History Of Diabetes Mellitus Type Research Articles

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 >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 < 250 mg/dl. Urinalysis showed > 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.

Gestational Diabetes Mellitus in a Multi-Ethnic, High-Risk Population: Adequacy of Screening for Diabetes Mellitus 6 Weeks after Delivery.

Gestational diabetes mellitus (GDM) during pregnancy is a marker for future type 2 diabetes mellitus (T2DM); therefore, a meticulous follow-up after delivery can help identify women at risk for T2DM. In a cohort of 5504 pregnant women, the postpartum follow-up of all 1043 women with GDM for hyperglycemia in a multi-ethnic, high-risk Arab population was investigated. The prevalence of GDM was 18.9%. A total of 265 (25.4%) women returned for an oral glucose tolerance test (OGTT) 4-6 weeks after delivery, with more South Asian than Arab women (p < 0.01). The other factors associated with return were (a) family history of T2DM, (b) lower basic metabolic index, (c) higher abortions and (d) lower gravida (p < 0.05), all with minimal effect. An abnormal postpartum OGTT was statistically associated with previous GDM history and hypoglycemic drug treatment, although these effects were small. Overall, the follow-up of women with GDM postpartum was dismal, ethnicity being the major factor influencing return. Urgent public measures are needed to educate women with GDM about follow-up highlighting (a) risk awareness for T2DM and (b) a healthy lifestyle after childbirth-if we are to turn the tide on the epidemic of T2DM plaguing the Arab world.

CARDIOGENIC SHOCK AND CRITICAL ILLNESS-RELATED CORTICOSTEROID INSUFFICIENCY: DID STEROIDS MAKE MY HEART GO ON?

CARDIOGENIC SHOCK AND CRITICAL ILLNESS-RELATED CORTICOSTEROID INSUFFICIENCY: DID STEROIDS MAKE MY HEART GO ON?

S3174 Statin-Induced Liver Injury With Short Latency to Onset

Introduction: Statins can cause an increase in liver enzymes, but these elevations resolve spontaneously in 70% of patients despite continued therapy. It is rare for it to cause significant, clinically apparent liver injury. The latency to the onset of liver injury had a median of 155 days, with most cases occurring around 3-4 months after initiation of statin. We describe a patient with statin-induced symptomatic liver injury within one month of statin initiation. Case Description/Methods: A middle-aged woman with past medical history of diabetes mellitus type 2, hypertension, hyperlipidemia, and recent ST-elevation myocardial infarction (STEMI) presented with nausea, vomiting, pruritus, painless jaundice and loss of appetite for over one week. One month prior to her onset of symptoms, she was started on atorvastatin after her STEMI. Her baseline liver biochemistries were normal. Her initial labs on presentation were alkaline phosphatase 2,170, AST 456, ALT 502 and direct bilirubin 10.7, showing a predominantly cholestatic pattern but also with some hepatocellular injury. Atorvastatin was stopped on admission. CT imaging and ultrasound showed liver steatosis and cholelithiasis. No biliary dilatation was seen on MRCP. Other workup was negative, including viral markers and autoimmune studies. Liver biopsy showed sinusoidal dilation/congestion and lymphocytic predominant portal inflammation with eosinophils and plasma cells suggestive of drug-induced liver injury (DILI). She was started on N-acetylcysteine and ursodiol. Her hepatic function initially continued to worsen as noted by high total bilirubin and rising INR, with mildly worsening mental status. She also had acute kidney injury requiring initiation of hemodialysis. Decision was made for expedited liver transplant evaluation. While waiting for the evaluation, she showed gradual improvement in her liver biochemistries and symptoms. Discussion: This case describes a patient who developed statin-induced liver injury within one month of atorvastatin initiation. Although statins can develop mild liver-enzyme elevations, it is rare for it to cause such clinically apparent DILI. Given the widespread use of statins, this case highlights the importance for physicians to closely monitor liver enzymes in patients after initiation of statins.

