High Prevalence Of Type Research Articles

Prevalence of multiple roots and complex canal morphology in mandibular premolars among a selected Southern Egyptian sub-population: a CBCT-analysis

The mandibular premolars can pose a significant challenge in root canal treatment due to their complex canal system. This study investigated the prevalence of multiple roots and complex canal morphology of mandibular premolars in a selected Egyptian sub-population using cone beam computed tomography (CBCT). 283 CBCT scans (131 males, 152 females, age 18–70) included 1132 mandibular premolars (566 first, and 566 second premolars) were viewed for incidences ofvariation in root numbers and canal configuration according to Vertucci’s classification. CBCT images were assessed by two endodontists, data were statistically analyzed using Fisher exact and Chi-square tests. The majority of first premolars (85.7%) exhibited a single root, whereas 14.7% had 2 roots with a significantly higher frequency in males (19.8%) than in females (9.5%) (P < .05). The most prevalent type was type I (57.8%), followed by type V (21.7%), while types II and VII made up only 1%. Types V and III were more prevalent among females, while males had a higher prevalence of types I and IV. In 2.5% of cases, mandibular second premolars were found to have 2 roots, with a higher incidence in males (P < .05). Type I canals were significantly more prevalent (90.8%) than other types, followed by type V (5.3%) (P < .05). A statistically significant gender correlation was found regarding root number and canal configuration. It is not uncommon to find mandibular first premolars with two roots in the southern Egyptian population, particularly in males. These observations may be valuable for dentists who treat Southern Egyptians, in Egypt and other countries.

Inverse association between total bilirubin and type 2 diabetes in U.S. South Asian males but not females.

United States South Asians constitute a fast-growing ethnic group with high prevalence of type 2 diabetes (T2D) despite lower mean BMI and other traditional risk factors compared to other races/ethnicities. Bilirubin has gained attention as a potential antioxidant, cardio-protective marker. Hence we sought to determine whether total bilirubin was associated with prevalent and incident T2D in U.S. South Asians. We conducted a cross-sectional and prospective analysis of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Total bilirubin was categorized into gender-specific quartiles (Men: <0.6, 0.6, 0.7-0.8, >0.8; Women: <0.5, 0.5, 0.6, >0.6 mg/dl). We estimated odds of type 2 diabetes as well as other cardiovascular (CV) risk factors using multivariable logistic regression. Among a total 1,149 participants (48% female, mean [SD] age of 57 [9] years), 38% had metabolic syndrome and 24% had T2D. Men and women in the lowest bilirubin quartile had 0.55% and 0.17% higher HbA1c than the highest quartile. Men, but not women, in the lowest bilirubin quartile had higher odds of T2D compared to the highest quartile (aOR [95% CI]; Men: 3.00 [1.72,5.23], Women: 1.15 [0.57,2.31]). There was no association between bilirubin and other CV risk factors. Total bilirubin was inversely associated with T2D in SA men but not women. Longitudinal studies are needed to understand temporality of association.

Hypertension in the emergency department: A missed opportunity to screen for primary aldosteronism?

Primary aldosteronism (PA) is a common but underdiagnosed secondary cause of hypertension. Emergency departments (EDs) often assess patients with severe hypertension or its sequelae, some of whom have underlying PA. We aimed to determine the proportion of patients presenting to the ED with hypertension who meet the Endocrine Society criteria for PA testing and the proportion who were screened. We performed a structured retrospective chart review of adults who presented to three EDs in an Australian tertiary health network between August 2019 and February 2020, with a coded presenting complaint of hypertension. Clinical parameters to determine whether the patients met the criteria for PA testing were extracted from electronic medical records. Of the 418 patients who presented to the EDs with documented elevated blood pressure (BP), 181 patients (43.3%) fulfilled PA screening criteria and nine patients (2.2%) underwent PA testing. Individuals who fulfilled screening criteria were older; had higher prevalence of Type 2 diabetes, coronary artery disease, and congestive heart failure; took more antihypertensive medications; and had lower estimated glomerular filtration rate. Individuals who were tested for PA were younger and had higher BP on presentation. Screening for PA was more frequent in patients who were referred to medical teams. As far as we are aware, our study is the first to evaluate PA testing in hypertensive patients who present to ED. More than 40% of adults presenting to the EDs with hypertension met the current criteria for testing for PA but only few were tested. These results emphasize that increased awareness of PA in the ED is needed to encourage opportunistic testing, referral, and treatment, especially in patients who present with hypertensive emergencies. Prospective studies are required to determine the feasibility and effectiveness of this.

