History Of T2DM Research Articles

COMPARATIVE OBSERVATIONAL STUDY OF SERUM VITAMIN B12 LEVELS IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS AND NON-DIABETIC PATIENTS

BACKGROUND:
 Methylcobalamin or Vitamin B12 is a coenzyme involved in the synthesis of methionine, pyrimidine and purine bases. Type 2 diabetes is associated with oxidative stress; Vitamin B12 deficiency in diabetic patients taking metformin has been linked with oxidative stress. Because of these associations, it is implied that Vitamin B12 deficiency must be considered a risk factor for complications related to diabetes. However, several studies also suggest that deficiency of Vitamin B12 starts from the early stages of Diabetes. It has also been suggested that Vitamin B12 supplementation may help in reducing the complications related to diabetes. Although, the use of prophylactic Vitamin B12 to reduce complications related to diabetes remains controversial.
 Objective: This study aimed to explore the clinical relevance of Vitamin B12 in newly diagnosed T2DM patients. This study measured Vitamin B12 levels in newly diagnosed patients with type 2 diabetes (T2DM) and explored the correlations between its serum levels and various metabolic parameters in T2DM.
 RESEARCH DESIGN AND METHODS
 This was a 1 year, single-center, prospective, comparative, observational study. To collect data on age, smoking history, alcohol consumption, physical activity status, family history of T2DM, and medications, all subjects completed a self-answered questionnaire. Plasma samples were used to assay the biochemical parameters such as FBS, PPBS, HbA1c, lipid profile, and serum Vitamin B12. The participants were divided into newly diagnosed T2DM patients (n = 300) and healthy control subjects (n = 300).
 RESULTS
 Serum Vitamin B12 was significantly lower in newly diagnosed T2DM patients than in healthy control subjects (362.07± 182.25 vs 559.23± 275.05 pg/mL; P < 0.001). Serum Vitamin B12 correlated negatively with FBS, PPBS, and HbA1c in newly diagnosed T2DM patients.
 CONCLUSION
 Serum Vitamin B12 levels are significantly decreased in newly diagnosed T2DM patients. Our results suggest that adding Vitamin B12 as a supplement in the early stages of T2DM may contribute to possible microvascular (neuropathy, retinopathy, nephropathy, etc. ) complications related to Type 2 Diabetes Mellitus.

ODP197 Familial Hypertriglyceridemia Initially Presenting with Hypertriglyceridemia-induced Pancreatitis: A Case Report

Abstract Case Presentation A 28 year old male with a past medical history of diabetes mellitus type 2 (T2DM) and hypertension presented to the emergency room with acute onset, progressive epigastric pain associated with nausea. The pain suddenly started earlier that day after a large meal. He denied alcohol use. He was previously on insulin Glargine 55 units nightly but was not using it for several months. Vitals signs were within normal limits, BMI was 38.5 kg/m 2 . Physical examination revealed marked epigastric tenderness and multiple yellow papules on the abdomen and extensor surfaces of extremities. Lab findings revealed WBC 14.3 k/mm cu, lipase 437 IU/L, triglycerides greater than 3000 mg/dl with VLDL greater than 3000 mg/dl. Computerized tomography of the abdomen was consistent with acute pancreatitis. He was diagnosed with familial hypertriglyceridemia presenting with hypertriglyceridemia-induced pancreatitis and was admitted to the intensive care unit (ICU). Treatment with regular insulin infusion was started. On day 3, triglyceride levels decreased to 543 mg/dl and insulin infusion was stopped. He reported symptomatic improvement and was able to tolerate oral diet. He was counseled on significance of lifestyle modifications and medication compliance and was discharged on Niacin, Omega 3, Fenofibrate, Ezetimibe, and Pravastatin with plans to follow up with an Endocrinologist. Discussion This case of a young male presenting with hypertriglyceridemia-induced pancreatitis due to underlying familial hypertriglyceridemia emphasizes the significance of comprehensive history taking and work up for patients initially presenting to the clinic with risk factors such as obesity and insulin resistance. Our patient classically had a history of T2DM, and as cardiovascular complications are the leading cause of mortality in diabetic patients, screening for and managing dyslipidemia is pivotal. Eruptive xanthomas are erythematous-yellow papules typically located on extensor surfaces which appear when triglyceride levels exceed 1500-2000 mg/dl. This characteristic skin finding led to a prompt suspicion for familial hypertriglyceridemia in our patient. Our patient was stabilized in the ICU and subsequently discharged on multiple oral agents. The current consensus is that single statin therapy is not recommended; however, further research is indicated to specify the optimal combination of triglyceride lowering agents based on the severity of hypertriglyceridemia. Presentation: No date and time listed