S3368 Bleeding From a Rare Omental Gastrointestinal Stromal Tumor Found on Capsule Endoscopy

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors involving the gastrointestinal tract compromising approximately 1 -2 % of gastrointestinal cancers. They can arise from the bowel wall as a subepithelial neoplasm in the stomach and small intestine, and less than 5% of them arise as extragastrointestinal tumors in the retroperitoneum, mesentery and omentum. They occur in older adults aged 65 to 69 years old, and vary in their presentation depending on their location. We present a unusual case of small bowel gastrointestinal bleeding from a GIST adherent to the omentum. Case Description/Methods: 58 year old male with a history of diabetes mellitus type II, hypertension, recent prolonged hospitalization for disseminated nocardia infection on long term antibiotics and a Decadron taper presented with several days of epigastric pain, nausea and non-bloody diarrhea. He denied any signs of gastrointestinal bleeding such as melena or hematochezia. His labs were notable for a hemoglobin of 4.2 g/dL with a mean corpuscular volume of 78.5 fL that was previously noted to be within normal limits. Computed tomography of the abdomen and pelvis with contrast showed a 4 cm circumscribed, hyperdense enhancing exophytic solid mass arising from the small bowel in the left lower quadrant with adjacent hyperenhancement. The patient subsequently underwent capsule endoscopy which showed fresh blood in the mid jejunum with more active bleeding surrounding a possible small bowel tumor. Due to ongoing bleeding and anemia, the patient underwent laparoscopic small bowel resection and lymphadenectomy of a small bowel tumor adherent to the omentum with about 10 cm of proximal and distal margins. Pathology was consistent with a low-grade gastrointestinal stromal tumor approximately 3.0 x 3.0 x 2.3 cms with tumor free margins and no evidence of lymphovascular spread. Thereafter, the patient remained hemodynamically stable with improvement of his blood counts and was discharged home. (Figure) Discussion: While GISTS are common findings in the gastrointestinal tract, only a small percentage of them can cause gastrointestinal bleeding needing surgical intervention. Surgical resection remains the mainstay of treatment for localized, non-metastatic GISTs that present with bleeding as it can both stop the bleeding and resect the lesion. However, other modalities of treatment include endoscopic intervention depending on the location or transcatheter arterial embolization.Figure 1.: Top: CT Abdomen and Pelvis with contrast demonstrating a 4 cm circumscribed hyperdense enhancing exophytic solid mass arising from the small bowel in the left lower quadrant. Bottom: Capsule endoscopy showing a small bowel tumor.

S3195 The Liver and Cryoglobulinemia: A Relationship Beyond Hepatitis C

Introduction: Cryoglobulinemia is a small and medium vessel vasculitis with varied clinical manifestations. The most common etiology is hepatitis C virus. Other hepatotropic viruses, including hepatitis A, have been rarely associated with very few cases reported. Here we present a unique case of cryoglobulinemia associated with hepatitis A. Case Description/Methods: A 58-year-old female presented to the Emergency Department (ED) with bloating, abdominal pain, and fullness for about a week. She has a past medical history of diabetes mellitus type II, hypothyroidism, and hypertension. She was afebrile and hemodynamically stable in the ED with Initial lab workup showing AST/ALT of 5228/4792, total bilirubin of 7.9 with a direct bilirubin of 6.1. Further workup showed positivity for hepatitis A, including IgM and positive type II cryoglobulins. The rest of the autoimmune workup was negative for rheumatoid factor, ANA, SS/Ro, SS/La, anti-smooth muscle antibody, and anti-mitochondrial antibody. She also had acute renal failure requiring hemodialysis. Management included supportive therapy with significant improvement in her symptoms. Discussion: Cryoglobulinemia is a condition where abnormal immunoglobulins precipitate in serum at temperatures below 37C. They can deposit in blood vessels and cause obstruction or vasculitis, with involvement of various organs. Type I cryoglobulinemia is usually associated with hematologic malignancies whereas mixed cryoglobulinemia (type II, III) is associated with hepatitis C and rarely seen with hepatitis A. Very few cases showing an interrelation between hepatitis A and cryoglobulinemia have been reported in the literature making this a rare association. Hence, more studies need to be done to investigate extrahepatic features of hepatitis A.

