Independent Predictor Of Diabetes Mellitus Research Articles

The Relationship between the Angiographic Atherosclerotic Burden and the Inflammatory Factors in Diabetic and Non-Diabetic Patients with Coronary Artery Disease

Objective: Inflammation is a known pathophysiological feature that is common in both diabetes mellitus (DM) and atherosclerosis. High-density lipoprotein (HDL) is an anti-atherogenic lipoprotein and has an inverse relationship with coronary artery disease (CAD). In the present study, the association between the severity of CAD and inflammatory parameters neutrophil to HDL (NHR), lymphocyte to HDL (LHR), and platelet to HDL (PHR) was investigated. Methods: In this single-center prospective study, 98 diabetic (type 2 DM), and 320 non-diabetic CAD patients who underwent coronary angiography were enrolled. Baseline demographic characteristics were recorded, hematologic and biochemical samples were measured, the angiographic profile was analyzed, SYNTAX and Gensini scores were calculated for all patients. Results: Hypertension and smoking rates and HbA1c were higher in the diabetic group (p:0.001, p<0.001, p<0.001, respectively). NHR, LHR, and PHR were significantly higher in the diabetic group compared with the non-diabetic group (p:0.007, p:0.002, p:0.005, respectively). The diabetic group had higher SYNTAX and Gensini scores (p<0.001 for both). NHR, LHR, PHR, age, and hemoglobin were positively correlated with both SYNTAX and Gensini scores in the correlation analysis. Univariate and multivariate analyses showed that NHR, LHR, SYNTAX and Gensini scores were found to be independent predictors of DM in CAD patients. Conclusion: Our study demonstrated that the inflammatory parameters NHR, LHR, and PHR and atherosclerotic burden parameters SYNTAX and Gensini scores were worsening in diabetic patients. NHR, LHR, and PHR were significantly associated with higher SYNTAX and Gensini scores in diabetic and nondiabetic patients.

EVALUATION OF NEUTROPHIL-LYMPHOCYTE RATIO IN DIABETES AND CORONARY ARTERY DISEASE: A CASE CONTROL STUDY FROM INDIA

IntroductionSystemic inflammation leads to the development of both type 2 diabetes mellitus (DM) and coronary artery disease (CAD). MethodologyA case-control study of 120 participants was conducted in a tertiary-care center in Northern India. Study participants comprised four groups; 30 healthy controls, 30 patients with DM, 30 with CAD, and 30 with concomitant DM and CAD. Groups were age and sex-matched. CAD was diagnosed by coronary angiography when ≥ one lesion with >50% stenosis was present. Anthropometric measurements, complete hemogram, neutrophil-lymphocyte ratio (NLR), HbA1c, lipid profile, highly-sensitive C-Reactive Protein (CRP), and uric acid levels were measured. ResultsThe mean age was 61.26 ± 7.61, and 80 (66.6%) were male. Multinomial logistic regression analysis was used to determine the association of different parameters with disease. After adjusting for other parameters including body-mass index, HbA1c levels, lipid profile, hsCRP, and uric acid, NLR was an independent predictor of DM vs. Controls (Odds Ratio) 3.802 [1.457-9.917], CAD vs. Controls 9.807 [3.556-27.050], and Both vs. Controls 13.448 [4/725-38.279]. Uric acid was not a significant predictor. hsCRP was an independent predictor of only concomitant CAD and DM vs. Controls 1.558 [1.053-2.303]. A clear stepwise increase in NLR was observed across the four groups: lowest among healthy controls, followed by the DM group, CAD group, and the highest among those with CAD and DM. ConclusionNLR is an easily accessible and inexpensive inflammatory parameter. Appropriate cut-offs of NLR may be beneficial as screening tools for DM, CAD or both.

Fatty acid-binding protein-4 as a biomarker predicting acromegaly-associated diabetes mellitus.