LBSAT127 An Underrecognized Entity: Hypercalcemia Induced PRES

Abstract Introduction Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity that can present with headaches, focal neurological deficits, altered mental status, and seizures. Common etiologies are uncontrolled hypertension, preeclampsia/eclampsia, and chemotherapeutic agents. Hereby, we present a patient with status epilepticus secondary to PRES induced by hypercalcemia due to primary hyperparathyroidism. Clinical Case A 59-year-old Caucasian female with history of T2DM, GERD, gout, and bowel resection for an incarcerated abdominal hernia three weeks ago presented to the emergency department due to seizure-like movements. She had no history of seizures. Initial vitals showed HR of 96 bpm, BP of 148/67 mmHg, RR of 20 rpm, Temperature of 97.7F, and a BMI of 31.5 kg/m2. Physical exam revealed the presence of abdominal wound-vac and tonic-clonic movements that failed to improve with lorazepam, midazolam, and levetiracetam; hence she was intubated for airway protection and started on propofol. Lumbar puncture performed in the ED was unremarkable. Laboratory studies were pertinent for acute kidney injury (AKI) with a serum creatinine of 1.78 mg/dL, lactic acid of 6.1 mmol/L, and serum calcium of 14.5 mg/dL (8.7-10.4) with albumin of 4.2 g/dL. AKI and lactic acidosis rapidly improved with IV fluids. CT-head without contrast was negative for any acute pathologies. MRI-brain showed abnormal subcortical FLAIR signals within the bilateral parietal and occipital lobes with corresponding diffusion restriction in bilateral occipital lobes consistent with PRES. Continuous EEG (cEEG) showed ongoing epileptiform activity with an intermittent suppression pattern. Hypercalcemia workup revealed inappropriately normal intact-PTH of 45.9 pg/mL (10. 0-66. 0), PTHrP <2pmol/L, and 25-(OH)-Vitamin-D3 level of 34 ng/mL (30. 0-100. 0). Paraproteinemia work-up was negative. Thyroid ultrasound demonstrated an incidental nodule in the external aspect of the inferior right lobe measuring 6×3×3mm suggestive of parathyroid gland enlargement. Hypercalcemia was successfully treated with aggressive IV fluids and zoledronic acid. Repeat cEEG showed resolution of epileptiform discharges. She was successfully extubated without recurrence of seizures. She was determined to have hypercalcemia induced PRES secondary to primary hyperparathyroidism. Given the significant elevation of calcium and associated neurological symptoms, she met the surgical criteria and was discharged with outpatient parathyroidectomy plan. Conclusion PRES secondary to severe hypercalcemia has been described in the literature, albeit rarely. The exact pathophysiology is unclear but thought to be due to vasospasm based on cerebral angiogram studies. Early recognition of hypercalcemia as a culprit for PRES along with prompt treatment is crucial to treat life-threatening complications of PRES. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

ODP183 Diabetic Ketoacidosis Precipitated by Ketogenic Diet and SGLT-2 Inhibitor Use in an Individual with T2DM

Abstract Background SGLT-2 inhibitors have been associated with increased risk of ketoacidosis even with normal blood glucose levels. A ketogenic diet is a low-carb, high-fat diet which has recently gained popularity for weight loss by producing a state of ketosis. We present this case to emphasize the risk of ketoacidosis in patients on SGLT-2 inhibitors and a ketogenic diet. Clinical Case A 48-year-old woman with a 16-year history of T2DM presented to the ER with a 3-day history of upper abdominal cramping and headaches, decreased urine output, and progressively worsening nausea and vomiting. Her glycated hemoglobin level was 9.4% (n: 4-6%) and her blood glucose readings were not elevated during this time. Other medical issues include dyslipidemia, transaminitis and hypertension. She does not smoke or drink alcohol. She takes glimepiride 0.5 mg daily and canagliflozin was added approximately 1.5 weeks prior to presentation. She was on a ketogenic diet. A few days prior to these symptoms she was in the process of moving out of her home, spending long days physically exerting herself. On exam she was in mild distress with dry mucous membranes. Vitals showed tachycardia (119BPM) but otherwise were stable. Labs revealed that she was severely acidotic with an anion gap of >27 and pH < 6.9 (n: 7.34-7.43), with urinalysis positive for ketones (2+, n: negative), protein (3+, n: negative), and glucose (3+, n: negative). Complete blood count showed leukocytosis (WBC: 18,000, n: 4. 00-12. 00*10 3 /mcL). Complete metabolic panel showed hyponatremia (130, n: 136-145mmol/L), elevated glucose (305, n: 70-99,g/dL), and low bicarbonate (<5, n: 22-30mmol/L). A chest X-ray, lumbar puncture and CT of head and abdomen were unrevealing. She was admitted to the ICU for treatment of suspected DKA with severe acidosis and hypovolemia. She was hydrated with IV fluids and was started on an insulin drip according to DKA protocol. Her anion gap closed in 22 hours. The patient spent 3 days in the ICU and 1 day on general floor before discharge on home medications and was advised to follow up with endocrinology. At follow up 2 months later her C-peptide was 2.14 (0.78-5.19 ng/mL) and GAD65 antibody assay was 0. 00 (<0. 02 nmol/L), the SGLT-2 inhibitor was discontinued, and she was instead started on a GLP-1 agonist. Conclusion The mechanism behind DKA with SGLT-2 inhibitor use involves glycosuria and volume depletion, lowering the insulin-to-glucagon ratio, while stimulating lipolysis. The addition of a low carbohydrate or ketogenic diet produces a state of ketosis as fat is utilized for energy and ketones are produced, further promoting DKA. With increased use of SGLT-2 inhibitors in patients with and without diabetes mellitus extreme caution should be exercised in prescribing SGLT-2 inhibiters in a patient on a low carbohydrate diet. Presentation: No date and time listed