Association of Circulatory Adiponectin with the Parameters of Madras Diabetes Research Foundation-Indian Diabetes Risk Score

Introduction: Adiponectin (APN) is an adipose-derived protein. It has shown a variety of functions such as anti-inflammatory, anti-atherogenic, antidiabetic, and insulin-sensitizing and lipid-oxidation-enhancing activities. The APN levels have shown a significant relationship with the risk factors for type 2 diabetes mellitus (T2DM). As per the Madras Diabetes Research Foundation-Indian Diabetes Risk Score (MDRF-IDRS), Asian Indians have high risk factors for T2DM and its complications. APN levels influence the risk factors for T2DM and its complications. Its circulatory level also varied with the age, family history of T2DM, waist circumference, and level of physical activity. Aim: The purpose of this narrative review is to find the association of circulatory APN with the parameters of MDRS-IDRS. Materials and Methods: Articles were searched by various databases such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar. Abstract, free full-text, and full-text articles were searched from the year 2003 to 2022. For this review, observational study, original articles, narrative review, systematic review, and meta-analysis articles published in the English language were included. It is needed to establish the association between the APN levels and the parameters of MDRF-IDRS. The modifiable risk factors of MDRF-IDRS may play a significant role to regulate the level of APN. The non-modifiable risk factors of MDRF-IDRS may help in the better management of APN levels and reduce the prevalence of T2DM. It is needed to clear that the APN levels influence the disease severities or not. It is also needed to improve the physical activity to regulate the APN level and to reduce the systemic inflammation and insulin resistance in Asian Indian population. Conclusion: Improvement in modifiable risk factors of MDRF-IDRS and level of APN may play a significant role in the therapeutic approach to prevent and/or delay the development of T2DM and its complications.

Association of Inflammatory and Metabolic Biomarkers with Mitral Annular Calcification in Type 2 Diabetes Patients.

(1) Background: Type 2 diabetes mellitus (T2DM) contributes to cardiovascular disease and related mortality through the insidious effects of insulin resistance and chronic inflammation. Mitral annular calcification (MAC) is one such degenerative process promoted by T2DM. (2) Methods: This is a post hoc analysis of insulin resistance, inflammation, and hepatic steatosis markers in T2DM patients without atherosclerotic manifestations, but with incidental echocardiographic detection of mild MAC. (3) Results: 138 consenting patients were 49.3% men, 57.86 years old, with a history of T2DM of 6.16 years and HbA1c 8.06%, of whom sixty had mild MAC (43.47%). The statistically significant differences between patients with/without MAC were higher HOMA C-peptide and C-peptide index for insulin resistance, higher TNF-α for inflammation, and lower estimated glomerular filtration rate. High-sensitive C-reactive protein (hsCRP) was significantly associated with insulin resistance and the strength of the relationship was higher in the MAC group. Predictive of MAC were TNF-α, HOMA C-peptide, and especially hepatic steatosis and hypertension. (4) Conclusions: MAC was more prevalent than reported in the literature. Insulin resistance and inflammation were predictive of MAC, but significant markers differ across studies. Widely available routine tests and echocardiographic assessments are useful in the early identification of mitral annular calcifications in diabetes patients.

Assessment of Bone Mineral Density in Type 2 Diabetes: A Cone Beam Computed Tomography (CBCT) Study.

