DM2 In Patients Research Articles

Risk factors for development of type 2 diabetes mellitus in patients with obesity in late post-COVID period

Objective. To study the risk factors for developing type 2 diabetes mellitus in patients with obesity after COVID-19. Materials and methods. 61 case histories and outpatient card abstracts of patients with obesity, who suffered from moderate and severe forms of COVID-19 from 02.2021–04.2022 were analyzed. Demographic, laboratory and clinical parameters were studied during hospitalization and 12 months after discharge from the hospital. All patients initially were divided into 2 groups according to the glycated hemoglobin level. Group 1 consisted of 46 patients with prediabetes and group 2 included 15 patients without carbohydrate disorders. Results. The median age of all patients was 64 (59–66) years. Median of HbAlc was 6,0 (5,6–6,2) %, BMI –34 (33–35) kg/m2. 24 patients from group 1, who took DPP-4-inhibitors in early post-COVID-19 period constituted subgroup 1A and 22 patients, who refused treatment with these drugs, constituted subgroup 1B. Currently, 2 patients from subgroup 1A and 10 patients from subgroup 1B (χ2=8,2 р=0,004) have been diagnosed with DM2. In patients who developed DM2 in late post-COVID period the levels of HbAlc, fasting plasms glucose and BMI at the time of admission to the hospital were significantly higher (n=12) than in patients with persistent prediabetes (n=34), (p0,05). Positive correlation between these parameters and the risk of developing DM2 (R=0,5, p0,05; R=0,74, p0,05; R=0,54, p0,05, respectively) was determined. In group 2, DM2 is currently diagnosed in 2 male patients with BMI over 40 kg/m2. When comparing subgroup 1B and group 2, it was found out that DM2 in the post-COVID period occurs in every second patient with the previous initial carbohydrate disorders: in 10 people of 22 – in subgroup 1B (every 2nd patient) versus 2 patients from group 2 (every 7th patient), (χ2=4,2, p=0,04). Online calculator from medstatistic. ru was used to determine relative risk (RR). Conclusions. Thus, presence of impaired glucose tolerance increases the risk of development of DM2 in late post-COVID period. In patients with hyperlycemia on hospitalization for COVID-19, who did not receive incretin therapy (subgroup 1B) risk of DM2 was 3,4 times higher (CI 95 %=0,87–13,40). Patients, who received incretin (subgroup 1A) had risk of DM2 = 0,6 (CI 95 %=0,09–3,97). It should be assumed that incretin therapy prevents development of DM2 in patients with hyperglycemia/impaired glucose tolerance after COVID-19.

IDF21-0377 Evaluation of the glycemic profile during 6 months after hospital discharge of patients with severe COVID-19

Background: COVID-19, caused by the novel coronavirus SARS-CoV-2, has resulted in more than 206 million infections and over 4 million deaths worldwide. Among the risk factors associated with the mortality of patients with the severe form of the disease, type 2 diabetes mellitus (DM2) is included. In addition, recent-onset hyperglycemia and complications of preexisting DM2 were observed in post-infection patients, establishing a bidirectional relationship between COVID-19 and diabetes, which is not sufficiently described. Aim: To describe the clinical and glycemic evolution of patients hospitalized due to severe COVID-19 during 6 months after discharge. Method: From July to October 2020, patients of both sexes, aged between 18 and 70 years, hospitalized with COVID-19, were recruited after the end of hospitalization. A questionnaire was applied on the 30th day after discharge to assess the profile of the patients. Blood samples were taken on the 30th, 90th, and 180th days after hospital discharge and, on the 180th day, an oral glucose tolerance test (OGTT) was performed for non-diabetics in order to assess their glycemic profile. Results: 44 patients were included, with 32 (73%) men (mean age: 49 years) and 12 (27%) women (mean age: 58 years). 30 (68%) had no previous history of DM2 and 14 (32%) had this diagnosis confirmed. Assessing only the 24 patients who completed the 6-months follow-up, the mean fasting glucose (FG, mmol/L) verified on the 30th day was 6.83 and glycated hemoglobin (HbA1c) was 7.5%, while on the 90th day the FG average was 6.44 and the HbA1c was 6.8% and, finally, on the 180th day, the FG average was 6.94 and the HbA1c was 6.7%. Considering those without a previous diagnosis of DM2, 12/28 (43%) had hyperglycemia on the 30th day after hospital discharge, 7/25 (28%) on the 90th day, and 9/20 (45%) on the 180th day. Among the 16 patients who underwent OGTT, 1 (6%) had a result compatible with DM2, 4 (25%) were intolerant to insulin and 11 (69%) had normal blood glucose 2 hours after drinking the 75g glucose solution. Discussion: The prevalence of DM2 in patients with severe COVID-19 (32%) was higher than in the global population (9.3%) [4], corroborating literature data. Severe post-COVID-19 patients have hyperglycemia for more than 4 weeks, but transient, as demonstrated by the drop in HbA1c levels at 3 and 6 months and by the normal OGTT found in more than 50% of non-diabetic patients. The increase in the mean FG on the 180th day may be a result of the small number of patients at the end of the study.

