Higher Prevalence Of Diabetes Mellitus Research Articles

Extract of cell culture Rejasa (Elaeocarpus grandiflorus) Decrease Blood Glucose Through Insulin Receptor Pathway

Diabetes mellitus is a metabolic disease characterized by the high blood glucose levels. The high prevalence of Diabetes Mellitus needed an innovation in prevention, treatment and control of case. Rejasa (Elaeocarpus grandiflorus) is one of plants has the potential to develop as an antidiabetic. The pretest and posttest control group design were conducted to 30 Rattus norvegicus Wistar strain. The rats induced alloxan monohydrate intraperitoneally at dose of 125 mg/kg BW once day until the blood glucose above 200 mg/dL The hyperglycemic rats were divided into 5 groups, that were negative control (K-), positive control (K+, given glibenclamide 0.072 mg/200 gBW), P1 (given E. glandiflorus cell extract 1 mg/kgBW), P2 (given E. glandiflorus cell extract 10 mg/kgBW), and P3 (given E. glandiflorus cell extract 100 mg/kgBW). The rats were given E. glandiflorus and glibenclamide orally for 10 days. Measurement of blood glucose levels was carried out on day 0 and day 10, after 10 h fasting. The mechanism of antidiabetic effect of E. glandiflorus was explored by in silico. The mean of blood glucose levels on day 0 were 455.2 mg/dL (K), 422.8 mg/dL (K+), 469.8 mg/dL (P1), 355.5 mg/dL (P2) and 446 mg/dL (P3). The blood glucose levels on day 10 were 367.8 mg/dL (K-), 89.6 mg/dL (K+), 285.6 mg/dL (P1), 136.8 mg/dL (P2) and 104.8 (P3). Statistical analysis showed the difference between K- from P2(p=0.015) and P3 (p0.001). When compared with K+, only P3 showed no difference (p=0.873). Flavonoid of E. glandiflorus act on insulin receptor pathway and involved HK2, PTPN1, AKT1, PI3KR1, HRAS and GSK3B protein. These results showed that extract cell of E. glandiflorus have antidiabetic activity on insulin receptor pathway.

Does Non-Alcoholic Steatohepatitis Independently Increase the Risk of Venous Thromboembolism?

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. Studies have shown a strong association between NASH (non-alcoholic steatohepatitis) cirrhosis and portal vein thrombosis (PVT). Data is scarce on the association of NASH and venous thromboembolism (VTE), with one such study predicting a 2.5-fold increased risk for VTE in comparison to other liver diseases in hospitalized patients. The mechanism is believed to be hepatocellular injury causing a chronic inflammatory state leading to unregulated activation of procoagulant factors. There is no prior analysis of the degree of steatosis and fibrosis (measured on transient elastography, commonly known as Fibroscan®) in NASH patients and its association with VTE. We performed an analysis to study the risk of unexplained VTE in patients with NASH. Methods: In our case-control study, we included patients with a documented diagnosis of NASH and excluded patients with inherited thrombophilia, hemoglobinopathy, malignancy, alcohol use disorder, autoimmune hepatitis, and primary biliary cirrhosis. Collected data included age, tobacco use, recreational drug use, medical history, and vibration-controlled transient elastography (VCTE) scores. Venous thromboembolism specific data included location, type of anticoagulant, need for hospital stay, and history of VTE recurrence. Steatosis was categorized as S0-S1 (mild) and S2-S3 (moderate to severe) based on the controlled attenuation parameter (CAP) score. Fibrosis was classified based on the kilopascal(KPA) score and graded as F0-F1 (metavir stage), F2, F3, and F4(cirrhosis). Chi-square and Mann-Whitney U tests were used for qualitative and quantitative variable analysis, respectively. Furthermore, we computed logistic regression using VTE as a dependent variable. Results: A total of 415 patients were analyzed, and 386 met the inclusion criteria (Figure 1). Fifty-one patients were in the VTE group and 335 in the non-VTE group. Patients with VTE had a mean age of 60.63 years compared to 55.22 years in the non-VTE group (p=0.014). Patients with VTE had a higher body mass index (31.14 kg/m² vs. 29.30 kg/m²) and a higher prevalence of diabetes mellitus (29.4% vs. 13.1%, p=0.002). The history of NASH was significantly higher in the VTE group (45.1% vs. 30.4%, p=0.037). Further, moderate to severe steatosis was significantly higher in the VTE group (66.7% vs. 47.2%, p=0.009). Similarly, the F2-F4 fibrosis grade had a higher prevalence of 58.8 % in the VTE group compared to 38.5% in the non-VTE group (p=0.006) (Table 1). On logistic regression, using VTE as a dependent variable, diabetes mellitus type II had an OR =1.702 (p = 0.015) and F2-F4 fibrosis grade had an OR = 2.5 (p=0.033). In the VTE group, 58.8% had deep vein thrombosis (DVT), 17.6 % had superficial venous thrombosis (SVT), 13.7 % had pulmonary embolism (PE), 5.9% had portal vein thrombosis, and embolic stroke (3.9%). The most common location of VTE was the lower extremity (56.9%), followed by the upper extremity (19.6%). Right-sided VTE (66.7%) was more common and a majority of patients (74.5%) required hospital admission with 2% requiring ICU admission. Concerning anticoagulation 64.71% of patients were on direct oral anticoagulants (DOAC), 25.5% were on warfarin, and 84.3% of patients continued indefinite anticoagulation. Discussion: Our analysis shows that NASH is an independent risk factor for VTE, especially DVT. Demographics including gender, tobacco use, alcohol consumption, and ethnicity, were equally distributed between the two groups. There is a statistically significant association between the incidence of VTE and moderate to severe steatosis and fibrosis. The current management strategy for NASH includes abstinence from alcohol and intense lifestyle modification to lose weight. Newer medications like glucagon-like peptides (semaglutide) and bariatric surgery are other recommended modalities for weight loss. All hospitalized patients should be considered for medical thromboprophylaxis, particularly in those with NASH, where a high index of suspicion for VTE should be maintained even in the presence of thromboprophylaxis. Additional studies are needed to analyze the risk of bleeding in this patient population who continue indefinite anticoagulation. Another area of interest would be to determine the reversibility of VTE risk with appropriate management of NAFLD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 12160: Sex Differences in Outcomes of Percutaneous Coronary Intervention in Octogenarians: A Retrospective Cohort Study From National Inpatient Sample 2016-2019

