Diabetes Mellitus Group Research Articles

Diabetes Risk Factors in People With HIV Receiving Pitavastatin Versus Placebo for Cardiovascular Disease Prevention : A Randomized Trial.

REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) led to new guidelines for statin use among people with HIV (PWH) with low to moderate risk for atherosclerotic cardiovascular disease (ASCVD). Little is known about the natural history of diabetes mellitus (DM) or mechanisms contributing to statin effects on DM among this population. To determine the contribution of known DM risk factors to excess risk for DM with pitavastatin in REPRIEVE. Phase 3, primary ASCVD prevention trial over a median of 5.6 years of follow-up. (ClinicalTrials.gov: NCT02344290). Global, multicenter trial. 7731 PWH aged 40 to 75 years with low to moderate ASCVD risk (by the pooled cohort equations from the American College of Cardiology and American Heart Association) without DM at study entry. Random 1:1 assignment to pitavastatin, 4 mg daily, or placebo. New-onset DM was determined at each visit by clinical diagnosis requiring initiation of medication treatment for DM. The incidence of new-onset DM was assessed in relation to predefined demographic and metabolic risk factors, stratified by treatment group. Treatment effects of pitavastatin on progression to new DM in key subgroups were determined. Participants with at least 3 DM risk factors (vs. no risk factors) had increased risk for DM in each treatment group (incidence rate, 3.24 per 100 person-years [PY] vs. 0.34 per 100 PY [pitavastatin] and 2.66 per 100 PY vs. 0.27 per 100 PY [placebo]). The incidence of DM was highest in South Asia. In adjusted analyses, high body mass index, prediabetes, and metabolic syndrome components were strongly associated with new-onset DM (all P < 0.005). Pitavastatin was the only statin assessed; DM was assessed clinically. Metabolic risk factors, including prediabetes and obesity, contributed to new-onset DM in statin- and placebo-treated participants. A clinically significant effect of pitavastatin on DM was seen primarily among those with multiple risk factors for DM at entry. Strategies targeting key metabolic risk factors, like obesity and prediabetes, may help protect against DM among PWH. National Heart, Lung, and Blood Institute of the National Institutes of Health.

Correlations between dyslipidemia and retinal parameters measured with Angio-OCT in type II diabetics without diabetic retinopathy.

To analyze the relationship between lipoproteins such as total cholesterol, LDL-c, TG, and retinal parameters in patients with DM type II without signs of DR. A case-control study, consisting of 2 groups. A group of 64 patients with type II diabetes without signs of DR and a control group of 24 healthy subjects. Patients with DM type I, those who showed signs of DR, and those who had associated other eye diseases were excluded. The patients of the two studied groups had a similar average age: 65 years in the DM type II group and 64 years in the control group. In the group with DM, the average CRT was 241.31 µm, a significantly lower value compared to the control group, 252.51. The average value of DVFC was 19.19%, in patients with DM and 24.29% in the control group. An indirect correlation with moderate intensity was established between total cholesterol and CRT, (rs=-0.442, p≤0.001), thus it tended to decrease as total cholesterol increased. With increasing total cholesterol level, DVFC had a mild tendency to decrease (rs=-0.381, p≤0.001). An indirect correlation, but weak in intensity, existed between the LDL/HDL ratio and the DVFC S value (rs=-0.240, p=0.001). Central retinal thickness and central vascular density of the superficial capillary plexus were significantly lower in patients with type II diabetes, compared to control subjects. Total cholesterol had higher values in the DM group and an indirect correlation was established with CRT and DVFC, these having a moderate tendency to decrease as the total cholesterol values increased. An indirect and moderate relationship in intensity was also present between LDL and retinal parameters studied. These results were similar to those of other studies conducted, such as that of Chen et al. or Bernaous et al., who showed an association between various lipid classes and the frequency of DR. However, other studies, such as Ausdiab, found that this association did not hold. Type II diabetes patients tend to have elevated serum lipid levels compared to normal subjects, but the impact of dyslipidemia on the onset and progression of DR is incompletely elucidated.

