Incidence Of DM Research Articles

MO987IMPACT OF POST-TRANSPLANT TUBERCULOSIS ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENTS: RISK FACTORS AND OUTCOME

Abstract Background and Aims TB is encountered worldwide more frequently among renal transplant recipients due to of the state of immunosuppression. Antituberculosis drugs cause CYP-450 enzyme induction that increase the metabolism of CNI and mTORi So, decreasing the plasma trough level which in turn expose the transplant recipient to the risk of rejection. Our study concerned with the impact of post-transplant TB on live donor kidney transplant recipients outcome. Method This is retrospective cohort study held in Urology and Nephrology Center, Mansoura University, Egypt. The study included 210 patients out of 3200 kidney transplant recipients (KTRs) who underwent renal transplantation at Mansoura urology and Nephrology Centre between March 1976 and December 2019. The patients were divided into 2 main groups according to history of post-transplant tuberculosis, a group of 70 kidney transplant recipients who developed tuberculosis after transplantation served as a study group and a matched group of 140 kidney transplant recipients who did not develop tuberculosis after transplantation served as control group. Study group was then subdivided into pulmonary and urinary TB groups. Results We found that patients with Low BMI are associated with higher incidence of post-transplant TB (p value: 0.023). While, post-transplant TB was associated with increased incidence of post-transplant DM, bacterial infection, CMV infection and surgical wound infection. Exposure to rejection episodes (either acute or chronic) is comparable among both groups. Post-transplant diabetes incidence was higher among TB group with statistical significant difference (p value: 0.01). Bacterial infection incidence including pneumonia, urinary tract infection and gastroenteritis were associated with higher incidence of TB with statistically significant difference (p value: 0.012). CMV infection incidence was significantly higher among TB group (p value: 0.02). Incidence of wound infection post-transplantation was higher among TB group with statistically significant difference (p value: 0.014). Both groups were comparable regarding creatinine and creatinine clearance at last follow-up (p value: 0.61, 0.51 respectively). Overall, there was no statistically significant difference among both groups regarding 5, 10 and 15 years graft and patient survival (p value: 0.54, 0.15 respectively). During treatment of TB in the study group, there was statistical significant difference regarding liver enzymes and CNI doses either before or during anti-tuberculous treatment as liver enzymes were elevated (p value: 0.023) and higher doses of CNI were required to achieve satisfactory trough level during antituberculus treatment (p value: 0.037). Liver enzymes dropped significantly and lower doses of CNI were used after cessation of anti-tuberculous treatment (p value: 0.041, 0.03 respectively). Study group was then subdivided into 2 main groups: pulmonary TB (42 KTRs) and Urinary TB (28 KTRs). There was no statistical significant difference among both groups regarding baseline data, transplantation data, post-transplant medical complication except that CMV infection incidence was higher among pulmonary TB group (p value: 0.012). Patient and graft survival were comparable. Conclusion Among renal transplant recipients, tuberculosis is a serious problem for both the disease itself and its treatment with anti-tuberculous medications. In our series the rejection was comparable in both groups (with or without tuberculosis) this may be explained by frequent monitoring of the immunosuppressive drug level.

Abstract P226: Longitudinal Work Hour Patterns Associated With Diabetes Risk

Introduction: Evidence shows a positive correlation between work hour (WH) duration and incident diabetes (DM). However, little is known about the association between longitudinal WH patterns and the risk of incident DM. Hypothesis: We hypothesized that the greatest risk of DM would be observed in consistently long WH patterns and that age, sex, and ethnicity would modify the relationship between WH patterns and incident DM. Methods: We utilized a representative sample of 15,843 U.S. adults from the Panel Study of Income Dynamics who reported weekly WH for a minimum of five years between 1985-2017 and did not have a history of DM prior to reporting five years of WH data. Latent class linear mixed modeling was used to identify distinct longitudinal WH trajectory patterns. Multivariable logistic regression analyses were then used to examine the association between WH patterns and incident DM, with initial adjustments made for sex, age, ethnicity, education, income-to-needs ratio, and occupation. We also tested for statistical interactions between WH patterns and baseline age, sex, and ethnicity. Results: Over a mean follow-up of 17.5 years, four WH trends were identified: standard, full-time (61.1%), increasing (11.5%), quickly decreasing (11.3%), and gradually decreasing (16.1%). Age (interaction p=0.013), but not ethnicity nor sex, modified the association between WH patterns and incident DM. In age stratified analyses, adults aged 18-29 showed no significant association between WH patterns and DM. In adults aged 30-39, a gradually decreasing WH trend showed lower DM risk compared to those working standard hours (OR=0.59; 95% CI: 0.45 - 0.77). Among those ≥40 years, both quickly decreasing (OR=0.66; 95% CI: 0.50 - 0.87) and gradually decreasing (OR=0.45; 95% CI: 0.34 - 0.60) WH patterns were associated with lower risk of DM compared to those working standard hours. Conclusion: Compared to individuals working standard WH over many years, decreasing WH patterns were associated with a lower risk of incident DM.