Background/aimThe known pathogenesis of diabetes mellitus (DM) in acromegaly is mainly based on growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess. Fatty acid-binding protein 4 (FABP-4), a novel adipokine, is found to induce insulin resistance and type 2 DM. We aimed to investigate the possible effect of FABP-4 on glucose metabolism in patients with acromegaly.Materials and methodsThis case-control study included 28 patients newly diagnosed with acromegaly and 57 healthy volunteers. The patients with acromegaly were classified according to their glycemic status as with DM, prediabetes, and normal glucose tolerance. Anthropometric measurements, laboratory test results, and FABP-4 levels of the subjects were evaluated.ResultsAlthough no difference was observed in FABP-4 levels between acromegaly and control groups, the FABP-4 level was higher in the patients with acromegaly having DM compared to the patients with acromegaly having prediabetes and NGT, and the control group (p = 0.004, p = 0.001, p = 0.004, respectively). Logistic regression analysis suggested that the FABP-4 is an independent predictor of DM in acromegaly (β = 7.382, OR = 38.96, 95% CI: 1.52-5.76, p = 0.018).Conclusion The FABP-4 may be a helpful predictor of acromegaly-associated DM.

Serum cortisol level after low dose dexamethasone suppression test may be predictive for diabetes mellitus and hypertension presence in obese patients: A retrospective study

AimsObesity, a remarkably increased healthcare problem, accompanies with morbidities including type 2 diabetes mellitus (DM), hypertension, and cardiovascular diseases. Hypothalamic-pituitary-adrenal (HPA) axis alteration is thought to be effective on the background of obesity, even concomitant with DM and hypertension. We aimed to evaluate the negative feedback mechanism of the HPA axis via overnight 1 mg dexamethasone suppression test (DST) and the association of post-1 mg DST cortisol level with DM and hypertension presence in obesity. MethodsThis study consisted of 402 obese patients who provide suppression after DST. Post-1 mg DST cortisol level and its association with other variables including anthropometric measurements, laboratory test results, hypertension, prediabetes, and DM presence were evaluated. Predictivity of post-1 mg DST for hypertension and DM was investigated. ResultsWe established a significant difference in post-1 mg DST cortisol level when compared patients with and without DM, patients without DM and with prediabetes, patients with prediabetes and DM (p < 0.001 vs. p = 0.003 vs. p = 0.022 respectively). Post-1 mg DST cortisol level was significantly higher in hypertensive patients (p < 0.001). Post-1 mg DST cortisol level had positive correlation with age (r = 0.319, p < 0.001), fasting plasma glucose (r = 0.168, p = 0.001), and HbA1c (r = 0.278, p < 0.001) levels. Logistic regression analyses demonstrated that post-1 mg DST cortisol level is an independent predictor of DM and hypertension presence. ConclusionCortisol negative feedback mechanism may be altered in obese patients who are complicated with hypertension and DM. Therefore, post-1 mg DST cortisol level can be predictive for hypertension and DM presence in obesity.

Long-Term Pancreatic Functional Impairment after Surgery for Neuroendocrine Neoplasms.

Radical surgery represents the only curative treatment for pancreatic neuroendocrine neoplasms (PanNEN). The aim of this study was to evaluate the postoperative onset of diabetes mellitus (DM) and/or pancreatic exocrine insufficiency (PEI) in surgically treated PanNEN. Consecutive PanNEN patients, without preoperative DM, who underwent partial pancreatic resection, were included. After a median follow-up of 72 months, overall 68/276 patients (24%) developed DM. Patients who developed DM were significantly older (p = 0.002) and they had a higher body mass index (BMI) (p < 0.0001) than those who did not; they were more frequently male (p = 0.017) and with nonfunctioning neoplasms (p = 0.019). BMI > 25 Kg/m2 was the only independent predictor of DM (p = 0.001). Overall, 118/276 patients (43%) developed a PEI, which was significantly more frequent after pancreaticoduodenectomy (p < 0.0001) and in patients with T3-T4 tumors (p = 0.001). Pancreaticoduodenectomy was the only independent predictor of PEI (p < 0.0001). Overall, 54 patients (20%) developed disease progression. Patients with and without DM had similar progression free survival (PFS), whereas patients without PEI had better five-year-PFS (p = 0.002), although this association was not confirmed in multivariate analysis. The risk of DM and PEI after surgery for PanNEN is relatively high but it does not affect PFS. BMI and pancreatic head resection are independent predictors of DM and PEI, respectively.

