History Of Diabetes Mellitus Type Research Articles

Medicated-related burden and adherence in patients with co-morbid type 2 diabetes mellitus and hypertension

BackgroundMedication adherence is an integral component in the management of patients with co-morbid type 2 diabetes mellitus (T2DM) and hypertension. However due to their combined conditions, there is likelihood of polypharmacy and medication-related burden, which could negatively impact adherence to therapy. This study aimed to assess the perceived medication-related burden among patients with co-morbid T2DM and hypertension and to evaluate the association between the perceived burden and adherence to medication therapy. MethodsA cross-sectional study was conducted among adult patients with co-morbid T2DM and hypertension attending a primary health facility. The living with medicines questionnaire and the medication adherence report scale were used to assess extent of medication-related burden and adherence respectively. Binary logistic regression model was used to estimate the adjusted odds and their corresponding 95% confidence interval for medication-related burden and adherence outcomes. All observed categorical variables were considered for the multivariable binary logistic regression model. ResultsThe total number of participants was 329 with a median age of 57.5 ± 13.2 years. The median score for the overall burden was 99 (IQR: 93–113), and this significantly varied by sex (p = 0.012), monthly income (p = 0.025), monthly expenditure on medications (p = 0.012), frequency of daily dose of medications (p = 0.020) and family history of T2DM (p < 0.001). About 30.7% and 36.8% of participants reported moderate/high burden and medication adherence respectively. Uncontrolled diastolic blood pressure (AOR: 2.46, 95% CI: 1.20–5.05, p = 0.014), high glucose (AOR: 4.24, 95% CI: 2.13–8.46, p < 0.001) and no family history of T2DM (AOR: 2.14, 95% CI: 1.14–4.02, p = 0.026) were associated with moderate/high medication burden. Uncontrolled diastolic blood pressure (AOR: 0.48, 95% CI: 0.25–0.94, p = 0.031), at least 5 years since hypertension diagnosis (AOR: 0.55, 95% CI: 0.30–0.99, p = 0.045) and moderate/high medication-related burden (AOR: 0.33, 95% CI: 0.16–0.69, p = 0.003) were associated with lower odds of medication adherence. ConclusionThese findings suggest that to improve the preventive and optimal care of patients with T2DM and hypertension, interventions that aim to reduce medication-related burden and morbidity are recommended. The study proposes that health stakeholders such as clinicians, pharmacists, and policy makers, develop multidisciplinary clinical and pharmaceutical care interventions to include provision of counselling to patients on adherence. In addition, developing policies and sensitization activities on deprescribing and fixed-dose drug combinations aimed at reducing medication-related burden, while promoting better adherence, blood pressure and blood glucose outcomes are recommended.

Neutrophil-Lymphocyte Ratio and its Association with Hyperglycaemia: A Cross Sectional Study

Introduction: Chronic subclinical inflammation indicated by an elevated neutrophil-lymphocyte ratio (NLR) calculated from a complete blood count (CBC) test is reported to be associated with hyperglycaemia, including prediabetes and type 2 diabetes mellitus (T2DM). Current evidence on the association between NLR and glycaemic status is limited and conflicting. AIM: To determine if NLR was higher in those with prediabetes compared to those with normoglycemia, and To compare the NLR among individuals on treatment for T2DM stratified by glycaemic control. Methods: We analysed hospital data of individuals attending a tertiary care hospital in south India between January, 2021 and December, 2021. Individuals had CBC and glycosylated haemoglobin (HbA1c) tests done at the same visit. Hospital records of only those individuals without any clinical features of inflammation at the time of hospital visit were included in this analysis. Normoglycemia and prediabetes were defined as HbA1c &lt; 5.7% and HbA1c ≥5.7 but ≤6.4% respectively, in those without a history of T2DM. Good glycaemic control and poor glycaemic control were defined as HbA1c&lt;7% and HbA1c ≥7 respectively in those on treatment for T2DM.CBC and HbA1c data of 109 individuals each with normoglycemia and prediabetes; and 373 individuals on treatment for T2DM were analysed. After confirming the normality of distribution of NLR, unpaired Student’s ‘t’ test was used: 1. to compare the NLR between those with normoglycemia and prediabetes and 2. to compare NLR among those on treatment for T2DM stratified by glycaemic control. Results: Demographic characteristics including mean age and sex ratio among individuals with and without prediabetes were similar. The Mean (SD) NLR was higher in those with prediabetes compared to those with normoglycemia 1.7(1.0) versus 1.4(0.3); p=0.002. Of the 373 individuals on treatment for T2DM,121(32.4%) had good glycaemic control. There were no differences in demographic characteristics of those with and without good glycaemic control. The mean (SD) NLR between those with and without good glycaemic control, respectively was not different; 1.6(0.1) versus 1.7(0.1); p=0.46. Conclusion: In individuals without any clinical features of inflammation, a higher neutrophil-lymphocyte ratio was associated prediabetes. However, there was no association between neutrophil-lymphocyte ratio and glycaemic control among those on treatment for T2DM.

