Increase In Diabetic Patients Research Articles

Deploying efficient net batch normalizations (BNs) for grading diabetic retinopathy severity levels from fundus images

Diabetic retinopathy (DR) is one of the main causes of blindness in people around the world. Early diagnosis and treatment of DR can be accomplished by organizing large regular screening programs. Still, it is difficult to spot diabetic retinopathy timely because the situation might not indicate signs in the primary stages of the disease. Due to a drastic increase in diabetic patients, there is an urgent need for efficient diabetic retinopathy detecting systems. Auto-encoders, sparse coding, and limited Boltzmann machines were used as a few past deep learning (DL) techniques and features for the classification of DR. Convolutional Neural Networks (CNN) have been identified as a promising solution for detecting and classifying DR. We employ the deep learning capabilities of efficient net batch normalization (BNs) pre-trained models to automatically acquire discriminative features from fundus images. However, we successfully achieved F1 scores above 80% on all efficient net BNs in the EYE-PACS dataset (calculated F1 score for DeepDRiD another dataset) and the results are better than previous studies. In this paper, we improved the accuracy and F1 score of the efficient net BNs pre-trained models on the EYE-PACS dataset by applying a Gaussian Smooth filter and data augmentation transforms. Using our proposed technique, we have achieved F1 scores of 84% and 87% for EYE-PACS and DeepDRiD.

Automatic Severity Classification of Diabetic Retinopathy Based on DenseNet and Convolutional Block Attention Module

Diabetic Retinopathy (DR) - a complication developed due to heightened blood glucose levels- is deemed one of the most sight-threatening diseases. Unfortunately, DR screening is manually acquired by an ophthalmologist, a process that can be considered erroneous and time-consuming. Accordingly, automated DR diagnostics have become a focus of research in recent years due to the tremendous increase in diabetic patients. Moreover, the recent accomplishments demonstrated by Convolutional Neural Networks (CNN) settle them as state-of-the-art for DR stage identification. This paper proposes a new automatic deep-learning-based approach for severity detection by utilizing a single Color Fundus photograph (CFP). The proposed technique employs DenseNet169’s encoder to construct a visual embedding. Furthermore, Convolutional Block Attention Module (CBAM) is introduced on top of the encoder to reinforce its discriminative power. Finally, the model is trained using cross-entropy loss on the Kaggle Asia Pacific Tele-Ophthalmology Society’s (APTOS) dataset. On the binary classification task, we accomplished (97% accuracy - 97% sensitivity - 98.3% specificity - 0.9455, Quadratic Weighted Kappa score (QWK)) compared to the state-of-the-art. Moreover, Our network showed high competency (82% accuracy - 0.888 (QWK)) for severity grading. The significant contribution of the proposed framework is that it efficiently grades the severity level of diabetic retinopathy while reducing the time and space complexity required, which demonstrates it as a promising candidate for autonomous diagnosis.

Design of gourmet menus high in fiber for diabetic patients of the French sanatorium: evaluation of the nutritional content, acceptability, organoleptic characteristics and glycemic control

Rationale: The first WHO global report on diabetes, shows that the number of adults with diabetes has quadrupled since 1980 to 422 million. However, there is scientific evidence that diabetes can be treated with diet, physical activity and medications. Therefore, given the increase in diabetic patients admitted to hospitals, the higher economic costs generated by their treatment and the growing demand for gourmet gastronomy in hospital settings for susceptible populations.

INitial Steps of Insulin Action in Parotid Glands of Male Wistar Rats.

The parotid gland is the largest salivary gland. It produces watery saliva, rich in proteins (amylase, lysozymes, and antibodies). Due to the gland's morphological cytoarchitecture composed of only serous acini, it contributes almost 50% of total salivary volume upon stimulation. It has been reported that the prevalence of saliva secretion impairments, periodontitis, delayed wound healing, and xerostomia increase in diabetic patients. Herein we evaluated the acute effects of insulin on insulin receptor phosphorylation status and its substrates IRS-1 and IRS-2 in the parotid glands of adult male Wistar rats, using Western blot analyses. We confirmed an acute effect of insulin on IR/IRS/PI3K/Akt and MAPK intracellular pathway activation in the parotid glands of male Wistar rats similar to the classical metabolic targets of the hormone, like the liver.

