Diabetes-related Comorbidities Research Articles

Assessment of Risk Factors Leading to Amputation Among Diabetic Septic Foot Patients in Khartoum, Sudan.

Introduction Diabetes is a rapidly growing global health concern, with the World Health Organization (WHO) estimating that 300 million adults will have diabetes by 2025. This chronic condition is associated with complications, including nephropathy, retinopathy, neuropathy, cardiovascular disease, and diabetic foot ulcers (DFUs), which can lead to amputation. Diabetic septic foot (DSF), a severe form of diabetic foot disease, is defined by the WHO as the presence of infection, ulceration, or tissue destruction in the lower limb, often accompanied by neurological abnormalities, peripheral vascular disease, and metabolic complications of diabetes. In Sudan, the incidence of lower limb amputations due to DSF is increasing, with various healthcare centers employing different management strategies, making it challenging to identify which factors are most strongly linked to the highest rates of amputations.This study aims to identify the key risk factors contributing to amputations in patients with diabetic foot syndrome (DFS) in Khartoum, Sudan. Specifically, it seeks to assess the common risk factors for amputation in diabetic septic foot patients at hospital wards and dressing centers in Khartoum State, Sudan. Objectives include identifying risk factors associated with amputations, determining the types and frequency of amputations, and evaluating diabetes control and foot self-care practices. Methods This was a descriptive cross-sectional study that was conductedanonymously between 01/11/2017 and 08/11/2017in various hospital wards and dressing centers in Khartoum, Sudan, on 46 diabetic septic foot patients. Data was collected using an interview questionnaire and checklist administered to the attending patients. Quantitative data was analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.This paper aims to explore the pathophysiology, risk factors, and clinical management of diabetic foot complications, with a focus on preventing the devastating outcome of amputation. Results The findings revealed that the most significant risk factors for amputation included a raised HbA1c level (74%), male gender (78%), age over 50 years (96%), and a history of preceding non-healing ulcers (93.5%). Other factors, such as smoking, diabetes-related comorbidities, and the type of diabetes management, showed no significant association with amputation. Normal saline and iodine were the most commonly used wound care solutions (52%). Regarding foot care habits, the most frequently practiced measures among patients included wearing special diabetic shoes (63%), avoiding walking barefoot (63%), and refraining from smoking (59%). Conclusions This study identified key risk factors for amputations in diabetic septic foot (DSF) patients, including elevated HbA1C levels, male gender, age over 50, and a history of unhealing ulcers, with poor foot care practices contributing to higher amputation rates. The findings highlight the importance of glycemic control, foot hygiene, and patient education in preventing amputations. Additionally, the study underscores the need for comprehensive management strategies that address both metabolic control and foot care, particularly in resource-limited settings. These insights can guide local healthcare policies focused on prevention, early intervention, and better resource allocation to reduce diabetes-related complications and improve patient outcomes.

Relationship between diabetes-related clinical characteristics and preserved ratio impaired spirometry (PRISm): findings from NHANES 2007–2012

IntroductionTo analyse the relationship between diabetes, its severity (including blood glucose levels, disease duration, antidiabetic drug use and number of comorbidities) and preserved ratio impaired spirometry (PRISm) using data from...

Characterization and progression of heart failure with preserved ejection fraction in SDT fatty rats

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a complex clinical phenotype associated with the presence of multiple comorbidities including diabetes, obesity, and metabolic syndrome. A major challenge in the search of new therapies for HFpEF is the development of relevant animal models. The Spontaneously Diabetic Torii (SDT) fatty rat is a well-established type2 diabetic model with multiple diabetes-related comorbidities such as nephropathy, neuropathy, and retinopathy. However, the onset and spontaneous progression of cardiac dysfunction is not yet reported in this model. Purpose To validate the SDT fatty rat as a type2 diabetes related HFpEF model, we assessed the natural evolution, i.e., without any diet or surgical intervention, of cardiac function in SDT fatty at different ages starting at 7-week of age. Methods The cardiovascular phenotyping of male SDT fatty rats was assessed by echocardiography at 7, 12 and 17-week of age and invasive left intraventricular and blood pressure measurements at 17-week of age. Vascular function of isolated thoracic aortas was also evaluated at 17-week of age. Renal function was investigated by measuring the Glomerular Filtration Rate (GFR) and urine parameters at 7, 12 and 17-week of age. A group of Sprague Dawley (SD) rats was included as a negative control. Results Compared to SD rats, echocardiography in SDT fatty showed cardiac remodeling starting at 7 weeks and persistent with age. Systolic function and ejection fraction were preserved, while diastolic function was impaired as early as 7-week of age and worsened with time. E/A was comparable in SDT fatty and SD rats at 7-week of age and then increased with age to reach 1.8±0.1 vs 1.2±0.05 in SD (p<0.001) at 17 weeks, while E’/A’ was already inverted at 7 weeks (0.9± 0.02 vs 1.3±0.03 in SD, p<0.001), and lasted with age which is a sign of relaxation default and suggestive of a restrictive filling pattern. E/E’ was significantly higher at 7-week of age (16.1± 0.9 vs 12.1±0.6 in SD, p<0.01) and further increased at 17 weeks (23.1± 0.8 vs 12.1±0.8 in SD, p<0.001) indicating higher filling pressure. Intraventricular and arterial pressure were also increased (p<0.05). As well, SDT fatty rats showed altered endothelium vasodilating properties. As expected, SDT fatty rats were hyperglycemic and showed renal impairment expressed by higher proteinuria, urine albumin/creatinine ratio, KIM-1 and cystatin-C levels and a hyperfiltration state (80% higher GFR, p<0.05). Conclusions The present data demonstrate that the SDT fatty rats developed diastolic dysfunction characterized by a restrictive profile combining compliance and relaxation impairments as well as higher filling pressure along with hypertension. This type2 diabetic model seems as a very promising model to translate the hypertension/kidney dysfunction and cardiometabolic clinical HFpEF phenogroups and is consequently a relevant model to evaluate drugs targeting HFpEF.

