vs HC and 2-fold (OR = 2.25, p= 0.047) higher risk than DM patients. In multivariate analysis in the APS group, plaque progression was independently associated with systemic lupus erythematosus (SLE) co-existence (OR = 7.78, p= 0.005) and number of CVRFs (OR = 3.02, p= 0.002), after adjusting for disease-related parameters and CVRF-related medications. Sustained low-density lipoprotein target attainment reduced plaque progression risk (OR = 0.34, p= 0.021). Half of APS patients develop new atherosclerotic plaques over a 7-year follow-up, having a three-times higher risk vs HC. Concomitant SLE and number of traditional CVRFs are associated with plaque progression, supporting the need for thorough CVRF assessment and control.

Association of bone turnover markers with glucose metabolism in type 2 diabetes mellitus

Introduction and Aim: Type 2 diabetes mellitus (Type 2 DM) subjects are at increased risk of fracture due to poor bone quality contributing to diabetic skeletal fragility. This study provides an understanding of the relationship between bone turnover markers (BTM) and glucose metabolism in Type 2 DM. Materials and Methods: One hundred types 2 diabetics and one hundred controls participated in this case control study. Serum FBS, osteocalcin, alkaline phosphatase (ALP), CTx (C- terminal cross linked telopeptide of type 1 collagen), HOMA-IR and HOMA-B was measured. Association between BTM and FBS, HOMA-IR and HOMA-B was studied. Comparison was done by Student’s t test. The correlation was established using Pearson's correlation test. P value less than 0.05 was used to determine statistical significance. Results: Mean levels of FBS, ALP and HOMA-IR were higher and mean levels of osteocalcin, CTx and HOMA-B were decreased in diabetics when compared to controls. Osteocalcin levels showed significant negative correlation with FBS, ALP, HOMA-B and HOMA-IR. CTx levels were negatively correlated with ALP and FBS. Conclusion: Early identification of decrease in bone mass in diabetic patients may be helpful in preventing bone loss and future fracture risks. Monitoring for diabetes associated with osteopenia is essential. The biochemical markers of bone metabolism can detect even small changes in the bone turnover, thus identifying diabetics who may become osteoporosis-prone.

Prevalence and Risk Factors for Angiotensin Converting Enzyme Inhibitor Induced Cough among Diabetic Patients in a Tertiary Institution in Southeast Nigeria

Introduction: The prevalence of diabetes mellitus (DM) is increasing worldwide, with the attendant cardiovascular morbidity and mortality especially heightened by co-existing hypertension and proteinuria. The renin–angiotensin system (RAS) has been a drug target of particular interest because of its involvement in the cardiovascular and renal disease progression. The ACE inhibitors (ACEI) have been proven effective for reducing cardiovascular events and mortality in patients with cardiovascular disease. However, these medications are associated with cough in certain subjects which could lead to poor drug adherence and increased cardiovascular morbidity and mortality. This study sought to determine the prevalence of ACEI-induced subjects in DM patients. Methodology: A total of 100 patients who fit eligibility criteria were included in the study. A questionnaire was administered on subjects who were on ACEI while data was abstracted from the medical records of subjects who had been on the medication in the preceding two years. Results: The prevalence of ACEI-induced cough was 20%. Female gender (p=0.022) and prolonged use of the medication (p=0.017) positively correlated with cough among DM subjects who had received ACEI in the preceding 2 years, or were on the medication at the time of this study. There was no correlation between the type of ACEI, anthropometry, and glycaemic control and the prevalence of cough among the subjects. Conclusion: Our study suggests that the prevalence of cough among patients with diabetes mellitus who have been exposed to ACEI is substantial. Keywords: ACE inhibitors; cough; diabetes mellitus.