Metabolic impact of the VDR rs1544410 in diabetic retinopathy.

To investigate the association between BsmI and DM2 in patients with and without DR and to correlate with clinical parameters in a population in northeastern Brazil. Cross-sectional case-control study in which data were collected from 285 individuals, including 128 patients with DM2 and 157 with DR. Clinical, biochemical and anthropometric parameters were analyzed, in addition to the single nucleotide polymorphism (SNP) BsmI of the VDR gene (rs1544410), genotyped by PCR-RFLP. In the DR group we found a greater number of patients using insulin therapy (p = 0.000) and with longer duration of DM2 (p = 0.000), in addition to higher serum creatinine values (p = 0.001). Higher fasting glucose levels and higher frequency of insulinoterapy were independently observed in patients with DR and b allele carriers, when compared to BB. The association of the bb/Bb genotypes (rs1544410) of the VDR gene with increased blood glucose levels and insulinoterapy may represent worse glicemic control in rs1544410 b allele carriers in DR Latin American individuals.

Risk factors for type 2 diabetes mellitus in patients with gout: results from a prospective study

The development of type 2 diabetes mellitus (DM) (DM2) in patients with gout can be influenced by both conventional and directly linked to gout risk factors (RFs).Objective: to identify RFs for the development of DM2 in patients with gout, including those directly associated with gout, based on long-term prospective follow-up data.Patients and methods. The study included 444 patients with gout older than 18 years (49 women, 395 men) who did not have DM. The followup period ranged from 2 to 8 years. The studied RFs for DM2 were: gender, age, family history of DM2, obesity, alcohol consumption >20 units per week, insufficient physical activity, unbalanced nutrition, history of hyperglycemia, coronary heart disease (CHD), arterial hypertension (AH), chronic heart failure, antihypertensive drugs, diuretics, glucocorticoids (GCs), urate-lowering therapy, serum levels of cholesterol, triglycerides, CRP, uric acid (UA), glucose, creatinine, glomerular filtration rate <60 ml/min/1.73 m2, the presence of tophi, >4 attacks of gout per year, ≥5 affected joints during the disease.Results and discussion. DM2 developed in 108 (24.3%) patients. These patients were older, had a family history of DM, more often received antihypertensive therapy, diuretics, and glucocorticoids (49.1; 73.1; 27.8 and 47.2%, respectively) than patients who did not develop DM2 (25.6; 50.5; 14.8 and 36.4%, respectively; p<0.05 for all cases). In addition, patients with DM2 were more likely to have subcutaneous tophi (59.3% versus 30.0%; p=0.001), among them there were more individuals (67.6% versus 31.6%; p=0.001) with frequent attacks of arthritis (>4 attacks per year). UA levels >480 and 600 μmol/l were also significantly more frequent (p=0.0002) in patients with DM2 (71.3 and 34.3%, respectively).According to logistic regression data, factors that increase the risk of developing DM2 were: family history of DM, a history of hyperglycemia, CHD, AH, intake of GCs, antihypertensive drugs, the presence of tophi, >4 exacerbations of gout per year. Febuxostat use and UA <300 μmol/L were associated with a lower risk of DM2.Conclusion. The occurrence of DM2 in gout is associated not only with well-known risk factors, but also with hyperuricemia and microcrystalline inflammation. Febuxostat therapy is associated with a lower risk of developing DM2.

