Higher Prevalence Of Diabetes Research Articles

The magnitude of undiagnosed diabetes mellitus, prediabetes, and associated factors among adults living in Debre Tabor town, northcentral Ethiopia: A community-based cross-sectional study

BackgroundDiabetes mellitus (DM) is a worldwide public health problem. The burden of diabetes has been continuously increasing from day to day, especially in developing countries like Ethiopia. Globally, half of all cases of diabetes mellitus are undiagnosed. Diabetes mellitus can be easily handled if it is detected early. There is limited evidence on the magnitude of undiagnosed diabetics and prediabetes at the community level in Ethiopia, particularly in the study area. ObjectiveTo assess the magnitude of undiagnosed diabetes mellitus, prediabetes, and associated factors among adults living in Debre Tabor town. MethodsA community-based cross-sectional study was conducted in Debre Tabor town from October to December 2021. A total of 407 participants were selected using a multistage sampling technique. A pretested structural questionnaire was used to collect demographic, behavioral, and clinical data. Anthropometric measurements were taken with standardized and calibrated equipment. A fasting venous blood sample was collected for blood glucose level determination. Logistic regression was used to identify risk factors. A P-value ≤0.05 was considered statistically significant. ResultThe magnitude of undiagnosed diabetes mellitus and prediabetes was found to be 4.5% (95% CI: 2.9–7.4) and 14.5% (95% CI: 11.1–18.1), respectively. Older age (AOR: 6.50, 95% CI: 1.82–23.21), abnormal body mass index (AOR: 6.84, 95% CI: 1.91–24.54), systolic hypertension (AOR: 8.74, 95% CI: 2.53–30.19), and family history of diabetes mellitus (FHDM) (AOR: 12.45, 95% CI: 3.63–42.65) were significantly associated with undiagnosed diabetes mellitus. Using saturated oil (AOR: 1.97, 95% CI: 1.09–3.55), having a high waist circumference (AOR: 2.16, 95% CI: 1.20–3.87), and being hypertensive (AOR: 2.26, 95% CI: 1.04–4.96) were all significantly associated with Prediabetes. ConclusionAdults in Debre Tabor town have a high prevalence of undiagnosed diabetes and prediabetes. A variety of modifiable risk factors were also identified. As a result, focusing the prevention strategy on such modifiable risk factors may help to minimize the prevalence of undiagnosed diabetes mellitus and prediabetes as well as future disease complications.

Exploring facilitators and barriers to patient-provider communication regarding diabetes self-management

ObjectiveLong-term type 2 diabetes management requires open communication between a patient and their provider for self-care adherence. This study explored facilitators and barriers to diabetes-specific communication in West Virginia, a medically underserved state with the highest prevalence of diabetes (16.2%) in the U.S. MethodsA secondary qualitative analysis was conducted using data from semi-structured interviews (n = 34) and 4 focus groups (n = 23) with participants of a diabetes education program. Transcripts were analyzed using thematic analysis. ResultsThree facilitators to patient-provider communication emerged: “Patient-Provider Partnership”, “Provider Accessibility”, and “Empowerment Through Education”. Partnership with providers, especially those who were accessible outside of scheduled appointments, and empowerment obtained through diabetes education facilitated diabetes-specific patient-provider communication. However, barriers included “Providers' Focus on ‘Numbers' Rather than Patient Concerns”, “Patient Lack of Preparation for Appointments”, and “Providers ‘Talking Down to’ Patients”. ConclusionThe findings highlight patient- and provider-related factors that impact diabetes-specific communication. InnovationPrevious interventions have trained providers in communication skills. Despite some success, challenges in implementation remain considering providers' limited time and overwhelming demands. This study suggests that diabetes education programs incorporating communication and self-advocacy skills could be a promising alternative as they can empower patients to communicate their diabetes-specific needs/preferences with providers.

Paradoxical GH increase after oral glucose load in subjects with and without acromegaly