To Study the Pattern of Anemia in Type 2 Diabetes Mellitus in Elderly Hospitalized Patients

Background: Anemia found in diabetes patients is often unrecognized like many other chronic diseases. Anemia is more common in people with diabetes due to a variety of causes. The aim of this study was to determine the severity and morphological types of anemia among type II diabetic elderly hospitalized patients. Methodology: The present study was a hospital based cross sectional study conducted at Father Muller Medical Collage Hospital, Mangalore Karnataka over a period of 6 months. The cases for the study included 129 elderly patients with having Type 2 Diabetes Mellitus (DM). 129 Hospitalized elderly patients over the age of 60 years who were confirmed to have type 2 DM patient’s demographic data and the blood samples are analyzed for Complete blood count, Peripheral smear for type of anemia, Random blood glucose, Glycated hemoglobin. Result: A total 129 Hospitalized elderly type 2 DM patients were included in the study. Out of 129 subjects, 55.03% were males and 44.97% were females. Of these 24.8% patients had mild anemia, 63.56% had moderate anemia and 11.64% had severe anemia according to clinical degree of anemia based on hemoglobin level. 67.76% patients had microcytic hypochromic anemia, and 30.24% patients had normocytic normochromic anemia. The prevalence of type 2DM is high in male than the female population. Conclusion: The study results exhibit a higher level of the prevalence of anemia in Type 2 DM subjects. The findings of our study suggest that moderate degree of anemia is a common finding, and morphologically, the leading type of anemia was normocytic normochromic anemia. Keywords: Diabetes Mellitus, Anemia, Hemoglobin, Hyperglycemia.

Control Level of Type 2 Diabetes Mellitus in the Elderly Is Associated with Polypharmacy, Accompanied Comorbidities, and Various Increased Risks According to the Beers Criteria.

Comorbidity rates in the geriatric population have increased because of rising life expectancy; thus, patients have had to use more medications. Type 2 diabetes mellitus, one of the most common diseases, may influence the number of drugs used in geriatric patients. The present study was designed to investigate the association between the level of type 2 DM and polypharmacy. Fifty patients with type 2 diabetes over the age of 65 were included according to the inclusion criteria; 23 were well-controlled and 27 had poorly controlled diabetes. The groups were similar in terms of age, sex, WBC, Hb, Plt, AST, ALT, serum creatinine, fasting glucose, and eGFR levels. Patients with HbA1c values above 7.5 were classified as poorly controlled diabetes patients, and those below were considered well-controlled diabetes patients and were evaluated for inappropriate medication use. The number of medications used daily by the cases (p < 0.001), the number of concomitant diseases (p = 0.001), and the number of increased risks according to the Beers Criteria (p = 0.02) were observed to be high in poorly controlled type 2 diabetes mellitus subjects. HbA1c levels were related to the number of medications (r = 0.4, p = 0.004), comorbidities (r = 0.28, p = 0.04), and the number of increased risks according to the Beers Criteria (r = 0.31, p = 0.014). In conclusion, the number of medications used in patients with poorly controlled type 2 diabetes mellitus was found to be more elevated than in individuals with well-controlled type 2 diabetes mellitus. The HbA1c values varied among patients regarding polypharmacy, comorbidities, and increased risks according to the Beers Criteria.

Prevalence and determinants of obesity among individuals with diabetes in Indonesia

Background: Obesity and diabetes mellitus (DM), both individually or simultaneously, increase the risk of morbidity and mortality. The present study aimed to determine the prevalence and determinants of obesity among diabetic individuals in Indonesia. Methods: Data were extracted based on 2018 Indonesian Basic Health Survey (Riset Kesehatan Dasar=RISKESDAS). This study involved all individuals with DM and categorized obesity based on body mass index. After data clearing, this study analyzed 3911 DM subjects of the 33.905 subjects acquired from the 2018 RISKESDAS. The study also observed demographic data, diabetes control parameters, history of hypertension, lipid profiles, and food consumption patterns. These variables were involved in a Chi-square test, and related variables were then involved in the Binary logistic regression to define the independent determinants of obesity among DM subjects. Results: Of the 3911 DM subjects included, the study found an obesity prevalence of 32.9%. This study found that female (prevalence odds ratio [POR]=2.15; 95% CI: 1.76-2.62), age 15-44 years (POR=2.46; 95% CI: 1.83-3.33), urban residence (POR=1.49; 95% CI: 1.25-1.77), history of hypertension (POR=1.25; 95% CI: 1.04-1.51), high diastolic blood pressure (POR=1.90; 95% CI: 1.58-2.29), high LDL (POR=1.44; 95% CI: 1.13-1.84), high HDL (POR=0.60; 95% CI: 0.46-0.78, and high triglycerides (POR=1.27; 95% CI: 1.07-1.50) were the risk factor of obesity among DM subjects; while higher education (POR=0.64; 95% CI: 0.53-0.78) and married (POR=0.73; 95% CI: 0.59-0.90) were protective factors of obesity among DM subjects. Conclusions: The study concluded that almost one-third of DM subjects in Indonesia were obese. Female, age, urban residence, education level, history of hypertension, diastolic blood pressure, and lipid profiles were all associated with obesity among DM subjects in Indonesia. These findings suggest that monitoring and controlling of related determinants is needed to prevent complications caused by the doubled burden of diabetes and obesity.

