Diabetes Outcomes Research Articles

Associations of SGLT2i with Cardiorenal Outcomes Among Diabetics with Prostate Cancer on Hormone Therapy.

Studies have reported associations between prostate cancer, type II diabetes mellitus (T2DM), and cardiovascular disease in the context of treatment with hormone therapy (HT). This study aimed to assess the role of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i) in preventing adverse cardiovascular and renal outcomes in diabetics with prostate cancer. Patients ≥ 18years of age with T2DM and prostate cancer who received HT between August 1, 2013, and August 31, 2021, were identified using the TriNetX research network. Patients were divided into two cohorts based on treatment with SGLT2i or alternative antidiabetic therapies. The primary outcome was the composite of all-cause mortality, new-onset heart failure (HF), acute myocardial infarction (MI), and peripheral artery disease over 2years from HT initiation. After propensity score matching, 2155 patients remained in each cohort. The primary composite outcome occurred in 218 patients (16.1%) in the SGLT2i cohort versus 355 patients (26.3%) in the non-SGLT2i cohort (OR 0.539, 95% CI 0.446-0.651; p < 0.001). Furthermore, SGLT2i were associated with significantly lower odds of HF, HF exacerbation, peripheral artery disease, atrial fibrillation/flutter, cardiac arrest, need for renal replacement therapy, overall emergency room visits/hospitalizations, and all-cause mortality. Use of SGLT2i for the treatment of T2DM among patients with prostate cancer on HT is associated with favorable cardiovascular, renal, and all-cause mortality outcomes. This observation supports the hypothesis that a therapeutically relevant link exists between HT and cardiovascular disease in the context of prostate cancer.

Oral Health and Systemic Disease: A Systematic Review of the Impact of Dental Care on Overall Health

Oral health is increasingly recognized as a critical component of overall health, with research highlighting its potential impact on various systemic diseases. This systematic review examines the current evidence on the association between oral health, particularly dental care, and systemic conditions such as cardiovascular disease, diabetes, respiratory illnesses, and adverse pregnancy outcomes. A comprehensive literature search was conducted across multiple databases, focusing on studies published from 2016 onward. Studies indicate that periodontal disease and other oral health issues may contribute to systemic inflammation, a common factor in many chronic conditions. Specifically, findings suggest that managing oral health can have beneficial effects on cardiovascular health, glycemic control in diabetic patients, and respiratory function, as well as reduce risks for adverse pregnancy outcomes. However, while associations are evident, causality remains difficult to establish, and further longitudinal research is needed to clarify these relationships. This review underscores the importance of incorporating dental care into holistic health approaches, advocating for greater collaboration between dental and medical professionals. Public health initiatives promoting regular dental check-ups and preventive care may play a crucial role in improving overall health outcomes.

The adaptation of a single institution diabetes care platform into a nationally available turnkey solution.

Digital decision support and remote patient monitoring may improve outcomes and efficiency, but rarely scale beyond a single institution. Over the last 5 years, the platform Timely Interventions for Diabetes Excellence (TIDE) has been associated with reduced care provider screen time and improved, equitable type 1 diabetes care and outcomes for 268 patients in a heterogeneous population as part of the Teamwork, Targets, Technology, and Tight Control (4T) Study (NCT03968055, NCT04336969). Previous efforts to deploy TIDE at other institutions continue to face delays. In partnership with the diabetes technology non-profit, Tidepool, we developed Tidepool-TIDE, a clinic-agnostic, turnkey solution available to any clinic in the United States. We present how we overcame common technical and operational barriers specific to scaling digital health technology from one site to many. The concepts described are broadly applicable for institutions interested in facilitating broader adoption of digital technology for population-level management of chronic health conditions.

Identifying the genetic association between severe autoimmune type 2 diabetes and the risk of focal epilepsy

