Longer Duration Of Diabetes Research Articles

Diabetic foot ulcers risk prediction in patients with type 2 diabetes using classifier based on associations rule mining

Identifying diabetic patients at risk of developing foot ulcers, as one of the most significant complications of diabetes, is a crucial healthcare concern. This study aimed to develop an associative classification model (CBA) using the Apriori algorithm to predict diabetic foot ulcers (DFU). This retrospective cohort study included 666 patients with type 2 diabetes referred to Shahid Beheshti Hospital in Iran between April 2020 and August 2022, of which 279 (42%) had DFU. Data on 29 specific baseline features were collected, which were preprocessed by discretizing numerical variables based on medical cutoffs. The target variable was the occurrence of DFU, and the minimum support, confidence, and lift thresholds were set to 0.01, 0.7, and 1, respectively. After data preparation and cleaning, a CBA model was created using the Apriori algorithm, with 80% of the data used as a training set and 20% as a testing set. The accuracy and AUC (area under the roc curve) measure were used to evaluate the performance of the model. The CBA model discovered a total of 146 rules for two patient groups. Several factors, such as longer duration of diabetes over 10 years, insulin therapy, male sex, older age, smoking, addiction to other drugs, family history of diabetes, higher body mass index, physical inactivity, and diabetes complications such as proliferative and non-proliferative retinopathy and nephropathy, were identified as major risk factors contributing to the development of DFU. The CBA model achieved an overall accuracy of 96%. Also, the AUC value was 0.962 (95%CI 0.924, 1.000). The developed model has a high accuracy in predicting the risk of DFU in patients with type 2 diabetes. The creation of accurate predictive models for DFU has the potential to significantly reduce the burden of managing recurring ulcers and the need for amputation, which are significant health concerns associated with diabetes.

Incidence and predictors of chronic kidney disease among patients with diabetes treated at governmental hospitals of Harari Region, eastern Ethiopia, 2022.

Chronic kidney disease (CKD) is the leading cause of morbidity and mortality in diabetic patients. However, limited evidence is available about its incidence and predictors in Ethiopia, specifically in the Harari region. A retrospective follow-up study was conducted among 520 diabetes patients who followed their treatment at governmental hospitals in the Harari region between 1 September 2012, and 30 May 2022. The risk of developing CKD was calculated with a 95% CI, and the risk was stratified by type of diabetes mellitus. Predictors of CKD were determined using the Gompertz regression model with the baseline Cox model. Data from 494 patients were included in the final analysis with 26 (5%) excluded. A total of 51 patients (10.32%) developed CKD over the 10-year follow-up period with an incidence rate of 2.16 cases (95% CI 1.64-2.84) per 100 person-years of observation. The risk of CKD was increased by three times (AHR: 3.09, 45 95% CI: 1.56, 6.14) among patients older than 60 years and by more than three times (AHR: 3.53, 95% CI: 1.43, 8.71) among patients with diabetes mellitus for longer than 5 years of stay with the diabetes mellitus. Moreover, the risk of CKD was increased four-fold among patients with high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL (AHR: 3.84, 95% CI, 1.80-8.18) and those with positive baseline proteinuria (AHR: 3.77, 95% CI: 1.43-8.71). We found that one in ten diabetic patients had developed CKD within 10 years of the diabetes mellitus diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level, and proteinuria had increased the hazards of developing CKD. We recommend a more focused follow-up of older adult patients with advanced disease status at baseline for optimal control of diabetes mellitus that prevents its furthering to CKD.

Association between Albuminuria, Glycated Hemoglobin with Comorbidities in Type 2 Diabetes Patients: Experience in Sulaimani City, Iraq

Background: Diabetes nephropathy is one of the most important complications of type 2 diabetes mellitus (T2DM). Albuminuria is an early clinical indicator for investigating diabetes nephropathy. Age, poor glycemic control, long duration of diabetes, and hypertension increase the risk of albuminuria. Objectives: To determine the relationship between albuminuria, HbA1c, and comorbidities in elderly patients with T2DM. Methods: A cross-sectional study was carried out on 136 elderly patients with T2DM at the Diabetes and Endocrine Center in Sulaimani City. Data was obtained from each patient through face-to-face interviews and laboratory tests for HbA1c, serum lipid profiles, and albumin levels in the urine. Results: Out of 136 patients, 82 elderly patients with T2DM were normoalbuminuric, 37 had microalbuminuria, and 17 had macroalbuminuria, respectively. The female gender was at greater risk of developing albuminuria (19.1% microalbuminuria and 6.6% macroalbuminuria) than the male gender (8% microalbuminuria and 5.8% macroalbuminuria). The risk factors for microalbuminuria and macroalbuminuria were poor glycemic control (HBA1c &gt;7.5) (16.9% microalbuminuria and 6.6% macroalbuminuria), long-term diabetes (5–10 years) (13.9% microalbuminuria and 5.1% macroalbuminuria), and coexisting comorbidity conditions (21.3%) microalbuminuria and 10.2% macroalbuminuria, mainly hypertension (20.5% microalbuminuria and 8.8% macroalbuminuria). Conclusion: Our findings showed that the incidence of albuminuria in elderly patients with T2DM was high in patients with poor diabetes control, a long duration of diabetes, and comorbidity conditions, particularly in patients with hypertension.