Investigating Vitamin D Status: A Key Factor in Gestational Diabetes among Pregnant Women

Background: Vitamin D deficiency within the general population suggests the emergence of glucose intolerance. The relationship between insufficient vitamin D levels and gestational diabetes mellitus remains a subject of ongoing discussion. Objectives: The investigation looked into the connection between vitamin D levels and the chances of developing gestational diabetes mellitus. Methodology: This cross-sectional analytic study includes 262 pregnant women who attended the Gestational Diabetes Center and Antenatal Counseling Center at the Maternity Teaching Hospital in Sulaimani City. The study used convenience sampling, and the data was collected from November 1st, 2021, to October 1st, 2022. The study used a specific questionnaire divided into four sections: demographics, medical, and obstetric. Simultaneously, the Roche Elecsys vitamin D3 assay determined serum vitamin D status. Results: Women with gestational diabetes mellitus had a significantly higher prevalence of vitamin D inadequate levels (p =0.000), Significant variance in residency (p =0.000), education (p =0.000), body mass index (p =0.038), age at marriage (p =0.023), history of using the contraceptive pill (p-value =0.000), parity (p =0.001), and gravidity (p =0.014) were additionally identified between the two groups of gestational diabetes mellitus and non-gestational diabetes mellitus. Conclusion: Women with gestational diabetes mellitus had higher rates of vitamin D deficiency than those without, but the differences were not statistically significant.

Maternal vascular indices and hemodynamic parameters at 36 weeks' gestation in gestational and pre-existing diabetes mellitus.

To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation in pregnancies complicated by gestational diabetes mellitus (GDM), those with pre-existing diabetes mellitus (DM) and those without GDM or pre-existing DM. This was a prospective observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics and medical history, and measurement of vascular indices and hemodynamic parameters using a non-invasive operator-independent device. These included carotid-to-femoral pulse-wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. The values in the GDM and pre-existing DM groups were compared to those in the unaffected group. We examined 6746 women, of whom 396 were excluded because they had chronic hypertension or developed pre-eclampsia or gestational hypertension. The study population of 6350 pregnancies contained 99 (1.6%) with pre-existing Type-I or Type-II DM and 617 (9.7%) that developed GDM, including 261 (42.3%) that were treated with diet alone, 239 (38.7%) treated with metformin alone and 117 (19.0%) treated with insulin with or without metformin. Among women with GDM and those with pre-existing DM, compared to those without GDM or pre-existing DM, there was a higher median cardiac output and heart rate, central systolic and diastolic blood pressure and pulse-wave velocity, but there was no significant difference in stroke volume and total peripheral resistance. There were no significant differences within the GDM group according to treatment type, except for higher heart rate in women treated with metformin alone compared to the group treated with diet alone. Women with GDM and those with pre-existing DM have evidence of early vascular disease in the third trimester, and this may contribute to their increased long-term cardiovascular risk. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Correlation between glycemic control and retinal nerve fiber layer parameters in type 2 diabetics without retinopathy: a case control study

Background Retinal neurodegenerative changes were found to develop in patients with diabetes mellitus (DM) before the onset of microvascular changes of diabetic retinopathy (DR). Such changes usually affect inner retinal layers in the form of retinal nerve fiber layer (RNFL) thinning. Aim To correlate the degree of glycemic control [in the form of hemoglobin A1c (HBA1c) levels] with changes in peripapillary RNFL thickness in patients with type 2 DM without DR using optical coherence tomography (OCT). Patients and methods Participants are divided into three groups each including 28 eyes: group 1: uncontrolled type 2 DM without DR (HBA1c≥7%), group 2: controlled type 2 DM without DR (HBA1c&lt;7%), group 3: healthy age and sex-matched controls. Peripapillary RNFL and macular ganglion cell complex (GCC) thickness were evaluated in all participants using RTVue spectral domain OCT device (Optovue, Fremont, USA). Results Peripapillary RNFL and macular GCC were significantly thinner in the uncontrolled type 2 DM group in comparison to both the controlled type 2 DM group and the healthy control group. No significant difference in OCT parameters between the controlled type 2 DM group and the healthy control group. HBA1c shows a statistically significant negative correlation with average, superior and inferior RNFL thickness as well as average, superior, and inferior GCC thickness. Conclusion Early and adequate glycemic control, indicated by HBA1c less than 7%, is of critical importance in delaying and reducing early neurodegenerative changes in the form of RNFL and GCC thinning in patients with type 2 DM without DR.