BackgroundObservational studies suggested a bidirectional relationship between severe autoimmune type 2 diabetes and focal epilepsy. However, it remains debated whether and in which direction a causal association exists. This genetics-based study aimed to explore the relationships of severe autoimmune type 2 diabetes (T2DM) and focal epilepsy outcomes with two sample Mendelian randomization (TSMR) method.MethodsGenetic instruments were obtained from large-scale genome-wide meta-analysis of severe autoimmune T2DM (Ncase = 452, Ncontrol = 2,744), and focal epilepsy (Ncase = 929, Ncontrol = 212,532) of European ancestry. A series of analyses were performed to select eligible genetic instruments robustly associated with each of the traits using summary-level statistics. Inverse variance weighted was used for primary analysis, with alternative 11 MR methods. A scatter plot was utilized to illustrate the association between single nucleotide polymorphism (SNP) effects on the exposure and SNP effects on the outcome. The Wald ratio for individual SNPs and their cumulative effects was depicted using a forest plot. And diagnostics and sensitivity analyses were used to evaluate if the causal estimates are robust to violations of MR underlying assumptions, including pleiotropy, heterogeneity assessment, and leave-one-out analysis. Then the results were validated using CURATED database of DisGeNET platform.ResultsFor forward analysis, genetic predisposition to severe autoimmune T2DM was associated with an increased risk of focal epilepsy (Inverse variance weighted (IVW) method: OR = 1.11, 95% CI = 1.03-1.18, p = 0.012). For reverse analysis, there was no enough instrument variables of focal epilepsy on severe autoimmune T2DM. Further, the interrelation between severe autoimmune T2DM and focal epilepsy was demonstrated via variant-disease association network analysis using the instrument SNPs.DiscussionThis MR study supports a causal link between severe autoimmune T2DM and focal epilepsy. More effort should be made to screen seizure in severe autoimmune T2DM, unravel its clinical implications, and explore its role as a putative modifiable risk factor.

Effects of atmospheric pressure change during flight on insulin pump delivery and glycaemic control of pilots with insulin-treated diabetes: an in vitro simulation and a retrospective observational real-world study.

Glycaemic control and clinical outcomes in diabetes are improved by continuous subcutaneous insulin infusion (CSII). Atmospheric pressure changes during flights may affect insulin delivery from pumps and cause unintended metabolic consequences, including hypoglycaemia, in people with type 1 diabetes. The present report evaluates both hypobaric flight simulation and real-world data in pilots using insulin pumps while flying. In the flight simulation part of this study, an in vitro study of insulin pumps was conducted in a hypobaric chamber, de-pressurised to 550 mmHg to mimic the atmospheric pressure changes in airliner cabins during commercial flights. Insulin delivery rates and bubble formation were recorded for standard flight protocol. Insulin infusion sets, without pumps, were tested in a simulated rapid decompression scenario. The real-world observational study was a 7.5-year retrospective cohort study in which pre- and in-flight self-monitored blood glucose (SMBG) values were monitored in pilots with insulin-treated diabetes. Commercial and private pilots granted a medical certificate to fly within the European Union Aviation Safety Agency approved protocol and receiving insulin either by pump or multiple daily injections (MDI) were included. In the flight simulation study, full cartridges over-delivered 0.60 U of insulin during a 20 min ascent and under-delivered by 0.51 U during descent compared with ground-level performance. During emergency rapid decompression, 5.6 U of excess insulin was delivered. In the real-world study, seven pilots using CSII recorded 4656 SMBG values during 2345 h of flying across 1081 flights. Only 33 (0.7%) values were outside an acceptable safe range (5.0-15.0 mmol/l [90-270 mg/dl]). No clinically significant fall in the median SMBG concentration was observed after aircraft ascent and no in-flight SMBG values were within the hypoglycaemic range (<4.0 mmol/l [<72 mg/dl]). Compared with pilots receiving MDI therapy, pilots using CSII recorded more SMBG values within the acceptable range (99.3% vs 97.5%), fewer values in the low red range (0.02% vs 0.1%), fewer in-flight out-of-range values (0.2% vs 1.3%) and maintained stricter glycaemic control during flight. Ambient pressure reduction during simulated flights results in bubble formation and expansion within insulin cartridges. This causes unintended delivery of small insulin doses independent of pre-determined delivery rates and represents the maximum amount of insulin that could be delivered and retracted. However, in vivo, pilots using CSII in-flight did not experience a fall in blood glucose or episodes of hypoglycaemia during these atmospheric pressure changes and the use of insulin pumps can be endorsed in view of their clinical benefits.

Organic vs. inorganic nitrates: Metabolic and vascular outcomes in STZ-induced diabetes in mice

Organic vs. inorganic nitrates: Metabolic and vascular outcomes in STZ-induced diabetes in mice

The association between the triglyceride-glucose index and serum anti-aging protein α- Klotho: a population-based study

