Incidence Of Diabetic Complications Research Articles

Diabetes complications in people with alcohol use disorder and type 2 diabetes.

People living with alcohol use disorder (AUD) who develop Type 2 Diabetes (T2DM) may be at higher risk of diabetes-complications. Our aims were to compare diabetes-monitoring and incidence of diabetes-complications between people with and without AUD prior to T2DM diagnosis attending primary care in England. We used the Clinical Practice Research Datalink (CPRD) Aurum linked with Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality data. The target population was people with incident T2DM diagnosed between 2004-2019. We defined AUD from codes indicating i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm. Outcomes were end stage renal disease (ESRD), lower limb amputation, myocardial infarction (MI), stroke, cardiovascular disease (CVD) mortality and all-cause mortality. We compared yearly HbA1c, creatinine and cholesterol monitoring activities for the first 5 years post T2DM diagnosis. The study population was 543,509 people, of whom 15 237(2.8%) had a code for AUD. Adjusting for measured confounders, people with AUD had higher rates of ESRD (IRR 1.95 95% CI 1.71, 2.23), lower limb amputation (IRR 1.78 95% CI 1.50, 2.21), stroke (IRR 1.35 95% CI 1.25, 1.46), CVD mortality (IRR 1.74 95% 1.63, 1.86) and all-cause mortality (IRR 2.10 95% CI 2.04, 2.17) but not MI (IRR 0.91 95% CI 0.82, 1.00) compared with people without AUD. Laboratory diabetes-monitoring was high in people with (83.5-91.1%) and without (83.7-92.4%) AUD. People with AUD had nearly double the rates of most of the diabetes-complications investigated than people without AUD.

Diabetic retinopathy incidence, predictors and its association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia: joint model.

Diabetes mellitus (DM) is a global public health problem characterized by an elevated blood glucose level. Monitoring blood sugar levels is vital for effective diabetes management and preventing complications. However, the association between longitudinal biomarkers and the incidence of diabetic complications is often overlooked. Therefore, this study aimed to assess the incidence of diabetic retinopathy, predictors, and association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia. A multicenter retrospective follow-up study was carried out in referral hospitals in Amhara region, Ethiopia. A random sample of 462 newly diagnosed DM patients was selected. The proportional hazard assumption was checked for the survival sub-model, and for the longitudinal sub-model, the normality assumption was checked. Then the joint modeling with time-dependent lagged parameterizations was fitted. Model assumptions and comparisons were checked. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value<0.05 was used to identify predictors. In this study, Overall, 54 patients developed DR, and the incidence rate was 2.33 per 1000 person-months over the follow-up period, with a 95% CI of [1.78, 3.05]. Rural residence (AHR = 2.21, 95% CI: [1.21, 4.05]), hypertension co-morbidity (AHR = 3.01, 95% CI: [1.85, 6.53]), and longer duration of DM (>5 years) (AHR = 2.28, 95% CI: [1.91, 5.15]) were important predictors for the incidence of DR. In addition, the incidence of DR was substantially correlated with the time-dependent lagged value of FBS change (AHR = 4.20, 95% CI [1.62, 10.85]). In this study, the incidence of diabetic retinopathy was somewhat high when compared to prior similar studies in Ethiopia. A joint model of longitudinal fasting blood sugar level changes was significantly associated with an increased risk of DR. Besides, being rural residence, hypertension co-morbidity, and a longer duration of DM were significant predictors for the incidence of DR. Therefore, public awareness, an integrated care approach, and prioritizing glycemic control are highly recommended.

Monogenic diabetes in a Chinese population with young-onset diabetes: A 17-year prospective follow-up study in Hong Kong.

Asians have a high prevalence of young-onset diabetes, but the pattern of monogenic diabetes is unknown. We aimed to determine the prevalence of monogenic diabetes in Chinese patients with young-onset diabetes and compare the clinical characteristics and outcome between patients with and without monogenic diabetes. We sequenced a targeted panel of 33 genes related to monogenic diabetes in 1021 Chinese patients with non-type 1 diabetes diagnosed at age ≤40years. Incident complications including cardiovascular disease (CVD), end-stage kidney disease (ESKD) and all-cause death were captured since enrolment (1995-2012) until 2019. In this cohort (mean±SD age at diagnosis: 33.0±6.0years, median[IQR] diabetes duration 7.0[1.0-15.0] years at baseline, 44.9% men), 22(2.2%, 95% confidence interval[CI] 1.4%-3.2%) had monogenic diabetes. Pathogenic (P) or likely pathogenic (LP) variants were detected in GCK (n=6), HNF1A (n=9), HNF4A (n=1), PLIN1 (n=1) and PPARG (n=2), together with copy number variations in HNF1B (n=3). Over a median follow-up of 17.1years, 5(22.7%) patients with monogenic diabetes (incidence rate 12.3[95% CI 5.1-29.4] per 1000 person-years) versus 254(25.4%) without monogenic diabetes (incidence rate 16.7[95% CI 14.8-18.9] per 1000 person-years) developed the composite outcome of CVD, ESKD and/or death (p=0.490). The multivariable Cox model did not show any difference in hazards for composite events between groups. In Chinese with young-onset non-type 1 diabetes, at least 2% of cases were contributed by monogenic diabetes, over 80% of which were accounted for by P/LP variants in common MODY genes. The incidence of diabetes complications was similar between patients with and without monogenic diabetes.

