History Of Diabetes Research Articles

High Frequency of Severe Hyperglycemia Observed During Intensive Hematologic Care: A Prospective Study Using Continuous Glucose Monitoring

ObjectiveDuring intensive hematologic care, patients are exposed to high-dose chemotherapy, corticosteroids, immunosuppressants, and total parenteral nutrition. Combined with physiologic stress and increased release of cytokines and hormones, this can lead to dysglycemia, which is associated with adverse clinical outcomes. This prospective study aimed to investigate continuous glucose monitoring (CGM) to identify dysglycemia during intensive hematologic care. MethodsPatients receiving chimeric antigen receptor T-cell therapy or allogeneic or autologous stem cell transplantation were eligible. Throughout the study, glucose levels were concurrently monitored using CGM and point-of-care (POC) glucose measurements in 60 patients (71% male, median age of 64 [interquartile range, 58-68] years, and 10% with diabetes). ResultsHyperglycemia (glucose level,>10 mmol/L) was prevalent in 93% of patients, of whom 90% had no history of diabetes. Severe hyperglycemia (glucose level, >13.1 mmol/L) was present in 38%. Additionally, hyperglycemia was associated with prolonged hospitalization in patients undergoing chimeric antigen receptor T-cell treatment (β, 0.19; 95% CI, 0.04-0.35) and autologous stem cell transplantation (β, 0.16; 95% CI, 0.01-0.32). CGM outperformed POC in detecting hyperglycemia (>10 mmol/L: 1060 vs 124, detected 2.8 [interquartile range, 0.7-4.0]) hours earlier. The mean absolute relative difference between CGM and POC was 21.5%, with 99.8% of measurements in the clinical acceptable zone A + B of the Clarke error grid. ConclusionThese findings emphasize the potential and importance of glucose monitoring with CGM for improved and earlier detection of hyperglycemia, in this patient population, which seems feasible. Our results suggest a need for further studies into CGM as method to optimize glucose levels, which could improve outcomes in patients receiving intensive hematologic care.

Correlation of Serum Uric Acid With Cardiovascular Risk in Nigerian Patients.

Studies exploring the relationship between serum uric acid (sUA) and cardiovascular risk in the Nigerian population remain sparse. The study aimed to assess the association between sUA levels and two measures of cardiovascular risk, namely the Framingham 10-year Cardiovascular Risk Score (FRS) and the Atherogenic Index of Plasma (AIP). This retrospective study used data from clinical records of new, previously unregistered patients presenting at a private cardiac hospital over one year from November 2022 to October 2023. In total, 428 patients presented newly to the hospital in that period. The records of 138 patients were included in the project after various exclusions were made including for incomplete anthropometric and laboratory data. Statistical tests of association were used to determine the significance of the relationship between sUA levels and the measures of cardiovascular risk. Two-tailed p <0.05 was deemed statistically significant. Hyperuricemia was more prevalent in individuals with central obesity, i.e., waist circumference ≥94cm in males or 80cm in females (93.4% vs 6.6%; p=0.03). Serum uric acid also positively correlated with FRS (correlation coefficient: 0.190; p<0.05) and serum triglyceride levels and AIP (correlation coefficient: 0.259 and 0.294, respectively; p<0.001 for both). After multivariate analyses, uric acid was significantly and independently associated with high FRS and AIP after adjusting for age, smoking and diabetes history, blood pressure, total and high-density lipoprotein cholesterol, serum triglyceridesand waist circumference (p<0.001). The results emphasize the emergence of sUA as a pertinent cardiovascular risk factor in clinical settings. More research is needed to deduce the relationship, if any, between cardiovascular risk reduction and pharmacological reduction of sUA levels.

