History Of Diabetes Mellitus Type Research Articles

Extramedullary Acute Myeloid Leukemia: Testicular Myeloid Leukemia, Leukemia Cutis with Leptomeningeal Involvement

Extramedullary Acute Myeloid Leukemia: Testicular myeloid leukemia, leukemia cutis with leptomeningeal involvementZ Saeed, H Aslam, A Weil, M MuzaffarMyeloid sarcoma also called granulocytic sarcoma, myeloblastoma, or chloroma is an extramedullary tumor of immature granulocytic cells. Extramedullary soft tissue manifestations are relatively rare in hematological malignancies. One of the rarest manifestations is myeloid sarcoma (MS). MS develops as part of acute myeloid leukemia, myeloproliferative neoplasm, or myelodysplastic syndrome or at relapse, especially following allogeneic hematopoietic stem cell transplant. Demographically, it has a slight male predominance with a male to female ratio of 1.2: 1. It may occur at any age and any site in the body leading to varied clinical presentations. The most reported sites are lymph nodes, skin and soft tissues, bone, testes, gastrointestinal tract, and peritoneum.44 year old male with past medical history of diabetes mellitus type 2 and morbid obesity presented with right testicular pain and swelling and underwent radical orchiectomy. Pathology reported seminoma and received adjuvant Carboplatin for pT3 disease. He developed left testicular pain and swelling 2 months later and underwent left radical orchiectomy. Pathology reported CD4+, CD56+ high grade hematopoietic neoplasm. It was sent for second opinion to NIH and was consistent with myeloid sarcoma with monoblastic features. Repeat evaluation of right testicular specimen was CD45+. Bone marrow biopsy showed normocellular marrow with multilineage hematopoiesis. PET scan showed hyper metabolic activity in the right hemi scrotum, widespread osseous areas of increased uptake and 3 soft tissue nodules within the subcutaneous tissues of the left abdominal wall. FNA of the subcutaneous nodule showed CD56 positive monocytoid cells. Induction chemotherapy with 7+3 (cytarabine 200 mg/m2, daunorubicin 60mg/m2) with gemtuzumab 3mg/m2 on day 1, 4, 7 was completed. Cerebrospinal fluid studies (CSF) showed monoblastic/monocytic proliferation and received intrathecal (IT) chemotherapy alternating between methotrexate and cytarabine every week. CSF studies were cleared after 2 IT chemotherapy. Patient remained in the hospital for 87 days due to poor count recovery and development of pulmonary embolism. Myeloid mutation screening identified a mutation in NRASG13D. Repeat PET scan showed 7 areas of hypermetabolic foci involving nodular densities of bilateral lower anterior abdominal wall. One of the lesion was biopsied that was negative. He completed 2 cycles of high dose cytarabine for consolidation but had repeated hospital admissions and therapy was switched to azacytidine and venetoclax. Patient was evaluated by bone marrow transplant team. He had disease progression at tenth month when he presented with severe back pain and lower extremity weakness. MRI brain and spine showed new patchy T2 hyperintense signal in the right frontal white matter, increased number and size of marrow replacing lesions throughout the visualized skeleton. Patient underwent bone biopsy that showed >90% marrow involvement (sheets of infiltrative cells with identical phenotype. Positive for CD56 (>90% of marrow cellularity), CD4 and lysozyme. Hospital course was complicated with renal failure, electrolytes imbalance and hemodynamically instability requiring vasopressor support. Discussions were held for re-induction with CLAG (cladribine 5mg/m2, and cytarabine 2gm/m2) vs best supportive care. Patient decided to pursue comfort care and passed away peacefully.The uniqueness of this case is the myeloid sarcoma of testes as initial presentation with normal bone marrow. Misdiagnosis is not uncommon and can delay the appropriate treatment. Extra medullary involvement from leukemia is very aggressive and needs high suspicious and prompt treatment. Systemic chemotherapy using AML-like regimens should be commenced early, even in non leukemic disease. Allogeneic hematopoietic stem cell transplantation has demonstrated promising results, particularly in patients who achieved complete remission with AML-induction protocols, and recent advances in genetic profiling may enable the development of novel targeted therapies. Prospective multicenter controlled trials are required to further refine management decisions and investigate the role of novel targeted therapies. DisclosuresNo relevant conflicts of interest to declare.