Positive airway pressure normalizes glucose metabolism in obstructive sleep apnea independent of diabetes and obesity

The relationship among obstructive sleep apnea syndrome (OSAS), type 2 diabetes mellitus (DM2) and obesity is very complex and multi-directional. Obesity and increased visceral fat are important perpetuating factors for DM2 in patients with OSAS. On the other hand, OSAS itself leads to obesity by causing both leptin and insulin resistance as a consequence of activation of the sympathetic nervous system. Risk for developing DM2 further increases in patients with OSAS and obesity. Data regarding effects of positive airway pressure (PAP) therapy, gold standard treatment for OSAS, on glycemic control were inconsistent due to variability in duration of and adherence to PAP therapy. In our cohort study we investigated effects of PAP treatment on glucose metabolism in normal-weighted non-diabetic OSAS patients, in obese non-diabetic OSAS patients, and in OSAS patients with DM2. We prospectively analyzed 67 patients diagnosed with OSAS and documented to be effectively treated with PAP therapy for three months. Apnea-hypopnea index was highest in the diabetic group, being significantly higher than in the normal-weighted group (p=0.021). Mean HOMA values were significantly higher in obese (p=0.002) and diabetic group (p=0.001) than normal-weighted group; the differences were still significant after PAP therapy. HbA1c levels were significantly higher in diabetic group compared to those in normal-weighted (p=0.012) and obese (p=0.001) groups. After PAP treatment, decrease in HbA1c levels were significant in normal-weighted (p=0.008), obese (p=0.034), and diabetic (p=0.011) groups. There was no correlation with the change in HbA1c levels and age (p=0.212), BMI (p=0.322), AHI (p=0.098) or oxygen levels (p=0.122). Our study showed that treatment of OSAS by PAP therapy offers beneficial effect on glucose metabolism, not only in diabetic patients, but also in obese and normal-weighted OSAS patients. Although data regarding overall effects of PAP therapy on glycemic control present contradictory results in the literature, it should be emphasized that duration and adherence to PAP therapy were main determinants for beneficial outcome of treatment.

Metformin and aspirin treatment could lead to an improved survival rate for Type 2 diabetic patients with stage II and III colorectal adenocarcinoma relative to non-diabetic patients.

Metformin, the drug of choice in the treatment of type 2 diabetes mellitus (DM2), in addition to aspirin (ASA), the drug prescribed for cardioprotection of diabetic and non-diabetic patients, have an inhibitory effect on cancer cell survival. The present population-based study conducted in the province of Trieste (Italy), aimed to investigate the prevalence of DM2 in patients with colorectal adenocarcinoma (CRC) and survival for CRC in diabetic and nondiabetic patients. All permanent residents diagnosed with a CRC between 2004 and 2007 were ascertained through the regional health information system. CRC-specific and relative survival probabilities were computed for each group of patients defined by CRC stage, presence or absence of DM2 treated with metformin, and presence or absence of daily ASA therapy. A total of 515 CRC patients without DM2 and 156 with DM2 treated with metformin were enrolled in the study. At the time of CRC diagnosis, 71 (14%) nondiabetic and 39 (25%) diabetic patients were taking ASA daily. The five-year relative survival for stage III CRC was 101% [95% confidence interval (CI)=76-126] in the 18 patients with DM2 treated with metformin and ASA, 55% (95% CI=31-78) in the 23 without DM2 treated with ASA, 55% (95% CI=45-65) in the 150 without DM2 not taking ASA, and 29% (95% CI=13-45) in the 43 with DM2 treated with metformin, however not with ASA. The findings support the hypothesis of a possible inhibitory effect of metformin and ASA on CRC cells. Randomized controlled trials are required to verify this hypothesis.

