Diabetic Subjects Research Articles

Brain Dopamine-Clock Interactions Regulate Cardiometabolic Physiology: Mechanisms of the Observed Cardioprotective Effects of Circadian-Timed Bromocriptine-QR Therapy in Type 2 Diabetes Subjects.

Despite enormous global efforts within clinical research and medical practice to reduce cardiovascular disease(s) (CVD), it still remains the leading cause of death worldwide. While genetic factors clearly contribute to CVD etiology, the preponderance of epidemiological data indicate that a major common denominator among diverse ethnic populations from around the world contributing to CVD is the composite of Western lifestyle cofactors, particularly Western diets (high saturated fat/simple sugar [particularly high fructose and sucrose and to a lesser extent glucose] diets), psychosocial stress, depression, and altered sleep/wake architecture. Such Western lifestyle cofactors are potent drivers for the increased risk of metabolic syndrome and its attendant downstream CVD. The central nervous system (CNS) evolved to respond to and anticipate changes in the external (and internal) environment to adapt survival mechanisms to perceived stresses (challenges to normal biological function), including the aforementioned Western lifestyle cofactors. Within the CNS of vertebrates in the wild, the biological clock circuitry surveils the environment and has evolved mechanisms for the induction of the obese, insulin-resistant state as a survival mechanism against an anticipated ensuing season of low/no food availability. The peripheral tissues utilize fat as an energy source under muscle insulin resistance, while increased hepatic insulin resistance more readily supplies glucose to the brain. This neural clock function also orchestrates the reversal of the obese, insulin-resistant condition when the low food availability season ends. The circadian neural network that produces these seasonal shifts in metabolism is also responsive to Western lifestyle stressors that drive the CNS clock into survival mode. A major component of this natural or Western lifestyle stressor-induced CNS clock neurophysiological shift potentiating the obese, insulin-resistant state is a diminution of the circadian peak of dopaminergic input activity to the pacemaker clock center, suprachiasmatic nucleus. Pharmacologically preventing this loss of circadian peak dopaminergic activity both prevents and reverses existing metabolic syndrome in a wide variety of animal models of the disorder, including high fat-fed animals. Clinically, across a variety of different study designs, circadian-timed bromocriptine-QR (quick release) (a unique formulation of micronized bromocriptine-a dopamine D2 receptor agonist) therapy of type 2 diabetes subjects improved hyperglycemia, hyperlipidemia, hypertension, immune sterile inflammation, and/or adverse cardiovascular event rate. The present review details the seminal circadian science investigations delineating important roles for CNS circadian peak dopaminergic activity in the regulation of peripheral fuel metabolism and cardiovascular biology and also summarizes the clinical study findings of bromocriptine-QR therapy on cardiometabolic outcomes in type 2 diabetes subjects.

The Prevalence of Diabetic Retinopathy in Type 1 Diabetic Subjects Attending Ain Shams Diabetes Outpatient Clinic

Abstract Background Diabetic retinopathy is a chronic progressive, potentially sight threatening disease of the retinal microvasculature associated with the prolonged hyperglycaemia and other conditions linked to diabetes mellitus such as hypertension Aim detect the prevalence of diabetic retinopathy in type 1 diabetic subjects in relation to duration of diabetes, control of blood glucose level and other micro-vascular complications. Patients and Methods This was a cross sectional study conducted on 120 patients attending diabetes outpatient clinic at ain shams university hospital during period from april 2020 to October 2020 to detect the prevalence of diabetic retinopathy in type 1 diabetic subjects in relation to duration of diabetes, control of blood glucose level and other micro-vascular complications Patients were subjected to full history taking and clinical examination. DN4 questionnaire for neuropathy assessment, Laboratory investigations included; fasting blood sugar, 2 hour post prandial blood glucose, (glycated haemoglobin HBAIC), serum creatinine and albumin/creatinine ratio, also all patients subjected to detailed fundus examnation using ophthalmoscope. Results Our study show that total patients of study is 120 patient, fundus examination results revealed that 66 of them normal fundus (55%), 17 mderate NPDR (14.17%), 8 sever NPDR (6.67%), 29 PDR (24.17%). Also show that there is statistically significant relation between fundus examination results and (age of the patient, duration of diabetes mellitus and smoking) also clinical data (SBP, DBP, pulse and BMI) also laboratory data (FBS, 2h PPBG, HBA1C and albumin /creatinine ratio). Also show that there is statistically significant relation between fundus examination results and total insulin dose and DN4 questionnaire. The study also show that there is no significant relation between fundus examination results and (gender, s. creatinine level, family history of diabetes or type of basal insulin). Conclusion DR. is a progressive blinding disease that affects 4.2 million people worldwide, making it a leading cause of blindness in adults and this number is expected to continue to increase. DR. affected by age of the patient, duration of diabetes mellitus and smoking also clinical data (SBP, DBP, pulse and BMI) also laboratory data (FBS, 2h PPBG, HBA1C and albumin /creatinine ratio) and total insulin dose.