IntroductionThe main purpose of the study was to assess and compare bone mineral density (BMD) at prospective implant sites in the mandible in type 2 diabetes mellitus (T2DM) and non-diabetic patients using cone beam computed tomography (CBCT).Material and methodologyA total of 40 patients were included in this type of cross-sectional study. They were divided into two groups, A and B, according to their haemoglobin A1c values. Group A consisted of patients with HbA1c between the range of 6.1%-8% and group B had patients with no history of T2DM. CBCT scans were made of the mandibular arches of both the patients to evaluate the BMD at lingual and buccal cortical plates and the trabecular regions in two successive slices with the assistance of PlanMeca Romexis software (PlanMeca Romexis®, Helsinki, Finland). The Shapiro-Wilk test was used to determine the normality of continuous data. The Mann-Whitney U test was used to compare the groups.ResultsThere were no differences that were statistically significant between the two cohorts according to the Mann-Whitney U test at buccal cortical plate points 1 and 2. However, the diabetes group's mean bone density at implant sites-A, B, C, D, and E at trabeculae points 1 and 2 was considerably (7p>0.001) lower than the non-diabetic groups. The mean bone density of the diabetes group was marginally but significantly (p=0.009) lower than the non-diabetic group at lingual cortical plates.ConclusionIndividuals with type 2 diabetes mellitus show significantly lower bone mineral density in the lingual cortical plate and trabecular region, however, implant therapy can be performed with certain mentioned guidelines in such regions. In the buccal cortical region, the bone mineral density is seen to be unaffected.

Effect of Dapagliflozin on the Outcome of Radiofrequency Catheter Ablation in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation.

Dapagliflozin, one of the sodium-glucose cotransporter-2 inhibitors, has been widely used for the treatment of type 2 diabetes mellitus (T2DM) and heart failure. In this study, we sought to determine the impact of dapagliflozin on the outcome of radiofrequency catheter ablation (RFCA) for patients with T2DM and atrial fibrillation (AF). This retrospective study included patients who underwent AF ablation between January 2019 to February 2021 at the First Affiliated Hospital of Zhengzhou University. All patients had a history of T2DM and were divided into the dapagliflozin group (n = 79) and the control group (n = 247) according to whether the patients were treated with dapagliflozin after ablation. The definition of AF recurrence was documented atrial arrhythmias over 30 s after a 1-month blanking period. Cox regression models were used to analyze the risk of AF recurrence. Overall, 326 patients were analyzed (mean age, 63.7±10.0 years old; male, 58.9%; paroxysmal AF, 52.8%; recurrence rate, 40.8%). We found that hemoglobin A1c before ablation was higher in the dapagliflozin group than in the control group (7.7±1.4 vs. 7.3±1.2, P = 0.007). After a mean follow-up of 15.5±8.9 months, the dapagliflozin group had a lower recurrence rate than the control group (27.8% vs. 44.9%, P = 0.007). Treatment with dapagliflozin (HR 0.614, ±95%CI 0.387-0.974, P = 0.038) was associated with a lower risk of recurrence of atrial arrhythmias (ATa) after ablation in multivariable Cox regression models that adjusted for duration of AF, BMI, AF type, left atrial diameter (LAD), and eGFR. The Cox regression model that incorporated hemoglobin A1c and other antidiabetic agents also demonstrated a similar reduction in the risk of recurrent atrial arrhythmias with dapagliflozin treatment (HR 0.611, ±95% CI 0.379-0.985, P = 0.043). In patients with T2DM, treatment with dapagliflozin appears to be independently associated with a significant reduction in the risk of recurrent atrial arrhythmias after RFCA.

The correlation between transcription factor 7-like 2 gene polymorphisms and susceptibility of gestational diabetes mellitus in the population of central China: A case-control study.