BackgroundBoth anti-aging protein α-Klotho and the triglyceride-glucose (TyG) index hold predictive value for the incidence, progression, and outcomes of cardiovascular disease, diabetes and many other diseases. However, their relationship remains unclear.MethodsWe conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2016. Weighted multivariate linear regression models and subgroup analysis were constructed to assess the association between TyG index and α-Klotho levels. Nonlinear correlations were explored using restricted cubic splines (RCS), generalized additive models (GAM) and smooth curve fitting. Segmented regression model was conducted to explore potential threshold effects and identify the inflection point.ResultsA total of 2568 participants satisfied the predetermined criteria were enrolled in the final analysis. After fully adjusting for covariates, TyG index was shown to be markedly negatively correlated with α-Klotho [β=-74.07, 95%CI (-100.29,-47.85), p < 0.001]. Gender was significantly correlated with this negative connection according to subgroup analysis and interaction testing (p for interaction < 0.05).Additionally, we discovered a linear association between TyG index and α-Klotho in all participants (p for nonlinear = 0.761), while non-linear association in female (p for nonlinear = 0.016).The analysis of threshold effect in the female participants found that the inflection point of TyG index was 8.01, exceed which the level of α-Klotho decreased significantly with increasing TyG index[β=-151.72, 95%CI (-201.93, -101.50), p < 0.001].ConclusionOur findings demonstrate a negative association between TyG index and α-Klotho levels, with the effect being more pronounced in females. TyG index may serve as an early indicator of individuals with low α-Klotho levels, especially among females. These findings highlight the need for gender-specific considerations in clinical interventions to improve public health. Further research is needed to clarify the causal direction of this association.

The prognostic significance of diabetes in non-small cell lung cancer patients treated with immune checkpoint inhibitors: A meta-analysis

AimsStudies on the prognosis of patients with diabetes and non-small-cell lung cancer (NSCLC) in the era of immune checkpoint inhibitors (ICIs) are limited, and existing findings remain inconsistent. This meta-analysis explored the association between diabetes and survival outcomes in this population. MethodsA total of 10 non-randomized studies comparing overall survival between patients with NSCLC receiving ICIs with and without diabetes were included. A meta-analysis was performed to estimate the hazard of death or disease progression between the two groups. Another analysis was employed to explore the difference in median survival between the groups. Additionally, subgroup, meta-regression, and sensitivity analyses were conducted. ResultsPatients with diabetes exhibited a significantly higher risk of death than those without diabetes (HR = 1.28, 95 % CI = 1.14–1.44; P < 0.01). Moreover, individuals with diabetes had a median life expectancy that was 6.04 months shorter (95 % CI = −10.53 to − 1.54 months, P = 0.009) than that of individuals without diabetes. Moreover, for every 1 % increase in the proportion of patients with diabetes using metformin, a corresponding 2.2 % decrease in the HR of progression-free survival was observed (95 % CI = 1.2–3.1 %). ConclusionDiabetes compromises the effectiveness of ICI treatment in patients with NSCLC.

A prospective mixed‐methods pilot study of a novel group structured education programme for adults with cystic fibrosis diabetes

AbstractBackground: Cystic fibrosis diabetes (CFD) is associated with increased morbidity and mortality in adults with cystic fibrosis (CF). In addition, poor glycaemic control can result in microvascular complications. Group educational programmes for people with type 1 and 2 diabetes have been shown to improve diabetes outcomes. The national guidelines recommend that people with CFD should receive education regarding diabetes; however, specific CFD group education programmes have not been evaluated.Aims: This study aimed to test whether this novel diabetes contents and intervention for CFD based on the Beta Cell Education Resources for Training in Insulin and Eating (BERTIE) type 1 diabetes education programme was beneficial for adults with CFD. The adapted course, Improved Diabetes Education in Adults with Cystic Fibrosis (IDEA‐CF ), incorporated CFD‐specific topics and was delivered virtually via videoconference group sessions to facilitate peer learning and support without the risk of cross‐infection. A pilot study was conducted utilising this novel IDEA‐CF virtual structured program to ensure that the intervention met the patients’ educational needs.Methods: This randomised controlled multimethods pilot study recruited adults with CFD taking insulin therapy and cared for by a large regional CF centre. After providing written informed consent, the participants completed all the study forms and questionnaires before randomisation. Randomisation was performed using a computerised randomisation system that allocated adults with CFD into the intervention group (IDEA‐CF) or routine care group for the 12‐week study period. Participants who were randomised into the routine group continued to receive one‐on‐one education as before. Using the CF quality‐of‐life (QoL) questionnaire (revised Cystic Fibrosis Questionnaire [CFQ‐R]), outcomes were measured at baseline and 12‐week visits in both groups. The participants in the intervention group were asked to take part in a semistructured qualitative interview after the completion of the intervention, which was performed by a CF psychologist.Results: A total of 20 participants were recruited, with 18 completing the intervention and study follow‐up visits. In the CFQ‐R domains, physical functioning, emotional functioning, eating, role functioning and respiratory symptoms were significantly improved in the intervention group compared with the routine care group. The IDEA‐CF Knowledge Assessing Questionnaire (IDEA‐CF KAQ) scores in the intervention group improved compared with the IDEA‐CF KAQ scores in the control group, suggesting that education improves knowledge and understanding. The IDEA‐CF structured virtual group education group was well received, with participants valuing the educational content and the ability to interact with each other and to learn from their peers’ experiences constructively.Conclusions: Our study demonstrated that the IDEA‐CF education programme improved health‐related QoL and diabetes knowledge, as evidenced by the results of the IDEA‐CF KAQ. The participants valued the educational contents of the programme and reported a positive experience interacting with their peers.