PSUN263 Diagnosis of Latent Autoimmune Diabetes of Adulthood Unveiled After Initiation of an SGLT2 Inhibitor

Abstract SGLT2-inhibitors have revolutionized treatment for Type II diabetes (T2DM) due to their numerous benefits including improved glycemic control, cardioprotective properties, reduction of high blood pressure, and mitigation of disease progression in CKD.ew studies have investigated the benefits of this medication class on patients with Type 1 DM (T1DM). Herein we describe a case in which the diagnosis of latent autoimmune diabetes of adulthood (LADA) was unmasked following the use of an SGLT2-inhibitor. A 56-year-old female with a history of T2DM diagnosed 10 years ago presented to the endocrine clinic for management of her poorly controlled diabetes. Her medications then included insulin detemir, insulin lispro, metformin, and repaglinide, but she still had an HbA1c of 11.3% (n<5.7%). She was tried on glipizide early in her disease course but it was discontinued due to fluid retention. She had a sedentary lifestyle with a BMI of 31.27 kg/m2. She was requiring increased doses of insulin over time with minimal improvement in her HbA1c. Two years later she was started on liraglutide with increasing dosages. Her HbA1c continued to decrease down to 8.7% and her BMI had decreased to 26.83 kg/m2. Over the next year, her HbA1c began to again increase up to 9.8%. At this time canagliflozin was added to her medication regimen. She responded very well to this medication initially with a drop in her HbA1c to 7.5% and a decrease in her BMI to 24.01 kg/m2. Unfortunately, one year after initiation of the SGLT2-inhibitor she was hospitalized for DKA and pancreatitis. At this time all her medications, except for insulin and metformin, were discontinued. A GAD65 antibody (>250 IU/mL; n<5.0 IU/mL) and c-peptide (<0.1 ng/mL; n = 1.1-4.4 ng/mL) levels were checked at this time which revealed the diagnosis of LADA approximately 16 years after her initial diagnosis of T2DM. She was transitioned to an insulin pump and managed according to protocol. SGLT2 inhibitors have been studied as an adjuvant treatment with insulin for T1DM due to their ability to increase urinary glucose excretion but are currently not approved for T1DM. Despite their recorded benefits, they have also been shown to significantly increase the risk of DKA when used in patients with T1DM. Our patient, who was mistakenly treated as T2DM for almost two decades, was diagnosed with LADA after initiation of an SGLT2 inhibitor led to hospitalization for DKA. Further research is needed to assess the safety of SGLT2 inhibitors in T1DM, and caution must be taken when prescribing this medication to patients who may have underlying LADA. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Association between type II diabetes mellitus and 90-day mortality in a large multicenter prospectively collected cohort. A FROG ICU post-hoc study

PurposeFactors associated with adverse outcomes in ICU patients with type II (T2DM) are poorly defined. The main goal of this study is to determine the impact of pre-existing T2DM on 90-day mortality post ICU admission. MaterialPost-hoc analysis from the FROG-ICU cohort. All patients admitted to ICU who were ventilated and/or treated by a vasoactive agent for >24 h were included.Association between T2DM and 90-day mortality was analyzed in unmatched, and populations matched by propensity score (PS) method to balance confounders recorded before ICU admission. Analysis was performed in non-imputed and imputed datasets. Results2002 patients were included, and 16% had a history of T2DM. The latter were at inclusion more severely ill (SAPSII score 51(39–67) vs 48(35–61), p < 0.0001; Charlson score 2(1–3) vs 0(0–2), p < 0.0001). In the unmatched cohort, T2DM patients had a higher 90-day risk of death compared to no-DM patients (HR 1.35(1.1–1.65)). The 90-day risk of death was not significantly different T2DM and no T2DM patients after PS matching (HR: 0.81 (0.56–1.18). Results were similar with the analysis performed on imputed datasets (pooled HR: 0.95 (0.69–1.30)). ConclusionsIn the present study, T2DM was not associated with 90-day mortality post ICU admission.