Introduction: The role of sex-based differences in the outcomes after principal percutaneous coronary intervention (PCI) in octogenarians is not well studied. Hypothesis: There are no differences in outcomes of PCI in octogenarians based on sex. Methods and Results: From 2016 to 2019, 37,147 hospitalizations (unweighted sample) for principal PCI procedures were identified. Among the principal PCI procedures performed, 44.9% (n = 16,660) were performed in females, and 55.2% (n = 20,487) in males (p < 0.001), 82.4% in Whites, 5.4% in Blacks, 6.4% in Hispanics, and 2.6% in Asians. 20,986 (56.5%) principal PCI hospitalizations had a Charlson comorbidity index (CCI) of three or higher. The mean age for Octogenarians was 83.6 ± 2.7 years. Compared to males, the females were slightly older (mean age: 83.8 vs. 83.5; p < 0.001), had higher prevalence of diabetes mellitus (20.5% vs 18%, p<0.001) and lower Charlson comorbidity index (CCI) of three or higher (53.6% vs. 58.9%, p <0.001). Females had higher incidence of cardiogenic shock (4.9% vs 4.2%, p=0.002), higher in-hospital mortality (4% vs 3%, p<0.001) and longer length of stay (LOS) (4.4 days vs 4.1 days, p<0.001). Multivariate regression analysis showed that, compared to males, females had a significantly higher odds of in-hospital mortality (aOR: 1.23; 95% CI: 1.10, 1.37; p <0.001) and cardiogenic shock (aOR: 1.17; 95% CI: 1.06, 1.30; p=0.002) after controlling for age, race, hospital region, hospital teaching status, income, insurance provider, and CCI. From 2016-2019, in octogenarians, the annual incidence of principal PCI hospitalizations increased from 127 per 100,000 hospitalizations in 2016 to 137 per 100,000 hospitalizations in 2019, p<0.001. Conclusions: The incidence of PCI done in octogenarians is rising every year. Females have an increased likelihood of in-hospital mortality, longer LOS, and cardiogenic shock.

Preoperative thromboelastography in the prediction of post-tonsillectomy hemorrhage by coblation tonsillectomy: a post-hoc analysis.

Post-tonsillectomy hemorrhage (PTH) affects around 4% of patients after tonsillectomy. We hypothesized that preoperative thromboelastography (TEG) might identify patients at higher risk of PTH. Investigate whether evaluation of coagulation function by preoperative TEG might help to predict PTH after tonsillectomy by coblation tonsillectomy (TE). Post-hoc analysis of randomized controlled study. Otolaryngology Department between January 2017 and August 2019. This post-hoc analysis included adults who underwent coblation TE for benign tonsillar disorders. Routine blood tests and TEG were performed preoperatively. The TEG parameters evaluated included coagulation reaction time (R) and maximum thrombus amplitude (MA). The main outcome was PTH during the 4-week postoperative period. 284 RESULTS: The 19 patients (6.7%) that experienced PTH had a higher prevalence of diabetes mellitus, lower use of intraoperative suturing, fewer patients with grade I and II tonsillar enlargement, a higher white blood cell count, lower platelet count, lower fibrinogen level, lower R value, and a lower MA value than patients without PTH (all P<.05). Multivariate logistic regression revealed that diabetes mellitus (P<.053), fibrinogen level ≤2.735 g/L (P<.027), R≤6.55 min (P<.011) and MA≤59.15 mm (P<.012) were independently associated with PTH. A regression model incorporating these four factors predicted PTH with a sensitivity of 73.7% and specificity of 83.8%. Preoperative evaluation of diabetes mellitus history, fibrinogen level, and TEG parameters might help to identify patients at higher risk of PTH after coblation TE. Single-center study with a small sample size; possibly underpowered statistically. TEG measurements might not accurately reflect coagulation function, and a validation cohort was unavailable. None. CHINESE CLINICAL TRIAL REGISTRY NUMBER OF STUDY USED IN THIS ANALYSIS: ChiCTR2000032171. http://www.chictr.org.cn/showprojen.aspx?proj=52553.

