History Of Diabetes Mellitus Type Research Articles

Associations between eating speed and food temperature and type 2 diabetes mellitus: a cross-sectional study.

This study aimed to evaluate the relationship between eating speed and food temperature and type 2 diabetes mellitus (T2DM) in the Chinese population. A cross-sectional survey was conducted between December 2020 to March 2022 from the department of Endocrinology at the Shandong Provincial Hospital. All recruited participants were asked to complete structured questionnaires on their eating behaviors at the time of recruitment. Clinical demographic data such as gender, age, height, weight, familial history of T2DM, prevalence of T2DM and various eating behaviors were collected. Univariate and multivariate logistic regression analyses were used to analyze the associations between eating behaviors and T2DM. A total of 1,040 Chinese adults were included in the study, including 344 people with T2DM and 696 people without T2DM. Multivariate logistic regression analysis of the general population showed that gender (OR = 2.255, 95% CI: 1.559-3.260, p < 0.001), age (OR = 1.091, 95% CI: 1.075-1.107, p < 0.001), BMI (OR = 1.238, 95% CI: 1.034-1.483, p = 0.020), familial history of T2DM (OR = 5.709, 95% CI: 3.963-8.224, p < 0.001), consumption of hot food (OR = 4.132, 95% CI: 2.899-5.888, p < 0.001), consumption of snacks (OR = 1.745, 95% CI: 1.222-2.492, p = 0.002), and eating speed (OR = 1.292, 95% CI:1.048-1.591, p = 0.016) were risk factors for T2DM. In addition to traditional risk factors such as gender, age, BMI, familial history of T2DM, eating behaviors associated with Chinese culture, including consumption of hot food, consumption of snacks, and fast eating have shown to be probable risk factors for T2DM.

Practice and Knowledge on Type 2 Diabetes Mellitus Risk Factors Among Office Workers in Mwanza City, Tanzania.

Type 2 diabetes mellitus (T2DM) mostly occurs in adults when the body becomes resistant to insulin. Genetic predisposition, age, an unhealthy diet, and a sedentary lifestyle are key factors leading to T2DM. Office workers are one of the populations at greatest risk of developing T2DM. This study assessed the level of knowledge and risk factors for T2DM among office workers in Mwanza City, Tanzania. A cross-sectional study was conducted among 309 office workers in public and private institutions in Mwanza City. A structured, pre-tested questionnaire was used to collect information from the participants. The coded data were analyzed using STATA Version 14. The associations between various risk factors for T2DM and knowledge on T2DM were determined using Chi-square or Fisher's exact tests. The level of knowledge was poor in 41.1%, moderate in 31.1%, and good in 27.8% of the study participants. Family history of T2DM showed a significant association with knowledge score (P=.001). Only 63 (20.4%) of respondents reported eating a healthy diet. Among the study participants, 154 (49.8%) had poor diabetes prevention practices, 82 (26.5%) had moderate practices, and 73 (23.7%) had good practices. The majority of the office workers who participated in this study had limited knowledge regarding risk factors for T2DM and poor practices concerning the prevention of the disease. In order to reduce the burden of T2DM, there is a need for lifestyle modification, provision of education, and raising awareness about the risk factors of T2DM among office workers in Mwanza City.

Endoscopic endonasal approach for MRI–Negative Cushing’s microadenoma

A 54-year-old male with a history of diabetes mellitus type 2 for 12 years and hypertension was seen in the clinic due to poorly controlled diabetes. Inferior petrosal sinus sampling (IPSS) confirmed Cushing’s disease with primary adrenocorticotropic hormone (ACTH)–secreting pituitary adenoma on the right. However, 3T and subsequent 7T MRI showed no visible tumor. An endoscopic transsphenoidal approach was selected to explore the pituitary gland and resect the presumed microadenoma. Tumor was identified in the lateral recess along the right medial cavernous sinus wall and gross-total resection (GTR) was performed. The normal pituitary gland was preserved, and the patient went into remission. The video can be found here: https://stream.cadmore.media/r10.3171/2023.4.FOCVID2324

Endocrinology for the hepatologist.

Endocrinology for the hepatologist.

Diagnostic Performance of Greyscale Ultrasound in Detecting Fatty Liver Disease in a Type 2 Diabetes Population Using FibroScan as the Reference Standard.