Short-Term Effects of Carbon Monoxide on Morbidity of Chronic Obstructive Pulmonary Disease With Comorbidities in Beijing.

The association between CO and chronic obstructive pulmonary disease (COPD) has been widely reported; however, the association among patients with type 2 diabetes mellitus (T2DM) or hypertension has remained largely unknown in China. Over-dispersed generalized additive model was adopted to quantity the associations between CO and COPD with T2DM or hypertension. Based on principal diagnosis, COPD cases were identified according to the International Classification of Diseases (J44), and a history of T2DM and hypertension was coded as E12 and I10-15, O10-15, P29, respectively. A total of 459,258 COPD cases were recorded from 2014 to 2019. Each interquartile range uptick in CO at lag 03 corresponded to 0.21% (95%CI: 0.08%-0.34%), 0.39% (95%CI: 0.13%-0.65%), 0.29% (95%CI: 0.13%-0.45%) and 0.27% (95%CI: 0.12%-0.43%) increment in admissions for COPD, COPD with T2DM, COPD with hypertension and COPD with both T2DM and hypertension, respectively. The effects of CO on COPD with T2DM (Z=0.77, P=0.444), COPD with hypertension (Z=0.19, P=0.234) and COPD with T2DM and hypertension (Z=0.61, P=0.543) were insignificantly higher than that on COPD. Stratification analysis showed that females were more vulnerable than males except for T2DM group (COPD: Z=3.49, P<0.001; COPD with T2DM: Z=0.176, P=0.079; COPD with hypertension: Z=2.48, P=0.013; COPD with both T2DM and hypertension: Z=2.44, P=0.014); No statistically significant difference could be found between age groups (COPD: Z=1.63, P=0.104; COPD with T2DM: Z=0.23, P=0.821; COPD with hypertension: Z=0.53, P=0.595; COPD with both T2DM and hypertension: Z=0.71, P=0.476); Higher effects appeared in cold seasons than warm seasons on COPD (Z=0.320, P<0.001). This study demonstrated an increased risk of COPD with comorbidities related to CO exposure in Beijing. We further provided important information on lag patterns, susceptible subgroups, and sensitive seasons, as well as the characteristics of the exposure-response curves.

Vitreous hemorrhage during GLP-1 receptor agonist treatment

BackgroundThe purpose of this case report is to describe a case of vitreous hemorrhage in a patient with a history of diabetic retinopathy and receiving dulaglutide for the management of type 2 diabetes mellitus (T2DM). Case summaryA 64-year-old African American male with a past medical history of T2DM and severe diabetic retinopathy for 4 years was restarted on dulaglutide 1.5 mg weekly after being off therapy for 3 months. Baseline laboratory test results included hemoglobin A1c (HbA1c) of 8.8% and random blood glucose (BG) of 280 mg/dL. In addition, the patient had an average fasting BG of 150 mg/dL. In absence of intolerance, the dulaglutide dose was gradually maximized to 4.5 mg weekly and HbA1c decreased to 7.3% and random BG to 121 mg/dL at week 12 since reinitiation. At week 17 of therapy, the patient presented to the emergency department with a 1-day history of vision loss in the left eye and was diagnosed as having vitreous hemorrhage. The etiology for vitreous hemorrhage is unclear and may be a spontaneous episode. In discussion with the patient and the ophthalmologist, dulaglutide was restarted at 1.5 mg once weekly. After 4 weeks of reinitiation, the patient denied any recurrent symptoms of vitreous hemorrhage or worsening diabetic retinopathy. The most recent ophthalmology evaluation indicated no change in diabetic retinopathy. Practice implicationsThis case report adds to the limited body of evidence available for the incidence of vitreous hemorrhage in the setting of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) therapy and pre-existing diabetic retinopathy. The case report illustrates that a history of diabetic retinopathy should not automatically preclude the use of GLP-1 RAs.

Association of triglycerides to high-density lipoprotein cholesterol ratio to identify future prediabetes and type 2 diabetes mellitus: over one-decade follow-up in the Iranian population