Impact of the South Asian Adolescent Diabetes Awareness Program (SAADAP) on diabetes knowledge, risk perception and health behaviour

Objective: Evidence suggests the increased prevalence of diabetes among South Asian (SA) adolescents is due to their genetic risk profile. The South Asian Adolescent Diabetes Awareness Program (SAADAP) is a pilot intervention for SA youth in Canada with a family history of type 2 diabetes mellitus (T2DM). We sought to investigate changes in (1) diabetes knowledge and associated risk factors, (2) risk perception and (3) health behaviours among adolescents participating in SAADAP. Design: One-group pre-test, post-test design informed by a commitment to community-based participatory research (CBPR). Setting: Sixty-eight adolescents aged 13–17 years with a family history of T2DM participated in SAADAP in a clinical-community setting in Canada. Method: Pre–post questionnaires were administered to evaluate diabetes knowledge and associated risk factors, risk perceptions and health behaviours. Analyses were restricted to 49 participants who attended at least four diabetes education sessions. Results: The mean age of adolescents was 14.5 years, and 57.1% self-identified as girls. The difference in knowledge about the definition, symptoms and complications of T2DM from baseline to post-intervention was 3.32 out of 21 ( p < .001) among SA youth. There was significant increase in learning about diabetes risk factors ( p < .001) from baseline to post-intervention. Almost 60% of participants exhibited no change in their risk perception after intervention. Approximately two-thirds of the participants self-reported positive changes in health behaviours after completing the programme. Conclusion: SAADAP showed promising outcomes in raising knowledge and improving health behaviours in SA adolescents with a family history of diabetes. Larger controlled trials with longer follow-up are recommended to support and expand on the current findings.

Similar incidence of over and underdiagnosis of heart failure in hospitalized patients with type 2 diabetes mellitus

Abstract Purpose To assess the incidence of over and underdiagnosis of heart failure (HF) in hospital patients with type 2 diabetes mellitus (T2DM) Methods In the single-center prospective study (registry) from 01.08.2018 to 31.01.2019 we included 1008 patients admitted to the city hospital. Key inclusion criteria: a history of T2DM, age ≥40 years. Key exclusion criteria: any other disorders of carbohydrate metabolism, age <40 years, acute coronary syndrome, functionally dependent patients. We assessed the presence of HF in the diagnosis at admission by the following criteria: the presence of HF stage C or D (ACCF/AHA) and at least II NYHA functional class. All patients underwent standard echocardiography and NT-proBNP assessment at 1–3 days after admission. The diagnosis of HF was established by the 2016 ESC HF Guidelines. After the examination, the patients were divided into subgroups: “Confirmed HF” (HF was in the diagnosis, its presence was confirmed), “Unconfirmed HF” (HF was in the diagnosis, its presence was excluded), “First diagnosed HF” (HF was not in the diagnosis, its presence was confirmed) and “Absent of HF” (HF was not in the diagnosis and its presence was excluded). We also analyzed the reasons for admissions in all patients. Results The presence of HF in the diagnosis at admission was in 68.8% (n=693) of patients and, accordingly, it was absent in 31.2% (n=315). By the ESC HF Guidelines HF was diagnosed in 68.1% (n=686) and, accordingly, in 31.9% (n=322) it was excluded. The analysis results by the diagnosis at admission are presented in Fig. 1. The analysis of the reasons for admission depending on the HF status is presented in Fig. 2. In 35 patients admitted with HF decompensation the presence of HF was not confirmed and the diagnosis was revised: atrial fibrillation in 11 (31,4%) patients, exacerbation of COPD – 7 (20,0%), pulmonary embolism – 6 (17,1%), pneumonia – 4 (11,4%), kidney diseases – 4 (11,4%), and asthma – 3 (8,7%). Conclusion Among hospitalized patients with T2DM, there is a similar incidence of over and underdiagnosis of HF. Patients with first diagnosed HF were more likely to be admitted for reasons unrelated to cardiovascular diseases (CVD), most often with hyperglycemia (Fig. 2). Patients with unconfirmed HF – for reasons related to CVD, while the reason for admission in a quarter of patients was HF decompensation (Fig. 2). Despite the availability of examination for HF, the problem of its diagnosis is still relevant. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Possibilities of predicting preclinical forms of cardiovascular diseases in young patients with type 1 diabetes mellitus using cardiac magnetic resonance imaging

Aim. To identify the indicators of cardiac magnetic resonance (CMR), which have diagnostic value in the individual assessment of the cardiovascular prognosis in young patients with type 1 diabetes mellitus (T1DM).Material and Methods. The study included a total of 60 patients (29 men and 31 women) aged 18 to 36 years with a history of T1DM from 5 to 16 years, who underwent contrast-enhanced CMR. Circular strain, strain relaxation index (SRI), peak early diastolic strain rate (SRe), epicardial fat thickness (EFT), ejection fraction (EF), stroke volume (SV), end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular mass (LVM) were assessed. Echocardiography, 24-h electrocardiography (ECG), treadmill test, and NT-proBNP blood test were performed to exclude heart pathology. Statistical data processing was used to identify the relationships of changes in CMR parameters of the left ventricle and epicardial adipose tissue with disease duration, carbohydrate metabolism compensation (HbA1c), total cholesterol, and low-density lipoprotein (LDL).Results. Using the nonparametric Mann – Whitney U-test, the study showed the presence of significant differences in the values of SV, EDV, end-diastolic volume index (EDVI), and LVM in the groups of 5–10and 11–16-year duration of disease, respectively. The assessment of Spearman’s rank correlation coefficients revealed negative correlations between the values of SV, ESV, ESV index (ESVI), EDV, and LVM and T1DM duration; between the index of circular strain and blood level of HbA1c; between the values of SV, EDVI, ESVI, EDV, ESV, and LVM and blood levels of total cholesterol and LDL; between SV, EDVI, ESVI, EDV, ESV, and LVM and mean EFT in the left ventricular projection.Conclusion. The CMR-based evaluation of strain parameters may become a key in personalized identification of young T1DM patients with a high risk of adverse cardiovascular events. The thickness and distribution of epicardial adipose tissue in young patients with T1DM may have predictive value for risk stratification of developing diseases associated with atherosclerosis and chronic heart failure, which will affect the primary prevention strategy in this population.

