Glycemic Status Research Articles

Association of Microalbuminuria with Glycemic Status Among Patients with Diabetes Mellitus

Objectives: To evaluate the association between micro-albuminuria and glycemic status among type 2 diabetic patients in Hyderabad, Sindh.
 Methods: Cross Sectional study was conducted at the Medical unit of Isra University, Hyderabad from January 2019 to June 2020. All the patients aged between 30 and 50 years, of either genders, with both good controlled as well as uncontrolled diabetes mellitus type II admitted in the medicine ward were included. All the participants were divided into two groups according to their glycemic level. The Group I comprised of patients with poor glycemic control that is HbA1c >7% while Group II comprises of patients with good glycemic control that is HbA1c<7%.
 Results: Majority (56.4%) of participants in the study were Male while most (31.0%) them belongs to age group 41-45 years. The mean age of all patients was 42.3 ± 4.1 years. The mean HbA1c level in group 1(poorly controlled) and 2 (good control) participants was 8.04± 0.97% and 5.87 ± 0.44%. There was a statistically significant association (p<0.05) between poorly controlled glycemic status and micro-albuminuria.
 Conclusion: Micro-albuminuria is significantly associated with the poor glycemic status among type 2 diabetic patients.

STUDY TO DETERMINE THE ASSOCIATION BETWEEN INFLAMMATORY MARKER (C-REACTIVE PROTEIN) AND HBA1C IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objectives: Patients with type 2 diabetes exhibit subclinical inflammation and nearly all signs of systemic inflammation, which characterized by high circulating levels of inflammatory parameters. The present study aimed to assess the levels of the inflammatory markers such as C-reactive protein (CRP) in patients with type 2 diabetes mellitus and to correlate their values with the hemoglobin A1c (HbA1c) levels. Methods: This cross-sectional study was conducted on 78 patients with type 2 diabetes in Patna Medical College and Hospital, Patna. All patients had laboratory investigations including HbA1C and CRP, patients were assessed according to glycemic status, patients with under control of diabetics (HbA1C level was equal to or <6.5%), and patients with poorly-controlled diabetics (HbA1c level was >6.5%). Results: Statistically significant association was observed between CRP levels and level of HbA1c. The CRP level was significantly higher in poorly-controlled diabetic patient than who with well-controlled diabetics (p=0.017). Conclusions: There is positive correlation between the level of glycemic control (HbA1c) and CRP levels; better glycemic control results in significant reduction in the highly sensitive C-reactive protein levels.

Honeymoon phase in type 1 diabetes mellitus: A window of opportunity for diabetes reversal?

The knowledge of the pathogenesis of type 1 diabetes mellitus (T1DM) continues to rapidly evolve. The natural course of the disease can be described in four clinical stages based on the autoimmune markers and glycemic status. Not all individuals of T1DM progress in that specific sequence. We hereby present a case of T1DM with a classical third phase (honeymoon phase) and discuss the intricacies of this interesting phase along with a possible future promise of "cure" with the use of immunotherapies. We now know that the course of T1DM may not be in only one direction towards further progression; rather the disease may have a waxing and waning course with even reversal of type 1 diabetes concept being discussed. The third phase popularly called the "honeymoon phase", is of special interest as this phase is complex in its pathogenesis. The honeymoon phase of T1DM seems to provide the best window of opportunity for using targeted therapies using various immunomodulatory agents leading to the possibility of achieving the elusive "diabetes reversal" in T1DM. Identifying this phase is therefore the key, with a lot of varying criteria having been proposed.