BackgroundTo determine the association between triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) for identifying subjects at risk of incident prediabetes and type 2 diabetes mellitus (T2DM).MethodsIn 5064 subjects (men = 2247) aged ≥ 20 years, using Cox proportional hazards regression analyses, the associations of TG/HDL-C with incident prediabetes and T2DM were examined among normoglycemic men and women. Furthermore, the association of this lipid ratio with incident T2DM was also assessed among prediabetic subjects (n = 1414). The multivariable analyses were adjusted for age, body mass index, waist-to-height ratio, wrist circumference, systolic blood pressure, family history of T2DM, education level, history of cardiovascular diseases, and fasting plasma glucose (FPG).ResultsDuring a median follow-up of 11.2 years, 2140 new cases of prediabetes (men = 1070) and 360 incident T2DM (men = 152) were identified among normoglycemic individuals. In the prediabetic population, 574 new cases of T2DM (men = 252) were developed. Among the whole population, compared to the first quartile (reference), higher quartiles of TG/HDL-C were significantly associated with higher risks of incident prediabetes and T2DM among normoglycemic individuals and incident T2DM in the prediabetic population (all P for trend < 0.001). The corresponding hazard ratios (HRs) and 95% confidence intervals (CIs) for the fourth quartiles were 1.37(1.20–1.58), 1.92(1.34–2.75), and 1.57(1.22–2.01), respectively. The sex-stratified analyses demonstrated similar significant associations in both sexes; however, TG/HDL-C lost its association with incident T2DM among prediabetic men. Among the normoglycemic population, 1 unit increase in TG/HDL-C was significantly associated with incident prediabetes and T2DM [1.02(1.00–1.03) and 1.06(1.03–1.08), respectively]. The corresponding value for incident T2DM in prediabetic individuals was 1.01(1.00–1.03). In a subgroup population having insulin data (n = 2897), the associations between TG/HDL-C and incident prediabetes and T2DM among normoglycemic individuals generally persisted even after replacing FPG with an index of insulin resistance (IR), i.e., homeostasis model assessment of IR (HOMA-IR) in the adjusted model.ConclusionsIn conclusion, in the normoglycemic population, the increasing value of TG/HDL-C was unfavorably associated with incident prediabetes and T2DM, especially among women. Similarly, TG/HDL-C was associated with incident T2DM in prediabetic individuals. Generally, we found that the correlation between TG/HDL-C and different states of dysglycemia is independent of HOMA-IR.

Pattern of macronutrients intake among type-2 diabetes mellitus (T2DM) patients in Malaysia

BackgroundThe incidence of type 2 diabetes mellitus (T2DM) is rising rapidly in Malaysia. Modifying dietary intake is key to both the prevention and treatment of T2DM. This study aims to investigate the pattern of macronutrient intake among T2DM patients in Malaysia.MethodsThis study was carried out on adults aged between 35 and 70 years, residing in urban and rural Malaysian communities. A series of standardised questionnaires was used to assess the sociodemographic information, dietary intake and physical activity level of 15,353 respondents who provided informed consent to participate in this study. Blood sampling (finger prick test) and physical examination were performed to obtain blood glucose and anthropometric data, respectively. The Chi-square test was used to assess differences in the trends of macronutrient intake among T2DM patients.ResultsThe total number of participants diagnosed with T2DM in this study was 2254. Of these, 453 (20.1%) were newly diagnosed, 1156 (51.3%) were diagnosed for ≤5 years and 645 (28.6%) were diagnosed for > 5 years. Male patients show that there were significant differences among the three groups of T2DM according to the following variables: age, BMI, residency, participant comorbidity of hypertension, family history of T2DM and hypertension, and active smoker. Meanwhile, female patients show significant differences among the three groups of T2DM according to the following variables: age, BMI, marital status, education level, residency, participant comorbidity of hypertension and family history of T2DM. Most of the male patients consumed appropriate proportions of carbohydrate (458, 60.7%) and protein (618, 81.9%). However, female patients did not show any significant differences of the macronutrients intake among the three groups of T2DM patients.ConclusionsThe pattern of dietary intake among T2DM patients in this study showed consumption of carbohydrate and protein within the range of Malaysian RNI, coupled with high fat intake. Compliance with the Recommended Nutrient Intake (RNI) was satisfactory for both carbohydrate and protein but not for fat. The pattern indicated a preference for fat rather than protein when carbohydrate intake was restricted.

Interactions between Bitter Taste Receptor Gene Variants and Dietary Intake Are Associated with the Incidence of Type 2 Diabetes Mellitus in Middle-Aged and Older Korean Adults.

The relationship between the variants of bitter taste receptor gene TAS2R4, dietary intake, and incidence of type 2 diabetes mellitus (T2DM) remains unclear. Hence, we aimed to examine the association of TAS2R4 rs2233998 variants with T2DM incidence in middle-aged and older Korean adults to understand if their association was modulated by dietary intake. Data of the Ansan-Ansung cohort from the Korean Genome and Epidemiology Study were used in this study. A total of 4552 Korean adults aged 40-69 years with no history of T2DM or cancer at baseline were followed-up for 16 years. Dietary intake was assessed using a 103-item food frequency questionnaire, and new T2DM cases were defined based on the World Health Organization and International Diabetes Federation criteria. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for T2DM incidence. During the mean follow-up period of 11.97 years, 1082 (23.77%) new T2DM cases were identified. Women carrying the TT genotype of TAS2R4 rs2233998 exhibited 1.48 times higher incidence of T2DM (HR: 1.48; 95 CI: 1.13-1.93) than those carrying the CC genotype. TAS2R4 rs2233998 variants were positively associated with the incidence of T2DM among Korean women with high intakes of carbohydrates or sugars and low intakes of fruits or vegetables. TT carrier women in the highest tertile of carbohydrate or sugar intake exhibited an increased incidence of T2DM (HR: 2.08, 95% CI: 1.33-3.27 for carbohydrates; HR: 2.31, 95% CI: 1.53-3.51 for sugars) than CC carrier women. Women carrying the TT genotype in the lowest tertile exhibited an increased incidence of T2DM (HR: 1.55, 95% CI: 1.02-2.37 for vegetables; HR: 1.62, 95% CI: 1.06-2.48 for fruits) than women carrying the CC genotype in the highest tertile of vegetable or fruit consumption. However, no association was observed between TAS2R4 rs2233998 variants and dietary intake with T2DM incidence in Korean men. Our findings suggest that variants of TAS2R4 rs2233998 are associated with T2DM incidence, and their associations are strengthened by excessive intake of carbohydrates or sugars and inadequate intake of fruits or vegetables. Diet encompassing optimal intake of carbohydrates or sugars and high intake of fruits or vegetables may minimize the risk of developing T2DM.