To Use or Not to Use a Self-monitoring of Blood Glucose System? Real-world Flash Glucose Monitoring Patterns Using a Cluster Analysis of the FGM-Japan Study.

Objective This study investigated self-monitoring of blood glucose (SMBG) adherence and flash glucose monitoring patterns using a cluster analysis in Japanese type 1 diabetes (T1D) patients with intermittently scanned continuous glucose monitoring (isCGM). Methods We measured SMBG adherence and performed a data-driven cluster analysis using a hierarchical clustering in T1D patients from Japan using the FreeStyle Libre system. Clusters were based on three variables (testing glucose frequency and referred Libre data for hyperglycemia or hypoglycemia). Patients We enrolled 209 participants. Inclusion criteria were patients with T1D, duration of isCGM use ≥3 months, age ≥20 years old, and regular attendance at the collaborating center. Results The rate of good adherence to SMBG recommended by a doctor was 85.0%. We identified three clusters: cluster 1 (low SMBG test frequency but high reference to Libre data, 17.7%), cluster 2 (high SMBG test frequency but low reference to Libre data, 34.0%), and cluster 3 (high SMBG test frequency and high reference to Libra data, 48.3%). Compared with other clusters, individuals in cluster 1 were younger, those in cluster 2 had a shorter Libre duration, and individuals in cluster 3 had lower time-in-range, higher severe diabetic distress, and high intake of snacks and sweetened beverages. There were no marked differences in the incidence of diabetic complications and rate of wearing the Libre sensor among the clusters. Conclusions We stratified the patients into three subgroups with varied clinical characteristics and CGM metrics. This new substratification might help tailor diabetes management of patients with T1D using isCGM.

New therapeutic directions in type II diabetes and its complications: mitochondrial dynamics.

As important organelles of energetic and metabolism, changes in the dynamic state of mitochondria affect the homeostasis of cellular metabolism. Mitochondrial dynamics include mitochondrial fusion and mitochondrial fission. The former is coordinated by mitofusin-1 (Mfn1), mitofusin-2 (Mfn2), and optic atrophy 1 (Opa1), and the latter is mediated by dynamin related protein 1 (Drp1), mitochondrial fission 1 (Fis1) and mitochondrial fission factor (MFF). Mitochondrial fusion and fission are generally in dynamic balance and this balance is important to preserve the proper mitochondrial morphology, function and distribution. Diabetic conditions lead to disturbances in mitochondrial dynamics, which in return causes a series of abnormalities in metabolism, including decreased bioenergy production, excessive production of reactive oxygen species (ROS), defective mitophagy and apoptosis, which are ultimately closely linked to multiple chronic complications of diabetes. Multiple researches have shown that the incidence of diabetic complications is connected with increased mitochondrial fission, for example, there is an excessive mitochondrial fission and impaired mitochondrial fusion in diabetic cardiomyocytes, and that the development of cardiac dysfunction induced by diabetes can be attenuated by inhibiting mitochondrial fission. Therefore, targeting the restoration of mitochondrial dynamics would be a promising therapeutic target within type II diabetes (T2D) and its complications. The molecular approaches to mitochondrial dynamics, their impairment in the context of T2D and its complications, and pharmacological approaches targeting mitochondrial dynamics are discussed in this review and promise benefits for the therapy of T2D and its comorbidities.

Chronic disease management program applied to type 2 diabetes patients and prevention of diabetic complications: a retrospective cohort study using nationwide data

BackgroundThe outcomes of education and counseling by medical professionals for patients with type 2 diabetes mellitus (T2DM) are unclear. This study examined the effects of the Chronic Disease Management Program (CDMP), a health insurance fee-for-service benefit, on the incidence of diabetic complications in patients newly diagnosed with T2DM using the National Health Insurance data.MethodsPatients newly diagnosed with T2DM aged ≥ 20 years from 2010 to 2014 were followed up until 2015. Selection bias was minimized using propensity score matching. A stratified Cox proportional hazards model was used to analyze the association between the CDMP and the risk of incident diabetic complications. Subgroup analysis was performed for patients with high medication adherence, which was indicated by a medication possession ratio (MPR) ≥ 80.ResultsAmong the 11,915 patients with T2DM in the cohort, 4,617 were assigned to the CDMP and non-CDMP group each. The CDMP helped reduce the overall and microvascular risks of complications compared to the non-CDMP group; however, the protective effect against macrovascular complications was only observed in those aged ≥ 40 years. Subgroup analysis of the group aged ≥ 40 years with high adherence (an MPR ≥ 80) showed that the CDMP effectively reduced the incidence of micro- and macrovascular complications.ConclusionsEffective management of T2DM is crucial in preventing complications in patients with the condition, and includes regular monitoring and adjustment of treatment by qualified physicians. Nevertheless, long-term prospective studies on the effects of CDMP are required to confirm this finding.

Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal Register of Diabetes Mellitus for the period 2010–2022

BACKGROUND. The clinical and epidemiological characteristics of diabetes mellitus (DM) and the quality of its therapy are the key prognostic dominant that determines the organizational aspects of the diabetic service. The continuous dynamic monitoring of DM has been carried out in the Russian Federation (RF) since 1996 through the activities of the Federal Register of Diabetes Mellitus (FDR).AIMS. The aim of our study was to analyze the epidemiological characteristics of DM in the RF (prevalence, morbidity, mortality), the prevalence diabetic of complications, the state of carbohydrate metabolism (level of HbA1c) and the dynamics of the structure of glucose-lowering therapy (GLT) according to the FDR.MATERIALS AND METHODS. The database of FRD (https://www.diaregistry.ru/), 85 regions of the RF. The data are presented as of 01.01.2023 and in dynamics for the period 2010–2022.RESULTS. The total number of DM patients in the RF as of 01.01.2023 was 4 962 762 (3.31% of the population), including: Type 1 (T1) — 5.58% (277.1 ths), T2 — 92.33% (4.58 million), other DM types —2.08% (103 ths). The dynamics of prevalence over the 13-year period (2010→2022) was 146.0→191.0/100 ths people with T1, and 2036.2→3158.8/100 ths people with T2; morbidity in T1 12.3→8.2/100 ths population, in T2 260.1→191.4/100 ths population; мortality: T1 2.1→2.4/100 ths population, T2 41.2→86.1/100 ths of the population. The main cause of death was cardiovascular: in T1 38.6% cases, in T2 — 50.9%. Life expectancy (average age of death of patients): T1 was 52.7 years, the dynamics in males 50.9 → 50.7 years, females 62.1→56.0 years; in T2 — 74.2 years, males 69.5→70.4 years, females 74.2→76.1 years. The dynamic of DM duration from onset to the death: in T1 15.4→19.9 years; in T2 11→11.4 10.2→11.8 years. The proportion of patients with laboratory-measured HbA1c &lt;7% in the dynamics of 2010–2022: with DM1 24.4%→29%, with DM2 41.5%→42.2%, with HbA1c ≥9.0%: with DM1 29, 4% → 20.4%, with DM2 13.8 → 9.0%.The incidence of diabetic complications as of 01.01.2023 in T1 and T2 patients: neuropathy 41.3% and 23.7%, nephropathy (CKD) 22.8% and 19.1%, retinopathy 28.9% and 12.3%, respectively. The structure GLT in T2 patients as of 01.01.2023: monotherapy — 41.6%; combination of 2 GLM — 30.0%, 3 GLM — 5.8%, insulin therapy in 18.3%.CONCLUSIONS. The information-analytical system FDR is a key tool for systematizing the most important epidemiological and clinical characteristics of DM based on data from real clinical practice, which allows optimizing the algorithm of patient management and improving the quality of care for diabetes.

Diabetic Neuropathy Assessed with Multifrequency Vibrometry Develops Earlier than Nephropathy but Later than Retinopathy.

Diabetes is associated with systemic complications. Prevalence of diabetic nephropathy, and retinopathy, in type 1 diabetes mellitus (T1DM) is declining, but it is not known if this is true also for diabetic neuropathy. To investigate the relationship between large fibre diabetic neuropathy and other diabetic complications. Neuropathy, defined here as large fibre neuropathy, was assessed by measuring vibration perception thresholds at four different frequencies on the sole of the foot, using a standard VibroSense Meter and/or neuropathic symptoms, in 599 individuals with T1DM. Retinopathy status was graded using the International Clinical Disease Severity Scale. Grade of albuminuria and previous history of any macrovascular complications were registered. Diabetic individuals without retinopathy had similar vibration thresholds as age- and gender-matched control participants without diabetes, whereas those without microalbuminuria had higher thresholds than controls. Two individuals out of 599 (0.3%) had microalbuminuria, but not retinopathy or neuropathy, and 12/134 (9%) without retinopathy had signs of neuropathy. Totally 119/536 (22%) of the patients without microalbuminuria had neuropathy. Vibration thresholds increased with the rising severity of retinopathy and grade of albuminuria. In a multinomial logistic regression analysis, neuropathy was associated with retinopathy (OR 2.96 [1.35-6.49], p=0.007), nephropathy (OR 6.25 [3.21-12.15]; p=6.7×10-8) and macrovascular disease (OR 2.72 [1.50-4.93], p=0.001). Despite recent changes in the incidence of diabetic complications, the onset of large fibre neuropathy follows that of retinopathy but precedes the onset of nephropathy in T1DM.