The effect of vitamin D and Physical exercise on glycaemic control in patients with Type 2 Diabetes Mellitus(DM)

Background: The purpose of this study was to find correlation between vitamin D, Physical exercise on glycaemic control in patients of type2DM. Methods: The study was conducted from November 2019 to December 2020 among subjects above 40 years of age at sub-district hospital Sopore, North Kashmir. Total 400 patients diagnosed with diabetes were registered for the study. Questionnaire containing relevant patient information was collected at regular intervals. Statistical analysis were performed. Results: Biochemistry values in the studied subjects with Type2DM compared to healthy controls in the study revealed that fasting glucose level,HbA1c,LDL,triglycerides,uric acid were higher inT2DM group compared to the control group. The results of our study showed that Vitamin D deficiency, lack of physical exercise, family history of T2DM, hypertension and smoking were significant predictors of diabetes. In Type2DM patients, mean vitamin D value was 21.45ng/ml opposed to 40ng/ml in the control group. Also physical activity was found to be higher in control group when compared to cases with p -value less than 0.00001. Also family history of DM was significantly higher in cases when compared to control group with p-value of 0.044.There was also statistically significant difference when parameters like HTN and smoking were compared (both higher in cases as against the control group) between two groups with p value 0.044 and 0.029 respectively. Conclusion: Vit D, physical exercise,family history of diabetes may be contributing factors for the rising burden of diabetes globally and in India.We need to take cognisance of the factors leading to the rising global burden of DM and take appropriate and necessary measures to stop this growing menace.

Development and internal validation of a risk model for hyperuricemia in diabetic kidney disease patients.

This research aimed to identify independent risk factors for hyperuricemia (HUA) in diabetic kidney disease (DKD) patients and develop an HUA risk model based on a retrospective study in Ningbo, China. Six hundred and ten DKD patients attending the two hospitals between January 2019 and December 2020 were enrolled in this research and randomized to the training and validation cohorts based on the corresponding ratio (7:3). Independent risk factors associated with HUA were identified by multivariable logistic regression analysis. The characteristic variables of the HUA risk prediction model were screened out by the least absolute shrinkage and selection operator (LASSO) combined with 10-fold cross-validation, and the model was presented by nomogram. The C-index and receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow test, and decision curve analysis (DCA) were performed to evaluate the discriminatory power, degree of fitting, and clinical applicability of the risk model. Body mass index (BMI), HbA1c, estimated glomerular filtration rate (eGFR), and hyperlipidemia were identified as independent risk factors for HUA in the DKD population. The characteristic variables (gender, family history of T2DM, drinking history, BMI, and hyperlipidemia) were screened out by LASSO combined with 10-fold cross-validation and included as predictors in the HUA risk prediction model. In the training cohort, the HUA risk model showed good discriminatory power with a C-index of 0.761 (95% CI: 0.712-0.810) and excellent degree of fit (Hosmer-Lemeshow test, P > 0.05), and the results of the DCA showed that the prediction model could be beneficial for patients when the threshold probability was 9-79%. Meanwhile, the risk model was also well validated in the validation cohort, where the C-index was 0.843 (95% CI: 0.780-0.906), the degree of fit was good, and the DCA risk threshold probability was 7-100%. The development of risk models contributes to the early identification and prevention of HUA in the DKD population, which is vital for preventing and reducing adverse prognostic events in DKD.

Type-2 Diabetes and the Clinical Importance of Exaggerated Exercise Blood Pressure.

Exaggerated exercise blood pressure (EEBP) during clinical exercise testing is associated with poor blood pressure (BP) control and cardiovascular disease (CVD). Type-2 diabetes (T2DM) is thought to be associated with increased prevalence of EEBP, but this has never been definitively determined and was the aim of this study. Clinical exercise test records were analyzed from 13 268 people (aged 53±13 years, 59% male) who completed the Bruce treadmill protocol (stages 1-4, and peak) at 4 Australian public hospitals. Records (including BP) were linked to administrative health datasets (hospital and emergency admissions) to define clinical characteristics and classify T2DM (n=1199) versus no T2DM (n=12 069). EEBP was defined as systolic BP ≥90th percentile at each test stage. Exercise BP was regressed on T2DM history and adjusted for CVD and risk factors. Prevalence of EEBP (age, sex, preexercise BP, hypertension history, CVD history and aerobic capacity adjusted) was 12% to 51% greater in T2DM versus no T2DM (prevalence ratio [95% CI], stage 1, 1.12 [1.02-1.24]; stage 2, 1.51 [1.41-1.61]; stage 3, 1.25 [1.10-1.42]; peak, 1.18 [1.09-1.29]). At stages 1 to 3, 8.6% to 15.8% (4.8%-9.7% T2DM versus 3.5% to 6.1% no-T2DM) of people with 'normal' preexercise BP (<140/90 mm Hg) were identified with EEBP. Exercise systolic BP relative to aerobic capacity (stages 1-4 and peak) was higher in T2DM with adjustment for all CVD risk factors. People with T2DM have higher prevalence of EEBP and exercise systolic BP independent of CVD and many of its known risk factors. Clinicians supervising exercise testing should be alerted to increased likelihood of EEBP and thus poor BP control warranting follow-up care in people with T2DM.