Transforming the diabetes outcomes for people with mental illness

AbstractThere is a complex bidirectional relationship between diabetes and mental illness, where diabetes is associated with an increased prevalence of a range of mental disorders and several mental illnesses increase the risk of diabetes. The reasons why people with mental illness are at higher risk of diabetes and vice versa are multifactorial. When diabetes and mental illness occur together, the outcomes for both conditions are worsened, and the co‐morbidity places a higher burden on the individual living with the conditions.Severe mental illness is associated with a twofold increased risk of diabetes, and the onset of diabetes is approximately 10 years earlier in people with mental illness than in the general population. Health behaviour interventions to reduce the incidence of diabetes may be less effective than previously thought. However, trials on obesity drugs, particularly glucagon‐like peptide‐1 receptor agonists, are showing promise. Diabetes care for people with severe mental illness seems to have improved in the past decade. Interventions have been developed to address the unique challenges of living with severe mental illness and diabetes.Depression is twice as common in people with diabetes. Depression increases the risk of diabetes and vice versa. Although general population risk factors for depression apply to people with diabetes, diabetes‐specific risk factors include the development of complications and insulin use in people with type 2 diabetes. Managing depression includes efforts to prevent depression, timely diagnosis and treatment with psychological or pharmacological treatments.Health care professionals have a responsibility to ensure that people with mental illness and diabetes are not disadvantaged.

Relationship between autonomic and peripheral neuropathies and cardiovascular outcomes in diabetes

This review explores the complex relationship between diabetic neuropathy and cardiovascular disease (CVD). Neuropathy, a common complication of type 1 and type 2 diabetes, is divided into autonomic and peripheral types, each impacting cardiovascular health. Cardiovascular autonomic neuropathy, a form of autonomic neuropathy, is associated with various CVD complications, including arrhythmias, impaired nocturnal blood pressure regulation, and increased mortality. The prevalence of cardiovascular autonomic neuropathy varies depending on the type and duration of diabetes and is influenced by factors like glycemic control and metabolic stress. Peripheral polyneuropathy, which is often linked to diabetic foot disease, is also correlated with elevated CVD risk; research suggests shared pathophysiological mechanisms between peripheral neuropathy and cardiovascular conditions. Screening for neuropathies using tools like the Michigan Neuropathy Screening Instrument and heart rate variability analyses can facilitate early detection of CVD risk. Additionally, emerging technologies, like deep learning models, have demonstrated promise in detecting early cardiovascular patterns associated with autonomic neuropathy through electrocardiogram analysis. These findings underscore the value of integrating novel diagnostic approaches for early intervention. As CVD represents a leading cause of death among patients with diabetes, this article emphasizes the need for thorough assessment and proactive management of neuropathy to mitigate cardiovascular risk. The review recommends a multidisciplinary approach to diabetes care, including early screening, accurate risk stratification, and targeted therapeutic strategies to prevent or slow the progression of CVD in patients with autonomic and peripheral neuropathies. Further research is warranted to clarify the optimal intervention strategies for reducing CVD risk in these populations.

The association between health literacy and quality of life of patients with type 2 diabetes mellitus: A cross-sectional study.

Health literacy-driven interventions in patients with type 2 diabetes have been found to play an important role in achieving glycemic control and enhancing diabetic self-management outcomes. The present study aimed to examine the role of health literacy as a predictor of quality of life among diabetic patients in Jordan. This cross-sectional study enrolled 400 Type 2 diabetic patients visiting the endocrinology department at the outpatient clinic at Al Basheer Hospital in Amman, Jordan. The data were collected between 1st of August and 28th of December 2023, using the validated Jordanian Diabetic Health Literacy Questionnaire and the EuroQol-5D tool. A quantile regression analysis was conducted to explore the factors associated with health-related quality of life among the study participants. This study included 68.8% females, with a median age of 58 (50-64) years. The median EQ5-D index score was 0.66 (0.41-0.78). Findings from regression analysis indicated as patients' age increased, their quality of life scores significantly decreased (-0.004, 95%CI (-0.006, -0.001), p = 0.002). Additionally, higher JDHLQ scores were significantly associated with higher EQ5-D scores (0.012, 95% CI (0.006-0.018), p<0.001). Moreover, patients with only an elementary education had significantly lower EQ5-D scores compared to those with a postgraduate education (-0.106, 95%CI (-0.190, -0.023), p = 0.013). The findings of the present study emphasize the importance of including health literacy assessments and interventions in the diabetes care plans of patients in Jordan.