Association between Age at Type 2 Diabetes Onset and Diabetic Retinopathy: A Double-Center Retrospective Study.

With the decreasing age of type 2 diabetes mellitus (T2DM) onset, the incidence of diabetic complications is gradually increasing. We evaluated the independent effect of age at diabetes onset on diabetic retinopathy (DR) development. A total of 7472 patients with T2DM were enrolled in the National Metabolic Management Center from September 2017 to May 2022. Anthropometry data, laboratory reports, and medical history were collected. The independent association of DR with age at diabetes onset was analyzed using multivariable logistic regression models. In addition, a stratified analysis was performed to determine the effect of confounding variables. Of the 7472 patients recruited, 1642 (21.98%) had DR. Patients with DR had considerably younger ages of diabetes onset than those without DR (45 (38-53) years vs. 50 (43-57) years, P < 0.001). The proportion of patients with T2DM onset at a younger age was higher in the DR group than that in the non-DR group. Participants were divided into four groups according to their age at diabetes onset, namely, ≥60, <40, 40-49, and 50-59 years. Compared with patients with diabetes onset at age ≥ 60 years, those with diabetes onset at <40 years (odds ratio (OR): 5.56, 95% confidence interval (CI): 3.731-8.285, P < 0.001), 40-49 years (OR: 2.751, 95% CI: 2.047-3.695, P < 0.001), and 50-59 years (OR: 1.606, 95% CI: 1.263-2.042, P < 0.001) were at an increased risk of DR after adjusting for potential confounding factors. Furthermore, stratification analyses demonstrated that young age at diabetes onset is an independent risk factor for DR. Compared with diabetes onset at an older age, diabetes onset at a younger age is associated with a significantly increased DR risk.

Development and internal validation of a model to predict type 2 diabetic complications after gestational diabetes

Gestational diabetes mellitus (GDM) increases the risk of early-onset type 2 diabetes, which further exacerbates the risk of developing diabetic complications such as kidney, circulatory, and neurological complications. Yet, existing models have solely focused on the prediction of type 2 diabetes, and not of its complications, which are arguably the most clinically relevant outcomes. Our aim was to develop a prediction model for type 2 diabetic complications in patients with GDM. Using provincial administrative data from Quebec, Canada, we developed a model to predict type 2 diabetic complications within 10 years among 90,143 women with GDM. The model was internally validated and assessed for discrimination, calibration, and risk stratification accuracy. The incidence of diabetic complications was 3.8 (95% confidence interval (CI) 3.4–4.3) per 10,000 person-years. The final prediction model included maternal age, socioeconomic deprivation, substance use disorder, gestational age at delivery, severe maternal morbidity, previous pregnancy complications, and hypertensive disorders of pregnancy. The model had good discrimination [area under the curve (AUROC) 0.72 (95% CI 0.69–0.74)] and calibration (slope ≥ 0.9) to predict diabetic complications. In the highest category of the risk stratification table, the positive likelihood ratio was 8.68 (95% CI 4.14–18.23), thereby showing a moderate ability to identify women at highest risk of developing type 2 diabetic complications. Our model predicts the risk of type 2 diabetic complications with moderate accuracy and, once externally validated, may prove to be a useful tool in the management of women after GDM.

1274-P: Prevalence and Clinical Characteristics of Monogenic Diabetes in Chinese Population

