Dysfunction In Type 2 Diabetes Mellitus Patients Research Articles

Subclinical impairment of left ventricular myocardium function in type 2 diabetes mellitus patients with or without hypertension.

Cardiovascular disease has been the leading cause of morbidity and mortality for type 2 diabetes mellitus (T2DM) patients over the last decade. To determine whether layer-specific global longitudinal strain (GLS) combined with peak strain dispersion (PSD) can be used to assess left ventricle (LV) myocardium systolic dysfunction in T2DM patients or without hypertension (HP). We enrolled 97 T2DM patients, 70 T2DM + HP patients and 101 healthy subjects. Layer-specific GLS and PSD were calculated by EchoPAC software in apical three-, four- and two-chamber views. GLS of the epimyocardial, middle-layer and endomyocardial (GLSepi, GLSmid, and GLSendo) were measured and recorded. Receiver operating characteristic analysis was performed to detect LV myocardium systolic dysfunction in T2DM patients. There were significant differences in GLSepi, GLSmid, GLSendo, and PSD between healthy subjects, T2DM patients and T2DM patients with HP (P < 0.001). Trend tests yielded the ranking of healthy subjects > T2DM patients > T2DM with HP patients in the absolute values of GLSepi, GLSmid and GLSendo (P < 0.001), while PSD was ranked healthy subjects < T2DM < T2DM with HP (P < 0.001). Layer-specific GLS and PSD had high diagnostic efficiency for detecting LV myocardium systolic dysfunction in T2DM patients, however, the area under the curve (AUC) for layer-specific GLS and PSD combined was significantly higher than the AUCs for the individual indices (P < 0.05). Layer-specific GLS and PSD were associated with LV myocardium systolic dysfunction in T2DM patients, T2DM patients with HP. T2DM patients with HP have more severe LV myocardium systolic dysfunction than T2DM patients without HP and normal control patients. The combination of layer-specific GLS and PSD may provide additional prognostic information for T2DM patients with or without HP.

Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease.

Peripheral vascular disease (PVD) is a common complication of type 2 diabetes mellitus (T2DM). Patients with T2DM have twice the risk of PVD as nondiabetic patients. To evaluate left ventricular (LV) systolic function by layer-specific global longitudinal strain (GLS) and peak strain dispersion (PSD) in T2DM patients with and without PVD. Sixty-five T2DM patients without PVD, 57 T2DM patients with PVD and 63 normal controls were enrolled in the study. Layer-specific GLS [GLS of the epimyocardium (GLSepi), GLS of the middle myocardium (GLSmid) and GLS of the endocardium (GLSendo)] and PSD were calculated. Receiver operating characteristic (ROC) analysis was performed to calculate the sensitivity and specificity of LV systolic dysfunction in T2DM patients with PVD. We calculated Pearson's correlation coefficients between biochemical data, echocardiographic characteristics, and layer-specific GLS and PSD. There were significant differences in GLSepi, GLSmid and GLSendo between normal controls, T2DM patients without PVD and T2DM patients with PVD (P < 0.001). Trend tests revealed a ranking of normal controls > T2DM patients without PVD > T2DM patients with PVD in the absolute value of GLS (P < 0.001). PSD differed significantly between the three groups, and the trend ranking was as follows: normal controls < T2DM patients without PVD < T2DM patients with PVD (P < 0.001). ROC analysis revealed that the combination of layer-specific GLS and PSD had high diagnostic efficiency for detecting LV systolic dysfunction in T2DM patients with PVD. Low-density lipoprotein cholesterol was positively correlated with GLSepi, GLSmid and PSD (P < 0.05), while LV ejection fraction was negatively correlated with GLSepi, GLSmid and GLSendo in T2DM patients with PVD (P < 0.01). PVD may aggravate the deterioration of LV systolic dysfunction in T2DM patients. Layer-specific GLS and PSD can be used to detect LV systolic dysfunction accurately and conveniently in T2DM patients with or without PVD.

Serum 25-Hydroxyvitamin D Level Is Positively Associated with Vascular Reactivity Index in Patients with Type 2 Diabetes Mellitus.