S3658 Liver, Lung, Brain Abscess 2/2 Strep Intermedius

Introduction: Streptococcus intermedius is a beta-hemolytic, non-motile, catalase-negative, gram-positive member of the Streptococcus anginosus group (SAG) and also a member of normal human microbiota in the respiratory, gastrointestinal, and genitourinary tracts. S. intermedius has a unique tropism in the brain, liver, and lungs leading to abscess formation. Case Description/Methods: A 47-year-old male presented with a 5-day history of nonproductive cough, shortness of breath, pleuritic chest pain and progressively worsening fever/chills. He has a medical history of diabetes mellitus type 2. He denied nausea, vomiting, diarrhea, abdominal pain, headache, recent travel, or recent dental procedures. He denied alcohol use, smoking, and recreational drug use. Vital signs were stable. Labs revealed WBC 27.93, CRP 208, Procalcitonin 1.11, Ferritin 2,568. CT of chest/abdomen/pelvis with contrast revealed a large multiloculated right-sided pleural effusion versus empyema and multiple hepatic abscesses. Prior to broad-spectrum antibiotics the empyema and hepatic abscess were drained and cultures grew streptococcus intermedius and the patient was continued on IV ceftriaxone. On the day of discharge, the patient lost balance while walking and a head CT was obtained which identified multiple basal ganglia and right occipital lesions, with a follow-up MRI brain that confirmed ring-enhancing lesions concerning brain abscesses. These lesions were deemed inaccessible by neurosurgery and then treated as a hematogenous spread of streptococcus intermedius in the setting of recent bacteremia. Follow-up imaging confirmed the lesions to have decreased bin size prior to discharge. Discussion: S. intermedius release pro-inflammatory proteins as well as hydrolytic enzymes such as hyaluronidase and sialidase to induce tissue liquefaction and the formation of pus. S. intermedius is unique to the other bacteria in SAG due to the expression of intermedilysin (ILY), allowing it to cause cell necrosis with membrane bleb formation. The ILY gene is being used as a specific marker to detect S. intermedius via PCR. Risk factors include dental manipulation, sinusitis, diabetes, alcohol use, and malignancy. Treatment is based on susceptibility. An untreated liver abscess may lead to hematogenous spread which increases the risk for mortality. The mortality rate for SAG-associated bacteremia is 10-16%. Early recognition and timely intervention are important for successful treatment and improved outcomes.Figure 1.: One of the multiple hepatic abscess 2/2 strep intermedius.