P221 ANKLE BRACHIAL INDEX AND ASSOCIATION WITH CHRONIC KIDNEY DISEASE IN THE H3 AFRICA KIDNEY DISEASE RESEARCH NETWORK

Background and Objective: Abnormal ankle brachial index (ABI) is common in patients with chronic kidney disease (CKD). We evaluated the association of ABI, a non-invasive tool to evaluate peripheral arterial disease and arterial stiffness, with CKD among West Africans enrolled in the H3Africa Kidney Disease Research Network (H3AKDRN). Methods: We recruited 9206 participants (5356 with CKD), from Ghana and Nigeria in the H3AKDRN, a multinational case-control study. CKD was defined as estimated glomerular filtration rate of &lt;60 ml/min/1.73m2 and/or albuminuria as albumin/creatinine ratio &gt;3.0 mg/mmol (&gt;30 mg/g) for ≥3months. ABI was divided into low (≤0.9), normal (0.91 – 1.3), and high (&gt;1.3). We assessed low ABI, a marker of peripheral artery disease, and high ABI, the marker of arterial stiffness. We determined association of ABI with CKD by multivariate logistic regression. Results: The mean age of participants was 45.8±15.36 years and 56.3% were males. The prevalence of low ABI was higher in CKD group (32%% versus 16% (control), p=0.013). The prevalence of high ABI was also higher in CKD (15% versus 10.9% (control), p = 0.01). Patients with CKD and low ABI have reduced BMI, low haemoglobin, higher systolic BP and increased albuminuria. Male gender, history of hypertension and diabetes were independently associated with CKD. Higher BMI was associated with reduced odds of CKD (p = &lt; 0.03). After adjustment for covariates, low ABI was associated with CKD, with 26% increased odd (aOR 1.26 (CI, 1.01 – 1.56; p = 0.037)), but high ABI was not associated with CKD (aOR 1.45 (0.88 – 2.38, p = 0.147)). Conclusion: The prevalence of abnormal ankle brachial index is high among adult populations of Ghana and Nigeria, with and without CKD. The Marker of peripheral arterial disease, but not marker of arterial stiffness was associated with CKD. A longitudinal study is required to determine the true relationship between ABI and CKD in West Africa.

P218 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY AND ITS RELATIONSHIP WITH HYPERTENSION AND COMORBIDITIES

Background and Objective: Within-visit blood pressure variability (BPV) is a predictor of cardiovascular events, independent of mean blood pressure (BP) levels. This study explored the associations of BPV with hypertension status and comorbidities in May Measurement Month (MMM) 2019 global survey participants. Methods: Adults (≥18 years) were surveyed via convenience sampling from 92 countries in May 2019. Each participant had up to three standardized seated BP readings. Participants with incomplete data on age or sex, or any missing BP readings were excluded. Hypertension was defined as having a BP ≥140 and/or 90 mmHg or being treated with BP-lowering medication. Participants were stratified into three groups: normotensive, untreated hypertensives, treated hypertensives, and normotensives. BPV was calculated as the variation independent of the mean (VIM) of the three BP readings. Associations between BPV and each of three conditions (previous stroke, previous myocardial infarction, or diabetes) were modelled using linear regression. Each model was adjusted for mean BP, age, sex, and an interaction term between age and sex. Results: Data from 1,128,889 participants were included. The mean age was 45.2 (SD 16.6) years and 51.4% were female. A third (33.6%) of participants were hypertensive, of whom 200,370 (53.2%) were treated. Of non-hypertensive and untreated hypertensive participants, those with a history of stroke, myocardial infarction, or diabetes had lower BPV relative to those without a history of these conditions (Figure). A stronger association was observed for diabetes within untreated hypertensive than non-hypertensive participants. However, amongst treated hypertensive participants, differences in BPV between those with comorbid conditions and those without were smaller than in the other two groups. Conclusions: Contrary to expectation, BPV was significantly lower in those with diabetes, or a history of stroke or myocardial infarction, amongst both untreated hypertensives and normotensives. However, among treated hypertensives, BPV was similar between those with or without each comorbidity, suggesting a modifying effect of BP-lowering medication.

Abstract P339: Association of Pre-Donation Blood Pressure with Kidney Function in Living Kidney Donors