Circulating 25-hydroxyvitamin D (25(OH)D) significantly influences endothelial function. This study assessed the correlation between serum 25(OH)D and endothelial function using the vascular reactivity index (VRI) in patients with type 2 diabetes mellitus (T2DM). Fasting blood samples from 102 T2DM participants and VRI were assessed. Patients were divided into three categories based on VRI: low (VRI < 1.0), intermediate (1.0 ≤ VRI < 2.0), and good (VRI ≥ 2.0). Among these patients, 30 (29.4%) had poor, 39 (38.2%) had intermediate, and 33 (32.4%) exhibited good vascular reactivity. Higher serum fasting glucose (p = 0.019), glycated hemoglobin (p = 0.009), and urinary albumin-to-creatinine ratio (p = 0.006) were associated, while lower prevalence of hypertension (p = 0.029), lower systolic blood pressure (p = 0.027), lower diastolic blood pressure (p < 0.001), and lower circulation 25(OH)D levels (p < 0.001) were associated with poor vascular reactivity. Significant independent associations between diastolic blood pressure (p = 0.002) and serum 25(OH)D level (p < 0.001) and VRI were seen in T2DM patients according to multivariable forward stepwise linear regression analysis. Serum 25(OH)D positively correlated with VRI values, and lower levels of serum 25(OH)D were linked to endothelial dysfunction in T2DM patients.

Mild renal dysfunction causes aggravated cardiac damage in type 2 diabetic patients: a comprehensive echocardiography study.

We sought to detect left ventricular (LV) adverse alterations in structure and function in type 2 diabetes mellitus (T2DM) patients with or without mild renal dysfunction (MRD) using comprehensive echocardiography techniques and to explore the independent risk factors for LV remodeling (LVR) and dysfunction in these patients. The study included 82 T2DM patients with normal LV ejection fraction (presence (n = 42)/absence (n = 40) of MRD). Age- and gender-matched controls (n = 40) were also recruited. LV structure and function were evaluated using conventional echocardiography and three-dimensional speckle tracking echocardiography (3DSTE). Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were all measured using 3DSTE. Compared with the controls with absolute advantage of LV normal geometry, LVR was more frequently present in the two T2DM groups, with the largest proportion in those with T2DM and MRD (P < 0.001). Fasting plasma glucose (FPG) and MRD were both significant risk factors for LVR in T2DM patients. The detection rates of LV diastolic dysfunction and subclinical systolic dysfunction were significantly higher in the T2DM groups than in the controls (P = 0.000). Moreover, the two case groups also showed significantly lower strain values in multiple directions than the controls (all P < 0.05). FPG was significantly associated with LV diastolic dysfunction, whereas FPG and MRD were both significantly associated with subclinical LV systolic dysfunction in T2DM patients. The combined use of conventional echocardiography and 3DSTE allowed the timely detection of early cardiac damage in T2DM patients with or without MRD.

Predictive value of clinical risk factors for bladder dysfunction in Syrian patients with type 2 diabetes mellitus

Diabetes mellitus (DM) is a prevalent disorder that affects the endocrine and metabolic systems. Among the various complications associated with DM, diabetic bladder dysfunction (DBD) is the most frequently occurring genitourinary complication. The presence of DBD can lead to complications that affect the upper urinary tract, significantly impacting the quality of life for individuals with DM. Therefore, it is crucial to identify early risk factors for DBD and predict its onset. Given the absence of studies involving bladder dysfunction in patients with type 2 diabetes mellitus (T2DM) in Syria, this study aims to examine the risk factors associated with bladder dysfunction in T2DM patients and develop a predictive model to identify DBD early. Patients diagnosed with T2DM were enrolled in six endocrinology centers spread across four Syrian provinces between January 2018 and December 2023. Factors that showed an association with DBD in the bivariate analysis, with a significance level of p < 0.05, were included in a multiple logistic regression analysis. The logistic regression analysis was used to identify independent risk factors and develop a prediction model. The receiver operating characteristic (ROC) curve was used to assess the predictive performance of the identified risk factors and the prediction model for DBD. One hundred and eighty-four patients were included in this study, and they were divided into the DBD group (n = 88) and the non‐DBD group (n = 96). Seven variables showed significance in the bivariate analysis. Furthermore, the multiple logistic regression analysis revealed that age (OR [95% CI]: 0.981 [0.614 − 1.337]), p < 0.007; diabetic peripheral neuropathy (DPN) (OR [95% CI]: 1.421 [1.027 − 3.308]), p = 0.03; glycated hemoglobin (HbA1c) (OR [95% CI]: 0.942 [0.821 − 1.141]), p = 0.042; and percentage of monocyte (Mono%) (OR [95% CI]: 1.109 [0.812 − 1.258]), p = 0.031 were independent risk factors for DBD. Analysis of the ROC curve revealed that the area under the curve (AUC) for age, DPN, HbA1c, and Mono were 0.703, 0.541, 0.613, and 0.836, respectively. Age, DPN, HbA1c, and Mono% were risk factors for DBD. The prediction model constructed based on the four risk factors had a good predictive value for predicting the occurrence of DBD.