S1818 Colonic Amyloidosis: A Rare Cause of Gastrointestinal Bleeding

Introduction: AL-amyloidosis is a rare systemic disorder with an annual U.S. incidence of ∼2000 cases. It results from abnormally folded protein deposition. Gastrointestinal (GI) amyloidosis presents with non-specific symptoms of weight loss, abdominal pain, diarrhea, and bleeding. Endoscopic findings vary from bulky mucosal lesions to friable, ulcerated mucosa. Endoscopy and histology are crucial in making the diagnosis. Our case highlights this rare, but important, etiology of GI bleeding, and showcases the interesting endoscopic findings seen. Case Description/Methods: 79-year-old male with a history of type-2 diabetes mellitus, chronic heart failure, hypothyroidism, and coronary artery disease presented with hematochezia. Other non-specific symptoms included lower abdominal pain, constipation, early satiety, dysphagia, 40-lbs weight loss, and weakness. History was negative for heavy alcohol use. Colonoscopy 13 years prior was normal. Physical exam showed an ill-appearing male with abdominal distension and generalized abdominal pain without rebound or guarding. Labs were notable for a WBC 16, chronic iron deficiency anemia (baseline hemoglobin 9), AST 54, ALT 24, ALP 369, and creatinine 1.7. CT scan demonstrated hepatosplenomegaly with ascites and diffuse colitis. Serum ascites albumin gradient was >1.1. Colonoscopy showed bulky clot-like masses protruding from the mucosa with patchy colitis throughout. Biopsies were positive for Congo Red stain, making the diagnosis of AL-kappa type amyloidosis. He was started on the appropriate therapy, but his clinical course deteriorated with eventual death from multi-organ failure. Discussion: Colonic involvement from amyloidosis is extremely uncommon. Within the GI tract, amyloid deposits in the muscularis mucosae leading to frailty of blood vessels, impaired peristalsis, and decreased gut wall compliance. Patients present with bleeding, malabsorption, dysmotility, and protein losing enteropathy resulting in ascites, edema, and pericardial effusion. Endoscopic findings are variable with more bulky mucosal deposition seen in AL-type compared to ulceration and friability seen in AA-type. Diagnosis is made by histology. Amyloidosis also may involve non-luminal organs of the GI tract, including the liver. Deposition within hepatic stellate cells promotes a fibrogenic state resulting in cirrhosis as seen in our patient. Early recognition of intestinal amyloidosis is important as it carries a poor prognosis. Multi-specialty approach is crucial for diagnosis and management.Figure 1.: A,B: Large intestine amyloid deposition noted on colonoscopy. You can see extension from mucosa in part A. C,D: Biopsy evaluation of mass on colonoscopy. D highlights positive Congo Red Staining leading to diagnosis of AL-Amyloidosis.

Ashwagandha-Induced Gastric Upset in Post-Covid Patient-A Case Report and Brief Review of the Literature

Adverse drug reporting of herbal drugs is less common as they are generally considered as safe. It is also very common to use self-medication by people in the case of herbal drugs. But many times, mild to severe events have been seen with the use of herbal or ayurvedic medicines. We have reported a case of post-covid patient, who was having complained of headache, body ache, lethargy, backache, generalized weakness and excessive sweating since one weak. Patient had past history of hospitalization due to COVID-19 moderate pneumonia one month back. Patient also had history of type-2 diabetes mellitus, hypertension and dyslipidemia and was taking anti-diabetic and anti-hypertensive medications continuously. Ashwagandha powder (Withania somnifera), Maha yogaraj guggulu (herbal anti-inflammatory) and Syrup Amynity Plus (herbal immune-booster) were prescribed for these complain. Conversely, moderate severity adverse reaction like nausea, vomiting, diarrhea, and abdominal cramps were noted after the intake of suspected drug i.e. ashwagandha powder. Nevertheless, symptoms were relieved after the de-challenge. This shows a temporal relation of the event with the suspected drug. One more possibility of drug-drug interaction in this case cannot be ruled out completely. Causality assessment was done for this adverse event and it was considered as the “probable” category of the adverse event in WHO causality classification.

Type 2 Diabetes Mellitus in Nepal from 2000 to 2020: A systematic review and meta-analysis

Aims: To evaluate the prevalence and risk factors of type 2 diabetes mellitus (T2DM) from 2000-2020 in various parts of Nepal. Methods: PubMed, Embase, Scopus, and Google Scholar were searched using the appropriate keywords. All Nepalese studies mentioning the prevalence of T2DM and/or details such as risk factors were included. Studies were screened using Covidence. Two reviewers independently selected studies based on the inclusion criteria. Meta-analysis was conducted using Comprehensive Meta-Analysis Software v.3. Results: A total of 15 studies met the inclusion criteria. The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal in the last two decades was 10% (CI, 7.1%- 13.9%), 19.4% (CI, 11.2%- 31.3%), and 11.0% (CI, 4.3%- 25.4%) respectively. The prevalence of T2DM in the year 2010-15 was 7.75% (CI, 3.67-15.61), and it increased to 11.24% between 2015-2020 (CI, 7.89-15.77). There were 2.19 times higher odds of having T2DM if the body mass index was ≥24.9 kg/m2. Analysis showed normal waist circumference, normal blood pressure, and no history of T2DM in a family has 64.1%, 62.1%, and 67.3% lower odds of having T2DM, respectively. Conclusion: The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal was estimated to be 10%, 19.4%, and 11% respectively.

Assessing the prevalence and predicting factors of an abnormal gated myocardial perfusion SPECT in asymptomatic patients with type 2 diabetes.