The Association between Diabetic Retinopathy and Cardiovascular Autonomic Neuropathy in People with Type 2 Diabetes

Abstract Background Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus, which is strongly associated with increased risk of cardiovascular mortality. The aim of the present work is to study the prevalence of CAN in diabetic subjects with retinopathy Methods Ninety subjects participated in the study. They were classified into three groups (Group I: 30 (T2DM) patients with diabetic retinopathy, Group II: 30 (T2DM) patients without retinopathy, Group III: 30 non diabetic volunteers). All patients were evaluated for detection of CAN (Basal Heart Rate, Supine and erect systolic blood pressure variation, Tilt Table Test), diabetes-related micro vascular complications (retinopathy), micro albuminuria (A/C Ratio). Results The prevalence of CAN (using tilt table test) is significantly higher (P = 0.004) in Group I compared to Group II and III. The percentage of positive tilt table test in Group I (43.33%), while in Group II (10%). In Group I, CAN prevalence is higher in proliferative diabetic retinopathy (PDR) compared to non-proliferative diabetic retinopathy (NPDR) (P = 0.007). Logistic regression analysis demonstrated that in T2DM, the odds [OR (95% confidence intervals)] of CAN increased with diabetes duration [4.99 (1.46-17.09)], A/C Ratio [9.99(2.41-41.36)]. Conclusion This study indicated that DR and micro albuminuria could predict CAN. The results suggest that fundus photography and clinical assessment (A/C RATIO) may be an alternative to autonomic function testing when Tilt Table Test is unavailable

Plasma Levels of Pentraxin 3 and Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus

Abstract Background Diabetes mellitus is a heterogeneous metabolic disorder characterized by the presence of hyperglycemia which is associated with long-term micro-vascular complications affecting the eyes resulting in diabetic retinopathy (a leading cause of blindness). Pentraxin 3 (PTX3) is a recently discovered mediator of acute inflammation which has been shown to be a sensitive biomarker of localized inflammatory reactions with a possibility of being used as a biomarker of peripheral vascular damage. Objective To evaluate the relation between levels of plasma Pentraxin 3 (PTX3) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus. Methods This case control study was conducted on70 patients with type 2 DM and 20 healthy subjects as control and their ages ranged from 40-70 years, selected from outpatient diabetes and endocrinology clinic at El Demerdash Hospital/Ain-Shams University and outpatient diabetes and endocrinology clinic at National Institute of Diabetes and Endocrinology. The included subjects were allocated into three groups: Group I (type 2 DM complicated with DR) and this group was further subdivided to subgroup Ia (diabetic patients with proliferative diabetic retinopathy) and subgroup Ib (diabetic patients with nonproliferative diabetic retinopathy); group II (type 2 DM without retinopathy) and group III (apparently healthy subjects representing control group). All subjects were subjected to full medical history taking, physical examination including BMI and blood pressure measurement as well as fundus examination. Fasting and 2 hr post-prandial plasma glucose, HbA1C, serum creatinine and urea, ALT, AST, serum albumin, microalbuminuria as well as plasma PTX3 wereassessed. Results Plasma PTX3 level was significantly higher in diabetic patients with diabetic retinopathy than that in both diabetic patients without diabetic retinopathy and control healthy subjects (3.20 ± 0.035 ng/dl versus 2.88 ± 0.32 ng/dl and 2.88 ± 0.167 ng/dl respectively; P-value =0.000).The Correlation between pentraxin 3 and other measured parameters in all studied subjects showed a statistical positive correlation between log PTX3 and age, duration of diabetes, DBP, FBG, 2HPP, HBA1c, albumin, creatinine, urea, microalbuminuria. Conclusion Serum pentraxin 3 is strongly correlated to diabetic retinopathy and the higher the grade of retinopathy, the higher the pentraxin 3 level. So, pentraxin 3 can be considered a reliable predictor for diabetic retinopathy. Serum pentraxin 3 and diabetic retinopathy are strongly correlated to level of glycaemia and duration of diabetes as well as to creatinine, urea and micro-albuminuria. This draws the attention to the role of tight glycemic control in the prevention or slowing diabetic retinopathy progression and to the relation between diabetic retinopathy and nephropathy.