Prevalence and Correlators of Diabetes Distress in Adults with Type 2 Diabetes: A Cross-Sectional Study.

To address the prevalence of diabetes distress (DD) and its correlators in adults with type 2 diabetes. During 2021 and 2022, we conducted a cross-sectional study in three Class A tertiary comprehensive hospitals in China, and received 947 participants who completed a printed survey covering DD, demographic, diabetic, physiological, and psychosocial factors. We used Jonckheere-Terpstra, chi-square, and Fisher's exact tests to assess intergroup differences between different levels of DD. We used ordinal logistic regression analysis to analyze correlators of DD further. The prevalence of DD was 34.64%. In univariate analysis, those with lower satisfaction with financial status, longer durations of diabetes, more complications, higher glycemia, more severe insomnia, treatment by medications only, poorer lifestyle interventions, fewer self-care activities, more types and frequencies of insulin injections, and spending more money and time on treatment were susceptible to DD. Type D personality, negative illness perceptions, negative coping styles, and psychological effects of major life events were related to higher DD. Hope, self-efficacy, positive coping styles, and social support can reduce DD. In ordinal logistic regression analysis, hypoglycemic episode (β=-1.118, p=0.019, "have hypoglycemic" as reference) and Brief Illness Perception Questionnaire (β=0.090, p<0.001) were significant positive correlators for DD, while diet intervention (β=0.803, p=0.022, "have diet intervention" as reference), money spent on diabetes treatment (β<-0.001, p=0.035), and SES (β=-0.257, p<0.001) were significant negative correlators. More than one-third of Chinese adults with type 2 diabetes experience moderate or high levels of DD. DD was associated with financial, diabetic, physiological, and psychosocial status.

The Hidden Battle Within: Shedding Light on the Co-existence of Sarcopenia and Sarcopenic Obesity among Participants with Type 2 Diabetes in a Tertiary Care Hospital, Gujarat.

Type 2 diabetes (T2DM) is characterised by chronic hyperglycaemia due to abnormal insulin secretion and/or utilisation. Currently, sarcopenia has emerged as a new complication of T2DM, which increases the risk of physical disability, and even death. The study aims to estimate the prevalence of sarcopenia and sarcopenic obesity (SO) as well as their association with various other factors related to T2DM. The study was an observational hospital-based cross-sectional study conducted among diabetic patients who came to the non-communicable diseases (NCD) clinic of a tertiary care hospital in Gujarat, India, from April 2023 to June 2023. Adult patients with T2DM attending follow-ups were included, with a diagnosis of T2DM for at least 1 year from the date of their electronic medical records, regardless of their mode of therapeutic treatment. They were on regular medical reviews with two or more visits to the study site in the past 1 year. Then a self-structured standard questionnaire was used to collect the data, containing socio-demographic characteristics, clinical profiles, anthropometric assessment (comprising weight, height and body mass index [BMI]), bio-impedance indices like body fat%, skeletal muscle% and handgrip by hand dynamometer. In the study, a total of 404 participants participated. Their mean age was 55 ± 13.5 years and their mean body fat (BF) % was 30 ± 7.4%. BF%-defined obesity was found in 260 (64.4%) participants. A total of 362 (89.6%) had possible sarcopenia, 183 (45.3%) had sarcopenia and 124 (30.7%) had SO. Age (OR: 2.6, CI: 1.7-3.9), duration of diabetes for more than 7 years (OR: 7.5, CI: 3.65-15.4) and BF%-defined obesity (OR: 2.2, CI: 3.6-15) were statistically associated with Sarcopenia, in similar pattern age (OR: 2.4, CI: 1.5-3.7), and duration of diabetes more than 7 years (OR: 18.9, CI: 5.7-62) were associated with SO (P < 0.05). Older age, longer diabetes duration and BF%-defined obesity are associated with an increased likelihood of developing sarcopenia and sarcopenic obesity. Healthcare providers should prioritise regular screening for sarcopenia and SO in elderly individuals with diabetes to facilitate early detection and intervention.