Evaluation of the role of atherogenic index of plasma in the reversion from Prediabetes to normoglycemia or progression to Diabetes: a multi-center retrospective cohort study

BackgroundAtherosclerosis is closely linked with glucose metabolism. We aimed to investigate the role of the atherogenic index of plasma (AIP) in the reversal of prediabetes to normal blood glucose levels or its progression to diabetes.MethodsThis multi-center retrospective cohort study included 15,421 prediabetic participants from 32 regions across 11 cities in China, under the aegis of the Rich Healthcare Group’s affiliated medical examination institutions. Throughout the follow-up period, we monitored changes in the glycemic status of these participants, including reversal to normal fasting glucose (NFG), persistence in the prediabetic state, or progression to diabetes. Segmented regression, stratified analysis, and restricted cubic spline (RCS) were performed based on the multivariable Cox regression model to evaluate the association between AIP and the reversal of prediabetes to NFG or progression to diabetes.ResultsDuring a median follow-up period of 2.9 years, we recorded 6,481 individuals (42.03%) reverting from prediabetes to NFG, and 2,424 individuals (15.72%) progressing to diabetes. After adjusting for confounders, AIP showed a positive correlation with the progression from prediabetes to diabetes [(Hazard ratio (HR) 1.42, 95% confidence interval (CI):1.24–1.64)] and a negative correlation with the reversion from prediabetes to NFG (HR 0.89, 95%CI:0.81–0.98); further RCS demonstrated a nonlinear relationship between AIP and the reversion from prediabetes to NFG/progression to diabetes, identifying a turning point of 0.04 for reversion to NFG and 0.17 for progression to diabetes. In addition, we observed significant differences in the association between AIP and reversion from prediabetes to NFG/progression to diabetes across age subgroups, specifically indicating that the risk associated with AIP for progression from prediabetes to diabetes was relatively higher in younger populations; likewise, a younger age within the adult group favored the reversion from prediabetes to NFG in relation to AIP.ConclusionOur study, for the first time, reveals a negative correlation between AIP and the reversion from prediabetes to normoglycemia and validates the crucial role of AIP in the risk assessment of prediabetes progression. Based on threshold analysis, therapeutically, keeping the AIP below 0.04 was of paramount importance for individuals with prediabetes aiming for reversion to NFG; preventatively, maintaining AIP below 0.17 was vital to reduce the risk of diabetes onset for those with prediabetes.

Prevalence of Distress among Diagnosed Type 2 Diabetics Residing in Rural and Urban Areas of District Amritsar: A Cross-Sectional Study

Background: Patients with diabetes face psychological issues which may be part of the spectrum of diseaseexperience, distinct from depression, which hinder glycemic control. Therefore, this study was planned todetermine the prevalence of diabetes related distress, and its association with socio-demographic variables,treatment status, and glycemic control in adults with type 2 diabetes.Materials and Methods: A cross-sectional study was conducted among diagnosed type 2 Diabetic patientsresiding in urban and rural field practice area of Government Medical College, Amritsar. Data was collected forperiod of one year. Pre-tested, validated questionnaire Diabetes Distress Screening Scale 17 (DDS17) was used.Quantitative and Qualitative variables were compared using t- test and Chi-square test respectively. P value <0.05was considered to be statistically significant.Results: Overall, 18% of study participants were found to be distressed. Distress was slightly higher among urbanstudy participants (21%) in comparison to rural study participants (15%) but this difference was not statisticallysignificant. Significantly higher distress levels were observed among study participants who reported inadequatetreatment, uncontrolled glycemic status and complications due to diabetes.Conclusions: Diabetes related distress is associated with treatment status, glycemic status and complications dueto diabetes. There is need to manage diabetes well and achieve glycemic control in all patients to reduce level ofdistress among them.

Associations of combined polygenic risk score and glycemic status with atrial fibrillation, coronary artery disease and ischemic stroke