Health-related quality of life and its determinants among South Indian type 2 diabetes patients with and without non-alcoholic fatty liver disease

Background and aimsNon-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease in type-2 diabetics. The quality of life among those patients was not explored well. Hence, the present study aimed to correlate the determinants with the quality of life (QoL) among the study subjects.MethodsA hospital-based case–control study was conducted at Bhargavi Gastro and Surgical Hospital, Warangal, Telangana, with 358 subjects, from 1 November 2019 to 31 October 2021 (24 months). A 358 of cohort type-2 diabetes mellitus (T2DM) subjects were recruited with 1:1 of NAFLD and without NAFLD. QoL was determined with the SF-36 questionnaire, which comprises eight domains. Statistical analysis included t test, chi-square, and Spearman correlation performed with SPSSV.25 software.ResultsOut of 358 subjects, 200 (55.8%) were males and 158 (44.1%) were females. Glycemic parameters (FBS and HbA1c), lipid profile, liver transaminases (SGPT and SGOT), and serum uric acid levels were significantly high in NAFLD subjects (p < 0.05). The SF-36 score, four domains (physical, energy, mental health, and pain) are significantly reduced in NAFLD subjects p < 0.05). A significant correlation between blood urea and impaired physical, emotional mental, and general health was observed in NAFLD subjects. In the NAFLD subjects, elevated FBS levels lead to impairment of physical and emotional status. Social functioning, general health, and pain were impaired with BMI and TG levels in NAFLD subjects. The mean, SD of SF-36 scores showed no significant difference in contrast to HbA1c among both groups (p > 0.05).ConclusionThe decreased QoL was observed in subjects of T2DM with NAFLD. The QoL is significantly influenced by elevated FBS, SGPT, SGOT, and TG levels. Hence, clinicians need to be vigilant and implement strategies to improve the quality of life in type 2 diabetics with NAFLD.

Identification of Glycoxidative Lesion in Isolated Low-Density Lipoproteins from Diabetes Mellitus Subjects.

Methylglyoxal (MG) is a precursor for advanced glycation end-products (AGEs), which have a significant role in diabetes. The present study is designed to probe the immunological response of native and glycated low-density lipoprotein (LDL) in experimental animals. The second part of this study is to probe glycoxidative lesion detection in low-density lipoproteins (LDL) in diabetes subjects with varying disease duration. The neo-epitopes attributed to glycation-induced glycoxidative lesion of LDL in DM patients' plasma were, analyzed by binding of native and MG-modified LDL immunized animal sera antibodies using an immunochemical assay. The plasma purified human LDL glycation with MG, which instigated modification in LDL. Further, the NewZealand-White rabbits were infused with unmodified natural LDL (N-LDL) and MG-glycatedLDL to probe its immunogenicity. The glycoxidative lesion detection in LDL of DM with disease duration (D.D.) of 5-15 years and D.D. > 15 years was found to be significantly higher as compared to normal healthy subjects (NHS) LDL. The findings support the notion that prolonged duration of diabetes can cause structural alteration in LDL protein molecules, rendering them highly immunogenic in nature. The presence of LDL lesions specific to MG-associated glycoxidation would further help in assessing the progression of diabetes mellitus.