ObjectiveA paradoxical GH rise after the glucose load (GH-Par) is described in about one-third of acromegalic patients. Here, we evaluated the GH profile in subjects with and without acromegaly aiming to refine the definition of GH-Par.DesignObservational case–control study.MethodsOur cohort consisted of 60 acromegalic patients, and two groups of subjects presenting suppressed GH (< 0.4 µg/L) and high (non-acro↑IGF−1, n = 116) or normal IGF-1 levels (non-acro, n = 55). The distribution of GH peaks ≥ 120% from baseline, insulin, and glucose levels were evaluated over a 180-min time interval after glucose intake.ResultsA similar proportion of subjects in all three groups shows a GH ratio of ≥ 120% starting from 120 min. Re-considering the definition of paradoxical increase of GH within 90 min, we observed that the prevalence of GH peaks ≥ 120% was higher in acromegaly than in non-acro↑IGF−1 and non-acro (respectively 42%, 16%, and 7%, both p < 0.001). In patients without GH-Par, a late GH rebound was observed in the second part of the curve. Higher glucose peak (p = 0.038), slower decline after load, 20% higher glucose exposure (p = 0.015), and a higher prevalence of diabetes (p = 0.003) characterized acromegalic patients with GH-Par (with respect to those without).ConclusionsGH-Par response may be defined as a 20% increase in the first 90 min after glucose challenge. GH-Par, common in acromegaly and associated with an increased prevalence of glucose metabolism abnormalities, is found also in a subset of non-acromegalic subjects with high IGF-1 levels, suggesting its possible involvement in the early phase of the disease.

523-P: Identifying Risk Factors Associated with Diabetic Foot Wounds Outcomes within a Safety-Net Hospital System

Dallas county has a high prevalence of diabetes and increasing rates of diabetic foot wound related lower extremity amputations in the past few years. The healthcare spending associated with diabetic foot wounds and its complications is significant, with an average cost of hospitalization for lower extremity amputation of $91,000 at Parkland Health. To better understand the risk factors for developing diabetic foot wounds and its complications, we performed an electronic medical record review of patients with diabetic foot wounds who had a visit at the Parkland Diabetes Clinic between 2019-2022. We identified 78 patients (average age 51 years, 81% male, 68% Hispanic, 21% Black, 10% Caucasian, 68% receiving charity care) with type 2 diabetes and diabetic foot wounds. The average diabetes duration was 13 years, and the average A1c was 11.1% at diagnosis and improved to 8.5% within 3-6 months. The wounds completely healed in 42% (33/78) of the patients by 4 months, with an average time to healing of 72 days. Patients with healed wounds had lower average final A1c (8.3 vs 8.7%), shorter duration of diabetes (12 vs 14 years), and lower rate of peripheral vascular disease (52 vs 60%) compared to those with non-healed wounds. In conclusion, diabetic foot wounds were particularly prevalent among uninsured male Hispanic population within our safety-net health system. Better glycemic control and earlier detection of diabetes may lead to improved diabetic foot wound outcomes. Identifying these risk factors will help us better tailor educational and clinical interventions to prevent the development of diabetic foot wounds and improve clinical outcomes for patients with diabetic foot wounds. Disclosure F.Gunawan: None. B.Johnny: None. U.Gunasekaran: None.

44-OR: Structural Racism and Prevalence of Diabetes in a Nationally Representative Sample of U.S. Adults

Background: Prior research has established that historic redlining is a reliable indicator of structural racism. The goal of this study was to investigate the direct and indirect relationships between historic redlining and prevalence of diabetes in a national sample. Methods: Using a previously validated conceptual model, we hypothesized pathways between structural racism and prevalence of diabetes via discrimination, incarceration, poverty, substance use, housing instability, education, and unemployment. We combined census tract level data including diabetes prevalence from the CDC PLACES 2019 database, redlining using historic Home Owners’ Loan Corporation (HOLC) maps from the Mapping Inequality project, and census tract data from the Opportunity Insights database. HOLC grade (a score between 1=best and 4=redlined) for each census tract was based on overlap with historically HOLC graded areas. The final analytic sample consisted of 9,590 US census tracts. Structural equation modeling was used to investigate direct and indirect relationships adjusting for 2010 population. Results: Higher prevalence of diabetes was directly associated with increased redlining (B=0.28, p&amp;lt;0.001). Redlining was directly associated with incarceration (B=0.25, p&amp;lt;0.001); poverty (B=-0.28, p&amp;lt;0.001); housing instability (B=-0.09, p&amp;lt;0.001)); education (B=-0.32, p&amp;lt;0.001); and unemployment (B=-0.34, p&amp;lt;0.001). Redlining was indirectly associated with prevalence of diabetes via discrimination, incarceration, poverty, substance use, housing instability, education, and unemployment with strongest associations for discrimination (B=0.32, p&amp;lt;0.001); binge drinking (B=-0.62, p&amp;lt;0.001) and smoking (B=0.39, p&amp;lt;0.001). Conclusions: Redlining has significant direct and indirect relationships with diabetes prevalence. Discrimination and substance use may be important targets for interventions aiming to mitigate the impact of structural racism on diabetes. Disclosure L.E.Egede: None. R.J.Walker: None. J.A.Campbell: None. S.Linde: None. Funding National Institutes of Health (R01DK118038, R01DK120861, R01MD013826, K01DK131319)