Abstract P043: Distance And Clinical Outcomes Of Patients Admitted For Covid-19: Lessons Learned From The Neighbors Of An Inner-city Hospital.

Background: In rural areas, the distance factor has been identified as key in the utilization of health services. We aim to determine whether distance to an inner-city hospital in Newark, was associated with mortality in patients admitted for COVID-19 during the peak of the pandemic. Methods: Patients who were admitted for COVID-19 at the Newark Beth Israel Medical Center (NBIMC) were stratified into two groups based on distance between the zip codes of their primary residence and the hospital. Baseline demographics, clinical characteristics and in-hospital outcomes were compared between subjects living within a 2-mile radius of the zip code of the hospital [Neighbors] and those living further than 2 miles [Distant]. The primary outcome was in-hospital mortality. Secondary outcomes were admission to the intensive care unit (ICU), length of hospitalization, and discharge disposition. Results: Between March 09 and May 04, 2020, a total of 769 patients were admitted for COVID-19 at NBIMC. 406 (53%) resided within a 2-mile radius of the hospital location. Of these 44% were obese. History of hypertension, diabetes mellitus and coronary artery disease was documented in 69%, 48% and 23% respectively. Compared with distant patients, neighbors were older (59 vs. 69 yrs. P=0.048), mostly of Black/African American race (64% vs. 82%; p<0.001) and had a higher incidence of diabetes mellitus (40% vs. 48%; p=0.025) or coronary artery disease (17% vs. 23%; p=0.039). Visitors were more likely to report an exposure history to a COVID-19 patient than neighbors (31% vs. 21%, p=0.001). In-hospital death rate were significantly higher in neighbors than visitors (32% vs. 22%, p=0.007). Admission to the ICU was similar between both groups (p=0.438). Among those who survived to discharge, distant patients had longer length of hospitalization (12 vs. 10 days; p=0.006), than neighbors. Discharge disposition was comparable in both groups (p=0.249) Conclusions: In this cross-sectional study of patients admitted to an inner-city hospital for COVID-19, majority of patients living within a 2-mile radius were of Blacks/African Americans who had a higher incidence of DM and CAD. A paradoxical association between distance to the hospital and in-hospital mortality was observed. Based on these findings, targeted interventions aimed at Impacting social determinants of health seem prudent.

Prognostic value of long-term trajectories of depression for incident diabetes mellitus in patients with stable coronary heart disease

BackgroundDiabetes mellitus (DM) and depression are bidirectionally interrelated. We recently identified long-term trajectories of depression symptom severity in individuals with coronary heart disease (CHD), which were associated with the risk for subsequent cardiovascular events (CVE). We now investigated the prognostic value of these trajectories of symptoms of depression with the risk of incident DM in patients with stable coronary heart disease.MethodsThe KAROLA cohort included CHD patients participating in an in-patient rehabilitation program (years 1999/2000) and followed for up to 15 years. We included 1048 patients (mean age 59.4 years, 15% female) with information on prevalent DM at baseline and follow-up data. Cox proportional hazards models were used to model the risk for incident DM during follow-up by depression trajectory class adjusted for age, sex, education, smoking status, body mass index, and physical activity. In addition, we modeled the excess risk for subsequent CVE due to incident DM during follow-up for each of the depression trajectories.ResultsDM was prevalent in 20.7% of patients at baseline. Over follow-up, 296 (28.2%) of patients had a subsequent CVE. During follow-up, 157 (15.0%) patients developed incident DM before experiencing a subsequent CVE. Patients following a high-stable depression symptom trajectory were at substantially higher risk of developing incident DM than patients following a low-stable depression symptom trajectory (hazard ratio (HR) = 2.50; 95% confidence interval (CI) (1.35, 4.65)). A moderate-stable and an increasing depression trajectory were associated with HRs of 1.48 (95%-CI (1.10, 1.98)) and 1.77 (95%-CI (1.00, 3.15)) for incident DM. In addition, patients in the high-stable depression trajectory class who developed incident DM during follow-up were at 6.5-fold risk (HR = 6.51; 95%-CI (2.77, 15.3)) of experiencing a subsequent cardiovascular event.ConclusionsIn patients with CHD, following a trajectory of highstable symptoms of depression was associated with an increased risk of incidentDM. Furthermore, incident DM in these patients was associated with asubstantially increased risk of subsequent CVE. Identifying depressive symptomsand pertinent treatment offers might be an important and promising approach toenhance outcomes in patients with CHD, which should be followed up in furtherresearch and practice.