Evaluation of Salivary Glucose and Salivary Cortisol in Association with Periodontitis in People with Type II Diabetes: A Case-control Study.

The relationship between type II diabetes mellitus (DM) and periodontal disease (PD) has been discussed in recent years and may vary according to the patient's location, sex, age and family history. In view of this possible association between periodontitis and DM, this study aimed to evaluate salivary glucose and salivary cortisol levels with periodontitis (staging and degree) in people with type II diabetes compared to non-diabetic individuals. This was a case-control study, with 60 participants divided into two groups: DM2- people with type II diabetes (n=30) and NDM- non-diabetic individuals (n=30). For both, a clinical form and periogram were filled out, and blood samples (glycemia, glycated hemoglobin, and cortisol) and saliva (glucose and cortisol) were collected. The diagnosis of periodontitis was 100% in the DM2 group and 80% in the NDM group. As for staging and degree, in the DM2 group, 70% of the participants were in stage IV and 86.67% were in grade C, while in the NDM group, 58.3% of the participants were in stage I and 70.8% were in grade A. Significant differences were observed for the following variables: bleeding to probing and clinical attachment level. The laboratory data presented significant results regarding serum glucose, salivary glucose, and glycated hemoglobin. Regarding the influence of salivary glucose and cortisol on periodontal status (staging and degree), these had higher means in the DM2 group when compared to the NDM group. An association of salivary glucose and cortisol levels with the periodontal condition presented by type II diabetic individuals compared to non-diabetic individuals is suggested.

Recurrence risk analysis for stage II and III colorectal cancer, and the implications of diabetes mellitus as a risk factor for the recurrence of stage III colorectal cancer.

The present study investigated the risk factors for recurrence in patients with stage II-III colorectal cancer (CRC) who underwent colorectal surgery. Data from 232 patients with stage II and III CRC who underwent primary tumor resection were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the risk factors for recurrence. The overall recurrence rate was 21.6% (n=50/232). Univariate Cox regression analysis identified diabetes mellitus (DM) (P=0.032) as a risk factor for recurrence. In addition, multivariate Cox regression analysis showed that DM was an independent risk factor for recurrence-free survival (RFS) (hazard ratio 2.40, P=0.016). The RFS curve obtained using the Kaplan-Meier method indicated that in patients with stage III colon cancer, the non-DM group demonstrated a significantly longer RFS than the DM group (P=0.012). In conclusion, the present study demonstrated that DM may be an independent risk factor for recurrence in patients undergoing curative resection for stage III CRC. Consequently, better postoperative therapy and careful monitoring might be required, especially in patients with stage III CRC and preoperative DM.

An In-depth Single-center Retrospective Assessment of In-hospital Outcomes in Acute Myocardial Infarction Patients with and without Diabetes.

Objective This study examined variations in in-hospital mortality causes and identified independent mortality predictors among patients with acute myocardial infarction (AMI) with and without diabetes mellitus (DM). Methods We examined factors influencing in-hospital mortality in a single-center retrospective observational study. Separate multivariate analyses were conducted for both groups to identify independent predictors of in-hospital mortality. Patients This study included consecutive patients admitted to Iwate Medical University Hospital between January 2012 and December 2017 with a diagnosis of AMI. Results Of 1,140 patients meeting the AMI criteria (average age: 68.2±12.8 years old, 75% men), 408 (35.8%) had diabetes. The DM group had a 1.87-times higher 30-day mortality rate, a lower prevalence of ST-elevated MI (56.6% vs. 65.3% in non-DM, p=0.004), and more frequent non-cardiac causes of death (32% vs. 14% in non-DM, p=0.046) than the non-DM group. Independent predictors of in-hospital mortality in both groups were cardiogenic shock (CS) [DM: hazard ratio (HR) 6.59, 95% confidence interval (CI) 2.90-14.95; non-DM: HR 4.42, 95% CI 1.99-9.77] and renal dysfunction (DM: HR 5.64, 95% CI 1.59-20.04; non-DM: HR 5.92, 95% CI 1.79-19.53). Among patients with DM, a history of stroke was an additional independent predictor of in-hospital mortality (HR 2.59, 95% CI 1.07-6.31). Conclusion Notable disparities were identified in the causes of death and predictive factors of mortality between these two groups of patients with AMI. To further improve AMI outcomes, individualized management and prioritizing non-cardiac comorbidities during hospitalization may be crucial, particularly in patients with DM.