1213-P: Artificial Intelligence–Based Body Composition Analysis Using Computed Tomography Images Predicts Both Prevalence and Incidence of Diabetes—A Cross-Sectional and Longitudinal Analysis of 10-Year Retrospective Cohort in Korea

Background: We aimed to assess how the ageing-related changes in body composition contribute to the prevalence and incidence of diabetes using artificial intelligence (AI)-based analysis of abdominal computed tomography (CT) images. Methods: In this retrospective cohort study, we identified 15330 subjects age ≥18 years with abdominal CT scans at baseline, who underwent medical checkup at Seoul National University Hospital Healthcare System Gangnam Center from January 1, 2011 to September 30, 2012. Of these, 11693 subjects with available follow-up data were included in the longitudinal analysis. The volume of each body segment involved in abdominal CT images was measured by using an AI-based image analysis software. Findings: The ratio of visceral fat to subcutaneous fat (VF/SF ratio) increased with ageing. The optimal cutoffs of VF/SF ratio to predict the prevalence of diabetes were 1.2 and 0.5 in men and women, respectively. A VF/SF ratio over the cutoff was associated with a higher prevalence of diabetes (age and BMI adjusted OR 2.1, [95% CI 1.8-2.4] in men; 3.1, [2.4-3.9] in women). The same cutoffs of VF/SF ratio were used to predict incident diabetes in ten years of follow-up. Subjects with normal glucose tolerance at baseline who had higher VF/SF ratio had increased risk of progression to prediabetes or diabetes (age and BMI adjusted HR 1.2, [95% CI 1.1-1.4] in men; 1.4, [1.2-1.6] in women). Subjects with prediabetes at baseline who had higher VF/SF ratio also more frequently progressed to diabetes (age and BMI adjusted HR 1.4, [95% CI 1.2-1.6] in men; 1.8, [1.5-2.3] in women). Interpretation: VF/SF ratio in the abdomen change with ageing and are associated with the prevalence and future incidence of diabetes. AI-based analysis of abdominal CT images may help easily obtain body composition data to clinically assess the risk of incident diabetes. Disclosure Y.Kim: None. H.Son: None. J.Yoon: None. H.Choe: None. T.Oh: None. Y.Cho: Consultant; LG Chem. Funding Ministry of Health &amp; Welfare, Republic of Korea

Quality of life assessment in diabetic patients: validity of the creole version of the EQ-5D-5L in Reunion Island.

Due to the high prevalence of diabetes and its complications, evaluating the patient's quality of life is critical. EQ-5D-5L is a valid tool for assessing health-related quality of life (HRQOL) in chronic diseases, including diabetes. However, no psychometric measures have been validated in a Creole-speaking population. Therefore, this study aimed for the first time to validate and cross-culturally adapt Creole and French versions of EQ-5D-5L on Type II diabetes patients in Reunion Island. The Creole translation and cross-cultural adaptation process were based on the EUROQOL methods. Internal consistency and construct validity were determined using confirmatory factor analysis (CFA) of EQ-5D-5L for both versions. CFA model for HRQOL and global fit measures were calculated based on the EQ-5D-5L items using the maximum likelihood (ML) method. From November 2016 to October 2017, 148 patients were included in the Creole group and 152 in the French group. EQ-5D-5L measures were unidimensional for both versions. Cronbach's coefficient alpha was 0.76 for the Creole version and 0.81 for the French version in CFA models. The root mean square error of approximation (RMSEA) was 0.06 for the Creole version and 0.02 for the French version. The Comparative Fit Index (CFI) was closer to 1 for both versions. CFA models for both the Creole and French versions fit the data adequately. Overall, our findings provided evidence that both the Creole and French versions of EQ-5D-5L are suitable for assessing HRQOL in diabetes patients in Reunion Island. However, further research could be done to investigate French-Creole differences concerning the perception of health status, and a cultural adaptation of the French version will be considered.