Finger print patterns distribution among diabetics and non-diabetics in western Uganda population

Background: Dactyloscopy is a branch of dermatoglyphics (the study of epidermal ridges) which involves assessment and classification of fingerprint patterns for identification. All fingerprint patterns are laid down permanently from the third month of the intra-uterine life and they remain unchanged throughout the life. This is also the time when all organs in the body are finalizing their development. Therefore, a positive association of the dermatoglyphic features with different diseases like diabetes, mongolism, schizophrenia and leprosy have been well documented in the literature. The aim of the present study was to evaluate the dermatoglyphic patterns and the specific variations which may be used as a valuable diagnostic tool for early detection of diabetes mellitus. Methods: This was a prospective cross-sectional study, a total of 150 diabetic subjects and 150 non- diabetics (control) were selected from the KIUTH Western Uganda and their fingerprints were taken by the Indian ink method. The print patterns including whorls, arches, ulnar and radial loops were analysed and the variations were cross-tabulated between sex, the side of the hand and pattern distribution indexes. Data was analysed using SPSS version 26 and Dankmeijer's index and Furuhata's index were used to assess variability of the fingerprint patterns. Chi square tests was used to test for significance in variations at a confidence interval of 95%. Results and conclusion: Ulnar loops were the most predominant patterns among diabetic subjects at 35.2% followed closely by whorls at 35.1%. The most common pattern were whorls found in both hands of females at 21% (315/1500), whilst the most common pattern for male group were whorls at 17.5% (262). However, some fingers such as the ring finger completely lacked an arch pattern in both groups. The increase in arches was strongly supported by a significant increase in Dankmeijer’s index. The presence of high number of ulnar loops can therefore maybe used as an early indicator of type two diabetes.

Assessment and Correlation of Serum Urea and Creatinine Levels in Normal, Hypertensive, and Diabetic Persons in Auchi, Nigeria

Background/Aim: There has been a progressive rise in the incidence and prevalence of End Stage Renal Disease (ESRD). It has also been observed that the most important reasons for a rapid increase in Chronic Kidney Disease (CKD) patients are the rapidly increasing worldwide incidence of diabetes and hypertension. The present study evaluates the effect of diabetes, hypertension, and comorbid state of hypertension and diabetes (hypertensive-diabetic) on renal function using serum creatinine and urea as markers. Method: A total number of 120 persons were recruited for the research; 30 controls, 30 hypertensive, 30 diabetic, and 30 hypertensive-diabetic persons. Of the 30 control persons, 18 were females and 12 were males; of the 30 hypertensive subjects, 17 were females and 13 were males; of the 30 diabetics subjects, 20 were females and 10 were males, whereas of the 30 hypertensive-diabetic subjects, 21 were females and 9 were males. In total, there were seventy-six (76) females and 44 males. The respondents were pulled from Central Hospital (Auchi) Diabetic and General Clinic and Auchi Polytechnic Cottage Hospital. Verbal consent was sort and questionnaires were used to extract information regarding biodata and patients’ history of diabetes and hypertension. Height and weight were measured, and blood pressure was determined taken. Blood samples were collected into fluoride oxalate and lithium heparin bottle for the assessment of FBS and (serum urea and creatinine) respectively. Results: The mean (±SD) serum creatinine was higher in the hypertensive-diabetic group (2.08 ± 1.06) and declined as follows: diabetic group (1.75 ± 1.01), hypertensive group (1.34 ± 0.96) and control group (0.70 ± 0.14). The mean (±SD) serum urea was also found to be higher in the hypertensive-diabetic group (17.5 ± 9.06) and declined as follows: diabetic group (14.5 ± 6.13), hypertensive group (12.7 ± 6.23) and control group (7.18 ± 5.06). There was a positive correlation between serum creatinine and fasting blood sugar The study also established a positive correlation between serum creatinine and blood pressure but not between serum urea and blood pressure with r values of 0.31 and 0.16 respectively. Conclusion: Good control of blood glucose and blood pressure levels reduces the likelihood of the development of renal impairment which is usually associated with both diabetes and hypertension. Co-morbidity of diabetes and hypertension poses a higher risk of developing renal disease than individual problems of diabetes and hypertension. Serum creatinine and serum urea are important biomarkers for renal impairment hence the two should be monitored on a regular basis for diabetic and hypertensive patients and much more frequently for hypertensive-diabetic patients.