Young-onset type 2 diabetes mellitus enhances proteinuria, but not glomerular filtration rate decline: A Japanese cohort study.

The time course of chronic kidney disease in young-onset type 2 diabetes mellitus remains unclear. We compared the trajectories of proteinuria and estimated glomerular filtration rate (eGFR) decline between young-onset (aged ≤40 years) and late-onset (aged >40 years) type 2 diabetes mellitus in a Japanese multicenter cohort. Participants without diabetic kidney disease were divided into two groups according to age at diagnosis: young- and late-onset. The primary endpoint was eGFR <60 mL/min/1.73 m2, proteinuria or both. Multivariable Cox proportional hazards were calculated to estimate incidence. Among 626 participants with type 2 diabetes mellitus, 78 (12.4%) had young-onset and 548 (87.6%) had late-onset diabetes. The incidence of eGFR <60 mL/min/1.73 m2 was lower (16.7% vs 33.5%, P = 0.003), but that of proteinuria was higher (46.2% vs 28.9%, P = 0.002) in the young-onset type 2 diabetes mellitus group. The Kaplan-Meyer curve showed that young-onset type 2 diabetes mellitus was associated with a decreased hazard ratio (HR) for eGFR <60 mL/min/1.73 m2 and an increased HR for proteinuria compared with late-onset type 2 diabetes mellitus. In the multivariate Cox analysis, young-onset type 2 diabetes mellitus increased the HR (95% confidence interval) of proteinuria (1.53, 95% confidence interval 1.03-2.26), but did not change the eGFR <60 mL/min/1.73 m2 HR. Young-onset type 2 diabetes mellitus has a lower HR of eGFR <60 mL/min/1.73 m2 and an increased HR of proteinuria compared with late-onset type 2 diabetes mellitus, indicating that young-onset type 2 diabetes mellitus has a different time course for the development of proteinuria and subsequent eGFR decline.

Sex differences in the correlation between lipids related to cardiovascular risk factors and small dense LDL particles in patients with type 2 diabetes.

Sex differences in lipid metabolism associated with prevalent small dense (S-) low-density lipoprotein (LDL) cholesterol particles are not elucidated. An LDL to apolipoprotein B (ApoB) ratio < 1.2 can estimate how prevalent S-LDL particles are and, thus, reflect cardiovascular risk. The aim of this study was to evaluate the sex distribution of LDL/ApoB ratio among patients with type 2 diabetes (DM) and to assess, in both sexes, the correlations between key lipid parameters and LDL/ApoB < 1.2. The study included 190 Caucasian participants (mean age 51.8 ± 6.4 years) with DM (DM group) or without DM (control group) divided into subgroups according to sex. The participants were examined for levels of several lipid parameters, selected lipid-related oxidative stress markers, and estimated S-LDL prevalence. An LDL/ApoB < 1.2 (p < 0.05) was observed in 67% of male and female patients with DM. Although triglyceride levels did not differ between men and women, women had higher levels of total cholesterol (p < 0.05) and LDL cholesterol (p < 0.01) than men. Among women with LDL/ApoB < 1.2, strong correlations were observed between values of lipid hydroperoxides (LOOH) and atherogenic index of plasma (p < 0.005) and between levels of triglycerides and LOOH (p < 0.005) and ApoB (p < 0.0001). The findings indicate that women with LDL/ApoB < 1.2 tend to have a higher cardiovascular risk than men. Additionally, LDL/ApoB < 1.2 can be a surrogate marker for estimating the S-LDL prevalence in individuals with potentially increased cardiovascular risk.