ObjectiveTo investigate the correlation between transcription factor 7-like 2 (TCF7L2) gene polymorphisms and gestational diabetes mellitus (GDM) risk in the central Chinese population.MethodsThis case–control study examined the association of seven TCF7L2 gene single-nucleotide polymorphisms (SNPs) (rs11196218, rs4506565, rs7895340, rs7901695, rs11196205, rs12243326, and rs290487) with GDM risk in the central Chinese population (843 GDM and 877 controls). The clinical information and blood samples were collected by trained interviewers and nurses. Genotyping of SNPs was conducted on the Sequenom MassARRAY platform. Statistical analyses including t-test, ANOVA, chi-square test, Fisher’s exact test, and logistic regression were performed.ResultsDifferences in age, pre-pregnant body mass index (BMI), and family history of type 2 diabetes mellitus (T2DM) between the case and control groups were significant (p < 0.05). Compared with the wild-type genotype, pregnant women with genotypes of rs4506565-AT (OR = 1.89, 95%CI: 1.18–3.02), rs7895340 GA (OR = 1.93, 95%CI: 1.06–3.54), rs7901695-TC (OR = 1.79, 95%CI: 1.11–2.88), and rs11196205-GC (OR = 2.15, 95%CI: 1.16–3.98) had a significantly higher risk of GDM, adjusted by age, pre-pregnant BMI, and family history of T2DM. Functional annotation showed that all these four SNPs fell in the functional elements of human pancreatic islets. Further cumulative effects analysis concluded that when participants carried all these four risk genotypes, the risk of GDM was 3.51 times (OR = 3.51, 95%CI: 1.38–8.90) than that of those without any risk genotypes.ConclusionsThe findings of this study suggested that rs4506565, rs7895340, rs7901695, and rs11196205 were the genetic susceptibility SNPs of GDM in the central Chinese population. Further studies are needed to validate our findings and clarify the underlying mechanisms.

A study of Heart Rate Variability (HRV) in healthy offsprings with parental history of type 2 diabetes mellitus

Introduction: Type 2 diabetes mellitus (T2DM) is a heterogeneous polygenic metabolic disease condition that is caused by insulin resistance leading to hyperglycemia. Since, T2DM is genetically inherited and autonomic dysfunction is its major complications, healthy offsprings of diabetic parents are highly vulnerable to manifest dysautonomia leading to insulin resistance.&#x0D; Objectives: We aimed to assess cardiac autonomic function using heart rate variability (HRV) parameters in healthy offsprings having parental history of T2DM.&#x0D; Methodology: A comparative cross-sectional study was carried out in the laboratory of department of Physiology enrolling 30 healthy offsprings of non-diabetic parents (Group 1) and 30 healthy offsprings of diabetic parents (Group 2). Anthropometric, biochemical and cardiovascular variables were assessed using standard procedures. Time domain and frequency domain parameters of HRV spectrum were assessed using photoplethysmography principle.&#x0D; Results: HRV findings revealed that markers of sympathetic regulation were significantly higher and those of parasympathetic function were significantly reduced in subject group having parental history of T2DM. LF/HF ratio was significantly increased suggesting sympatho-vagal imbalance in offspring of diabetic parents even in their euglycemic state.&#x0D; Conclusion: Alteration of cardiovascular autonomic function is found in healthy offspring of diabetic parents, characterized by reduced vagal activity and pronounced sympathetic regulation. Assessment of cardiac autonomic function would help in timely detection of such dysautonomia and reducing the life-threatening effects on offspring having parental history of T2DM.

Association Between Some Different Obesity Anthropometric Indices and Type 2 Diabetes Mellitus in Middle-Aged and Elderly Chinese Men and Women in Beijing, China: A Cross-Sectional Study.