Background: Prognosis of monogenic diabetes in Chinese is not well reported. We identified pathogenic mutations in monogenic diabetes genes in a prospective cohort of Chinese with young-onset diabetes, and compared the clinical characteristics and outcome between patients with and those without mutations. Methods: From patients enrolled in the Hong Kong Diabetes Register between 1995-2012, DNA samples of 1021 Chinese with non-type 1 diabetes diagnosed ≤40 years old were sequenced. The custom targeted panel included 34 genes related to neonatal diabetes, maturity-onset diabetes of the young, syndromes associated with diabetes and severe insulin resistance. Variants were interpreted according to standard guidelines by ACMG. Patients were followed for incident complications until 2019. Results: Pathogenic or likely pathogenic mutations in monogenic diabetes genes were detected in 33 (3.2%) patients. Mutations were more common in HNF1A (n=7) , GCK (n=6) and ABCC8 (n=5) genes. Mutation carriers had a higher female ratio (72.7 vs. 54.6%, p=0.05) and lower age at enrollment (37.9±10.6 vs. 41.5±10.4 years, p=0.05) but were similar age at diagnosis (31.5±7.3 vs. 33.1±6.0 years, p=0.13) and in diabetes duration (5.0[1.0-11.0] vs. 6.0[1.0-13.0] years, p=0.29) at baseline compared to non-carriers. Mutation carriers had lower BMI (23.6±3.5 vs. 26.0±4.8 kg/m2, p&amp;lt;0.01) , systolic blood pressure (119.4±14.9 vs. 125.6±17.4 mmHg, p=0.05) , HbA1c (7.3±1.3 vs. 7.9±2.0%, p=0.01) and triglyceride level (1.01[0.66-1.53] vs. 1.38[0.90-2.17] mmol/L, p=0.01) . Over a median follow-up of 17.1 years, (30.3%) patients with mutation vs. 369 (37.3%) without mutations developed cardiovascular disease, chronic or end-stage kidney disease and/or died (p=0.47) . Conclusion: Around 3% of Chinese with young-onset non-type 1 diabetes had mutation in monogenic diabetes genes. Despite a more favorable metabolic profile, patients with mutation had similar incidence of diabetes complications to those without mutations. Disclosure S.Tsoi: None. C.K.Lim: None. R.C.Ma: Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc. E.S.Lau: None. B.Fan: None. E.Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc., Speaker's Bureau; Novartis AG, Sanofi. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Other Relationship; AstraZeneca, Novo Nordisk, Research Support; Boehringer Ingelheim, Speaker's Bureau; AstraZeneca, Bayer, Eli Lilly and Company, Sanofi, Stock/Shareholder; Aptorum Group Limited. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer AG, Boehringer Ingelheim International GmbH, Celltrion, Merck Sharp &amp; Dohme Corp., Roche Diabetes Care, Viatris Inc., Research Support; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Hua Medicine, Servier Laboratories, Stock/Shareholder; GemVCare Ltd. A.Luk: None. Funding Research Grants Council of Hong Kong (14114918) ; Research Impact Fund (R4012-18)

Adding GABA to Insulin leads to new era in Type 1 Diabetes Management

Introduction: Diabetes mellitus is not just a disease, it dramatically affects people's lives, both physically and psychologically. It is like a permanent guest, never leaving its owner. It is promising to know that, it was detected that GABA can stimulate and multiply beta cells in islets of langerhans through activation of PI3K/Akt pathway and can also convert alpha cells to beta cells with long term use. Materials and Methods: 100 patients of type 1 diabetes followed in a private clinic for 1 year. They is on multiple insulin injections in the form of lantus and actrapid. Results: The results show a statistically significant difference in hba1c in patients before and after 6 months of treatment with GABA. Conclusion: GABA is considered as the best choice for adding to insulin for patients with type 1 diabetes decreasing insulin dose, decreasing incidence of diabetes complications.

IDF21-0357 Association of Sodium and Potassium intake with Incidence of Diabetic Complications in Chinese patients with diabetes

Background: Recent studies have shown that high sodium and low potassium diet may be associated with an increased risk of type 2 diabetes. However, there is little evidence on the relationship between sodium or potassium intake and microvascular complications in individuals with diabetes.

Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal diabetes register data of 01.01.2021

BACKGROUND. One of the priority directions in the development of the health care system is to reduce the medical and social damage caused by the increase in the prevalence of diabetes mellitus (DM). From this point of view, the development of a diabetes register is very important as the main information and analytical platform for clinical and epidemiological monitoring of diabetes in the Russian Federation (RF).AIMS. The aim of our study was to analyze a dynamic (2016–2020) of the epidemiological characteristics of diabetes mellitus in the Russian Federation (prevalence, morbidity, mortality), the prevalence of complications, the level of HbA1c and the dynamics of the structure of glucose-lowering therapy (GLT) according to the Federal Diabetes Register (FDR).MATERIALS AND METHODs. The database of FRD (http://diaregistry.ru) 84 regions of the RF. The data are presented in dynamics 2016→2020.RESULTS. The total number of DM patients in the RF as of 01.01.2021 was 4,799,552 (3.23% of the population), including: Type 1 (T1) — 5.5% (265.4 ths) , T2 — 92.5% (4.43 million), other DM types — 2.0% (99.3 ths). The dynamics of prevalence was 168.7→180.9/100 ths people with T1, and 2709 → 3022/100 ths people with T2; morbidity in T1 10.5→7.7/100 ths population, in T2 219.6→154.2/100 ths population. Age and sex characteristics: the proportion of men in T1 — 54%, in T2 — 30%; the max proportion of patients with T1 at the age of 30–39 years, T2 65–69 years. Mortality: T1 3.0 → 2.7/100 ths population, T2 87.7→93.9/100 ths of the population, the main cause of death was cardiovascular: in T1 38,1% cases, in T2 — 52,0%. Life expectancy (average age of death of patients): T1 was 53.2years, the dynamics in males 50.7 → 50.5years, ­females 58.7→55.2years; in T2 — 73.5 years, males 70.2→70.1years, females 75.7→75.4 years. The dynamic of DM duration until the death: in T1 17.4→19.0 years; in T2 11→11.4 years. The incidence of diabetic complications in T1 and T2 patients: neuropathy 43.3% and 24.4%, nephropathy (CKD) 25.9% and 18.4%, retinopathy 31.7% and 13.5%, respectively. The ­proportion of ­patients with HbA1c &lt;7%: in T1 32.3%→36.9%, in T2 51.9%→52.1%, with HbA1c ≥ 9.0% in T1 23.1%→18.7% , in T2 8.9%→8.0%. The structure GLT in T2 patients: glucose lowering medications (GLM) — 76.2% (monotherapy — 44.1%; ­combination of 2 GLM — 28.9%, 3 GLM — 3.2%), insulin therapy in 18,8%, without drug therapy in 4.9%.CONCLUSIONS. The performed analysis demonstrates the importance of dynamic assessment of epidemiological characteristics and monitoring of clinical data on patients with diabetes through a registry for assessing the quality of diabetes care and the prospects for its development.