Background: Although BP is associated with kidney outcomes, its clinical significance in living kidney donors (LKD) is unknown. We aim to examine the association between pre-donation BP and the risk of kidney function decline in LKD. Methods: A retrospective cohort study using OPTN/SRTR including adult LKD, who underwent donation between 6/1972 and 9/2022, was utilized to examine the association of quartile (Q) of pre-donation SBP and DBP with time-to-event of ≥35% decline in post-donation eGFR from pre-donation eGFR by multiple Cox regression. Results: Of 174,311 adult LKD, mean±SD age was 41±12 years and 60% were female. Mean pre-donation SBP and DBP were 122±13 and 74±9 mmHg, respectively. Mean pre-donation SBP in Q 1, 2, 3, and 4 were 106±6, 117±2, 126±3, and 140±9 mmHg, respectively and the corresponding DBP were 62±5, 71±2, 78±2, and 86±5 mmHg, respectively. The median (IQR) of pre-donation eGFR was 91 (75, 111) mL/min/1.73 m 2 . Median(IQR) eGFR at immediate post-donation, 6-, 12-, and 24-months post-donation were 50 (40, 62), 54 (44, 67), 55 (45, 68), and 57 (47, 70) mL/min/1.73 m 2 , respectively. Out of 38,780 LKD with post-donation eGFR data at 6, 12, or 24 months, 31,054 had the event of ≥35% decline in post-donation eGFR from pre-donation eGFR with a median time to follow-up of 6.77 months(IQR 5.93, 12.67). The incidence rate of the event was 0.08 person-months. Compared to patients with SBP in Q 1, those with SBP in Q 2, 3, and 4 had a significantly increased risk for the event(HR SBP Q2,3,4 1.05, 1.08, and 1.15; P &lt;0.001 – 0.003) but only patients with DBP in Q 3 and 4 had a significantly increased risk for the event (HR SBP Q3,4 1.04 and 1.09). After adjusting for age, gender, race/ethnicity, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, and urine protein:creatinine ratio, there was a J-shaped association between pre-donation SBP and post-donation eGFR decline and only patients in the Q 2 became significantly associated with lower the risk for the event (HR 0.87, 95%CI 0.76, 0.99; Fig1). The pre-donation DBP – post-donation eGFR association was similar to the SBP – eGFR association but there was no statistically significant in all Q (Fig2). There was no effect-measured modifier for all covariates. Conclusions: Pre-donation SBP in a normal range(113 - 120 mmHg) is associated with the lowest risk for a post-donation eGFR decline. BP control in the normal range should be achieved for potential LKD.

P140 PREVALENCE OF HYPERTENSION IN A RURAL COMMUNITY IN THE FEDERAL CAPITAL TERRITORY ABUJA (GBESSA) NORTH CENTRAL NIGERIA

Background: High Blood pressure, once rare, is rapidly becoming a major public health burden in sub-Saharan Africa. This has been attributed to acculturation of the populace who are rapidly adopting modern lifestyle changes. Aim This study aimed to describe the prevalence and identify risk factors for hypertension in rural community in the Federal capital territory in Nigeria. Methods A cross sectional survey of 491 households with 1,739 adults aged 18 years and above was carried out. Information about health and lifestyle was obtained from structured questionnaire interviews, followed by assessment of blood pressure (BP) and anthropometry. Results: There were 18.1% (95% confidence interval (CI), 16.0-20.6% participants with hypertension (defined as a systolic BP-140, diastolic BP-90mmHg or on antihypertensives medication). This prevalence of Hypertension was found to rise with age. Between the sexes males recorded a higher prevalence of 19.6% compared to 17.4%: females but this was not statistically ×2 P-value =0.34. Single and widowed subjects recorded high prevalence of 32.2% and 30.0% of Hypertension while students had low rate of 5.6%. The prevalence of Hypertension was 20.5% among farmers.Whereas, obesity (measured by WHR), alcohol intake, cigarette smoking, and family history of hypertension had no valid statistical evidence, chewing tobacco/ snuff, previously diagnosed diabetes mellitus or family history of diabetes showed statistically significant differences. Conclusion: This findings underscore the need for public health campaign at community levels to prevent increasing blood pressure and it's sequelae. This will involve campaigns to maintain the age- long tradition of exercise, avoidance of smoking, alcohol and weight maintenance.

Knowledge and Awareness of Type 2 Diabetes Complications in Conflict-Affected Regions: A Cross-Sectional Study in Homs, Syria.