Serum Chromium is Inversely Correlated with the Carotid Intima– Media Thickness in Type 2 Diabetic Subjects

Objective: The aim of this study was to determine and correlate the serum chromium in Carotid intima - media thickness (CIMT) in type 2 Diabetes Mellitus (T2DM) subjects.&#x0D; Materials and Methods: The present case – control study included 40 healthy controls and 45 T2DM subjects that were selected through non-probability (purposive) sampling by prior inclusion and exclusion criteria. Serum chromium (Cr) was detected and measured on inductively coupled “Plasma Optical Emission Spectrophotometer” (ICP- OES)- Carotid artery was examined with a 7.5-MHz linear-array transducer (Siemens Acuson x300) sonography. Data was analyzed by Student’s t test and Chi square test in the SPSS 22.0 (USA). Linear regression model was used for predicting carotid intima media thickness. Level of confidence interval of statistical significance was 95% (P≤ 0.05).&#x0D; Results: Serum Cr in controls and cases was noted 0.873 (± 0.162) and 0.281 (± 0.240) µg/ml (P= 0.001). Serum Cr proved negative correlation with random blood sugar (r= -0.145, P= 0.185), HbA1c (r= -0.145, P= 0.0001) and CIMT (r= -0.730, P= 0.0001). Multiple regression analysis model showed significant association of serum Cr (r= -0.730, P&lt; 0.0001) and HbA1c (r= 0.754, P&lt; 0.0001) with the CIMT.&#x0D; Conclusion: The present study reported serum Cr was inversely correlated with the carotid intima - media thickness that is a marker of atherosclerosis. Cr supplements may be advised to diabetics in clinical management.

Clinical evaluation of the combined efficacy of injectable platelet-rich fibrin along with scaling and root planing in the non-surgical periodontal therapy of stage III and grade C periodontitis patients having type 2 diabetes mellitus: Arandomized controlled trial.

This randomized controlled trial was aimed to evaluate the combined efficacy of injectable platelet-rich fibrin (i-PRF) and scaling and root planing (SRP) in type 2 diabetes mellitus subjects having periodontitis. Twenty-six Stage III, grade C periodontitis subjects (HbA1c > 7) were recruited in this split-mouth study. Following SRP, the test sites received subgingival application of i-PRF, while the control sites received saline. Plaque index, bleeding on probing, modified gingival index, probing pocket depth (PPD) and clinical attachment level (CAL) were measured at baseline, 3 and 6 months. Twenty-three participants completed the course of research. The Friedman test followed by Dunn's post hoc test, revealed significant improvement in all the clinical parameters from baseline to 3 and 6 months in both the study groups (p ≤ 0.05). The mean PPD and CAL decreased from 6.30 ± 1.25 and 7.48 ± 1.75 at baseline to 3.48 ± 1.34 and 4.39 ± 1.67 at 6 months in control sites and from 6.57 ± 1.56 and 7.61 ± 1.69 to 3.39 ± 1.23 and 4.26 ± 1.81 at 6 months in test sites (p ≤ 0.0001). Intergroup analysis found no statistical significant differences in the evaluated parameters across all time intervals (p > 0.05) CONCLUSION: The results indicated that the adjunctive application of i-PRF to SRP provided similar benefits as saline and SRP in diabetes mellitus subjects. Question: To find the combined efficacy of injectable platelet-rich fibrin (i-PRF) along with scaling and root planing (SRP) in the management of periodontal pockets of Stage III and Grade C periodontitis patients having Type 2 Diabetes Mellitus (T2DM). All of the treated sites showed satisfactory healing. Both the treatment modalities (i-PRF + SRP and Saline + SRP) were effective in the treatment of periodontal pockets. At 3 and 6 months, there were no significant differences in periodontal parameters between groups. Meaning: The application of i-PRF as an adjunct to SRP provided similar benefits as saline and SRP in improving clinical parameters in subjects with stage III and grade C periodontitis patients having T2DM (HbA1C > 7).

Difference of Clinical Parameters and Correlation between Type-1 and Type-2 Diabetes Mellitus (DM) Subjects in Bangladesh

