Higher Prevalence Of Diabetes Research Articles

Impact of Gender and Age in HbA1c Levels among Libyan Adults Without Known Diabetes in Zeletin City, Libya: A Cross-Sectional Study

The objective of our study was to examine the correlation between HbA1c levels, gender and age in Libyan adults in Zeletin city who have not been diagnosed with diabetes. In our cross-sectional study, we enrolled a total of 300 participants. Blood samples were collected from each participant and subsequently analyzed to determine their HbA1c levels. Statistical analysis included t-tests, linear regression analysis, and one-way ANOVA. Our results showed a significant positive correlation between HbA1c levels in relation to both age and gender. Furthermore, approximately 58.7% of the individuals had HbA1c levels equal to or exceeding 6.5%, which is commonly used as a threshold for diagnosing diabetes. This indicates that there is a notable occurrence of undiagnosed diabetes within the participants of the study. When examining different age groups, we observed a substantial increase in HbA1c levels with advancing age. Additionally, in the 50-59 and above 60 age groups, males exhibited significantly higher HbA1c levels compared to females (p<0.001). In conclusion, our study validated the previously observed link between elevated HbA1c levels and increasing age in individuals without diabetes. Additionally, our study highlights a high prevalence of undiagnosed diabetes in Zeletin, Libya, suggesting an impending increase in diabetes cases that will pose a significant economic burden on healthcare.

Leveraging Machine Learning and Long-Short Term Memory Algorithm for Early Prediction of Diabetes

Diabetes, a chronic condition, affects numerous populations. Poor insulin production from the pancreas combined with high blood sugar levels can result in the onset of diabetes. Diabetes can be caused by numerous factors. Observe and prevent these factors to reduce the high prevalence of diabetes. This study concentrates on medical record data for determining diabetes risk factors via statistical correlation analysis. These factors will be utilized as machine learning and LSTM input parameters for diabetes prediction. The factors analyzed include blood glucose levels, HbA1c levels, age, BMI, hypertension, heart disease, smoking habits, and gender. Based on the research results, we found that glucose levels (>137 mg/dL) and HbA1c levels (>6.5%) are the main benchmarks in diagnosing diabetes. It is also supported by the correlation value, which is relatively high (0.42 and 0.40, respectively) compared to other factors. Increasing age and BMI also increase the risk of developing diabetes. Comorbidities (such as hypertension or heart disease) and smoking habits can worsen the condition of people with diabetes. Meanwhile (based on gender), women are more at risk of developing diabetes than men because their body mass index increases during the monthly cycle. Apart from that, there is a tendency for blood sugar levels in women to increase in the last two weeks before menstruation. Based on the prediction results, the highest levels of accuracy, sensitivity, and F1 score were obtained (96.97%, 99.97%, and 98.37%) using the LSTM method. This performance shows that LSTM is relatively good for the diabetes prediction process based on existing factors/parameters.

Predictors of Optical Coherence Tomography-Defined Calcified Nodules in Patients With Acute Coronary Syndrome - A Substudy From the TACTICS Registry.

Recent studies suggest that the presence of calcified nodules (CN) is associated with worse prognosis in patients with acute coronary syndrome (ACS). We investigated clinical predictors of optical coherence tomography (OCT)-defined CN in ACS patients in a prospective multicenter registry.Methods and Results: We investigated 695 patients enrolled in the TACTICS registry who underwent OCT assessment of the culprit lesion during primary percutaneous coronary intervention. OCT-CN was defined as calcific nodules erupting into the lumen with disruption of the fibrous cap and an underlying calcified plate. Compared with patients without OCT-CN, patients with OCT-CN (n=28) were older (mean [±SD] age 75.0±11.3 vs. 65.7±12.7 years; P<0.001), had a higher prevalence of diabetes (50.0% vs. 29.4%; P=0.034), hemodialysis (21.4% vs. 1.6%; P<0.001), and Killip Class III/IV heart failure (21.4% vs. 5.7%; P=0.003), and a higher preprocedural SYNTAX score (median [interquartile range] score 15 [11-25] vs. 11 [7-19]; P=0.003). On multivariable analysis, age (odds ratio [OR] 1.072; P<0.001), hemodialysis (OR 16.571; P<0.001), and Killip Class III/IV (OR 4.466; P=0.004) were significantly associated with the presence of OCT-CN. In non-dialysis patients (n=678), age (OR 1.081; P<0.001), diabetes (OR 3.046; P=0.014), and Killip Class III/IV (OR 4.414; P=0.009) were significantly associated with the presence of OCT-CN. The TACTICS registry shows that OCT-CN is associated with lesion severity and poor clinical background, which may worsen prognosis.

Risk factors, associations, and high-risk patient profiles for nocturnal pain in carpal tunnel syndrome: implications for patient care.