Analysis of the interplay between proximal lower limb and foot joint structures as a mechanical predictor of neuropathic ulceration

BackgroundDiabetes-related foot ulcers are a leading cause of morbidity and mortality globally, in which the most significant contributing factor is peripheral neuropathy. The purpose of this research was to evaluate the influence of diabetic peripheral neuropathy and ulceration on lower limb and foot joint kinematics during gait. Research questionAre there any significant alterations lower limb and foot joint kinematics during gait in the presence of active and history of diabetic neuropathic ulceration? MethodsA prospective, cross-sectional study was conducted, recruiting eighty adult participants who were equally divided into four groups, namely, the diabetes (DM), diabetic peripheral neuropathy (DPN), active diabetic neuropathic ulceration (DNU) and history of diabetic neuropathic ulceration (DHNU) groups. Three-dimensional gait analysis was performed, and participants were instructed to walk barefoot over a 10-m walkway at self-selected speed. The acquired pelvic, hip, knee, ankle and foot joint segmental kinematic data was compared between individuals with and without active neuropathic ulceration. ResultsMean scores between the four independent groups was performed using the Kruskal-Wallis test. Participants within the DNU and DHNU groups demonstrated significantly reduced knee flexion, ankle dorsiflexion and first metatarsal dorsiflexion kinematics with resultant increased anterior pelvic tilt, hip flexion and midtarsal kinematics (all values p<0.01) when compared to participants within the DM and DPN groups. SignificanceThrough the integration of a more individualised, biomechanical approach, the findings in this study may provide improved preventative and management strategies of ulceration amongst the diabetic population.

Swimming Exercise Regulates Indices of Skeletal Muscle Glucose Metabolism and Attenuates Cardiac Inflammatory Cytokines Activity Via IL-6/TNF-α Pathway In Streptozotocin-Induced Diabetic Rats.

Diabetes mellitus (DM) manifests with impaired glucose metabolism that affects the musculoskeletal and cardiovascular systems. This study investigated the effects of swimming exercise on some indices of muscle glucose metabolism and cardiac inflammatory markers in diabetic rats induced with streptozotocin. Wistar rats of both sexes (150-200 g) were assigned into five groups of seven (7) rats. Group 1: Control (CON), Group 2: Diabetes only (DM), Group 3: Exercise only (EX), Group 4: Diabetes + Exercise (DM+EX), Group 5: Diabetes + Insulin (DM+IN). Type 1 DM was induced via intraperitoneal injection of streptozotocin (60 mg/kg). Insulin (6 IU/g) was administered (IP) to animals in group 5. Swimming exercise test was done for 27 days after which animals were euthanized. Blood samples were collected while hamstring muscles and heart were harvested and homogenized to assess biochemical parameters. The body weight, serum insulin level, muscle glucose metabolic indices (glycogen, Glut-4, CK-MB), and cardiac troponin-T were significantly (P<0.05) decreased. In contrast, the random blood glucose, cardiac TNF-α, and IL-6 levels were increased (P<0.05) in diabetic rats when compared with the control group. Swimming exercise regimen significantly (P<0.05) reversed these anomalies by reducing blood glucose and cardiac inflammatory cytokines (TNF-α and IL-6) levels, improving serum insulin, muscle glycogen, and GLUT-4 expression in diabetic rats when compared to the DM group. The cardiac inflammatory cytokine levels in DM+EX were comparable to the DM+IN group. In conclusion, swimming exercise improves muscle glucose metabolism and protects the heart against cardiac inflammation in diabetic conditions.

Investigation of serum Metrnl levels in pregnant women with gestational diabetes mellitus: a prospective non-interventional cohort study.

The objective of this study was to investigate serum Metrnl levels in pregnant women with gestational diabetes mellitus and compare them with pregnant women without gestational diabetes mellitus. The gestational diabetes mellitus group consisted of 87 pregnant women diagnosed with gestational diabetes mellitus, and the control group consisted of 93 healthy pregnant women without gestational diabetes mellitus. Serum Metrnl levels were determined by the enzyme-linked immunosorbent assay method. The two groups were similar in terms of demographic features. The median serum Metrnl level was found to be 1.16 ng/mL in the gestational diabetes mellitus group, while it was determined as 2.2 ng/mL in the control group (p=0.001). The two groups were divided into two subgroups based on participants' body mass index, normal weight and overweight. The lowest median Metrnl level was detected in the normal weight gestational diabetes mellitus group, followed by the overweight gestational diabetes mellitus group, normal weight control group, and overweight control group (1.1, 1.2, 2, and 2.4 ng/mL, respectively). Receiver operating curve analysis was performed to determine the value of the serum Metrnl level in terms of predicting gestational diabetes mellitus. The area under the curve analysis of serum Metrnl for gestational diabetes mellitus estimation was 0.768 (p=0.000, 95%CI 0.698-0.839). The optimal cutoff value for serum Metrnl level was determined as 1.53 ng/mL with 69% sensitivity and 70% specificity. Serum Metrnl levels in pregnant women with gestational diabetes mellitus were found to be significantly lower than in pregnant women without gestational diabetes mellitus. The mechanisms underlying the decrease in serum Metrnl levels in gestational diabetes mellitus remain unclear for now, and future studies will reveal the role of Metrnl in the pathophysiology of gestational diabetes mellitus.