Type I and Type 2 diabetes are the two main types with types diabetes accounting for the majority (&gt;85%) of total diabetes prevalence. Both forms of diabetes can lead to multisystem complications of microvascular endpoints including retinopathy, nephropathy and neuropathy and microvascular endpoints including is cadmic heart disease, stroke and peripheral vascular disease. The premature morbidity, mortality, reduced life expectancy and financial and other others costs of diabetes make if an important public health condition. The aim of this study was to observe the clinical condition and consequences patients with diabetes mellitus in Bangladesh. A descriptive cross-sectional study was conducted for the study. Data are collected from BIHS General Hospital. The results showed that, among 100 patients 20% patient was affected by Type-1 Diabetes Mellitus (DM) and 80% patient was affected by Type-2 Diabetes Mellitus (DM). In comparison between Type-1 and Type-2 DM patient’s result showing that Fasting Plasma Glucose (FPG) and 2 hour ABF plasma Glucose range is slightly high in Type-1 DM than Type-2 DM. On the other hand, Creatinine, HbA1C, TSH, Total cholesterol (TC), Triglycerides (TG), HDL ranges are increased in Type-2 DM patient. In this study males are affected 62% and females are 32%. So the ratio between male and female is 2:3. More patients were found in the age between 50-60 years and has risk among 40-50 years. Eating the right foods and adopting other life style behaviors that promotes healthy blood sugar and insulin levels will give you the best chance at avoiding diabetes.

Suitability of pearl millet (Pennisetum glaucum (L.) R. Br.) and sorghum (Sorghum bicolor (L.) Moench) based food products for diabetics

AbstractIn the study, suitability of porridge, bun, and salad prepared from processed pearl millet FBC16 and sorghum PSC4 had been evaluated organoleptically by a panel of semi-trained judges and 25 non-insulin dependent diabetes mellitus subjects. Organoleptically, germinated pearl millet was found to be more suitable for porridge (50%) and salad (100%), while puffed sorghum was best suitable for bun (15%) preparation. Prepared porridge had significantly (P ≤ 0.05) higher protein (16.9%) and total phenols (178.8 mg GAE/100 g) contents and antioxidant capacity (1,036 mg TE/100 g) than control. The dietary fibre and in vitro starch digestibility of composite porridge and bun increased significantly (P ≤ 0.05). Most acceptable composition of porridge, bun, and salad had low glycaemic index (17.64–26.79) and medium to low glycaemic load (8.82–13.40). Suitability of pearl millet and sorghum using appropriate processing techniques (germination and puffing) is recommended for preparation of indigenous food products especially for diabetics.

Analysis of MCP-1 Levels and TNF-alfa /Il-10 Ratio in First Degree Relatives (FDR) Type 2 Diabetes Mellitus Subjects with High Fat Diet Treatment

Type 2 diabetes mellitus is a chronic metabolic disease, which involves a variety of pathogenic processes. Overall these processes result in loss of mass and/or function of pancreatic-cells which is manifested as hyperglycemia. The influence of familial factors appears to be involved in the initiation and development of T2DM through both genetic and non-genetic factors. In the same family environment as patients with diabetes, first-degree relatives of patients with diabetes show a 30-70% increased risk of developing diabetes. Insulin resistance and cell dysfunction have been identified in individuals with a family history of diabetes, even before the onset of T2DM symptoms. Monocyte chemoattractant protein-1 (MCP-1) is a CC-chemokine with an attractant effect on monocytes, memory T cells and basophils. Expression of adipose tissue MCP-1 and circulating levels were positively correlated with adiposity. Larger adipocytes are associated with insulin resistance. This study aims to determine the changes in MCP-1 expression on monocytes before and after treatment with a high-fat diet for five days. The results showed that there was a change in inflammatory activity which was indicated by a high ratio of TNF-alfa/IL – 10 in the FDR group so that it could increase MCP-1 activity. However, there was no relationship between serum MCP-1 levels and the percentage of CD14+CD16+ monocytes in both groups.

Regional differences in islet amyloid deposition in the residual pancreas with new-onset diabetes secondary to pancreatic ductal adenocarcinoma.