Asociación del índice de desarrollo humano y diabetes mellitus tipo 2 en unidades de medicina familiar del estado San Luis Potosí, México

Objective: to determine the association between the human development index in the population with diabetes mellitus type 2 (dm2) who attend Family Medicine Units. Methods: Cross-sectional and crossed association study. To create the database, prevalence was considered for official records of dm2 in patients over 20 years old, who were attended at outpatient of 30 Family Medicine Units of the San Luis Potosi delegation, of the Mexican Institute of Social Security (imss). The Human Development Index (hdi) of San Luis Potosi was obtained through the data published by the United Nations Development Program. Descriptive and inferential statistics with the Spearman correlation coefficient was applied, as well as multiple linear regression. The stata v. 12 program was used for statistical analyses. Results: a significant association between high hdi and the prevalence of dm2 (p=0.0016), this association is directly proportional between the two variables. Conclusions: it was determined that the hdi is not only a useful measure to evaluate the economic development, in health or education, but is also a variable closely associated to the dm2 prevalence for the analyzed municipalities.

Parental type 2 diabetes in patients with non-affective psychosis

ObjectivePeople with schizophrenia have an increased risk of diabetes that may be independent of antipsychotics. Previous studies have explored the prevalence of a family history of type 2 diabetes (DM2) in schizophrenia. We hypothesized that parental DM2 is increased in probands with non-affective psychosis (NAP) compared to controls, and parental DM2 predicts comorbid diabetes in NAP, after controlling for potential confounders. MethodN=217 patients with NAP and N=67 controls were interviewed for a history of parental DM2. NAP was investigated as a predictor of parental DM2 in binary logistic regression models, controlling for age, sex, race, smoking, body mass index, socioeconomic status, and parental psychiatric history. ResultsThere was an increased prevalence of DM2 in the mother (30.0% vs 13.8%, p=0.013) and in either the mother or father (44.5% vs 24.6%, p=0.006) in patients with NAP versus controls. After accounting for potential confounders, NAP was associated with significant increased odds of parental DM2 (OR=2.80, 95% CI 1.08–7.23, p=0.034). Parental DM2 was also associated with increased odds of comorbid DM2 in NAP (OR=3.67, 95% CI 1.58–8.56, p=0.003). ConclusionsWe replicated an association of an increased prevalence of parental DM2 in patients with NAP. Parental DM2 was also an independent predictor of comorbid DM2 in these patients. These associations may be due to shared environmental or genetic risk factors, or gene by environment interactions. Given risks of incident diabetes with antipsychotic treatment, screening for parental DM2 status is germane to the clinical care of patients with NAP.

No relevant excess prevalence of myotonic dystrophy type 2 in patients with suspected fibromyalgia syndrome

Myotonic dystrophy type 2 (DM2) is a rare, autosomal dominant, multisystem disorder with proximal weakness, myotonia, pain and cataract as important symptoms. Given the assumed underreporting of DM2 in the Netherlands combined with the predominant role of pain in DM2 as well as in fibromyalgia syndrome (FMS), we hypothesized there will be an excess prevalence of DM2 in patients with (suspected) FMS. Our objective was to determine the prevalence of DM2 in patients with suspected FMS. A prevalence of 2% was considered a relevant excess frequency.Between November 2011 and April 2014, 398 patients with suspected FMS who had been assessed by a rheumatologist participated in this cross-sectional study. 95% of the study population was female, with a mean age of 42 years. The final ICD-9 diagnoses were collected, in 96% the diagnosis was FMS. 92% met the 2010 American College of Rheumatology (ACR) diagnostic criteria for FMS. A questionnaire including neuromuscular symptoms was completed. Creatine kinase was determined, and genetic testing for DM2 was conducted in all patients. DM2 was established in only one patient (0.25%, 95% CI 0.04–1.4%), thus disapproving our hypothesis of a relevant prevalence of 2%. Our results suggest that patients with suspected FMS should not routinely be tested for DM2.

Serum Cytokeratin-18 Fragment Levels Predict Development of Type 2 Diabetes Mellitus in Adult Patients With Nonalcoholic Fatty Liver Disease