Associations Between Arterial Stiffness and Metabolic Target in Children and Adolescents With Type 1 Diabetes Treated in a Modern Setting

Objective: To investigate the prevalence of elevated arterial stiffness and associations to known and potentially novel risk factors in a modern European technology‐based cohort of children and adolescents with type 1 diabetes.Research Design and Methods: Cross‐sectional study, including 127 children recruited from Pediatric Diabetes Departments across Eastern Denmark between May 2022 and January 2024. Arterial stiffness was assessed as carotid–femoral pulse‐wave‐velocity (cfPWV) using the Sphygmocor XCEL system. Unadjusted and adjusted linear regression models explored associations between cfPWV and other risk factors. Adjustments included age, sex, diabetes duration, time‐in‐range, hemoglobin A1c (HbA1c), body mass index (BMI) z‐score, low‐density lipoprotein (LDL)‐cholesterol, and mean arterial pressure (MAP).Results: Median (interquartile range [IQR]) age was 14.2 years (12.0, 16.4), diabetes duration was 4.7 years (2.7, 8.4), HbA1c level was 7.0% (6.5, 7.9), (53 mmol/l: 48–63), time‐in‐range was 63% (53–75), and 52% were male. The majority were treated with continuous‐subcutaneous‐insulin‐infusion (82%), and all (except two) used continuous‐glucose‐monitors. The prevalence of elevated arterial stiffness (cfPWV z‐score over the 90th percentile) was 16%. Unadjusted analyses demonstrated higher cfPWV was associated with longer diabetes duration, higher age, HbA1c, MAP, and liver stiffness, and lower time‐in‐range and insulin sensitivity. Higher cfPWV remained associated with higher age (standardized β (confidence interval (CI) 95%): 0.38 (0.27, 0.48); p &lt; 0.001) and lower time‐in‐range (−0.15 ((−0.26), (−0.03)); p &lt; 0.011) after adjustment.Conclusions: Despite modern treatment technology and better overall metabolic control, children and adolescents with type 1 diabetes present with a high prevalence of elevated arterial stiffness. Higher arterial stiffness was associated with higher age and lower time‐in‐range, independent of other risk factors, including HbA1c.

Alterations in aortic elasticity indices among type 2 diabetes patients in a low and middle income country using M-mode echocardiography: A cross-sectional comparative study.

Diabetes is one of the leading causes of noncommunicable diseases worldwide. It is known to induce cardiovascular remodeling, which can result in a variety of complications, including a considerable increase in aortic stiffness. While studies in Western populations have explored these effects, data on Asians, mainly Vietnamese, are limited. This study aimed to assess aortic elasticity in type 2 diabetes mellitus (T2DM) patients compared to healthy individuals. This quantitative, cross-sectional study compared aortic elasticity indices between individuals with T2DM and healthy controls in Vietnam. Aortic elasticity indices were assessed for all participants using M-mode echocardiography. A comparison between the healthy and T2DM groups revealed substantial differences in aortic elasticity indices. The aortic stiffness index (ASI) was significantly greater in the T2DM group than in the control group, with median values of 6.10 (3.64-12.47) and 3.79 (2.40-8.50), respectively (p = 0.003). Aortic strain (AS) was substantially lower in the T2DM group than in the control group, with median values of 8.21% (4.24-13.07) and 10.66% (6.01-18.23), respectively (p = 0.039). Furthermore, the median aortic compliance (AC, 10-2mm/mmHg) and aortic distensibility (AD, 10-3mmHg-1) in individuals with T2DM were 4.07 (2.28-7.44) and 3.08 (1.57-5.26), respectively, lower than those in the control group, with median values of 6.40 (3.08-10.75) and 5.33 (2.80-9.79). A longer diabetes duration was linked to a greater ASI (r = 0.43, p < 0.05), while the AS decreased (r = -0.37, p < 0.05). Substantial variations in aorta elasticity indices were found in patients with T2DM using M-mode echocardiography. These differences highlight the impact of T2DM on vascular health. More research is needed to investigate the consequences of these discrepancies and their significance for clinical purposes.

Impact of Duration of Diabetes Mellitus on Long-Term Outcome in Type 2 Diabetic Patients with Primary Percutaneous Coronary Intervention after the First Myocardial Infarction.