Prevalence and incidence of micro- and macro-vascular complications in a diabetic population of Bangladesh: a retrospective cohort study

Background and objectives: Diabetes mellitus (DM) is a major health problem in South Asian Region including Bangladesh. Increasing prevalence of DM is likely to cause higher morbidity and mortality. The objective of this study was to find out the prevalence and incidence of diabetic complications in a Bangladeshi diabetic cohort attending BIRDEM, a largest referral center in Bangladesh for endocrine and metabolic diseases. Methodology: The study was conducted in BIRDEM-OPD (outpatient department) from 1 January to 31 December of 1995 and analyzed the data of diabetic cases preserved in BIRDEM registry since 1956. Up to 31 December 1985, the REFERENCE NUMBER (Ref No) of last case was ‘49,510’. Therefore, this retrospective cohort comprised of all those patients having Ref No 49,510 or less and attending BIRDEM-OPD for follow-up. In the year 1995, the cohort had follow-up for at least ten years. The duration of follow-up was 39 years (1956 to 1995). The study also retrieved follow-up data from the guidebook of each registered diabetic patient. All data regarding clinical, anthropometric and biochemical investigations preserved in BIRDEM registry and in the patient's guidebook were retrieved and analyzed. The cohort was categorized into three groups (Gr1, 2 and 3) based on follow-up duration: &gt;15, 10-15 and &lt;10years, respectively. Results: Micro-vascular complications (retinopathy and nephropathy) were the highest among both Gr1 with follow-up &gt;15y and Gr2 with follow-up 10-15y. Compared with the Gr2, retinopathy (34.4 vs. 48.5 %: c2 =11.5, p &lt;0.001) and nephropathy (24.0 vs. 39.2 %: c2 = 15.6, p&lt;0.001) were significantly higher in the Gr1. In contrast, HTN, skin-lesion and periodontal diseases were significantly higher in the Gr2 than in Gr1. All types of complications were found increasing with the duration of follow-up. For Gr1, the increasing trend of cerebrovascular accident (CVD/ stroke) and CHD was significant (p&lt;0.01 and p&lt;0.001). Mean blood glucose of study population revealed moderate to severe hyperglycemia in successive follow-up visits. The comparison between patients with and without severe hyperglycemia (2hPG: &lt;10.0 vs. ³10.0 mmol/l) showed very little difference of complications. The increasing age over 40 years showed significant risk for CHD and hypertension. Conclusion: CHD, stroke and PVD were less frequent compared to those with retinopathy and nephropathy. Compared to microvascular complications the macrovascular events resulted in either early death or complete disability to pursue long-term follow-up. The most important and consistent predictors were female gender and duration of diabetes. IMC J Med Sci 2022; 16(1): 002 *Correspondence: M. Abu Sayeed, Department of Community Medicine, Ibrahim Medical College, 1/A Ibrahim Sarani, Segunbagicha, Dhaka-1000. email: sayeed@imc.ac.bd; sayeed1950@gmail.com

Effect and Safety of Acupuncture for Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of 21 Randomised Controlled Trials.