B7-H4 Polymorphism Influences the Prevalence of Diabetes Mellitus and Pro-Atherogenic Dyslipidemia in Patients with Psoriasis.

The co-inhibitory molecule B7-H4 is located in the genomic regions associated with type 1 diabetes (T1D) susceptibility. However, the correlation of B7-H4 with glycometabolism and dyslipidemia has never been studied. To explore the influence of B7-H4 polymorphism on the prevalence of diabetes mellitus (DM) and dyslipidemia in psoriasis. In this single-center cross-sectional study, we recruited 265 psoriatic patients receiving methotrexate (MTX) treatment. Thirteen single-nucleotide polymorphisms (SNPs) in B7-H4 were genotyped. Serum levels of total cholesterol (TC), triglycerides (TG), lipoprotein (a) (LP(a)), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were measured at baseline and week 12. The GG genotype carriers of rs12025144 in B7-H4 had a higher prevalence of DM (57.14% vs. 17.71% vs. 18.67%, p = 0.0018), and had a poorer response to MTX in diabetic patients (p &lt; 0.05), compared with AA or AG genotype carriers. The AG genotype of rs2066398 was associated with higher levels of pro-atherogenic lipids. MTX significantly downregulated the level of anti-atherogenic lipid ApoA1 in AA genotype carriers of rs2066398. The genotypes rs12025144 and rs2066398 in B7-H4 were correlated with a higher prevalence of DM and dyslipidemia in psoriasis, respectively.

Vitiligo and Crohn′s disease form an autoimmune cluster: insights from a population-based study

Background While the coexistence of vitiligo and Crohn′s disease (CD) has been reported in individual patients, the epidemiological association between these autoimmune conditions remains inconclusive. Objective To assess the bidirectional association between vitiligo and CD. Methods A population-based study was performed to compare vitiligo patients (n = 20,851) with age-, sex- and ethnicity-matched control subjects (n = 102,475) regarding the incidence of new-onset and the prevalence of preexisting CD. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were calculated by multivariable Cox regression and logistic regression, respectively. Results The incidence rate of new-onset CD was evaluated at 3.6 (95% CI, 2.7–4.9) cases per 10,000 person-years (PY) in patients with vitiligo and 2.4 (95% CI, 2.0–2.9) cases per 10,000 PY in controls. Patients with vitiligo experienced an elevated risk of CD (fully adjusted HR, 1.60; 95% CI, 1.10–2.34; p = 0.015). Congruently, a history of preexisting CD predicted elevated odds of having subsequent vitiligo (fully adjusted OR, 1.49; 95% CI, 1.15–1.93; p = 0.002). Compared to other patients with vitiligo, those with vitiligo and comorbid CD were older and had a higher prevalence of diabetes mellitus, hyperlipidemia, and hypertension but a comparable all-cause mortality rate. Conclusions The current study depicts a robust bidirectional association between vitiligo and CD. This knowledge is of clinical implication for physicians managing patients with both conditions. The diagnostic threshold for CD should be lowered in vitiligo patients with compatible symptoms.

Pancreatic cancer, pancreatogenic diabetes, type 2 diabetes mellitus

Pancreatic cancer (PC) is the fourth leading cause of death among all types of cancer. PC is very aggressive with a low 5-year overall survival rate. The highest prevalence of diabetes mellitus (DM), significantly exceeding the average population, is registered among patients with prostate cancer Recommendations for systemic screening of patients with diabetes for the detection of PC are not standardized. The purpose of this review is to present an analysis of current literature data on pathogenetic relationships between DM and PC and prospects for PC screening. Research data indicate that there is a bidirectional relationship between DM and PC, in which DM can act either as a risk factor for PC or as a marker of paraneoplastic syndrome of PC. In the differential diagnosis of type 2 diabetes, pancreatogenic diabetes and diabetes associated with PC, a set of clinical signs can be used. Patients with DM who have additional signs/symptoms of increased risk can be considered as a group subject to mandatory screening. Numerous studies of various proteomic, metabolomic, genetic and transcriptomic biomarkers PC have been published. The search for an easy-to-use clinically useful and cost-effective PC marker is still ongoing.