Diabetes mellitus (DM) increases the risk of mortality in patients with acute myocardial infarction (AMI). The impact of the diabetes duration on the long-term outcome of those with percutaneous coronary intervention (PCI) after the first AMI is unclear. In this study, we evaluated the predictive value of diabetes duration in the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs). A total of 394 type 2 DM patients with PCI after the first AMI were enrolled and were divided into two groups by the diabetes duration: a short-DM group with diabetes duration of &lt;5 years and a long-DM group with a duration of ≥5 years. The clinical endpoint was MACCEs. Multivariate Cox regression analysis found that the diabetes duration was independently associated with increased occurrence of MACCEs (HR: 1.512, 95% CI: 1.033, 2.215, p = 0.034), along with hypertension, Killip class III or IV, creatinine, multivessel disease, and continuous hypoglycemic therapy. After adjusting for the confounding variables, a nested Cox model showed that diabetes duration was still an independent risk factor of MACCEs (HR: 1.963, 95% CI: 1.376, 2.801, p &lt; 0.001). The Kaplan-Meier survival curve illustrated a significantly high risk of MACCEs (HR: 2.045, p &lt; 0.0001) in long-duration DM patients. After propensity score matching, a longer diabetes duration was associated with an increased risk of MACCE occurrence. Long-duration diabetes was independently associated with poor clinical outcomes after PCI in patients with their first myocardial infarction. Despite the diabetes duration, continuous hypoglycemic therapy significantly improved long-term clinical outcomes.

Awareness About Diabetes And Its Complications Among Patients With Diabetes Mellitus

Objective: Awareness of diabetes and its potential complications is crucial for effective management and prevention of long-term health risks. This study aimed to assess the level of awareness and understanding of diabetes and its complications among patients diagnosed with type 2 diabetes mellitus. Methods: A cross-sectional study included 200 patients with type 2 diabetes mellitus as per the American Diabetes Association (ADA) criteria. Type 1 diabetes and gestational diabetes patients were excluded from the study. The duration of the study was 8 months. The patient’s awareness regarding diabetes and its complications was assessed as per the prefixed questionnaire. Analysis of the data was carried out with SPSS version 28. The Chi-square test was used to investigate the association of awareness of diabetes mellitus with various independent variables variable as age and duration of diabetes. The level of statistical significance was p &lt;0.05. Results: Among the participants, 80 (40%) were male and 120 (60%) were female. A significant portion of patients 73 (36.5%) were never informed about diabetes or its complications. 69 (34%) of patients were never educated about the symptoms of hypoglycemia. 142 (71%) of the patients had a glucometer and 88 (44%) participants had poor follow-up and never checked HbA1C. Moreover, Patients with longer diabetes duration were more likely to visit ophthalmologists at regular intervals (P value 0.023). 111 (56%) never checked their urine for proteinuria and 172 (86%) were aware that diabetes can affect their kidneys. Foot care and awareness of diabetic foot complications were lacking among patients. 48 (24%) examined their feet daily, 66 (33%) never examined their feet, and 73 (36%) were never told about foot care by their doctors. The statistically significant impact of age on patients' knowledge regarding blood sugar levels (P=0.009) and foot care (P=0.013) Conclusion: There is a significant lack of awareness among individuals with diabetes, highlighting the urgent need for educational initiatives. Both the public and private healthcare sectors should take the responsibility of providing awareness programs. Keywords: Type 2 diabetes mellitus, awareness, complications.

Systemic and ocular outcomes in patients with young-onset type 2 diabetes

PurposeTo analyze the systemic and ocular outcomes in patients with young-onset type 2 diabetes (YO-DM2) based on grade of presenting diabetic retinopathy (DR). MethodsRetrospective cohort study analysis of empaneled patients with type 2 diabetes <40 years old with retinopathy screening within the Los Angeles Department of Health Services between 01/01/2017–07/01/2021 were included. Patients were stratified based on presenting severity of DR determined on fundus photographs or clinical examination. Patient's systemic co-morbidities and ocular outcomes were then compared across each group. Procedural (e.g. intravitreal injections) and surgical interventions (e.g. pars plana vitrectomy) were documented as performed by the treating physician. Results2795 patients were screened from 12,456 patients diagnosed with diabetes younger than age 40 (22.4 %). Of these, 1496 patients were diagnosed with type 2 DM. 1084 (72.4 %) of patients presented without DR, 307 (20.5 %) presented with non-proliferative diabetic retinopathy (NPDR), and 105 (7.0 %) of patients presented with proliferative diabetic retinopathy (PDR). Increasing presenting diabetic retinopathy severity was associated with longer duration of diabetes, greater systemic comorbidities (e.g. diabetic foot disease, neuropathy, chronic kidney or end stage renal disease), worse baseline and final visual acuity, and required more procedural and surgical interventions. ConclusionsWorse presenting DR severity in patients young-onset type 2 diabetes was associated with greater comorbid systemic and ocular disease with worse visual acuity outcomes. <1 % of patients without diabetic retinopathy or with mild NPDR were likely to progress to PDR. Diabetic kidney disease was an independent risk factor for developing neovascular glaucoma and retinal detachments. Prompt evaluation and intervention in patients with YO-DM2 may help reduce the associated systemic and ocular morbidity.