Considering the significant prevalence of silent myocardial ischemia and its related morbidity and mortality in asymptomatic type 2 diabetic patients, it is not well known whether early screening with MPI is cost-effective and predicting factors are not well elucidated. This was a cross-sectional study including 63 asymptomatic patients with type 2 diabetes mellitus (T2DM), with normal ECG and ejection fraction. Patients with any history of documented valvular, congestive or ischemic heart disease, renal or hepatic failure were excluded. At first all patients were interviewed and checked for risk factors and then patients underwent a two-day rest/stress 99mTc-MIBI gated MPI SPECT. Data was assessed by QPS/QGS and 4DM software and evaluated by a nuclear medicine specialist with summed stress score (SSS) of more than 4 defined as CAD. There were 42 females (67%) and 21 males (33%), with a mean age of 61.33 ± 6.98years and 7.97 ± 4.86years history of T2DM. CAD was detected in 26 (41.3%) patients and was significantly associated with male gender, smoking and requiring insulin therapy (P-value = 0.019, 0.046, 0.05, respectively). A significant association was found between the duration of diabetes, especially when > 15years, and the probability of having CAD. Multivariable logistic regression revealed that smoking; male gender and diabetes duration were the strongest independent predictors of abnormal MPI results. We found a high (46%) prevalence of abnormal stress MPI SPECT in patients with type 2 diabetes mellitus, despite being asymptomatic. Asymptomatic patients with a history of smoking, long duration of diabetes, being under insulin treatment and male gender might benefit from MPI for early detection of silent ischemia.

ASSOCIATION BETWEEN KNOWLEDGE, ATTITUDE, AND PRACTICE ABOUT DIETARY FIBRE INTAKE AND TYPE 2 DIABETES AMONG RURAL PEOPLE IN TERENGGANU, MALAYSIA

Awareness of the dietary fibre intake (DF) and its importance in prevention and management of type 2 diabetes mellitus (T2DM) among rural people is seldom reported in Malaysia. This study aimed to determine the knowledge, attitude, and practice (KAP) of DF intake and their association with type 2 diabetes mellitus (T2DM) among rural people in Terengganu, Malaysia. A community-based cross-sectional study was carried out among the households in Kampung Jati, Kuala Nerus, Terengganu, Malaysia from 29th December 2019 until 20th February 2020. The village has 524 houses, the data was collected from all available and eligible subjects in each household by completed socio-demographic, validated KAP on DF intake questionnaire, as well as a 24-hour dietary recall using a self-administered questionnaire. In our study of 396 respondents, 208 (52.5%) were men. The mean age of participants was 37.85 (15.13). Most of the subjects were Malay 384 (97.0%), employed 207 (52.3%) and 274 (69.2%) attained high level of education (from tertiary school level). However, only 170 (42.9%) had a high family income which was of >RM 3860 per month. Out of 396 respondents, 157 (39.6%) of them had family history of diabetes mellitus. Respondents had moderate knowledge (39.1%), positive attitude (88.1%) and good practice (59.3%) scores towards DF intake. Among the respondents, only 39.1% of total respondents knew the nationally recommended amount of daily fibre intake which is of 20-30 grams per day. With multivariable analysis using multiple logistic regression, the analysis results revealed that age (adjusted OR: 1.11, 95% CI: 1.08, 1.15; p <0.001), having family history of T2DM (adjusted OR: 6.81, 95% CI: 2.75, 16.84; p <0.001) and having total attitude scores (adjusted OR: 0.84, 95% CI: 0.76, 0.93; p <0.001) were found to be adjusted significant associated factors of T2DM among the respondents after controlling confounders. Public health authorities should raise awareness on health benefit of consuming dietary fibre to promote an increase in consumption which can help in prevention and management of chronic diseases among rural population of Malaysia.

High early pregnancy serum 25-hydroxy vitamin D level, within a sub-optimal range, is associated with gestational diabetes mellitus: a prospective cohort study.

BACKGROUND/OBJECTIVESLow early pregnancy serum 25-hydroxy vitamin D (25[OH]D) levels can increase gestational diabetes mellitus (GDM) risk, although inconsistent findings related to that association have been reported. This study examined the association of serum vitamin D with GDM and the possible influencers on this association.SUBJECTS/METHODSThis study included 259 pregnant women within the Seremban Cohort Study (SECOST). Blood samples at < 14 weeks of gestation were drawn to determine serum 25(OH)D levels. GDM diagnosis was made at 24 to 32 weeks of gestation using a standard procedure. Association between serum vitamin D and GDM was tested using binary logistic regression.RESULTSNearly all women (90%) had mild (68.3%) or severe (32.2%) vitamin D deficiency (VDD). Non-GDM women with mild VDD had a significantly higher mean vitamin D intake than GDM women with mild VDD (t = 2.04, p < 0.05). Women with higher early pregnancy serum vitamin D levels had a greater risk of GDM. However, this significant association was only identified among those with a family history of type 2 diabetes mellitus (T2DM) and in women with a body mass index indicating overweight or obese status.CONCLUSIONSThe high prevalence of VDD in this sample of pregnant women underscores the need for effective preventive public health strategies. Further investigation of this unexpected association between serum vitamin D level and GDM risk in predominantly VDD pregnant women and the potential effects of adiposity and family history of T2DM on that association is warranted.