Role of Ultrasound in the Evaluation of Skeletal Muscle Changes in Patients with Type 2 Diabetes Mellitus

Abstract Background Diabetes is a global public health problem, with type 2 diabetes mellitus (T2DM) accounting for more than 90% of the diabetic population and it has been consistently reported as one of the strongest correlates of mobility limitation, especially in older people, and a potential risk factor for future mobility disability and loss of independence. Long-term complications and diabetes-related comorbidities only partially explain the excess risk of disability associated with diabetes. Changes in body composition, in particular progressive loss of muscle mass and increase in fat mass, with decline in muscle strength and quality have been proposed as additional potential mediators of the association between diabetes and disability. Aim of the Work to investigate the differences in Skeletal muscle ultrasound features in people with and without type 2 diabetes mellitus. Patients and Methods This was a Case control study conducted at the Ultrasound Radiology Unit, Radiology Department, Ain Shams University Hospitals from July, 2023 to January 2024. The study was performed on simple random sample consists of 36 T2DM patients on regular follow up in the endocrinology clinics in Ain Shams University Hospitals. And 36 Healthy controls came for routine checkup in Ain Shams University Hospitals clinics and meeting the study inclusion criteria. A signed informed consent was obtained from all patients and controls prior to inclusion in the study after explaining the procedure details. The approval of research ethical committee of faculty of Medicine - Ain Shams University was obtained before starting the study. The privacy of participants and confidentiality of data was guaranteed during the various phases of the study. Results we measured three ultrasonic parameters. MT, FL and PA. The FL and PA are measured in both relaxed and contracted states. the DPN group had the lowest MT, FL at both rest and contracted states and PA at contracted state as well as the lowest ΔFL and ΔPA. The control group had the highest MT, FL at both rest and contracted states and PA at contracted state as well as the highest ΔFL and ΔPA. The non-DPN group had intermediate values for the same variables. The differences among the groups were statistically significant for all the variables except for the pennation angle at rest. It showed that the ΔFL of the DPN group was significantly lower than that of the non-DPN group (p < 0.001), which was similar to a previous conclusion that the gastrocnemius fascicles undergo the smallest length changes in a DPN group. Conclusion The combination of MT,ΔFL and ΔPA of the MG showed high-diagnostic accuracy (sensitivity >80%; specificity >95%) for predicting DPN, which could be used for rapid screening in the future. Early muscle ultrasound screening should be timely carried out in patients with T2DM, especially those with a long disease course and poor long-term blood glucose levels, and there is no difference between men and women.

Clinical application of cluster analysis in patients with newly diagnosed type 2 diabetes.