Foot Care Nurses: Improve Outcomes for Diabetic Patients

At a Southwestern Academic Trauma Hospital, there has been a sharp increase of below the knee amputations due to uncontrolled diabetic patient foot diseases. Diabetic patients, who receive preventative care from foot care nurses, are able to reduce the likelihood of foot infections, and improve their health outcomes. These infections result in high medical costs to the healthcare system, medical professionals and the community. Limited access to Podiatrists in a community can delay healthcare for patients suffering from Diabetes, and can cause lifelong disabilities. The IRB approved research found improved outcomes in diabetic patients with lower foot infections, and amputations under the care of foot care nurses. Research has established that diabetic patients who do not have access to preventative podiatry services are susceptible to severe foot ulcers, life-threatening complications, and increased rates of amputation. In New Mexico, diabetes is growing at an epidemic rate with 241,120 people, or 14.1% of the population. 12,000 new diabetic patients are diagnosed every year. Adults living with diabetes have medical expenses almost 3 times higher, than those who do not have diabetes. In New Mexico, medical expenses are estimated at $1.6 billion per year. Foot care nurses can significantly reduce these podiatry complications in diabetic patients. Ten clinic nurses became certified in foot care, and created their own Foot Care Clinics. This was a trial of community care to reduce strain on medical professionals, and to ease the burden of expenditures within the healthcare system. Preventative podiatry services resulted in reduced diabetic foot complications, decreased patient suffering and reducing costs to patients and society. As the increase of diabetic patients are diagnosed every year, these foot care nurses can significantly decrease foot issues in patients living with diabetes.

Osteomyelitis, diabetic foot ulcers and the role of the community nurse.

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.

Distribution of SNP rs4430796 in Hispanic Population of Southern California as a predisposition method of developing type II diabetes

One in ten people have diabetes in America, about 13% are Hispanic descent. From this 13% of Hispanic adults, 50% of that population will develop diabetes at some point in their life. As the Hispanic community keeps growing as the years go by the increase in diabetic patients goes up. Physically, mentally and financially, diabetes makes a big impact in people's lives as the disease progresses. Genetics can play a big role in identifying and preventing diseases, one way of that is by detecting single nucleotide polymorphisms (SNP). The rs4430796 in gene HNF1β which is a transcription factor expressed in the liver and pancreas associated with type II diabetes. The goal of this experiment is to identify the prevalence of rs4430796 SNP in Hispanic descent which has been associated with diabetes. We are analyzing 17 control and 24 diabetic samples from Hispanics living in Southern California. After buccal samples were collected and the DNA was extracted, a polymerase chain reaction (PCR) was running. To confirm the SNP we used an enzymatic digestion using SfaN1 enzyme. This experiment will help contribute to the overall knowledge in the distribution of SNPs associated with type II diabetes in the Hispanic population of Southern California. If a person learns he or she possesses the SNP, this could help take preventive measures before the disease sets in by making better diet choices, increase the physical activity and keep a close monitoring of their blood sugar to catch the disease before it gets out of control.

The State of Ferritin in Patients With Diabetes Mellitus Type II/Iraq

This study aims to examine the effects of anemia on patients with diabetes mellitus type II (DM). The cross-sectional study included 75 patients with (DM). They were divided into two groups according to the presence of anemia. The first group includes 50 diabetic patients suffering from anemia, while the second group contains only 25 patients with diabetes only. There was no specification in gender; the patients included both sexes and their ages were above 20 years. A blood sample was collected from each patient to measure (fasting blood glucose, hemoglobin, glycosylated hemoglobin, and ferritin). The results revealed an increase in anemia in females with diabetes mellitus more than males while the levels of HbA1c was on the contrary; it increased in males and decreased in females. A significant negative correlation is confirmed between ferritin and HbA1c in anemic diabetic women. Diabetic patients suffering from anemia recorded a sharp decrease in the levels of ferritin compared with patients with diabetes only. In conclusion, the incidence of anemia increase in diabetic patients with increased levels of HbA1c.