BackgroundObesity can lead to the development of type 2 diabetes mellitus (T2DM). However, the predictive power of different obesity anthropometric indices (ObAIs) for T2DM varies with race and geographical area. Therefore, the study aimed to investigate the association between different ObAIs and T2DM and determine the best index for screening T2DM in middle-aged and elderly men and women in Beijing, China.MethodsA cross-sectional study was conducted in Shijingshan district (Beijing, China) from November 2011 to August 2012, involving a total of 14,558 subjects aged ≥40 years. Data on demographic information, lifestyle, history of T2DM, hypertension and dyslipidemia were collected. Body height, body weight, waist circumference (WC), hip circumference, and blood pressure were recorded. The oral glucose tolerance test or a standard meal test and blood lipid test were performed. The relationship between different ObAIs and T2DM was analyzed using multiple logistic regression.ResultsAfter adjustment for age, smoking status, alcohol intake, occupation and education degree, diabetes family history, hypertension and dyslipidemia, body mass index (BMI), WC, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were positively associated with T2DM in both men and women. Compared with the lowest BMI, WC, WHR, and WHtR quartiles, ORs of the highest quartiles were 2.131 (95% CI: 1.465–3.099), 1.752 (95% CI: 1.270–2.417), 1.342 (95% CI: 1.072–1.678), 2.739 (95% CI: 2.293–3.271) in men and 1.837 (95% CI: 1.584–2.130), 3.122 (95% CI: 1.980–4.924), 3.781 (95% CI: 2.855–5.007), 2.379 (85% CI: 2.040–2.775), respectively, in women. The areas under ROC curve of BMI, WC, WHR, and WHtR for men were 0.584 (95% CI: 0.568–0.600), 0.509 (95% CI: 0.492–0.525), 0.501 (95% CI: 0.485–0.518), and 0.642 (95% CI: 0.627–0.658) and 0.619 (95% CI: 0.607–0.632), 0.709 (95% CI: 0.697–0.720), 0.741 (95% CI: 0.730–0.752), and 0.654 (95% CI: 0.642–0.666), respectively, for women.ConclusionWHtR and WHR have been found to perform better as predictors of T2DM in middle-aged and elderly Chinese men and women, respectively.

Severe Coronary Artery Vasospasm after Mitral Valve Replacement in a Diabetic Patient with Previous Stent Implantation: A Case Report.

Postoperative coronary vasospasm is a well-known cause of angina that may lead to myocardial infarction if not treated promptly. We report a case of a 70-year-old female with severe mitral regurgitation submitted to mitral valve replacement, and a history of diabetes mellitus type II, stroke, idiopathic thrombocytopenic purpura on steroid therapy, and previous percutaneous coronary intervention (PCI) for severe obstruction of the circumflex coronary artery, 4 months prior to surgery. Immediately after intensive care unit admission, the patient developed pulseless electrical activity which required extracorporeal membrane oxygenation for hemodynamic support. The coronary angiography showed diffuse occlusive coronary artery vasospasm, ameliorated after intra-coronary administration of nitroglycerin. The following postoperative evolution was marked by cardiogenic shock and multiple organ dysfunction syndrome. Subsequent echocardiographic findings showed an increase in left ventricular function with an EF of 40%, and extracorporeal membrane oxygenation (ECMO) support was weaned after seven days. However, after a few hours, the patient progressively deteriorated, with cardiac arrest and no response to resuscitation maneuvers. Hemodynamic instability following the surgical procedure in a patient with previous PCI associated with an autoimmune disease and diabetes mellitus should raise the suspicion of a coronary artery vasospasm.

Sonographic Intima-Media Thickness Evaluation of Common Carotid and Internal Carotid Arteries in Type-2 Diabetes Mellitus

Background: Intima-media thickness (IMT) is a useful marker in early detection of atherosclerotic lesions in carotid arteries in Type-2 Diabetes Mellitus (T2DM) patients. The study was conducted to determine the association of IMT with various physical and biochemical parameters in the Indian population. Objective: To compare IMT of common and internal carotid arteries in T2DM patients and healthy individuals and study the correlation of IMT with physical and biochemical parameters. Methods: Case group with T2DM (n=27) were matched with Control group consisting of healthy individuals (n=27) of similar age and sex were included. Physical parameters and routine biochemical data were collected and compared. Ultrasonographical imaging of the common and internal carotid arteries of both sides were performed presence of plaque was observed. Data was analyzed by software IBM® SPSS Statistics V20.0. For all analyses, P&lt;0.05 was considered as statistically significant. Results: Mean IMT value obtained in case and control group are 0.711±0.14 mm and 0.601±0.16 mm respectively (P=0.005). Presence of plaque was noticed in 37.03% subjects in case group and in 14.81% subjects in control group. Mean IMT was significantly higher for smoker than non-smokers (P=0.004). Fasting blood sugar, postprandial blood sugar, Postprandial triglycerides and total cholesterol were significantly higher in case group (P&lt;0.05). There was a strong family history of T2DM in case group (51.85%) compared to control group (14.81%) with a statistical significance between them (P=0.009). Conclusion: IMT of common and internal carotid arteries have a significant association in T2DM patients compared to healthy subjects and IMT is significantly associated with physical and biochemical parameters.