Early prevention and treatment of type 2 diabetes mellitus (T2DM) is still a huge challenge for patients and clinicians. Recently, a novel cluster-based diabetes classification was proposed which may offer the possibility to solve this problem. In this study, we report our performance of cluster analysis of individuals newly diagnosed with T2DM, our exploration of each subtype's clinical characteristics and medication treatment, and the comparison carried out concerning the risk for diabetes complications and comorbidities among subtypes by adjusting for influencing factors. We hope to promote the further application of cluster analysis in individuals with early-stage T2DM. In this study, a k-means cluster algorithm was applied based on five indicators, namely, age, body mass index (BMI), glycosylated hemoglobin (HbA1c), homeostasis model assessment-2 insulin resistance (HOMA2-IR), and homeostasis model assessment-2 β-cell function (HOMA2-β), in order to perform the cluster analysis among 567 newly diagnosed participants with T2DM. The clinical characteristics and medication of each subtype were analyzed. The risk for diabetes complications and comorbidities in each subtype was compared by logistic regression analysis. The 567 patients were clustered into four subtypes, as follows: severe insulin-deficient diabetes (SIDD, 24.46%), age-related diabetes (MARD, 30.86%), mild obesity-related diabetes (MOD, 25.57%), and severe insulin-resistant diabetes (SIRD, 20.11%). According to the results of the oral glucose tolerance test (OGTT) and biochemical indices, fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hBG), HbA1c, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride-glucose index (TyG) were higher in SIDD and SIRD than in MARD and MOD. MOD had the highest fasting C-peptide (FCP), 2-hour postprandial C-peptide (2hCP), fasting insulin (FINS), 2-hour postprandial insulin (2hINS), serum creatinine (SCr), and uric acid (UA), while SIRD had the highest triglycerides (TGs) and TyG-BMI. Albumin transaminase (ALT) and albumin transaminase (AST) were higher in MOD and SIRD. As concerms medications, compared to the other subtypes, SIDD had a lower rate of metformin use (39.1%) and a higher rate of α-glucosidase inhibitor (AGI, 61.7%) and insulin (74.4%) use. SIRD showed the highest frequency of use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i, 36.0%) and glucagon-like peptide-1 receptor agonists (GLP-1RA, 19.3%). Concerning diabetic complications and comorbidities, the prevalence of diabetic kidney disease (DKD), cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and hypertension differed significantly among subtypes. Employing logistic regression analysis, after adjusting for unmodifiable (sex and age) and modifiable related influences (e.g., BMI, HbA1c, and smoking), it was found that SIRD had the highest risk of developing DKD (odds ratio, OR = 2.001, 95% confidence interval (CI): 1.125-3.559) and dyslipidemia (OR = 3.550, 95% CI: 1.534-8.215). MOD was more likely to suffer from NAFLD (OR = 3.301, 95%CI: 1.586-6.870). Patients with newly diagnosed T2DM can be successfully clustered into four subtypes with different clinical characteristics, medication treatment, and risks for diabetes-related complications and comorbidities, the cluster-based diabetes classification possibly being beneficial both for prevention of secondary diabetes and for establishment of a theoretical basis for precision medicine.

Adipose Tissue Dysfunction Related to Climate Change and Air Pollution: Understanding the Metabolic Consequences.

Obesity, a global pandemic, poses a major threat to healthcare systems worldwide. Adipose tissue, the energy-storing organ during excessive energy intake, functions as a thermoregulator, interacting with other tissues to regulate systemic metabolism. Specifically, brown adipose tissue (BAT) is positively associated with an increased resistance to obesity, due to its thermogenic function in the presence of uncoupled protein 1 (UCP1). Recently, studies on climate change and the influence of environmental pollutants on energy homeostasis and obesity have drawn increasing attention. The reciprocal relationship between increasing adiposity and increasing temperatures results in reduced adaptive thermogenesis, decreased physical activity, and increased carbon footprint production. In addition, the impact of climate change makes obese individuals more prone to developing type 2 diabetes mellitus (T2DM). An impaired response to heat stress, compromised vasodilation, and sweating increase the risk of diabetes-related comorbidities. This comprehensive review provides information about the effects of climate change on obesity and adipose tissue, the risk of T2DM development, and insights into the environmental pollutants causing adipose tissue dysfunction and obesity. The effects of altered dietary patterns on adiposity and adaptation strategies to mitigate the detrimental effects of climate change are also discussed.

Audit of diabetes-related lower extremity amputations in the Northern Region of New Zealand 2013-2016.

To characterise diabetes-related lower extremity amputations (DRLEA) and prior contact with specialist podiatrists in Northern New Zealand. Using administrative data, DRLEA ≥35 years were identified for the Northern Region (July 2013 to June 2016). For those domiciled in Metro Auckland (July 2015 to June 2016), additional clinical data described amputation cause, diabetes-related comorbidities and podiatry contact. There were 862 DRLEA for 488 people, including 25% (n=214) major amputations. Age-standardised amputation rates were three times higher for males than females (41.1 vs 13.6 per 100,000 population [95% confidence interval (CI): 37.3-44.9 vs 11.6-15.6 per 100,000] respectively). Amputation rates varied by ethnicity, being 2.8 and 1.5 times higher respectively for Māori and Pacific people than non-Māori, non-Pacific people. Mortality was high at 1-, 3- and 6-months post-admission (7.9%, 12.4 % and 18.3% respectively). There was high prevalence of peripheral vascular disease (78.8%), neuropathy (75.6%), retinopathy (73.6%) and nephropathy (58%). In the 3 months prior to first DRLEA admission, 65% were not seen by specialist podiatry. Our study confirms higher DRLEA admission rates for Māori and males. We identified elevated rates among Pacific populations and observed suboptimal utilisation of specialist podiatry services.