Clinical and thoracic radiography features determine patient outcome in young and middle age adults with COVID-19

Background: The new coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019. Researchers described COVID-19 mortality risk factors as being elderly, male, having comorbidities, and in some ethnicities. Some authors validated the use of first chest x-ray (CXR) severity scores (CSE) as an independent indicator of poor outcomes with COVID-19. Our objective was to evaluate the clinical and CXR findings as predictors of poor outcomes (death, needing intubation, Intensive Care Unit (ICU) admission) in patients with COVID-19. Methods: We performed a retrospective study of case-controls using a sample size of 60 patients admitted with the diagnosis of COVID-19 during the period of July-August 2020 to the Cuban Hospital in Qatar, as determined with the free online OpenEpi software (https://www.openepi.com/SampleSize/SSCC.htm). We defined cases as patients with a complication like death, needing intubation, ICU admission, or organ failure, and controls as patients who did not demonstrate the described complications. The dependent variables used were patient evolution divided into poor outcome or good outcome. The independent variables used were age, history of diabetes mellitus type II, and high blood pressure (HBP), CSE, and white blood count (WBC). The bivariate analysis was performed using the Chi-Square test or Fisher exact test. Multivariate analysis was done using binary logistic regression (IBM SPSS software 25). The results are expressed in Odds Ratio with p-value &lt; 0.05 defined as statistically significant. Results: The bivariate analysis showed being older, having a history of HBP, diabetes, abnormal WBC, and high CSE were linked to poor outcome (p &lt; 0.05) . The multivariate analysis defined WBC and CSE with independent influence over the patient evolution . Conclusion: We demonstrated that the value of WBC and CSE are predictors of poor outcome in patients with COVID-19. WBC increases the possibility of the described complications in COVID-19 patients 68,634 times and CSE 12,201 times.

Nomogram Model for Screening the Risk of Type II Diabetes in Western Xinjiang, China.

ObjectiveA simple type 2 diabetes mellitus (T2DM) screening model was established preciously based on easily available variables for identifying high-risk individuals in western Xinjiang, China.MethodsA total of 458,153 cases participating in the national health examination were recruited. Logistic regression and the least absolute shrinkage and selection operator (LASSO) models were used for univariate analysis, factors selection, and the establishment of prediction model. Receiver operating characteristic (ROC) curve, Hosmer–Lemeshow test and clinical decision curve (CDA) were applied for evaluating the discrimination, calibration and clinical validity, respectively. The optimal threshold for predicting risk factors for T2DM has been estimated as well.ResultsThe nomogram depicted the risk of T2DM based on different genders, the factors mainly consisted of age, family history of T2DM (FHOT), waist circumference (WC), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDLc), body mass index (BMI), high-density lipoprotein cholesterol (HDLc), etc. The area under ROC of men and women was 0.864 and 0.816 in the development group, similarly in the validation group, which was 0.865 and 0.815, respectively. The calibration curve showed that the nomogram was accurate for predicting the risk of T2DM, and the CDA proved great clinical application value of the nomogram. Threshold values of the age, WC, TC, TG, HDLc, BMI in different genders were 52.5 years old (men) and 48.5 years old (women), 85.50 cm (men) and 89.9 cm (women), 4.94 mmol/L (men) and 4.94mmol/L (women), 1.26mmol/L (men) and 1.67mmol/L (women), 1.40mmol/L (men) and 1.40mmol/L (women), 24.70kg/m2 (men) and 24.95kg/m2 (women), respectively.ConclusionOur results give a clue that the nomogram may be useful for identifying adults who have high risk for diabetes, which is simple, affordable, with high credibility and can be widely implemented. Further studies are needed to evaluate the utility and feasibility of this model in various settings.

Epicapsular stars

A 50-year old female presented with decreased vision. She had a past medical history of Diabetes Mellitus type 2 treated with subcutaneous insulin and Metformin, her past ocular and family history was non-contributory. On initial ophthalmologic examination her best corrected visual acuity was 20/20 OD, and 20/25 OS. Gonioscopy and intraocular pressure (IOP) were within normal limits. She presented small pigmented opacities, shaped as stars in the center of her anterior capsule. (Figures 1 and 2.) Fundus examination revealed a healthy macula and retina.

Heritability Estimation and Environmental Risk Assessment for Type 2 Diabetes Mellitus in a Rural Region in Henan, China: Family-Based and Case-Control Studies.