Diabetes mellitus in patients with mental disorders: Prevalence and associated factors

People with mental disorders have comorbid physical illnesses, particularly an increased risk of diabetes mellitus (DM), found in many psychiatric disorders; schizophrenia, major depression and bipolar disorder. This elevated risk is associated with increased mortality, more so, as treatment of such medical conditions is not easily accessible by people with mental disorders. The aim of the paper is to determine the prevalence and associated factors for DM in patients with mental disorders in Kano, northwest Nigeria. In this cross-sectional study, one hundred and fifty-seven consecutive patients, aged 18 years and above, attending the outpatient psychiatry clinic of Aminu Kano Teaching Hospital were recruited. Sociodemographic and clinical characteristics questionnaires were completed. Height, weight and blood pressure were measured. Subsequently 3 mL of blood was taken using aseptic venepuncture technique and glycated hemoglobin (HbA1c) levels were detected, with a cutoff point of 6.5% used for diagnosis of DM. The age of the patients ranged between 18-79 years with a mean (SD) of 35.5 (±10.6) years. Majority of the patients 91 (58%) were female. Schizophrenia was the most common diagnosis (37.6%) The prevalence of DM was 24.2%. A statistically significant association was found between DM and age (P=0.021), duration of illness (P=0.016) and diagnosis of schizophrenia (P=0.027). DM is common in patients with mental disorders. Associated factors for DM in people with mental disorders include increasing age, prolonged duration of illness and a diagnosis of schizophrenia, the latter being an independent predictor of DM in people with mental disorders.

Statin Therapy and Risk of Diabetes Mellitus in Aging Patients With Heterozygous Familial Hypercholesterolemia or Familial Combined Hyperlipidemia: A 10-Year Follow-Up.

We assessed the incidence of diabetes mellitus (DM) in patients with heterozygous familial hypercholesterolemia (HeFH) and familial combined hyperlipidemia (FCH) treated with statins. Participants (n = 280) of mean age 59 ± 5 years were included (90 patients with HeFH, 112 patients with FCH, and 78 aged-matched participants). The median statin intensity treatment product (statin intensity in arbitrary equivalence units × duration of statin therapy in months) was 119 and 85 for patients with HeFH and FCH, respectively, at 10-year follow-up. The incidence of DM was significantly lower in patients with HeFH compared to the patients with FCH (2% vs 20%) and the reference group (2% vs 17%) during the 10-year follow-up period (all Ps < .001). Impaired fasting blood glucose at entry ( P < .001) and central obesity ( P = .02) were the only independent predictors of DM. The incidence of DM was significantly lower in older patients with HeFH compared to either aged-matched patients with FCH or individuals not receiving statins. Statins did not increase risk of DM in aging patients with FCH. These findings have implications, given the importance of high-intensity statin therapy for prevention of cardiovascular events, especially in patients with HeFH, a population with high cardiovascular risk.

Correlates of pre-diabetes and Type 2 diabetes in Buffalo City Municipality, South Africa