A Rare Case of Vancomycin-Induced Immune Thrombocytopenia

Vancomycin-induced immune thrombocytopenia (ITP) is a rare type of drug-induced immune thrombocytopenia (DITP) that can lead to life-threatening consequences as a result of its use. We herein report a case of a 74-year-old male with a history of diabetes mellitus type II, Alzheimer’s disease, and stroke who presented to the ICU with sepsis. The patient was on heparin for 20 days prior to presentation, with platelet levels at the time within normal limits as per his baseline. Following the introduction of vancomycin to his clinical regimen in the treatment of sepsis, the patient developed a significant drop in platelet count from 400 x10³/mm³ to 70 x10³/mm³. Discontinuation of the drug leads to improvement of the platelet counts confirming the diagnosis of vancomycin-induced ITP.

Effectiveness of Early Advanced Glycation End Product Accumulation Testing in the Diagnosis of Diabetes: A Health Risk Factor Analysis Using the Body Mass Index as a Moderator.

ObjectiveTo evaluate the value of non-invasive detection of advanced glycation end products (AGEs) in the early screening of type 2 diabetes mellitus (T2DM) in the community of China.MethodsFrom January 2018 to January 2019, a total of 912 patients with community health physical examination and no history of T2DM were selected, excluding the results of missing value > 5%. Finally, 906 samples were included in the study, with a response rate of 99.3%. Non-invasive diabetic detection technology was used to detect AGEs in the upper arm skin of all participants, AGE accumulations were classified as ≤P25, P25∼P50, P50∼P75, and >P75; HbA1c, insulin, C-peptide, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), creatinine, urea, and other indicators were measured at the same time. Univariate analysis of variance was used to compare the differences in general data, biochemical indexes, skin AGE levels, and blood glucose among groups, and logistic regression analysis and latent category analysis were performed.ResultsIn univariate analysis, SBP, FBG, HbA1c, and age were correlated with higher AGE (p < 0.01); TG, TC, HDL, UA, and gender were not positively correlated with AGE (p < 0.01). After controlling for covariates (waist circumference, hip circumference), AGE accumulation was interacted with other variables. The results of latent category analysis (LCA) showed that the health risk factors (HRFs), including age, systolic blood pressure, HbA1c, FBG, triglyceride, total cholesterol, HDL-C, and uric acid, were divided as three groups, and AGE is divided into four categories according to the quartile method, which were low risk (≤P25), low to medium risk (P25∼P50), medium to high (P50∼P75), and high risk (>P75), respectively. The association between the quartile AGE and risk factors of the OR values was 1.09 (95% CI: 1.42, 2.86), 2.61 (95% CI: 1.11, 6.14), and 5.41 (95% CI: 2.42, 12.07), respectively. The moderation analysis using the PROCESS program was used to analyze whether BMI moderated the link between risk factors and AGE accumulation. There was also a significant three-way interaction among HRFs, BMI, and gender for AGE accumulation in the total sample (β = -0.30).ConclusionNon-invasive skin detection of AGEs has a certain application value for the assessment of T2DM risk and is related to a variety of risk factors.