Objective: The prevalence of type 2 diabetes mellitus (T2DM) varies greatly in different regions and populations. This study aims to assess the heritability and environmental risk factors of T2DM among rural Chinese adults.Methods: Thousand five hundred thirty three participants from 499 extended families, which included 24 nuclear families, were recruited in the family-based study to assess the heritable risk of T2DM. Heritability of T2DM was estimated by the Falconer method. Using conditional logistic regression model, couple case-control study involving 127 couples were applied to assess the environmental risk factors of T2DM.Results: Compared with the Henan Rural Cohort, T2DM was significantly clustered in the nuclear families (OR: 8.389, 95% CI: 5.537–12.711, P < 0.001) and heritability was 0.74. No association between the heredity of T2DM and sex was observed between the extended families and the Henan Rural Cohort. Besides, results from the couple case-control study showed that physical activity (OR: 0.482, 95% CI: 0.261–0.893, P = 0.020) and fat intake (OR: 3.036, 95% CI: 1.070–8.610, P = 0.037) was associated with T2DM, and the proportion of offspring engaged in medium and high physical activity was higher than that of mothers in mother-offspring pairs.Conclusion: People with a family history of T2DM may have a higher risk of developing T2DM, however, there was no difference in genetic risk between males and females. Adherence to active physical activity and low fat intake can reduce the risk of T2DM.

Type 2DiabetesMellitus inNepalfrom 2000 to 2020: A systematic review and meta-analysis.

Aims:To evaluate the prevalence and risk factors oftype 2diabetes mellitus (T2DM)from 2000-2020invarious parts ofNepal. Methods:PubMed, Embase, Scopus, and Google Scholar were searched using the appropriate keywords. All Nepalese studies mentioning the prevalence ofT2DMand/or details such asrisk factors were included. Studies were screened using Covidence. Two reviewers independently selected studies based on the inclusion criteria. Meta-analysis was conducted usingComprehensive Meta-AnalysisSoftwarev.3. Results:Total 15 studies met the inclusion criteria. The prevalence ofT2DM, pre-diabetes, and impaired glucose tolerance in Nepal in the last two decades was 10% (CI, 7.1%- 13.9%), 19.4% (CI, 11.2%- 31.3%), and 11.0% (CI, 4.3%- 25.4%) respectively. The prevalence ofT2DM in the year 2010-15 was 7.75% (CI, 3.67-15.61), and it increased to 11.24%between 2015-2020(CI, 7.89-15.77). There were 2.19 times higher odds of havingT2DMif the body mass index was ≥24.9 kg/m 2. Analysis showed normal waist circumference, normal blood pressure, and no history ofT2DM inafamilyhas64.1%, 62.1%, and 67.3%lower odds ofhaving T2DM,respectively. Conclusion:The prevalence ofT2DM, pre-diabetes, and impaired glucose tolerance in Nepal was estimated to be 10%, 19.4%, and 11% respectively.

Role of FOXP3 gene polymorphisms (SNPs rs3761547, rs3761549, and rs2232365) in the development of Type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a multifactorial disease induced by an intricated interaction of several genetic variants and multiples environmental factors. A total of 281 patients diagnosed with T2DM and 281 non-diabetic control were enrolled in this study. Three SNPs (rs3761547, rs3761549, and rs2232365) in the FOXP3 gene were selected to study their role in the development of T2DM and T2DM-associated hypertension in an Iraqi population. The DNA extraction and genotyping were performed using allele-specific PCR. Our results showed that 212 patients were positive for a family history of T2DM, and 69 patients were negative (P < 0.001). The distribution of the rs3761547 genotypes among the diabetic patients with a positive family history was statistically significant (P < 0.001). Moreover, 205 patients were positive for hypertension, and 76 patients were negative (P < 0.001). The distribution of the rs3761547 genotypes among the diabetic patients with hypertension was statistically significant (P < 0.001). Furthermore, there was a statistical association for the rs3761549 genotype distribution among the diabetic patients without hypertension (P = 0.038). The correlation of the rs3761547 genotypes between the patients and controls was strongly significant for AA, GG, and AG (P < 0.001, P < 0.001, and P < 0.001, respectively). In contrast, there was no statistical significance for the rs3761549 genotypes (CC, TT, and CT; P = 0.362, P = 0.584, and P = 0.140, respectively). The rs2232365 (GG) genotype revealed a significant relationship (P < 0.001), while no statistical significance was displayed for the AA genotype (P = 0.130) and the AG genotype (P = 0.081). We concluded the FOXP3 gene polymorphisms rs3761547 and rs2232365 are linked with T2DM, while rs3761549 is not.

Type 2 diabetes mellitus duration and obesity alter the efficacy of autologously transplanted bone marrow-derived mesenchymal stem/stromal cells.