539-P: The Trend of Diabetic Kidney Disease with Low eGFR and Absence of Albuminuria in Type 2 Diabetic Patients in Japan from 1996-2015

Diabetic kidney disease is now attracting great attention from the trend of an increase of diabetic patients with decreased eGFR (mL/min/1.73m2) and absence of albuminuria (ACR, mg/gCre) in the United States over the last 20 years. However, it remains to be clarified whether such trends are common or not in other regions. The aim of the present study is to investigate the prevalence of type 2 diabetic (T2D) patients with low eGFR of less than 60 and ACR less than 30 as normoalbuminuria (NA) from 1996 to 2015 in Japan. We enrolled 2233 T2D subjects who received diabetic complication check programs at our diabetes center and divided into 4 groups by the 5-year periods (P1, 1996-2000, n = 331; P2, 2001-2005, n = 891; P3, 2006-2010, n = 500; P4, 2011-2015, n = 511, respectively). The median age was increased and HbA1c was decreased from P1 to P4 (both p <0.001). The statin or RAS inhibitors (RASI) user was also increased over the period. The prevalence of low eGFR was increased from P1 to P4 (P1 18.7%, P2 26.2%, P3 36.4%, P4 38.0%, p<0.001). Similarly, the prevalence of NA was increased (P1 60.1%, P2 57.7%, P3 61.6%, P4 66.4%, p=0.016) in conjunction with the decrease of microalbuminuria (p=0.015). Finally, the prevalence of subjects with low eGFR and NA was increased from P1 to P4 (P1 2.1%, P2 5.7%, P3 12.6%, P4 18.8%, p<0.001). In multivariate logistic analysis for the prevalence of subjects with low eGFR and NA, odds ratios (95% CI) of P3 and P4 as a reference period of P1 were found to be significant (P3, 3.04 (1.17-7.91) and P4, 5.22 (2.02-13.5)) even after adjusting by age, sex, duration, the use of statin or RASI, BMI, blood pressure, HbA1c and non-HDL-C. In conclusion, the prevalence with low eGFR and NA was also increased among T2D patients in Japan from 1996 to 2015. There might be unknown clinical factors or situations contributing to such trends other than conventional factors such as aging, use of RASI and/or improved metabolic states of HbA1c and lipid profile. Disclosure Y. Kakutani: None. M. Emoto: Research Support; Self; Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Taisho Toyama Pharmaceutical CO., Ltd., Takeda Pharmaceutical Company Limited. K. Mori: Speaker's Bureau; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd. Y. Yamazaki: None. A. Ochi: None. T. Morioka: Research Support; Self; Eli Lilly and Company, Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Sanofi K.K., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Roche Diagnostics K.K., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Other Relationship; Self; Ono Pharmaceutical Co., Ltd. S. Fukumoto: Research Support; Self; Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Kowa Pharmaceutical Europe Co. Ltd., Mitsubishi Tanabe Pharma Corporation, Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi K.K. A. Shioi: None. T. Shoji: Research Support; Self; Bayer Yakuhin, Ltd., Chugai Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd. Speaker's Bureau; Self; Kissei Pharmaceutical Co., Ltd., Kowa, Kyowa Hakko Kirin Co., Ltd. M. Inaba: None.

The Significance of Oxidized Low-Density Lipoprotein in Body Fluids as a Marker Related to Diseased Conditions.