Background Diabetes mellitus is a significant global health problem characterized by high blood sugar levels due to either a lack of insulin or insensitivity to it. Concerns about diabetes complications are growing both globally and locally, making effective preventive measures crucial to tackle these complications. This research aimed to determine the level of knowledge and awareness regarding type 2 diabetes complications among patients in Homs, Syria, during the ongoing conflict. Methods A cross-sectional study was conducted among 1016 diabetic patients aged 16 years and above attending internal medicine and diabetes clinics in Homs City through a structured questionnaire administered via social media, telephone interviews, and paper forms. The data collected were analyzed using SPSS version 23.0 (IBM Corp., Armonk, USA). Descriptive statistics were used to summarize the demographic characteristics. In contrast, inferential statistics such as the chi-square test were used to test for associations between different variables with p-value < 0.05 as the significance level. Results The study found that 478 (47.1%) of participants were male, and 538 (53%) were female. The majority 652 (64.2%) were between 46 and 70 years old, and 422 (41.5%) had primary-level education. Most were married 750 (73.8%) and lived in urban areas 856 (84.2%). Diabetes knowledge varied significantly by age, education, occupation, and residence. Housewives and those with lower education levels had the least knowledge, while urban residents and those with 1-5 years since diagnosis had better awareness. Individuals with relatives in the medical field had higher knowledge levels.Results indicate that gender did not significantly influence diabetes knowledge (p = 0.19), while younger adults showed poorer awareness compared to older age groups (p < 0.05). Higher education levels were associated with better knowledge (p < 0.05), and a family history of diabetes correlated with greater awareness of complications. Occupation significantly impacted knowledge, with employed individuals and urban residents demonstrating higher awareness levels (p < 0.05). Diabetes knowledge peaked during the 6-10 year disease duration (p < 0.05). Conclusion This study assesses diabetes knowledge and management practices among 1016 participants in Homs, Syria, focusing on demographic and socioeconomic factors. Our findings underscore the need for targeted educational initiatives to improve diabetes management, particularly among younger, less educated, and rural populations in Homs.The analysis reveals significant knowledge gaps about diabetes across different demographics in Homs, highlighting the need for targeted educational programs, especially for younger individuals, the less educated, and rural residents. The study emphasizes the importance of education and medical practice in understanding diabetes, particularly in conflict-affected areas.

Incidence of Posterior Capsule Rupture During Phacoemulsification Cataract Surgery Among Patients Treated With Intravitreal Bevacizumab Injections.

To assess whether intravitreal bevacizumab injections increase the risk of posterior capsular rupture during phacoemulsification cataract surgery in diabetic patients. A retrospective study that included diabetic patients who underwent phacoemulsification cataract surgery at King Hussein Medical Center of the Jordanian Royal Medical Services during a one-year period from January 2023 until January 2024. Patients were categorized into four groups. The first group did not receive an intravitreal bevacizumab injection; the second group received only one injection; the third group received two injections; and the fourth group received three or more injections. Results from the four groups were compared with a control group for patients who underwent phacoemulsification surgery and were not known to have diabetes mellitus and did not receive previous intravitreal injections. All injections were received within a period of one year before the time of phacoemulsification surgery. Inclusion criteria for the study groups included diabetic patients with a history of diabetes of more than 10 years with the presence of diabetic retinopathy. Exclusion criteria included patients who received intravitreal injections other than bevacizumab, previous intraocular surgery or trauma, and the presence of ocular pathology that led to an increased risk of posterior capsular rupture. The incidence of posterior capsular rupture was compared among these groups. A p-value was used to assess statistical significance and was considered to be statistically significant if ≤0.05. The number of patients in the control group (group 0) was 1440 patients with a mean age of 64.9, and in the study groups were 1306 patients. Group 1 included 244 patients (18.7%) with a mean age of 62.4 years, compared to 306 patients (23.4%) in group 2 with a mean age of 66.1 years, 352 patients (27%) in group 3 with a mean age of 64.2 years, and 404 patients (30.9%) in group 4 with a mean age of 63.1 years. Posterior capsular rupture occurred more significantly in patients with group 4. It occurred in 21 patients, representing 5.2% of them, compared to four patients (1.6%) of group 1, six patients (2%) of group 2, and eight patients (2.3%) of group 3, while in the control group, the number of patients with posterior capsular rupture was 20 (1.4%). Intravitreal bevacizumab in diabetic patients is considered a risk factor for posterior capsular rupture in phacoemulsification cataract surgery in patients receiving more than three injections.

A novel nonsense mutation c.747C>G in the NEUROD1 gene detected within a Chinese family affected by maturity-onset diabetes of the young type 6.