Carpal tunnel syndrome results from chronic compression of the median nerve, causing pain and paresthesia, especially at night. The impact of these symptoms on patients includes disrupted sleep patterns and a desire to alleviate discomfort through hand movements. Our study aims to investigate risk factors, associations, and high-risk patient profiles associated with these nocturnal manifestations in carpal tunnel syndrome. Utilizing a retrospective case-control design, our study comprises 681 patients with carpal tunnel syndrome, including 581 with nocturnal symptoms and 90 without. Data were obtained through personalized phone calls and health records, covering health profiles, medical comorbidities, perioperative variables, and selected outcomes. Analyzing 591 patients with night symptoms revealed significant differences compared to the non-night symptoms group. The night symptoms group exhibited a lower mean age (51.3 vs. 56.6 years, p = 0.001), higher prevalence of diabetes (30.1% vs. 45.6%, p = 0.003), and paresthesia (98.5% vs. 81.1%, p < 0.001). In addition, the night symptoms group reported a higher incidence of disabling pain (89.2% vs. 70.0%, p < 0.001), weak hand grip (80.5% vs. 62.2%, p < 0.001), and night splints use (37.7% vs. 24.4%, p < 0.001). Preoperatively, the night symptoms group exhibited slightly higher intraoperative anxiety (40.9% vs. 30.0%, p = 0.12) and a slightly longer recovery time (1.7 vs. 1.4 months, p = 0.22), with no significant difference in pain relief scores (8.1 vs. 7.7, p = 0.16). Patients with night symptoms show increased likelihood of comorbidities (diabetes, and renal, conditions), along with a propensity for disabling symptoms and paresthesia. Although they experience slightly longer recovery times, they demonstrate improved pain relief scores. Case-Control Study.

Innovative cell transplant advancement A Research breakthrough by Chinese doctors for diabetes management

This study presents a groundbreaking advancement in diabetes treatment achieved by Chinese scientists through an innovative cell transplant technique. Traditional diabetes management, typically involving regular insulin injections and constant monitoring, imposes a significant burden on patients. However, this new therapy promises to revolutionize diabetes care. A team of researchers from Shanghai Changzheng Hospital, the Centre for Excellence in Molecular Cell Science under the Chinese Academy of Sciences, and Renji Hospital successfully cured a 59-year-old patient with type-2 diabetes using cell therapy. The patient, whose blood sugar levels remained uncontrolled despite regular insulin injections, underwent a cell transplant in July 2021. Peripheral blood mononuclear cells from the patient were reprogrammed into "seed cells" that act like pancreatic islet cells and then implanted. Within eleven weeks, the patient no longer required insulin injections, and after a year, he stopped all diabetes-related medications. Follow-up examinations confirmed the restoration of pancreatic islet function, and the patient has been insulin-free for 33 months, highlighting the long-term efficacy of the treatment. This therapy harnesses the body's regenerative capabilities, marking a significant milestone in regenerative medicine. The innovative approach not only cures the patient but also offers the potential for preventing diabetes. With China facing a substantial healthcare burden due to its high diabetes prevalence, this technique could significantly alleviate the burden by reducing dependency on lifelong insulin injections.

Racial Disparities in Outcomes of Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a rare cause of ST-segment elevation myocardial infarction (STEMI), predominantly affecting women. Because primary percutaneous coronary intervention (PPCI) is reserved for a select group of patients, vulnerable and minority patients may suffer delays in appropriate management and adverse outcomes. We examined racial differences in the outcomes for SCAD patients undergoing PPCI for STEMI. Records of patients ≥18 years old who underwent PPCI for SCAD-related STEMI between 2016 and 2020 were identified from the National Inpatient Sample database. Clinical, socioeconomic, and hospital characteristics were compared between non-White and White patients. Weighted multivariate analysis assessed the association of race with inpatient mortality, length of stay (LOS), and hospitalization costs. The total weighted estimate of SCAD-STEMI patients undergoing PPCI was 4945, constituting 25% non-White patients. Non-White patients were younger (56 vs. 60.7 years, p<0.001), had a higher prevalence of diabetes, acute renal failure, and obesity, and were more likely to be uninsured and be in the lowest income group. Inpatient mortality (7.7% vs. 8.4%, p=0.74) and hospitalization costs ($34213 vs. $31858, p=0.27) were similar for non-White and White patients, and adjusted analysis did not show any association between patients’ race and inpatient mortality (odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.32-1.13; p=0.11) or hospitalization costs (β: 215; 95% CI: -4193 to 4623; p>0.90). Similarly, there was no association between patients’ race and LOS (incident rate ratio: 1.20; 95% CI: 1.00-1.45; p=0.054]. Weighted multivariate analysis showed that age; clinical comorbidities such as diabetes, acute renal failure, valvular dysfunction, and obesity; low-income status; and hospitalization in the Western region were associated with adverse outcomes. In conclusion, our study does not show any differences in inpatient mortality, length of stay, and hospitalization costs between non-White and White patients undergoing PPCI for SCAD-related STEMI.

Abdominal aortic calcification volume as a preoperative prognostic predictor for pancreatic cancer.