Significant Systemic Insulin Resistance is Associated With Unique Glioblastoma Multiforme Phenotype.

Some glioblastoma multiforme (GBM) are characterized by the presence of gemistocytes (GCs), a unique phenotype of reactive astrocytes. Certain GCs can be identified as neoplastic cells but these cells were also found to be associated with diabetes in non-neoplastic lesions of the central nervous system. Our aim was to find a correlation between insulin - resistance metabolic features and the presence of GCs in patients with newly diagnosed GBM. Medical records from histologically confirmed GBM patients were retrospectively extracted for different systemic metabolic variables. A statistic-based comparison was made between GBM, diabetic patients with and without GC. Patients with poorly controlled diabetes (ie, hemoglobin A1C ⩾ 8.0) were also compared between the 2 groups. A total of 220 newly diagnosed GBM patients were included in our study. 58 (26.3%) patients had a history of diabetes mellitus type 2 (DM2) at the time of admission. The rate of poorly-controlled DM2 was nearly as twice in the GC-GBM group than in the non-GC GBM group (18.75% vs 9.5%; P = .130). In the DM2 cohort, the subgroup of GC-GBM was significantly associated with demographic and metabolic features related to insulin resistance such as male gender predominance (89% vs 50%, P = .073) and morbid obesity (weight ⩾85 kg: OR 6.16; P = .0019 and mean BMI: 34.1 ± 11.42 vs 28.7 ± 5.44; P = .034 for group with and without GCs, respectively). In the poorly-controlled DM2 group, none of the GC-GBM patients were using insulin prior to diagnosis, compared to 61.1% in the non-GC GBM patients (OR = 0.04, P = .045). Systemic metabolic factors related to marked insulin resistance (DM2, morbid obesity, male gender) are associated with a unique histologic phenotype of GBM, characterized by the presence of GCs. This feature is prominent in poorly-controlled DM2 GBM patients who are not using synthetic insulin. This novel finding may add to the growing data on the relevance of glucose metabolism in astrocytes and in astrocytes associated with high-grade gliomas. In GBM patients, a correlation between patients' metabolic status, tumor's histologic phenotype, tumor's molecular changes, use of anti-diabetic drugs and the respective impact of these factor on survival warrants further investigation.

PS-C20-4: SGLT2I - A POTENTIAL ANTIHYPERTENSIVE AGENT IN HYPERTENSION PATIENTS WITH TYPE 2 DIABETES MELLITUS

Introduction: Sodium-Glucose cotransporter 2 inhibitor is a class of treatment for type 2 diabetes mellitus (T2DM) recently recommended in the treatment of patients with heart failure. We evaluated the effect of blood pressure-lowering of this agent in patients with T2DM. Methods: A prospective study in all hypertensive patients with T2DM admitted to the Department of Cardiology Department of Hue Central Hospital who had not been treated with SGLT2i between 12/2020 and 05/2021. In the end, 236 patients were participating in the study, in which 110 patients received Dapagliflozin 10 mg daily with OMT and 126 patients received OTM. The patients were followed up at the hospital and 2 months after discharge. Comprehensive examination, and measurement of upper arm blood pressure (BP) with Omron HEM-7121. Results and discussion: The mean age was 66.77 ± 15.53. The patient had a 9 (0–40) year history of hypertension and a 5 (0–37) year history of T2DM. The baseline BP was 146.29 ± 19.17 / 83.78 ± 13.1 mmHg, with no significant difference in baseline BP values in the 2 groups of patients. The results after 2 months showed that in the group of patients in combination with SGLT2i, there was a significant decrease in the mean SBP value compared with the group of patients with OTM of 5.95 mmHg (95%CI: 2.08 - 9.82, p = 0.003) but the decrease in DBP was not significantly different (95% CI: -0.09 - 5.40, p = 0.058). Subgroup analysis showed that in the group of patients with resistant hypertension, the group of patients using SGLT2i reduced DBP more than the group of patients with OTM by 2.77 mmHg (95%CI: 1.89 - 4.24, p = 0.005) but was not significant for SBP. In contrast, in patients with isolated systolic hypertension, the SBP in the group of patients using SGLT2i decreased more than in the group without using SGLT2i by about 8.91 mmHg (95%CI: 6.20 - 11.24, p = 0.035). These results were not observed in patients with heart failure and chronic kidney disease. Conclusion: SGLT2i has shown potential to be used as an antihypertensive agent in patients with heart failure and chronic kidney disease and shows superior efficacy in patients with isolated systolic pressure and resistant hypertension.