The role of first-trimester systemic immune-inflammation index for the prediction of gestational diabetes mellitus.

The aim of this study was to investigate the role of systemic immune-inflammation index, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratios calculated in the first trimester as inflammatory markers in predicting gestational diabetes mellitus diagnosis. This study was conducted retrospectively at a tertiary center between January 2020 and June 2023. A total of 111 pregnant women with gestational diabetes and 378 pregnant women in the control group were included in the study. Systemic immune-inflammation index, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratios values were compared between the gestational diabetes mellitus group patients and the healthy group. Receiver operating characteristic analysis curve was used for predicting gestational diabetes mellitus using systemic immune-inflammation index and lymphocyte-monocyte ratio. In pregnant women in the first trimester, systemic immune-inflammation index and lymphocyte-monocyte ratio values based on routine complete blood count parameters were found to be statistically significantly higher in gestational diabetes mellitus patients compared to healthy patients, while neutrophil-lymphocyte ratio and platelet-lymphocyte ratios values were found to be similar (p=0.033, p=0.005, p=0.211, and p=0.989). For predicting gestational diabetes mellitus, a cut-off value of 655.75 for systemic immune-inflammation index resulted in 80.2% sensitivity and 34.4% specificity, and a cut-off value of 3.62 for lymphocyte-monocyte ratio resulted in 56.8% sensitivity and 63.2% specificity, indicating good discriminatory ability. We believe that systemic immune-inflammation index and lymphocyte-monocyte ratio values measured in the first-trimester complete blood count parameters are effective in predicting gestational diabetes mellitus but are not effective in determining insulin requirement.

A Probiotic Mixture Decreases Neuropathy and Oxidative Stress Markers in Diabetic Rats

Diabetic neuropathy (DN) is a type of nerve damage caused by long-term hyperglycemia in diabetes mellitus (DM). The gut microbiota alters in DM. Therefore, improvement of the gut flora may affect neuropathic pain and oxidative biomarkers' responsiveness to the probiotic treatment. The present study aimed to assess the effects of probiotic supplementation on neuropathic pain and oxidative stress biomarkers in diabetic rats’ serum. Forty-eight rats (200-250 g) were randomly divided into four groups (n = 12 per group) to examine the effects of the probiotics mixture as follows: the control group (CO), and the diabetic groups received 1 ml probiotics mixture (DP) containing &lt;em&gt;Lactobacillus rhamnosus&lt;/em&gt;, &lt;em&gt;Lactobacillus acidophilus&lt;/em&gt;, &lt;em&gt;Lactobacillus delbrueckii&lt;/em&gt;, &lt;em&gt;Lactobacillus plantarum&lt;/em&gt;, and &lt;em&gt;Bifidobacterium bifidum&lt;/em&gt; (10&lt;sup&gt;9&lt;/sup&gt; CFU of each), 100 mg/kg Gabapentin (DG), or normal saline (DM) daily. The study used animals with plasma glucose concentrations between 70 and 100 mg/dl. Behavioral tests, including mechanical allodynia, cold allodynia, and thermal hyperalgesia, were used to evaluate the pain on days 1, 4, 7, 14, and 21 of the study. After that, the serum's biochemical analysis was completed. Taking the probiotics mixture decreased mechanical and cold allodynia as well as thermal hyperalgesia. The probiotics group also showed significant reductions in lipid peroxidation levels and increases in total antioxidant capacity (TAC) and glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities compared to the DM group. Our results showed that supplementation with the probiotics mixture could reduce pain-related behaviors in diabetic rats by enhancing the antioxidant capacity in their serum.