The protective role of carnosine against type 2 diabetes-induced cognitive impairment.

The morbidity and mortality associated with type 2 diabetes mellitus (T2DM) have grown exponentially over the last 30 years. Together with its associated complications, the mortality rates have increased. One important complication in those living with T2DM is the acceleration of age-related cognitive decline. T2DM-induced cognitive impairment seriously affects memory, executive function, and quality of life. However, there is a lack of effective treatment for both diabetes and cognitive decline. Thus, finding novel treatments which are cheap, effective in both diabetes and cognitive impairment, are easily accessible, are needed to reduce impact on patients with diabetes and health-care systems. Carnosine, a histidine containing dipeptide, plays a protective role in cognitive diseases due to its antioxidant, anti-inflammation, and anti-glycation properties, all of which may slow the development of neurodegenerative diseases and ischemic injury. Furthermore, carnosine is also involved in regulating glucose and insulin in diabetes. Herein, we discuss the neuroprotective role of carnosine and its mechanisms in T2DM-induced cognitive impairment, which may provide a theoretical basis and evidence base to evaluate whether carnosine has therapeutic effects in alleviating cognitive dysfunction in T2DM patients.

Altered cortical thickness-based structural covariance networks in type 2 diabetes mellitus

Cognitive impairment is a common complication of type 2 diabetes mellitus (T2DM), and early cognitive dysfunction may be associated with abnormal changes in the cerebral cortex. This retrospective study aimed to investigate the cortical thickness-based structural topological network changes in T2DM patients without mild cognitive impairment (MCI). Fifty-six T2DM patients and 59 healthy controls underwent neuropsychological assessments and sagittal 3-dimensional T1-weighted structural magnetic resonance imaging. Then, we combined cortical thickness-based assessments with graph theoretical analysis to explore the abnormalities in structural covariance networks in T2DM patients. Correlation analyses were performed to investigate the relationship between the altered topological parameters and cognitive/clinical variables. T2DM patients exhibited significantly lower clustering coefficient (C) and local efficiency (Elocal) values and showed nodal property disorders in the occipital cortical, inferior temporal, and inferior frontal regions, the precuneus, and the precentral and insular gyri. Moreover, the structural topological network changes in multiple nodes were correlated with the findings of neuropsychological tests in T2DM patients. Thus, while T2DM patients without MCI showed a relatively normal global network, the local topological organization of the structural network was disordered. Moreover, the impaired ventral visual pathway may be involved in the neural mechanism of visual cognitive impairment in T2DM patients. This study enriched the characteristics of gray matter structure changes in early cognitive dysfunction in T2DM patients.

Impact of insulin resistance on mild cognitive impairment in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease

AimsInsulin resistance (IR) is a pivotal factor in the pathogenesis of type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Nevertheless, the impact of IR on cognitive dysfunction in T2DM patients with NAFLD remains inadequately understood. We aim to investigate the effect of IR on mild cognitive impairment (MCI) in T2DM individuals with NAFLD.Materials and methods143 T2DM individuals were categorized into Non-MCI and MCI groups, as well as Non-NAFLD and NAFLD groups. Clinical parameters and cognitive preference test outcomes were compared. Correlation and regression analyses were executed to explore the interconnections between IR and cognitive details across all T2DM patients, as well as within the subgroup of individuals with NAFLD.ResultsIn comparison to the Non-MCI group, the MCI group displayed elevated HOMA-IR levels. Similarly, the NAFLD group exhibited higher HOMA-IR levels compared to the Non-NAFLD group. Additionally, a higher prevalence of MCI was observed in the NAFLD group as opposed to the Non-NAFLD group. Notably, HOMA-IR levels were correlated with Verbal Fluency Test (VFT) and Trail Making Test-B (TMTB) scores, both related to executive functions. Elevated HOMA-IR emerged as a risk factor for MCI in the all patients. Intriguingly, increased HOMA-IR not only correlated with TMTB scores but also demonstrated an influence on TMTA scores, reflecting information processing speed function in patients with NAFLD.ConclusionIR emerges as a contributory factor to cognitive dysfunction in T2DM patients. Furthermore, it appears to underlie impaired executive function and information processing speed function in T2DM individuals with NAFLD.

Evaluation of subclinical left ventricular myocardial systolic dysfunction in type 2 diabetes mellitus patients with and without diabetes peripheral neuropathy by global myocardial work.