Type 2 Diabetes Mellitus and Non-Metastatic Colorectal Cancer: A Retrospective Study on Survival and Toxicity Profiles.

Being one of the most common cancers accounting for approximately 185 million cases globally, colorectal cancer (CRC) is one of the leading derivers of cancer-related mortalities. A high prevalence of Type 2 diabetes mellitus and CRC was noted, together with a causal link between diabetes and CRC development. Thereby, the goal of this study was to properly evaluate type 2 Diabetes mellitus in non-metastatic colorectal cancer patients, and to highlight its impacts on patient's outcome. Patients with non-metastatic colorectal cancer diagnosed between January 2016 and December 2020 were studied retrospectively. Patients were divided into two groups based on whether or not they had type II diabetes. The clinico-pathological, laboratory, treatment and survival data were gathered. A total of 318 patients were included in this study. The toxicity of the drugs used in CRC patients receiving the treatment protocols (169 in non-T2DM group and 39 in T2DM group), both groups reported close percentage of side effects and a similar frequency of drug toxicity occurrence as well as grade of toxicity, with the exception of neuropathy, which was more common in the T2DM group (33.3% vs 11.2%). As for prognosis, non-T2DM and T2DM patients had a mean progression free survival of (71.4 and 60.83 months, respectively) (p = 0.019). Overall survival was 73.1% for T2DM and 85.3% for non T2DM cases. The median overall survival was not reached for both groups in terms of overall survival. T2DM is considered a risk factor for poor survival among CRC patients. Treatment related toxicity is not affected by the presence or absence of diabetes, yet neuropathy needs further studies for diabetic patients receiving oxaliplatin.

A scoping review of type 2 diabetes mellitus in Pakistan investigating the status of glycemic control, awareness, treatment adherence, complications and cost.

The high prevalence of Type 2 diabetes mellitus(T2DM) in Pakistan is a challenge to the existing healthcare system. This is the first comprehensive review of the status of glycemic control, diabetes knowledge, treatment adherence, complications and financial burden faced by the diabetic patient population of the country. We searched PubMed, Web of Science and Scopus for studies on diabetes control, knowledge, treatment adherence, prevalence of complications and cost in Pakistan published in English from 2000 to 2024. We hand-searched Google Scholar for additional papers and included a total of 45 studies in our review. The review shows that poor glycemic control prevails among diabetic patients ranging from 44.7% to 86.4% along with half of the patients have poor diabetes knowledge (46.0% -70.0%). Treatment adherence level in diabetic patients varies widely in different studies, frequently reported complications are retinopathy (14.5%-43.0%), nephropathy (14.0%-31.0%) and neuropathy (10.8%-59.6%); and the disease poses a great deal of economic burden. Most of the studies were observational. Glycemic control and knowledge among individuals with T2DM in Pakistan are inadequate, leading to a high prevalence of complications that impose significant health and economic burdens. Further longitudinal studies generating evidence of lifestyle modifications as primary and secondary prevention strategies against diabetes in the Pakistani population can form a strong foundation for awareness campaigns and policy revisions.

TCF7L2 and FTO Polymorphisms Are Associated with Type 2 Diabetes Mellitus Risk in Kuwait