Type 2 diabetes mellitus as a possible risk factor for myasthenia gravis: a case-control study.

A certain number of myasthenia gravis (MG) patients clinically had type 2 diabetes mellitus (T2DM) prior to MG onset, which suggests that the onset of MG may correlate with the history of T2DM. This study aimed to examine the correlation between MG and T2DM. In a single-center, retrospective, 1:5 matched case-control study, all 118 hospitalized patients with a diagnosis of MG from 8 August 2014 to 22 January 2019 were enrolled. In total, four datasets with different sources of the control group were retrieved from the electronic medical records (EMRs). Data were collected at the individual level. A conditional logistic regression analysis was used to test the risk of MG associated with T2DM. The risk of MG was significantly associated with T2DM, and there were notable differences by sex and age. Whether compared to the general population, general hospitalized patients without autoimmune diseases (AIDs), or patients with other AIDs except MG, women aged over 50 years with T2DM had an increased risk of MG. The mean onset age of diabetic MG patients was more than that of the non-diabetic MG patients. This study demonstrates that T2DM is strongly associated with the subsequent risk of MG and varies significantly by sex and age. It reveals that diabetic MG may be a unique subtype that is different from the conventional MG subgroup classification. More clinical and immunological features of diabetic MG patients need to be explored in further studies.

870 COMBINING PERCUTANEOUS CORONARY INTERVENTION AND TRASCATHETER AORTIC VALVE REPLACEMENT PROCEDURES: THE IMPORTANCE OF INTRAVASCULAR LITHOTRIPSY

Abstract Background Calcified coronary artery disease and severe valvular aortic stenosis (AS) often coexist. For instance, severely calcified lesions may strongly influence the revascularization strategy in patients undergoing transcutaneous aortic valve replacement (TAVR). Shock wave intravascular lithotripsy (S-IVL) (Shockwave Medical Inc. Santa Clara, CA) is the only technology available that cracks both medial and intimal calcium while minimizing trauma to the vessel wall, thus allowing a safe plaque debulking. We report a case of percutaneous coronary intervention (PCI) and TAVR in the same procedure, where S-IVL has been used to treat a heavily calcified lesion and optimize stent under-expansion. Case Report A 79 years-old male patient with a history of diabetes mellitus type 2, hypertension, and peripheral artery disease, was admitted to our institution with symptomatic severe AS and severe calcified left anterior descending (LAD) artery lesion at CT scan. Deemed eligible for TAVR, Heart Team planned a percutaneous coronary intervention (PCI) of LAD and TAVR in the same procedure. Through the left radial artery, coronary angiography confirmed 90% stenosis of the LAD at the central segment. Accordingly, pre-dilatation of the stenosis was performed with a 2.5×12 mm non-compliant balloon (NCB) and, because of the severe calcification, S-IVL with a 3.0×12 mm balloon inflated at 4-6 Atmospheres (ATM), delivering 40 pulses. Following, a 3.5×18-mm drug-eluting stent was implanted at 18 ATM. After implantation, an inadequate expansion of the stents was observed, which persisted despite post-dilation with 3.75×8 mm NCB at high-pressure. Bail-out S-IVL was then performed with the 3.0×12 mm balloon inflated at 4-6 ATM, delivering 40 pulses in-stent, followed by a further stent post-dilated with a 3.75×8 mm NCB up to 20 ATM. The final angiogram showed a satisfactory stent expansion. Since the low contrast volume was used, we decided to go ahead with transfemoral TAVR. Therefore, through the left femoral artery access, a 34-mm self-expandable Evolut R valve was implanted. Transthoracic echocardiography showed optimal valve implantation with a trivial periprosthetic leak. No complications were observed after the procedures and the patient was discharged after 6 days with 6 months of mandated dual antiplatelet therapy (Aspirin and Clopidogrel). Discussion In this case, the bail-out use of S-IVL was essential for an optima stent implantation, allowing TAVR procedure and avoiding prolonged theoretical antithrombotic therapy underlying suboptimal stent implantation. Despite encouraging initial results, future large studies with long-term observation are required to evaluate the safety and efficacy of S-IVL in this scenario.

Prevalence of gestational diabetes mellitus in women with a family history of type 2 diabetes in first- and second-degree relatives