Oxidatively modified low-density lipoprotein (oxLDL) is known to be involved in various diseases, including cardiovascular diseases. The presence of oxLDL in the human circulatory system and in atherosclerotic lesions has been demonstrated using monoclonal antibodies. Studies have shown the significance of circulating oxLDL in various systemic diseases, including acute myocardial infarction and diabetic mellitus. Several different enzyme-linked immunosorbent assay (ELISA) procedures to measure oxLDL were utilized. Evidence has been accumulating that reveals changes in oxLDL levels under certain pathological conditions. Since oxLDL concentration tends to correlate with low-density lipoprotein (LDL)-cholesterol, the ratio of ox-LDL and LDL rather than oxLDL concentration alone has also been focused. In addition to circulating plasma, LDL and oxLDL are found in gingival crevicular fluid (GCF), where the ratio of oxLDL to LDL in GCF is much higher than in plasma. LDL and oxLDL levels in GCF show an increase in diabetic patients and periodontal patients, suggesting that GCF might be useful in examining systemic conditions. GCF oxLDL increased when the teeth were affected by periodontitis. It is likely that oxLDL levels in plasma and GCF could reflect oxidative stress and transfer efficacy in the circulatory system.

DIBc, a nanochelating-based nano metal-organic framework, shows anti-diabetic effects in high-fat diet and streptozotocin-induced diabetic rats.

AimsDespite daily increase in diabetic patients in the world, currently approved medications for this disease, at best, only reduce its progression speed. Using novel technologies is a solution for synthetizing more efficient medicines. In the present study, we evaluated anti-diabetic effects of DIBc, a nano metal–organic framework, which is synthetized based on nanochelating technology.MethodsHigh-fat diet and streptozotocin-induced diabetic rats were treated by DIBc or metformin for 6 weeks.ResultsDIBc decreased plasma glucose, triglyceride, cholesterol, high-density lipoprotein, and low-density lipoprotein compared with diabetic and metformin groups. In DIBc-treated rats, significant homeostasis model assessment of insulin resistance index, malondialdehyde, and tumor necrosis factor-α decrease was observed. H&E staining showed increased islet number and area in DIBc-treated rats compared with diabetic controls.ConclusionThe results showed anti-diabetic effects of nanochelating-based framework. So DIBc, as a nano structure, has the capacity to be evaluated in future studies as a novel anti-diabetic agent.

Elevated hepatic expression of H19 long noncoding RNA contributes to diabetic hyperglycemia.

Excessive hepatic glucose production (HGP) contributes significantly to the hyperglycemia of type 2 diabetes; however, the molecular mechanism underlying this dysregulation remains poorly understood. Here, we show that fasting temporally increases the expression of H19 long noncoding RNA (lncRNA) in nondiabetic mouse liver, whereas its level is chronically elevated in diet-induced diabetic mice, consistent with the previously reported chronic hepatic H19 increase in diabetic patients. Importantly, liver-specific H19 overexpression promotes HGP, hyperglycemia, and insulin resistance, while H19 depletion enhances insulin-dependent suppression of HGP. Using genome-wide methylation and transcriptome analyses, we demonstrate that H19 knockdown in hepatic cells alters promoter methylation and expression of Hnf4a, a master gluconeogenic transcription factor, and that this regulation is recapitulated in vivo. Our findings offer a mechanistic explanation of lncRNA H19's role in the pathogenesis of diabetic hyperglycemia and suggest that targeting hepatic H19 may hold the potential of new treatment for this disease.

Development of a high-sensitivity and portable cell using Helmholtz resonance for noninvasive blood glucose-level measurement based on photoacoustic spectroscopy.

We describe the possibility of high-sensitivity noninvasive blood glucose measurement based on photoacoustic spectroscopy (PAS). The demand for noninvasive blood glucose-level measurement has increased due to the explosive increase in diabetic patients. We have developed a noninvasive blood glucose-level measurement based on PAS. The conventional method uses a straight-type resonant cell. However, the cell volume is large, which results in a low detection sensitivity and difficult portability. In this paper, a small-sized Helmholtz-type resonant cell is proposed to improve detection sensitivity and portability by reducing the cell dead volume. First, the acoustic property of the small-sized Helmholtz-type resonant cell was evaluated by performing an experiment using a silicone rubber. As a result, the detection sensitivity of the small-sized Helmholtz-type resonant cell was approximately two times larger than that of the conventional straight-type resonant cell. In addition, the inside volume was approximately 30 times smaller. Second, the detection limits of glucose concentration were estimated by performing an experiment using glucose solutions. The experimental results showed that a glucose concentration of approximately 1% was detected by the small-sized Helmholtz-type resonant cell. Although these results on the sensitivity of blood glucose-level measurement are currently insufficient, they suggest that miniaturization of a resonance cell is effective in the application of noninvasive blood glucose-level measurement.