BackgroundIt is unknown whether high hemoglobin A1c (HbA1c) is associated with increases in the risk of cardiovascular disease among individuals with elevated genetic susceptibility. We aimed to investigate the association between HbA1c and atrial fibrillation (AF), coronary artery disease (CAD), and ischemic stroke according to the polygenic risk score (PRS).MethodsThe UK Biobank cohort included 502,442 participants aged 40–70 years who were recruited from 22 assessment centers across the United Kingdom from 2006 to 2010. This study included 305,605 unrelated individuals with available PRS and assessed new-onset AF, CAD, and ischemic stroke. The participants were divided into tertiles based on the validated PRS for each outcome. Within each PRS tertiles, the risks of incident events associated with HbA1c levels were investigated and compared with HbA1c < 5.7% and low PRS. Data were analyzed from November 2022 to May 2023.ResultsOf 305,605 individuals, 161,605 (52.9%) were female, and the mean (SD) age was 56.6 (8.1) years. During a median follow-up of 11.9 (interquartile range 11.1–12.6) years, the incidences of AF, CAD, and ischemic stroke were 4.6, 2.9 and 1.1 per 100 person-years, respectively. Compared to individuals with HbA1c < 5.7% and low PRS, individuals with HbA1c ≥ 6.5% and high PRS had a 2.67-times higher risk for AF (hazard ratio [HR], 2.67; 95% confidence interval (CI), 2.43–2.94), 5.71-times higher risk for CAD (HR, 5.71; 95% CI, 5.14–6.33) and 2.94-times higher risk for ischemic stroke (HR, 2.94; 95% CI, 2.47–3.50). In the restricted cubic spline models, while a U-shaped trend was observed between HbA1c and the risk of AF, dose-dependent increases were observed between HbA1c and the risk of CAD and ischemic stroke regardless PRS tertile.ConclusionsOur results suggest that the nature of the dose-dependent relationship between HbA1c levels and cardiovascular disease in individuals with different PRS is outcome-specific. This adds to the evidence that PRS may play a role together with glycemic status in the development of cardiovascular disease.

ROLE OF GLYCATED HEMOGLOBIN (HbA1c) ON SEVERITY OF ISCHEMIC STROKE IN PATIENTS WITH (TYPE1AND 2) DIABETES MELLITUS

Diabetes mellitus is a metabolic disorder that can interact with atherosclerosis in ischemic strokes to initiate, activate and propagate vascular events. Glycated hemoglobin (HbA1c) has emerged as a useful biochemical marker reflecting the average glycemic control over the last 3 months, its prognostic value in the acute neurological conditions such as stroke is still not well-established. To study the effect of glycemic status (HbA1c) on severity of acute ischemic stroke in patients with diabetes (type1 and 2) at admission. This was a prospective cross sectional, hospital-based study done at Aden public and private hospitals for a period of thirteen months (January 2020 to February 2021). We evaluated 75 diabetic patients with acute ischemic stroke which was confirmed by brain computed tomography (CT scan). All subjects had blood hemoglobin A1c (HbA1c) measured at admission. They were classified into two groups according to the level of HbA1c: good glycemic control group ((GGC)) HbA1c&lt;7.0% and poor glycemic control group((PGC))) HbA1c ≥7). Neurological impairment was evaluated by using the National Institutes of Health Stroke Scale (NIHSS). A higher percentage of patients (84%) with acute ischemic stroke had elevated HbA1C levels (≥7), High percentage of patients in PGC (66.7%) as well as who were in GGC (75%) had moderate to severe stroke (NIHSS &gt;8). The association between stroke severity and HbA1C levels on admission was statistically not significant (P value&gt; 0.05). We found that HbA1c cannot be used for predication of severity in diabetic patients with ischemic stroke. Our results provide evidence that although chronic hyperglycemia increases risk of stroke, it is not associated with increased stroke severity.

Attention to Innate Circadian Rhythm and the Impact of Its Disruption on Diabetes.

Novel strategies are required to reduce the risk of developing diabetes and/or clinical outcomes and complications of diabetes. In this regard, the role of the circadian system may be a potential candidate for the prevention of diabetes. We reviewed evidence from animal, clinical, and epidemiological studies linking the circadian system to various aspects of the pathophysiology and clinical outcomes of diabetes. The circadian clock governs genetic, metabolic, hormonal, and behavioral signals in anticipation of cyclic 24-hour events through interactions between a "central clock" in the suprachiasmatic nucleus and "peripheral clocks" in the whole body. Currently, circadian rhythmicity in humans can be subjectively or objectively assessed by measuring melatonin and glucocorticoid levels, core body temperature, peripheral blood, oral mucosa, hair follicles, rest-activity cycles, sleep diaries, and circadian chronotypes. In this review, we summarized various circadian misalignments, such as altered light-dark, sleep-wake, rest-activity, fasting-feeding, shift work, evening chronotype, and social jetlag, as well as mutations in clock genes that could contribute to the development of diabetes and poor glycemic status in patients with diabetes. Targeting critical components of the circadian system could deliver potential candidates for the treatment and prevention of type 2 diabetes mellitus in the future.