A Study to Assess the Knowledge and Attitude Regarding Diabetes Mellitus among Diabetic and Non Diabetic Patients attending Medicine Outpatient Department

The study was to assess the knowledge and attitude regarding Diabetes Mellitus among diabetic and non diabetic patients, and compare the knowledge and attitude regarding Diabetes Mellitus among diabetic and non diabetic patients. A Comparative Descriptive research design was used Sample size of 100 diabetic and non diabetic patients (50 in diabetic mellitus and 50 in non diabetic mellitus) were selected through non probability convenient sampling technique. The study was conducted in GGSMCH hospital Faridkot, Punjab. Results: Data was collected through the self structured knowledge questionnaire and attitude scale. Discussion was based on statistical analysis in diabetic majority of diabetic study subjects 43(86%) had average knowledge followed by 4(8%) had poor knowledge and only 3(6%) had good knowledge. In non diabetic patients majority 25(50%) had average knowledge followed by 18(36%) had poor knowledge and only 7(14%) had good knowledge. 42(84%) had fair attitude whereas in diabetic study subjects and in non diabetic study subjects figure presents the 40(80%) poor attitude. The coefficient of correlation between knowledge and attitude regarding diabetes mellitus among diabetic patients is 0.22 and coefficient of correlation between knowledge and attitude regarding diabetes mellitus among non diabetic patients is 0.25.

The effects of effortless exercise on diabetic status

Treating physicians have consistently recommended exercise to either prevent diabetes or de-escalate symptomatology. Diabetic complications, however, render physical activity undesirable or unattainable. These involve: hypothyroidism leading to substantial weight gain; perpetual fatigue due to accumulation of white adipose tissue serving as fat storage, and inadequate supply of brown fat to generate energy; accumulated toxicity causing hormonal imbalance that increases hunger; chronic pain and wounds on extremities associated with diabetic neuropathy, etc. Recent research with an effortless exercise method demonstrated enhanced fitness and T3 increase, juxtaposed by decreased inflammation, an optimal relationship between leptin and ghrelin that control appetite, and a significant decrease of visceral fat along with VLDL, the very low-density lipoprotein that carries triglycerides to the tissues. We measured the fasting and postprandial glucose and insulin of 21 diabetics and 20 prediabetics respectively, pre and post twenty treatments. Both previously abnormally high fasting and postprandial (PP) glucose decreased considerably in all 21 diabetic subjects (100%). Nine of the diabetic subjects (42.85%) manifested normal fasting glucose levels after 20 treatments, while the fasting glucose of the remaining twelve diabetic subjects (57.2%) dropped down to the prediabetic level. Ten of the diabetic subjects (47.6%) manifested normal PP insulin levels, while the PP insulin of the remaining eleven diabetic subjects (52.38%) dropped to the prediabetic level after the 20 treatments. Prediabetics had more robust results as expected by their baseline healthier status. Eighteen of prediabetics (90%) manifested both normal fasting and PP insulin levels after the 20 treatments, while the fasting and PP insulin of the remaining two subjects (10%) remained within the prediabetic level. All subjects also exhibited a statistically significant increase in muscle mass, normalized T3 levels, decreased visceral and overall fat along with reduced CRP, advocating diminished inflammation. Dyslipidaemia appeared to subside as denoted by suppressed levels of triglycerides contrasted by elevated HDL.

Effects of GLP-1 receptor agonists on mitochondrial function, inflammatory markers and leukocyte-endothelium interactions in type 2 diabetes

ObjectiveType 2 diabetes (T2D) is linked to metabolic, mitochondrial and inflammatory alterations, atherosclerosis development and cardiovascular diseases (CVDs). The aim was to investigate the potential therapeutic benefits of GLP-1 receptor agonists (GLP-1 RA) on oxidative stress, mitochondrial respiration, leukocyte-endothelial interactions, inflammation and carotid intima–media thickness (CIMT) in T2D patients. Research design and methodsType 2 diabetic patients (255) and control subjects (175) were recruited, paired by age and sex, and separated into two groups: without GLP-1 RA treatment (196) and treated with GLP-1 RA (59). Peripheral blood polymorphonuclear leukocytes (PMNs) were isolated to measure reactive oxygen species (ROS) production by flow cytometry and oxygen consumption with a Clark electrode. PMNs were also used to assess leukocyte-endothelial interactions. Circulating levels of adhesion molecules and inflammatory markers were quantified by Luminex's technology, and CIMT was measured as surrogate marker of atherosclerosis. ResultsTreatment with GLP-1 RA reduced ROS production and recovered mitochondrial membrane potential, oxygen consumption and MPO levels. The velocity of leukocytes rolling over endothelial cells increased in PMNs from GLP-1 RA-treated patients, whereas rolling and adhesion were diminished. ICAM-1, VCAM-1, IL-6, TNFα and IL-12 protein levels also decreased in the GLP-1 RA-treated group, while IL-10 increased. CIMT was lower in GLP-1 RA-treated T2D patients than in T2D patients without GLP-1 RA treatment. ConclusionsGLP-1 RA treatment improves the redox state and mitochondrial respiration, and reduces leukocyte-endothelial interactions, inflammation and CIMT in T2D patients, thereby potentially diminishing the risk of atherosclerosis and CVDs.