District health policies on non-communicable diseases are informed by reliable epidemiological data which are scarce in Buffalo City Metropolitan Municipality (BCMM), South Africa. This study addresses this evidence gap by examining the prevalence and correlates of pre-diabetes and type 2 diabetes among South African adult residents of BCMM. A cross-sectional survey of 998 adults (321 men and 677 women) attending the three largest out-patient clinics in BCMM was conducted using the World Health Organisation STEPwise Questionnaire. Glycaemic status was determined by analysing fasting blood glucose and use of diabetes medications. Multivariate logistic regression models were used to estimate the independent associations of sociodemographic, behavioural and cardiovascular risk factors with diabetes. The prevalence of prediabetes and diabetes was 14% and 24%, respectively. Age (p<0.000), marital status (p<0.000),employment status (p<0.000), level of income (p<0.000), level of education (p<0.000), alcohol consumption (p<0.000), physical activity (p<0.014), obesity (p<0.000) and hypertension (p<0.000) were significantly associated with diabetes mellitus. However, in the multivariate logistic regression analysis, after adjusting for confounders, only age (26 years and above)(AOR=1.9, CI= 1.4-2.7), ever married (AOR= 4.0, CI= 1.1-2.4), abdominal obesity (AOR= 1.9, CI= 1.2-2.9), alcohol use (AOR=1.6, CI= 1.1-2.4) and hypertension (AOR= 2.7, CI= 1.9-3.8) were the significant and independent predictors of diabetes mellitus. A high prevalence of diabetes found among the study participants could be attributed to modifiable risk factors and ageing. District health policies should be tailored toward addressing cardio-metabolic risk factors at both the primary health care and population levels.

High Serum Irisin Level as an Independent Predictor of Diabetes Mellitus

Irisin, a novel exercise-induced myokine, has been suggested to regulate energy homeostasis and insulin sensitivity. However, it remains unclear whether circulating irisin plays a role in the development of DM in human. We investigated the possible association between circulating irisin levels and incident DM in a 2.6-year longitudinal study of a population-based cohort comprised of rural Korean subjects.We conducted a longitudinal study within the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG) study from November 2005 to January 2008. Cases (n=85) were patients with incident DM during the follow-up period and controls (n = 85) were matched to incident DM cases based on sex and age at baseline. The relative risk of serum irisin/adiponectin level for incident DM was analyzed using conditional logistic regression analysis.Baseline irisin_ENREF_1 levels were significantly higher in subjects who developed DM than in subjects who did not. The serum irisin level was positively associated with glycated hemoglobin (HbA1c) and postprandial glucose. Irisin was negatively associated with adiponectin (R = –0.189, P = 0.014). After adjustment for potential confounders, including body mass index, the odds ratios [95% confidence intervals] for incident DM increased in a graded manner as the serum irisin level increased (Quartile 1 vs Quartile 2 vs Quartile 3 vs Quartile 4 = 1 vs 0.80 [0.28–2.35] vs 3.33 [1.11–10.00] vs 4.10 [1.35–12.44], respectively), whereas the odds ratios for incident DM decreased in a graded manner as the serum adiponectin level increased.High serum irisin was independently associated with the development of DM, indicating that irisin may be a useful predictor of DM in Korean adults.

Prevalence and Risk Factors For Diabetes Mellitus and Impaired Fasting Glucose among Adults Aged 15-64 Years in Gilgel Gibe Field Research Center, Southwest Ethiopia, 2013:Through a Who Step Wise Approach

Background: Diabetes mellitus is a common metabolic disorder resulting from defects in insulin action, production, or both. Despite the huge health and economic burden of diabetes mellitus, prevalence and risk factors of diabetes and pre diabetes mellitus are not well documented in Ethiopia generally and in the study area in particular. Therefore, this study was conducted to determine prevalence of diabetes mellitus and impaired fasting glucose and their risk factors among adults 15-64 years old in Gilgel Gibe Field Research Center. Method and materials: The study was based on secondary data collected from late September 2008 to the end of January 2009 in Gilgel Gibe Field Research Center of Jimma University according to WHO-STEP wise approach in a community setting. A total of 4371, 2653 and 1861adults in the age group of 15-64 years were included for step I, II and III respectively. Odds ratio with 95% confidence interval was estimated using multivariable logistic regression to identify independent predictors of diabetes mellitus and impaired fasting glucose. Results: The crude prevalence of diabetes mellitus and impaired fasting glucose among the study participants was 4.4 % [0.6% self-reported (95% CI: 0.30% 0.80%) vs 3.8% newly diagnosed (95% CI: 0.02 – 0.04)] and 9.7% [95% CI: 0.080.11] respectively. The age adjusted prevalence of DM and IFG to the standard world population was 3.7% [95%CI: 0.17-0.45] and 10.1% [95%CI: 0.32-0.67] respectively. Being male [AOR:3.0 (95%CI: 2.80-5.67)], being in the age group of 35-44 [AOR: 4.5 (95%CI: 3.05-10.23)], being current smoker [AOR:1.8 (95%CI:1.68-3.14)] and physically inactive [AOR:2.3 (95%CI:1.27-4.02)] while having central obesity [AOR: 2.5(95%CI:2.40-4.10)] and being in the age group of 55-64 [AOR:2.1(95%CI:1.69-5.23)]were independent predictors of diabetes mellitus and impaired fasting glucose respectively. Conclusion and recommendation: The prevalence of newly diagnosed diabetes mellitus and impaired fasting glucose was higher than the previous reports in Ethiopia and hence health information dissemination on modifiable risk factors such as smoking and regular physical activities as well as screening of high risk groups to reduce the disease burden are needed.