Alternative therapeutic strategies in diabetes management

Diabetes is a heterogeneous metabolic disease characterized by elevated blood glucose levels resulting from the destruction or malfunction of pancreatic β cells, insulin resistance in peripheral tissues, or both, and results in a non-sufficient production of insulin. To adjust blood glucose levels, diabetic patients need exogenous insulin administration together with medical nutrition therapy and physical activity. With the aim of improving insulin availability in diabetic patients as well as ameliorating diabetes comorbidities, different strategies have been investigated. The first approaches included enhancing endogenous β cell activity or transplanting new islets. The protocol for this kind of intervention has recently been optimized, leading to standardized procedures. It is indicated for diabetic patients with severe hypoglycemia, complicated by impaired hypoglycemia awareness or exacerbated glycemic lability. Transplantation has been associated with improvement in all comorbidities associated with diabetes, quality of life, and survival. However, different trials are ongoing to further improve the beneficial effects of transplantation. Furthermore, to overcome some limitations associated with the availability of islets/pancreas, alternative therapeutic strategies are under evaluation, such as the use of mesenchymal stem cells (MSCs) or induced pluripotent stem cells for transplantation. The cotransplantation of MSCs with islets has been successful, thus providing protection against proinflammatory cytokines and hypoxia through different mechanisms, including exosome release. The use of induced pluripotent stem cells is recent and requires further investigation. The advantages of MSC implantation have also included the improvement of diabetes-related comorbidities, such as wound healing. Despite the number of advantages of the direct injection of MSCs, new strategies involving biomaterials and scaffolds have been developed to improve the efficacy of mesenchymal cell delivery with promising results. In conclusion, this paper offered an overview of new alternative strategies for diabetes management while highlighting some limitations that will need to be overcome by future approaches.

#2587 Survival and access to renal transplantation of patients with type 1 diabetes: a study from the REIN registry

Abstract Background and Aims One of the most severe complication of type 1 diabetes (D1) is renal injury which can lead to end stage renal disease. Even though improvement have been made to slow the progression of the renal disease, some of D1 patients still reach dialysis. Those patients seem to have more comorbidities and poor prognosis compare to patients without diabetes (D0) starting dialysis or patients with type 2 (D2) diabetes. Method The French Renal Epidemiology and Information Network (REIN) registry collects information on all patients starting dialysis in France. We used this cohort to explore survival and access to renal transplantation of D1 on dialysis patients compare to D0 and D2 patients, using Cox proportional hazard models and graphical representation of the variables to explore the pathway from type 1 diabetes to the outcomes of interest. We performed sensitivity analysis on the imputed base obtain by MICE (in order to reduce the influence of missing data) to compare HR. Results From January 1, 2010 to December 31,2016, 1596 D1 patients were compared to 39540 D0 patients and 28170 D2 patients. Excess in all-cause mortality rate were 1.26 [1.14-1.40] (p < 0.001) for D1 versus D0 and rises to 1.45 [1.32-1.59] (p < 0.001) when considering diabetes-related comorbidities on the pathway from diabetes to death. D1 had a poorer access to kidney transplantation (0.74 [0.66-0.82] p < 0.001) adjusting for non-diabetes-related comorbidities. Using the survival model to compare D1 and D2 on the imputed bases, we obtained an HR: 1.11; 95% CI: 1.01-1.21 p = 0.027, in favor of a worse survival of D1 patients in dialysis compare to D2 patients Conclusion These results confirm that D1 patients starting dialysis are severely ill and particular care need to be given to detect and so reduce diabetes-related comorbidities and increase access to kidney transplantation.

Self-Care of Diabetes and Diabetes Distress in Non-Hispanic Black Adults With Type 2 Diabetes.

The purpose of the study was to describe the level of self-care of diabetes and diabetes distress and examine their relationship in non-Hispanic Black adults living with type 2 diabetes. This cross-sectional, correlational study was conducted with 275 non-Hispanic Black adults with type 2 diabetes in North Carolina over 10 weeks, July 2022 to September 2022. An online survey collected sociodemographic and clinical characteristics, self-care measures of diabetes, and diabetes distress. The theory of self-care of chronic illness guided the study. Median regression examined the relationship between self-care of diabetes and diabetes distress. Of the 275 participants, over half reported a diagnosis of type 2 diabetes at younger ages than expected, with a mean age of 40. The self-reported mean A1C of 9% exceeded the recommended goal of <7%, with an average of 2 diabetes-related comorbidities. The self-care of diabetes scale scores were low, and total diabetes distress scores were high. Significant positive associations were found between total diabetes distress and self-care monitoring and self-care management. In this sample, non-Hispanic Black adults had low levels of self-care of diabetes and high levels of diabetes distress. The findings indicate a relationship between self-care of diabetes and diabetes distress; as diabetes distress increases, so do the attempted activities of self-care of diabetes. Health care professionals in diabetes care are uniquely positioned to address further the behavioral aspects of diabetes management, particularly diabetes distress, to support non-Hispanic Black adults living with type 2 diabetes.