Introduction: Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for the development of type 2 diabetes (DM2). Whether the histologic severity of NAFLD correlates with higher risk of DM2 has not been investigated. Cytokeratin-18 (CK18) serum levels have been extensively validated as a reliable non-invasive marker of NAFLD severity and the presence of nonalcoholic steatohepatitis (NASH). We aimed to investigate baseline CK18 level as predictor of the development of DM2 in patients with NAFLD. Methods: Patients with biopsy-proven NAFLD who had serum CK18 fragment levels measured at the time of liver biopsy and were followed at our institution for at least 2 years were included in the current study. Charts were reviewed for the development of DM2 during the course of their follow-up. The diagnosis of DM was made using the American Diabetes Association (ADA) criteria. CK18 fragment levels at baseline were measured using the M30-Apoptosense ELISA kit. Student’s t tests were used to assess the association between the development of DM2 and CK-18 levels. A p< 0.05 was considered statistically significant. Results: Thirty-nine patients met the criteria for inclusion in the study, out of which 32 (82.1%) were white and 20 (51.3%) were female. At baseline, the mean age was 51.3±11.2 years and the mean BMI was 33.8±5.6 Kg/m2. Patients were followed for a median of 62.4 (38.8, 81.0) months. Fourteen patients had DM2 at baseline. Out of the remaining 25 patients, 6 (24.0%) developed DM during the course of the follow-up and had significantly higher mean values of CK-18 at baseline (768.8±821.4) as compared to the 19 that did not develop DM (285.1±166.5) (p =0.019) (Figure 1). Furthermore, there was a trend toward having higher baseline CK18 levels in patients that developed metabolic syndrome at last followup compared to those who did not (361.3±195.9 versus 195.4±103.1; p=0.077).Figure 1Conclusion: Baseline CK18 level may be a useful marker to predict the development of DM2 in adults with NAFLD. If these findings are validated in larger studies, having higher CK18 level may require a more aggressive approach to lifestyle modifications to prevent the development of DM2.

Comparison of HbA1c and oral glucose tolerance test for diagnosis of diabetes in patients with coronary artery disease

Measurement of glycated hemoglobin A1c (HbA1c) to diagnose diabetes mellitus (DM-2) is recommended by several expert groups. DM-2 occurs very frequently among patients with coronary artery disease (CAD). Therefore, we aimed to investigate the diagnostic strengths of HbA1c and oral glucose tolerance test (OGTT) in detecting latent glucometabolic disturbances among patients with CAD. One hundred ninety-nine consecutive patients admitted with CAD were included in this observational study. Fasting plasma glucose as well as HbA1c measurement was performed in all study participants and those without preexisting DM-2 underwent an OGTT. Patients were subdivided according to their medical history into those with previous DM-2 (n = 37). The remaining 162 patients underwent OGTT, which revealed 39 patients with diabetes (DM-(OGTT)), 35 with impaired glucose tolerance (IGT), 20 with impaired fasting glucose (IFG) and 68 with normal glucose tolerance (NGT). Using HbA1c resulted in 6.8% DM and 45.6% at risk (HbA1c 5.7-6.4%) diagnosis. OGTT identified 24.1% DM (p = 0.002 compared with HbA1c) and 21.6% IGT patients. Among those with intermediate HbA1c (5.7-6.4%) 26.5% patients were NGT and only 30.9% displayed DM-2 by use of OGTT. Among patients with HbA1c of <5.7%, 44% (n = 31) of patients had disturbed glucose metabolism. Using receiver-operating curve HbA1c cutoff with the highest sensitivity and specificity was found to be 5.8%. There is a large discordance between OGTT and HbA1c in terms of detecting latent DM-2 in patients with CAD. Measurement of HbA1c could result in lower propensity of DM-2 diagnosis.

Cognitive dysfunction and its clinical and radiological determinants in patients with symptomatic arterial disease and diabetes

Background and aims Both vascular disease and diabetes type 2 (DM2) decrease cognitive functioning in elderly people. It is uncertain if DM2 affects cognition independent of vascular disease. In patients with symptomatic arterial disease, we studied the effect of DM2 on cognition and identified clinical and radiological determinants for impaired cognition in patients with DM2. Methods 766 patients (mean age 58.8 ± 9.5 years; 108 DM2) with symptomatic arterial disease underwent neuropsychological testing. In 542 patients (77 DM2), volumes of brain tissue, ventricles and white matter lesions were obtained by segmentation of brain MR images. Infarcts were distinguished into small (lacunar) or large (cortical or subcortical). Results Patients with arterial disease and DM2 performed worse on neuropsychological tests compared to similar patients without DM2 (adjusted composite z-score: β − 0.14 [− 0.25 to − 0.02]). Insulin treatment, systolic and diastolic blood pressures were significantly associated with cognition in patients with DM2. Large infarcts, global and cortical atrophy on MRI were independently associated with cognition in patients with DM2. Conclusion The presence of DM2 in patients with symptomatic arterial disease is associated with decreased cognitive functioning. Insulin treatment, high blood pressure, brain atrophy and large infarcts were determinants for cognitive dysfunction in patients with DM2 and arterial disease.