Speckle-tracking echocardiography can non-invasively estimate myocardial work (MW) to evaluate left ventricular (LV) myocardial systolic function. The present study evaluated whether MW may detect subclinical LV myocardial systolic dysfunction in type 2 diabetes mellitus (T2DM) patients with and without diabetes peripheral neuropathy (DPN). A total of 127 T2DM patients were included in the present study, including 67 T2DM patients with DPN. In addition, 73 sex- and age- matched healthy individuals served as normal controls. The global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW), global positive work (GPW), global negative work (GNW), global work efficiency (GWE) and GCW/GWW were measured and analysed. Furthermore, the differences in MW parameters among normal controls, T2DM patients, and T2DM patients with DPN were analysed. Multiple regression models were built to explore for the independent influencing factors of GWI and GPW values in T2DM patients with DPN. Receiver operating characteristic curve analysis was performed to evaluate the sensitivity and specificity of MW in evaluating subclinical LV myocardial systolic dysfunction in T2DM patients with DPN. The GWI, GCW and GPW of T2DM patients with DPN were significantly decreased compared with those of T2DM patients and normal controls (P < 0.001) and showed a significant decreasing trend overall (P trend < 0.001). GWE and GCW/GWW were significantly decreased in T2DM patients with DPN compared with normal controls (P < 0.05). Although GWW was not significantly different among the three groups, it showed an increasing trend (Ptrend = 0.033). High-density lipoprotein cholesterol (HDL-C) levels were independent influencing factor for decreased GWI (β = 0.21, P = 0.031) and GPW (β = 0.19, P = 0.043) values in T2DM patients with DPN. The combination of the GWI, GCW, GWE, GPW and GCW /GWW had good sensitivity (62.69%) and specificity (89.04%) when evaluating subclinical LV myocardial systolic dysfunction in T2DM patients with DPN. Non-invasive evaluation of LV myocardial work can detect subclinical LV myocardial systolic dysfunction in T2DM patients with and without DPN. DPN has additive deleterious effects on LV myocardial systolic function in T2DM patients. The reduction of HDL-C levels may indicate the occurrence of subclinical LV myocardial systolic dysfunction in T2DM patients with DPN.

Subclinical left ventricular deformation and microvascular dysfunction in T2DM patients with and without peripheral neuropathy: assessed by 3.0 T cardiac magnetic resonance imaging

BackgroundDiabetic peripheral neuropathy (DPN) has been shown to be independently associated with cardiovascular events and mortality. This study aimed to evaluate changes in left ventricular (LV) microvascular perfusion and myocardial deformation in type 2 diabetes mellitus (T2DM) patients with and without DPN, as well as to investigate the association between myocardial perfusion and LV deformation.MethodsBetween October 2015 and July 2022, one hundred and twenty-three T2DM patients without DPN, fifty-four patients with DPN and sixty age‑ and sex‑matched controls who underwent cardiovascular magnetic resonance imaging were retrospectively analyzed. LV myocardial perfusion parameters at rest, including upslope, time to maximum signal intensity (TTM), max signal intensity (max SI), and myocardial strains, including global radial, circumferential and longitudinal strain (GRS, GCS and GLS, respectively), were calculated and compared among the groups with One‑way analysis of variance. Univariable and multivariable linear regression analyses were performed to explore the independent factors influencing LV myocardial perfusion indices and LV strains in diabetes.ResultsThe LV GLS, upslope and max SI were significantly deteriorated from controls, through patients without DPN, to patients with DPN (all P < 0.001). Compared with controls, TTM was increased and LV GRS and GCS were decreased in both patient groups (all P < 0.05). Multivariable regression analyses considering covariates showed that DPN was independently associated with reduced upslope, max SI and LV GLS (β = − 0.360, − 2.503 and 1.113, p = 0.021, 0.031 and 0.010, respectively). When the perfusion indices upslope and max SI were included in the multivariable analysis for LV deformation, DPN and upslope (β = 1.057 and − 0.870, p = 0.020 and 0.018, respectively) were significantly associated with LV GLS.ConclusionIn patients with T2DM, there was more severe LV microvascular and myocardial dysfunction in patients with complicated DPN, and deteriorated subclinical LV systolic dysfunction was associated with impaired myocardial circulation.