#6633 DIURETIC RESISTANCE PREDICTORS IN ACUTE DECOMPENSATED HEART FAILURE ADMISSIONS: A BROADER LOOK

Abstract Background and Aims Failing to relieve congestion portends a rise in mortality rate and length of stay in acute decompensated heart failure (ADHF) hospitalizations. That situation corresponds to diuretic resistance (RDIUR). We sought to evaluate clinical and biochemical predictors of RDIUR, including those non-conventional ones we noticed as relevant in prognosis in our clinical practice. Method We conducted an observational, analytical and cross-sectional study, with prospective and consecutive patient (P) data acquisition. We included P over 18 years-old, who were admitted to the Intensive Care Telemetry Unit in our Hospital in the period between July, 2011 and May, 2022 due to ADHF diagnosis. All P received diuretic IV therapy as part of pharmacological treatment. As mentioned in earlier presentations, urine output (UO) was registered in all P, and failure to achieve an UO ≥ 1.5 ml/kg/hour under a pre-established protocol that included and initial 100 mg of IV furosemide bolus followed by a 2 hours of a 5 mg/hour furosemide continuous infusion. Under failure to achieve the goal, furosemide dose was doubled for two additional hours. Failure to respond to this strategy was called “diuretic resistance”. P who received a heart transplant during index admission or those who were on chronic dialysis were excluded from this study. Clinical, epidemiological and biochemical variables were registered. Missing data was imputed by means of multiple regression with chained equations. We constructed a multivariate logistic regression, with selection of relevant predictors completed by resampling and regularization of a Lasso regression model. Statistical significance was considered with a 5% of alpha error. Analysis was conducted using R (R Core Team, 2021), with RStudio (RStudio Team, 2020) as Integrated Development Environment for R, and the tidymodels package (Silge and Kuhn, 2022). Results A total of 1359 P were included. RDIUR was observed in 177 P (13%). These P were younger (69 years old vs 72 p = 0.02), with a higher prevalence of diabetes (39.5% vs 28%; p = 0.002), admission creatinine levels (1.4 vs 1.1 mg/dl; p &amp;lt; 0.001), lower total T3 serum levels (0.56 ng/ml vs 0.7; p &amp;lt; 0.001), with higher incidence of cholestasis (61 vs 40%; p &amp;lt; 0.001), and anasarca as clinical phenotype of systemic congestion (17.5% vs 8.5% p &amp;lt; 0.001). In-hospital mortality was higher in P who developed RDIUR (32.8 vs 5.6%, p &amp;lt; 0.001), in the same way that inotropic support (62 vs 16, p &amp;lt; 0.001), worsening heart failure (48% vs 11; p &amp;lt; 0.001), and furosemide dose at 2nd admission day (175.4 vs 123.4 p &amp;lt; 0.001) were higher in these P. We found no differences in left ventricular ejection fraction (38 vs 41 p = 0.21), first day natriuresis (75.5 vs 78.4, p = 0.093), coronary etiology vs others (20% vs 22; p = 0.26) or one month readmission rate (33% vs 37; p = 0.27). In the adjusted model, inotropic support (OR 5.2; IC95% 3.4-8; p &amp;lt; 0.001), worsening heart failure (OR 3.4; IC95% 2.2-5.3; P &amp;lt; 0.001), furosemide dose at 2nd day (OR 1, IC95%1, P 0.001), admission creatininemia (OR 2.05; IC95% 1.7-2.6; p &amp;lt; 0.001), anasarca phenotype (OR 2.3; IC95 1.4-3.9; p = 0.002) and normal T3 levels (OR 0.05; IC95% 0.02-0.14; p &amp;lt; 0.001) were identified as independent predictors of RDIUR development. Model accuracy was 0.89 and ROC-AUC 0.87. In the same way, RDIUR (OR 2.57; IC95% 1.5-4.3; p &amp;lt; 0.001), worsening heart failure (OR 4.1 IC95% 2.4-7; p &amp;lt; 0.001), inotropic support (OR 3; IC95% 1.7-5.2; p &amp;lt; 0.001) and cholestasis (OR 3.1; IC95% 1.9-5.2; p &amp;lt; 0.001) were found as independent predictors of in-hospital mortality. Conclusion Diuretic resistance is a serious event in patients hospitalized for ADHF, and considerably associated with mortality. A decreased renal reserve, low T3 levels, and anasarca at admission were significantly associated with diuretic resistance development. Considering “new” biochemical predictors as admission T3 levels might add strength to this subset of patients, opposed to information displayed by “classical” event predictors in ADHF patients, as ventricular function or etiology of cardiac disease. Due to clinical potential implications these observational results should be confirmed under evidence based protocols.