Ketosis-Prone Type 2 Diabetes Mellitus and &lt;emph type="ital"&gt;Human Herpesvirus 8&lt;/emph&gt; Infection in Sub-Saharan Africans

An atypical form of type 2 diabetes mellitus (DM-2) is revealed by ketosis (ketosis-prone type 2 diabetes mellitus), frequently occurring in individuals who are black and of African origin, and characterized by an acute onset requiring transient insulin therapy. Its sudden onset suggests precipitating factors. To investigate the putative role of human herpesvirus 8 (HHV-8) in the pathogenesis of ketosis-prone DM-2. A cross-sectional study in which antibodies were searched against latent and lytic HHV-8 antigens using immunofluorescence. The presence of HHV-8 in genomic DNA was investigated in 22 of the participants at clinical onset of diabetes. We also tested whether HHV-8 was able to infect human pancreatic beta cells in culture in vitro. The study was conducted at Saint-Louis University Hospital, Paris, France, from January 2004 to July 2005. All participants were black and of African origin: 187 were consecutive diabetic patients of whom 81 had ketosis-prone DM-2 and 106 had nonketotic DM-2, and 90 individuals were nondiabetic control participants who were matched for age and sex. Seroprevalence of HHV-8 and percentage of patients with HHV-8 viremia at onset in ketosis-prone DM-2. HHV-8 antibodies were found in 71 patients (87.7%) with ketosis-prone DM-2 vs 16 patients (15.1%) with nonketotic DM-2 (odds ratio, 39.9; 95% confidence interval, 17.1-93.4; P < .001) and 36 of the control participants (40.0%) (odds ratio, 10.7; 95% confidence interval, 4.9-23.4; P < .001). HHV-8 in genomic DNA was present in 6 of 13 patients with ketosis-prone DM-2 tested at acute onset and in 0 of 9 patients with nonketotic DM-2. HHV-8 proteins were present in human islet cells that were cultured for 4 days in the presence of HHV-8. In this preliminary cross-sectional study, the presence of HHV-8 antibodies was associated with ketosis-prone DM-2 in patients of sub-Saharan African origin. Longitudinal studies are required to understand the clinical significance of these findings.

Prevalence and factors affecting occurrence of type 2 diabetes mellitus in Saudi patients with chronic liver disease.

Background/AimType 2 diabetes mellitus (DM-2) is more common in patients with chronic liver disease (CLD) in general and chronic hepatitis C virus (HCV) infection in particular. We aimed to determine the prevalence and factors affecting the occurrence of DM-2 in Saudi patients with CLD.Materials and MethodsRetrospective study at the King Fahd Central Hospital (KFCH), Gizan, Saudi Arabia. A total of 277 patients with either cirrhosis (CH) or hepatocellular carcinoma (HCC) were analyzed for patient demographics, severity of liver disease, HBsAg, and anti-HCV, associated diseases including DM-2, and presence of HCC. The prevalence of DM-2 was also estimated in 400 age- and sex-matched Saudi patients admitted for various nonliver diseases (control group). Chi-square test, univariate analysis, and multivariate regression.ResultsPrevalence of DM-2 in patients with CH was higher than in controls (19.2 vs. 9.2%; P = 0.001). Although those with HCC had a higher prevalence, the difference was not significant (10.9 vs. 9.2%; P = 0.5). Seventy-six percent of patients with HCC had associated CH. On multivariate analysis, age and hypertension were more common in diabetics. Although patients with HCV-related disease had a higher prevalence of DM-2 compared to HBV-related disease, the difference was not significant (26.3 vs. 15.7%; P > 0.05).ConclusionsDM-2 occurred more frequently in CLD patients, particularly in cirrhotics. Age and hypertension predicted the occurrence of DM-2. Small sample size of patients with HCV-related CH probably precluded higher prevalence of DM-2 in them.