Dipeptidyl peptidase 4 inhibitors vs. metformin for new-onset dementia: a propensity score-matched cohort study.

Hypoglycemic pharmacotherapy interventions for alleviating the risk of dementia remains controversial, particularly about dipeptidyl peptidase 4 (DPP4) inhibitors versus metformin. Our objective was to investigate whether the initiation of DPP4 inhibitors, as opposed to metformin, was linked to a reduced risk of dementia. We included individuals with type 2 diabetes over 40 years old who were new users of DPP4 inhibitors or metformin in the Chinese Renal Disease Data System (CRDS) database between 2009 and 2020. The study employed Kaplan-Meier and Cox regression for survival analysis and the Fine and Gray model for the competing risk of death. Following a 1:1 propensity score matching, the analysis included 3626 DPP4 inhibitor new users and an equal number of metformin new users. After adjusting for potential confounders, the utilization of DPP4 inhibitors was associated with a decreased risk of all-cause dementia compared to metformin (hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.45-0.89). Subgroup analysis revealed that the utilization of DPP4 inhibitors was associated with a reduced incidence of dementia in individuals who initiated drug therapy at the age of 60 years or older (HR 0.69, 95% CI 0.48-0.98), those without baseline macrovascular complications (HR 0.62, 95% CI 0.41-0.96), and those without baseline microvascular complications (HR 0.67, 95% CI 0.47-0.98). In this real-world study, we found that DPP4 inhibitors presented an association with a lower risk of dementia in individuals with type 2 diabetes than metformin, particularly in older people and those without diabetes-related comorbidities.

Poorer Outcomes in Bladder Cancer Patients With Diabetes: A Systematic Review and Meta-analysis Addressing Over 226,472 Bladder Cancer Patients

Purpose: Diabetes mellitus, a frequent comorbid condition in cancer patients, has been shown to increase risk of all-site cancer mortality. This relationship has not been systematically studied in bladder cancer patients. This systematic review and meta-analysis aimed to identify, evaluate, and synthesize available evidence on the relationship between history of diabetes and outcomes in bladder cancer patients.Materials and Methods: Systematic searches interrogated OVID MEDLINE, Embase, Web of Science, Google Scholar, and Cochrane Library to identify scholarly reports relating diabetes to all-cause mortality, bladder cancer-specific mortality, recurrence, and progression in bladder cancer patients. After critical review, meta-analysis was used to quantitively synthesize qualifying data and assess potential influence of publication bias, clinical heterogeneity, and residual confounding.Results: We synthesized data on over 226,472 patients treated with curative intent uniquely represented in 28 studies that met quality metrics. Having diabetes was positively associated with each outcome. Hazard ratio estimates were indistinguishable for mortality from any cause, 1.22 (95% confidence interval [CI], 1.12–1.33) and bladder cancer-specific mortality, 1.28 (95% CI 1.17–1.41) and notably stronger in patients with muscle-invasive and high-risk non–muscle-invasive bladder cancer, 1.32 (95% CI, 1.15–1.50) and 1.48 (95% CI, 1.06–2.06). Neither publication bias, systematic error, nor confounding by factors such as smoking or obesity is likely to explain the observed associations.Conclusions: Bladder cancer patients with diabetes experience elevated mortality that is not explained by diabetes-related comorbidities or complications. Future research should explore type, severity, and duration of diabetes in relation to unfavorable bladder cancer outcomes.

Effectiveness of the Pasifika Women's Diabetes Wellness Program (PWDWP): Protocol for a Pilot Intervention and Feasibility Randomized Controlled Trial.