Highlights Maturity-onset diabetes of the young type 6 (MODY6) is a rare form of monogenic diabetes mellitus due to NEUROD1 gene mutation on chromosome 2q32. A 21-year-old woman exhibiting weight loss, polyuria, and hyperglycemia was initially misdiagnosed with type 1 diabetes mellitus. Considering the early-onset age, a three-generation family history of diabetes, and negative autoimmune antibodies, a MODY diagnosis was suspected. Genetic analysis revealed that she inherited a novel heterozygous nonsense NEUROD1 mutation c.747C>G (p.Tyr249*) from her father. Correct MODY6 diagnosis facilitates appropriate interventions.

O06 HYPERTENSION CONTROL AND COMORBIDITIES: INSIGHTS FROM THE MAY MEASUREMENT MONTH CAMPAIGN, 2017-2019

Background and Objective: Hypertension frequently coexists with other chronic conditions and cardiometabolic risk factors. The identification of comorbidities is key in the management of hypertensive patients. May Measurement Month (MMM) is a global initiative aimed at enhancing the detection and awareness of hypertension. This study analyzes data from MMM collected between 2017 and 2019 to evaluate hypertension control among adults aged 18 years and the frequency of comorbidities. Methods: Three sitting blood pressure (BP) readings, anthropometric measurements, and self-reported history of diabetes, myocardial infarction and stroke were collected. Missing BP readings were inputted using multiple imputation based on available BP measurements and sociodemographic variables. Hypertension was defined as an average systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. Hypertension treatment was defined as current medication use; control was defined as BP &lt;140/90 mmHg. Results: Among 2,907,848 participants from 95 countries, 34.2% had hypertension, and 12.1% had a history of at least one other chronic condition. Specifically, 8.3% self-reported type 2 diabetes, 4.5% had experienced myocardial infarction, and 2.9% had a history of stroke. Some individuals had multiple comorbidities at the time of the screening: 6% had both myocardial infarction and type 2 diabetes, 8% had myocardial infarction and stroke, 2% had stroke and type 2 diabetes, and 8% had all three comorbidities. Among those with hypertension, 58.9% were on medication and 24.0% had at least one additional comorbidity, specifically, 15.8% reported type 2 diabetes, 8.8% had experienced myocardial infarction, and 5.5% had a history of stroke. Of those with hypertension on medication, 43.1% were controlled. Among treated individuals, hypertension control rates were higher in individuals with comorbidities (50% vs 30%). Conversely, individuals without comorbidities had poorer hypertension control. Conclusions: The data suggest a high prevalence of comorbidities within the screened population and among individuals diagnosed with hypertension. Additionally, individuals without comorbidities exhibited suboptimal hypertension management.

A Phenomenological Study To Assess The Lived Experience Of Health Related Quality Of Life Of Diabetic Patient In Selected Hospitals Of Pune City

Diabetes is the top health emergencies from the 21st century. Every year more people live with diabetes that could be a result of sedentary life and health related complication. First world health organization’s global report in (2016) about diabetes shows that the numbers of peoples with diabetes, almost from the year 1980 to 2014, has quadrupled. The number of peoples with diabetes has been increased from 108 million in 1980 to 422 million in 2014.The study aims to assess the Health related quality of life of diabetic patients. Phenomenological research designwas used with Purposive sampling technique to select the participants. Sample size was 10 as determined by data saturation technique using a semi-structured questionnaire technique was adapted to collected data using colaizzi approach. The study finding revealed that in Baseline data 30% of the diabetic patients had age 25-35 years and 70% of them had age 35-45 years.50% of them were females and 50% of them were male.50% of them had higher secondary, 40% of them were illiterate and 10% of them had secondary education.90% of them were married and 10% of them were unmarried and 30% of them had 5-10 years of working experience.10% of them were non-vegetarians and 90% of them were vegetarians.All of them had family history of diabetes.40% of their fathers having diabetes and 60 of their mothers had diabetes mellitus. And common themes were found like confusion, giddiness, restlessness and uncomfortable, effect of the medications as Anger, Anxiety, Frustration, Headache, Irritation, Nausea, Stress and Vomiting, 'Confusion about the dose', 'Difficult to manage', 'Difficult to remember dose', 'Easy to manage' and 'Forget amount and dose of medication'.Joint pain, Tenderness, Tiredness Uncomfortable and Weakness

Treating hyperglycaemia in a patient with maternally inherited diabetes and deafness with an inhibitor of dipeptidyl peptidase-4: a case report and two-year follow-up.