#4666 ASSOCIATION BETWEEN URINARY ALBUMIN CREATININE RATIO AND CARDIOVASCULAR DISEASE

Abstract Background and Aims The association between microalbuminuria and cardiovascular disease (CVD) is accumulating in various patient populations. However, when stratified by sex, the relationship between microalbuminuria and CVD remains unclear. Method We obtained data from the 2011–2014 and 2019–2020 Korea National Health and Nutrition Examination Survey (KNHANES). Microalbuminuria was measured based on spot urine albumin-creatinine ratio (UACR). The Framingham risk score (FRS) model was implemented to evaluate the CVD risk. Linear and logistic regression models were used to identify the associations of microalbuminuria status with cardiometabolic predictors and CVD status determined by the FRS score. Results Among 19,340 representative Korean participants, the (UACR) in Korean women and men with history of CVD was higher than in those without history of CVD. Among patients without history of CVD, multivariate regression analysis showed that a high UACR was related to older age, lower high-density lipoprotein cholesterol level, higher total cholesterol level, higher systolic blood pressure, higher prevalence of current smoking, higher prevalence of diabetes, and higher anti-hypertensive medication use in both women and men. The UACR showed a positive linear correlation with the Framingham risk score in both women and men. Conclusion The presence of microalbuminuria was significantly associated with the cardiometabolic risk factors and the increased risk of CVD evaluated by FRS model in both women and men in a nationally representative sample of Korea.

Age and Gender-Specific Pattern of Cardiovascular Disease Risk Factors in Saudi Arabia: A Subgroup Analysis from the Heart Health Promotion Study.

To investigate gender and age-specific distribution patterns of cardiovascular disease risk factors in the Saudi population for tailored health policies. From the heart health promotion study, 3063 adult Saudis were included in this study. The study cohort was divided into five age groups (less than 40 years, 40-45 years, 46-50 years, 51-55 years and ≥56 years). The prevalence of metabolic, socioeconomic, and cardiac risk was compared between the groups. Anthropometric and biochemical data were gathered using the World Health Organization stepwise approach to chronic disease risk factors. The cardiovascular risk (CVR) was determined using the Framingham Coronary Heart Risk Score. The prevalence of CVR risk increased with age in both genders. Both Saudi men and women exhibit similar propensities for sedentary lifestyles and unhealthy food habits. The prevalence of tobacco smoking was significantly higher and from an early age in males compared to females (28% and 2.7%, respectively, at age 18-29 years). There is no significant difference in either the prevalence of diabetes, hypertension, or metabolic syndrome between men and women before the age of 60 years. Old Saudi females (≥60 years) have a higher prevalence of diabetes (50% vs. 38.7%) and metabolic syndrome (55.9% versus 43.5%). Obesity was more prevalent in females aged 40-49 years onwards (56.2% vs. 34.9% males), with 62.9% of females aged ≥60 years being obese compared to 37.9% of males. Dyslipidaemia prevalence increased with the progression of age, significantly more in males than females. Framingham high-risk scores showed that 30% of males were at high risk of cardiovascular diseases at the age group of 50-59 years, while only 3.7% of the females were considered as such. Both Saudi men and women exhibit similar propensities for sedentary lifestyles and unhealthy food habits, with a marked increase in cardiovascular and metabolic risk factors with age. Gender differences exist in risk factor prevalence, with obesity as the main risk factor in women, while smoking and dyslipidaemia were the main risk factors in men.

COVID-19 and Diabetes: will Novel Drugs for Diabetes Help in COVID-19?

COVID-19 is caused by the SARS-CoV-2 virus, which has afflicted more than 245.37 million individuals worldwide and resulted in more than 4.9 million deaths as of today, with a mortality rate of 2.1%. Diabetes mellitus (DM) and its secondary complications are the major serious global health concerns today due to its growth rate, and it is the fastest-growing non-communicable disease. According to International Diabetes Federation (IDF) data, one out of 11 adults is diabetic, and the projection says that the figure will reach 642 million by 2040 globally. The occurrence of DM and its secondary complications is also associated with the severity of COVID-19 and high mortality. People with DM have a weakened immune system owing to innate immunity defects affecting phagocytosis, neutrophil chemotaxis, and cellmediated immunity; however, the high prevalence of diabetes in serious cases of COVID-19 may reflect the higher prevalence of type 2 DM (T2DM) in older people. Moreover, DM is linked to cardiovascular illness in older people, which could underlie the correlation between COVID-19 and fatal outcomes. SARS-CoV-2 infects via the angiotensin-converting enzyme 2 (ACE2), which is found in pancreatic islets, and infection with SARS-CoV-1 has been linked to hyperglycemia in individuals who do not have DM. And hence diabetic patients need to take more precautions and maintain their blood glucose levels. Many pieces of research say that COVID-19 and DM, especially its secondary complications are interlinked. But it also needs more elaborative evidence on whether the anti-diabetic drugs can manage only blood glucose or SARS-CoV-2.