Analysis of the Influence of Risk Factors of Type 2 DM on Outpatients at DKT Bandar Hospital Lampung, 2020

DM is a chronic metabolic disease characterized by hyperglycemia and cause serious complications with an increasing prevalence rate. Control of risk factors that affect the incidence of DM is needed to prevent the emergence of DM and delay disease complications. The purpose of this study is to determine the risk factors that influence the incidence of type 2 diabetes outpatients at the DKT Bandar Lampung Hospital. This type of research is quantitative observational analytic with a case control approach. The population came from all patients undergoing outpatient treatment at the Internal Medicine Department of the DKT Hospital in Bandar Lampung with 44 case samples and 44 control samples. Data analysis used univariate analysis with percentages, bivariate analysis with Chi Square and multivariate analysis with multiple logistic regression. The results showed that there was a significant influence between the risk factors for age (p value 0.017), hereditary history of diabetes (p value 0.03), physical activity (p value 0.002) and obesity (p value 0.001) with the incidence of type 2 diabetes, while a history of hypertension has no effect on the incidence of type 2 diabetes mellitus (p value 0.135). Meanwhile, the most dominant variable influencing the incidence of outpatient type 2 diabetes mellitus at DKT Bandar Lampung Hospital is physical activity with OR 5.29. Maximum promotive, preventive, curative and rehabilitative efforts are needed to control risk factors for type 2 diabetes

CHA2DS2-VASC Score as a Predictor of Coronary Artery Disease: A Cross Sectional Observational Study

Background: The CHA2Ds2-VASC was was revealed to be a predictor for thromboembolism event in patients who do not have atrial fibrillation or who have supra ventricular arrhythmia. The aim of this work was to evaluate the role of CHA2DS2 – VASC score in prediction of coronary artery disease.
 Methods: This cross sectional observational study included 150 patients underwent coronary angiography for diagnosis and treatment of CAD. There were 59 patients with ACS (including STEMI and Non-STEMI) and 91 patients with no ACS. All patients were subjected to complete history taking, clinical, general examination and local cardiac examination. Standard 12-lead ECG was obtained within 10 minutes of first medical contact (FMC) according to ESC guidelines. Baseline laboratory tests were done including serum creatinine, INR, hemoglobin, platelets, cholesterol and triglycerides. Arterial coronary angiography (Femoral approach), right and left coronary imaging and echocardiographs were performed.
 Results: The incidence of HTN, CHF, DM and Vascular disease was statistically significantly higher in the cases with ACS as compared with the cases with no ACS. The total mean Gensini score was significantly higher in the cases with ACS as compared with the cases with no ACS. There was a statistically significantly strong positive correlation between CHA2DS2‐VASc Score and Gensini score. The best cut-off point of CHA2DS2‐VASc Score to differentiate between cases with ACS and no ACS WAS > 2 with 79.7% sensitivity and 56% specificity. With univariate regression analysis, increasing age, CHF, DM, previous stroke, vascular disease and increasing CHADS-VASC score were reported as risk factors for vessel affection, however with multivariate regression analysis CHF, DM and increasing CHADS-VASC score were shown as independent risk factors of vessel affection
 Conclusions: CHA2DS2-VASc score could be utilized as a useful diagnostic and predictor tool in cases with CAD. Patients with higher CHA2DS2-VASc scores had higher risks of cardiovascular disease severity.

Harnessing the Endogenous Plasticity of Pancreatic Islets: A Feasible Regenerative Medicine Therapy for Diabetes?