Clinical routines for diabetes screening and treatment in cardiac rehabilitation improves detection and treatment of diabetes mellitus in patients with myocardial infarction

Abstract Background Patients with myocardial infarction (MI) have a high prevalence of diabetes mellitus (DM). Prognosis in patients with MI and DM is substantially worse than for those without DM. An unacceptably high proportion of patients with DM remain both undiagnosed and undertreated despite follow-up at cardiac rehabilitation (CR) centres. Purpose Using nationwide survey and registry data to investigate associations of clinical routines for DM screening and treatment at CR centres in Sweden with detection and treatment of DM at one-year post-MI. Methods Data on CR clinical routines were derived from the Perfect-CR survey, evaluating structures and follow-up processes at CR centres in Sweden (n=78). The response rate was 100% and missing data was minimal. Clinical routines for DM screening and treatment during CR (exposures) included the following: 1) laboratory assessments of fasting glucose and/or HbA1c as a part of initial patient assessment by a nurse, 2) routine use of oral glucose tolerance test (OGTT), 3) joint case rounds with diabetologists, and 4) whether diabetes medication is adjusted by cardiologists. Patient baseline and outcome data was derived from the national quality registry SWEDEHEART (n=7549). Primary outcome was DM incidence at one-year post-MI. Secondary outcome was the proportion of patients receiving diabetes medication other than insulin (secondary outcome). The association between exposures (for each clinical routine and cumulatively [0–4 work routines]) and outcomes was estimated using unadjusted and adjusted logistic regression, adjusting for relevant covariates. Results Number (%) of CR centres applying each of the clinical routines is shown in Table 1. The most common routine applied was fasting glucose and/or HbA1c being routinely evaluated at initial patient assessment (n=48 (62%)), while the least common was CR centres having joint case rounds with diabetologists (n=7 (9%)). Twenty (26%) CR centres did not apply any of the clinical routines while 7 (9%) centres applied 3 or 4 routines. Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (CI) for incident DM are shown in Figure 1. Compared to not applying any routines, 1) applying one or more routines was positively associated higher DM incidence at one-year post-MI (p for trend in unadjusted and adjusted models &amp;lt;0.001. Figure 1), and 2) at centres where all four working routines were applied, the odds for patients being treated with diabetes medication was significantly higher (crude OR 2.37 [1.80–3.13], adjusted OR 1.78 [1.19–2.66]). Conclusion Applying structured clinical routines for DM screening and treatment within CR can improve detection and treatment of DM in patients with MI Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The current study was supported by The Swedish Research Council for Health, Working Life and Welfare (FORTE, grant number 2019-00365); The Swedish Heart and Lung Association (grant number 20190431); The Swedish Heart and Lung Patient Organization; The Swedish Cardiology Society; The faculty of Medicine, Lund University, Sweden; Astra Zeneca; and Amgen.

S1635 Gender-Related Difference on Demographics and Comorbidities of Gastroparesis

Introduction: Gastroparesis is known to be more prevalent in females than males, even though the pathophysiology behind it remains unclear. There is lack of gender specific comparison of gastroparesis in terms of demographics and comorbidities. The aim of the study was to compare the demographics and comorbidities of gastroparesis between female and male patients. Methods: Patients who had completed a gastric emptying study and diagnosed with gastroparesis were identified using a nationwide database, IBM Explorys (1999-2022). The following conditions were excluded: cyclical vomiting syndrome, psychoactive substance abuse, eating disorder, factitious disorder, chemotherapy, malignant tumor of esophagus and stomach, neoplasm of abdomen, gastric or intestinal obstruction, IBD, adhesion of intestine, carcinomatosis, perforation of intestine, Roux-en-Y gastrojejunostomy, and gastrectomy. Patients were subdivided into males and females. Demographic information, clinical symptoms and comorbidities were collected. Chi-square tests were performed to compare categorical data. Odds Ratios with a 95% confidence interval were reported. Results: A total of 17,570 patients were identified with gastroparesis, of which 13,090 (75%) patients were females and 4,390 (25%) patients were males. Females and males demonstrated similar trend in the distribution of ethnicity: most patients were White (76.6 vs 74.0%), followed by African American (13.0 vs 14.4%) and other races respectively (Table). There was a higher percentage of females than males in the younger age group: age 20-29 (F vs M: 5.3 vs 4.3%) and age 30-39 (F vs M: 13.8 vs 11.4%) respectively. Male patients with GP had a higher prevalence of diabetes mellitus (M vs F: 52.8 vs 42.8%) and other comorbidities, such as: hypertension (64.0 vs 54.5%), hyperlipidemia (57.2 vs 50.1%), chronic kidney disease (24.1 vs 15.8 %), coronary artery disease (26.4 vs 16.6 %) and smoking (16.6 vs 13.8%) (All P value < 0.0001) (Figure). Female patients had a higher prevalence of anxiety (F vs M: 41.3 vs 27.1%), depression (45.8 vs 31.7%), autoimmune conditions (13.8 vs 5.0%) and morbid obesity (15.6 vs 11.6%) (All P value < 0.0001). Conclusion: Female and male patients with gastroparesis demonstrate similar ethnic distribution. There is a higher percentage of female patients than males in the younger age group. However, female and male patients demonstrate different comorbidities.Figure 1.: Comparison of Comorbidities Between Female and Male patients with Gastroparesis. Table 1. - Comparison of Demographics and Comorbidities Between Female and Male Patients with Gastroparesis Female (N=13090) % Male (N=4390) % OR P Age 20-29 690 5.3% 190 4.3% 1.04-1.45 0.0135 30-39 1810 13.8% 500 11.4% 1.12-1.39 < 0.0001 40-49 2370 18.1% 740 16.9% 1.00-1.19 0.0612 50-59 2710 20.7% 1060 24.1% 0.76-0.89 < 0.0001 60-69 2810 21.5% 970 22.1% 0.89-1.05 0.3811 70-79 2000 15.3% 720 16.4% 0.84-1.01 0.0760 80-89 930 7.1% 290 6.6% 0.94-1.24 0.2618 90 above 260 2.0% 80 1.8% 0.85-1.41 0.4963 Race Caucasian 10030 76.6% 3250 74.0% 1.06-1.24 0.0005 African American 1700 13.0% 630 14.4% 0.81-0.98 0.0215 Asian 110 0.8% 50 1.1% 0.06-0.09 < 0.0001 Hispanic/Latino 120 0.9% 40 0.9% 0.70-1.44 0.9733 Unknown/Other 1130 8.6% 420 9.6% 0.79-1.00 0.0595 Comorbidities DM 5600 42.8% 2320 52.8% 0.62-0.71 < 0.0001 HTN 7130 54.5% 2810 64.0% 0.63-0.72 < 0.0001 HLD 6560 50.1% 2510 57.2% 0.70-0.81 < 0.0001 CKD 2070 15.8% 1060 24.1% 0.54-0.64 < 0.0001 CAD 2170 16.6% 1160 26.4% 0.51-0.60 < 0.0001 Smoking 1810 13.8% 730 16.6% 0.73-0.88 < 0.0001 Anxiety 5410 41.3% 1190 27.1% 1.76-2.04 < 0.0001 Depression 6000 45.8% 1390 31.7% 1.70-1.96 < 0.0001 Autoimmune disease 1800 13.8% 220 5.0% 2.62-3.49 < 0.0001 Morbid obesity 2040 15.6% 510 11.6% 1.27-1.56 < 0.0001