Glycemic Control Among Type 2 Diabetics: Comparison of Patients Coming to Specialized Clinics vs General Clinics for Diabetes

Objective: To analyze the difference of glycemic control (Mean HBA1c) between patients consulting at specialized Diabetic clinic and those coming to usual general practices. Study Design: Quasi Experimental study Place and Duration: OPDs of general Practice clinics and Outpatient department of a specialized diabetes clinic at Sialkot for 3 months. Methodology: Total n=250 patients were inducted using consecutive sampling technique carried for 3 months. The sample was divided into two groups “Diabetes Specialist clinics” (n=125) and with traditional setup without a team approach as “general practice clinics” (n=125).In this study patients included were of both gender with age group comprising &gt; 40 years and history of T2Dm for at least one year. Type1 dm, gestational diabetes and those without signing consent were excluded. Data was collected using structured questionnaire by primary investigator after informed consent and at the end of three months the difference of means of HBa1c of two different groups. Analysis was done on SPSS version 22 using independent sample t-test. Mean and standard deviation were taken for numerical data, while for categorical data, percentages and frequency were taken out. Statistically significant p value was viewed as &lt; 0.05. Results: When Independent T Test was applied, in specialist clinic HBA1c was 8.51±1.23 whereas in General practice clinic it was 9.57±1.62 with statistically significant difference (p value 0.000). When ANOVA applied to see differences in HBA1c among those with primary, secondary, Intermediate and graduate level education, statistically insignificant results were found (p value 0.373). Likewise, when compared by duration of diabetes, statistically insignificant results were found (p value 0.379). Results were statistically insignificant (p value 0.95), when compared based on rural and urban residence. Conclusion: The study shows statistically significant difference in glycemic control (HBA1c) levels between those coming to general practice clinics and those consulting at specialized diabetic clinics. Keywords: Diabetes, Diabetes Specialist clinic, HbA1C

The Prediction of Micro- and Macrovascular Complications in Individuals with T2DM with Different Risk Factors in Iraq

Background: Diabetes mellitus (T2DM) is a serious health problem that affects people all over the world and places a heavy financial and social burden on individuals, families, and communities. The objectives of the study were to evaluate the risk factors of T2DM and its relationship to micro- and macrovascular complications. Methods: A cross-sectional observational study was conducted on 1189 individuals with T2DM attending A Tertiary Endocrine Center. All patients’ data were gathered from direct interviewees and the digital records of the tertiary center, which used an internal network system and Microsoft Access program. Results: The mean age was 55.9 ±11.7 years, female 58%, body mass index 31.2 ±5.5 kg/m2, waist circumference 108±11.6 cm, mean duration of T2DM 10.1 ±7 years, and glycated hemoglobin (HbA1c) 9.6 ±2.1%. The prevalence risk factors were as follows smoking 27.3%, central obesity 84.3%, history of dyslipidemia 74.6%, family history of T2DM 64.9%, hypertension 63.5%, signs of insulin resistance (IR) 61.7%, gestational Diabetes (GDM) and History of cardiovascular diseases(CVD) 20.9%. These risk factors had a statistically significant impact on both macrovascular and microvascular T2DM. Conclusion: history of dyslipidemia and GDM were the most significant independent risk factors for the prediction of macrovascular complications among T2DM, while female gender, history of dyslipidemia, and GDM were independent risk factors for the prediction of microvascular complications among T2DM. Other risk factors including: History of CVD, hypertension, central obesity, duration of T2DM more than 5 years, estimated GFR &lt;60 ml/min/1.73 m2, and any signs of IR were significantly effect on both micro- and macrovascular complications, but as dependent risk factors to further cofounders.

The risk factors of type 2 diabetes in hypertensive subjects.