Diabetes is a chronic metabolic disease caused by an absolute or relative deficiency in functional pancreatic β-cells that leads to defective control of blood glucose. Current treatments for diabetes, despite their great beneficial effects on clinical symptoms, are not curative treatments, leading to a chronic dependence on insulin throughout life that does not prevent the secondary complications associated with diabetes. The overwhelming increase in DM incidence has led to a search for novel antidiabetic therapies aiming at the regeneration of the lost functional β-cells to allow the re-establishment of the endogenous glucose homeostasis. Here we review several aspects that must be considered for the development of novel and successful regenerative therapies for diabetes: first, the need to maintain the heterogeneity of islet β-cells with several subpopulations of β-cells characterized by different transcriptomic profiles correlating with differences in functionality and in resistance/behavior under stress conditions; second, the existence of an intrinsic islet plasticity that allows stimulus-mediated transcriptome alterations that trigger the transdifferentiation of islet non-β-cells into β-cells; and finally, the possibility of using agents that promote a fully functional/mature β-cell phenotype to reduce and reverse the process of dedifferentiation of β-cells during diabetes.

Faktor Risiko Diabetes Mellitus di Puskesmas Mangasa Kota Makassar

Background: Diabetes mellitus is a chronic disease that is suffered by the sufferer for life. Causes are genetic, lifestyle, BMI, stress management and physical activity / xercise.
 Objective: The purpose of this study was to determine the risk factors for the incidence of DM. at the Puskesmas Mangasa, Makassar City.
 Methods: This research method is descriptive analytic with a case control study design. Place of research at Puskesmas Mangasa. The research was carried out on 1- 21 September 2020. Sampling used purposive sampling. The sample size of the study was 47 samples.
 Results: The results showed diet value OR = 5.111 (95% CI: 1.36-19.16), p = 0.028, BMI OR value = 0.242 (95% CI: 0.064-0.906), p = 0.065, Stress Management OR Value = 0.609 (95% CI: 0.149-2.484), p = 0.496 and sports activities OR = 0.267 (95% CI: 0.071-1.007), p = 0.090.
 Conclusion: The conclusion of this study is that there is a relationship between diet and the incidence of DM, there is no relationship between BMI and the incidence of DM, there is no relationship between stress management and the incidence of DM and there is no relationship between sports activities and the incidence of DM.

Branched-chain amino acids predict incident diabetes in the Brazilian Longitudinal Study of Adult Health – ELSA-Brasil

AimsTo evaluate the role of branch chain amino acid (BCAA) concentrations as a predictor for incident type 2 diabetes (DM). MethodsParticipants from ELSA-Brasil without diabetes at baseline and followed for 3.9 ± 0.6 years were included in the analysis. The determinations of BCAA (valine, leucine, isoleucine) were performed by proton nuclear magnetic resonance spectroscopy. Cardiometabolic profile and incidence of DM were evaluated according to quartiles of BCAA at baseline, stratified by sex. ResultsFrom 3,828 participants (56% female, 50.5 ± 8.7 years) 299 (8.5%) were diagnosed with DM. For both sexes, a worsening of cardiometabolic profile was observed across increasing BCAA quartiles. In survival analysis, incidence rates of DM for the entire period were highest in participants in the third and fourth quartile of BCAA (log Rank analysis < 0.001 for both sexes). In Cox regression analysis, for men, the HR (95%CI) for risk of DM was 2.24 (1.24–4.03) for those from the fourth quartile of BCAA, while in women it was 1.94 (1.07–3.50), comparing to first quartile of BCAA after adjustments for age, BMI, physical activity, family history of DM, pre-diabetes, blood pressure, total cholesterol and HOMA-IR. ConclusionsHigher levels of BCAA were independently predictors of DM.