AimsA family history of type 2 diabetes mellitus (T2DM) markedly increases an individual's lifetime risk of developing the disease. For gestational diabetes (GDM), this risk factor is less well characterized. This study aimed to investigate the relationship between family history of T2DM in first- and second-degree relatives in women with GDM and the differences in metabolic characteristics at early gestation.MethodsThis prospective cohort study included 1129 pregnant women. A broad risk evaluation was performed before 16 + 0 weeks of gestation, including a detailed family history of the different types of diabetes and a laboratory examination of glucometabolic parameters. Participants were followed up until delivery and GDM assessed according to the latest diagnosis criteria.ResultsWe showed that pregnant women with first- (FHD1, 26.6%, OR 1.91, 95%CI 1.16 to 3.16, p = 0.005), second- (FHD2, 26.3%, OR 1.88, 95%CI 1.16 to 3.05, p = 0.005) or both first- and second-degree relatives with T2DM (FHD1 + D2, 33.3%, OR 2.64, 95%CI 1.41 to 4.94, p < 0.001) had a markedly increased risk of GDM compared to those with negative family history (FHN) (n = 100, 15.9%). The association was strongest if both parents were affected (OR 4.69, 95%CI 1.33 to 16.55, p = 0.009). Women with FHD1 and FHD1 + D2 had adverse glucometabolic profiles already in early pregnancy.ConclusionsFamily history of T2DM is an important risk factor for GDM, also by applying the current diagnostic criteria. Furthermore, we showed that the degree of kinship plays an essential role in quantifying the risk already at early pregnancy.

Prevalence of prediabetes in an urban Nigerian population using the Finnish Diabetes Risk Score

Background: Type 2 Diabetes Mellitus (T2DM) is a global problem in emerging economy Nigeria. Early detection can help delay or prevent the disease. Aims: This study aims to characterize the prevalence of prediabetes in the study population using the validated Finnish Diabetes Risk Score (FINDRISC) in the adult population in an urban Sagamu Ogun State South-Western Nigeria. Patients and Methods: Healthy participants (n=581) aged 18-65yrs with no known history of T2DM or pregnancy were recruited from local urban churches in Sagamu. The FINDRISC questionnaire was then administered, which included questions on age, BMI, waist circumference, vegetable consumption, physical activity, history of high blood pressure, family history of T2DM and history of high blood sugar. Results: Overall, 51.8% of the participants were assigned a risk of developing T2DM in the next 10 years, with a range of categories from slightly elevated to very high risk; 34.4% of the participants had a risk score of 7-11, indicating a slightly elevated risk; 11.2% of the participants had a risk score of 12-14, indicating a moderately elevated risk, while 5.3% of the participants had a risk score of 15-20, indicating a high risk and 0.9% of the participants had a risk score higher than 20 indicating very high elevated risk. The gender distribution of the risk scores showed that 1.7% of the males and 9.5% of the females had a moderate to high risk (score ≥ 12) of developing T2DM in the next 10 years. The FINDRISC score was positively and significantly correlated with body weight (r=0.49; p&lt;0.001), BMI (r=0.55; p&lt;0.001) and age (r=0.27; p&lt;0.001). This prevalence of prediabetes is similar to that found in other studies in Nigeria. Conclusion: This study confirms the use of this simple and non-invasive screening tool for T2DM among adults in Nigeria. It is also a useful tool to increase awareness of this condition in the population.

Swallowing Apraxia Post Ischemic Stroke

A 55-year-old male patient with a known medical history of diabetes mellitus type 2 and treated lymphoma was first admitted with a sudden left-sided facial asymmetry and mouth deviation to the left side with no other neurological symptoms. A Computerized Tomography (CT) scan of the brain showed acute infarct and small left basal ganglia old lacunar infarction. He was discharged on a dual antiplatelet. One week later, the patient's condition had worsened and, therefore, was admitted with an impression of ischemic stroke. A bedside swallowing assessment, VFSS, and FEES study were conducted to diagnose this case. The bedside assessment did not reveal any sensory or motor deficits in his oral cavity and the FEES examination was also unable to rule out pharyngeal dysphagia. However, a videofluoroscopic swallowing study (VFSS) revealed a significant dysfunction of oral preparation and oral phases and presented difficulty initiating the pharyngeal phase. Given these features, we believe that this swallowing difficulty is caused by swallowing apraxia. This case provides additional information and understanding on management from the swallowing side.

Birth weight is associated with obesity and T2DM in adulthood among Chinese women

BackgroundPrevious studies have indicated an association between birth weight (BW) and type 2 diabetes mellitus (T2DM), but few studies have explored this relationship under different conditions of obesity in adulthood.MethodsA total of 4,005 individuals from ten provinces of China were randomly selected to participate in this study. We used a questionnaire to collect age, BW, current weight, height, T2DM history, age at T2DM diagnosis, and other variables. The participants were divided into three groups were according to BW trisection (BW ≤ 2500 g for the lower BW group, 2500 g < BW ≤ 3500 g for the normal BW group, and BW > 3500 g for the higher BW group). The cutoff of overweight and obesity were 25 kg/m2 and 28 kg/m2, respectively.ResultsThe prevalence rates of T2DM among women with lower BW, normal BW and higher BW were 5.2%, 3.6% and 2.0%, respectively. The obesity prevalence rates in the lower BW, normal BW and higher BW groups were 8.1%, 6.7% and 9.0%, respectively. In the obese population, we did not find a relationship between BW and T2DM, but in the nonobese population, we found that with increasing BW, the risk of developing T2DM was reduced. Obese status in adulthood modified the association between BW and the risk of T2DM.ConclusionThere is a “U” shape association between BW and risk of adulthood obesity in Chinese women, but this trend is not existed between BW and risk of developing T2DM. In non-overweight females, the risk of developing T2DM decreased with increasing BW, but this trend was not observed in overweight females.