Maternally inherited diabetes and deafness (MIDD) is a mitochondrial disorder with diverse characteristics, which make early diagnosis difficult. We report a case of 32-year-old woman with diabetes who was admitted due to weight loss and poor glycemic control. She had a history of gestational diabetes at age 26. Pancreatic function was evaluated by oral glucose tolerance. An ophthalmologic examination detected conjunctivitis and refractive errors and hearing tests were normal. The patient had a family of diabetes. Then we tested the patient and her first-degree relatives with a confirmed genetic mutation at position 3243 in the tRNA. After two years of treatment with linagliptin, both glycated hemoglobin and pancreatic function have shown improvement to some extent. Although MIDD is a rare form of diabetes, due to distinctive management and associated comorbidities it is important to diagnose.

Maternal Death Due to Lymphocytic Hypophysitis: A Case Report

Lymphocytic hypophysitis is a rare condition characterized by lymphocyte and plasma cell infiltration, leading to fibrosis and functional impairment of the pituitary gland. Although lymphocytic hypophysitis is associated with pregnancy, its diagnosis may be challenging in pregnant women owing to unclear symptoms of pituitary dysfunction. Lymphocytic hypophysitis can lead to serious complications, including a sudden death; however, no case of maternal death has been reported in Korea. This study presents a case of maternal death after childbirth. The deceased had a history of hypertension, obesity, hypothyroidism, and gestational diabetes and died suddenly the day after the emergency cesarean section. Notably, no other pregnancy-related complications were observed. Histopathological examination of the pituitary gland confirmed lymphocytic hypophysitis. This case report emphasizes the requirement of clinical awareness and underscores the significance of examining the pituitary gland during autopsy investigations of maternal deaths.

MANAGEMENT OF JALODARA (ASCITES) THROUGH AYURVEDIC PRINCIPLES: A CASE STUDY

The accumulation of fluid in the peritoneum is called ascites. It is the most prevalent sign of liver damage. In contemporary medicine, there is currently no proven cure for ascites patients. It only relieves symptoms, and recurrence occurs over time. Such cases benefit from the side-effect-free results of ayurvedic treatment. Eight categories of Udara roga are stated in Ayurveda, and this case is correlated with Jalodara. A 44-year-old male patient came to Rognidan OPD in Government Ayurveda College, Nagpur, India, with symptoms including abdominal distension, anorexia, bipedal edema, icterus, dyspnea on exertion, interrupted sleep, and overall weakness. In addition to being a persistent alcoholic, the patient had no prior history of diabetes or hypertension. He was treated in accordance with the Jalodara therapeutic principles as stated in the Charaka Samhita, which included nitya virechana (daily purgation) using Ayurvedic medicines, strotoshodhana (microchannel cleaning), and a few hepatoprotectives. After receiving therapy for one month, the patient's symptoms showed significant improvement; hence, it was concluded that Ayurvedic treatments benefit Jalodara.

Efficacy of Dry Needling in Enhancing Hand Function and Reducing Spasticity in MCA Stroke Patients: A Prospective Case Report

Stroke, particularly involving the middle cerebral artery (MCA), often leads to persistent disability, significantly impairing hand function and inducing severe spasticity in the forearm flexors due to complex motor pathway involvement. This case report evaluates the effectiveness of combining dry needling therapy (DNT) with task-oriented training (TOT) in reducing spasticity and improving hand function in a post-MCA stroke patient. A 61-year-old male with right-side hemiplegia following a left MCA stroke, compounded by a history of diabetes, hypertension, and recent kidney stone diagnosis, participated in this study. The patient experienced severe functional limitations due to spasticity (grade 3 on the Modified Ashworth Scale) and scored 31 on the CAHAI-13, indicating significant hand dysfunction. DNT was applied to key forearm muscles (flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, and pronator teres), followed by TOT targeting daily tasks. Post-intervention, the patient demonstrated significant improvements: spasticity was reduced (Modified Ashworth Scale score decreased from grade 3 to grade 2), and muscle hypertonicity, as measured by EMG, was reduced in all targeted muscles. Functional hand use improved markedly, with the CAHAI-13 score increasing from 31 to 45. These improvements led to enhanced independence in daily activities. This case report highlights the clinical relevance of integrating DNT with TOT in stroke rehabilitation. The combined intervention not only reduced spasticity and improved neuromuscular function but also led to meaningful gains in hand function, enhancing the patient’s ability to perform daily activities independently. Given the promising results, this combined approach could serve as a practical and effective strategy for improving motor recovery and functional independence in post-stroke patients. Further studies with larger sample sizes are necessary to confirm these findings and explore the broader application of this approach in clinical practice.