Fetal Overgrowth and Preterm Delivery in Women With Type 1 Diabetes Using Insulin Pumps or Multiple Daily Injections: A Post Hoc Analysis of the EVOLVE Study Cohort.

To compare the risk of fetal overgrowth and preterm delivery in pregnant women with type 1 diabetes (T1D) treated with insulin pumps versus multiple daily injections (MDI) and examine whether possible differences were mediated through improved glycemic control or gestational weight gain during pregnancy. The risk of pregnancy and perinatal outcomes were evaluated in a cohort of 2,003 pregnant women with T1D enrolled from 17 countries in a real-world setting during 2013-2018. In total, 723 women were treated with pumps and 1,280 with MDI. At inclusion (median gestational weeks 8.6 [interquartile range 7-10]), pump users had lower mean HbA1c (mean ± SD 50.6 ± 9.8 mmol/mol [6.8 ± 0.9%] vs. 53.6 ± 13.8 mmol/mol [7.1 ± 1.3%], P < 0.001), longer diabetes duration (18.4 ± 7.8 vs. 14.4 ± 8.2 years, P < 0.001), and higher prevalence of retinopathy (35.3% vs. 24.4%, P < 0.001). Proportions of large for gestational age (LGA) offspring and preterm delivery were 59.0% vs. 52.2% (adjusted odds ratio [OR] 1.36 [95% CI 1.09; 1.70], P = 0.007) and 39.6% vs. 32.1% (adjusted OR 1.46 (95% CI 1.17; 1.82), P < 0.001), respectively. The results did not change after adjustment for HbA1c or gestational weight gain. Insulin pump treatment in pregnant women with T1D, prior to the widespread use of continuous glucose monitoring or automated insulin delivery, was associated with a higher risk of LGA offspring and preterm delivery compared with MDI in crude and adjusted analyses. This association did not appear to be mediated by differences in glycemic control as represented by HbA1c or by gestational weight gain.

Associations of genetic variants contributing to gut microbiota composition in diabetic nephropathy.

The gut microbiota is strongly associated with multiple kidney diseases, and since microbial composition is heritable, we hypothesized that genetic variations controlling gut microbiota composition were associated with diabetic nephropathy susceptibility or clinical subphenotypes. The genetic variations associated with gut microbiota were retrieved from the genome-wide association study database and analysed in our diabetic nephropathy susceptibility gene screening cohort. Candidate microorganisms with possible genetic associations were identified using the annotation of microbial quantitative trait loci. Finally, the candidate microorganisms were verified by 16S rDNA gene sequencing. There were 13 genetic variation loci associated with susceptibility to diabetic nephropathy. The TCF7L2 risk genotype was associated with a long duration of diabetes and high diastolic blood pressure, the ZCWPW2 risk genotype was associated with increased glycosylated hemoglobin, and the ZNRF3 risk genotype was associated with an increased urinary microalbumin-to-creatinine ratio. Both the ZNRF3 and SPECC1L risk genotypes were associated with the abundance of Lactococcus. 16S rDNA sequencing confirmed that there was indeed a significant difference in the Lactococcus genus between DN and DM patients. In this study, we preliminarily confirmed that the gut microbiota of diabetic nephropathy patients is influenced by host genetics and provide a new basis for future accurate diagnosis and treatment.

Inflammageing mediated by cytotoxic lymphocytes is associated with diabetes duration

AimsInflammageing, the age-related systemic increase of proinflammatory factors, has been linked to the development of cardiovascular disease, chronic kidney disease and cancer in the elderly. Chronic inflammation is believed to be a causative factor in the development of diabetic complications. However, exactly how type 2 diabetes impacts the inflammatory state of the immune system is incompletely characterised. MethodsBlood collection and anthropometric measurements were performed in patients with type 2 diabetes (n=49) and control subjects (n=30). The phenotype, proliferation capacity and cytokine production by cytotoxic lymphocytes were analysed using multiparametric flow cytometry. ResultsType 2 diabetes did not impact the phenotype or proliferation of the investigated cells. However, we observed a significantly increased production of tumour necrosis factor-α by CD8+ T cells and Granzyme B by natural killer cells and γδ T cells compared to controls. Hyperresponsiveness of cytotoxic blood lymphocytes did not correlate with glycaemia or body mass index, but instead was associated with older age and longer diabetes duration. ConclusionsType 2 diabetes is associated with an increased pro-inflammatory potential of cytotoxic blood lymphocytes correlating with age and diabetes duration. Further research is necessary to explore potential benefits of diabetes medications in reverting this effect.