Clinically inapparent right heart dysfunction is associated with reduced myofilament force development in coronary artery disease

BackgroundRight ventricular dysfunction after CABG is associated with poor peri- and postoperative outcomes. We aimed to identify clinical and experimental predictors for preoperative inapparent right ventricular dysfunction and therefore hypothesized that reduced myofilament force development as well as altered levels of biomarkers might predict inapparent right ventricular dysfunction.MethodsFrom 08/2016 to 02/2018, 218 patients scheduled for CABG were divided into two groups (TAPSE ≥ 20 mm, n = 178; TAPSE < 20 mm, n = 40). Baseline serum samples for biomarkers (Galectin, TGFß1, N Acyl-SDMA, Arginine, ADMA and Pentraxin-3), clinical laboratory and transthoracic echocardiographic parameters were evaluated. To examine the myocardial apparatus of the right ventricle intraoperative right auricular tissue was harvested for stepwise skinned fiber force measurements.ResultsPatients with TAPSE < 20 mm had a higher incidence of DM (55 vs. 34%, p = 0.018), preoperative AFib (43 vs. 16%, p < 0.001), reduced GFR (67 ± 18 vs. 77 ± 24 ml/min/1.73 m2, p = 0.013), larger LA area (22 ± 6 vs. 20 ± 5 cm2, p = 0.005) and reduced LVEF (50 vs. 55%, p = 0.008). Furthermore, higher serum ADMA (0.70 ± 0.13 vs. 0.65 ± 0.15 µmol/l, p = 0.046) and higher serum Pentraxin-3 levels (3371 ± 1068 vs. 2681 ± 1353 pg/dl, p = 0.004) were observed in these patients. Skinned fiber force measurements showed significant lower values at almost every step of calcium concentration (pCa 4.52 to pCa 5.5, p < 0.01 and pCa 5.75–6.0, p < 0.05). Multivariable analysis revealed DM (OR 2.53, CI 1.12–5.73, Euro Score II (OR 1.34, CI 1.02–1.78), preoperative AF (OR 4.86, CI 2.06–11.47), GFR (OR 7.72, CI 1.87–31.96), albumin (OR 1.56, CI 0.52–2.60), Pentraxin-3 (OR 19.68, CI 14.13–25.24), depressed LVEF (OR 8.61, CI 6.37–10.86), lower force values: (pCa 5.4; OR 2.34, CI 0.40–4.29 and pCa 5.2; OR 2.00, CI 0.39–3.60) as predictors for clinical inapparent right heart dysfunction.ConclusionsThese preliminary data showed that inapparent right heart dysfunction in CAD is already associated with reduced force development of the contractile apparatus.

Glycemic Control of Non-Hodgkin Lymphoma (NHL) Non-Diabetes Mellitus (DM) Patient in the First CHOP Chemotherapy

Non-Hodgkin’s lymphoma (NHL) chemotherapy is cyclophosphamide, doxorubicin, vincristine, andprednisone (CHOP) have hyperglycemia side effects that affect the success of chemotherapy. Improvedglycemic control decreases morbidity and mortality. Determine the glycemic control changes in non-DMNHL patients before and the sixth day after the first CHOP chemotherapy.Method: Prospective longitudinal observational analytic study in the Internal Medicine Inpatient Unit Dr.Soetomo Teaching Hospital Surabaya, involved all the first CHOP chemotherapy NHL patients duringNovember 2019-February 2020. A total of 21 patients met chemotherapy requirements and were not DM.The glycemic control check uses the hexokinase method and a glucometer (Easy Touch®). Data analysisusing the Wilcoxon test was considered significant if p <0.05.Results: Total research subjects were 21 people, female domination (66.7%), mean age 49.24 ± 13.96 years,clinical stage 3 dominance (52.38%), mean HbA1C 5.75 ± 0.49%, average FBG 90.86 ± 13.13 mg/dL, themean PPBG 114.33 ± 20.16 mg/dL. Daily blood glucose levels during chemotherapy were highest on thefirst day’s pre-dinner. There were significant differences in FBG and PPBG before chemotherapy and thesixth day after chemotherapy (p-values 0.032 and 0.002). The incidence of new-onset DM on the sixth dayafter the first CHOP chemotherapy was 2 subjects (9.53%).Conclusion: There was an increase in FBG and PPBG of NHL non-DM patients before and the sixth dayafter the first CHOP chemotherapy

Assessment of Glucose Metabolism Alterations after Partial Pancreatectomy Using Biochemical Markers: A Prospective Observational Study

Introduction: Most previous studies on glucose metabolism after pancreatectomy used medical records as diagnostic criteria of DM. This study aimed to evaluate the incidence and characteristics of new-onset DM (NODM) and worsened preexisting DM after pancreatectomy using serial assessment of biochemical markers in a prospective cohort.

Incidence, risk factors, and prognosis of meningiomas with distant metastases at presentation.