Systematic Literature Review: Analisis Faktor Risiko Diabetes Melitus Tipe 1 pada Anak dan Remaja di Negara Maju Wilayah Eropa Barat

The incidence of type 1 diabetes mellitus mostly occurs in children and adolescents has increased significantly every year, especially in developed countries in Western Europe which continue to experience the highest increase. The purpose of this study was to analyze the risk factors for type 1 diabetes in children and adolescents in developed countries in Western Europe. This type of research is a systematic literature review. The literature search strategy as a source of information was carried out by accessing electronic databases online, namely Science Direct, PubMed, and Google Scholar. Article quality assessment using Critical Appraisal Skill Programme (CASP). The results showed that out of 10 (2014-2024), conducted in the United Kingdom (n=1), Sweden (n=1), Germany (n=1), England (n=2), Denmark (n=3), Norway (n=1) and conducted in Norway and Denmark (n=1). Of the 10 articles, 5 out of 10 articles examined BMI on the development of type 1 diabetes in children and adolescents. The results of this systematic review found that age, gender, race, family history of diabetes, socioeconomic, BMI, nutritional intake in mothers and children, physical activity, infection and smoking will increase the risk of type 1 diabetes mellitus in children and adolescents in developed countries in Western Europe.

Insulin Resistance and Impaired Insulin Secretion Predict Incident Diabetes: A Statistical Matching Application to the Two Korean Nationwide, Population-Representative Cohorts.

To evaluate whether insulin resistance and impaired insulin secretion are useful predictors of incident diabetes in Koreans using nationwide population-representative data to enhance data privacy. This study analyzed the data of individuals without diabetes aged >40 years from the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2010 and 2015 and the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). Owing to privacy concerns, these databases cannot be linked using direct identifiers. Therefore, we generated 10 synthetic datasets, followed by statistical matching with the NHIS-HEALS. Homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) were used as indicators of insulin resistance and insulin secretory function, respectively, and diabetes onset was captured in NHIS-HEALS. A median of 4,580 (range, 4,463 to 4,761) adults were included in the analyses after statistical matching of 10 synthetic KNHANES and NHIS-HEALS datasets. During a mean follow-up duration of 5.8 years, a median of 4.7% (range, 4.3% to 5.0%) of the participants developed diabetes. Compared to the reference low-HOMA-IR/high-HOMA-β group, the high-HOMA-IR/low- HOMA-β group had the highest risk of diabetes, followed by high-HOMA-IR/high-HOMA-β group and low-HOMA-IR/low- HOMA-β group (median adjusted hazard ratio [ranges]: 3.36 [1.86 to 6.05], 1.81 [1.01 to 3.22], and 1.68 [0.93 to 3.04], respectively). Insulin resistance and impaired insulin secretion are robust predictors of diabetes in the Korean population. A retrospective cohort constructed by combining cross-sectional synthetic and longitudinal claims-based cohort data through statistical matching may be a reliable resource for studying the natural history of diabetes.

Hyperglycaemia in Pregnancy Is Less Frequent in Smokers: A French Observational Study of 15,801 Women.