Efficacy of a training programme for the management of diabetes mellitus in the hospital: A randomized study (stage 2 of GOVEPAZ healthcare).

To assess the efficacy of a structured educational intervention for health professionals on the appropriateness of inpatient diabetes care and on some clinical outcomes in hospitalised subjects. A multicentre (6 regional hospitals) cluster-randomized (2:1) two parallel-group pragmatic intervention trials, as a part of the GOVEPAZ study, was conducted in three clinical settings, that is, Internal Medicine, Surgery and Intensive Care. Intervention consisted of a 2-month structured education of clinical staff to inpatient diabetes care. Twelve wards - 2 for each hospital - and 6 wards - 1 for each hospital - were randomized to usual care and to the intervention arm, respectively. Consecutively hospitalised diabetic subjects (n=524, age 74±14years, 57% males, median HbA1C 57mmol/mol) were included. The clinical appropriateness of inpatient diabetes management was assessed by a previously validated multi-domain performance score (PS). Clinical outcomes included hypoglycemia, glucose control biomarkers, clinical conditions at discharge and inpatient mortality rate. A numerically, but not statistically significant, higher PS (+0.94; 95% C.I.: -0.53 - +2.4) was achieved in the intervention than in the usual care wards. Hypoglycemias (p=0.32), glucose control (p=0.89) and survival rates (p=0.71) were similar in the two experimental arms. Plasma glucose on admission (OR=1.52 per 1 SD; C.I. 1.07-2.17; p=0.021) and the number of hypoglycemic events per patient (OR=1.55 per 1 SD; C.I.:1.11-2.16; p=0.011) were independently associated with the inpatient mortality rate. Structured education of the clinical staff failed to improve the inpatient appropriateness of diabetes care or clinical outcomes. In-hospital hypoglycemia was confirmed to be an independent indicator of death risk.

Short and medium chain acylcarnitines as markers of outcome in diabetic and non-diabetic subjects with acute coronary syndromes

BackgroundCarnitine metabolism produces numerous molecular species of short-, medium-, and long-chain acylcarnitines, which play important roles in energy homeostasis and fatty acid transport in the myocardium. Given that disturbances in the carnitine metabolism are linked to cardiometabolic disease, we studied the relationship of circulating acylcarnitines with outcomes in patients with acute coronary syndromes (ACS) and evaluated differences in circulating levels of these metabolites between diabetic and non-diabetic patients. MethodsHarnessing a prospective multicentre cohort study (SPUM-ACS; NCT01000701), we measured plasma levels of acylcarnitines, carnitine, and carnitine metabolites to assess their relationship with adjudicated major adverse cardiac events (MACE), defined as composite of myocardial infarction, stroke, clinically indicated revascularization, or death of any cause. The SPUM-ACS study enrolled patients presenting with ACS to Swiss University Hospitals between 2009 and 2012. Acetylcarnitine, octanoylcarnitine, proprionylcarnitine, butyrylcarnitine, pentanoylcarnitine, hexanoylcarnitine, carnitine, γ-butyrobetaine, and trimethylamine N-oxide were measured in plasma using stable isotope dilution high-performance liquid chromatography with online electrospray ionization tandem mass spectrometry. ResultsA total of 1683 patients with ACS were included in the study. All measured metabolites except γ-butyrobetaine and carnitine were higher in diabetic subject (n = 294) than in non-diabetic subjects (n = 1389). On univariate analysis, all metabolites, apart from octenoylcarnitine, were significantly associated with MACE at 1 year. After multivariable adjustment for established risk factors, acetylcarnitine remained an independent predictor of MACE at 1-year (quartile 4 vs. quartile 1, adjusted hazard ratio 2.06; 95% confidence interval 1.12–3.80, P = 0.020). ConclusionCirculating levels of acetylcarnitine independently predict residual cardiovascular risk in patients with ACS.

Is subclinical cardiovascular disease linked with periodontal disease in diabetic and non-diabetic subjects?

Periodontal disease leads to a systemic hyper-inflammatory state that might impair other co-morbidities including cardiovascular disease. Evidence-based findings showed that periodontitis may be linked with subclinical signs of cardiovascular diseases such as arterial stiffness. Nevertheless, some contrasting results have been reported over the years. A cross-sectional study regarding the relationship between periodontal disease and subclinical cardiovascular diseases, in non-diabetic and diabetic individuals, has been recently published. Therefore, the aim of this commentary is to give an in-depth on this topic.