Objective: Despite the high prevalence of type 2 diabetes mellitus (T2DM) and obesity in the region, reports are limited on genetic risk factors associated with T2DM risk in Kuwait. Our aim was to investigate the association of reported FTO and TCF7L2 T2DM genetic risk variants in Kuwaiti T2DM patients. Subjects and Methods: FTO rs9939609 and TCF7L2 rs7903146 variants were genotyped in 203 T2DM patients and 162 healthy controls. Data analysis included Fisher’s exact test, χ2 test, and linear and logistic regression analyses. Results: FTO rs9939609 (AA) and TCF7L2 rs7903146 (TT) genotypes associated with T2DM risk among Kuwaitis (p = 0.0016 and p < 0.0001; respectively). Both variants had the strongest association with T2DM risk in an autosomal recessive inheritance model (FTO rs9939609A: odds ratio (OR) 2.136, 95% confidence interval (CI): 1.21–3.67, p = 0.0075; TCF7L2 rs7903146T: OR 3.283, 95% CI: 1.92–5.76, p < 0.0001). Moreover, rs7903146T associated with risk of peripheral neuropathy (β = 0.735, 95% CI: 0.514–0.96, p < 0.001) and risk of myocardial infarction (β = 0.36, 95% CI: 0.024–0.7, p = 0.036) in T2DM patients. Conclusion: The increased susceptibility of Kuwaitis to T2DM is influenced by the same common genetic factors found in other T2DM populations. Further investigations of other T2DM genetic risk factors in Kuwait should refine and further support the clinical utility of a genetic risk score in predicting T2DM risk in a high-risk population such as Kuwait.

Classification of the Os Calcis Subtalar Morphology in Symptomatic Flexible Pediatric Pes Planus Deformity Using Weight-Bearing CT and Distance Mapping

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: The etiology of symptomatic pediatric pes planus (PP) deformity, is unclear. Reduced os calcis subtalar joint (OCST) anterior facet morphology has been suggested to result in less support to the talar head and a higher propensity to develop PP deformity. Weight Bearing Computed Tomography (WBCT) and Distance Mapping (DM) offer new opportunities to investigate PP deformity and the OCST specifically. The purpose of this study is to examine the OCST morphology using DM and to classify PP subtalar subtypes with DM using Bruckner's A-D classification system. Methods: Forty feet in 25 patients in a national referral center were evaluated for symptomatic PP deformity that failed nonoperative treatment. A WBCT scan was performed as part of the preoperative evaluation. Visualization of the distance distribution between the articulating surfaces of the subtalar joint was based on a DM technique. Intra- and interobserver agreement of the subtalar morphology was assessed using Bruckner's classification system. Results: The mean age was 10.7 ± 1.4 years. The following mean ± s.d and median +-ranges. Measures were semiautomatically measured for this group: Meary’s angle -21 ± 8, calcaneal inclination 15 ± 4 degrees, talar coverage angle 39 (range 32.6- 49) degrees, and hind-foot moment-arm 16 ± 5 millimeters. Classifying subtalar morphology using DM yielded an excellent intra- and interobserver agreement.The individual percentages of each individual subtype were calculated; type A 5%, type B 38%, type C 4%, type D in 44%. Conclusion: This study demonstrated excellent intraobserver and interobserver agreement in classifying the OCST using DM. A higher prevalence of types B and D were observed compared to types A and C in this PP cohort.

Unrecognised orgasmic phase disorders in men presenting with new-onset erectile dysfunction-Findings from a real-life, cross-sectional study.

Orgasmic phase disorders in men worsen the burden of erectile dysfunction on sexual satisfaction. To investigate the prevalence of and predictors of unreported orgasmic phase disorder in a cohort of men looking for their first urological assessment for new-onset erectile dysfunction in a real-life setting. Data from 1107 heterosexual, sexually active men consecutively assessed for new-onset erectile dysfunction were analysed. Throughout a comprehensive medical and sexual history, all patients were asked to self-report any orgasmic phase disorder and to complete the International Index of Erectile Function and the Beck's Inventory for Depression (depressive symptoms scored as Beck's Inventory for Depression ≥11). Men self-reporting orgasmic phase disorder during the interview were excluded from further analyses. The median value of the International Index of Erectile Function-orgasmic function domain was arbitrarily used to categorise men with (International Index of Erectile Function-orgasmic function ≤5) and without unreported orgasmic phase disorder (International Index of Erectile Function-orgasmic function >5). Circulating hormones were measured in every patient. Descriptive statistics and logistic regression models were used to test the association between clinical variables and unreported orgasmic phase disorder. Of 1098 patients with non-self-reporting orgasmic phase disorder, 314 (28.6%) had International Index of Erectile Function-orgasmic function ≤5. Patients with erectile dysfunction + unreported orgasmic phase disorder were older (median [interquartile range]: 58 [44-66] years vs. 51 [40-60] years), had higher body mass index [25.8 (23.7-28.1) kg/m2 vs. 25.2 (23.3-27.4) kg/m2 ], higher prevalence of type 2 diabetes (36 [11.5%] vs. 45 [5.7%]) and lower International Index of Erectile Function-erectile function scores (6 [2-10] vs. 18 [11-24]) than men with erectile dysfunction-only (all p<0.05). Patients with erectile dysfunction + unreported orgasmic phase disorder depicted higher rates of severe erectile dysfunction (75.5%vs. 25%) and Beck's Inventory for Depression ≥11 (22.6%vs. 17.9%) (all p<0.05). In the multivariable logistic regression analysis, older age (odds ratio: 1.02) and lower International Index of Erectile Function-erectile function scores (odds ratio: 0.83) were independently associated with unreported orgasmic phase disorder (all p<0.05). Almost one in three men seeking first medical help for erectile dysfunction depicted criteria suggestive of unreported orgasmic phase disorder. Men with unreported orgasmic phase disorder were older and had higher rates of severe erectile dysfunction and concomitant depressive symptoms. These real-life findings outline the clinical relevance of a comprehensive investigation of concomitant sexual dysfunction in men only complaining of erectile dysfunction to more effectively tailor patient management.