Polymorphism of Uncoupling Protein 2 (UCP2) Gene in Obes People with the Family History of Type 2 Diabetes Mellitus

History with type 2 diabetes mellitus (T2DM) is manifested by the presence of insulin resistance and β-cell dysfunction which prerequisites for T2DM development involving unbalanced energy intake and expenditure. Uncoupling gene protein 2 is the main regulator of energy balance. This study aims to determine the UCP2 -866G/A genetic variation in obese individuals with a family history of T2DM and without a family history of T2DM. The study was a case control design in which the case subjects (n = 60) were obese individuals with a family history of T2DM and control subjects (n = 60) without a family history of T2DM. Polymorphism was analyzed with PCR-RFLP. The value of HOMA-IR and HOMA-β was calculated by the HOMA formula. Data was analyzed by Independent Sample t-test, Mann Whitney U-test, Chi-Square test and Kruskal-Wallis test with a significance level of p &lt; 0.05. The frequency of genotype and alleles in obese individuals with a family history of T2DM and without a history of T2DM did not differ significantly, GA+AA (56.7 %) and A (32.5 %) allele was higher in individuals with a family history of T2DM. The GG+AA genotype in the male group with a family history of T2DM could significantly increase the risk of UCP2 gene polymorphism in T2DM by 2.23 times (CI 95 % 0.64 - 8.14) whereas in the female group there was no risk of T2DM. HOMA-IR and HOMA-β value in both family background did not differ significantly. The value of HOMA-β in the female gender group had significant relationship between obese individuals with a family history of T2DM (p = 0.04). Conclusion: The result suggests obese individuals with a family history of T2DM have a higher risk of getting GA+AA genotypes and A allele than individuals without a family history of T2DM.&#x0D; HIGHLIGHTS&#x0D; &#x0D; Energy intake that exceeds energy expenditure will cause body fat mass to increase when a state of positive energy balance occurs&#x0D; The genetic component for obesity is associated with relative risks between family relationships and body composition relationships&#x0D; The obese individuals with a family history of T2DM have a higher risk of GA + AA genotype and A allele than individuals without a family history of T2DM&#x0D; &#x0D; GRAPHICAL ABSTRACT

Longitudinal changes in blood biomarkers and their ability to predict type 2 diabetes mellitus-The Tromsø study.

IntroductionIdentification of individuals at high risk of developing type 2 diabetes mellitus (T2DM) is important for early prevention of the disease. Once T2DM is established, it is difficult to treat and is associated with cardiovascular complications and increased mortality. We aimed to describe pre‐ and post‐diagnostic changes in blood biomarker concentrations over 30 years in individuals with and without T2DM, and to determine the predictive potential of pre‐diagnostic blood biomarkers.MethodsThis nested case–control study included 234 participants in the Tromsø Study who gave blood samples at five time points between 1986 and 2016: 130 did not develop T2DM and were used as controls; 104 developed T2DM after the third time point and were included as cases. After stratifying by sex, we investigated changes in pre‐ and post‐diagnostic concentrations of lipids, thyroid hormones, HbA1c, glucose and gamma‐glutamyltransferase (GGT) using linear mixed models. We used logistic regression models and area under the receiver operating characteristic curve (AROC) to assess associations between blood biomarker concentrations and T2DM, as well as the predictive ability of blood biomarkers.ResultsCases and controls experienced different longitudinal changes in lipids, free T3, HbA1c, glucose, and GGT. The combination of selected blood biomarker concentrations and basic clinical information displayed excellent (AROC 0.78–0.95) predictive ability at all pre‐diagnostic time points. A prediction model that included HDL (for women), HbA1c, GGT, and basic clinical information demonstrated the strongest discrimination 7 years before diagnosis (AROC 0.95 for women, 0.85 for men).ConclusionThere were clear differences in blood biomarker concentrations between cases and controls throughout the study, and several blood biomarkers were associated with T2DM. Selected blood biomarkers (lipids, HbA1c, GGT) in combination with BMI, physical activity, elevated blood pressure, and family history of T2DM had excellent predictive ability 1–7 years before T2DM diagnosis and acceptable predictive ability up to 15 years before diagnosis.