Prevalence, Metabolic Consequences of Non Alcoholic Fatty Liver Disease (NAFLD) and its Association with Microvascular Complications and Ventricular Dysfunction in Patients with Type 2 Diabetes Mellitus

ABSTRACT Objective: To study the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association of with microvascular complications and ventricular dysfunction in patients with type 2 diabetes mellitus (T2DM). Methods: In this cross-sectional study, 100 T2DM patients were screened randomly for detection of fatty liver in ultrasonography. Patients with fatty liver (NAFLD group, n = 36) were compared with subjects without fatty liver (non-NAFLD group, n = 64). Detailed clinical, biochemical, and imaging parameters like lipid profile, LFT, fasting plasma glucose, 2-hour post-prandial plasma glucose, HbA1C, fasting insulin, spot urinary albumin/creatinine ratio, and 2-D ECHO (M-mode) were performed. Results: The prevalence of NAFLD was found to be 36%. NAFLD group had significantly higher BMI, WHR, blood pressure, glycemic profile, and lipid parameters compared to non-NAFLD group. HOMA IR was elevated significantly in NAFLD group (3.16 ± 1.96) compared to non-NAFLD group (1.73 ± 1.59). There was significantly higher prevalence of all the diabetes-related microvascular complications and LV diastolic dysfunction in NAFLD patients with higher odds for the occurrence of neuropathy (OR = 4.74; P = 0.001), nephropathy (OR = 3.92; P = 0.003), retinopathy (OR = 5.95; P = 0.002), and LV diastolic dysfunction (OR = 1.84; P = 0.043). Conclusions: NAFLD is significantly associated with various diabetes-related microvascular complications as well as LV diastolic dysfunction in T2DM patients.

Preliminary study of the interactive effects of coronary heart disease and lacunar infarction on renal function in patients with type 2 diabetes mellitus by gender

BackgroundCoronary heart disease (CHD) and lacunar infarction (LI) are the most common cardio- cerebrovascular complications of type 2 diabetes mellitus (T2DM) and a recognized risk factor for renal injury. Although a unidirectional association of CHD or LI with T2DM or the kidney has been demonstrated, however, it remains unknown whether there is an interactive effect of the coexistence of CHD and LI on renal function in T2DM patients. The aim of our study was to investigate the interaction between CHD and LI on renal function in gender-specific patients with T2DM and the association between cardio-cerebrovascular disease-related conventional serum markers and the estimated glomerular filtration rate (eGFR). MethodsWe conducted a cross-sectional study in Beijing and Tianjin from April 2019 to August 2021. Participants with T2DM aged ≥18 years were asked to complete a one-to-one questionnaire and physical examination. ResultsIn this study, 389 eligible patients with T2DM were included, with a mean age of 63.04 ± 9.41 years, of whom 200 (51.41 %) were male. The proportions of patients with CHD, LI, and both CHD and LI were 28.53 %, 24.42 %, and 11.05 %, respectively. Compared to T2DM patients without either CHD or LI, those with both CHD and LI were found to have a significantly greater risk of reduced eGFR (OR: 12.82, 95 % CI 5.06–32.52, P < 0.001) than those with CHD alone (OR: 2.42, 95 % CI 1.37–3.00, P = 0.004) or LI alone (OR: 1.15, 95 % CI 0.61–2.18, P = 0.664). The combined presence of CHD and LI is associated with a significantly greater risk of decreased eGFR in female T2DM patients compared to their male counterparts. We found both multiplicative and additive effects in all T2DM patients; however, when stratified by sex, only multiplicative effects were observed. After controlling for interference from CHD, LI, and age, we found that total cholesterol (TC) was negatively correlated with eGFR in females (r = −0.156, P = 0.034), and low-density lipoprotein cholesterol (LDL-C) was negatively correlated with eGFR in males (r = −0.229, P = 0.001). ConclusionThis study provides novel evidence that the synergistic effect of CHD and LI on renal injury in patients with T2DM is significantly greater than their individual effects. Women with T2DM who have both CHD and LI are at a 4.85-fold higher risk of decreased eGFR than men. Therefore, increased clinical attention should be given to preventing and treating vascular complications in T2DM patients, as well as aggressively reducing lipid levels, particularly TC and LDL-C, to delay or prevent renal dysfunction in T2DM patients.

Association between triglyceride glucose index and subclinical left ventricular systolic dysfunction in patients with type 2 diabetes