Influence of Nitrosyl Iron Complex with Thiosulfate Ligands on Therapeutically Important Targets Related to Type 2 Diabetes Mellitus.

The high prevalence of type 2 diabetes mellitus (T2DM), and the lack of effective therapy, determine the need for new treatment options. The present study is focused on the NO-donors drug class as effective antidiabetic agents. Since numerous biological systems are involved in the pathogenesis and progression of T2DM, the most promising approach to the development of effective drugs for the treatment of T2DM is the search for pharmacologically active compounds that are selective for a number of therapeutic targets for T2DM and its complications: oxidative stress, non-enzymatic protein glycation, polyol pathway. The nitrosyl iron complex with thiosulfate ligands was studied in this work. Binuclear iron nitrosyl complexes are synthetic analogues of [2Fe-2S] centers in the regulatory protein natural reservoirs of NO. Due to their ability to release NO without additional activation under physiological conditions, these compounds are of considerable interest for the development of potential drugs. The present study explores the effects of tetranitrosyl iron complex with thiosulfate ligands (TNIC-ThS) on T2DM and its complications regarding therapeutic targets in vitro, as well as its ability to bind liposomal membrane, inhibit lipid peroxidation (LPO), and non-enzymatic glycation of bovine serum albumin (BSA), as well as aldose reductase, the enzyme that catalyzes the reduction in glucose to sorbitol in the polyol pathway. Using the fluorescent probe method, it has been shown that TNIC-ThS molecules interact with both hydrophilic and hydrophobic regions of model membranes. TNIC-ThS inhibits lipid peroxidation, exhibiting antiradical activity due to releasing NO (IC50 = 21.5 ± 3.7 µM). TNIC-ThS was found to show non-competitive inhibition of aldose reductase with Ki value of 5.25 × 10-4 M. In addition, TNIC-ThS was shown to be an effective inhibitor of the process of non-enzymatic protein glycation in vitro (IC50 = 47.4 ± 7.6 µM). Thus, TNIC-ThS may be considered to contribute significantly to the treatment of T2DM and diabetic complications.

1274-P: High Prevalence of Type 2 Diabetes without Traditional Risk Factors among Men Who Inject Drugs in Chennai, India