Effect of probiotic supplementation on lipoprotein-associated phospholipase A2 in type 2 diabetic patients: a randomized double blind clinical controlled trial

BackgroundIt has been recently reported that lipoprotein-associated phospholipase A2 (Lp-PLA2) may predict the risk of cardiovascular disease. The effect of multi-strain probiotics on Lp-PLA2 in patients with type 2 diabetes is still not clear.AimsThis study aimed to determine the effect of multi-strain probiotic supplementation on lipoprotein-associated phospholipase A2, and glycemic status, lipid profile, and body composition in patients with type 2 diabetes.MethodsIn this randomized double-blind placebo-controlled clinical trial, 68 participants with type 2 diabetes, in the age group of 50–65 years, were recruited and randomly allocated to take either probiotic (n = 34) or placebo (n = 34) for 12 weeks. The primary outcome was lipoprotein-associated phospholipase A2, and secondary outcomes were glycemic parameters, lipid profile, anthropometric characters, and body composition (fat mass and fat-free mass).ResultsThere was a significant reduction in serum lipoprotein-associated phospholipase A2, in the probiotic group, it dropped by 6.4 units at the end of the study (p < 0.001) compared to the placebo group. Probiotic supplementation also resulted in a significant improvement in the hemoglobin A1c and high-density lipoprotein cholesterol 1.5% (p < 0.001) and 6 mg/dl (p 0.005), respectively. There were no significant changes in other outcomes.ConclusionProbiotic supplementation was beneficial for reducing Lp-PLA2 and hemoglobin-A1c and improving high-density lipoprotein cholesterol, which may suggest an improvement in the prognosis in patients with type 2 diabetes.

Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus.

Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile. The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT. The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation. The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.

Evaluation of Glycosylated Hemoglobin Levels and Effect of Tobacco Smoking in Periodontally Diseased Non-Diabetic Patients.

Chronic diseases have progressively increased worldwide, impacting all areas and socioeconomic groups. Periodontal disease is an increasing global concern and contains risk factors similar to other chronic illnesses. The main risk factor for periodontitis is smoking. Smoking not only hastens periodontal disease but also complicates periodontal therapy. Serum glycosylated hemoglobin levels, which are derived from the average life span of an erythrocyte, are a good indicator of glycemic management during the preceding one to three months. This study was undertaken to assess the association between tobacco smoking and periodontal disease by evaluating plaque score, gingival score, extent and severity index (ESI), and glycemic status by estimating serum HbA1c in cigarette smoker patients compared to non-smokers. The study was conducted with 40 patients in the age range of 20-40 years. Patients were divided into two groups: non-smokers (Group I) and cigarette smokers (Group II). Periodontal clinical parameters such as the plaque index (PI), gingival index (GI), and ESI were recorded during the oral cavity examination. The biochemical marker, serum glycosylated hemoglobin, was measured in both groups. All parameters were measured at baseline and three months after periodontal therapy. The statistical tests used were the paired t-test, and Chi-square test for comparison between both groups. The mean difference of PI of non-smokers was 0.33 ± 0.30, and smokers were 0.52 ± 0.32, which was statistically significant. The mean difference of GI of non-smokers was 0.34 ± 0.19 and smokers 0.36 ± 0.303, which was statistically significant. The mean difference of extent in non-smokers was 5.33 ± 1.59, 5.52 ± 2.43, and smokers were 0.18 ± 0.17. The mean difference in severity in non-smokers was 0.18 ± 0.17, and smokers were 0.31 ± 0.25, which was statistically significant. The mean difference of HbA1c in non-smokers and smokers was 0.43 ± 0.277 and 0.415 ± 0.230, which shows a higher mean difference in non-smokers, which was statistically non-significant. This study concluded that each of Group I and Group II showed substantial improvements in all clinical periodontal variables, which include plaque index (PI), gingival index (GI), extent and severity index (ESI), and biochemical marker serum glycosylated hemoglobin. Controlling inflammation with SRP can improve insulin resistance, lower glucose levels, and prevent non-enzymatic glycation of hemoglobin.