Atherosclerosis and cancer may progress through common pathological factors. This study was performed to investigate the association between the abdominal aortic calcification (AAC) volume and outcomes following surgical treatment for pancreatic cancer. The subjects of this retrospective study were 194 patients who underwent pancreatic cancer surgery between 2007 and 2020. The AAC volume was assessed through routine preoperative computed tomography. Univariate and multivariate analyses were performed to evaluate the impact of the AAC volume on oncological outcomes. A higher AAC volume (≥ 312 mm3) was identified in 66 (34%) patients, who were significantly older and had a higher prevalence of diabetes and sarcopenia. Univariate analysis revealed several risk factors for overall survival (OS), including male sex, an AAC volume ≥ 312 mm3, elevated carbohydrate antigen 19-9, prolonged operation time, increased intraoperative bleeding, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy. Multivariate analysis identified an AAC volume ≥ 312 mm3, prolonged operation time, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy as independent OS risk factors. The OS rate was significantly lower in the high AAC group than in the low AAC group. The AAC volume may serve as a preoperative prognostic indicator for patients with pancreatic cancer.

Serum Endocan Is a Risk Factor for Aortic Stiffness in Patients Undergoing Maintenance Hemodialysis.

Background and Objectives: Endocan, secreted from the activated endothelium, is a key player in inflammation, endothelial dysfunction, proliferation of vascular smooth muscle cells, and angiogenesis. We aimed to investigate the link between endocan and aortic stiffness in maintenance hemodialysis (HD) patients. Materials and Methods: After recruiting HD patients from a medical center, their baseline characteristics, blood sample, and anthropometry were assessed and recorded. The serum endocan level was determined using an enzyme immunoassay kit, and carotid-femoral pulse wave velocity (cfPWV) measurement was used to evaluate aortic stiffness. Results: A total of 122 HD patients were enrolled. Aortic stiffness was diagnosed in 53 patients (43.4%), who were found to be older (p = 0.007) and have a higher prevalence of diabetes (p < 0.001) and hypertension (p = 0.030), higher systolic blood pressure (p = 0.011), and higher endocan levels (p < 0.001), when compared with their counterparts. On the multivariate logistic regression model, the development of aortic stiffness in patients on chronic HD was found to be associated with endocan [odds ratio (OR): 1.566, 95% confidence interval (CI): 1.224-2.002, p < 0.001], age (OR: 1.040, 95% CI: 1.001-1.080, p = 0.045), and diabetes (OR: 4.067, 95% CI: 1.532-10.798, p = 0.005), after proper adjustment for confounders (adopting diabetes, hypertension, age, systolic blood pressure, and endocan). The area under the receiver operating characteristic curve was 0.713 (95% CI: 0.620-0.806, p < 0.001) for predicting aortic stiffness by the serum endocan level, at an optimal cutoff value of 2.68 ng/mL (64.15% sensitivity, 69.57% specificity). Upon multivariate linear regression analysis, logarithmically transformed endocan was proven as an independent predictor of cfPWV (β = 0.405, adjusted R2 change = 0.152; p < 0.001). Conclusions: The serum endocan level positively correlated with cfPWV and was an independent predictor of aortic stiffness in chronic HD patients.

Associations of retinal microvascular alterations with diabetes mellitus: an OCTA-based cross-sectional study

BackgroundDiabetes, a health crisis afflicting millions worldwide, is increasing rapidly in prevalence. The microvascular complications triggered by diabetes have emerged as the principal cause of renal disease and blindness. The retinal microvascular network may be sensitive to early systemic vascular structural and functional changes. Therefore, this research endeavored to discern the systemic determinants influencing the retinal microvascular network in patients with and without diabetes.MethodsThe Kailuan Eye Study is a cross-sectional study based on the community-based cohort Kailuan Study. Participants underwent optical coherence tomography angiography (OCTA) (Zeiss Cirrus 5000; Carl Zeiss Meditec) and comprehensive systemic examination. Metrics such as perfusion density (PD), vascular density (VD), foveal avascular zone (FAZ) parameters of the superficial capillary plexus (SCP) in the macula were assessed.ResultsThis study included 860 eligible participants (average age = 62.75 ± 6.52 years; 21.9% female), of which 449 were diabetics. People with diabetes had diminished PD and VD in the entire macular and parafoveal regions compared to people without diabetes. Reduced PD in the whole macular region was correlated with higher fasting plasma glucose (FPG, mmol/L) concentration (Beta = -0.19, 95% CI = -0.42 to -0.36, P < 0.001), longer axial length (AL, mm) (Beta = -0.13, 95%CI = -0.48 to -0.25, P = 0.002), and elevated heart rate (Beta = -0.10, 95%CI = -0.14 to -0.19, P = 0.014), after adjusting for younger age (Beta = -0.18, 95%CI = -0.24 to -0.35, P < 0.001), consistent with VD of the whole macular region. A higher FPG level was significantly correlated with lower SCP density of both PD and VD in the macular and parafoveal region (P < 0.05 for all), as well as increased systolic blood pressure and low-density lipoprotein cholesterol concentration (P < 0.01 for all).ConclusionsIn this large-sample cross-sectional study, OCTA evaluation revealed that high prevalence of diabetes and elevated FPG levels were correlated with reduced retinal VD and PD. Hypertension and hyperlipidemia are important risk factors for the development of atherosclerotic cardiovascular disease but have no significant effect on retinal microvascular abnormalities.