Long-Term Follow-up of Complex Calcaneal Osteomyelitis Treated With Modified Gaenslen Approach.

The treatment of chronic calcaneal osteomyelitis is a challenging and increasing problem because of the high prevalence of diabetes mellitus and operative fixation of heel fractures. In 1931, Gaenslen reported treatment of hematogenous calcaneal osteomyelitis by surgical excision through a midline, sagittal plantar incision. We have refined this approach to allow successful healing and early mobilization in a modern series of complex patients with hematogenous, diabetic, and postsurgical osteomyelitis. Twenty-eight patients (mean age 54.6 years, range 20-94) with Cierny-Mader stage IIIB chronic calcaneal osteomyelitis were treated with sagittal incision and calcaneal osteotomy, excision of infected bone, and wound closure. All patients received antibiotics for at least 6 weeks, and bone defects were filled with an antibiotic carrier in 20 patients. Patients were followed for a mean of 31 months (SD 25.4). Primary outcome measures were recurrence of calcaneal osteomyelitis and below-knee amputation. Secondary outcome measures included 30-day postoperative mortality and complications, duration of postoperative inpatient stay, footwear adaptions, mobility, and use of walking aids. All 28 patients had failed previous medical and surgical treatment. Eighteen patients (64%) had significant comorbidities. The commonest causes of infection were diabetes ± ulceration (11 patients), fracture-related infection (4 patients), pressure ulceration, hematogenous spread, and penetrating soft tissue trauma. The overall recurrence rate of calcaneal osteomyelitis was 18% (5 patients) over the follow-up period, of which 2 patients (7%) required a below-knee amputation. Eighteen patients (64%) had a foot that comfortably fitted into a normal shoe with a custom insole. A further 6 patients (21%) required a custom-made shoe, and only 3 patients required a custom-made boot. Our results show that a repurposed Gaenslen calcanectomy is simple, safe, and effective in treating this difficult condition in a patient group with significant local and systemic comorbidities. Level III, case series.

Knowledge, attitude and perception towards lower limb amputation amongst persons living with diabetes in rural South Africa: A qualitative study.

South Africa has a high prevalence of diabetes mellitus (DM), a leading risk factor for lower limb amputation (LLA). Lower limb amputation is associated with significant morbidity and mortality. Lower limb amputation incidence can be mitigated through prompt identification and treatment of individuals at risk and engagement in self-management practices. Also, when LLA is inevitable, outcomes or prognosis can be improved with timely surgery. This study explored the knowledge, attitude and perception of persons living with diabetes towards LLA and its prevention. Nqamakwe, a rural community in the Eastern Cape province of South Africa. This was a descriptive, qualitative study involving persons living with DM, with and without LLA, and community leaders. Fifteen participants were recruited purposively and conveniently from a rural community in the Eastern Cape, South Africa. Data collection took place through semistructured interviews, in English and a local language, Xhosa. Interviews were transcribed and translated, and an inductive approach was used for thematic analysis. A total of 15 individual interviews were conducted. Of those, 13 were persons with DM, five with LLA, including one with bilateral LLA. There was a gap in knowledge on foot self-examination as a measure of preventing LLA amongst persons with DM. The attitude of persons without LLA was mostly fearful and their fears centred around perioperative death, risk for contralateral amputation, loss of limb and independence. Consent to LLA procedure was a last resort and only when pain levels were unbearable. Family support and information on rehabilitation services and assistive devices also fostered consent to LLA surgery. There is a need for awareness creation and adequate health education for persons living with DM on LLA and its prevention measures, especially foot care practices. Also, health education programmes for persons living with DM in rural areas should address the various misperceptions of LLA to reduce delays.Contribution: The article revealed gaps in knowledge on LLA and its prevention among individuals living with diabetes as well as areas of concerns that may potentially delay acceptance when LLA is inevitable. Findings from our study may assist primary health care providers to determine important issues to be addressed during routine and pre-operative patient education.