Association of Neutrophil-Lymphocyte Ratio (NLR) with Prediabetes and Type-2 Diabetes Mellitus

Background: Diabetes mellitus and associated complications are related to systemic inflammation and insulin resistance. Recently NLR has been used as a marker of the systemic inflammatory process in chronic diseases. NLR is a widely available inexpensivehematological parameter and can be used in the prediction of diabetes-related complications. Objectives: The present study aimed to explore the association of NLR with the glycemic status of pre-diabetes and type 2 DM in comparison to normal healthy adults. Methods: A total of 105 study subjects were included.Fasting plasma glucose (FPG), 2 hours after 75gm glucose load (2 hrs PG), HbA1c, and Complete blood count (CBC) tests were done.Then the study subjects were categorized into Group 1 (Normal healthy adult), Group 2 (Pre-diabetes), and Group 3 (Diabetes). Each group contains 35 study subjects. Data (collected in preformed proforma) were analyzed by SPSS Version 22-0. Comparison of various parameters was done by Chi-Square test, ANOVA test, and Kruskal-Wallis test followed by post-hoc test. Spearmen correlation coefficient test was done to see the correlation of NLR with glycemic status (FPG, 2 hrs PG, and HbA1c). Results: Age and sex were not statistically significant.Median values of FPG, 2hrs PG, and HbA1c were significantly higher in Group 2 and Group 3 in comparison to Group 1(p-value &lt;0.001). Median values of NLR were significantly higher in Group 2 and Group 3 in comparison to Group 1 (p&lt;0.001). NLR was also positively correlated with 2hrs PG and HbA1c in Group 2 and Group 3 with p values 0.034, 0.013 &amp; 0.019, and 0.036 respectively. Group 1 showed no significant correlation with NLR. Conclusion: This study showed that NLR was higher in both pre-diabetes and type 2 DM with a positive correlation. It can be used in the prediction of dysglycemia-related complications in the future.

Psychosocial Well-being among Diabetic Individuals

Background: Quality of life (QoL) assessment is considered an important outcome measure in chronic disease management. With an increase in the prevalence of diabetes in India, it becomes imperative to assess QoL in diabetic patients for their better care and control. The present study aimed to assess the QoL among diabetic patients attending the diabetic outpatient clinic and probe its association with glycemic status and management. Methodology: A cross-sectional study was conducted for 4 months among 185 type 2 diabetes mellitus (T2DM) patients. Information on sociodemographic profile, diabetic history, and current medications was obtained. QoL was assessed using the General Health Questionnaire-28 (GHQ-28). The results were statistically analyzed. Results: Using GHQ-28, the psychosocial components of the patients in the fields related to somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression were assessed. Significantly higher GHQ scores (P &lt; 0.05) were noted in T2DM patients with higher glycated hemoglobin and increased plasma glucose levels, suggesting stronger associations of poorer QoL with compromised glycemic status. Insulin users exhibited higher GHQ scores (higher scores for depression subdomains) compared to noninsulin users. QoL was also found significantly dependent on the duration of diabetes and other comorbidities. Conclusion: The psychosocial well-being of the patients is significantly impacted in cases of chronic ailments like diabetes which adds to the total disease burden eventually. The present study warrants periodic assessment of QoL in diabetic individuals as a part of routine care along with advise of psychiatric counseling for those in need.

Associations of heavy metal exposure with diabetic retinopathy in the U.S. diabetic population: a cross-sectional study.