Diabetes and Financial Well-Being: Differential Hardship Among Vulnerable Populations.

The purpose of the study was to examine financial well-being among a diverse population of individuals with and without diabetes. Data from the Understanding America Survey, a nationally representative, longitudinal panel, were utilized to identify adults with self-reported diabetes diagnoses between 2014 and 2020. We used longitudinal mixed effects regression models to assess the association between diabetes and financial well-being score (FWBS) among racial and ethnic population subgroups. Models included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, employment, and health insurance, incorporating individual- and household-level fixed effects. Racial and ethnic differentials were captured using group-condition interactions. Black participants (17.06%) had the highest prevalence of diabetes, followed by White participants (12.2%), "other" racial groups (10.7%), and Hispanic participants (10.0%). In contrast, White participants (M = 67.66, SD = 22.63) and other racial groups (M = 67.99, SD = 18.45) had the highest FWBSs, followed by Hispanic participants (M = 59.31, SD = 22.78) and Black participants (M = 55.86, SD = 25.67). Compared to White participants, Black participants (β = -5.49, SE = 0.71) and Hispanic participants (β = -2.06, SE = 0.63) have significantly lower FWBSs. Compared to males, females (β = -3.25, SE = 0.41) had lower FWBSs among individuals with diabetes. FWBSs of individuals with diabetes was 2.71 points lower (SE = 0.52), on average, than those without diabetes. Education, household size, age, marital status, and income were also significantly associated with FWBSs. Findings suggest potential disparities in the financial ramifications of diabetes among socially marginalized populations.

Salud mental y enfermedad psiquiátrica en las tiroidopatías y otras endocrinopatías

Both hypothyroidism and hyperthyroidism are linked to an increased risk of anxiety and depression, although the causal relationship is unclear. The efficacy of the treatment of both varies and is controversial. In addition, certain psychotropic drugs such as antipsychotics and lithium can influence thyroid function. In patients with eating disorders, especially restrictive eating disorders, low energy intake together with the low fat mass associated with lower leptin production may affect the hypothalamic-pituitary axis. This can cause hypogonadism with secondary osteoporosis and also alters other hormonal axes such as the somatotropic axis or oxytocin production, for example. Many psychiatric diseases are associated with a greater vitamin D deficiency and, thus, osteoporosis. There is a bidirectional relationship between depression on the one hand and obesity and type 2 diabetes on the other. Also, in patients with schizophrenia or bipolar disorder, there is a higher prevalence of diabetes, obesity, and metabolic syndrome, mainly related to a sedentary lifestyle and the use of antipsychotics (mainly clozapine and olanzapine). In fact, the main cause of death is cardiovascular disease in both psychiatric disorders.

Barriers and facilitators of self-management of diabetes amongst people experiencing socioeconomic deprivation: A systematic review and qualitative synthesis.

The number of people living with diabetes is rising worldwide and a higher prevalence of diabetes has been linked to those experiencing socioeconomic deprivation. Self-management strategies are vital and known to reduce the risks of long-term complications amongst people living with diabetes. Lack of knowledge about self-care activity required to manage diabetes is a key barrier to successful self-management. Self-management interventions can be less effective in socioeconomically deprived populations which can increase the risk of exacerbating health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management of diabetes amongst people who are socioeconomically disadvantaged. MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions amongst socioeconomically disadvantaged populations. Relevant papers which focused on diabetes were identified. Data were coded and thematically synthesised using NVivo. From the search results, 79 qualitative studies were identified after full-text screening and 26 studies were included in the final thematic analysis. Two overarching analytical themes were identified alongside a set of subthemes: (1) Socioeconomic barriers to diabetes self-management; healthcare costs, financial costs of healthy eating, cultural influences, living in areas of deprivation, competing priorities and time constraints, health literacy, (2) facilitators of diabetes self-management; lifestyle and having goals, support from healthcare providers, informal support. Self-management of diabetes is challenging for people experiencing socioeconomic deprivation due to barriers associated with living in areas of deprivation and financial barriers surrounding healthcare, medication and healthy food. Support from healthcare providers can facilitate self-management, and it is important that people with diabetes have access to interventions that are designed to be inclusive from a cultural perspective as well as affordable. A patient advisory group contributed to the research questions and interpretation of the qualitative findings by reflecting on the themes developed.

Monogenic diabetes in a Chinese population with young-onset diabetes: A 17-year prospective follow-up study in Hong Kong.