Patient's Perception of Diabetes Care Services in Hail, Kingdom of Saudi Arabia.

Globally, 643 million people will be affected by 2030, and 783 million by 2045 with diabetes mellitus (DM), a severe disease that affects 537 million people worldwide in 2021. Kingdom of Saudi Arabia (KSA) has the highest prevalence of diabetes mellitus among the top ten countries worldwide. Therefore, the present study aimed to identify the factors influencing diabetes care and assess their relative importance. Research was conducted in the Hail region of the Kingdom of Saudi Arabia. The study recruited 258 diabetes patients visiting the Primary Health Centers in Hail City as part of their routine healthcare. Analyzing the data was performed using the Statistical Package for Social Sciences (SPSS-22). As far as Cronbach's Alpha is concerned, it was 0.717, and Kaiser-Meyer-Olkin (KMO) was 0.705. The study has found that the six factors including accessibility of diabetes care (p = .024), availability of diabetes services (p = .029), quality of diabetes care (p = .024), disease management strategies (p = .037), basic amenities of health system (p = .028) and health education resources (p = .030) play a significant role in providing diabetes care services to patients. According to the adjusted R2 of 0.773 (p 0.001), diabetes care is significantly influenced by these six variables. The comparative importance of the factors indicates that, out of six, quality of diabetes care is the most influential; the availability of diabetes services and health education resources are the second and third most influential factors. In order to provide better care for diabetic patients, healthcare organizations should focus on these factors.

Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction

The impact of sex and diabetes mellitus (DM) on patients with heart failure with mildly reduced ejection fraction (HFmrEF) is not well elucidated. This study aims to evaluate sex differences in the clinical profile and outcomes in Asian HFmrEF patients with and without DM. Patients admitted nationally for HFmrEF (ejection fraction 40-49%) between 2008 and 2014 were included and followed up until December 2016. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular (CV) death and/or heart failure (HF) rehospitalisations. A total of 2,272 HFmrEF patients (56% male) were included. More women had DM than men (60% versus 55%, P=0.013). Regardless of DM status, HFmrEF females were older, less likely to smoke, had less coronary artery disease, narrower QRS and lower haemoglobin compared to men. The odds of having DM decreases in smokers who are women as opposed to men (Pinteraction =0.017). In multivariate analysis, DM reached statistical analysis for all-cause mortality and combined CV mortality or HF rehospitalisation in both men and women. However, the results suggest that there may be sex differences in terms of outcomes. DM (vs non-DM) was less strongly associated with increased all-cause mortality (adjusted hazards ratio [adj HR] 1.234 vs adj HR 1.290, Pinteraction <0.001] but more strongly associated with the combined CV death/HF rehospitalisation (adj HR 1.429 vs adj HR 1.317, Pinteraction =0.027) in women (vs men). Asian women with HFmrEF had a higher prevalence of DM, with differences in clinical characteristics, compared to men. While diabetes conferred poor outcomes regardless of sex, there were distinct sex differences. These highlight the need for sex-specific management strategies.

Expert consensus on the management of diabetes mellitus in patients with liver cirrhosis

In view of the high prevalence of diabetes mellitus in patients with liver cirrhosis and the increasing trend of non-alcoholic fatty liver disease-associated cirrhosis, the diagnosis and treatment of diabetes mellitus in patients with liver cirrhosis are becoming widespread concerns. Therefore, the Chronic Disease Management Branch, China Pharmaceutical Biotechnology Association, organized multidisciplinary experts from gastroenterology, infective disease, endocrinology, etc, to draw up expert consensus on the management of diabetes mellitus in patients with liver cirrhosis, with focusing on the classification and management of hyperglycemia in cirrhotic patients. The consensus summarizes the prevalence, pathogenesis, clinical setting and prognosis of the concomitant diabetes mellitus in patients with liver cirrhosis, and definitely puts forward a proposal regarding "hepatogenous diabetes" as one of the four subtypes of diabetes mellitus in cirrhotic patients, and further recommends the basic principles for diagnosing and monitoring diabetes mellitus and the selection of antidiabetic drugs based on liver functions in patients with liver cirrhosis.