Type 2 diabetes poses public health challenges for Māori and Pasifika communities in Australia. The women of these communities face a greater burden from type 2 diabetes-related mortality and comorbidities. Lifestyle modification behaviors through previous women's wellness programs have been shown to reduce the risk of developing complications in established type 2 diabetes. The Pasifika Women's Diabetes Wellness Program (PWDWP) pilot study, co-designed with Māori and Pasifika communities, was aimed at addressing late hospital presentations from diabetes-related complications. This study (1) examines the efficacy of women with type 2 diabetes in the intervention group for improved glycated hemoglobin (HbA1c) clinical levels and diabetes self-management compared with the control group from baseline (T0) to week 12 (T1) and week 24 (T2; postintervention) and (2) assesses the cultural adaptability, acceptability, and feasibility of the pilot intervention for future studies. This study uses a quasiexperimental design that involves a 24-week intervention. We recruited 50 Māori and Pasifika women with type 2 diabetes (25 in the intervention group from the south side of Brisbane and 25 in the control group from the north side of Brisbane) using participatory talanoa methodologies. The intervention group participated in face-to-face and virtual whānau education workshops (5 weeks) and had access to individual coaching and virtual support delivered by trained Māori and Pasifika health professionals and community health workers. The control group received usual care with their identified health provider. Both groups received copies of the PWDWP journal, fact sheets, and a health check passbook with tailored motivational text messages. An advisory committee was set up to oversee the program implementation, including protocols of engagement, health checks, and data collection in community settings. The quantitative data were collected at T0, T1, and T2 with HbA1c as the primary outcome measure. Secondary outcomes measured changes in diabetes self-care and body composition (eg, BMI, waist circumference). Qualitative data will ascertain the program's feasibility and cultural adaptability using talanoa focus groups. This pilot study was approved by the Queensland University of Technology Human Ethic Research Committee (5609) and began in January 2023 after participant recruitment between July 2022 and December 2022. The final data collection including the health check, focus group, and survey data was completed in November 2023, and data analysis and reporting are expected to conclude in 2024. This study provides a blueprint for PWDWP. Collaborative partnerships with community organizations and stakeholders are crucial for program success and suggest a potential model for targeting diabetes management for Māori and Pasifika communities, emphasizing the need for culturally relevant interventions. The findings will have significant implications for policymakers and practitioners when developing and implementing public health initiatives, particularly for communities with unique cultural nuances. Australian New Zealand Clinical Trials Registry ACTRN12622001100785p; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384470&isReview=true. DERR1-10.2196/55435.

Is Tirzepatide the New Game Changer in Type 2 Diabetes?

Background: Tirzepatide (TZP) is a once-weekly glucagon-like peptide 1 (GLP-1) and glucose-dependent-insulinotropic-polypeptide (GIP) receptor co-agonist approved for T2D. TZP provides promising evidence in improving glucose control and weight loss in T2D and obesity across preclinical and human studies, including data from the SURPASS program. Aims: The goal of this paper was to review the evidence on TZP in terms of glucose control, body weight, and the progression of chronic diabetes-related complications and comorbidities. Results: The mean change in HbA1c ranged from −1.6% to −2.06% over placebo, from −0.29% to −0.92% over each GLP-1RAs, and from −0.7% to −1.09% over basal insulins. In SURPASS-6, TZP was more effective than insulin lispro U100 added to basal insulin in reducing HbA1c levels at the study end (−2.1% vs. −1.1%, respectively). Compared to placebo, TZP induces a significant weight loss: 7.5 (5 mg/week); 11 (10 mg/week); and 12 kg (15 mg/week). Compared to GLP-1RAs, TZP reduces body weight from −1.68 kg to −7.16 kg depending on the dose (5 to 15 mg, respectively). Compared to basal insulin alone rigorously titrated, TZP added onto basal-insulin results in the best strategy for the composite endpoint of improvement of glucose control and weight loss. In SURPASS-6, TZP compared to insulin lispro U100 in add-on to insulin glargine U100 reduced body weight by 9 kg in mean (versus weight gain in basal-bolus users: +3.2 kg). TZP has pleiotropic effects potentially dampening the individual cardiovascular risk, including a reduction in systolic arterial pressure by 4 to 6 mmHg and total cholesterol by 4–6% compared to baseline. A post hoc analysis of SURPASS-4 revealed that TZP, compared to glargine U100, delayed the rate of glomerular filtration decline (−1.4 mL/min vs. −3.6 mL/min, respectively), reduced the rate of urinary albumin excretion (−6.8% vs. +36.9%, respectively), and was associated with a lower occurrence of the composite renal endpoint (HR 0.58 [0.43; 0.80]). Conclusions: Consistent evidence indicates that TZP dramatically changes the clinical course of T2D in different clinical scenarios. The efficacy and safety of TZP on chronic diabetes-related comorbidities and complications seem promising, but ongoing trials will clarify the real benefits.