Asians have a high prevalence of young-onset diabetes, but the pattern of monogenic diabetes is unknown. We aimed to determine the prevalence of monogenic diabetes in Chinese patients with young-onset diabetes and compare the clinical characteristics and outcome between patients with and without monogenic diabetes. We sequenced a targeted panel of 33 genes related to monogenic diabetes in 1021 Chinese patients with non-type 1 diabetes diagnosed at age ≤40years. Incident complications including cardiovascular disease (CVD), end-stage kidney disease (ESKD) and all-cause death were captured since enrolment (1995-2012) until 2019. In this cohort (mean±SD age at diagnosis: 33.0±6.0years, median[IQR] diabetes duration 7.0[1.0-15.0] years at baseline, 44.9% men), 22(2.2%, 95% confidence interval[CI] 1.4%-3.2%) had monogenic diabetes. Pathogenic (P) or likely pathogenic (LP) variants were detected in GCK (n=6), HNF1A (n=9), HNF4A (n=1), PLIN1 (n=1) and PPARG (n=2), together with copy number variations in HNF1B (n=3). Over a median follow-up of 17.1years, 5(22.7%) patients with monogenic diabetes (incidence rate 12.3[95% CI 5.1-29.4] per 1000 person-years) versus 254(25.4%) without monogenic diabetes (incidence rate 16.7[95% CI 14.8-18.9] per 1000 person-years) developed the composite outcome of CVD, ESKD and/or death (p=0.490). The multivariable Cox model did not show any difference in hazards for composite events between groups. In Chinese with young-onset non-type 1 diabetes, at least 2% of cases were contributed by monogenic diabetes, over 80% of which were accounted for by P/LP variants in common MODY genes. The incidence of diabetes complications was similar between patients with and without monogenic diabetes.

Atrial anatomical variations on computed tomography angiography associated with atrial fibrillation and those predicting recurrence following pulmonary vein isolation

Abstract Background We aim to investigate the atrial anatomical variations in patients with and without atrial fibrillation (AF) using cardiac-computed tomography angiography (CCTA) and identify features associated with AF recurrence following pulmonary vein isolation. Materials and Methods We retrospectively reviewed 502 CCTAs of patients with AF performed prior to a pulmonary vein isolation procedure with 1058 CCTAs of patients without AF performed to rule out coronary artery disease between 2014 and 2017. Anatomical variations of both atria including left atrial diverticula (LAD), right atrial diverticula (RAD), Bachmann bundle shunt (BBS), and pulmonary vein anatomy were assessed. Results We found that patients with AF were older (67 ± 14 vs 63 ± 13 years, P = .039), had a higher prevalence of diabetes (24.4%) versus (14.7%), P = .006, and cerebrovascular accidents (3.8%) versus (0.9%), P = .044 when compared with patients without AF. Furthermore, on CCTAs patients with AF demonstrated a significantly higher prevalence of BBS (11% vs 4.1%, P &amp;lt; .001), LAD (19% vs 7.7%, P &amp;lt; .001), and RAD (9.8% vs 2.1%, P &amp;lt; .001) when compared to patients without AF. Logistic multivariable regression analyses of CCTA findings demonstrated increased odd ratios (OR) in those with AF of BBS (OR = 3.51, 95% CI, 2.32-5.35, P &amp;lt; .001), LAD (OR = 2.94, 95% CI, 2.12-4.07, P &amp;lt; .001), RAD (OR = 1.54, 95% CI, 1.19-2.11, P = .03), LA diameter (OR = 2.42, 95% CI, 1.65-3.39, P &amp;lt; .001). Importantly, multivariate Cox regression showed that the LA dimension is a predictor of AF recurrence (HR = 1.019, 95% CI, 1.001-1.051, P = .02). Conclusion AF patients have a higher prevalence of BBS, LAD, and RAD in comparison to patients without AF. Mean LA diameter predicts AF recurrence after the pulmonary vein isolation procedure.

Comparative Analysis of Outcomes of Unibody Endoprosthesis and Aortobifemoral Bypass for Aortoiliac Occlusive Disease

Aortoiliac occlusive disease (AIOD) has traditionally been treated with aortobifemoral bypass (ABF). Unibody endograft (UBE) for AIOD, however, has been increasingly utilized in selected patients. We report outcomes of patients undergoing ABF or UBE for AIOD. Patients (2016-2021) undergoing elective ABF or UBE with a unibody device for AIOD were identified at an academic institution. Chi-square and Kaplan-Meier analysis were used to evaluate outcomes by group. One hundred thirty-one patients undergoing UBE or ABF were screened, with 82 included. Twenty-one patients underwent UBE (25.6%) and 61 (74.4%) underwent ABF. UBE patients were older (63.8 vs. 58.2years; P=0.01), with a higher prevalence of diabetes (52.4 vs. 19.7%; P=0.004). Significant differences were seen between UBE and ABF including a shorter surgery length (214 vs. 360min; P=0.0001), less blood loss (300 vs. 620mls; P=0.001), larger minimum aortic diameter (14.6 vs. 12.6; P=0.0006), larger common iliac artery (9.5 vs. 7.9; P=0.005) and lower postoperative ankle-brachial index (0.8 vs. 0.9; P=0.04). There were no differences in TASC C/D iliac lesions in the UBE than ABF group (66.6% vs. 63.9%; P<0.82) or Trans-Atlantic Inter-Society Consensus classification femoropopliteal lesions. Unadjusted analysis revealed no significant differences between UBE and ABF for 30-day mortality (0 vs. 1.6%; P=1), stroke (0 vs. 3.3%; P=1), or major adverse cardiac events (4.8 vs. 4.9%; P=1). There were no significant differences in mid-term surgical outcomes over a mean follow-up period of 23.7months between UBE and ABF groups; specifically endovascular (0 vs. 8.2%; P=0.3) or open/hybrid reintervention (9.5 vs. 14.8%; P=0.7) with similar limb occlusion (4.8 vs. 27.8; P=0.12). Kaplan-Meier estimated primary, primary-assisted, and secondary patency at 36months were similar with 94%, 100%, and 94% for UBE and 86%, 95%, and 86% for ABF, respectively. Estimated survival at 36months was 95% for UBE and 97% for ABF (P=0.8). Equivalent outcomes were seen between AIOD treated with UBE or ABF in similar patient populations. Mid-term outcomes such as reintervention and patency are similar for UBE and ABF. We still recommend ABF over UBE as a primary modality of treatment in surgically fit patients with greater complexity aortoiliac lesions and with smaller arterial diameters, especially women.