Abstract P3164: Podocalyxin, A Renal Podocyte Specific Protein Expression In Urine Exosome Acts As A Marker For Podocyte Injury During Sars-cov-2 Infection

COVID-19 attributed to SARS-CoV2 infection has been associated with cardiovascular disease and diabetes. COVID-19 has been associated with endothelial cell dysfunction (ECD), which is manifested by entities such as microvascular thrombosis. ECD is quite common in type 2 diabetes mellitus (T2DM) where the renal podocyte dysfunction is often an early manifestation of microvascular complication. We explored whether presence of hyperglycemia predisposes to increased SARS-CoV2 infection and whether SARS-CoV2 infection puts an individual at a higher risk of developing cardio-metabolic complications such as kidney disease (DKD), with podocyte damage. We evaluated albuminuria and podocyte protein in urine derived exosomes in urine exosomes from SARS-CoV2 patients at 10 days, 6 months and 12 months post SARS-CoV2 infection. Methods: Blood and Urine samples from SARS-CoV2 patients post-acute phase of infection were procured. Peripheral blood mononuclear cells (PBMNCs) and urine exosomes were isolated and podocyte protein marker Podocalyxin (PODXL) was identified by western blot analysis. Results: Podocyte specific proteins were examined in urine exosomal fraction such as Podocalyxin and Nephrin (normalized to CD9 exosomal protein band intensities) levels increased significantly compared to urine samples from type-2 diabetes subjects with documented evidence of nephropathy. Podocalyxin levels were significantly high at 12month time point (p=0.001; n=9) and Nephrin levels were noted to be high at 10week (p=0.01; n=8), 6months (p=0.04; n=14 ) and 12Months (p=0.001; n=6) time points. Podocalyxin and Nephrin obtained from urine exosome samples collected from non diabetic subjects who never had COVID-19, showed little or barely detectable corresponding western blot bands. Interestingly, there was no significant differences noted on urine albumin: creatinine (UAR) ratios between the two groups, indicating that urine exosomal protein estimation may be an ideal biomarker to monitor podocyte damage in early phases of CKD. Conclusion: A persistent high levels of podocyte specific proteins was noted in urinary exosomes even at 12 months post acute Covid which may be secondary to long-standing podocyte inflammation leading to long term renal damage.

An analysis of the associations of high-sensitivity C-reactive protein and uric acid with metabolic syndrome components in Korean adults by sex: a cross-sectional study using the Korea national health and nutrition examination survey 2016–2018

BackgroundLow-grade inflammation plays a role in the pathogenesis of metabolic syndrome (MetS), and measuring levels of inflammatory molecules, such as high-sensitivity C-reactive protein (hs-CRP), may indicate Mets progression. Serum uric acid (SUA) has also been identified as an independent risk factor for MetS. This study aimed to investigate the association between MetS components and levels of serum hs-CRP and SUA using representative and reliable data for the Korean population.MethodsThis study used the data of the Korea National Health and Nutrition Examination Survey 2016–2018, a cross-sectional and nationally representative survey performed by the Korean Centers for Disease Control and Prevention.ResultsWe analysed the data of 13,454 individuals. High hs-CRP levels were observed in 1,164 (8.7%) subjects while 3,296 (24.5%) subjects had high SUA levels. Moreover, hs-CRP was negatively correlated with serum high-density lipoprotein (HDL) (OR, 1.703; 95% CI, 1.431–2.027). When stratified by sex, this trend remained, but the correlation was stronger in women than in men. Furthermore, high SUA levels were significantly associated with hypertension (HTN) (OR, 1.399; 95% CI, 1.210–1.616), hypertriglyceridemia (OR, 1.735; 95% CI, 1.486–2.026), and low HDL (OR, 1.257; 95% CI, 1.106–1.429), but not with diabetes mellitus (DM) (OR, 0.478; 95% CI, 0.382–0.597). When grouped by sex, this trend remained, however, all MetS components were found to be more prevalent in women with high SUA.ConclusionsOur findings showed that low HDL was more prevalent in subjects with high hs-CRP, and high SUA levels were observed in subjects with HTN, hypertriglyceridemia, and low HDL. However, the prevalence of high SUA was lower in diabetic subjects.

Examination of Lower Limb Microcirculation in Diabetic Patients with and without Intermittent Claudication.