ObjectiveHypertension (HTN) and type 2 diabetes (T2DM) share common risk factors and usually co-occur. This study examined the relationship between HTN history and T2DM incidence in a cohort of Chinese hypertensive subjects.MethodsWe recruited 443 cases (T2DM and HTN) and 443 sex- and age-matched controls (HTN). The history of peak systolic blood pressure (SBP) was divided into 140-159, 160-179, and ≥ 180 mmHg, and that of peak diastolic blood pressure (DBP) was divided into 90-99, 100-109, and ≥ 110 mmHg. Multiple binary logistic regression models were used to explore the association between controlled HTN status and T2DM.ResultsCreatinine concentrations were higher in the cases than in the controls (P < 0.05). The HTN duration was longer in the cases than in the controls (14.7 years vs. 13.2 years; P < 0.05). Significant differences were also found in the history of peak SBP and DBP between the cases and controls (both P < 0.05). Creatinine, HTN duration, and family history of T2DM were risk factors for T2DM in hypertensive subjects, with odds ratios (95% confidence intervals) of 1.013 (1.004-1.022), 1.025 (1.003-1.047), and 5.119 (3.266-8.026), respectively. Compared with the lowest level of peak DBP, the odds ratio for T2DM at the highest level of peak DBP was 1.757 (1.074-2.969). Subgroups analyses showed that the effect of the history of peak DBP on T2DM was significantly modified by sex (P-interaction = 0.037).ConclusionThe highest DBP and the longest HTN duration were both independently associated with T2DM in hypertensive subjects.

The Predictive Value of Glucagon-Like Peptide 1 Plasma Levels on Acute Heart Failure

Acute Heart Failure (AHF) is one of the mechanical complications of Acute Myocardial Infarct (AMI). The diagnostic approach of AHF caused by AMI is based on clinical score, imaging, use of invasive instruments, and laboratory parameters. Glucagon-Like Peptide-I (GLP-1) is an incretin hormone derivate of proglucagon gene transcription, secreted by the L cells from the mucosa of the ileum, colon, and rectum. The cardioprotective effect of GLP-1 through the dependent and independent pathway produces a direct and indirect cardiovascular effect that increases the functional capacity in AHF patients. This study aims to find the predictive value of plasma GLP-1 towards the incidence of AHF in patients with AMI. This study was conducted on 35 patients diagnosed with AMI at Dr. Moewardi General Hospital Surakarta, in October-December 2020. Glucagon-like peptide-I was measured using the ELISA sandwich. The cut-off of plasma GLP-1 was determined using the Receiver Operating Characteristic (ROC) curve. Statistical analysis showed an RR (95% CI) of 2.292 (0.587–8.943) with a p=0.229 for age, 1,143 (0.299–4.367) with a p – 0.127 for a history of type 2 diabetes (T2DM) and plasma GLP-1 concentrations below Cut-Off Value (COV), which was 2.881 (0.729–11.381) with p=0.127. Age, a history of T2DM, and plasma GLP-1 below COV did not significantly affect AHF complications in patients with AMI.

Prediabetic risk factors among children and adolescents with obesity

Type 2 diabetes mellitus, previously considered an adult disease but currently being observed in children and adolescents all over the world due to parallel increase in obesity. It is crucial to check obese children and adolescents for prediabetes to avoid long-term diabetes problems. This study aimed to identify a risk factors for prediabetes in obese children and adolescents. Method: A prospective case-control study was conducted on children aged 6-18 years at Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basra (South Iraq). Results: A total of 155 children participated in the study; 60% were males. Prediabetes was present in 44.5% (n=69) participants. The proportion of prediabetes by FBS was 40%, OGTT was 16.8%, and HbA1c was 37.4%. A family history of T2DM, diastolic blood pressure, physical activity, and triglycerides were found to be significantly associated with prediabetes (P-value &lt;0.05). In a multivariate logistic analysis of risk factors; a family history of T2DM (OR = 0.205; CI =0.094-0.446; p-value &lt; 0.0001), physical activity (OR = 3.059; CI =1.532-6.109; p-value=0.002), high triglycerides (OR, 2.888; CI: 1.241-6.722; p-value=0.014), and hypertension (OR, 0.447; CI: 0.230-0.868; p-value=0.017) were positive or negative significantly associated with the occurrence of prediabetes.