Distant metastases (DM) at presentation in meningiomas is a very rare event, and the incidence and factors predicting this are uncertain. This population-based study also aimed to investigate the prognostic implication of DM at presentation and clinical parameters to prognosticate the overall survival (OS) of meningiomas presenting with DM (M1). We accessed the Surveillance, Epidemiology, and End Results program to search for patients who were diagnosed with meningioma between 2004 and 2016. The log-rank test was used to compare Kaplan-Meier survival curves and multivariate Cox regression model was utilized to evaluate the prognostic parameters of meningiomas with DM at presentation. The incidence of DM at presentation among all meningiomas was 0.18%. Clinical variables associated with this event were male gender, large tumor size, and WHO grade III. The presence of DM at diagnosis conferred a shorter survival in comparison to those without DM (HR = 2.015; 95% CI = 1.600-2.536). Older patient age, male gender, malignant histology, and the lesser extent of resection were independent prognostic factors that could negatively impact OS of M1 meningiomas. Radiotherapy and chemotherapy were not associated with an improved outcome for these patients. Our study highlighted the clinical and prognostic factors of M1 meningiomas. These data suggest that a greater extent of resection is associated with increased OS across a nationwide analysis and emphasize the need to establish the standards of care in these patients.

Progression of pregnancy induced diabetes mellitus to type two diabetes mellitus, an ambidirectional cohort study

IntroductionDiabetes mellitus (DM) is a metabolic disorder characterized by elevated level of blood glucose. It affects more than 422 million people globally. In resource limited settings, the progression of gestational diabetes (GDM) to DM was not well investigated and this research work was conducted to estimate the incidence of DM after GDM and their predictors in resource limited settings. MethodsA retrospective and prospective cohort studies were used from January 2010 until December 2019. The data were collected using patients chart review, interview and collecting blood sample. Initially, baseline data were collected from GDM and GDM free women and update data were collected every 3 month. Clinical nurses were used to extract the necessary data from medical charts and to collect the data using patient interview. Laboratory technologists were used to measure the blood glucose level of the study participants. The study was conducted in pregnant women presenting themselves in the referral hospitals of Amhara regional state. The sample size was calculated using Epi-info software. Descriptive statistics were used to describe the profile of study participants. Kaplan Meier survival curve and life-table were used to estimate the survivals of study participants. Incidence density was used to estimate the incidence of DM. Cox regression was used to identify the predictors DM. ResultsA total of 4892 women were followed giving for the response rate of 88.62%. The mean age of study participants at the start of the study was 28.34 years with standard deviation [SD] ±7.48 years. DM was associated with gestational diabetes mellitus [AHR (adjusted hazard ratio); 2.53, 95% CI: 2.14–2.99], frequency of breastfeeding [AHR; 0.72, 95% CI: 0.69–0.74], age [AHR; 1.04, 95% CI: 1.03–1.05], parity [AHR; 1.14, 95% CI: 1.07–1.21], regular physical exercise [AHR; 0.45, 95% CI: 0.37–0.55], family history of DM [AHR; 2.04, 95% CI: 1.76–2.37], stillbirth [AHR; 1.67: 95% CI: 1.34–2.07], abortion [AHR; 2.64, 95% CI: 2.25–3.09]. ConclusionThe progression of GDM to DM was very high and special follow up should be implemented for women with a history of abortion, stillbirth, and family history of DM.

Associations between Relative Handgrip Strength and Incidence of Type 2 Diabetes Mellitus in Middle-aged and Older adults: Finding from the Korean Genome and Epidemiology Study