Mounting evidence suggests a correlation between heavy metals exposure and diabetes. Diabetic retinopathy (DR) is a prevalent and irreversible complication of diabetes that can result in blindness. However, studies focusing on the effects of exposure to heavy metals on DR remain scarce. Thus, this study aimed to investigate the potential correlation between heavy metals exposure and DR. A total of 1,146 diabetics from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 were included in this study. Heavy metal levels were measured via urine testing. Weighted logistic regression, Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS) regression, and restricted cubic spline (RCS) were utilized to investigate the potential relationships between exposure to 10 heavy metals and DR. Finally, subgroup analysis was conducted based on the glycemic control status. Among the 1,146 participants, 239 (20.86%) were diagnosed with DR. Those with DR had worse glycemic control and a higher prevalence of chronic kidney disease compared to those without DR. Moreover, both the WQS regression and BKMR models demonstrated a positive relationship between exposure to mixed heavy metals and the risk of DR. The results of weighted logistic regression revealed a positive correlation between cobalt (Co) and antimony (Sb) exposure and the risk of DR (OR = 1.489, 95%CI: 1.064-2.082, p = 0.021; OR = 1.475, 95% CI: 1.084-2.008, p = 0.014), while mercury (Hg) exposure was found to promote DR exclusively in the group with good glycemic control (OR = 1.509, 95% CI: 1.157-1.967, p = 0.003). These findings were corroborated by the results of the RCS analysis. Heavy metal exposure is associated with an increased risk of DR, especially Sb, Co, and Hg exposure. Nevertheless, well-designed prospective studies are warranted to validate these findings.

Estimation of Serum Adenosine Deaminase Levels as a Marker for Risk Assessment and Immunomodulation in Patients with Diabetic Foot

Introduction: Diabetic foot ulcers are critical complications of uncontrolled diabetes, with peripheral neuropathy, peripheral arterial disease, and immune suppression as primary contributing factors. Adenosine Deaminase (ADA), an enzyme, has been identified as a promising marker for cell-mediated immunity. Its estimation may serve as a predictive marker for immunomodulation, which, in turn, leads to complications among individuals with diabetes. Aim: To estimate serum ADA levels in diabetic patients without diabetic foot and diabetic patients with diabetic foot. Additionally, the study aimed to investigate the association of ADA serum levels with glucose, Glycated Haemoglobin (HbA1c), and the severity of wounds. Materials and Methods: This cross-sectional study was conducted in the central laboratory Department of Biochemistry at Krishna Rajendra Hospital (KR Hospital), Mysuru Medical College and Research Institute, Mysuru, India, from August to September 2021. The study included diabetic foot cases (n=45) and Type 2 diabetes patients on regular follow-up in the Department of Medicine without diabetic foot and any other complications (n=45). Venous blood samples were analysed for ADA, glucose, HbA1c, and complete blood count. The data were statistically analysed using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman rank correlation test. Results: The present study observed a higher incidence of diabetic foot among males. It showed a statistically significant increase in serum ADA, HbA1C, and neutrophil count in patients with diabetic foot compared to patients with diabetes without diabetic foot ulcers, with mean Standard Deviation (SD) of 71.79±25.11, 11.53±3.11%, and 75.91±9.77%, respectively. Serum ADA exhibited a positive correlation with HbA1C and different grades of ulcers. Conclusion: The present study demonstrated a significantly increased serum ADA in diabetic ulcers and a positive correlation with different grades of ulcers. This finding contributes to a better understanding of the disease's pathogenesis at different stages. Furthermore, the positive correlation between ADA and HbA1C levels may play an important role in predicting the glycaemic and immunological status of these patients

Comparative analysis of hemodialysis and peritoneal dialysis on the risk of new onset diabetes mellitus