Predictors of metabolic syndrome and its components in patients with type 2 diabetes: A cross-sectional study in the Ho municipality, Ghana

BackgroundMetabolic syndrome refers to a group of risk factors that individually or synergistically increase the risk of cardiovascular disease. The predictors of metabolic syndrome are thought to vary between populations and ethnicities. Hence, this study aimed to investigate the factors predicting metabolic syndrome and its components among patients with type 2 diabetes in the Ho municipality. MethodsA hospital-based cross-sectional study was designed to include 197 patients with type 2 diabetes at the Ho Municipal Hospital. A semi-structured questionnaire was used to obtain data on demography and lifestyle variables. Anthropometric, haemodynamic, and biochemical parameters were measured. Metabolic syndrome was defined according to the harmonised criteria. Renal function was evaluated based on the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI)] and the evidence of proteinuria. Chi-square test and logistic regression analyses were performed to determine the predictors of metabolic syndrome and its components. ResultsOverall, the prevalence of metabolic syndrome was 59.90 %. Females had higher odds of metabolic syndrome [OR: 2.64, 95 % CI: 1.48–4.71; p = 0.001], abdominal obesity [OR: 11.49, 95 % CI: 5.18–25.49, p < 0.001], and low HDL-C levels [OR: 17.67, 95 % CI: 4.73–65.99, p < 0.001]. Having a family history of diabetes increased the risk of metabolic syndrome [OR: 1.94, 95 % CI: 1.09–3.54, p = 0.023] and abdominal obesity [OR: 2.60, 95 % CI: 1.25–5.42, p = 0.011]. Having diabetes for 5 years or more was associated with uncontrolled FBG [OR: 4.75, 95 % CI: 1.25–17.98, p = 0.022] and low HDL-C levels [OR: 4.52, 95 % CI: 1.64–12.45, p = 0.004]. Attainment of secondary education increased the risk of abdominal obesity [OR: 5.73, 95 % CI: 1.46 – 22.49, p = 0.012], while the attainment of tertiary education increased the risk of low HDL-C [OR: 4.20, 95 % CI: 1.09 – 16.24, p = 0.038]. Physical inactivity was associated with metabolic syndrome [OR: 2.19, 95 % CI: 1.12 – 4.28, p = 0.022]. Being older than 50 years had a two-fold increased risk of elevated BP [OR: 2.53, 95 % CI: 1.36–4.69, p = 0.003]. However, females were about 56 % unlikely to be associated with elevated BP [OR: 0.44, 95 % CI: 0.23–0.84, p = 0.013]. ConclusionThe female gender, family history of diabetes, and longer duration of diabetes as well as attainment of secondary and tertiary level education and physical inactivity were significant predictors of metabolic syndrome and its components in patients with type 2 diabetes.

Continuous glucose monitoring in older adults with diabetes: Data from the diabetes prospective follow-up (DPV) registry.

To analyse predictors for continuous glucose monitoring (CGM) use in people with diabetes aged ≥60 years using insulin therapy and to assess the rates of CGM use during recent years (2019-2021). Prospective study including 6849 individuals with diabetes and insulin therapy (type 2 diabetes: n = 5320; type 1 diabetes: n = 1529) aged ≥60 years. Data from 129 treatment centres were retrieved from the Diabetes Prospective Follow-up Registry (DPV) in March 2023. Sensor use in individuals aged ≥60 years has increased in type 1 (2019: 28%, 2020: 39%, 2021: 45%) and type 2 diabetes (2019: 10%, 2020: 16%, 2021: 18%). Predictors for sensor use in older individuals with type 1 diabetes are younger age and CSII use (p < 0.001). Predictors in older individuals with type 2 diabetes are younger age, longer diabetes duration, higher BMI and CSII use (p < 0.001). CGM has become more common in older adults with diabetes and will presumably increase further. Age is a predictor for sensor use in older adults with diabetes. Age-related physical barriers and insufficient usability of devices, lack of interest in technologies, but possibly also effects of prejudice on the grounds of age may contribute to this finding.

A cross-sectional study in type 2 diabetes patients reveals that elevated pulse wave velocity predicts asymptomatic peripheral arterial disease associated with age and diabetes duration