Islet amyloid deposition and reduced β-cell mass are pathological hallmarks in type 2 diabetes mellitus subjects. To date, the pathological features of the islets in diabetes secondary to pancreatic ductal adenocarcinoma (PDAC) have not been specifically addressed. To provide further insight into the relationship between islet amyloid deposition of the residual pancreas in PDAC patients and to explore whether regional differences (proximal vs distal residual pancreas) are associated with islet amyloid deposition. We retrospectively collected clinical information and pancreatic tissue removed from tumors of 45 PDAC patients, including 14 patients with normal glucose tolerance (NGT), 16 patients with prediabetes and 15 new-onset diabetes (NOD) patients diagnosed before surgery by an oral glucose tolerance test at West China Hospital from July 2017 to June 2020. Pancreatic volume was calculated by multiplying the estimated area of pancreatic tissue on each image slice by the interval between slices based on abdominal computer tomography scans. Several sections of paraffin-embedded pancreas specimens from both the proximal and/or distal regions remote from the tumor were stained as follows: (1) Hematoxylin and eosin for general histological appearance; (2) hematoxylin and insulin for the determination of fractional β-cell area (immunohistochemistry); and (3) quadruple insulin, glucagon, thioflavin T and DAPI staining for the determination of β-cell area, α-cell area and amyloid deposits. Screening for pancreatic histologic features revealed that duct obstruction with islet amyloid deposition, fibrosis and marked acinar atrophy were robust in the distal pancreatic regions but much less robust in the proximal regions, especially in the prediabetes and NOD groups. Consistent with this finding, the remnant pancreatic volume was markedly decreased in the NOD group by nearly one-half compared with that in the NGT group (37.35 ± 12.16 cm3 vs 69.79 ± 18.17 cm3, P < 0.001). As expected, islets that stained positive for amyloid (islet amyloid density) were found in the majority of PDAC cases. The proportion of amyloid/islet area (severity of amyloid deposition) was significantly higher in both prediabetes and NOD patients than in NGT patients (P = 0.002; P < 0.0001, respectively). We further examined the regional differences in islet amyloid deposits. Islet amyloid deposit density was robustly increased by approximately 8-fold in the distal regions compared with that in the proximal regions in the prediabetes and NOD groups (3.98% ± 3.39% vs 0.50% ± 0.72%, P = 0.01; 12.03% vs 1.51%, P = 0.001, respectively). In conclusion, these findings suggest that robust alterations of the distal pancreas due to tumors can disturb islet function and structure with islet amyloid formation, which may be associated with the pathogenesis of NOD secondary to PDAC.

Effects of Nonsurgical Periodontal Therapy on Glycemic Control in Diabetic Patients under Systemic Administration of Antidiabetic Ayurvedic Drug.

This study aimed to monitor the metabolic response of nonsurgical periodontal therapy in type-2 diabetic patients with chronic periodontitis under systemic administration of antidiabetic ayurvedic drug. About 90 newly diagnosed mild-to-moderate forms of type-2 diabetes mellitus (DM) subjects with generalized chronic periodontitis were selected according to the inclusion and exclusion criteria and were randomly divided into group A and group B with 45 patients in each group. Clinical parameters, including plaque index, probing pocket depth, clinical attachment level, and glycemic status, were assessed at baseline. Following initial periodontal clinical examination, the drug Nishamalaki (NA) 2 gm twice daily for 3 months was prescribed after food by an Ayurvedic physician to all the patients enrolled in group A and group B, and scaling and root planing were completed only for group B patients. Patients were recalled for review, and all the parameters were reassessed at the end of the 1st, 2nd, and 3rd months following interventions. Regarding clinical and metabolic parameters at baseline, no statistically significant differences were displayed between the two groups. However, at the 3-months follow-up period, the patients in group B demonstrated significantly better clinical and metabolic outcomes than patients in group A. Periodontal therapy improved glycemic control in patients with type-2 DM in both groups; however, the reduction in FBS values reached statistical significance only in the group receiving scaling and root planing alone. Nonsurgical periodontal therapy may have a beneficial effect on the periodontal clinical and glycemic levels in type-2 diabetic patients with chronic periodontitis.

Dysglycemia in non-functioning pancreatic neuroendocrine tumors (NF-PNET): Further insights into an under recognized entity