BackgroundDiabetes mellitus is a significant risk factor for cardiovascular events and mortality in dialysis patients. The impact of different dialysis modalities on the risk of new onset diabetes mellitus (NODM) remains a subject of debate. Previous studies did not adequately account for critical confounding factors such as pre-dialysis glycemic status, medication use, and nutritional status, which may influence the association between dialysis modality and NODM risk. MethodsWe conducted a retrospective cohort study of 1426 non-diabetic end-stage renal disease (ESRD) patients who underwent either hemodialysis (HD) or peritoneal dialysis (PD) at a single medical center. We used different statistical methods, adjusting for potential confounding factors, and accounted for competing risk of death. ResultsOver 12 years, 331 patients (23 %) developed NODM. After adjusting for potential confounding factors and mortality, PD patients had a significantly higher risk of NODM compared to HD patients (adjusted HR 1.52, p = 0.001). A propensity-matched cohort sensitivity analysis yielded similar results. Among patients with prediabetes, those receiving PD had a 2.93 times higher risk of developing NODM than those receiving HD (p for interaction <0.001), whereas no significant difference was observed among euglycemic patients. NODM was also associated with a 1.78 times increased risk of major cardiovascular events. ConclusionOur study provides evidence that PD treatment may increase the risk of NODM in ESRD patients, particularly among those with preexisting prediabetes. These findings highlight the importance of personalized treatment approaches, and nephrologists should consider prediabetes when choosing the dialysis modality for their patients.

Plant-based diets, mediating biomarkers, and mortality risk among adults with diabetes or prediabetes.

Background: A healthy eating pattern characterized by a higher intake of healthy plant foods has been associated with a lower risk of premature mortality, but whether this applies to individuals with varying glycemic status remains unclear. Methods: This study included 4621 participants with diabetes and 8061 participants with prediabetes from the US National Health and Nutrition Examination Survey (2007-2016). Using the dietary data assessed by two 24 h dietary recalls, a healthful plant-based diet index (hPDI) and an unhealthful plant-based diet index (uPDI) were created based on 15 food groups and were assessed for their relationships with mortality risk. Results: Over a median follow-up of 7.2 years, there were 1021 deaths in diabetes and 896 deaths in prediabetes. A higher hPDI (highest vs. lowest quartile) was associated with a 41% (HR = 0.59, 95% CI: 0.49-0.72; P-trend < 0.001) lower risk of all-cause mortality in diabetes and a 31% (HR = 0.69, 95% CI: 0.55-0.85; P-trend < 0.001) lower risk in prediabetes. A higher uPDI was associated with an 88% (HR = 1.88, 95% CI: 1.55-2.28; P-trend < 0.001) higher risk of mortality in diabetes and a 63% (HR = 1.63, 95% CI: 1.33-1.99; P-trend < 0.001) higher risk in prediabetes. Mediation analysis suggested that C-reactive protein and γ-glutamine transaminase explained 6.0% to 10.9% of the relationships between hPDI or uPDI and all-cause mortality among participants with diabetes. Conclusions: For adults with diabetes as well as those with prediabetes, adhering to a plant-based diet rich in healthier plant foods is associated with a lower mortality risk, whereas a diet that incorporates less healthy plant foods is associated with a higher mortality risk.

Interaction Of Newly Developed Markers Of Insulin Resistance And Liver Fibrosis

Introduction: Insulin resistance is one of the most common causes of liver fibrosis. Instead of the Homeostatic Model Assessment- Insulin Resistance (HOMA-IR) index, which has been used to indicate insulin resistance for many years, Triglyceride-Glucose index (TyG) has recently been used, which is thought to be more predictive. (AST) to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) are newly developed markers to indicate liver fibrosis. In this study, we aimed to examine the relationship between TyG and HOMA-IR and APRI and FIB-4. Material and Methods: 8618 patients who applied to Turgut Özal Medical Center internal medicine outpatient clinic between March 2019 and March 2024 were retrospectively examined. APRI and FIB-4 levels were compared in patients by grouping them by age and as having/not having insulin resistance according to TyG and HOMA-IR Results: There was a statistically significant positive correlation between TyG with APRI and FIB4. (ρ= 0.041, p&lt;0.001 for APRI and ρ= 0.109, p&lt;0.001 for FIB4). There was a significant difference in APRI and FIB-4 in the grouping made according to the presence of insulin resistance. In the grouping made according to glycemic status, FIB-4 was significantly different among all subgroups( p&lt;0.001 for each), while there was no significant difference in APRI. Conclusion: Insulin resistance is one of the conditions that should be closely monitored not only because it predisposes to diabetes but also because it causes dysfunction in liver. Newly diagnosed indexes may be useful to folow-up this patient before any symptoms ocur. Widespread use of these indices especially FIB-4 index which we claim that it is more predictive than others, in clinical practice may be beneficial due to their predictive effects and noninvasiveness.