South Asians with type 2 diabetes (T2DM) are predominately normal- or underweight, due to early loss of beta cell function in addition to insulin resistance. Substances of misuse are an additional stressor on beta cells and may lead to an increased prevalence of T2DM. We determined the prevalence of T2DM and its correlates among people who inject drugs (PWID) in Chennai. We conducted a cross-sectional analysis among male PWID. T2DM was defined as fasting glucose ≥126mg/dL or a prior diagnosis. Logistic regression was used to identify correlates of T2DM. Among 1039 PWID, median age was 38.9 years (IQR 32.1, 44.9) and median BMI was 19.7 kg/m2 (IQR 17.8, 22.9). The most common injected substance was heroin (94.8%, n=998). T2DM prevalence was 8.4% (n=87), among whom 60% were underweight or normal weight and 64% had normal waist circumference. On univariable regression analysis, T2DM was not associated with greater frequency of drug use, type of drug, HIV, or Hepatitis C. On multivariable analysis, age &amp;gt;40 years (OR 3.0, 95% CI 1.3-6.8) and high waist circumference (OR 1.9, 95% CI 1.1-3.2) were associated with T2DM. The prevalence of T2DM among PWID is similar to India as a whole, though most cases would not be detected by screening using weight or waist circumference. Integrating universal metabolic disease screening into substance abuse treatment programs may help reduce morbidity and mortality from T2DM. Disclosure P.Chebrolu: None. S.Mehta: Research Support; Abbott Diagnostics. A.Mcfall: None. T.Brown: Advisory Panel; Merck &amp; Co., Inc., Gilead Sciences, Inc., ViiV Healthcare, Jannsen. A.Srikrishnan: None. M.Kumar: None. H.Iqbal: None. J.S.Mathad: None. G.Lucas: None. S.S.Solomon: Research Support; Gilead Sciences, Inc., Abbott. Funding National Institute on Drug Abuse (R01DA026727); Fogarty International Center (D43TW009337); Weill Cornell Department of Medicine; National Institute of Allergy and Infectious Diseases (K24AI120834 to T.B.)

287-OR: An ABCC8 R1420H Loss-of-Function Variant Affects Insulin Secretory Function and Microvascular Disease in American Indians

The ABCC8 gene regulates insulin secretion and plays a critical role in glucose homeostasis. An R1420H loss-of-function variant in ABCC8 was previously detected in ~3% of people in an American Indian Community with a high prevalence of type 2 diabetes (T2D); heterozygous carriers had a doubling in T2D risk and developed this disease at younger ages and lower BMIs. To further examine the phenotype of this variant, we analyzed the relationship between insulin secretion (2-h post-load corrected insulin response) and insulin sensitivity index [104/(fasting insulin*glucose)] in 5701 members of this population without diabetes aged ≥5 years using standard major axis regression, which adjusts insulin secretion for sensitivity. We used hierarchical logistic regression models in up to 7672 individuals to study cross-sectional associations with diabetes complications including increased albuminuria [albumin to creatinine ratio (ACR) ≥30 mg/g], severe albuminuria (ACR ≥ 300 mg/g), reduced eGFR (eGFR&amp;lt;60 mL/min/1.73m2), and retinopathy assessed by fundoscopic examination. Variant carriers had worse beta-cell function than non-carriers both in children and adults (p=0.0003) with no difference in insulin sensitivity (p=0.50). This variant did not associate significantly with increased albuminuria, severe albuminuria or reduced eGFR after adjustment for age, sex, and presence and duration of diabetes. By contrast, carriers had significantly higher odds of retinopathy (OR=1.74, 95% CI: 1.19, 2.53). Increased odds of retinopathy were also observed among individuals with and without diabetes, and when adjusted for fasting plasma glucose (FPG) [carriers had higher FPG (b=6.1 mg/dl, 95% CI: 3.0, 9.2) adjusted for age, sex, and presence and duration of diabetes]. In sum, carriers of the R1420H ABCC8 variant have a higher risk of retinopathy but not of abnormal ACR or eGFR; this may be partially explained by higher glycemia levels and worse beta-cell function. Disclosure E.Vazquez arreola: None. W.C.Knowler: None. L.Baier: None. R.L.Hanson: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases

Type 2 Diabetes Mellitus (Case Study at Insan Rizkillah Clinic)

Diabetes Mellitus is a public health problem known as the Mother of Disease which is the mother of other diseases such as cardiovascular disease, kidney failure and blindness (American Diabetes Association, 2017). Diabetes Mellitus Type-2 is the most common type of diabetes. Risk factors and prevalence of Type 2 diabetes mellitus include: 1) Dietary factors, such as high-fat and high-carbohydrate foods, 2) Too many thoughts, 3) Obesity, 4) Unbalanced diet, 5) Lack of exercise. This research is a descriptive qualitative research using the method of observation, observation, interviews, study of documents, giving questionnaires and analyzing the results of statistical tests. The research subjects were the people of Sape District who had received treatment at the General Practitioner Insan Rizkillah with a total of 100 people with male and female identities aged between 40-70 years. The frequency of the very high prevalence of Type 2 diabetes mellitus occurs between the ages of 40-50 years with a result of 3.7%, the percentage of the next category occurs at the age of 51-60 years with a result of 2.9% and the third category is between the ages of 61-70 years with yield 3.4%. The results of the data analysis showed that the patient experienced a very significant increase in level.