Background: We aimed to explore the still-debated association between smoking and hyperglycaemia in pregnancy (HIP). Methods: A multiethnic prospective study of 15,801 women who delivered at Jean Verdier University Hospital between 2012 and 2018. Of these, 13,943 (88.2%) were non-smokers, 624 (4.5%) former smokers, and 1234 (7.8%) current smokers. Universal HIP screening was proposed to the entire sample (IADPSG/WHO criteria). Results: A total of 13,958 women were screened for HIP. Uptake differed between non-smokers, former smokers, and current smokers (89.5%, 88.3%, and 75.7%, respectively, p < 0.0001). HIP prevalence in these groups was 19.9%, 15.4%, and 12.3%, respectively (p < 0.0001). After adjusting for age, body mass index, family history of diabetes, history of HIP, history of macrosomic baby, and ethnicity, current (odds ratio 0.790 [95% confidence interval 0.636-0.981], p < 0.05) but not former (1.017 [0.792-1.306]) smokers were less likely to have HIP than non-smokers. Furthermore, 1 h and 2 h oral plasma glucose test values were lower in current smokers than in non-smokers (p < 0.01). To exclude potential selection bias, we compared risk factors for HIP and HIP-related adverse pregnancy outcomes in current smokers according to HIP screening status. Compared with screened current smokers (n = 934), their unscreened counterparts (n = 300) were younger, less frequently employed, and more likely to be of non-European origin. Moreover, infant birthweight was lower in this group, and preterm deliveries and perinatal deaths were more likely (all p < 0.01). Conclusions: Smoking during pregnancy was independently associated with lower HIP prevalence. The low HIP screening rate in current smokers did not explain this finding.

Hypoglycemia in a non - diabetic patient: a case report

Non diabetic hypoglycemia (or endogenous hypoglycemia) is an uncommon clinical problem, their study and treatment are a complex process. Under normal physiologic conditions, counterregulatory mechanisms prevent hypoglycemia. The use (involuntary or prescribed) of drugs associated with hypoglycemia (meglitinides, sulfonylureas and insulin) must always be ruled out. In healthy patients the main cause is an insulinoma (a type of neuroendocrine pancreatic tumor) and demands multidisciplinary management. The key for the diagnosis of insulinoma is the Whipple's triad described in 1930 by Allen Whipple (an American surgeon); symptoms occur during fasting or exercise, and are weird after eating. Surgical treatment is usually the only curative option. We aim to improve the diagnosis approach and our comprehension about these rare cases in clinical practice. Below we present a clinical case of a 51-year-old female patient with no history of diabetes admitted to our institution due to persistent hypoglycemia.

Variations in antihypertensive medication treatment and blood pressure control among Veterans with HIV and existing hypertension

BackgroundHypertension is a leading risk factor for cardiovascular disease among patients living with HIV (PLWH). Understanding the predictors and patterns of antihypertensive medication prescription and blood pressure (BP) control among PLWH with hypertension (HTN) is important to improve the primary prevention efforts for this high-risk population. We sought to assess important patient-level correlates (eg, race) and inter-facility variations in antihypertension medication prescriptions and BP control among Veterans living with HIV (VLWH) and HTN. MethodsWe studied VLWH with a diagnosis of HTN who received care in the Veterans Health Administration (VHA) from January 2018 to December 2019. We evaluated HTN treatment and blood pressure control across demographic variables, including race, and by medical comorbidities. Data were also compared among VHA facilities. Predictors of HTN treatment and control were assessed in 2-level hierarchical multivariate logistic regression models to estimate odds ratios (ORs). The VHA facility random-effects parameters from the hierarchical models were used to calculate the median odds ratios to characterize the variation across the different VHA facilities. ResultsA total of 17,468 VLWH with HTN (mean age 61 years, 97% male, 54% Black, 40% White) who received care within the VHA facilities in 2018-2019 were included. 73% were prescribed antihypertension medications with higher prescription rates among Black vs White patients (75% vs 71%) and higher prescription rates among patients with a history of cardiovascular disease, diabetes, and kidney disease (>80%), and those receiving antiretroviral therapy and with controlled HIV viral load (∼75%). Only 27% of VLWH with HTN had optimal BP control of systolic BP <130 mmHg and diastolic BP <80 mmHg, with a lower rate of control among Black vs White patients (24% v. 31%). In multivariate regression, Black patients had a higher likelihood of HTN medication prescription (OR 1.32, 95% CI: 1.22-1.42) but were less likely to have optimal BP control (OR 0.82; 0.76-0.88). Important positive correlates of antihypertensive prescription and optimal BP control included: number of outpatient visits in prior year, and histories of diabetes, coronary artery disease, and heart failure. There was about 10% variability in both antihypertensive prescription and BP control patterns between VHA facilities for patients with similar characteristics. There was increased inter-facility variation in antihypertensive prescription among those with a history of heart failure and those not receiving antiretroviral therapy. ConclusionIn a retrospective analysis of large VHA data, we found that VLWH with HTN have suboptimal antihypertensive medication prescription and BP control. Black VLWH had higher HTN medication prescription rates but lower optimal BP control.