Propolis attenuates diabetes-induced testicular injury by protecting against DNA damage and suppressing cellular stress.

Introduction: Propolis has a wide range of biological and pharmacological actions, including antioxidant properties-particularly its phenolic and flavonoid constituents-that could potentially protect the reproductive system from oxidative damage. Method: Four groups were allocated 40 male Wistar rats each. The vehicle was given to the first group's normal control rats negative control. The second, third, and fourth groups of diabetic rats were given vehicle (diabetic control) and propolis orally at 50 and 100mg/kg, respectively, for 8weeks. Diabetes was induced in rats via injection of nicotinamide and streptozotocin (STZ). Fasting blood glucose (FBG) and insulin levels, homeostatic model assessment for insulin resistance (HOMA-IR), and semen analysis were assessed. In addition, assessments of serum reproductive hormones, including total testosterone (TTST), estradiol (E2), follicle-stimulating hormone luteinizing hormone (LH), and prolactin (PRL), were measured at the end of the study. Tissue total testosterone, E2, and dihydrotestosterone were also evaluated. Serum and tissue oxidative enzymes, including catalase (CAT), superoxide dismutase, and glutathione peroxidase activities, were examined, and malondialdehyde content was determined. The pancreatic and testicular tissues were histopathologically examined, and proliferating cell nuclear antigen (PCNA) and B-cell lymphoma 2 (Bcl-2) in testicular tissue were immunohistochemically analyzed. Testicular tissue was examined for DNA integrity using a comet assay. Results: Compared to the STZ-control group, propolis greatly decreased FBG levels and improved the glycemic status of diabetic rats. In comparison to the STZ-DC group, propolis increased the number of sperm cells and the percent of morphologically normal and viable sperm in male rats, improving their fertility. Propolis also restored the pancreatic islets, protected the testis from oxidative stress, and increased levels of reproductive hormones in the blood, especially testosterone. Moreover, propolis at high doses demonstrated a strong positive response for Bcl-2 and a negative expression of proliferating cell nuclear antigen in spermatogenic cells. Conclusion: The data obtained strongly indicate that STZ causes severe impairments to the testis whereas propolis, acting as an antioxidant, protects against the adverse effects of STZ on the testis.

Impact of diabetes mellitus and other systemic diseases on oral health and tooth mortality.

Poor oral health in systemically diseased individuals besides worsening the glycaemic status also has functional, social consequences such as masticatory inefficiency and stigmatized social participation, respectively. Periodontal problems remain one of the most common reasons for tooth mortality along with tooth decay and trauma. The study was conducted in the outpatient department of teaching dental institution among the individuals visiting the institution. Persons with systemic illness were included in the study. In the preliminary step, interviews were conducted among the study participants regarding health status followed by an oral health examination. The oral health examination included recording of community periodontal index and dentition status. Data were collected and statistical analyses were performed. Chi-square test, one-way ANOVA and Bonferroni post-hoc tests were used to analyze the data. Patients with diabetes showed the highest (3.56 ± 2.98) number of missing teeth, followed by other systemic diseases (2.78 ± 2.74), and the patients who were not having any systemic diseases (1.81 ± 1.54). This distinction was found to be statistically significant (P = 0.001), and Bonferroni post-hoc shows statistical significance (P < 0.05) in group-wise comparisons. The number of teeth last due to caries among diabetics was higher (20.8%) when compared to nondiabetic (12.2%), and the most tooth loss due to periodontitis was also observed within the patients with diabetes (21%) when compared to patients with other systemic diseases (12%), which is statistically significant (P = 0.001). The current study revealed tooth loss is more common in the patients who have systemic diseases when compared to the patients who do not have any systemic diseases, while dental caries and periodontal problems are the principle causes of tooth mortality.