PURPOSE: We investigated whether relative handgrip strength (RHS) and change in handgrip strength predicted Type 2 DM incidence in middle-aged and older adults.METHODS: Total of 29,098 participants (8,609 men and 20,489 women) aged 40-69 who were free of diabetes at the baseline examination drawn from the Korean Genome and Epidemiology Study-Urban Health Examinees cohort (KoGES-HEXA), a large prospective population-based study. RHS was assessed with a dynamometer and divided by body mass index. Diabetes was defined as selfreported physician-diagnosed diabetes, use of anti-diabetic medications or measured fasting glucose ≥126 mg/dl, or glycated hemoglobin (HbA1C) ≥6.5%. Cox proportional hazard regression analysis was used to estimate the hazard ratio (HRs) and 95% confidence intervals (CIs) of Diabetes incidences according to baseline RHS levels and RHS changes.RESULTS: During a mean follow-up period of 4 years (49.8±13.3 month), 1,167 (4.0%) participants developed diabetes. Compared with the high RHS group, higher risk of diabetes incidence was observed in low RHS group (men HR=1.28, 95% CI 1.06-1.55, women HR=1.32, 95% CI 1.12-1.54) after adjusted for age, triglyceride, cigarette smoking, alcohol consumption, marriage, income, education hypertension, family history of diabetes, fasting glucose, regular exercise. In addition, compared with the sustained high RHS group, sustained low RHS group showed an increased risk of diabetes incidence (men HR=1.60, 95% CI 1.28-2.00, women HR=1.85, 95% CI 1.52-2.24) after adjustment. However, the risk was not statistically significant in increased RHS group (men HR=0.98, 95% CI 0.73-1.31, women HR=1.11, 95% CI 0.85-1.43).CONCLUSIONS: The present findings indicate that RHS is independently associated with the risk of incident diabetes in middle and older adults. RHS measurement may be useful to identify individuals at increased risk for diabetes incidence. Maintaining a high level of RHS is important strategies for diabetes prevention among adults.

Intraperitoneal, but not retroperitoneal, visceral adipose tissue is associated with diabetes mellitus: a cross-sectional, retrospective pilot analysis

AimDiabetes mellitus (DM) is associated with adverse outcomes, and visceral adipose tissue (VAT), classified into intraperitoneal VAT (IVAT) and retroperitoneal VAT (RVAT), is associated with insulin resistance. This study aimed to evaluate the association of IVAT and RVAT with the prevalence or incidence of DM.MethodsIn this cross-sectional, retrospective, cohort study, the prevalence and incidence of DM was analyzed in 803 and 624 middle-aged Japanese participants, respectively. The cross-sectional area of the abdominal adipose tissue was evaluated from an unenhanced computed tomography scan at the third lumbar vertebrae, and the IVAT or RVAT was analyzed using specialized software. The areas were normalized for the square value of the participants’ height in meters and described as the IVAT or RVAT area index.ResultsThe IVAT area index (adjusted odds ratio [OR], 1.04; 95% confidence intervals [CI], 1.02–1.07, per 1.0 cm2/m2) or IVAT/RVAT area ratio (1.89; 1.23–2.85, per 1.0) was independently associated with the prevalence of DM, whereas the RVAT area index was not. During a follow-up (mean) of 3.7 years, 30 participants were diagnosed with DM. The IVAT area index (adjusted hazards ratio [HR], 1.02; 95% CI 1.003–1.04, per 1.0 cm2/m2) or IVAT/RVAT area ratio (2.25; 1.40–3.43, per 1.0) was independently associated with the incidence of DM, whereas the RVAT area index was not.ConclusionsIVAT, but not RVAT, is associated with the prevalence or incidence of DM.

FIB-4 index is a marker for a subsequent decrease in insulin secretion in a non-diabetic Japanese population

Non-alcoholic fatty liver disease (NAFLD) is associated with a high risk of type 2 diabetes (DM), therefore, early diagnosis of NAFLD is important to prevent incident DM. FIB-4 index, a biomarker, often used to evaluate severity of NAFLD, may be useful to evaluate risk for incident DM in ordinary clinical setting. Here, we determined the association of FIB-4 index with changes in indices representing glucose metabolism with aging in a non-diabetic population. From among the participants of the population-based Iwaki study of Japanese people conducted during 2014–2017, 1,268 non-diabetic individuals with complete data sets (age: 51.4 ± 15.9 years; men/women: 485/773) were enrolled in a cross-sectional study. In addition, of the participants, 439 who attended consecutive appointments between 2014 and 2017 were enrolled in a longitudinal study that aimed to evaluate the changes in insulin secretion and resistance with aging (age: 53.1 ± 13.7 years; men/women: 178/261). The cross-sectional study showed significant correlations of FIB-4 index with homeostasis model of assessment (HOMA) indices, even after adjustment for multiple factors (HOMA-β: β = − 0.254, p < 0.001; HOMA-R: β = − 0.247, p < 0.001). The longitudinal study showed a significant association between FIB-4 index and the change in HOMA-β (p < 0.001) but not HOMA-R (p = 0.639) during the 3-year study period. Use of the optimal cut-off value of the FIB-4 index for the prediction of decreased insulin secretion (HOMA-β < 30), determined using receiver operating characteristic analysis (1.592), showed that individuals at risk had a hazard ratio of 2.22 (confidence interval 1.17−4.06) for decreased insulin secretion, after adjustment for confounders. FIB-4 index may represent a useful predictor of a subsequent decrease in insulin secretion, at least in a non-diabetic Japanese population.