BackgroundPeripheral arterial disease (PAD) reduces functional capacity and raises cardiovascular risks, but underdiagnosis is common, resulting in less comprehensive care than other cardiovascular conditions. While diabetes has long been viewed as a key risk factor for PAD, recent studies indicate that its impact is influenced by the presence of concurrent cardiovascular risk factors. The aim of this study is to elucidate the intricate relationship between the prevalence of PAD, diabetic complications, and cardiovascular risk factors among asymptomatic patients with type 2 diabetes mellitus (T2DM). MethodsNinety-one patients with T2DM and no symptoms or previous diagnosis of PAD were recruited from the outpatient diabetic clinic. Clinical data were extracted from electronic medical records, and the screening for PAD was conducted using MESI mTABLET. ResultsScreening for PAD among asymptomatic individuals with T2DM revealed that 5.49 % of patients exhibit a low ankle-brachial index (ABI). Patients who had previously experienced major adverse cardiovascular events or exhibited albuminuria displayed lower ABI values. Furthermore, a striking 45.05 % of the participants displayed an abnormally high carotid-femoral pulse wave velocity (cfPWV) value, with elevated PWV values correlating with advanced age and longer diabetes duration. ConclusionsThe prevalence of elevated cfPWV is more pronounced than that of decreased ABI in T2DM patients with asymptomatic PAD and is associated with older age and longer diabetes duration, therefore measurement of both ABI and PWV is crucial for the cardiovascular risk assessment protocol for patients with T2DM and timely PAD diagnosis.

Fracture patterns in adult onset type 1 diabetes and associated risk factors – A nationwide cohort study

ObjectiveThis study aimed to determine the hazard ratios (HR) for various fracture sites and identify associated risk factors in a cohort of relatively healthy adult people with newly diagnosed type 1 diabetes (T1D). MethodsThe study utilized data from the UK Clinical Practice Research Datalink GOLD (1987–2017). Participants included people aged 20 and above with a T1D diagnosis code (n = 3281) and a new prescription for insulin. Controls without diabetes were matched based on sex, year of birth, and practice. Cox regression analysis was conducted to estimate HRs for any fracture, major osteoporotic fractures (MOFs), and peripheral fractures (lower-arm and lower-leg) in people with T1D compared to controls. Risk factors for T1D were examined and included sex, age, diabetic complications, medication usage, Charlson comorbidity index (CCI), hypoglycemia, previous fractures, falls, and alcohol consumption. Furthermore, T1D was stratified by duration of disease and presence of microvascular complications. ResultsThe proportion of any fracture was higher in T1D (10.8 %) than controls (7.3). Fully adjusted HRs for any fracture (HR: 1.43, CI95%: 1.17–1.74), MOFs (HR: 1.46, CI95%: 1.04–2.05), and lower-leg fractures (HR: 1.37, CI95%: 1.01–1.85) were statistically significantly increased in people with T1D compared to controls. The primary risk factor across all fracture sites in T1D was a previous fracture. Additional risk factors at different sites included previous falls (HR: 1.64, CI95%: 1.17–2.31), antidepressant use (HR: 1.34, CI95%: 1.02–1.76), and anxiolytic use (HR: 1.54, CI95%: 1.08–2.29) for any fracture; being female (HR: 1.65, CI95%: 1.14–2.38) for MOFs; the presence of retinopathy (HR: 1.47, CI95%: 1.02–2.11) and previous falls (HR: 2.04, CI95%: 1.16–3.59) for lower-arm and lower-leg fractures, respectively. Lipid-lowering medication use decreased the risk of MOFs (HR: 0.66, CI95%: 0.44–0.99).Stratification of T1D by disease duration showed that the relative risk of any fracture in T1D did not increase with longer diabetes duration (0–4 years: HR: 1.52, CI95%: 1.23–1.87; 5–9 years: HR: 1.30, CI95%: 0.99–1.71; <10 years: HR: 1.07, CI95%: 0.74–1.55). Similar patterns were observed for other fracture sites. Moreover, the occurrence of microvascular complications in T1D was linked to a heightened risk of fractures in comparison to controls. However, when considering the T1D cohort independently, the association was not statistically significant. ConclusionIn a cohort of relatively healthy and newly diagnosed people with T1D HRs for any fracture, MOFs, and lower-leg fractures compared to controls were increased. A previous fracture was the most consistent risk factor for a subsequent fracture, whereas retinopathy was the only diabetes related one. We postulate a potential initial fracture risk, succeeded by a subsequent risk reduction, which might potentially increase in later years due to the accumulation of complications and other factors.

Evaluation of Cardiovascular Risk in Patients with Type 1 Diabetes: How Ankle Brachial Index Can Be Usefull?