The impact of diabetes during pregnancy on neonatal outcomes among the Aboriginal population in Western Australia: a whole-population study.

Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have a high prevalence of diabetes in pregnancy (DIP), which includes pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). We aimed to characterize the impact of DIP in babies born to Aboriginal mothers. A retrospective cohort study, using routinely collected linked health data that included all singleton births (N = 510 761) in Western Australia between 1998 and 2015. Stratified by Aboriginal status, generalized linear mixed models quantified the impact of DIP on neonatal outcomes, estimating relative risks (RRs) with 95% CIs. Ratio of RRs (RRRs) examined whether RRs differed between Aboriginal and non-Aboriginal populations. Exposure to DIP increased the risk of adverse outcomes to a greater extent in Aboriginal babies. PGDM heightened the risk of large for gestational age (LGA) (RR: 4.10, 95% CI: 3.56-4.72; RRR: 1.25, 95% CI: 1.09-1.43), macrosomia (RR: 2.03, 95% CI: 1.67-2.48; RRR: 1.39, 95% CI: 1.14-1.69), shoulder dystocia (RR: 4.51, 95% CI: 3.14-6.49; RRR: 2.19, 95% CI: 1.44-3.33) and major congenital anomalies (RR: 2.14, 95% CI: 1.68-2.74; RRR: 1.62, 95% CI: 1.24-2.10). GDM increased the risk of LGA (RR: 2.63, 95% CI: 2.36-2.94; RRR: 2.00, 95% CI: 1.80-2.22), macrosomia (RR: 1.95, 95% CI: 1.72-2.21; RRR: 2.27, 95% CI: 2.01-2.56) and shoulder dystocia (RR: 2.78, 95% CI: 2.12-3.63; RRR: 2.11, 95% CI: 1.61-2.77). Birthweight mediated about half of the DIP effect on shoulder dystocia only in the Aboriginal babies. DIP differentially increased the risks of fetal overgrowth, shoulder dystocia and congenital anomalies in Aboriginal babies. Improving care for Aboriginal women with diabetes and further research on preventing shoulder dystocia among these women can reduce the disparities.

Phenotyping of atrial fibrillation with cluster analysis and external validation

ObjectivesAtrial fibrillation (AF) is a heterogeneous condition. We performed a cluster analysis in a cohort of patients with AF and assessed the prognostic implication of the identified cluster phenotypes.MethodsWe used...

MINIMUM OXYGEN SATURATION LEVELS AND CAROTID ATHEROMATOSIS

Objective: Verify the relationship between the presence carotid atheromatosis getting by cervical Doppler echo and the variation of minimum levels oxygen saturation assessed by polysomnography. Design and method: Analytical, observacional and cross-sectional study was conducted with a sample of 63 individuals who had cervical Doppler echo examination and polysomnography in one year, recording multiple modifiable and no-modifiable vascular risk factors. Results: The sample consisted of 63 individuals, 29 female and 34 male. The mean age was 61.83, aged between 35 and 82 years (+/- 12.64). Regarding the presence of other risk factors under analysis, most of the sample has high prevalence of hypertension (44 individuals - 69.8%), mellitus diabetes (23 individuals - 36.5%) and dyslipidemia (36 individuals - 57.1%). In cervical Doppler echo 51 individuals (81%) have thickening of the intima-media layer and in polysomnography the minimum oxygen saturation levels has a mean value of 77.7%, between the minim of 47% and the maxim of 90% (+/- 9.71). There is a significant relationship between the presence of minimum oxygen saturation levels and the presence of the intimae-media layer thickening (p = 0.0001) and with carotid atheromatosis with hemodynamic repercussions (p = 0.0001). Conclusions: In this sample, it is possible to conclude that the minimum levels of oxygen saturation are lower in presence of carotid atheromatosis, regardless of the degree of hemodynamic compromise, with hypertension being a common risk factor.

Long-Term Exposure to Traffic-Related Air Pollution and Diabetes: A Systematic Review and Meta-Analysis.