Extensive Tinea Infection in a Post Covid 19 Patient of Type 2 Diabetes-A Case Study

Introduction: Dermatophytes are the most common agents of superficial fungal infections worldwide, and especially widespread in the tropical and subtropical countries like India, where the environmental temperature and relative humidity are high. Corona virus disease-2019 (COVID-19) likely increases the risk for fungal infections because of its effect on the immune system and because the treatments for COVID-19 (like steroids and other drugs) can weaken the body’s defenses against fungi. The present case discusses extensive Tinea infection in post COVID-19 patient living with Type-2 Diabetes Mellitus (T2DM). Case presentation, diagnosis, and management: A 58-year-old male with history of T2DM for 27 years presented with progressively increasing skin lesions on his back, gluteal area and back of thigh over 2 months duration. Around 3 months back, he had developed RTPCR positive COVID-19 infection with involvement of lower respiratory tract with dip in peripheral oxygen saturation (SpO2). During hospitalisation, he received deflazacort 30mg once daily along with symptomatic treatment as per contemporary guidelines. At the time of presentation, the lesions were maculopapular with pigmentation and scaling. There were no definite ring lesions with central clearing, which is usually seen in fungal superficial skin infections. Few pustular lesions were also present in genital area. Nearly one month after discharge slightly elevated circular scaly lesions on his thighs with minimal itching developed which progressed involving back of thighs, gluteal areas, and the back. Diagnosed as Psoriasis, local steroid ointment along with Fexofenadine (antihistamine) was used. There was initial improvement in lesion and symptoms, however there was a flare up in lesion within 2 weeks and several satellite lesions appeared on all over back and gluteal region. Direct microscopic examination of scrapings from the skin lesion after treatment with 20% potassium hydroxide (KOH) was done. The scrapings were characterized by presence of refractile, long, smooth, undulating, branching, and septate hyphal filaments with or without arthroconidiospores confirming the diagnosis of dermatophytosis. Patient was put on local luliconazole 3% cream as it has anti-inflammatory properties along with strong antifungal effect. Looking at the extensive nature of his lesion, he was also started on systemic antifungal Itraconazole 200mg per day for 8 weeks. His insulin doses were modified to achieve a better glycaemic control while avoiding hypoglycaemic events. Conclusion: Tinea corporis is a common fungal infection and the differential diagnosis is broad and, at times, difficult due to the prior use of medications, such as calcineurin inhibitors or corticosteroids. Furthermore, diseases may present with bizarre morphology in immunocompromised patients. Physicians must be familiar with this condition so that an accurate diagnosis can be made, and appropriate treatment initiated.

ODP446 Where's the Nodule?: Atypical Presentation of an Occult Metastatic Papillary Thryoid Carcinoma

Abstract Papillary thyroid Carcinoma (PTC) with apparent distant metastasis but lacking a primary thyroid cancer on pre-operative ultrasonographic examination, is referred by some as occult PTC. In most cases, primary carcinomas are identified after careful pathologic examination of the specimen but in some rare cases the primary tumors were not detected. Hereby, we describe the rare case of a patient with metastatic PTC without initial visualization on imaging of primary tumor location along with inconsistent pathology results between fine needle aspiration (FNA) biopsy and gross specimen pathology results. A 60-year-old female with past medical history of Diabetes Mellitus type 2 and Hypothyroidism presenting for follow-up visit after being found with neck nodules on head and neck CT scan. Thyroid and neck Ultrasound (US) were performed finding three right irregularly shaped hypoechoic lymph nodes (LN's) measuring &amp;gt; 1 cm, concerning for metastatic disease, but no thyroid nodules were noted. Patient denies family history of thyroid cancer, and no head and neck radiation exposure. Physical examination did not reveal goiter or palpable nodules. Laboratory results: TSH: 2.95 and Total T4: 9.32, both within normal range. Cervical LN's FNA biopsy was performed, yielding results consistent with PTC tall cell variant. Chest CT scan showed suspicious lesions for pulmonary micrometastasis. Total thyroidectomy was performed and gross pathology findings showed an infiltrating, follicular variant PTC with multifocal tiny primary tumors of the thyroid, with lesions measuring up to 0.2 cm, dimension which explains why nodules could not be identified on imaging studies. LN's FNA biopsy results and thyroid pathology did not correlate. Thyroid gross pathology was clearly PTC with follicular variant, infiltrating a small area away from greatest dimension tumor, with cells with apparent dedifferentiation to tall cell cytologic features. Due to high risk of recurrence, radioactive iodine therapy was recommended as adjunctive therapy for metastatic disease and eradication of residual neck disease to be started with levels of TSH&amp;gt;30 mU/ml. Postopertative Thyroglobulin level (Tg) was adequate &amp;lt; 0. 01 ng/ml but unreliable based on above normal range antithyroglobulin antibody &amp;gt; 1000 IU/ml, which increases risk of recurrence. Whole body scan also done showing bilateral lung metastasis and small neck metastatic disease. Repeated postoperative thyroid US also demonstrated a suspicious cystic lymph node in right central neck for which FNA with saline washout of aspirate for Tg measurement was ordered. Metastatic thyroid carcinoma without primary tumor after extensive thyroid sampling is a rare but existent phenomenon that can be encountered in daily practice. Genotyping or immunostaining mestastatic lesions could help direct the Pathologist to the source of the metastasis. Patients with a higher risk of recurrence are monitored more aggressively as it is believed that early detection of recurrent disease offers the best opportunity for effective treatment. Presentation: No date and time listed