#2775 ERCOS multicenter Spanish study: clinical profile of patients with chronic kidney disease G3a-G5D and osteoporosis

Abstract Background and Aims Fracture risk evaluation has recently been integrated into the 2017 KDIGO CKD-MBD (Chronic Kidney Disease- Mineral and Bone Disorder) guideline and its 2021 Spanish endorsement. It is now suggested to test bone mineral density (BMD) to assess fracture risk “if results will impact treatment decisions”. In fact, multiple new prospective studies have now documented that lower BMD predicts incident fractures in patients with CKD G3a–G5D. However, we scarcely know current real clinical practice in this population. Thus, the aim of the ERCOS (“Enfermedad Renal Crónica OSteoporosis”) study was to describe the clinical profile of patients with CKD who had been diagnosed of osteoporosis in outpatient Nephrology and Rheumatology clinics in Spain. Method ERCOS is a descriptive, observational, and multicenter Spanish study. Patients were recruited by consecutive sampling from 15 different Spanish hospitals. Osteoporosis characteristics (history of fragility fracture, BMD and other fracture risk factors), associated comorbidities, biochemical parameters and treatment were analyzed. Results A total of 163 patients (median age 77 years old) were included. Most were women (71.2%) and 98.3% of them were postmenopausal. Hypertension was the most frequent comorbidity (87.1%) and “attributed” cause of CKD (43.2%). Diabetes mellitus and cardiovascular disease were present in 35.6% and 29.4% of patients, respectively. Median estimated glomerular filtration rate was 36 ml/min/1.73 m2 [creatinine 1.48 mg/dl (95% CI 1,2-2)]. 38% of patients were G5D CKD patients (95.2% undergoing hemodialysis). 37.7% of patients had had a fragility fracture after the diagnosis of CKD (vertebral 52.5%, hip 24.6%, wrist 21.3%, humerus 16.4%, among others). Importantly, despite the diagnosis of osteoporosis, only 60.1% of the patients received specific treatment (mainly bisphosphonates or denosumab). Moreover, antiosteoporotic treatment was much more frequently prescribed by rheumatologists (46.9%), internal medicine physicians (23.5%), and only 13.3% was prescribed by nephrologists. 19.4% of patients suffered from fragility fractures even after initiating specific treatment. Conclusion Most patients with moderate and severe CKD with osteoporosis were old postmenopausal women with a high prevalence of diabetes or cardiovascular disease. Although about 40% had even suffered a fragility fracture, there is a high treatment gap, especially relevant among nephrologists. A call to action and to avoid existing therapeutic nihilism seems necessary, expanding the knowledge of the new more proactive guidelines and homogenizing the care and therapeutic approach in these patients.