Association of dietary patterns with diabetes-related comorbidities varies among diabetes endotypes

Background and aimsDifferences of dietary pattern adherence across the novel diabetes endotypes are unknown. This study assessed adherence to pre-specified dietary patterns and their associations with cardiovascular risk factors, kidney function, and neuropathy among diabetes endotypes. Methods and resultsThe cross-sectional analysis included 765 individuals with recent-onset (67 %) and prevalent diabetes (33 %) from the German Diabetes Study (GDS) allocated into severe autoimmune diabetes (SAID, 35 %), severe insulin-deficient diabetes (SIDD, 3 %), severe insulin-resistant diabetes (SIRD, 5 %), mild obesity-related diabetes (MOD, 28 %), and mild age-related diabetes (MARD, 29 %). Adherence to a Mediterranean diet score (MDS), Dietary Approaches to Stop Hypertension (DASH) score, overall plant-based diet (PDI), healthful (hPDI) and unhealthful plant-based diet index (uPDI) was derived from a food frequency questionnaire and associated with cardiovascular risk factors, kidney function, and neuropathy using multivariable linear regression analysis. Differences in dietary pattern adherence between endotypes were assessed using generalized mixed models.People with MARD showed the highest, those with SIDD and MOD the lowest adherence to the hPDI. Adherence to the MDS, DASH, overall PDI, and hPDI was inversely associated with high-sensitivity C-reactive protein (hsCRP) among people with MARD (β (95%CI): −9.18 % (−15.61; −2.26); −13.61 % (−24.17; −1.58); −19.15 % (−34.28; −0.53); −16.10 % (−28.81; −1.12), respectively). Adherence to the PDIs was associated with LDL cholesterol among people with SAID, SIRD, and MOD. ConclusionsMinor differences in dietary pattern adherence (in particular for hPDI) and associations with markers of diabetes-related complications (e.g. hsCRP) were observed between endotypes. So far, evidence is insufficient to derive endotype-specific dietary recommendations. Trial registrationClinicaltrials.gov: NCT01055093.

A novel few shot learning derived architecture for long-term HbA1c prediction

Regular monitoring of glycated hemoglobin (HbA1c) levels is important for the proper management of diabetes. Studies demonstrated that lower levels of HbA1c play an essential role in reducing or delaying microvascular difficulties that arise from diabetes. In addition, there is an association between elevated HbA1c levels and the development of diabetes-related comorbidities. The advanced prediction of HbA1c enables patients and physicians to make changes to treatment plans and lifestyle to avoid elevated HbA1c levels, which can consequently lead to irreversible health complications. Despite the impact of such prediction capabilities, no work in the literature or industry has investigated the futuristic prediction of HbA1c using current blood glucose (BG) measurements. For the first time in the literature, this work proposes a novel FSL-derived algorithm for the long-term prediction of clinical HbA1c measures. More importantly, the study specifically targeted the pediatric Type-1 diabetic population, as an early prediction of elevated HbA1c levels could help avert severe life-threatening complications in these young children. Short-term CGM time-series data are processed using both novel image transformation approaches, as well as using conventional signal processing methods. The derived images are then fed into a convolutional neural network (CNN) adapted from a few-shot learning (FSL) model for feature extraction, and all the derived features are fused together. A novel normalized FSL-distance (FSLD) metric is proposed for accurately separating the features of different HbA1c levels. Finally, a K-nearest neighbor (KNN) model with majority voting is implemented for the final classification task. The proposed FSL-derived algorithm provides a prediction accuracy of 93.2%.

Risk factors associated with falls among older adults with diabetes

Abstract Background Globally, falls are a major public health concern and it is the second leading cause of death due to unintentional injury. The prevalence of falls in older adults with diabetes is unknown in many parts of the world. This study aims to explore the association between diabetes-related comorbidities and falls among older adults with diabetes. The study aims to provide evidence and advice for the preventing falls among this vulnerable population. Methods This is a cross-sectional study of all older adults with diabetes aged 60 years or older with at least one encounter with the primary health care centers in Qatar during the period 2017-2022. Data on documented falls, demographic variables, and medical comorbidities were extracted from all primary care centers in Qatar. Descriptive and inferential statistics were used to address the aim of the study. Results A total of 38,285 older adults with diabetes had at least one encounter with the primary care clinics. The median age was 68.0 years, 56.8% were males, and 40.6% of Qatari nationality.The prevalence of falls was 8.9% (95% CI 6.6 - 6.9). Age, gender (female), nationality, diabetes retinopathy, neuropathy, dyslipidemia, and hypertension were independently associated with increased prevalence of falls. Conclusions Given a growing population of older adults in the MENA region, the prevalence of falls is a public health concern. The risk factors identified in this study suggest the need for active screening for risk of falls and preventive interventions in this region. Key messages • Prevalence of falls among older individuals with diabetes is relatively high and requires public health attention. • Females, and older adults with diabetes retinopathy, neuropathy, dyslipidemia, and hypertension are at a higher risk for falls in our sample.