Characteristics, risk factors and outcomes of community-acquired acute kidney injury in the elderly: a prospective tertiary hospital study, Egypt

Acute Kidney Injury (AKI) is a public health problem. Elderly present a greater predisposition to the development of AKI, either due to kidney senility, or due to high prevalence of comorbidities and polypharmacy. Considering the scarcity of studies on AKI in the elderly particularly in developing countries, this study emphasizes on the pattern and outcome of AKI in the Egyptian elderly. To analyze the demographics, risk factors and outcomes of Acute Kidney Injury (AKI) in the Egyptian elderly. A total of 199 patients were included over one year and were divided into two groups; group I (79 elderly patients) and group II (120 non-elderly patients). The two groups were compared regarding demographics, risk factors and major outcomes including patient and renal survival. Elderly patients showed a higher prevalence of Diabetes Mellitus and chronic kidney disease (p=0.004 and 0.005 respectively). Pre-renal causes of AKI principally dehydration represented the major risk factor (p=0.003). Sepsis and hypertension predicted mortality in the elderly (p=0.001 and 0.035 respectively). In our locality; the elderly is highly vulnerable to AKI. Pre-renal causes principally dehydration represent the main triggers of AKI. Sepsis and hypertension contribute to mortality in this population. Preventive strategies are crucial not only in the hospital but also at home.

Oral lichen planus and diabetes mellitus: Prevalence and clinical features in a Tunisian population

Background: Oral lichen planus (OLP) is a chronic inflammatory disease. It is characterized by multiple clinical presentations and periods of exacerbation and remission of symptoms of these lesions. The relationship between OLP and diabetes mellitus (DM) has been extensively studied, but with dissimilar conclusions. The main aim of this study was to determine the prevalence of DM in a tunisian population of patients with OLP. While the secondary objective was to describe features of these patients. Materials and methods: Forty-four patients suffering from OLP according to clinical and pathological criteria proposed by the World Health Organization were enrolled for this study. Screening for diabetic patients was conducted according to the DM diagnosis guidelines suggested by The American Diabetes Association (ADA-1997). Inclusion and Exclusion criteria were taken into consideration. The variables considered for each patient were: age, gender, medical history, clinical forms, location and extension of the lesions. Results: twenty-two point seventy two percent (22,72 %) of OLP patients were diabetics. No significant differences could be observed in terms of mean age and clinical forms between diabetic and non-diabetic OLP patients. The extension of lesions was significantly higher in the diabetes -associated OLP group than the non-diabetic group. Conclusion: Within the limits of this study it showed a high prevalence of DM in patients with OLP.

Disparities in Metabolic Conditions and Cancer Characteristics among Hispanic Women with Breast Cancer: A Multi-Institutional Study.

Simple SummaryThis multi-institutional analysis suggests associations of common metabolic conditions with ethnicity among Hispanic patients with breast cancer. Hispanic individuals with breast cancer are diverse and have been historically lumped under one category in research protocols without distinction or reference to their country of origin. This study highlights differences in tumor characteristics and their associations with metabolic conditions among the various Hispanic patients with breast cancer based on their ethnic origins, which should be considered when referencing race and ethnicity. This study supports a more focused approach to addressing obesity and other metabolic conditions in patients with breast cancer within the Hispanic population. In addition, the authors aim to increase awareness regarding the prevalence of common metabolic conditions in the Hispanic population and recommend measures to improve overall health and breast cancer care, including prioritizing lifestyle modifications for Hispanics and other minorities.While the associations of common metabolic conditions with ethnicity have been previously described, disparity among Hispanic individuals based on country of origin is understudied. This multi-institutional analysis explored the prevalence of metabolic conditions and their association with cancer subtypes among Mexican and non-Mexican Hispanics. After IRB approval, we conducted a cross-sectional study at two academic medical centers with a significant Hispanic patient population (Texas Tech University Health Sciences Center, El Paso, TX (TTUHSC-EP) and Cleveland Clinic Florida in Weston, FL (CCF)). A total of n = 1020 self-identified Hispanic patients with breast cancer consecutively diagnosed between 2005 and 2014 were selected from the two institutional databases. Comparisons between Mexican and Non-Mexican Hispanics revealed variations in tumor types and metabolic conditions. Mexican Hispanics were found to have a higher prevalence of diabetes mellitus (27.8% vs. 14.2%, p < 0.001), obesity (51.0% vs. 32.5%, p < 0.001), and ductal carcinoma type (86.6 vs. 73.4%, p < 0.001). On the other hand, hormone-receptor-positive breast cancer was more common in non-Mexicans, while Mexicans had more triple-negative breast cancer, especially in premenopausal women. In addition to highlighting these variations among Hispanic patients with breast cancer, this study supports a more focused approach to addressing obesity and other metabolic conditions prevalent in the Hispanic population with breast cancer. Moreover, Hispanic individuals with breast cancer are diverse and should not be lumped under one category without reference to their country of origin regarding the impact of race and ethnicity.

Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure.