A Comparative Study on the Impact of Fasting on Blood Glucose and Blood Pressure Among Diabetic and Non-Diabetic Individuals During Ramadan, Kurdistan Region, Iraq

Objective: The primary aim of this research was to evaluate the differential effects of regular and fasting dietary patterns on blood glucose levels and blood pressure among diabetic patients and non-diabetic control group. A comprehensive analysis was conducted to compare physiological responses on fasting versus non-fasting days during the holy Ramadan month. Methods: This observational study involved 92 participants, with a subset of 38 diabetic patients and 54 non-diabetic control group, aged 19-76 years, who were observed on regular and fasting days. Participants were monitored for pre-prandial, postprandial, evening blood sugar, and fasting blood glucose levels, as well as blood pressure. Statistical analysis was performed using paired sample t-tests to compare mean ± SD between regular and fasting days of both groups. The study cohort consisted of male and female adults diagnosed with type 1 or type 2 diabetes. Exclusion criteria included individuals under 18 years, pregnant women, and patients unable to fast during the study period. Results: Statistical analysis revealed significant differences in fasting blood glucose levels during Ramadan compared to non-fasting days. In the diabetic group, significant changes were observed in fasting blood glucose levels during Ramadan compared to after Ramadan ( postprandial blood sugar p=0.04, evening blood sugar p=0.019). In contrast, the non-diabetic group also showed significant changes in blood glucose levels during Ramadan compared to after Ramadan (postprandial blood sugar p=0.001, evening blood sugar p=0.020). Blood pressure showed no significant differences between these periods, suggesting that fasting does not alter blood pressure significantly in diabetic individuals. Additionally, a two-way ANOVA demonstrated significant dietary influences on post-Iftar glucose levels in non-diabetics (p&lt;0.001), but not in diabetics, suggesting differential metabolic responses to dietary intake during Ramadan. These findings emphasize the critical need for personalized dietary management and continuous monitoring to optimize diabetic care during fasting. Conclusion: Fasting significantly influences blood glucose levels in diabeticand non-diabetic individuals but does not affect blood pressure. This study underscores the necessity for personalized medical guidance and balanced meal planning to minimize complications and enhance diabetes management during fasting. Further research is warranted to explore the long-term effects of different fasting practices on diabetic health outcomes.

The value of lncRNAs as a biomarker for the pregnancy outcomes of gestational diabetes: a meta-analysis.

Long non-coding RNAs (lncRNAs) are tissue-specific and highly stable and may serve as early molecular markers of adverse pregnancy outcomes in patients with gestational diabetes mellitus (GDM). This study aimed to investigate the relationship between aberrant expression of lncRNAs and adverse pregnancy outcomes in GDM patients. We searched electronic databases: Embase, Medline, EBSCO, PubMed, CNKI, and Wanfang databases to find relevant articles. Included studies quality was assessed using the QUADAS-2 quality assessment tool. Prognostic value of lncRNAs were pooled using risk ratio (RR) with 95% confidence interval (95%CI). The heterogeneity was analyzed using the Cochran Q test and I2 statistical test, and subgroup analyses were performed to explore the sources of heterogeneity. Begg's test funnel plots were analyzed for publication bias. The review included nine studies. Overall, the review found that altered expression of lncRNAs was associated with adverse pregnancy outcomes of GDM patients (RR: 1.616, 95%CI: 1.308-1.996), and was a risk factor for adverse pregnancy outcomes both of Infants (RR: 1.68, 95% CI: 1.30-2.17) and maternal (RR: 4.14, 95% CI: 1.90-9.03) in patients with GDM. The diagnostic procedure, diagnostic criteria, expression trend of lncRNAs, and adverse pregnancy outcomes were the sources of heterogeneity. Aberrant expression of lncRNAs was strongly associated with the adverse pregnancy outcomes in GDM.