Attainment of low-density lipoprotein cholesterol goals in patients treated with combination therapy: A retrospective cohort study in primary care

The attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in real-world settings among patients receiving combination lipid-lowering therapy (LLT, statins plus non-statins) is not well characterised. To evaluate LDL-C levels and LDL-C goal attainment in patients treated with combination LLT in real-world primary care settings. A retrospective cohort study of patients treated with combination LLT. Data were drawn from general practitioner electronic medical records across Australia from 2013 to 2019. The on-treatment goal for LDL-C was < 2 mmol/L (77 mg/dL), as per Australian guidelines. The cohort analysed included 9,173 individuals treated with combination LLT. The mean age was 65.8 years (standard deviation [SD] 11.5), 60.1% were males, and 56.7% had at least one cardiovascular risk factor. The median on-treatment LDL-C was 2.1 mmol/L (IQR 1.6-2.8), and overall 45.4% of the cohort met LDL-C goals, with individuals on fixed-dose combination of statins plus ezetimibe having the highest rates of achievement (49.8%). In multivariable logistic regression analyses, factors associated with LDL-C goal achievement were male sex (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.6, p < 0.001), aged >80 years (OR 4.2, 95% CI 1.5 - 6.6, p=0.006), and a history of T2DM (OR 1.7; 95% CI 1.5-1.9, p < 0.001) or coronary heart disease (OR 1.4, 95% CI 1.2 - 1.6, p < 0.001). More than half of Australians on combination LLT did not achieve LDL-C goals. Urgent measures are needed to address this gap in clinical practice to minimise negative health outcomes.

D2 MTE3 Case 8: Diagnosing diabetes mellitus in children

An eight-year boyHeight: 134.9 cmsWeight: 47 kgsBMI: 26 kg/m2Positive Family history of T2DM (mother)Pubertal status: A1, P1, TV 3 ml bilateralNo signs of insulin resistanceNo osmotic symptomsRBS: 284 mg/dlBlood ketones: 0.1 mmol/l. Laboratory investigation:Reports revealed Fasting blood sugar 130 mg/dl with HbA1c 7.4% and TSH 42.63 μIU/ml. He was advised the following treatment: Levothyroxine 75 mcgCalcium and vitamin D On follow up visit after 30 days and 60 days. Fasting blood glucose readings were ranging between 95-221 mg/dl and Post prandial 96-396 mg/dl. C-peptide 1.12 ng/ml (2 hours post meal) and Serum GAD 65 IgG (IU/ml) >2000. After thyroid hormone replacement TSH came down to 4.11 (μIU/ml). No significant finding in abdominal ultrasound. Points to ponder: Inconclusive diagnosisBelow normal C-peptide with highly elevated GAD suggested some beta cell dysfunction.Line of treatment?

Abstract 116: Clinical and biochemical predictors in early pregnancy for development of gestational diabetes mellitus

Background: Early prediction of GDM is vital. Current risk prediction models are based on maternal and clinical parameters, lacking a strong predictive value.Objective: To identify clinical and biochemical parameters in early pregnancy for prediction of GDM.Methods: In this prospective cohort study, we screened 581 consecutive healthy women with singleton pregnancy for GDM during their first antenatal visit. Fasting blood samples were collected and stored at -800C. Detailed history and clinical assessment were done for each patient and findings were noted in a pre-specified proforma. GDM was diagnosed as per IADPSG criteria at 24-28 weeks. During prospective follow up, 55 patients developed GDM. A total of 110 age and BMI matched controls were recruited for comparison. We measured OGTT, fasting insulin, HbA1c, hsCRP, uric acid and Lipid Profile. HOMA-IR, HOMA-β and QUICKI were used to estimate insulin sensitivity and β-cell function.Results: Significant higher proportion of subjects in GDM cohort had presence of Acanthosis nigricans, positive family history of T2DM in 1st degree relative. GDM cohort had significantly higher waist circumference, 2 hr plasma glucose, HbA1c, fasting insulin, HOMA-IR, uric acid and serum triglyceride levels. The area under the curve were as follows: HbA1c - 0.71 (95%CI: 0.628–0.793), Fasting Insulin - 0.748 (95%CI: 0.671–0.826), hsCRP - 0.634 (95%CI: 0.546 - 0.722) and Uric acid - 0.693 (95%CI: 0.606–0.780). Multiple regression analysis revealed HbA1c (OR 4.225; 95%CI – 1.421-12.561), 2 hr PPG (OR 1.026; 95%CI – 1.003-1.049), Insulin (OR 1.057; 95%CI – 1.006-1.111) and uric acid (OR 1.039; 95%CI – 1.026-2.793) to be independently associated with GDM outcome.Conclusions: Fasting Insulin, HbA1c, HOMA-IR, hsCRP and Uric acid levels are significantly altered in early pregnancy in individuals who develop GDM subsequently. Hence utilization of these parameters may identify at risk group in routine clinical care and help in improving feto-maternal outcome.