Introduction Brightness mode ultrasound (B-mode US) and FibroScan (Echosens, Paris, France) are the two ultrasound methods often recommended for screening non-alcoholic fatty liver disease (NAFLD) in persons with type 2 diabetes mellitus (T2DM). This study assessed the diagnostic performance of B-mode US using FibroScan as the reference standard. Methods Persons with a known history of T2DM were invited to screen for NAFLD using B-mode US and FibroScan on separate days within a one-month period. Assessors of B-mode US and FibroScan were blinded to each other's findings. Both B-mode US and FibroScan independently assessed and graded each participant for the presence of NAFLD. Using the diagnostic test findings of FibroScan as a reference standard, the sensitivity and specificity of B-mode US were analyzed.The area under the receiver operating characteristic curve (AUROC) was analyzed using Jamovi (version 2.3.21). A multinomial logistic regression of the B-mode US and FibroScan in predicting NAFLD grade was also analyzed. Results A total of 171 participants were assessed. B-mode US detected NAFLD in T2DM patients with 63.6% sensitivity, 65.6% specificity, and 0.646 AUROC. Sensitivity and specificity in overweight and obese participants were 36-43% and 76-85%, respectively. Multinomial logistic regression demonstrated an insignificant statistical relationship between FibroScan and B-mode US in predicting grade 1 steatosis (p-value = 0.397), which was significantly affected by a higher BMI (p-value = 0.034) rather than a higher liver fibrosis level (p-value = 0.941). The logistic regression further showed a significant relationship between B-mode US and FibroScan in predicting steatosis grade 2 (p-value = 0.045) and grade 3 (p-value < 0.001), which was not significantly affected by BMI (p-value = 0.091). Conclusion B-mode US can replace FibroScan for severe steatosis; however, it cannot be used to screen for NAFLD in T2DM patients due to lower sensitivity for early detection in the overweight.

768-P: Effect of Dulaglutide Therapy Initiation on the Course of Coronavirus Infection and the Dynamics of Inflammatory Markers in Hospitalized Patients with Type 2 Diabetes

Aim: To determine the impact of initiation of dulaglutide therapy on the course of COVID-19 and the dynamics of inflammatory markers in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods: The inclusion criteria were history of T2DM, BMI &amp;gt; 27 kg/m2, PCR-confirmed diagnosis of COVID-19. The intervention group of 53 patients started dulaglutide therapy (1.5 mg once weekly) during the first 24 hours of admission, the control group consisted of 50 patients, who proceeded with glucose-lowering therapy. In both groups we compared COVID-19 outcomes (mortality/survival rate, ICU admission, need for assisted ventilation) and the duration of hospitalization. On days 3 and 7 of hospitalization we assessed laboratory parameters (FPG, CRP, ALT, AST, LDH, lymphocyte levels, D-dimer). Results: The initiation of dulaglutide therapy reduced the risk of death and transfer to assisted ventilation by 3.5 times in the intervention group compared to the control one (5.7% vs 20.0%, p=0.038). No differences were found in the risk of ICU admission (17.0% vs 28.0%, p=0.18) and the duration of hospitalization (10 bed-days vs 11-bed days, p=0.26). The groups were comparable in respect to carbohydrate metabolic compensation. Compared to those in the control group, patients on dulaglutide therapy demonstrated a lower CRP level (15.8 vs 24.6 mg/L, p=0.035), higher lymphocyte levels (1.2 vs 0.9 × 10*9/L, p=0.049) on day 3 of hospitalization, and a significantly lower LDH concentration level on day 7 (261.6 vs 326.1 U/L, p=0.016). There were no differences in ALT, AST, and D-dimer levels. Conclusion: The initiation of dulaglutide therapy in hospitalized patients with T2DM and COVID-19 decreased the risk of lethal outcomes and transfer to assisted ventilation, as well as proved effective in regards to inflammatory markers (CRP, lymphocytes levels). Disclosure T.Markova: None. M.Stas: None. A.Anchutina: None.