Dimethylarginines, blood glucose, and C-reactive protein in patients with acute myocardial infarction

Summary Background Asymmetric dimethylarginine (ADMA), and its symmetrical stereoisomer (SDMA) — as methylated products of l -arginine, decrease nitric oxide (NO) availability. Their elevated levels in diabetes increase the risk of acute myocardial infarction (MI), through endothelial dysfunction. Aims We investigated the relationship between circulating levels of ADMA, SDMA and functional relevant parameters in patients with acute MI. Methods Prospective study from 31 MI patients hospitalized l -arginine were determined using high-performance liquid chromatography (HPLC). Results Mean age was 65y, most were male, hypertensive, 1/3rd were current smokers, or had a history of CAD and 23% were diabetic. ADMA and l -arginine values were similar whatever the risk factor, except for ADMA that was positively correlated with blood glucose (r = 0.37). In contrast, SDMA was correlated with age (r = 0.43), and admission glucose (r = 0.57). SDMA was elevated in hypertension, prior CAD, statin therapy and showed a trend toward an increase in diabetic patients (p = 0.191). Moreover, there was a trend toward an elevation of SDMA with decreased LVEF (r = − 0.25). In multivariate linear regression analysis, blood glucose was an estimate of SDMA (s = 0.373, p = 0.025), beyond traditional markers of dimethylarginines including kidney failure. Conclusion Our study showed that in patients with acute MI, SDMA, and only weakly ADMA, are associated with admission blood glucose, beyond traditional dimethylarginine determinants and may therefore have biological activity beyond renal function.

The Relationship between Serum 25-Hydroxyvitamin D and Resistin Levels in Saudi Diabetic Patients

Objectives: The aim of this study was to investigate the relationship between the levels of 25-hydroxyvitamin D and the adipokine resistin in Saudi diabetic patients and those at high risk to develop atherosclerotic cardiovascular diseases. Methodology: One hundred and sixty seven subjects were recruited for the cross-sectional study at King Fahad Medical City, Saudi Arabia. Blood samples were analyzed for biochemical parameters. Serum 25-hydroxyvitamin D and resistin levels were measured for all the participants. Result: Fifty six type-1, 55 type-2 diabetic patients and 56 healthy controls were recruited. Serum 25-hydroxyvitamin D level in the control group was 44.21 ± 41.80 μg/ml compared to 50.67 ± 35.60 μg/ml in the diabetic group (P = 0.427) with no significant different between type-2 diabetes mellitus and type-1 diabetes mellitus (P = 0.628). Resistin level in the control group was 14.00 ± 7.39μg/ml compared to 20.21 ± 16.94 μg/ml in the diabetic group (P ≤ 0.01), no significant difference between type-2 diabetes mellitus and type-1 diabetes mellitus (P = 0.817). Resistin in those taking vitamin D supplementation was 21.34 ± 18.27 μg/ml; and in those not taking vitamin D supplementation, it was 17.4 ± 11.19 μg/ml; (P = 0.237). There was significant negative correlation between 25-hydroxyvitamin D and resistin in type-2 diabetes mellitus (P ≤ 0.043) and no significant correlation was found between vitamin 25 (OH) D and resistin level in type-1 diabetes mellitus (P = 0.538). Blood urea and creatinine showed significant positive correlation with vitamin 25 (OH) D in one hand and resistin level on the other hand. Discussion and Conclusions: Several in vitro and in vivo studies have confirmed that the vitamin 25 (OH) D have numerous important functions in the body. The circulating vitamin 25 (OH) D and resistin levels were associated with general inflammation in renal diseases. This study showed significant negative correlation between resistin level and vitamin 25 (OH) D in type 2 diabetes mellitus reflecting their roles in glucose homeostasis. The positive correlation of resistin and vitamin D with urea may reflect their involvement in kidney dysfunction. The level of serum resistin showed slight increase in diabetic patients compared to control group and it was higher in type-2 diabetes mellitus. More efforts are needed to explore the physiological mechanism of vitamin 25 (OH) D and resistin action in metabolic disorders.