Cancer, cardiovascular disease, and all-cause mortality in Iraqi- and Swedish-born individuals in Sweden: the MEDIM cohort study

Immigrants from the Middle East to Sweden have a twice as high prevalence of type 2 diabetes (T2D) and obesity as native-born Swedes. Both obesity and T2D have been linked to increased incidence of cancer, cardiovascular disease (CVD) and all-cause mortality (ACM); however, data on differences between ethnicities are scarce. In a population-based cohort we aimed to study the impact of Middle Eastern and European ethnicity on ACM, cancer- and CVD related mortality, incidence of cancer and CVD in an eight-year follow-up study. Methods: People born in Iraq or Sweden, who were 30–75 years of age, were invited from 2010 to 2012 to participate in the population based MEDIM study including a health exam, fasting blood sampling, assessment of insulin secretion and action (through oral glucose tolerance test) and questionnaires assessing history of CVD, cancer and T2D. Register data were retrieved from baseline until the 31st of December 2018 from the Swedish National Patient Register and Cause of Death register regarding CVD diagnosis, cancer diagnosis and cause of death. Information regarding diabetes diagnosis was retrieved from the National Diabetes Register. Individuals with a history of cancer or CVD at baseline were excluded. Cox regression analysis was assessed to study the adjusted hazard ratios (HR) for the relationships between ethnicity and ACM, cancer events, CVD events, death from cancer, and death from CVD, with adjustments for age, sex, anthropometrical measures, T2D and lifestyle. A total of 1398 Iraqi- and 757 Swedish-born residents participated in the study. ACM was considerably lower in Iraqi- compared to Swedish-born individuals HR 0.32 (95% CI 0.13–0.79) (p < 0.05). Furthermore, cancer related morbidity and mortality HR 0.39 (0.22–0.69) (p < 0.01) as well as CVD related morbidity and mortality HR 0.56 (0.33–0.95) (p < 0.05) were lower in the Iraqi-born group compared to the Swedish-born group for. The differences in mortality and cancer rates across ethnicities are not fully explained by anthropometric, environmental or metabolic measures but lie elsewhere. Further studies are needed to increase the understanding of contributing mechanisms.

Classification of the Os Calcis Subtalar Morphology in Symptomatic Flexible Pediatric Pes Planus Deformity Using Weightbearing CT and Distance Mapping.

The etiology of symptomatic pediatric pes planus (PP) deformity is unclear. Reduced os calcis subtalar joint (OCST) anterior facet morphology has been suggested to result in less support to the talar head and a higher propensity to develop PP deformity. Weightbearing computed tomography (WBCT) and distance mapping (DM) offer new opportunities to investigate PP deformity in general and the OCST specifically. The purpose of this study is to investigate the OCST morphology using DM and to classify PP subtalar subtypes with DM using Bruckner's A-D classification system. Forty feet in 25 patients in a national referral center were evaluated for symptomatic PP deformity that failed nonoperative treatment. A WBCT scan was performed as part of the preoperative evaluation. Visualization of the distance distribution between the articulating surfaces of the subtalar joint was based on a DM technique. Intra- and interobserver agreement of the subtalar morphology was assessed using Bruckner's classification system. The mean age was 10.7 ± 1.4 years. The following mean ± SD and median ± ranges were semiautomatically measured for this group: Meary angle -21 ± 8, calcaneal inclination 15 ± 4 degrees, talar coverage angle 39 (range 32.6-49) degrees, and hindfoot moment-arm 16 ± 5 mm. Classifying subtalar morphology using DM yielded an excellent intra- and interobserver agreement. The individual percentages of each individual subtype were calculated: type A 5%, type B 48%, type C 4%, and type D in 44%. This study demonstrated excellent intraobserver and interobserver agreement in classifying the OCST using DM. A higher prevalence of types B and D was observed compared to types A and C in this PP cohort. Level III, retrospective study.