1338-P: Characteristics of Patients with Type 2 Diabetes without Nonalcoholic Fatty Liver Disease (NAFLD)

About 70% of patients with type 2 diabetes mellitus (T2DM) have NAFLD which is a risk factor for cirrhosis and hepatocellular carcinoma. Many factors may be associated with more severe disease (i.e., insulin resistance, obesity). However, the metabolic profile of T2DM patients spared from having NAFLD and liver fibrosis is unclear. To this end, we recruited 266 patients with a history of T2DM without a known history of NAFLD (age: 59 ± 10 years; female 58.3 %; BMI: 33.0 ± 6.3 kg/m2, A1c: 7.0 ± 1.4 %) attending the outpatient university clinics. We performed a medical history, physical exam and measured routine/metabolic laboratories, liver fat (by CAP score ≥ 274 dB/m) and fibrosis (by liver stiffness measurement or LSM ≥7.0 kPa or F≥1) by elastography. A total of 32% patients did not have NAFLD, but when compared to NAFLD patients there were no differences in terms of age, gender, or race. Those without NAFLD had a lower mean BMI ± SD (29.6 ± 5.2 vs. 34.6 ± 6.2 kg/m2) and better glycemic control (mean A1c: 6.7 ± 1.3% vs. 7.2 ± 1.4%, both p&amp;lt;0.05). Patients without NAFLD had lower plasma ALT levels (mean 21 ± 12 vs. 28 ± 19 U/L; p&amp;lt;0.05). Patients with NAFLD had more severe (hepatic) insulin resistance (IR) (HOMA-IR: 3.0 ± 2.3 vs. 4.9 ± 3.2, p&amp;lt;0.05), with more people having a HOMA-IR ≥3.0 (35% vs. 72%, p&amp;lt;0.05). In multiple regression analysis, with a 95% CI, obesity (OR 4.0, 2.3-7.1), HOMA-IR (OR 3.1, 1.0-5.7), and worse glycemic control (A1c) (OR 1.7, 1.1-2.9) accounted for most of the difference between subjects with vs. without NAFLD. In NAFLD patients, comparing those with vs. without fibrosis, obesity (OR 2.8, 1.6-4.9) and elevated aminotransferases (OR 2.1, 1.3-3.2) accounted for most of the difference among patient. Conclusion: Patients with type 2 diabetes mellitus without NAFLD are usually more insulin sensitive and have a more favorable cardiometabolic profile than those with NAFLD. This highlights the role of insulin resistance and lipotoxicity in the development of NAFLD in this population. Disclosure E.Valdez saenz: None. D.Barb: None. M.J.Gurka: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck &amp; Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. E.Godinez leiva: None. R.Lomonaco: None. S.A.Marangi: None. S.Kalavalapalli: None. M.A.Gonzalez: None. X.Chi: None. A.Ortiz rocha: None. Y.Mohseni: None. Funding National Institutes of Health (R01120331-01A1)

Cutaneous aspergillosis in a diabetic patient- A cytological encounter in FNAC

Diabetes mellitus is a public health problem significantly contributing to morbidity and mortality worldwide. The patients are highly prone to opportunistic infections with major systemic as well as cutaneous fungi. The fungal infections frequent in diabetics include Candidiasis as well as cutaneous Aspergillosis. The most commonly involved species include Aspergillus niger, Aspergillus flavus and Aspergillus fumigatus. Presenting here is a case of 60 years male with history of diabetes mellitus type 2 on oral hypoglycaemic agents, presenting in Medicine Out Patient Department with complaints of progressive painless left cystic medial ankle swelling for last 4 months. Patient was then asked to undergo FNAC which revealed pyogenic inflammation with giant cells and fungal hyphae showing acute angled branching. Furthermore, microbiological confirmation was also done and patient was initiated treatment for the same. This case report underlines the importance of FNAC and Cytological study in the accurate and early diagnosis of Cutaneous Aspergillosis even before the more expensive and time-consuming microbiological diagnostic modalities are applied.

#4951 NON-ADHERENCE TO CARDIOMETABOLIC DRUGS AS ASSESSED BY LS-MS/MS IN URINE AND ITS ASSOCIATION WITH RENAL AND CARDIOVASCULAR OUTCOMES IN T2DM