#2852 Iron status and incident diabetes in kidney transplant recipients

Abstract Background and Aims Kidney transplant recipients (KTR) are prone to develop post-transplant diabetes (PTD). Iron plays a role in glucose homeostasis and patients with iron overload have a high prevalence of diabetes. Since iron overload can also occur in KTR, we investigated whether levels of ferritin are associated with incident PTD in KTR. Method This is a prospective observational cohort study of adult KTR ≥1 year after transplantation of the Transplantlines Insulin Resistance and Inflammation Biobank and Cohort study. Cox regression analyses were applied to study the association of serum ferritin with incident PTD (fasting plasma glucose ≥126 mg/dL, or nonfasting plasma glucose ≥200 mg/dL combined with diabetes symptoms, or use of glucose-lowering medication). Models were adjusted for age, sex, body mass index, C-reactive protein (CRP), diabetes risk factors, transplantation factors, and immunosuppressive drugs. To explore potential clinical cut-offs of ferritin levels from which the risk of PTD might increase, categories of ferritin (&amp;lt;100, 100-300, 300-500, and &amp;gt;500 µg/L) were used in subsequent analysis. Results We included 399 KTR (age 51 [IQR, 41-59 years], 54% males, and at a median of 6.1 [3.0-12.1] years after transplantation) without diabetes at baseline. During a median follow-up of 9.7 [7.6-10.3] years, 45 KTR (11%) developed PTD. In multivariable Cox regression analyses, serum ferritin levels were significantly associated with incident PTD independent of adjustment for potential confounders (Table 1, hazard ratio (HR) per 50 µg/L, 1.12; 95% CI 1.05-1.18; P = 0.0002). Furthermore, in analysis with ferritin categories, we identified that KTR with ferritin &amp;gt;500 µg/L (n = 38) had a significantly higher chance of PTD compared to KTR with ferritin between 100-300 µg /L (Fig. 1, HR, 3.66; 95% CI 1.37-9.77; P = 0.01). KTR with ferritin levels &amp;lt;100 and between 300-500 µg/L had a similar risk of PTD compared to KTR with ferritin levels between 100-300 µg/L. Conclusion Ferritin levels are associated with PTD in KTR, independent of other known diabetes risk factors, including inflammation. KTR with ferritin levels above 500 µg/L appear particularly prone to develop PTD. Further investigation should determine the underlying mechanisms and consequences of these findings with respect to target goals of ferritin levels after kidney transplantation.

#767 Utility of cystatin C as a predictor for postoperative acute kidney injury in non-cardiac surgeries [S1

Abstract Background and Aims Serum creatinine has been widely utilized to estimate glomerular filtration rate (eGFR), although various biomarkers have been developed to address its limitations. Among these biomarkers, the clinical use of Cystatin C is increasingly gaining recognition. However, there is a lack of evaluation regarding the utility of cystatin C in predicting the risk of postoperative acute kidney injury (PO-AKI) in non-cardiac surgeries. Method A retrospective cohort study was conducted on patients who underwent non-cardiac surgeries more than 1 hour from five departments (general surgery, neurosurgery, obstetrics and gynecology [OBGY], orthopedics, and urosurgery) at Chung-Ang University Hospital between 2018 and 2020. Patients with missing baseline information, including creatinine and cystatin C, and those without follow-up serum creatinine levels were excluded. PO-AKI was defined as KDIGO-AKI criteria occurring within 7 days after surgery. The estimated glomerular filtration rate (eGFR) was calculated from 2012 and 2021 chronic kidney disease-epidemiology collaboration (CKD-EPI) equations. Logistic regression was used to develop a prediction model, and C-statistics and the Delong test were used to compare the performance. Baseline comorbidities (diabetes mellitus [DM] and hypertension), laboratory findings (hypoalbuminemia [serum albumin &amp;lt;3.5 g/dL], anemia [hemoglobin &amp;lt;12 g/dL for female or &amp;lt;13 g/dL for male], and hyponatremia [sodium &amp;lt;135 mEq/L]), medication usage within 90 days of surgery (nonsteroidal anti-inflammatory drug and renin-angiotensin-system [RAS] blocker), and operation information (Anesthesia type, emergency operation, and operation duration) were adjusted. Results Overall, 339 patients were enrolled, with 49 patients (14.5%) developed PO-AKI. The median age was 73.0 [64.0; 80.0]; eGFR-Cr 86.4 [65.5; 99.1] mL/min/1.73 m2, eGFR-Cystatin C 70.0 [45.2; 92.7] mL/min/1.73 m2; eGFR-Cr/Cystatin C 77.2 [54.5; 100.5] mL/min/1.73 m2. Patients who developed AKI had a higher prevalence of diabetes (AKI 49.0%, no AKI 28.3%; p-value 0.006) and prescription of RAS blockers (AKI 63.3%, no AKI 34.5%; p-value &amp;lt;0.001), longer operation duration (AKI 63.3%, no AKI 34.5%; p-value &amp;lt;0.001), and lower eGFR of all types (AKI: eGFR-Cr 69.8, eGFR-Cystatin C 48.0, eGFR-Cr/Cystatin C 57.2; no-AKI: eGFR-Cr 88.0, eGFR-Cystatin C 74.0, eGFR-Cr/Cystatin C 80.5 mL/min/1.73 m2; p-values &amp;lt;0.001). No statistical differences were observed in other laboratory findings between the two groups (Table 1). The model with eGFR-Cystatin C demonstrated the highest area under the curve (AUC) among the three models (eGFR-Cr: AUC 0.78, 95% confidential interval [CI] 0.702‒0.857; eGFR-Cystatin C: AUC 0.81, 95% CI 0.735‒0.877; eGFR-Cr/Cystatin C: AUC 0.80, 95% CI 0.724‒0.871). Only the eGFR-Cystatin C-based model showed significant improvement in prediction compared to the eGFR-Cr-based model in the Delong test (eGFR-Cystatin C vs eGFR-Cr: p-value 0.033; eGFR-Cr/Cystatin C vs eGFR-Cr: p-value 0.055, Fig. 1). Conclusion Our findings suggest the potential usefulness of cystatin C in predicting the risk of PO-AKI non-cardiac surgery in addition to conventional PO-AKI risk factors. Further studies including larger and external cohorts, are needed for validation.