Increasing prevalence of diabetes mellitus in association with fatty liver in a Japanese population

The prevalence of diabetes mellitus (DM) has been increasing. The present study was carried out to examine the relationship between this increase and fatty liver. Japanese participants who underwent regular health examinations in 1991, 1996, 2001, 2006, and 2011 were enrolled. Fatty liver was diagnosed using ultrasonography. DM was defined as requiring the use of medication for DM, having a fasting blood glucose level ≥ 126 mg/dl, or hemoglobin A1c level ≥ 6.5 %. Logistic regression analysis on data from 11,235 participants (6,882 men and 4,271 women) in 2011 revealed that the association between fatty liver and DM was independent of age, body composition, and other confounders [odds ratio (OR) 1.97, 95 % confidence interval (95 % CI) 1.66-2.32 in men, and OR, 3.12; 95 % CI, 2.29-4.26 in women]. In 2006, 5,318 participants did not have DM and were able to be followed up in 2011. Fatty liver in 2006 was an independent predictor of DM in 2011 [OR 1.73 (95 % CI 1.20-2.50) in men, 4.13 (2.16-8.10) in women]. The prevalence of DM increased significantly during the 20-year period examined among both men (6.0, 8.9, 10.0, 10.8, 12.0 %, P < 0.001) and women (3.3, 4.5, 4.2, 4.1, 5.1 %, P = 0.004), accompanied with an increased prevalence of fatty liver among both men (10.8, 26.3, 33.8, 36.7, and 38.0 %, P < 0.001) and women (6.5, 16.7, 22.2, 21.3, and 20.8 %, P < 0.001). Fatty liver independently predicts both present and future DM. Fatty liver may play an important role in the recent increases in the prevalence of DM.

Racial/Ethnic Variability in Diabetes Mellitus among United States Residents Is Unexplained by Lifestyle, Sociodemographics and Prognostic Factors

Background. The mortality and prevalence of diabetes mellitus (DM) vary across racial/ethnic groups with African Americans/blacks being disproportionately affected. However, it is unclear to what extent such disparities persist after the adjustment for covariates related to race/ethnicity and/or DM in the population. We aimed to assess racial/ethnic disparities in DM and to determine which covariates account for the observed racial/ethnic variabilities. Materials and Methods. We utilized a large cross-sectional survey of the US noninstitutionalized residents (n=30,852) to investigate the racial/ethnic disparities in diabetes mellitus, and the degree in which the disparities are explained by the relevant covariates. Pearson’s chi-square was used to examine study variables by race/ethnicity, while logistic regression was used to assess the effect of race/ethnicity and other covariates on DM prevalence. Results. There were statistically significant ethnic/racial differences with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P&lt;0.05, but not insurance coverage, P&gt;0.05. Race/ethnicity was a single independent predictor of DM, with African Americans (non-Hispanic blacks) more likely to be diagnosed for DM compared with non-Hispanic whites, prevalence odds ratio (POR) 1.45, 95% confidence interval (CI) 1.30–1.62, while Hispanics were less likely to be diagnosed, POR = 0.98, 95% CI 0.87–1.09. Similarly, after controlling for potential confounders, the racial/ethnic variability in DM between AA/blacks and non-Hispanic whites persisted, adjusted POR = 1.30, 95% CI 1.15–1.47. Conclusions. Racial/ethnic variability exists in DM prevalence and is unexplained by racial/ethnic variance in education, income, marital status, smoking, alcohol, physical activities, age, and sex.