BackgroundThe triglyceride glucose (TyG) index has been considered a new biomarker for the diagnosis of angiocardiopathy and insulin resistance. However, the association of the TyG index with subclinical left ventricular (LV) systolic dysfunction still lacks comprehensive exploration. This study was carried out to examine this relationship in patients with type 2 diabetes mellitus (T2DM).MethodsA total of 150 T2DM patients with preserved LV ejection fraction (LVEF ≥ 50%) from June 2021 to December 2021 were included in this study. The subclinical LV function was evaluated through global longitudinal strain (GLS), with the predefined GLS < 18% as the cutoff for subclinical LV systolic dysfunction. The TyG index calculation was obtained according to ln (fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2), which was then stratified into quartiles (TyG index—Q).ResultsAnalyses of clinical characteristics in the four TyG indexes-Q (Q1 (TyG index ≤ 8.89) n = 38, Q2 (8.89 < TyG index ≤ 9.44) n = 37, Q3 (9.44 < TyG index ≤ 9.83) n = 38, and Q4 (TyG index > 9.83) n = 37) were conducted. A negative correlation of the TyG index with GLS (r = -0.307, P < 0.001) was revealed according to correlation analysis. After gender and age were adjusted in multimodel logistic regression analysis, the higher TyG index (OR 6.86; 95% CI 2.44 to 19.30; P < 0.001, Q4 vs Q1) showed a significant association with GLS < 18%, which was still maintained after further adjustment for related clinical confounding factors (OR 5.23, 95% CI 1.12 to 24.51, p = 0.036, Q4 vs Q1). Receiver operator characteristic analysis indicated a diagnostic capacity of the TyG index for GLS < 18% (area under curve: 0.678; P < 0.001).ConclusionsA higher TyG index had a significant association with subclinical LV systolic dysfunction in T2DM patients with preserved ejection fraction, and the TyG index may have the potential to exert predictive value for myocardial damage.

Type 2 Diabetes Mellitus Coincident with Clinical and Subclinical Thyroid Dysfunctions Results in Dysregulation of Circulating Chemerin, Resistin and Visfatin

The alterations of circulating adipocytokines have been reported in thyroid diseases or type 2 diabetes mellitus (T2DM), but such data in T2DM coincident with clinical and subclinical thyroid-dysfunctions are limited, and remain to be investigated. We studied the changes in serum chemerin, resisitin and visfatin in T2DM patients with thyroid dysfunctions, and their association with inflammatory and insulin resistance-markers. A total of 272 female and male Iranian participants were selected and divided into six groups: the euthyroid group, T2DM, T2DM coincident with clinical and sub clinical hypothyroidism (SC-HO, and C-HO), and T2DM coincident with clinical and sub clinical hyperthyroidism (SC-HR, C-HR).Demographic characteristics, serum levels of adipocytokines, thyroid hormones, inflammatory factors (IL1-β, IL-6 and CRP) and insulin resistance-markers were determined in all participants. T2DM patients with clinical thyroid dysfunctions showed higher levels of circulating resistin, visfatin, chemerin and inflammatory factors, compared with the T2DM group and T2DM coexisted with subclinical thyroid diseases. No significant differences were observed in circulating adipocytokines and inflammatory markers between T2DM coexisting with subclinical thyroid diseases and those without thyroid dysfunctions. Our results revealed that clinical thyroid dysfunction in T2DM patients was associated with elevated levels of circulating resistin, chemerin, visfatin and inflammatory factors, while no such alteration was detected in T2DM coincident with subclinical thyroid dysfunction.

Change in left ventricular diastolic function after pioglitazone treatment in patients with type 2 diabetes mellitus: A protocol for systematic review and meta-analysis

Pioglitazone is currently used as an anti-diabetic agent and can reduce cardiovascular events in in patients with type 2 diabetes mellitus (T2DM). Left ventricular diastolic dysfunction has been recognized as an early manifestation of myocardial dysfunction in T2DM patients. This systematic review and meta-analysis aimed to investigate changes in the left ventricular diastolic function after the treatment of pioglitazone. A systematic literature search of PubMed, Embase, and the Cochrane Library until May 2021 with keywords pioglitazone and left ventricular diastolic function was performed in accordance with the meta-analysis of observational studies in epidemiology guidelines and preferred reporting items for systematic reviews and meta-analyses statement. Three reviewers independently selected the studies and extracted data. Quality assessment of the included studies was undergone. A fixed effects model was used to calculate overall effect sizes. Subgroup analyses were subsequently performed. A fixed effects model was used to calculate the overall effect size. Subgroup analyses were then performed. Seven studies with 233 patients were investigated. We found pioglitazone significantly improved hemoglobin A1c (%) in patients with T2DM and left ventricular diastolic function had an improvement tendency (weighted mean difference [WMD], 0.03; 95% confidence interval [CI], 0.01-0.05, P < .01) despite moderate heterogeneity (I2 = 66%). Subsequent subgroup analysis indicated that left ventricular diastolic function were significantly improved (WMD, 0.20; 95% CI, 0.12-0.29, P < .001) in T2DM patients whose average age < 55 after receiving pioglitazone treatment. However, in T2DM patients with mean age ≥ 55 years, there was no significant improvement of left ventricular diastolic function (WMD, 0.02; 95% CI, 0-0.04, P = .04). Pioglitazone treatment significantly improved left ventricular diastolic function in type 2 diabetic patients with a mean age of < 55 years, but did not improve left ventricular diastolic function in patients with a mean age of ≥ 55 years.