#1050 Diabetes mellitus mediates the association between chronic hepatitis C virus infection and incidence of end-stage kidney disease

Abstract Background and Aims Chronic infection with the hepatitis C virus (HCV) is known to lead to extra-hepatic complications, notably affecting the kidneys. While prior research has established a link between chronic HCV infection and chronic kidney disease (CKD), there remains ongoing debate regarding whether this association is influenced by the presence of diabetes mellitus. Method This study, part of the REVEAL-HCV project in Taiwan, investigated the relationship between chronic HCV infection and end-stage kidney disease (ESKD). Initially, 23,820 individuals aged 30-65 from Taiwan were enrolled since 1991-1992. Data included physical exams, blood tests, and questionnaires covering sociodemographics, lifestyle, and comorbidities. The cohort was linked to Taiwan's National Health Insurance Research Database, providing extensive patient data. Hepatitis C status was determined by HCV RNA testing. ESKD was identified using ICD-9-CM codes from the health database. Covariates like age, sex, lifestyle factors, comorbidities, and lab results were considered. The study emphasized accurate diagnosis of diabetes based on insurance claims with well validation. The mediation analysis was done by constructing 2 logistic regression models, with one regressing the risk of ESKD on chronic HCV infection status and the other regressing the risk of ESKD on diabetes status. The direct and indirect (mediated through the risk of diabetes) effects of chronic HCV infection on the risk of ESKD were estimated using odds ratios. Confidence intervals for direct and indirect effects were estimated using 5000 bootstrapping replicates. Results The study examined 22,800 participants, with a mean age of 46.9 years. Among them, 738 were chronically infected with HCV. These HCV-infected participants were generally older, more likely to be female, had lower education levels, and higher prevalence of diabetes, hypertension, and CKD. During the 16.8-year median follow-up, covering 319,474 person-years, 378 end-stage kidney disease (ESKD) events occurred. The incidence of ESKD was higher in HCV-infected subjects (2.6%) compared to non-HCV-infected (1.6%). The univariate and multivariate-adjusted odds ratios (ORs) and 95% confidence interval for ESKD in HCV-infected participants were 2.06 (0.90-2.08) and 1.57 (1.01-2.44), respectively. HCV infection also showed a significant association with diabetes mellitus. The multivariable-adjusted OR for diabetes in HCV-infected individuals was 1.53 (1.31-1.78). Further, the study identified a diabetes-mediated pathway linking HCV infection to ESKD. In this pathway, HCV infection increased the odds of ESKD by 0.8%. This indirect pathway mediated by diabetes accounted for 16% of the overall association between HCV infection and ESKD with statistically significant. The direct pathway, though not statistically significant, indicated a 57% increased odds of ESKD in HCV-infected individuals compared to those without HCV. Conclusion Chronic HCV infection is linked to higher incidences of diabetes and ESKD. The mechanisms are intricate, with diabetes serving as a significant mediator in the pathway from HCV infection to ESKD.

Understanding health service utilisation patterns for care home residents during the COVID-19 pandemic using routinely collected healthcare data

BackgroundHealthcare in care homes during the COVID-19 pandemic required a balance, providing treatment while minimising exposure risk. Policy for how residents should receive care changed rapidly throughout the pandemic. A lack of accessible data on care home residents over this time meant policy decisions were difficult to make and verify. This study investigates common patterns of healthcare utilisation for care home residents in relation to COVID-19 testing events, and associations between utilisation patterns and resident characteristics.MethodsDatasets from County Durham and Darlington NHS Foundation Trust including secondary care, community care and a care home telehealth app are linked by NHS number used to define daily healthcare utilisation sequences for care home residents. We derive four 10-day sets of sequences related to Pillar 1 COVID-19 testing; before [1] and after [2] a resident’s first positive test and before [3] and after [4] a resident’s first test. These sequences are clustered, grouping residents with similar healthcare patterns in each set. Association of individual characteristics (e.g. health conditions such as diabetes and dementia) with healthcare patterns are investigated.ResultsWe demonstrate how routinely collected health data can be used to produce longitudinal descriptions of patient care. Clustered sequences [1,2,3,4] are produced for 3,471 care home residents tested between 01/03/2020–01/09/2021. Clusters characterised by higher levels of utilisation were significantly associated with higher prevalence of diabetes. Dementia is associated with higher levels of care after a testing event and appears to be correlated with a hospital discharge after a first test. Residents discharged from inpatient care within 10 days of their first test had the same mortality rate as those who stayed in hospital.ConclusionWe provide longitudinal, resident-level data on care home resident healthcare during the COVID-19 pandemic. We find that vulnerable residents were associated with higher levels of healthcare usage despite the additional risks. Implications of findings are limited by the challenges of routinely collected data. However, this study demonstrates the potential for further research into healthcare pathways using linked, routinely collected datasets.