Abstract Background and Aims Cardiovascular and renal complications have a detrimental impact on the prognosis and quality of life of patients with type 2 diabetes mellitus (T2DM). Guidelines recommend combination drug therapy to prevent or delay these complications[1]. However, non-adherence to medication is common and a barrier to successful disease management[2]. Most previous studies on adherence and outcome used indirect methods to assess adherence[3]. In this study we used liquid chromatography-tandem mass spectrometry (LC-MS/MS), a direct and objective adherence measure, to asses adherence to cardiometabolic drugs in a large real-world cohort of individuals with T2DM and analyzed non-adherence in the context of cardiovascular and renal outcomes. Method 1125 eligible PROVALID participants were included. PROVALID is a prospective observational cohort study of patients with T2DM followed annually at the primary health care level. Urine samples from the PROVALID biobank were screened for 79 cardiometabolic drugs and metabolites thereof by LC-MS/MS. An individual was classified as fully adherent when markers for all prescribed drugs were detected, partially non-adherent when at least a marker for one drug was detected and totally non-adherent when no marker for any prescribed drug was detectable. In order to assess outcome by adherence we defined a cardiovascular (myocardial infarction, stroke, and cardiovascular death) and a renal (ESKD, renal death, sustained 40% reduction in eGFR to &amp;lt; 60 ml/min per 1.73 m², sustained progression of albuminuria) composite endpoint. Results The mean age was 64.2 (±8.9) years and 46.1% were female. The mean duration of T2DM was 11.4 (±7.9) years. The mean HbA1c was 7.1 (±1.1)%, the mean eGFR was 77.6 (±23.6) ml/min/1.73 m2 and mean albuminuria 67.3 (±287.9) mg/g creatinine. Participants were prescribed 5.4 (±2.0) cardiometabolic drugs on average. Based on the results of LC-MS/MS measurements, 56.3% were totally adherent, 42.0% were partially adherent, and 1.7% were totally non-adherent to screened cardiometabolic drugs. Adherence was highest to antiplatelet and glucose lowering drugs and lowest to lipid lowering drugs (totally adherent individuals 90.1%, 89.2% and 70.7%, respectively). Non-adherent patients had a longer history of T2DM (12.3 ± 8.5 vs. 10.7 ± 7.5, p = 0.003) and a higher number of prescribed drugs (5.8 ± 2.1 vs. 5.1 ± 1.9, p &amp;lt; 0.001). Age per se had no influence on adherence, however the number of prescribed medications had more impact on adherence in younger patients (Fig. 1). Ex-smokers were more likely to be adherent than current or never-smokers (odds ratio 1.4, p-value = 0.014). Patients who were adherent to lipid lowering drugs had significantly lower LDL (82.4 ± 29.8 vs. 111.4 ± 39.7 mg/dl, p &amp;lt; 0.001). A trend for lower HbA1c with adherence to glucose-lowering drugs and lower systolic blood pressure with adherence to antihypertensive drugs could be observed, however these differences were not statistically significant. In the longitudinal analysis, worse cardiovascular prognosis was especially seen with non-adherence to antiplatelet drugs and worse renal outcome especially with non-adherence to antihypertensive drugs (Fig. 2). Conclusion Our analysis confirms that non-adherence, especially partial non-adherence, to cardiometabolic drugs is common in T2DM. A higher incidence of cardiovascular events was observed with non-adherence to antiplatelet drugs, whereas non-adherence to antihypertensive drugs was associated with a higher renal event rate.

Signaling pathways and intervention for therapy of type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) represents one of the fastest growing epidemic metabolic disorders worldwide and is a strong contributor for a broad range of comorbidities, including vascular, visual, neurological, kidney, and liver diseases. Moreover, recent data suggest a mutual interplay between T2DM and Corona Virus Disease 2019 (COVID-19). T2DM is characterized by insulin resistance (IR) and pancreatic β cell dysfunction. Pioneering discoveries throughout the past few decades have established notable links between signaling pathways and T2DM pathogenesis and therapy. Importantly, a number of signaling pathways substantially control the advancement of core pathological changes in T2DM, including IR and β cell dysfunction, as well as additional pathogenic disturbances. Accordingly, an improved understanding of these signaling pathways sheds light on tractable targets and strategies for developing and repurposing critical therapies to treat T2DM and its complications. In this review, we provide a brief overview of the history of T2DM and signaling pathways, and offer a systematic update on the role and mechanism of key signaling pathways underlying the onset, development, and progression of T2DM. In this content, we also summarize current therapeutic drugs/agents associated with signaling pathways for the treatment of T2DM and its complications, and discuss some implications and directions to the future of this field.