Circulating Endothelial Microparticles in Diabetes Mellitus

Background. Endothelial Microparticles (EMPs) are small vesicles shed from activated or apoptotic endothelial cells and involved in cellular cross-talk. Whether EMP immunophenotypes vary according to stimulus in Diabetes Mellitus (DM) is not known. We studied the cellular adhesion molecule (CAM) profile of circulating EMPs in patients with and without Diabetes Mellitus type 2, who were undergoing elective cardiac catheterization. Methods and Results. EMPs were analyzed by flow cytometry. The absolute median number of EMPs (EMPs/μL) specific for CD31, CD105, and CD106 was significantly increased in the DM population. The ratio of CD62E/CD31 EMP populations reflected an apoptotic process. Conclusion. Circulating CD31+, CD105+, and CD106+ EMPs were significantly elevated in patients with DM. EMPs were the only independent predictors of DM in our study cohort. In addition, the EMP immunophenotype reflected an apoptotic process. Circulating EMPs may provide new options for risk assessment.

Leptin and cardiovascular disease: response to therapeutic interventions.

Leptin and cardiovascular disease: response to therapeutic interventions.

Prognostic significance of diabetes in acute myocardial infarction. Are the differences linked to female gender?

Sir at variance with the Diabetes Mellitus and Acute We read with interest the recent paper by GalceraMyocardial Infarction (DIAGAMI) Study [10,11] Tomas et al. [1] in The Journal, which found that where gender was not an independent predictor of diabetes mellitus was not an independent predictor of mortality. mortality post-myocardial infarction. Interestingly, Such variation in outcome following myocardial female gender was associated with an increased risk infarction may be due, in part, to gender-related of adverse events following acute myocardial infarcdifferences in the interaction between the left ventrition but only in the diabetic population. cle and the arterial tree (ventriculo-vascular couThe link between diabetes mellitus and carpling). An important determinant of which is the diovascular disease is well described [2], and previshape of the central pressure waveform. A recent ous studies have demonstrated a worse prognosis for study by Hayward and Kelly demonstrated differdiabetics post-myocardial infarction [3]. However, ences in the aortic pressure waveform between men the effect of gender on cardiovascular risk, and the and women [12]. Augmentation index (AIx) – a interaction between gender and diabetes mellitus is measure of the degree to which systolic pressure is complex. Women have a lower incidence of isaugmented by wave reflection – was consistently chaemic heart disease than men until they reach the greater in women compared with men throughout all menopause [4] or develop diabetes [5]. However, the decades of life [12]. This was due mainly to shorter mechanisms involved in the protective effect of stature and a different ejection pattern in women, female gender remain poorly understood, although resulting in earlier return of the reflected pressure oestrogens may clearly be important. This is despite a wave to the ascending aorta. Increased augmentation greater age-related rise in left ventricular mass, an not only raises central systolic pressure and left important and independent predictor of all cause ventricular workload, which may explain why healthy mortality, amongst women compared with men [6]. women have a greater left ventricular mass compared A number of studies have investigated the effect of with men, but also reduces the subendocardial viabiligender on prognosis following myocardial infarction. ty index [12]. This may account for the correlation In non-diabetics, at least, the results appear to be between short stature and the risk of coronary heart consistent, with higher rates of heart failure postdisease and stroke in both men [13] and women [14]. infarction [7,8], and a significantly greater risk of Moreover, since women are, in general, shorter than ventricular rupture [9] amongst women. Within the men, height may be a potential confounding variable diabetic population, the results are less consistent. in studies assessing the effect of gender on carIndeed, the findings from Galcera-Tomas et al. [1] are diovascular risk. Unfortunately, although body mass