Intermittent claudication is a frequent complaint in lower extremity artery disease, but approximately two thirds of patients are asymptomatic, most of which are diabetic patients. Non-invasive angiological and microrheological tests on diabetic subjects with and without intermittent claudication were performed in the present study. In total, 98 diabetic patients were included and divided into two groups: 20 patients (63.5 ± 8.8 years, 55% men, 45% women) had intermittent claudication, 78 patients (65.5 ± 9.3 years, 61.5% men, 38.5% women) were asymptomatic. Hand-held Doppler ultrasound examination, transcutaneous tissue partial oxygen pressure (tcpO2) measurement, Rydel-Seiffer tuning fork tests, and 6-min walk tests were performed, and erythrocyte aggregation was investigated. Ankle-brachial index (p < 0.02) and tcpO2, measured during provocation tests (p < 0.003) and the 6-min walk test (p < 0.0001), significantly deteriorated in the symptomatic group. A higher erythrocyte aggregation index and faster aggregate formation was observed in claudication patients (p < 0.02). Despite the statistically better results of the asymptomatic group, 13% of these patients had severe limb ischemia based on the results of tcpO2 measurement. Claudication can be associated with worse hemodynamic and hemorheological conditions in diabetic patients; however, severe ischemia can also develop in asymptomatic subjects. Non-invasive vascular tests can detect ischemia, which highlights the importance of early instrumental screening of the lower limbs.

Characterization of the Gut Microbiome in Healthy Dogs and Dogs with Diabetes Mellitus.

With a close pathogenetic resemblance to human diabetes, canine Diabetes Mellitus, a chronic metabolic disease featuring abnormally high blood sugar levels, is increasing in prevalence worldwide. Unlike humans, canine glycemic control requires life-long insulin injections and dietary control in most cases, thereby jeopardizing diabetic dogs' quality of life and increasing the difficulty of disease control. While many research studies have focused on elucidating the relationship between the canine gut microbiome and diseases, there is currently no research on the subject of diabetes mellitus in dogs. We hypothesized that the gut microbiome of canines with diabetes mellitus is different from that of healthy controls. Thus, we performed targeted 16S rRNA sequencing and comprehensive bioinformatic analysis to compare the gut microbiome profiles of 16 diabetic dogs with those of 32 healthy dogs. Clostridioides difficile, Phocaeicola plebeius, Lacrimispora indolis, and Butyricicoccus pullicaecorum were found to be enriched in diabetic dogs. A distinct shift towards carbohydrate degradation metabolic pathways was found to be differentially abundant in the diabetic subjects. Alteration of the co-occurrence network was also evident in the diabetic group. In conclusion, our study suggests that the gut microbial landscape differs in diabetic canines at the genera, species, functional, and network levels. These findings have significant implications for disease management, and thus warrant further research.

Comparative proteomics of proliferative diabetic retinopathy in people with Type 2 diabetes highlights the role of inflammation, visual transduction, and extracellular matrix pathways.

To explore the vitreous humor proteome from type 2 diabetes subjects with proliferative diabetic retinopathy (PDR) in the Indian population. We performed mass spectrometry-based label-free quantitative analysis of vitreous proteome of PDR (n = 13) and idiopathic macular hole (IMH; control) subjects (n = 14). Nine samples of PDR and 10 samples of IMH were pooled as case and control, respectively, and compared. Four samples each of PDR and IMH were analyzed individually without pooling to validate the results of the pooled analysis. Comparative quantification was performed using Scaffold software which calculated the fold changes of differential expression. Bioinformatics analysis was performed using DAVID and STRING software. We identified 469 proteins in PDR and 517 proteins in IMH vitreous, with an overlap of 172 proteins. Also, 297 unique proteins were identified in PDR and 345 in IMH. In PDR vitreous, 37 proteins were upregulated (P < 0.05) and 19 proteins were downregulated compared to IMH. Protein distribution analysis clearly demonstrated a separation of protein expression in PDR and IMH. Significantly upregulated proteins included fibrinogen gamma chain, fibrinogen beta chain, and carbonic anhydrase 1 and downregulated proteins included alpha-1-antitrypsin, retinol-binding protein 3, neuroserpin, cystatin C, carboxypeptidase E and cathepsin-D. Diabetic retinopathy pathogenesis involves proteins which belong to inflammation, visual transduction, and extracellular matrix pathways. Validation-based experiments using enzyme-linked immunosorbent assay (ELISA) or western blotting are needed to establish cause and effect relationships of these proteins to the disease state, to develop them as biomarkers or drug molecules.