SAT161 The Impact Of A Very Low-calorie Diet On Reversal Of Metabolic Disorders Among Indian Subjects: A Real World Clinic-based Study

Abstract Disclosure: N. Deshpande: None. N. Kapoor: None. Introduction: Reversal/remission of diabetes has been tested and well proven in the Caucasians. However, the Asian Indian phenotype is genetically and clinically distinct and there is a lack of robust data on this subject. Also, hitherto, the benefits of such an intervention have been reported only in a tightly monitored trial-based environment, but its efficacy from real-world data in busy clinical practices is lacking from the Indian subcontinent. In this study we aimed to study the impact of marked reduction of calorie intake on obesity indicators and diabetes related comorbidities in subjects of Indian ethnicity in a clinic-based cohort. Material and Methods: A 3-month structured Reversal Diet of 800-830 calories/day, comprising an inhouse packed commercially available meal replacement liquid formula, along with non-starchy veggies/soups/ diluted buttermilk, and fat replaced all 3 major meals. Clinical and biochemical metabolic parameters were assessed at baseline and at 3 months. Only those subjects who completed the 3-month assessment were included. Body composition was analyzed using bioimpedance with the INBODY 230 Analyser. Statistical analysis was undertaken using the SPSS 16·0 software package. This study was approved by the Institutional Review Board. Results: 374 subjects were included of which 117(31.2%) had type 2 Diabetes (T2DM). At baseline the mean (SD) age of the participants was 40.1(12.4) years and 333/374(89.1%) participants were women. There was significant improvement in body weight (85.4 Vs 77.7 Kg), BMI (32.6 Vs 29.8 kg/m2), Waist circumference (103.6 Vs 98.3 cm) and hip circumference (109.2 Vs 103.8 cm) at 3 months, compared to baseline. Body fat % changed from 41.9 to 37.6 and other anthropometric indicators (neck circumference, thigh circumference and arm circumference) were also significantly better after the intervention (P&amp;lt; .001). Among subjects with T2DM (31.2%), 40% had remission in diabetes, 28% of insulin users stopped insulin and about 30% stopped oral anti diabetic agents. Even among those who did not go into diabetes remission, Insulin was stopped in 29% and reduced in 38%, Oral Anti Diabetic agents reduced in 22%, blood pressure was normalized without medicines in 14% and NAFLD remission was attained in 41% of patients. Conclusion: A significant impact towards reversal of metabolic disorders was observed following a structured very low-calorie diet intervention, in this clinic-based cohort. Further follow-up studies are currently needed to provide long term evidence on the sustainability and long-term efficacy of such an intervention in the metabolically unique Indian population. Presentation: Saturday, June 17, 2023

Autophagy and diabetes

The current literature findings on autophagy’s beneficial and detrimental roles in diabetes mellitus (DM) and diabetes-related comorbidities were reviewed. The effects of oral hypoglycaemic medicines and autophagy in DM. Autophagy plays an important function in cellular homeostasis by promoting cell survival or initiating cell death in physiological settings was also assessed. Although autophagy protects insulin-target tissues, organelle failure caused by autophagy malfunction influences DM and other metabolic diseases. Endoplasmic reticulum and oxidative stress enhance autophagy levels, making it easier to regulate stress-induced intracellular changes. Evidence suggests that autophagy-caused cell death can occur when autophagy is overstimulated and constitutively activated, which might prevent or develop DM. Even though the precise role of autophagy in DM complications is uncertain, deregulation of the autophagic machinery is strongly linked to beta cell destruction and the aetiology of DM. Thus, improving autophagy dysfunction is a possible therapeutic objective in treating DM and other metabolic disorders.

Pediatric Type 1 Diabetes: Mechanisms and Impact of Technologies on Comorbidities and Life Expectancy.

Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood, with a progressively increasing incidence. T1D management requires lifelong insulin treatment and ongoing health care support. The main goal of treatment is to maintain blood glucose levels as close to the physiological range as possible, particularly to avoid blood glucose fluctuations, which have been linked to morbidity and mortality in patients with T1D. Indeed, the guidelines of the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend a glycated hemoglobin (HbA1c) level < 53 mmol/mol (<7.0%) for young people with T1D to avoid comorbidities. Moreover, diabetic disease strongly influences the quality of life of young patients who must undergo continuous monitoring of glycemic values and the administration of subcutaneous insulin. In recent decades, the development of automated insulin delivery (AID) systems improved the metabolic control and the quality of life of T1D patients. Continuous subcutaneous insulin infusion (CSII) combined with continuous glucose monitoring (CGM) devices connected to smartphones represent a good therapeutic option, especially in young children. In this literature review, we revised the mechanisms of the currently available technologies for T1D in pediatric age and explored their effect on short- and long-term diabetes-related comorbidities, quality of life, and life expectation.