Human bone marrow‐derived mesenchymal stem/stromal cells (BM‐MSCs) represent promising stem cell therapy for the treatment of type 2 diabetes mellitus (T2DM), but the results of autologous BM‐MSC administration in T2DM patients are contradictory. The purpose of this study was to test the hypothesis that autologous BM‐MSC administration in T2DM patient is safe and that the efficacy of the treatment is dependant on the quality of the autologous BM‐MSC population and administration routes. T2DM patients were enrolled, randomly assigned (1:1) by a computer‐based system into the intravenous and dorsal pancreatic arterial groups. The safety was assessed in all the treated patients, and the efficacy was evaluated based on the absolute changes in the hemoglobin A1c, fasting blood glucose, and C‐peptide levels throughout the 12‐month follow‐up. Our data indicated that autologous BM‐MSC administration was well tolerated in 30 T2DM patients. Short‐term therapeutic effects were observed in patients with T2DM duration of <10 years and a body mass index <23, which is in line with the phenotypic analysis of the autologous BM‐MSC population. T2DM duration directly altered the proliferation rate of BM‐MSCs, abrogated the glycolysis and mitochondria respiration of BM‐MSCs, and induced the accumulation of mitochondria DNA mutation. Our data suggest that autologous administration of BM‐MSCs in the treatment of T2DM should be performed in patients with T2DM duration <10 years and no obesity. Prior to further confirming the effects of T2DM on BM‐MSC biology, future work with a larger cohort focusing on patients with different T2DM history is needed to understand the mechanism underlying our observation.

169-LB: Type 1 Diabetes Mellitus and Stiff-Person Syndrome

Introduction: Type 1 diabetes mellitus (T1DM) is often associated with other autoimmune diseases. One of them is Stiff-Person Syndrome (SPS), a rare neurological disorder characterized by muscle spasms and progressive muscle stiffness, which most often affects females. Glutamic acid decarboxylase antibodies (anti-GAD) are associated with the pathogenesis of this disease as well as T1DM. These antibodies cause a deficit in the synthesis of γ-aminobutyric acid (GABA) that is essential both in the function as neurotransmitter and in the secretion of insulin in pancreatic β cells. Clinical case: We present the case of a 32-year-old female patient diagnosed with T1DM at 18 years old. Currently under intensive functional insulin therapy and flash glucose monitoring (FGM). Since 2019 with subcutaneous insulin infusion system. At the age of 26, the patient reports dystonia in the left lower limb with subsequent involvement of the contralateral lower limb, upper limbs, trunk and face. Collaboration was made with the Neurology department. Among the laboratory findings, of note: positive serum anti-GAD65 (5437 U/mL; &amp;lt;1) and positive cerebrospinal fluid anti-GAD65 (126.23 U /mL; &amp;lt;1). The diagnosis of SPS was made. The patient started human immunoglobulin therapy with progressive clinical improvement. Estimated HbA1c from FGM was 6,8 % at February, 2021. Discussion: The association between T1DM and SPS is frequent. In this case, a patient with a known history of T1DM was presented, but cases of diagnosis of T1DM in patients with SPS have also been described. About 43% of patients have T1DM at the time of diagnosis of SPS. Anti-GAD are involved in the pathophysiology of these two diseases and anti-GAD titers are much higher in cases of association with SPS (about 50 to 100 times). In the treatment of patients with T1DM, physicians should be alert to the onset of other autoimmune diseases and active surveillance is essential for early diagnosis. Disclosure C. A. Araújo: None. C. Baptista: None. I. Paiva: None. A. Morgadinho: None.

Efficacy of a Combination of Metformin and Vildagliptin in Comparison to Metformin Alone in Type 2 Diabetes Mellitus: A Multicentre, Retrospective, Real-World Evidence Study.

BackgroundEarly use of combination therapy in diabetes patients may lead to sustained glycemic control and thereby reduce the progression of diabetic complications. Given the limitation of the traditional stepwise intensification strategy, early combination therapy can be an effective approach. Therefore, this study aims to assess the real-world efficacy of a combination of metformin and vildagliptin in comparison to metformin alone in type 2 diabetes mellitus (T2DM) patients in India.MethodsThis was an observational, retrospective, non-interventional study based on electronic medical records (EMRs) of 2740 T2DM patients, retrieved from 2010 onwards from 22 diabetes centres across India. Adult drug naïve patients with a 5-year history of T2DM treated with either metformin or a combination of metformin and vildagliptin for at least 3 months were considered for this study. Efficacy assessment was done to evaluate the post-treatment HbA1c levels and patients requiring additional oral antidiabetic drugs (OADs) at the time of follow-up visit. Patients were also analyzed for the occurrence of adverse events.ResultsOut of the total, 2452 patients were in metformin only arm, and 288 patients were in metformin plus vildagliptin treatment arm. A more significant reduction in HbA1c level was observed in metformin plus vildagliptin arm than metformin only arm (median: −0.5% vs 0%, respectively; p<0.001). Patients requiring additional OAD at follow-up were significantly lesser in the metformin plus vildagliptin arm than the metformin only arm (15.6% vs 35.2%, respectively; p<0.001). The adverse events were comparable across the two arms, and commonly reported adverse events were giddiness, fatigue and gastric discomfort.ConclusionThe findings of this EMR-based real-world study emphasizes the need for early initiation of combination therapy (metformin plus vildagliptin) over metformin monotherapy for achieving better glycemic control.