The comparison of mitral annular plane systolic excursion (MAPSE) and mitral annular systolic velocity (Sm) in determining subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is an independent factor in increasing the risk of heart failure in the absence of coronary heart disease and hypertension. Global longitudinal strain (GLS) as the gold standard in determining subclinical left ventricular (LV) systolic dysfunction is not available on all echocardiographic tools and requires good-quality images. Mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic velocity (Sm) are simpler, faster, and widely available method that can determine left ventricular systolic dysfunction regardless of image quality. Methods: This study involved 72 asymptomatic T2DM patients, divided into two groups, patients with subclinical left ventricular systolic dysfunction (GLS &gt;-18%) and normal systolic function (GLS ≤-18%). GLS was obtained from the mean of 18 left ventricular segments on the apical 4-chamber, 3-chamber and 2-chamber images. MAPSE was obtained on the septal and lateral sides of the mitral annulus using M-mode on apical 4-chamber view, while Sm was obtained using tissue doppler imaging (TDI). Results: The study included 72 asymptomatic T2DM patients, 34 samples (47.2%) were found with subclinical LV systolic dysfunction. According to receiver operating characteristic (ROC) curve analysis, lateral TDI Sm had the highest area under the curve (AUC), it was 0.85, followed by average TDI Sm was 0.83 and average MAPSE was 0.81. The cut-off value of average TDI Sm &lt;7.425 cm/s had the best sensitivity and specificity, 82.4% and 81.6%, while cut-off value of average MAPSE &lt;13.4 mm had sensitivity of 76.5% and specificity of 73.7%. Conclusion: TDI Sm had better accuracy than MAPSE in determining subclinical LV systolic dysfunction in T2DM patients. However, both of them can be used as alternative diagnostic methods of GLS.

Significant correlation between taste dysfunction and HbA1C level and blood sugar fasting level in type 2 diabetes mellitus patients in at a tertiary care center in north India

Type 2 diabetes mellitus (T2DM) effect quality of life very much and causes various complications. Diabetic autonomic neuropathy (DAN) is one of the common complications in diabetes. The taste threshold affected by various factors such as age, ethnic backgrounds, drugs, local and systemic diseases, consumption of alcohol, smoking, and tobacco chewing. The present study is undertaken with the objectives to compare the alteration in taste threshold for four primary sensations in Type 2 DM with autonomic neuropathy. 60 patients of T2DM with autonomic neuropathy and 60 healthy controls were taken for the study. Autonomic neuropathy was assessed clinically. Chemical taste test using four solutions of basic tastes (sweet, sour, salty, bitter) were done. Taste dysfunction for sweet was significant in T2DM with uncontrolled hyperglycemia. The taste dysfunction in T2DM patients was not related to gender, disease duration, and type of treatment taken. The study found a significant correlation between taste dysfunction, HbA1C level and blood sugar fasting level in T2DM patients. The taste dysfunction was mainly for sweet. Sour and bitter did not show any difference in case groups compared to controls.

SGLT2-inhibitors reduce the cardiac autonomic neuropathy dysfunction and vaso-vagal syncope recurrence in patients with type 2 diabetes mellitus: the SCAN study

BackgroundIn patients with type 2 diabetes mellitus (T2DM) the vaso-vagal syncope (VVS) recurrence could be due to the alteration of autonomic system function, evaluated by heart rate variability (HRV), and by 123I-metaiodobenzylguanidine (123I-mIBG) myocardial scintigraphy indexes: Heart to Mediastinum ratio (H/Mlate), and Washout rate (WR). The SGLT2-I could modulate/reduce autonomic dysfunction in T2DM patients with VVS. This effect could reduce the VVS recurrence in T2DM patients. MethodsIn a prospective multicenter study, after propensity score matching, we studied a population of 324 T2DM patients with VVS, divided into 161 SGLT2-I-users vs. 163 Non-SGLT2-I users. In these patients as SGLT2-I-users vs. Non-SGLT2-I users, we investigated the HRV and 123I-MIBG modifications and VVS recurrence at 12 months of follow-up. ResultsAt follow-up end, the SGLT2-I-users vs. Non-SGLT2-I users had best glucose homeostasis and lower values of inflammatory markers, and resting heart rate (p < 0.05). The SGLT2-I-users vs. Non-SGLT2-I users evidenced the lowest low frequency/high frequency ratio (LF/HFr), a significant difference for all the indexes of autonomic dysfunction via ECG Holter analysis, and higher values of H/Mlate (p < 0.05). Finally, comparing SGLT2-I-users vs. Non-SGLT2-I users, we found a higher rate of VVS recurrence events, specifically of the vasodepressor VVS recurrence at 1-year follow-up (p < 0.05). We did not find a significant difference of mixed and cardio-inhibitory VVS recurrence events at 1 year of follow-up in the study cohorts (p > 0.05). At the Cox regression analysis H/Mlate (0.710, [0.481–0.985]), and SGLT2-I therapy (0.550, [0.324–0.934]) predicted all causes of syncope recurrence at 1 year of follow-up. ConclusionsNon-SGLT2-I users vs. SGLT2-I-users had alterations of the autonomic nervous system, with a higher rate of VVS recurrence at 1 year of follow-up. The indexes of cardiac denervation predicted the VVS recurrence, while the SGLT2-I reduced the risk of VVS recurrence.Clinical trial registration number: NCT03717207.