The Correlation of Food and Physical Activity with Diabetes Incidence Among Older-Adult

Introduction: Diabetes in older adults is associated with higher mortality, reduced functional status, and increased risk of institutionalization. Older adult with Diabetes type 2 additionally have high risk for both intense and constant microvascular and cardiovascular disease. The purpose of this study is to analyze the correlation of food and physical activity with diabetes incidence among older adults in Pasir Panjang public health community, Kupang. Methods: The research used observational analytic design with cross-sectional approach. The sampling technique taken was convenience sampling. The samples were 120 respondents. To analyze food and physical activity with DM incidence, the researchers used a statistical chi square. To measure activity, the instrument used was the Global Physical Activity Questionnaire (GPAQ) from the WHO and to measure food it used the Indonesian Family Life Survey (IFLS) from Indonesia’s health ministry. Results: This study showed that there was a correlation between food and type 2 DM incidence for the older adults in Pasir Panjang public health community Kupang (p = 0.008 &lt;0.05), but there was no correlation between activity with the incidence of type 2 DM (p = 0.138&gt; 0.05). Conclusion: Nurses need to create suitable health education regarding food consumed for older adult with type 2 diabetes, and involve their family to support patients to consume the diet.

Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: A call for prediabetes screening, diagnosis, and referral for intervention

AimsThis study estimates incidence of diabetes (DM) and pre-DM relative to DM risk factors among relatively healthy Alaska Native and American Indian (henceforth AN) adults living in urban south central Alaska.Methods:Baseline (2004–2006) and follow-up (2014–2017) surveys, blood samples, and medical chart review data were collected from AN adults living in south central Alaska. We analyzed associations between prevalent risk factors and incident DM and pre-DM using Cox proportional hazards and used multivariable models to identify independent predictors for both DM and pre-DM.Results:Among 379 participants with follow-up data, overall DM incidence was 16.5/1,000 PY; overall pre-DM incidence was 77.6/1,000 PY, with marked differences between men and women. Prevalent cardiometabolic risk factors also varied with greater amounts of overweight in men and greater amounts of obesity in women. Controlling for age and sex, obesity, abdominal adiposity, pre-DM, and metabolic syndrome independently increased DM risk.Conclusion:Health care providers of AN populations must seize the opportunity to screen, refer, and treat individuals with pre-DM and other modifiable DM risk factors prior to DM diagnosis if we are to alter the epidemiologic course of disease progression in this urban AN population.

Prediabetes and Their Contributed Factors: A Study in Semarang

&lt;p&gt;Background. Prediabetes is a condition when blood glucose levels are above normal but do not yet meet the criteria for diabetes mellitus. Many people have already been diagnosed with prediabetes. However, there is little data that shows the prevalence and characteristics of people with prediabetes.&lt;/p&gt;&lt;p&gt;Objective. To identify the prevalence and demographic characteristics of adults with prediabetes in Semarang, Central Java, Indonesia.&lt;/p&gt;&lt;p&gt;Method. A cross-sectional study conducted in 21 Puskesmas (public health centers) in Semarang which were randomly selected from a total of 37 Puskemas. Out of 123 respondents participating in this study, 105 respondents met the inclusion criteria of the study. Oral Glucose Test Tolerance (OGTT) was done after peripherally screening for random glucose levels. Univariate analysis was performed to calculate the frequency and percentage of each variable.&lt;/p&gt;&lt;p&gt;Results. The result shows that the prevalence of adult respondents with prediabetes in this study accounted for 17.14%. This study also found that the respondents’ mean age was 38.57 ± 14.84. The majority of the respondents were women (66.7%). They have normal BMI, yet higher waist circumference (23.82 ± 4.48; 83.13 ± 11.34), respectively.&lt;/p&gt;&lt;p&gt;Conclusion. Prediabetes is prevalent among adults in Semarang. Thus, to control the incidence of uncontrolled DM, screening needs to be done to identify individuals with prediabetes in order to prevent it from developing into DM. In addition, the application of healthy lifestyle interventions among adults at risk of diabetes also needs to be improved.&lt;/p&gt;