Objectives: We report results of a systematic review on the health effects of long-term traffic-related air pollution (TRAP) and diabetes in the adult population. Methods: An expert Panel appointed by the Health Effects Institute conducted this systematic review. We searched the PubMed and LUDOK databases for epidemiological studies from 1980 to July 2019. TRAP was defined based on a comprehensive protocol. Random-effects meta-analyses were performed. Confidence assessments were based on a modified Office for Health Assessment and Translation (OHAT) approach, complemented with a broader narrative synthesis. We extended our interpretation to include evidence published up to May 2022. Results: We considered 21 studies on diabetes. All meta-analytic estimates indicated higher diabetes risks with higher exposure. Exposure to NO2 was associated with higher diabetes prevalence (RR 1.09; 95% CI: 1.02; 1.17 per 10μg/m3), but less pronounced for diabetes incidence (RR 1.04; 95% CI: 0.96; 1.13 per 10μg/m3). The overall confidence in the evidence was rated moderate, strengthened by the addition of 5 recently published studies. Conclusion: There was moderate evidence for an association of long-term TRAP exposure with diabetes.

FLUORESCENCE LIFETIME IMAGING OPHTHALMOSCOPY IN PATIENTS WITH MACULAR TELANGIECTASIA TYPE 2 WITH AND WITHOUT DIABETES.

Macular telangiectasia type 2 (MacTel) is a vision-altering retinal disease with a high prevalence of diabetes. Differences between patients with MacTel with and without diabetes were investigated using fluorescence lifetime imaging ophthalmoscopy (FLIO). Eighty-six patients with MacTel (59 ± 12 years) were included. 40 patients (46%) did not have diabetes, 16 patients (19%) were prediabetic, and 30 patients (35%) were diabetic. Of these, seven had diabetic retinopathy. 18 diabetic patients without MacTel and 42 age-matched healthy controls were included. FLIO lifetimes (FLTs) were obtained in short (SSC, 498-560 nm) and long (LSC, 560-720 nm) spectral channels from different areas of interest using a Heidelberg Engineering FLIO. Fundus autofluorescece lifetimes did not show significant differences when comparing diabetic with nondiabetic MacTel eyes (MacTel zone, SSC, diabetic: 243 ± 65 ps; nondiabetic: 232 ± 51 ps; P = 1.0; LSC, diabetic: 327 ± 66 ps; nondiabetic: 309 ± 54 ps; P = 0.582). Longitudinal changes were similarly unrelated to diabetes status. A nonsignificant trend of increased FLT progression with higher body mass index was found. Fundus autofluorescece lifetimes in diabetic patients without MacTel were significantly shorter within the MacTel zone and longer in the periphery compared with diabetic patients with MacTel. Although MacTel has a high prevalence of diabetes, FLTs from the MacTel zone are unrelated to diabetes. Fluorescence lifetime imaging ophthalmoscopy retains diagnostic abilities in patients with MacTel even in the presence of prediabetes, diabetes, and advanced diabetic retinopathy. The lack of diabetic FLT changes in the periphery of diabetic patients with MacTel is an interesting finding that needs further investigation.

Management of Fatty Liver: What Evidence Says?

Fatty liver is a global pandemic and Bangladesh is no exception. Specially high prevalence of diabetes, improved socio-economic condition is contributing to the growing trend of fatty liver in Bangladesh. Currently there is no definite pharmacologic therapy for fatty liver although some drugs are showing promise and as of now life style modification remains the only option. Bangladesh has a rich heritage of traditional medicine with coexistence of Hekimi or Muslim and Ayurveda or Hindu traditional medicines within the political boundary of today’s Bangladesh. However today’s unfortunate reality remains that in Bangladesh, we have not been able to retain our glory. It is now one of our principal research focuses to revive our traditional herbal medicine. We have already demonstrated the beneficial effects of Glycyrrhiza Glabra (joshtimodhu) in end stage hepatocellular carcinoma. Currently we are focusing on non-alcoholic fatty liver disease. We are exploring the prospects of Kalmegh (Andrographispaniculata), Milk thistle (Silybummarianum), Arjun (Terminaliaarjuna) and Moringa (Moringaoleifera). We are collaborating with a galaxy of public-private universities in our humble effort to revive our glory. Our initial experience with Kalomegh in fatty liver is encouraging. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188

Clinical, Socio-Demographic and Biochemical Variables in Patients With Covid-19: A Cross Sectional Study