Diabetes, hypertension, and cardiovascular disease development

BackgroundWe aimed to compare cardiovascular risks among participants with T2DM with and without subsequent HTN and participants with HTN with and without subsequent T2DM.MethodsFrom January 1, 2000, to December 31, 2018, we identified 16,236 matched pairs of T2DM participants with and without HTN (T2DM cohorts), 53,509 pairs of HTN participants with and without T2DM (HTN cohorts), and 21,158 pairs of comorbid HTN and T2DM participants with T2DM history or HTN history (comorbid cohorts) from Taiwan’s National Health Insurance Research Database. Cox proportional-hazard models were used to calculate the risk of cardiovascular disease.ResultsThe mean follow-up time of this study was 6.75 years. Mean incident rates of coronary artery disease for T2DM cohorts, HTN cohorts, and comorbid cohorts were 16.80, 23.18, and 31.53 per 1000 person-years, respectively. The adjusted hazard ratios (HRs) (95% confidence intervals [95% CIs]) for incident coronary artery disease, stroke, and heart failure in T2DM participants with versus without HTN were 2.22 (2.07–2.37), 1.19 (1.16–1.23), and 0.92 (0.82–1.02), respectively; the adjusted HRs for HTN participants with versus without T2DM were 1.69 (1.55–1.84), 1.25 (1.21–1.30), and 0.98 (0.93–1.05), respectively; the adjusted HRs for comorbid T2DM and HTN participants with previous T2DM versus previous HTN were 2.78 (2.37–3.27), 1.20 (1.13–1.28), and 0.95 (0.88–1.03), respectively.ConclusionsThis nationwide cohort study demonstrated that both T2DM with subsequent HTN and HTN with subsequent diabetes were associated with higher cardiovascular disease risks.

Comparison of salivary calprotectin levels in periodontitis associated with diabetes mellitus after low-level laser therapy as an adjunct to scaling and root planing: A randomized clinical trial.

Context and Aims:Calprotectin is a myeloid protein, exerting pro-inflammatory effects on various cells and are shown to be elevated in inflammatory diseases. Periodontal therapy has been shown to decrease the levels of calprotectin in body fluids. Hence, the present study was aimed at assessing salivary calprotectin levels in periodontitis associated with diabetes mellitus after low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP).Materials and Methods:Sixty-four participants were divided into Groups A (periodontitis) and B (periodontitis associated with type 2 diabetes mellitus [T2DM]) based on probing depth of ≥5 mm, clinical attachment level (CAL) of >2 mm, and history of T2DM. Based on assigned treatments, the groups were subdivided into A1, A2, B1, and B2 where A1 and B1 were subjected to SRP alone and A2 and B2 received LLLT as an adjunct to SRP, respectively. The parameters assessed included probing pocket depth, CAL, bleeding on probing (BOP), plaque index (PI), and salivary calprotectin. All the values were subjected for comparison at baseline and 8 weeks.Statistical Analysis Used:Multiple group comparisons were done using analysis of variance; intragroup comparisons were made using t-test. The level of significance was assessed at P < 0.05 for all tests.Results:All parameters showed a significant difference within the groups from baseline to 8 weeks. Intergroup comparison of PI, BOP, and salivary calprotectin showed a significant difference (P < 0.05).Conclusions:Reduction in calprotectin levels was noticed with LLLT when used as an adjunct to SRP. Calprotectin may be used as a prognostic marker for periodontitis.

ASSOCIATION BETWEEN PRO12ALa POLYMORPHISM OF PPARγ2 GENE AND CORONARY ARTERY DISEASE IN IRANIAN POPULATION WITH TYPE TWO DIABETES MELLITUS.

Coronary artery disease (CAD) is one of the common diseases in patients with type two diabetes mellitus (T2DM). The nuclear hormone receptor peroxisome proliferator-activated receptor-gamma (PPARγ) plays a vital role in dyslipidemia, and oxidative stress is involved in atherogenesis. The study aimed to determine the association between Pro12Ala polymorphism of the PPARγ2 gene(rs1801282) and CAD risk in T2DM patients in the Iranian population. A group of 145 T2DM patients with a history of CAD were enrolled, together with 145 sex and gender-matched individuals who had neither CAD nor history of T2DM who were enrolled in a case-control study. Polymerase chain reaction-restriction fragment length polymorphism technique was applied to genotype the PPARγ2 gene polymorphisms. Statistical analysis was done using SPSS version 22. CC and GC genotypes of Pro12Ala had a higher frequency in the control and case groups, respectively. The GC genotype was associated with a significantly increased CAD risk compared to the CC genotype (adjusted OR= 2.66, 95% CI = 1.5-29.5, p<0.01). The mean triglycerides and total cholesterol level were significantly higher in the CC genotype than the GC genotype in both case and control groups (p<0.05). The mean level of fasting blood glucose was significantly higher in the CC genotype compared to GC genotype in the case group (p<0.05). The mean of creatinine, lipid profiles, microalbuminuria, and hemoglobin A1c had no significant difference between CC and GC genotypes in both groups (p>0.05). PPARγ2 Pro12Ala polymorphism could be an essential indicator for the increased risk of CAD in the Iranian people with T2DM.