Background: Patients with type 1 diabetes (T1D) face a significantly higher mortality risk compared to the general population, primarily due to elevated rates of cardiovascular disease (CVD). Detecting cardiovascular disease at its preclinical stage is essential for effective primary prevention in this relatively young population. This study aims to assess the link between steno-risk and subclinical atherosclerotic disease, as detected by the Ankle-Brachial Index (ABI), in T1D patients and determine the prevalence of these abnormalities among them. Methods: A cohort of 312 adults with T1D (151 males and 161 females, mean age 31 ± 12 years) was examined. Patients were categorized based on their ABI values (ABI &lt; 0.9 indicating peripheral arterial disease (PAD), ABI ≥ 1.3 indicating arterial calcification (AC), and ABI between 0.9 and 1.3 indicating normal ABI). The study analyzed the relationship between ABI anomalies and cardiovascular risk factors and their association with the steno-risk category. Results: Among the patients, 138 (44.2%) had a normal ABI, 112 (35.9%) had PAD, and 62 (19.9%) had AC. AC was more prevalent in men than in women (p = 0.006). A family history of stroke was common in both the PAD and AC groups (p = 0.042 and p = 0.046, respectively). Patients with AC were often older (36 ± 13 vs. 30 ± 12; P = .012), had a longer duration of diabetes (20 ± 11 vs. 14 ± 9; P &lt; 0.001), a higher prevalence of hypertension (25.8% vs. 14.5%, P = 0.05), and a higher prevalence of smoking (19.3% vs. 9.4%, P = 0.046). A higher number of subjects with AC were found in the Steno-Risk 10–20% and Steno-Risk ≥20% categories compared to the Steno-Risk &lt; 10% (37.5 vs. 15.5; 29 vs. 15.5, p = 0.0106, respectively). Conclusion: This study demonstrates that an ABI &gt; 1.30 is more common in older patients with type 1 diabetes and is associated with a longer duration of diabetes, male gender, smoking, hypertension, and a family history of stroke. Furthermore, an ABI &gt; 1.30, indicating arterial calcification, is significantly linked to moderate and high cardiovascular risk assessed by steno-risk in patients with type 1 diabetes. The ABI may serve as a straightforward tool for screening atherosclerosis in T1D.

DRUG-ELUTING STENTS OUTCOMES IN DIABETICS WITH CORONARY ARTERY DISEASE AND PULMONARY IMPLICATIONS

The study aims to investigate the outcomes of drug-eluting stents (DES) in patients with diabetes mellitus and coronary artery disease (CAD) while considering implications for pulmonary and cardiac health. A prospective observational study design was employed. A cohort of 54 patients who underwent percutaneous coronary intervention (PCI) with DES implantation was included. Primary outcome measures included stent patency rates, restenosis rates, major adverse cardiovascular events (MACE), and pulmonary function tests. Subgroup analyses were conducted based on age and gender. The study unveiled a 91.5% stent patency rate at six months and a 12.3% restenosis rate. Furthermore, the cumulative MACE incidence at one year was 18.5%. Subgroup analysis identified gender-based differences in restenosis rates and a slightly elevated MACE incidence among patients with longer diabetes duration. Importantly, pulmonary function tests, encompassing spirometer and lung volume assessments, demonstrated no significant pulmonary impairment following DES implantation. These assessments indicated only a marginal 1.2% reduction in FEV1, while TLC remained statistically unchanged, reassuring that DES utilization does not adversely impact pulmonary health. This study contributes to the growing body of evidence supporting the use of DES as a viable intervention in managing CAD in diabetic patients with potential implications for both cardiac and pulmonary health. The outcomes highlight DES's potential to enhance long-term cardiovascular effects in this high-risk population.

Effect of healthcare expenditure on the health related quality of life among diabetic patients of South India: A cross- sectional study

BackgroundDiabetes mellitus imposes a huge economic burden along with impairing health related quality of life (HRQoL) among patients. The purpose of this study was to determine the effect of healthcare expenditure on HRQoL among diabetic patients. MethodsA Cross -Sectional study was carried out among 328 Type 2 diabetics in Southern India. HRQoL was assessed using EQ-5D-5L questionnaire and data regarding expenditure were gathered using a validated questionnaire. Poisson regression and Multivariate regression analysis were performed to predict the factors associated with healthcare expenditure and quality of life respectively. ResultsThe annual expenditure in management of diabetes was INR 10969.6 (USD 132.83) with direct medical cost INR 8727 (USD 105.67) forming the bulk. 11.6% of participants spent over 30% of their annual income in diabetes care. Older age group, being obese, lower socioeconomic status, longer duration of diabetes, presence of complication, episodes of hospitalization were associated with higher healthcare expenditure. Mean quality of life score was 0.84 ± 0.13 and mean visual analog score was 73.15 ± 11.21. Participants with EQ-5D-5L index of range (0.0–0.3) had an expenditure of INR 31703.56. On linear regression analysis, proportion of total income spent for diabetes care was associated with poor quality of life (β = −0.163, 95% CI = −0.239 to −0.086, p < 0.001). ConclusionCost of diabetes care was inordinately high and an increased spending particularly among the socioeconomically disadvantaged group, resulting in poorer QoL. Policymakers need to focus on strengthening primary healthcare facilities for Non-Communicable diseases and implementing cost containment policy for reducing the financial burden.