To evaluate the effects of acupuncture on hypoglycaemic outcomes in type 2 diabetes mellitus (T2DM). PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched from inception up to July 2020, to identify randomised controlled trials (RCTs) that enrolled patients with T2DM and compared acupuncture combined with antidiabetic drugs to antidiabetic drugs alone. The primary outcomes were haemoglobin A1c (HbA1c) and fasting blood glucose (FBG). The secondary outcomes included 2-h blood glucose (2hBG), fasting insulin (FINS), homeostatic model assessment for insulin resistance (HOMA-IR), and acupuncture-related adverse events. Mean difference (MD) and 95% confidence interval (CI) were used as the effect measure in the meta-analysis. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Twenty-one RCTs (n=1,188) were included. The meta-analytic results showed that the acupuncture group had greater reductions in FBG (MD -6.46 mg/dL, 95% CI -11.95 to -0.98; moderate-quality evidence) and HOMA-IR (MD -1.23, 95% CI -2.16 to -0.31; low-quality evidence), but comparable changes in HbA1c (MD -0.39%, 95% CI -0.84 to 1.61; very-low-quality evidence), 2hBG (MD -4.99 mg/dL, 95% CI -20.74 to 10.76; low-quality evidence), and FINS (MD -1.32 µIU/mL, 95% CI -3.76 to 1.12; low-quality evidence). No data on the incidence of diabetic complications were found. All acupuncture-related adverse events reported were mild. The current evidence suggests that acupuncture, as a complementary therapy to antidiabetic drugs, has a small but statistically significant effect on decreasing FBG and improving insulin resistance. The effects of acupuncture on HbA1c, 2hBG, and FINS remain uncertain. Acupuncture is generally safe in patients with mild diabetes. More evidence for the long-term effects of acupuncture on T2DM is needed. (Trial registration No. CRD42018115639).

Diabetes prevalence and complication rates: In individual First Nations communities in the Sioux Lookout region of Ontario.

To test the feasibility of reporting diabetes indicators at a regional and community level in order to provide feedback to local leaders on health system performance. Analysis of administrative data from hospital discharges and physician billings. Sioux Lookout region of Ontario. Residents from 30 remote communities served by the Sioux Lookout First Nations Health Authority. Incidence and prevalence of diabetes and incidence of diabetes complications, including heart attack, stroke, retinopathy, amputations, end-stage kidney disease, diabetes-related hospitalizations, and death. Data were available for 18 542 residents from the 30 remote communities. Residents were almost entirely of First Nations descent. The prevalence of diabetes was 12.9%, the annual incidence was 1.0%, and the annual rate of complications was 5.4% in 2015-2016. Prevalence increased slightly over time. We had sufficient data to report prevalence in 25 of 30 communities (average population 738; range 234 to 2626). We reported statistically significant differences in prevalence by community; 8 were above average and 2 were below average. For diabetes complications, data were pooled over 5 years, and while community-level results could be reported, the variance was too high to allow detection of significant differences. Using 2-tailed t tests for difference of proportions, we determined that grouping communities into subregions of approximately 2000 persons would permit the detection of differences of 30% from the average 5-year complication rate. This study demonstrates the possibility of reporting diabetes prevalence by individual First Nations reserve communities. Complication rates can be reported by individual community, but estimates are more useful for comparison if the smallest communities are grouped together. Such studies could be replicated across Canada to promote local use of these data for resource planning and monitoring long-term progress of diabetes programs and services.

Laurus Nobilis Linn. Inhibits Polyol Pathway Enzymes: Strategy for Managing Diabetic Complications

Background: The rising incidence of diabetic complications necessitate the continuous search for safer, cheaper, and effective pharmacological agents. The polyol pathway is an underlying process implicated in the pathogenesis of diabetic complications. Inhibition of enzymes in the polyol pathway is a veritable means of ameliorating diabetic complications. Objective: This study evaluated the inhibitory potential of some spicy plants on the activities of polyol pathway enzymes (aldose reductase and sorbitol dehydrogenase). Methods: Aqueous extracts of Laurus nobilis (bay), Cinnamomum zeylanicum (cinnamon), Murraya koenigii (curry), Thymus vulgaris (thyme), and Curcuma longa (turmeric) were incubated with appropriate enzymes and substrates, and inhibition percentages were determined. Results: The results showed that bay extract had effective IC50 for the inhibition of both aldose reductase (174.87 μg/mL) and sorbitol dehydrogenase (37.08 μg/mL). It also revealed that bay extract inhibited aldose reductase and sorbitol dehydrogenase in a non-competitive and competitive manner, respectively. Conclusion: It is, therefore, concluded that bay extract effectively inhibited activities of polyol pathway enzymes and might contribute to the amelioration of diabetic complications.