Cardiac structure and function in resistant hypertension: The beneficial role of blood pressure control.

Cardiac structure and function in resistant hypertension: The beneficial role of blood pressure control.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Method of Developing a Culturally Tailored Diabetes Intervention for American Indians.

American Indians have the highest prevalence of type 2 diabetes compared with any other racial or ethnic group. Developing a culturally tailored diabetes prevention and management intervention is one way to reduce diabetes-related health disparities among American Indian populations. The purpose of this article is to describe our approach for developing a diabetes prevention and management intervention study using Kolb's Experiential Learning Theory as the framework. To ensure the intervention study was culturally meaningful and relevant we used community-based participatory principles by partnering with a team of nurse researchers, tribal diabetes educators, tribal leaders, and tribal community members who were involved in all aspects of the study process. We conducted seven focus groups predominantly in rural American Indian communities in Oklahoma. Using focus group findings, the team collaboratively designed and developed a multi-generational diabetes prevention and management intervention study. The intervention group sessions will focus on ways to prevent and manage diabetes while the control group sessions will focus on general health education topics that have been identified by the team as important and relevant. Family interventions that involve multiple generations and provide emotional and behavioral support to those with type 2 diabetes and family members at risk may provide our best chance at improving diabetes-related outcomes and reducing health disparities in this critical population.

Abstract P621: Visceral Adipose Tissue Attenuation: A Marker of Liver Fat Content Beyond the Body Mass Index and Visceral Adipose Tissue Area

Introduction: Body mass index (BMI) and visceral adiposity cannot fully discriminate individuals at risk of presenting non-alcoholic fatty liver. Discordant visceral adiposity/liver fat phenotypes highlight the need for a better understanding of mechanisms involved in liver fat (LF) accumulation independent of BMI and visceral adipose tissue (VAT) quantity. Hypothesis: As VAT attenuation is a marker of VAT quality, we hypothesized that this marker would be an important determinant of LF accumulation and that a lower VAT attenuation would be associated with an increased LF accumulation irrespective of BMI and VAT area. Methods: Analyses included 3002 participants (51% men) aged 40 to 70 years with BMI values between 18.5 and 40.0 kg/m 2 of INSPIRE ME-IAA, a prospective observational study conducted in 29 countries in America, Asia, and Europe. Computed tomography was used to measure subcutaneous adipose tissue (SAT) and VAT area and attenuation (a marker of adipocyte size) and liver attenuation (a marker of LF content). Participants’ cardiometabolic health profile was assessed in the fasting state. Partial Pearson correlation coefficients were computed to document the associations between VAT area and attenuation and liver attenuation. Multivariable regression analyses were performed to quantify the contribution of SAT and VAT area and attenuation to LF attenuation. A mixed-model ANOVA was used to compare liver attenuation according to VAT area and attenuation, and to compare VAT attenuation according to LF level and VAT area. A generalized linear mixed model was used to compare the prevalence of type 2 diabetes according to LF content and VAT area. Results: VAT attenuation was associated with liver attenuation in women (r=0.34, p&lt;0.0001; r=0.38, p&lt;0.0001; r=0.36, p&lt;0.0001) and men (r=0.42, p&lt;0.0001; r=0.30, p&lt;0.0001; r=0.24, p&lt;0.0001) within each BMI category (normal weight, overweight, obesity), respectively. VAT attenuation better explained LF attenuation than SAT and VAT area. A low VAT attenuation was associated with a lower liver attenuation within each VAT area tertile in all BMI categories (p&lt;0.05). Furthermore, an increased LF content was associated with a lower VAT attenuation (p&lt;0.05) independent of SAT and VAT area in both sexes in all BMI categories. An increased LF content was also associated with a higher prevalence of type 2 diabetes (p&lt;0.05) in individuals with normal weight and overweight beyond VAT area. Conclusion: A low VAT attenuation reflecting larger adipocytes is associated with an increased LF content and risk of type 2 diabetes independent of BMI and VAT area. These results suggest that VAT attenuation as a marker of adipose tissue quality might be involved in the development of non-alcoholic fatty liver disease.

Critical Overview on Endocrine Disruptors in Diabetes Mellitus.