Influences of cardiovascular disease on the relationship between baseline systolic blood pressure and adverse outcomes in diabetes: insights from large population-based study

Abstract Objective To evaluate the influences of cardiovascular disease (CVD) on the relationship between baseline systolic blood pressure (SBP) and adverse outcomes in diabetes. Methods This is an observational study of 16431 community-dwelling adults with diabetes and 7.8% had CVD. The relationship between SBP (either as a categorical or continuous variable) with major adverse cardiovascular event (MACE) and all-cause death were evaluated by baseline CVD status using multivariable-adjusted Cox proportional hazard models and restricted cubic spline. Results After a median follow-up of 3.4 years, 2145 (13.1%) MACE and 1025 (6.2%) all-cause death occurred. In the overall participants there was a linear relationship between SBP and MACE (P-nonlinear=0.55) and a U-shaped relationship between SBP and all-cause death (P-nonlinear=0.002). In participants free of CVD, in reference to SBP &amp;lt; 120 mmHg group, the risks for MACE increased as SBP category (120-129, 130-139, and ≥ 140 mmHg) advanced (P-trend &amp;lt; 0.001) and there was a linear relationship (P-nonlinear=0.75; Figure 1A); while the risks for all-cause death were lower in SBP of 120-139 mmHg and 140-159 mmHg groups while higher in SBP ≥ 160 mmHg group, and there was a U-shaped relationship (P-nonlinear&amp;lt;0.001; Figure 1B). Notably, in participants with existing CVD the relationship between SBP with MACE and all-cause death did not show any specific pattern. Conclusion The relationship between baseline SBP with MACE and all-cause death varied substantially by baseline CVD status. Future studies to investigate the threshold of initiating BP-lowering treatment and the appropriate BP target in diabetes may consider applying a CVD-based stratification strategy.

Left atrial function predicts long-term outcome in hypertension and diabetes across genders

Abstract Introduction In the last decade, peak atrial longitudinal strain (PALS) was ascertained to be superior to conventional echocardiographic indices for secondary cardiovascular (CV) prevention. Purpose Standard and advanced echocardiography including PALS was evaluated to find predictors of prognosis in patients with arterial hypertension and/or diabetes for the optimization of primary CV prevention. Methods Hypertensive and/or diabetic patients &amp;gt;40 years old and in sinus rhythm who underwent a complete cardiological evaluation at our centre in 2008-2015 were retrospectively included. Personal history, physical examination, standard and advanced (speckle tracking) echocardiographic data were collected. The exclusion criteria were previous cv events or cardiac surgery, active pacemaker, more than moderate valvular regurgitation and/or stenosis, missing informed consent. All patients were followed up for a mean time of 11.2±1.3 years for the development of first atrial fibrillation (AF) episode, congestive heart failure hospitalization, transient ischemic attack, stroke, myocardial infarction/coronary revascularization, and CV death. Univariate and multivariable stepwise Cox regressions were performed to estimate Hazard Ratio (HR). Kaplan Meier curves (KM) compared the survival between patients with different ranges of Global PALS. Log-rank test was performed to compare the KM curves. Results This retrospective study included 292 adults (mean age 63.0±9.0 years, 50% female), among which 210 hypertensives and 67 diabetics. Mean left ventricular (LV) ejection fraction (EF) was 58.2±4.9%, mean GLS was -17.0±6.6%, mean left atrial volume was 52.9±24.9ml and mean PALS 29.7±11.1%. During follow up, 110 patients developed at least one cv event: 52 all-cause deaths, 28 CV deaths, 30 heart failure admissions, 31 first AF episode, 18 TIA/strokes, 25 myocardial infarction/revascularization. Dividing the population according to events occurrence, patients with events had similar EF (p= 0.06), while being older (65.8±9.6 vs 61.3±9.0 years) and with a worse diastolic function (E/E’ ratio 10.6±5.0 vs 8.7±3.6), LV longitudinal strain (GLS, -17.7±2.9 vs -15.7±3.4%) and PALS (34.6±9.9 vs 21.6±7.7%, all p &amp;lt;0.001). From univariate statistical analysis, age, E/E’, PAPs, GLS and PALS were all predictors of events, but only age (HR 1.03, p=0.03) and PALS (PALS&amp;lt;22.5% HR 18.99 and PALS 22.5-30 HR 7.68, both p&amp;lt;0.001) remained independently associated with outcome at multivariate analysis. Patients with PALS&amp;lt;22.5 have an event-free survival of 82.4% at 1 year, 49.8% at 5 years and 25.3% at 10 years compared to 100% at 1 year, 98.5% at 5 years and 92.5% at 10 years if PALS PALS&amp;gt;30% (Fig.1). The same results were confirmed in female population (Fig.2). Conclusions If confirmed by larger studies, PALS could be a quick, feasible and reliable part of cardiologic evaluation for prognostic stratification in primary CV prevention in hypertensive and/or diabetic patients.Fig. 1Fig. 2