The Impact of Barley-based diet on Diabetes: A Case-Report

Background: Diabetes is becoming more prevalent in India. The increase in prevalence in most populations has probably been driven by modifiable risk factors, including lack of exercise and an increasing prevalence of overweight/obesity and unhealthy diets and habits. Yava(Barley)is one among the food articles and its preparation is extensively suggested in Prameha(Diabetes) and other lifestyle disorders. Diet intervention is the primary and effective way to control sugar levels. Diet therapy without much alteration of one’s habits will be acceptable to individuals. A barley-based diet is formulated and evaluated for its effectiveness in the case of diabetics.&#x0D; Aim: To study the effectiveness of a Yava-based diet on fasting and postprandial blood sugars, fasting and postprandial urine sugars and lipid profile. &#x0D; Study Design: Modified crossover study&#x0D; Place and Duration of the Study: Department of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, between December 2022 and February 2023.&#x0D; Methodology: A single case study was designed and a barley-based diet was planned as a flatbread, suggested for a month as a dietetic intervention along with the routine dietary habit. The diabetic subject was screened in the outpatient department. Laboratory investigations were carried out at one-month intervals three times. Subject studied for observation period and intervention period with the follow-ups. &#x0D; Results: There were decreases in blood sugar and urine sugar levels and in lipid profile. Symptoms like polyphagia, heaviness in the body are also reduced.&#x0D; Conclusion: Ayurveda literature opines Prameha is a disease of vitiated Kapha and fat tissue. Yava has the properties of pacifying Kapha and fat. The diet plan acts as a potential antidiabetic food. Yava can be an alternative to other grains and more beneficial for diabetes.

Accuracy of Small Dense Low-density Lipoprotein-cholesterol Concentration Estimated via Sampson's Equation in Healthy Subjects and Patients with Diabetes.

Sampson et al. proposed a method to calculate small dense low-density lipoprotein-cholesterol (sdLDL-C) concentrations using common lipid measurements, but its accuracy remains unresolved. We examined the difference between Sampson's equation and direct measurement in patients with diabetes. sdLDL-C was measured directly by our established homogeneous assay and estimated by Sampson's equation in patients with diabetes (n=1542) and healthy control subjects (n=673). Large-buoyant (lb)LDL-C was estimated using triglycerides and LDL-C, and sdLDL-C was obtained by subtracting lbLDL-C from LDL-C. The effect of fasting/nonfasting state or lipid-lowering drug therapy on sdLDL-C values was also examined in 30 and 43 patients with diabetes, respectively. The coefficient of determination (R 2 ) between calculated sdLDL-C and direct measurement was 0.73 and 0.61 for healthy controls and patients with diabetes, respectively. The R2 between calculated sdLDL-C and nonHDL-C or apolipoprotein B was 0.64 and 0.65, respectively. Calculated sdLDL-C was 4-5 mg/dl or 17%-18% higher than the direct measurement. The lower the plasma lipids, especially sdLDL-C, the greater the dissociation between the two methods. Sampson sdLDL-C was also found to give a positive bias when calculated for the nonfasting samples. Statins and pemafibrate significantly reduced sdLDL-C, but their therapeutic effect was underestimated by 5 mg/dl (24%) via Sampson's equation. The correlation between Sampson's equation and direct measurements of sdLDL-C was reduced in patients with diabetes. Furthermore, the correlations with nonHDL-C and apolipoprotein B were even higher than those with direct sdLDL-C. The accuracy of Sampson's equation decreased with lower sdLDL-C concentrations and was also influenced by diet.

Serum uric acid level in patients with diabetes and prediabetes Experience at a tertiary care hospital.

Objective: To determine the serum uric acid levels in diabetic, pre-diabetic and euglycemic study subjects. Study Design: Cross Sectional. Setting: Department of Pathology Sheikh Zayed Medical College /Hospital Rahim Yar Khan. Period: 1st December 2022 to 31st May 2023. Material &amp; Methods: 144 patients of both genders with age 20 -70 year were included. Data was collected from the patients who came to lab for their HbA1C test. The blood samples for HbA1C and serum uric acid was collected in EDTA and gel tube respectively. HbA1C and serum uric acid was performed on Atellica CH930 fully automated chemistry analyzer based on photometry. The patients were grouped based on HbA1C as euglycemic group (Hba1C 4%-5.6%), pre-diabetic group (HbA1C 5.7%-6.4%) and diabetics group (HbA1C &gt;6.5%) as per American Diabetes Association (ADA) criteria. Data was entered and analyzed using SPSS 22 version. ANOVA was applied to access the significance of difference of serum uric acid between euglycemic, prediabetic and diabetic groups. P-value &lt;0.05 was taken as statistically significant. Results: The mean serum uric acid level in euglycemics, prediabetics and diabetics was 5.59±1.16, 6.07±1.04 and 5.01±1.61 respectively and the difference of serum uric acid between these 3 groups was statistically significant with p value 0.001. Conclusion: Serum uric acid was higher in prediabetics as compared to diabetics and euglycemics. Serum uric acid level should be done in prediabetic patients for prompt diagnosis of hyperuricemia and to avoid its related complications.