Background: Acute decompensated heart failure (ADHF) is a life-threatening condition with a high mortality rate. Levosimendan is an effective inotropic agent used to maintain cardiac output and a long-lasting effect. However, only few studies have compared the clinical outcomes, after levosimendan therapy, among etiologies of ADHF. Methods: Between July 2014 and December 2019, 184 patients received levosimendan therapy for ADHF at our hospital. A total of 143 patients had ischemic cardiomyopathy (ICM), and 41 patients had non-ICM (NICM). Data on comorbidities, echocardiographic findings, laboratory findings, use of mechanical devices, consumption of other inotropic or vasopressor agents, frequency of HF hospitalization, cardiovascular (CV) mortality, and all-cause mortality were compared between the ICM and NICM groups. Results: Patients with ICM were older with higher prevalence of diabetes mellitus when compared to patients with NICM. Patients with NICM had a poorer left ventricular ejection fraction (LVEF) and higher left ventricular end-systolic volume when compared to patients with ICM. At the 30 day follow-up period, a lower CV mortality (ICM vs. NICM: 20.9% vs. 5.1%; log-rank p = 0.033) and lower all-cause mortality (ICM vs. NICM: 28.7% vs. 9.8%; log-rank p = 0.018) was observed in the NICM patients. A significantly lower all-cause mortality was noted at 180 day (ICM vs. NICM: 39.2% vs. 22.0%; log-rank p = 0.043) and 1 year (ICM vs. NICM: 41.3% vs. 24.4%; log-rank p = 0.046) follow up in the NICM subgroup. NICM (hazard ratio (HR): 0.303, 95% confidence interval (CI): 0.108–0.845; p = 0.023) and ECMO use (HR: 2.550, 95% CI: 1.385–4.693; p = 0.003) were significant predictors of 30 day all-cause mortality. Conclusions: In our study on levosimendan use for ADHF patients, better clinical outcomes were noted in the NICM population when compared to the ICM population. In the patients with cardiogenic shock or ventilator use, significantly lower incidence of 30 day mortality presented in the NICM population when compared with the ICM population.

Effect of a Self-care Training Program Based on Temperament Modification on the Quality of Life of Patients with Type 2 Diabetes

Objective: Considering the high prevalence of diabetes mellitus and its effect on the quality of life (QoL) of patients which can lead to low self-care and increased risk of disease complications, this study aims to assess the effect of a self-care training program based on temperament modification on the QoL of patients with type 2 diabetes (T2D). Methods: In this quasi-experimental study, 110 patients with T2D were selected by a convenience sampling method and were randomly divided into two groups of intervention and control using the random number table. After obtaining informed consent from them, they completed a demographic from and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, and their temperament was diagnosed by a doctor expert in Iranian traditional medicine. The intervention group received four sessions of self-care training based on temperament modification each for 45 minutes. The control group received routine treatment without any intervention. Then, they completed the WHOQOL-BREF questionnaire again three months after the intervention. Data were analyzed in SPSS software, version 22 using chi-square test, paired t-test, and independent t-test. The significant level was set at 0.05. Results: Before the intervention, there was no significant difference in the quality of life score between the intervention (83.2±11.9) and control (85±9.4) groups (P= 0.194). After the intervention, the difference was significant between the intervention (87.7±11.3) and control (85.1±9.5) groups (P=0.044). There was no significant difference in the quality of life score in control group before and after the intervention (P=0.244). Conclusion: The self-care program training based on temperament modification can improve the quality of life of patients with T2D.

The Impact of the Association between Cancer and Diabetes Mellitus on Mortality.

The prevalence of cancer, diabetes mellitus (DM), and hypertension is increasing in ageing populations. We analyzed the association of DM with cancer and its effects on cancer mortality. The data of 2009–2018 from the Korea National Hospital Discharge In-depth Injury Survey were used; 169,959 adults with cancer as the main diagnosis were identified. The association rule for unsupervised machine learning was used. Association rule mining was used to analyze the association between the diseases. Logistic regression was performed to determine the effects of DM on cancer mortality. DM prevalence was 12.9%. Cancers with high DM prevalence were pancreatic (29.9%), bile duct (22.7%), liver (21.4%), gallbladder (15.5%), and lung cancers (15.4%). Cancers with high hypertension prevalence were bile duct (31.4%), ureter (30.5%), kidney (29.5%), pancreatic (28.1%), and bladder cancers (27.5%). The bidirectional association between DM and hypertension in cancer was the strongest (lift = 2.629, interest support [IS] scale = 0.426), followed by that between lung cancer and hypertension (lift = 1.280, IS scale = 0.204), liver cancer and DM (lift = 1.658, IS scale = 0.204), hypertension and liver cancer and DM (lift = 3.363, IS scale = 0.197), colorectal cancer and hypertension (lift = 1.133, IS scale = 0.180), and gastric cancer and hypertension (lift = 1.072, IS scale = 0.175). DM increased liver cancer mortality (p = 0.000), while hypertension significantly increased the mortality rate of stomach, colorectal, liver, and lung cancers. Our study confirmed the association between cancer and DM. Consequently, a patient management strategy with presumptive diagnostic ability for DM and hypertension is required to decrease cancer mortality rates.