Evaluation of serum IL 18 / IL 18 binding protein ratio and their relation with IL- 18 gene polymorphisms in sample of Iraqi type 2 diabetes mellitus patients. A case control study.

To evaluate the ratio of interleukin18 and interleukin18 binding protein in type 2 diabetes mellitus patients, and its relation with the presence of interleukin18-607C/A and interleukin18-137G/C gene polymorphisms and the type of complications. The case-control study was conducted at the endocrinology clinic of the Madinat Al-Imamin Al-Kazemin Teaching Hospital, Iraq, from September 2020 to July 2021, and comprised diagnosed patients of type 2 diabetes mellitus, and healthy controls matched for age and gender. Blood samples were obtained that were processed for serum separation. Serum interleukin18 and interleukin18 binding protein levels were assessed, and part of the sample was used for deoxyribonucleic acid extraction using tetra-primer amplification refractory mutation system polymerase chain reaction with four specific primers for interleukin18-607C/A and interleukin-18-137G/C gene polymorphisms in both the groups. Data was analysed using SPSS 20. Of the 168 subjects, 86(51.2%) were patients; 67(77.9%) females and 19(22.1%) males with mean age 52±8.97 years. There were 82(48.8%) controls; 56(68.3%) females and 26(31.7%) males with mean age 48±9.44 years (p>0.05). Higher serum level of interleukin18 and lower level of interleukin18 binding protein were seen in type 2 diabetes mellitus group compared to the controls (p<0.001). Interleukin18-137G/C and interleukin18-607C/A mutant alleles had odd ratios 3.52 (confidence interval: 1.91- 6.63) and 3.25 (confidence interval: 1.77-5.83), respectively, as risk factors for the occurrence of type 2 diabetes mellitus. There was an association of interleukin18- 137G/C homozygous mutant genotype with the occurrence of retinopathy among type 2 diabetes mellitus patients (p=0.046), but risk allele C was not associated with retinopathy (p>0.05). The presence of interleukin18-137G/C and interleukin18-607C/A gene polymorphism might be considered a risk factor for type 2 diabetes mellitus.

Remote ischemic conditioning slows blood-retinal barrier damage in type 1 diabetic rats

Diabetic retinopathy (DR) is one of the major complications of diabetes and can cause severe visual impairment. Blood-retina barrier (BRB) destruction resulted from chronic hyperglycemia underlines its major pathological process. However, current treatments have limited efficacy and may even cause serious complications. Remote ischemic conditioning (RIC), through repeated transient mechanical occlusion of limb blood vessels, has been confirmed to promote blood–brain barrier integrity after stroke, but its role in BRB disruption has not been elucidated. This study aimed to investigate the protective effects of RIC on the BRB in diabetic rats and its potential mechanisms. 48 Sprague-Dawley rats were randomly assigned to the Sham group, Sham + RIC group, diabetes mellitus (DM) group and DM+RIC group. The diabetic model was successfully induced by intraperitoneal injection of streptozotocin. RIC treatment was administered daily and lasted for 9 weeks. In functional analysis, RIC improved the retinal function based on electroretinogram data and reduced the leakage of BRB in diabetic rats. In proteomic analysis, tight junction pathway was enriched after RIC treatment, in which Patj gene was significantly increased. We also found that RIC increased mRNA levels of Patj, claudin-1 and zonula occludens (ZO)-1, protein expression of claudin-1 when compared with diabetic models. In conclusion, RIC slowed BRB damage in diabetic rats, which may be related to the preservation of tight junction proteins. RIC may be a promising protective strategy for the treatment of DR.

Aortic Stiffness Measured by Carotid Femoral-Pulse Wave Velocity at Different Stages of Normal Glucose, Prediabetes, and Diabetes Mellitus: A Systematic Review and Meta-Analysis.