INTRODUCTION&#x0D; Covid-19 is a debilitating disorder which affects the lungs with multiple organs involvement. The biochemical variables play important role in the management of the Covid-19 patients who are with different clinical profile, socio-demographic, and co-morbid conditions like diabetes and hypertension.&#x0D; MATERIAL AND METHODS&#x0D; This cross sectional study was conducted in the Covid-19 hospitalized cases at UCMS, Bhairahawa. Total of 150 patients were enrolled in the study period from May 2021 and October 2021 whose clinical profile, sociodemographic and biochemical variables were assessed.&#x0D; RESULTS&#x0D; The gender wise distribution shows the male dominancy with M:F ratio 1:0.85. The maximum age group vulnerable to Covid-19 in our study was found to be 41-60 years with median age of 47 years. There were constellations of symptom with shortness of breath 70% becoming first followed by cough 67.3% and fever 54%. The frequency of diabetes and hypertension was 19.3% and 24% showing co-morbidity associated changes in biochemical parameters. The male to female differences in biochemical changes have been associated with Covid-19 patients, however age wise distribution do not show any difference in biochemical parameters.&#x0D; CONCLUSION&#x0D; COVID 19 patients have a high prevalence of diabetes and hypertension, which is a common morbidity. A few biochemical indices (D-dimer, LDH, CRP, and ALT) change significantly between males and females. All biochemical parameters, on the other hand, are unaffected by age.&#x0D;

High glucose inhibits neural differentiation by excessive autophagy &lt;em&gt;via&lt;/em&gt; peroxisome proliferator-activated receptor gamma

The high prevalence of prediabetes and diabetes globally has led to the widespread occurrence of severe complications, such as diabetic neuropathy, which is a result of chronic hyperglycemia. Studies have demonstrated that maternal diabetes can lead to neural tube defects by suppressing neurogenesis during neuroepithelium development. While aberrant autophagy has been associated with abnormal neuronal differentiation, the mechanism by which high glucose suppresses neural differentiation in stem cells remains unclear. Therefore, we developed a neuronal cell differentiation model of retinoic acid induced P19 cells to investigate the impact of high glucose on neuronal differentiation in vitro. Our findings indicate that high glucose (HG) hinders neuronal differentiation and triggers excessive. Furthermore, HG treatment significantly reduces the expression of markers for neurons (Tuj1) and glia (GFAP), while enhancing autophagic activity mediated by peroxisome proliferator-activated receptor gamma (PPARγ). By manipulating PPARγ activity through pharmacological approaches and genetically knocking it down using shRNA, we discovered that altering PPARγ activity affects the differentiation of neural stem cells exposed to HG. Our study reveals that PPARγ acts as a downstream mediator in high glucose-suppressed neural stem cell differentiation and that refining autophagic activity via PPARγ at an appropriate level could improve neuronal differentiation efficiency. Our data provide novel insights and potential therapeutic targets for the clinical management of gestational diabetes mellitus.

Gut microbiome transitions across generations in different ethnicities in an urban setting—the HELIUS study

BackgroundDuring the course of history, various important lifestyle changes have caused profound transitions of the gut microbiome. These include the introduction of agriculture and animal husbandry, a shift from a nomadic to a more sedentary lifestyle, and recently increased levels of urbanization and a transition towards a more Western lifestyle. The latter is linked with shifts in the gut microbiome that have a reduced fermentative capability and which are commonly associated with diseases of affluence. In this study, in which 5193 subjects are included, we investigated the direction of microbiome shifts that occur in various ethnicities living in Amsterdam by comparing 1st and 2nd generation participants. We furthermore validated part of these findings with a cohort of subjects that moved from rural Thailand to the USA.ResultsThe abundance of the Prevotella cluster, which includes P. copri and the P. stercorea trophic network, diminished in the 2nd generation Moroccans and Turks but also in younger Dutch, whilst the Western-associated Bacteroides/Blautia/Bifidobacterium (BBB) cluster, which has an inverse correlation with α-diversity, increased. At the same time, the Christensenellaceae/Methanobrevibacter/Oscillibacter trophic network, which is positively associated with α-diversity and a healthy BMI, decreased in younger Turks and Dutch. Large compositional shifts were not observed in South-Asian and African Surinamese, in whom the BBB cluster is already dominant in the 1st generation, but ASV-level shifts towards certain species, associated amongst others with obesity, were observed.ConclusionThe Moroccan and Turkish populations, but also the Dutch population are transitioning towards a less complex and fermentative less capable configuration of the gut microbiota, which includes a higher abundance of the Western-associated BBB cluster. The Surinamese, whom have the highest prevalence of diabetes and other diseases of affluence, are already dominated by the BBB cluster. Given the continuous increase in diseases of affluence, this devolution towards low-diversity and fermentatively less capable gut microbiome compositions in urban environments is a worrying development.9koSLJh1fDbsjUtu7rD1NMVideo Graphical