Dapagliflozin reduces epicardial adipose tissue in patients with heart failure with reduced ejection fraction and type 2 diabetes

Abstract Introduction Epicardial adipose tissue (EAT) accumulation is associated with adverse outcome in heart failure with preserved ejection fraction, however its role in HF with reduced ejection fraction (HFrEF) is less clear. The relationship between EAT thickness and their impact on patients who have diabetes and heart failure remains unclear. SGLT2 inhibitors such as dapagliflozin improve outcomes in heart failure and diabetes, however their mechanism of benefit is not well understood. The aim of our study was to assess whether dapagliflozin reduced EAT in patients with type 2 diabetes and HFrEF. Methods We performed an analysis of individuals with type 2 diabetes and HFrEF who were randomised to receive either dapagliflozin or a placebo for 12 months as part of the REFORM trial. Participants had cardiac magnetic resonance (CMR) scans at baseline and at 12 months. Epicardial fat was measured utilizing 4-chamber cine images to quantify adipose tissue between the myocardium and the visceral layer of the pericardium. This assessment was carried out using the single end-diastolic image, with measurements conducted by evaluators blinded to the randomisation status of participants. Results 47 participants completed the stud. At baseline, not only EAT thickness and BMI level (placebo: 33, dapagliflozin 32, p=0.49) but also heart rate (74.39 bpm vs. 77.61 bpm, p=0.35), systolic blood pressure (132.75 mmHg vs. 135.00 mmHg, p=0.63), diastolic blood pressure (71.39 mmHg vs. 74.04 mmHg, p=0.33) and age (67 vs. 66, p=0.79) were comparable between the two groups. 23 randomised to placebo and 24 to dapagliflozin. Baseline EAT was similar in both groups (placebo: 11.54 cm², dapagliflozin 11.74 cm², p=0.414). After 12 months of treatment dapagliflozin caused a significant reduction in EAT compared to placebo (1.21 cm² vs. 0.09 cm², p=0.007). Conclusion Dapagliflozin significantly reduced epicardial adipose tissue compared to placebo in patients with type 2 diabetes and HFrEF. The reduction in EAT may play a role in the beneficial effects of dapagliflozin in heart failure patients.4 Ch CMRBox plot

Gestational diabetes and pregnancy outcome in Kurdish, Somali and general population in Finland

Abstract Gestational diabetes (GDM) increases the risk of type II diabetes and cardiovascular morbidity later in life but GDM incidence in women from different cultural backgrounds varies. This study aims to examine treatment of GDM and pregnancy outcomes in Somali, Kurdish and general population women. Patient data of 312 Kurdish, 254 Somali and 508 general population women was collected from Turku University Hospital records from 2008 to 2019. The general population was selected by randomization with matching year, BMI, age, and parity. Singleton deliveries after 34th gestational week with no prior diabetes mellitus were included. Descriptive and comparison analyses (SPSS, version 29.0) were used to identify associations between ethnic background and pregnancy outcomes in women with GDM. The incidence of GDM was 22 % (CI 95 % 17-27) in Somali, 36 % (CI 95 % 31-42) in Kurdish, and 16 % (CI 95 % 13-19) in the general population women. Kurdish women had medication for GDM more often (43 % CI 95 % 34-53) than the Somali (22 % CI 95 % 11-33) and general population women (18 % CI 95 % 9-26). Metformin was more commonly used among Kurdish (30 % CI 95 % 22-39) compared to the general population (12 % CI 95 % 4-18) and Somali women (13 % CI 95 % 4-22). There was no difference in insulin or combined metformin and insulin treatment between the groups. In GDM group, vaginal deliveries were more common in general population (89 % CI % 81-95) than in Somali women (67 % CI % 64-81). Induction of labour (indication GDM or other) and instrumental vaginal delivery rates were similar between the groups. Newborns of all Somali women had a lower weight (SD -0.3 CI 95 % -0.7 - -0.2) compared to the general population (SD 0 CI 95 % -0.1 - 0.3). The prevalence of GDM was increased and dietary treatment decreased in Kurdish women compared to the general population in Finland. In the future, the treatment of GDM should be adjusted to better optimize the care for different cultural background women. Key messages • Kurdish women have increased incidence of GDM and less dietary treatment compared to the general population with similar risk factors. The pregnancy outcomes remain good in all groups. • With Somali women, the birth weight of the child is lower despite GDM status. This might direct clinicians to underestimate the effect of GDM when considering individual treatment.