Atrioventricular coupling and left atrial abnormality in type 2 diabetes mellitus with functional mitral regurgitation patients verified by cardiac magnetic resonance imaging

BackgroundFunctional mitral regurgitation (FMR) in type 2 diabetes mellitus (T2DM) patients induced by left ventricular (LV) enlargement and mitral valve abnormality may aggravated the impairment in left atrial (LA) compliance. Thus, this study aimed to depict how FMR and LV dysfunction affect LA compliance in T2DM patients with FMR.Materials and methodsA total of 148 patients with T2DM and 49 age- and sex-matched normal controls underwent cardiac magnetic resonance examination. LA longitudinal strain and LA and LV functional indices were compared among controls and different T2DM patients. The multivariate analysis was used to identify the independent indicators of LA longitudinal strain.ResultsT2DM Patients without FMR had a lower total LA empty fraction (LAEF) compared with the controls (all P < 0.05). T2DM patients with mild and moderate FMR showed increased LA volume (LAV) and LV volume while decreased LAEF, LA strain, and LV ejection fraction (P < 0.05). T2DM patients with severe FMR showed markedly increased LAV and LV volume while decreased LAEF, LA strain, and LVEF (P < 0.05). In T2DM patients with FMR, reservoir strain (εs) was independently correlated with LV end-diastolic volume (LVEDV) (β = − 0.334) and regurgitation degree (β = − 0.256). The passive strain (εe) was independently correlated with regurgitation degree (β = − 0.297), whereas the active strain (εa) was independently correlated with LVESV (β = − 0.352) and glycated haemoglobin (β = − 0.279).ConclusionFMR may aggravate LA and LV dysfunction in T2DM patients. Regurgitation degree was an independent determinant of the εs and the εe, LVEDV was an independent determinant of the εs, and LVESV was an independent determinant of the εa in T2DM patients with FMR.

Serum ferritin level in type 2 diabetic patients with renal dysfunction

Background and objective: Nephropathy is the major cause of end-stage renal disease (ESRD) in type 2 diabetes mellitus (T2DM). Delay in identification and management of nephropathy in T2DM may cause development of ESRD. An increased level of serum ferritin plays a role in the pathogenesis of chronic kidney disease (CKD) in T2DM. Hence, the present study intended to assess the level of serum ferritin in renal dysfunction in patients with T2DM. Material and methods: This was a retrospective study with 81 T2DM patients with and without nephropathy. They were categorized into two groups. Group-1 consisted of 46 T2DM cases without nephropathy and remaining 35 with nephropathy.The clinical and biochemical parameters such as blood glucose, urea, creatinine, iron, ferritin, transferrin, total iron binding capacity (TIBC), and haemoglobin were measured by standard methods, and estimated glomerular filtration rate (eGFR) by MDRD formula. Results: Significantly (p&lt;0.05) elevated level of serum ferritin along with urea and creatinine was found in patients with T2DM with nephropathy.A significant positive correlation (r = 0.37) of serum ferritin and negative correlation (r = - 0.852) of eGFR with creatinine were found. It indicated that ferritin could be a good marker to monitor kidney function in T2DM. Conclusion: Apart from eGFR and serum creatinine, raised serum ferritin level was a good indicator of renal dysfunction in T2DM patients and might play an important role in renal dysfunction in early stage diabetic nephropathy. IMC J Med Sci 2022; 16(2): 008. DOI: https://doi.org/10.55010/imcjms.16.018 *Correspondence: Dr. Siva Prasad Palem., M.Sc., Ph.D., Department of Biochemistry, Faculty of Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar-505001, Telangana, India. Affiliated with Kaloji Narayana Rao University of Health Sciences (KNRUHS), Warangal, Telangana, India. E-mail: sp.biocom@yahoo.co.in.