To explore aortic stiffness measured by carotid femoral-pulse wave velocity (cf-PWV) at different stages of normal glucose, prediabetes, and diabetes mellitus (DM). The literature comparing aortic stiffness (AS) with cf-PWV between DM and non-DM samples was systematically retrieved from Pubmed, Ovid Medline, Web of Science, Embase, Scopus, CNKI, and Wanfang databases. The Newcastle-Ottawa Scale was used to assess the quality of the literature. The primary endpoint was the mean difference (MD) of cf-PWV between the normal glucose and DM samples and normal glucose and prediabetes samples. The secondary endpoints were the MD of carotid intima-media thickness (cIMT) and carotid-radial pulse wave velocity (cr-PWV). Aggregated MD and 95% confidence intervals were calculated. When the I2 value was >50% or p < 0.01, the heterogeneity was considered large, and the random-effect model was used; otherwise, the fixed-effect model was used. A sensitivity analysis was conducted to identify the source of heterogeneity, and a funnel plot and the regression Egger test was utilized to assess the publication bias. A total of 37 studies were finally enrolled. Samples with DM had a higher cf-PWV value and cIMT value than those without DM, and the differences were statistically significant. The cr-PWV measurements tended to be higher in the DM group than in the non-DM group, but the difference was not significant. Samples with prediabetes also had a significantly higher cf-PWV value than samples with normal glucose. Samples with DM and prediabetes were associated with a higher cf-PWV value, indicating that DM patients had a higher central AS. Central AS progresses at the prediabetes stage. These data provide insight into understanding the mechanism of adverse effects of DM and prediabetes on artery stiffness.

The Systemic Risk Factors for the Development of Infectious Keratitis after Penetrating Keratoplasty: A Population-Based Cohort Study.

Penetrating keratoplasty (PK) is a corneal surgery that is employed to repair the full-thickness corneal lesion. This study aimed to survey the possible systemic risk factors of infectious keratitis after penetrating keratoplasty (PK) via the Taiwan National Health Insurance Research Database (NHIRD). A retrospective case-control study was conducted, and 327 patients who received the PK were enrolled after exclusion. The main outcome was the development of infectious keratitis, and people were divided into those with infectious keratitis and those without the outcome. Cox proportional hazard regression was conducted to produce adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of specific demographic indexes and systemic diseases on infectious keratitis. There were 68 patients who developed infectious keratitis after the whole follow-up period. The diabetes mellitus (DM) (aHR: 1.440, 95% CI: 1.122-2.874, p = 0.0310) and chronic ischemic heart disease (aHR: 1.534, 95% CI: 1.259-3.464, p = 0.0273) groups demonstrated a significant association with infectious keratitis. The DM group also revealed significant influence on infectious keratitis development in all the subgroups (all p < 0.05). Nevertheless, the effect of chronic ischemic heart disease on infectious keratitis was only significant on those aged older than 60 years (p = 0.0094) and both sexes (both p < 0.05). In conclusion, the presence of DM and chronic ischemic heart disease are associated with infectious keratitis after PK. However, local risk factors for infectious keratitis developed in those receiving PK had not been evaluated.

Cardiac magnetic resonance imaging-derived pathophysiology and prognosis of diabetes mellitus with acute myocardial infarction after revascularization: a prospective cohort study

Background Little is known about the underlying factors contributing to unfavourable clinical outcomes in patients with diabetes mellitus (DM) complicated by new-onset acute myocardial infarction (AMI). The aim of this study was to investigate the impact of DM on the pathophysiologic features and prognosis of patients with new-onset AMI following successful revascularization by utilizing cardiac magnetic resonance (CMR). Methods Consecutive patients diagnosed with new-onset AMI between June 2022 and January 2024 were included. All patients underwent culprit vessel revascularization upon admission and CMR imaging 3-7 days later. The primary clinical endpoint of this study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), for which the average follow-up was 10 months. Results A total of 72 patients were divided into a DM group (n = 23) and a non-DM group (n = 49). Multivariate logistic regression analysis revealed that DM was an independent risk factor for the occurrence of microvascular obstruction. Multivariate linear regression analysis found that DM was the influencing factor of global radial strain (B = −4.107, t = −2.328, p = 0.023), while fasting blood glucose influenced infarct segment myocardial radial strain (B = −0.622, t = −2.032, p = 0.046). DM independently contributed to the risk of MACCEs following successful revascularization in patients with AMI (p < 0.05). Conclusion Comprehensive phenotypic characterization of myocardial injury and microcirculatory status could enable reliable identification of high-risk MACCEs in DM patients with new-onset AMI following successful revascularization.