Improving Drug Prescription in Elderly Diabetic Patients

Nowadays, there is no doubt that there is a good epidemic of ageing with the inversion of the population pyramid. There is no doubt either about the current epidemic of obesity and bad nutritional habits that have resulted in an increase of diabetic patients in the world. And the union of these epidemics has led to an increase of diabetes (DM) in the elderly.

Editorial: Cell-Based Therapies for Diabetic Microvascular Complications.

Editorial: Cell-Based Therapies for Diabetic Microvascular Complications.

Arterial hypertension and diabetes mellitus

The pathogenesis of arterial hypertension in patients with diabetes is a complicated process and involves a complex of biological and ecological factors, as well as genetic predisposition; as a result, the elevated blood pressure (BP) in patients with diabetes mellitus (DM) creates a higher risk of adverse events. Morbidity and mortality increase in diabetic patients who do not effectively control their BP to the targeted values of less than 140/90 (130/80) mm Hg. Large randomized trials and meta-analyses of large randomized controlled studies showed that the pharmacological reduction of BP is the most effective single way for reduction of mortality and of target organs damage in patients with DM, especially the related cardiovascular risk. Frequently, a combination of two or more medications (diuretics, angiotensin converting enzyme inhibitors, β-blockers, calcium channel blockers, angiotensin receptor blockers, spironolactone, etc.) is needed for effective pharmacotherapy, mostly in patients with difficult BP control. However, the costs of the health care to intensively lower BP are significantly lower than the expenditures to treat the hypertension complications, and the latter may be even prevented with BP reduction.

What is the ideal biological marker in diagnosis of diabetic neuropathies?

What is the ideal biological marker in diagnosis of diabetic neuropathies?

Platelet Isoprostane Overproduction in Diabetic Patients Treated With Aspirin

Aspirin modestly influences cardiovascular events in patients with type 2 diabetes mellitus (T2DM), but the reason is unclear. The aim of the study was to determine whether in T2DM patients aspirin enhances platelet isoprostanes, which are eicosanoids with proaggregating properties derived from arachidonic acid oxidation by platelet NOX2, the catalytic subunit of reduced NAD phosphate oxidase. A cross-sectional study was performed comparing T2DM patients, treated (n = 50) or not treated (n = 50) with 100 mg/day aspirin, with 100 nondiabetic patients, matched for age, sex, atherosclerosis risk factors, and aspirin treatment. A short-term (7 days) treatment with 100 mg/day aspirin also was performed in 36 aspirin-free diabetic and nondiabetic patients. Higher platelet recruitment, platelet isoprostane, and NOX2 activation was found in diabetic versus nondiabetic patients and in aspirin-treated diabetic patients versus nontreated patients (P < 0.001). Platelet thromboxane (Tx) A2 (P < 0.001) was inhibited in all aspirin-treated patients. In the interventional study, aspirin similarly inhibited platelet TxA2 in diabetic and nondiabetic patients (P < 0.001). Platelet recruitment, isoprostane levels, and NOX2 activation showed a parallel increase in diabetic patients (P < 0.001) and no changes in nondiabetic patients. These findings suggest that in aspirin-treated diabetic patients, oxidative stress–mediated platelet isoprostane overproduction is associated with enhanced platelet recruitment, an effect that mitigates aspirin-mediated TxA2 inhibition.