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

LBSUN290 A Rare, Sordid Tale Of The Two Most Dreaded Adverse Effects Of SGLT-2 Inhibitors Occurring Concurrently - Acute Pancreatitis And Euglycemic Diabetic Ketoacidosis - Within Days Of Initiating Empagliflozin Therapy.

Abstract Introduction Empagliflozin is an anti-diabetic agent belonging to the class of SGLT-2 inhibitors, which was approved by the U. S. Food and Drug Administration (FDA) in 2013. It has emerged as a popular choice of second line diabetic therapy owing to benefits of reduction in cardiovascular adverse events and delayed progression of kidney disease. However, in 2015, FDA issued a safety warning in connection to its use with euglycemic ketoacidosis and subsequently in 2016, started investigating its link with pancreatitis. We present a case of a type 2 diabetic started on Empagliflozin therapy 4 days prior to his presentation to the ER with nausea, vomiting and diarrhea when he was found to have concurrent euglycemic DKA and acute pancreatitis. Case presentation A 49 year old male with a history of diabetes mellitus type 2 presented to the ER with nausea, vomiting, diarrhea and fatigue. He reported these symptoms since starting a new anti-diabetic agent Empagliflozin four days ago. He denied fever, chills, chest pain, shortness of breath, abdominal pain, and urinary symptoms. He denied heavy alcohol use or binge drinking. Lab tests showed: WBC count 18.7 k/mm cu (4 -11), Glucose 229 mg/dL (70 - 99), Bicarbonate 7 mmol/L (21 - 31), Anion gap 30 mmol/L (6 -14), Lactate 1.8 mmol/L (0.7 - 2.5), Serum beta hydroxybutyrate level &amp;gt;4 mM (0. 02 - 0.27), Lipase 866 IU/L (11 - 82) and Venous blood pH 6.98 (7.30 - 7.45). Repeat blood glucose measurements remained &amp;lt; 250 mg/dl. Urinalysis showed &amp;gt; 500 mg/dl glucose. CT abdomen and pelvis showed moderate fat stranding consistent with acute pancreatitis. He was started on insulin infusion and admitted to the intensive care unit. He was subsequently discharged on a basal-bolus regimen with instructions to discontinue Empagliflozin. Discussion Acute pancreatitis and euglycemic DKA are grave clinical entities, associated with significant mortality. Our patient presented with nausea, vomiting, diarrhea and fatigue; he denied the characteristic abdominal pain yet was noted to have pancreatitis by laboratory and imaging studies. It is extremely important that pancreatitis be considered and ruled out in patients presenting with non-specific symptoms while on SGLT-2 inhibitor therapy. In addition, a high radar of suspicion should be maintained in both inpatient and outpatient settings for euglycemic DKA in patients on SGLT-2 inhibitor therapy presenting with non-specific symptoms, even in the absence of a classic identifiable triggering event, especially as there is evidence to suggest that pancreatitis may actually serve as a triggering factor for euglycemic DKA suggesting that, due to a cause-effect phenomenon, these two conditions may co-exist more often than expected. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Epidemiological criteria and risk factors for type two diabetes mellitus (T2DM) in children and adolescents: Can we modify them?

Type 2 Diabetes Mellitus (T2DM) has become an increasingly important public health concern globally among children and adolescents. The unique features of T2DM in children are the rapidly progressive decline in β-cell function and accelerated development of complications. Important proven environmental risk factors for developing T2DM include, prediabetes (high blood glucose short of T2DM definition), obesity, inactivity, family history of T2DM, being a member of a high-risk ethnic group, and poverty. The estimated T2DM prevalence per 1000 youths aged 10 to 19 years increased significantly in many countries in the past 20 years. T2DM impacts more specific ethnic groups compared to children of other ethnicities. This search reviews the literature about epidemiological data on T2DM in children and adolescents and the different interventions adopted for its prevention and management. Epidemiological evidence indicates that T2DM in youth is different from type 1 Diabetes Mellitus (T1DM) and T2DM in adults. Many research articles showed that screening for abnormal blood glucose (prediabetes and diabetes) in high-risk children and adolescents represents an effective population intervention method for the early diagnosis and management of prediabetes and T2DM. The use of lifestyle intervention programs (LSI), applied successfully in the US, and many European countries, have shown some success in reversing glucose abnormalities and preventing the progression to T2DM decreasing cardiovascular risk factors. In conclusion, Proper screening, and the wide application of LSI programs in selected high-risk populations are expected to have good preventive outcomes reducing the incidence and complications of T2DM in children and adolescents.