ObjectivePancreatic neuroendocrine tumors (PNETs) are rare, but their incidence has risen significantly in recent years. Whereas diabetes mellitus (DM) is recognized in association with chronic pancreatitis and pancreatic cancer, it has not been well-characterized concerning non-functioning (NF)-PNETs.Study aim:to determine whether NF-PNETs are associated with DM/ Pre-DM and characterize the features of this putative association. MethodsRetrospective study to evaluate rate of Pre-DM /DM in subjects with NF-PNETs. ResultsStudy cohort of 129 patients with histologically confirmed NF-PNETs, ∼60% were men (M/F: 77/52). Abnormal glucose metabolism that preceded any treatment was seen in 70% of this cohort: overt DM in 34% and Pre-DM in 36% of the subjects. However, during follow-up, the overall prevalence rose to 80.6%, owing exclusively to newly diagnosed DM in subjects who received treatment.Patients with DM/Pre-DM were older (65 ± 11; 54 ± 14; p < 0.0001), the tumor was more commonly localized in the pancreatic body and tail (76.5% vs. 23.5% p = 0.03), while BMI (27 ± 6 vs. 28 ± 5 kg/m2), and tumor size (2.4 ± 2 vs. 2.9 ± 3.2 cm) were similar. The relative prevalence of DM in our cohort of NF-PNETs was 1.6 higher than that in the age and gender-adjusted general Israeli population (95 %CI: 1.197–2.212p = 0.03). ConclusionsWe found a high rate of impaired glucose metabolism, either DM or Pre-DM, in a large cohort of NF-PNETs. The high prevalence of diabetes/pre-diabetes was unrelated to obesity or tumor size. This observation should increase awareness of the presence of DM on presentation or during treatment of “NF”-PNETs.

High Prevalence of Diabetes Among Hospitalized COVID-19 Minority Patients: Data from a Single Tertiary Hospital.

Type 2 diabetes mellitus (DM) is a common comorbidity in the minority population and is associated with poor outcomes in COVID-19 patients. We hypothesized that COVID-19 patients with pre-existing diabetes mellitus are prone to fatal outcomes compared to non-diabetic patients. We aimed to illustrate the characteristics and outcomes and identify the risk factors for in-hospital mortality of COVID-19 patients with DM. In this single-center retrospective study, electronic medical records of hospitalized patients with confirmed COVID-19 diagnosis at Howard University Hospital (HUH) from March 2020 to Dec 2021 were analyzed. Clinical, demographic, and serological information, as well as outcomes, were recorded and analyzed. Among 463 COVID-19 patients, 66.3% (n = 307) were African Americans (AA) and 35.9% (n = 166) had diabetes, with a mean age of 64years. The majority of the diabetic patients were AA (n = 123, 74.1%) and had a higher mortality rate (n = 26, 74.3%) compared to others. Length of stay in the hospital is significantly more for the diabetic than for the non-diabetic patients (11.3 vs. 8.3days, p = 0.03). A higher proportion of ICU admission (32.3% vs. 17.9%, p = < 0.001), intubation (17% vs. 11.7%, p = 0.04), and increased mortality (21.1% vs. 12.2%, p = 0.01) were identified in COVID-19 patients with DM than in those with no DM. Among DM patients, non-survivors were older (69.9 vs. 62.9years). DM patients were more likely to have underlying hypertension (72.3% vs. 43.3%, p = < 0.001), obesity (44.8% vs. 32.1%, p = 0.007), chronic kidney disease (23.6 vs. 11.8%, p = 0.001), and cardiovascular disease (29.5% vs. 14.3%, p = 0.001) than the non-DM patients. HbA1C above 9%, indicating poorly controlled hyperglycemia, was associated with poor outcome among the DM subjects. AST (23.5% vs. 31.3%) and creatinine (61.4% vs. 37.9%) were significantly more elevated in DM COVID-19 patients (all p-values < 0.05). The levels of serum troponin (42.5% vs. 30.9%, p = 0.03), interleukin-6 (67.2 vs. 50%, p = 0.04), ferritin (65.6% vs. 44.6%, p = 0.03), procalcitonin (58.1% vs. 46.1, p = 0.03), and D-dimers (92.8% vs. 86.5%, p = 0.04) were significantly higher in DM patients as compared to those in non-DM COVID-19 patients, indicating more susceptibility of diabetic COVID-19 patients to coagulation dysfunction and inflammatory storm. The prevalence of DM is high among hospitalized COVID-19 patients in our cohort. While DM patients have a higher mortality rate and ICU admission than non-DM patients, other factors such as underlying comorbidities, old age, elevated creatinine, AST, serum inflammatory markers, and D-dimer are more significant predictors of fatal outcomes. DM patients had higher metabolic derangements, hypercoagulability, and severe inflammatory response. No significant difference of outcome was noted between DM patients of different races in our cohort. In the diabetic group, it appears that race may not significantly contribute to the observed mortality disparity. This could be attributed to the significant influence of diabetes, which acts as a major effector, potentially overshadowing the significance of race in this context.

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.