Advancing care in type 2 diabetes and atherosclerosis: assessing pharmacist-led strategies in England's primary care - a retrospective observational study

Abstract Background Type 2 diabetes (T2D) mellitus is a complex multi-system disorder with a tendency to develop complications. ‘Persistence to therapy’ plans affect almost 50% of all people with T2D, leading to suboptimal glycaemic and cardiovascular (CVD) risk factor control. The interplay between T2D and established atherosclerotic cardiovascular disease (ASCVD) underscores the need for a comprehensive, multidisciplinary approach to care that addresses both glycaemic control and CVD risk factors. Purpose This study retrospectively analysed pharmacist-led interventions in patients living with T2D and established ASCVD in general practices in a large UK city. Methods A retrospective pre-post observational study was conducted using electronic health record data from men and women diagnosed with T2D and ASCVD. Participants attended an independent prescribing pharmacist-led clinic within 21 general practices. The practices operated linked and comprehensive electronic health records systems, facilitating access to high-quality longitudinal data that align with study objectives. Results A total of 380 patients received pharmacist-led interventions. Comparisons of pre-intervention and post-intervention data revealed a significant decrease in HbA1c levels (73.7 ± 10.7 mmol/mol vs 67.2 ± 8.5 mmol/mol, p &amp;lt; 0.01), systolic blood pressure (132 ± 10.2 mmHg vs 125.9 ± 9.9 mmHg, p &amp;lt; 0.01), and diastolic blood pressure (76.8 ± 5.9 mmHg vs 72.4 ± 5.0 mmHg, p &amp;lt; 0.001). Additionally, total cholesterol levels significantly reduced from 4.4 ± 0.7 mmol/L to 3.9 ± 0.7 mmol/L (p &amp;lt; 0.001). The proportion of patients achieving the triple target of HbA1c (≤58 mmol/mol), BP (≤140/80 mmHg), and total cholesterol (≤5 mmol/L) increased significantly from 2.4% before the intervention to 23.4% afterward (p &amp;lt; 0.001). The initiation of the sodium-glucose co-transporter 2 inhibitors (SGLT2i) therapies was the most common prescribing intervention (67%). Conclusions Pharmacist-led interventions in a general practice setting significantly improved several critical diabetes and CVD risk related outcomes. These findings underscore the potential benefits of integrating pharmacist-led care models into the management of T2D, particularly for patients with concurrent ASCVD and adopting an individualised, evidence-based approach to prescribing interventions.

Equity of continuous glucose monitoring in young people with type 1 diabetes: a systematic review

Abstract Background Socioeconomic (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are widespread. There is concern that unequal access to technologies, such as continuous glucose monitoring (CGM), may increase disparities. This systematic review summarises the evidence for inequalities in access to CGM for children and young people (CYP) and outcomes for CGM users. Methods MEDLINE, Embase, and Web of Science were searched for observational studies published between January 2020 and July 2023 which report CGM use stratified by any PROGRESS-plus criteria for T1D patients under 26. Reports based in low- or middle-income countries or ≤ 500 participants were excluded. Primary outcomes were the proportion of patients using CGM and HbA1c of CGM users. Quality assessment was performed using the Newcastle-Ottawa Scale. Unadjusted odds ratios were calculated from extracted data, though heterogeneity precluded meta-analysis. The protocol was pre-registered with PROSPERO (CRD42023438139). Results Of the 3,369 unique studies identified, 27 met inclusion criteria. We found decreased CGM use and higher discontinuation for low SES, low education, publicly insured, and minority ethnic, especially black, CYP. These associations were generally robust to adjustment for other sociodemographic variables, suggesting an independent effect. Lower SES inequalities were seen in countries where CGM is reimbursed. Although low SES and minority ethnicity were generally associated with poorer outcomes, there was no significant association between domains of disadvantage and higher HbA1c for CGM users, excepting parental education. Conclusions There are significant SES, ethnic, and education inequalities in CGM use for CYP with T1D, particularly when reimbursement is limited. This is contributing to outcome inequalities. However, evidence suggests CYP benefit equally from CGM use, irrespective of ethnicity and SES. Increasing CGM funding and use is likely to reduce outcome inequalities. Key messages • There are significant SES, ethnic, and education inequalities in continuous glucose monitoring use for young people with T1D. Inequalities are more marked when technology is not reimbursed. • Increasing access to CGM may reduce outcome inequalities, as evidence suggests that young people benefit equally from CGM use, regardless of ethnicity or SES.