Abstract #1411932: Pseudo-myocardial Infarction in Diabetic Ketoacidosis with Normokalemia

Diabetic ketoacidosis (DKA) is a rare cause of the “pseudo-infarct pattern." It indicates the presence of EKG changes suggestive of myocardial ischemia without a coronary artery lesion. Pseudo-myocardial infarction has been associated with hyperkalemia seen in DKA. We report a case of ST elevation in the absence of a coronary artery lesion in a patient presenting with severe DKA and normokalemia. 41-year-old male with a history of type-1 diabetes mellitus with HbA1c of 13.6%, presented with altered mental status and unresponsiveness. He was intubated in the emergency department. Labs revealed severe DKA with glucose of 1307 mg/dl, non-calculable anion gap metabolic acidosis with bicarbonate level of <10 mEq/L, and B- hydroxybutyrate of 12.38mmol/L. Serum potassium level was normal at 5.1 mEq/L. Other electrolyte derangements include phosphorous at 11.9 mg/dl, magnesium at 4.6 mg/dl, and sodium at 146 mEq/L. Initial EKG revealed bradycardia without ischemic changes. He was started on DKA protocol with insulin drip, resulting in the closure of the anion gap and improvement of blood sugars. The next day, EKG was notable for ST elevations suggestive of anteroseptal infarction. Troponin level was 16.7 ng/ml. Serum potassium remained normal at 3.5 mEq/L. Due to risk factors for coronary artery disease (CAD), he underwent a coronary angiogram and was found to have normal coronaries. EKG changes are thought to be in the setting of DKA, which was subsequently resolved. Several cases have reported ST segment changes in patients with DKA. However, these have been associated with hyperkalemia. The EKG changes in our case were seen in the normokalemia setting and after the anion gap closure. In the absence of metabolic derangements, the etiology of the pseudo-infarct pattern remains unclear. As diabetes is a risk factor for CAD, these patients require ischemic evaluation with a coronary angiogram.

Atypical clinical features of post COVID-19 mucormycosis: A case series.

This case series aims to evaluate patients affected with post COVID-19 mucormycosis from clinical presentation to surgical and pharmacological treatment to improve the disease prognosis. This case series was conducted at a specialized surgery hospital in Baghdad Medical City for over 10 months. Fifteen cases who had mild to severe COVID-19 infections followed by symptoms similar to aggressive periodontitis, such as mobility and bone resorption around the multiple maxillary teeth, were included in this case series. All patients did not receive COVID-19 vaccination; seven had a history of diabetes mellitus type 2, another five patients had a history of diabetes-like syndrome during the COVID-19 infection, and the remaining three patients had no history of any systemic diseases. No intracranial involvement was seen in all patients, and bilateral sinus involvement was seen in three patients. Being highly suspicious of all patients affected with COVID-19 is highly recommended to avoid the complications of the late diagnosis of mucormycosis. In addition, our knowledge and methods in diagnosing and treating classical mucormycosis should be modified regarding post COVID-19 mucormycosis.

Nutritional Status, Vitamin D and Lifestyle of Adults with and without Type 2 Diabetes in Baghdad, Iraq: A Comparative Cross-Sectional Study

INTRODUCTION: Understanding the status of diabetes is important to predict thevariables that affect risks due to diabetes or can be used to prevent diabetes. This studyaimed to compare the socio-demographic characteristics, nutritional status, vitamin D(VitD) levels, and lifestyles of diabetic versus non-diabetic adults in Baghdad, Iraq.MATERIALS AND METHODS: A comparative cross-sectional study was carried out fromOctober to December 2019, and data were collected from adults aged 20 to 65 years.Logistic regression analysis was used to identify factors that contributed to thedevelopment of Type 2 Diabetes Mellitus (T2DM). Data was analyzed using SPSSVersion 22. RESULTS: One-hundred seventy subjects were divided into two groups of85 respondents in non-diabetic and diabetic groups, respectively. Educational level, vitDlevel and daily consumption of red meat, pizza, pastries, nut and bread were significantlyhigher in the non-diabetic than in the diabetic group (p&lt;0.05). On the other hand,respondents with T2DM had higher family history of T2DM, waist-to-hip ratio (WHR),body fat percentage (BF%), fasting blood glucose (FBG) and daily consumption of brownbread (p&lt;0.05). Multiple logistic regression showed that the only significant factorscontributing to the status of diabetes were educational attainment and FBG (p&lt;0.05).CONCLUSION: Higher educational level and decreasing one unit of FBS reduced the riskof T2DM by 10% and 67%, respectively. Future Interventions on fostering educationallevel, normal BMI, healthier diet and vitamin D intake are recommended for T2DMprevention and control in Iraqi adults.

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.