Diabetes mellitus is a major public health problem in all countries due to its high human and economic burden. Major metabolic alterations are associated with the chronic hyperglycemia that characterizes diabetes and causes devastating complications, including retinopathy, kidney failure, coronary disease and increased cardiovascular mortality. The most common form is type 2 diabetes (T2D) accounting for 90 to 95% of the cases. These chronic metabolic disorders are heterogeneous to which genetic factors contribute, but so do prenatal and postnatal life environmental factors including a sedentary lifestyle, overweight, and obesity. However, these classical risk factors alone cannot explain the rapid evolution of the prevalence of T2D and the high prevalence of type 1 diabetes in particular areas. Among environmental factors, we are in fact exposed to a growing amount of chemical molecules produced by our industries or by our way of life. In this narrative review, we aim to give a critical overview of the role of these pollutants that can interfere with our endocrine system, the so-called endocrine-disrupting chemicals (EDCs), in the pathophysiology of diabetes and metabolic disorders.

Association between insulin resistance indices and perioperative functional status and immediate prognosis in patients with carbohydrate metabolism disorders undergoing coronary artery bypass grafting

Highlights. Patients with coronary artery disease undergoing coronary artery bypass grafting have a high prevalence of type 2 diabetes mellitus and prediabetes. The frequency of postoperative stroke and hospital stay is significantly higher in patients with impaired carbohydrate metabolism.Insulin resistance markers are associated with a variety of perioperative characteristics, but according to multivariate analysis, only free fatty acids and HOMA-IR were independent predictors of hospitalacquired complications and long-term hospital stayAim. To analyze insulin resistance markers and their association with the preoperative outcome and in-hospital complications of coronary bypass grafting (CABG) in patients with type 2 diabetes mellitus (DM 2), prediabetes and normoglycemia.Methods. The study included 383 consecutive patients undergoing CABG at the same center. Glycemic status, free fatty acids (FFA), fasting insulin, glucose, lipid profile of all patients were determined before surgery and the following insulin resistance indices (IR) were calculated: HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), QUICKI (Quantitative Insulin Sensitivity Check Index), Revised QUICKI, McAuley. Patients were divided into 2 groups: the group that included patients with carbohydrate metabolism disorders (CMD), type 2 diabetes mellitus and prediabetes (n = 192), and the group of patients without CMD (n = 191). Perioperative characteristics of patients, postoperative complications and their association with insulin resistance markers were analyzed.Results. FFA and calculated indices of insulin resistance such as HOMA-IR, QUICKI, RevisedQUICKI, and McAuley correlated with the following perioperative characteristics: the duration of surgical intervention and cardiopulmonary bypass, lipid levels, coagulation index, left ventricular dimension and myocardial diastolic function, etc. The analysis of in-hospital complications revealed that the frequency of postoperative stroke (p = 0.044) and hospital stay after CABG &gt;30 days (p = 0.014) was significantly higher in patients with CMD. According to the results of multivariate analysis, the predictors of the composite endpoint (hospital stay after CABG&gt;10 days and/or significant perioperative complication) were as follows: female sex (odds ratio (OR) 2.862, 95% confidence interval (CI) 1.062-7.712, p = 0.036); age (OR 1.085, 95%CI 1.027–1.147, p = 0.003); duration of cardiopulmonary bypass (OR 1.146, 95%CI 1.008–1.301, p = 0.035); body mass index (OR 1.125, 95% CI 1.035–1.222, p = 0.005), left atrial dimension (OR 5.916 95% CI 2.188–15.996, p&lt;0.001); any CMD (OR 1.436, 95%CI 1.029–2.003, p = 0.032), type 2 DM (OR 2.184, 95%CI 1.087–4.389, p = 0.027), FFA levels (OR 5.707, 95%CI 1.183–27.537, p = 0.029) and HOMA–IR index (OR 1.164, 95%CI 1.025–1.322, p = 0.019).Conclusion. FFA, HOMA-IR, QUICKI, Revised-QUICKI, and McAuley correlate with a variety of perioperative characteristics of patients undergoing CABG, but multivariate analysis revealed that only FFA levels and the HOMA-IR can be used as predictors of in-hospital complications and prolonged hospital stay.