1054-P: Incidence of Micro- and Macrovascular Complications among Persons with Type 2 Diabetes with and without Severe Mental Illness: A Nationwide Study

Background: Severe mental illness (SMI) is linked with a higher incidence of type 2 diabetes (T2D); however, it is unclear whether persons with SMI and T2D have a higher incidence of diabetes complications compared to persons with T2D only. We calculated incidence rate ratios (IRR) and incidence rates (IR) of micro- and macrovascular diabetes complications among persons with T2D and SMI compared to those with T2D only. Methods: We used Danish nationwide registers to follow all persons with T2D from 1996 to 2018. IRR and age-specific IR of first event of each diabetes complication was estimated using Poisson regression models with risk time as offset comparing persons with T2D with and without SMI, while adjusting for sex, age, diabetes duration, calendar year, substance abuse and Charlson’s Comorbidity Index. Results: A total of 371,625 persons with T2D were on average followed for 6.9 - 7.6 year depending on the complication outcome. Persons with T2D and SMI (n=29,249) were younger at T2D diagnosis than persons with T2D only (mean [SD], 59 [15] vs. 63 [14] year). In total, 73,598 (27%) developed cardiovascular disease (CVD), 25,846 (7%) developed retinopathy, 20,191 (5%) developed nephropathy, and 6,796 (2%) underwent an amputation during follow-up. Persons with T2D and SMI had an increased risk of CVD (IRR: 1.14 (95% CI: 1.11-1.18)) and nephropathy (IRR: 1.11 (95% CI: 1.03-1.16)), and a decreased risk of retinopathy (IRR: 0.83 (95% CI: 0.78-0.86)) compared to persons with T2D only when adjusting for confounders. The risk for amputations were similar in persons with T2D with and without SMI (IRR: 1.00 (95% CI: 0.90-1.12)). The increased risk of CVD and nephropathy in persons with SMI were persistent in all ages except for the ages 80-95 year. Conclusion: Persons with T2D and SMI have a slightly higher risk of CVD and nephropathy and a lower risk of retinopathy compared to persons with T2D only. Disclosure S. H. Scheuer: None. V. Kosjerina: None. N. Lindekilde: None. F. Pouwer: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk. M. E. Jørgensen: Research Support; Self; Boehringer Ingelheim International GmbH, Sanofi-Aventis, Stock/Shareholder; Self; Novo Nordisk A/S. M. E. Benros: None. G. S. Andersen: Stock/Shareholder; Self; Novo Nordisk A/S.

Эпидемиологические характеристики сахарного диабета в Российской Федерации: клинико-статистический анализ по данным регистра сахарного диабета на 01.01.2021

BACKGROUND . One of the priority directions in the development of the health care system is to reduce the medical and social damage caused by the increase in the prevalence of diabetes mellitus (DM). From this point of view, the development of a diabetes register is very important as the main information and analytical platform for clinical and epidemiological monitoring of diabetes in the Russian Federation (RF). AIMS . The aim of our study was to analyze a dynamic (2016–2020) of the epidemiological characteristics of diabetes mellitus in the Russian Federation (prevalence, morbidity, mortality), the prevalence of complications, the level of HbA 1c and the dynamics of the structure of glucose-lowering therapy (GLT) according to the Federal Diabetes Register (FDR). MATERIALS AND METHOD s. The database of FRD (http://diaregistry.ru) 84 regions of the RF. The data are presented in dynamics 2016→2020. RESULTS . The total number of DM patients in the RF as of 01.01.2021 was 4,799,552 (3.23% of the population), including: Type 1 (T1) — 5.5% (265.4 ths) , T2 — 92.5% (4.43 million), other DM types — 2.0% (99.3 ths). The dynamics of prevalence was 168.7→180.9/100 ths people with T1, and 2709 → 3022/100 ths people with T2; morbidity in T1 10.5→7.7/100 ths population, in T2 219.6→154.2/100 ths population. Age and sex characteristics: the proportion of men in T1 — 54%, in T2 — 30%; the max proportion of patients with T1 at the age of 30–39 years, T2 65–69 years. Mortality: T1 3.0 → 2.7/100 ths population, T2 87.7→93.9/100 ths of the population, the main cause of death was cardiovascular: in T1 38,1% cases, in T2 — 52,0%. Life expectancy (average age of death of patients): T1 was 53.2years, the dynamics in males 50.7 → 50.5years, ­females 58.7→55.2years; in T2 — 73.5 years, males 70.2→70.1years, females 75.7→75.4 years. The dynamic of DM duration until the death: in T1 17.4→19.0 years; in T2 11→11.4 years. The incidence of diabetic complications in T1 and T2 patients: neuropathy 43.3% and 24.4%, nephropathy (CKD) 25.9% and 18.4%, retinopathy 31.7% and 13.5%, respectively. The ­proportion of ­patients with HbA 1c <7%: in T1 32.3%→36.9%, in T2 51.9%→52.1%, with HbA1c ≥ 9.0% in T1 23.1%→18.7% , in T2 8.9%→8.0%. The structure GLT in T2 patients: glucose lowering medications (GLM) — 76.2% (monotherapy — 44.1%; ­combination of 2 GLM — 28.9%, 3 GLM — 3.2%), insulin therapy in 18,8%, without drug therapy in 4.9%. CONCLUSIONS . The performed analysis demonstrates the importance of dynamic assessment of epidemiological characteristics and monitoring of clinical data on patients with diabetes through a registry for assessing the quality of diabetes care and the prospects for its development.