Lower HbA1c Levels Research Articles

Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study.

Biochemical remission of type 2 diabetes is achievable through dietary changes, physical activity and subsequent weight loss. We aim to identify distinct diabetes remission trajectories in a large population-based cohort over seven-years follow-up and to examine associations between remission trajectories and diabetes complications. Group-based trajectory modelling examined longitudinal patterns of HbA1c level (adjusting for remission status) over time. Multivariable Cox models quantified the association between each remission trajectory and microvascular complications, macrovascular complications, cardiovascular (CVD) events and all-cause mortality. Four groups were assigned. Group 1 (8,112 [13.5%]; achieving HbA1c <48 mmol/mol (6.5%) followed by increasing HbA1c levels); Group 2 (6,369 [10.6%]; decreasing HbA1c levels >48 mmol/mol (6.5%)); Group 3 (36,557 [60.6%]; stable high HbA1c levels); Group 4 (9,249 [15.3%]; stable low HbA1c levels (<48mmol/mol or <6.5%)). Compared to Group 3, Groups 1 and 4 had lower risk of microvascular complications (aHRs (95% CI): 0.65 (0.61-0.70), p-value <0.001;0.59 (0.55-0.64) p-value<0.001, respectively)), macrovascular complications (aHRs (95% CI): 0.83 (0.75-0.92), p-value<0.001; 0.66 (0.61-0.71), p-value<0.001) and CVD events (aHRs (95% CI): 0.74(0.67-0.83), p-value<0.001; 0.67(0.61-0.73), p-vlaue<0.001). Risk of CVD outcomes were similar for Groups 2 and 3. Compared to Group 3, Group 1 (aHR: 0.82(95% CI: 0.76-0.89)) had lower risk of mortality, but Group 4 had higher risk of mortality (aHR: 1.11(95% CI: 1.03-1.19)). Risk of CVD outcomes vary by pattern of remission over time, with lowest risk for those in remission longer. People who achieve remission, even for shorter periods of time, continue to benefit from this lower exposure to hyperglycaemia, which may, in turn, lower the risk of CVD outcomes including mortality.

Albuminuria Screening in People With Type 2 Diabetes in a Managed Care Organization

Albuminuria-an increased amount of urine albumin, in milligrams, adjusted for grams of urine creatinine-is an early marker of diabetic kidney disease. Several new classes of medications are now available that effectively lower albuminuria levels with the potential to delay or prevent the progression of diabetic kidney disease. However, screening for albuminuria in the U.S. is low in population-based studies (<10% to ∼50% at most). In this study, we examine whether screening for albuminuria was improved in an integrated model of healthcare delivery following the recommendations of the National Committee for Quality Assurance mandate (an umbrella group for the managed healthcare industry) to screen for albuminuria. We examined screening for albuminuria over a 2-year period among people with Type 2 diabetes in a U.S. HMO with an electronic medical record, onto which automated laboratory ordering for albuminuria could be added when a patient appeared at the laboratory (for any reason) if albuminuria testing had not been obtained within the previous 365 days. Participants under this plan received diabetes education at no cost and panel managers to guide their diabetes care. Logistic regression using data from 2020 and 2021, separately, evaluated the relationship between patient characteristics and the likelihood of albuminuria screening. There were 20,688 and 22,487 participants with Type 2 diabetes mellitus in 2020 and 2021, respectively, who were analyzed. Approximately 80% were screened for albuminuria in both years. African American participants and those aged >64 years were more likely to have completed albuminuria screening. Screened individuals had lower HbA1c, blood pressure, and low-density lipoprotein cholesterol levels than those who were not screened. In an integrated healthcare model, it is possible to achieve consistently high rates of albuminuria screening in people with Type 2 diabetes, especially in groups at high risk for kidney disease.

The association between blood sugar control and hearing impairment in individuals with type 2 diabetes mellitus: a prospective study using otoacoustic emissions as a biomarker

Background: The existing association between hearing impairment and diabetes mellitus (DM) prompted us to investigate the relationship between glycaemic control, as measured by HbA1c levels, and hearing impairment in individuals with type 2 diabetes mellitus (T2DM). Methods: In this study, we assessed the auditory function of a sample of 100 individuals diagnosed with T2DM, who were aged 30 years or older and had a disease duration of at least 5 years. The evaluation was conducted using distortion product otoacoustic emissions and transient evoked otoacoustic emissions. The criteria for poor glycaemic control were established as HbA1c levels equal to or exceeding 7.5%. Results: Individuals with a haemoglobin A1c (HbA1c) level of 7.5% or higher exhibited a nearly threefold increased likelihood of developing hearing impairment in comparison to those with lower HbA1c levels. The gender-based observation revealed a stronger association in females, although the observed correlation did not reach statistical significance. Conclusions: The findings of our study establish a significant association between inadequate management of blood glucose levels and the occurrence of hearing impairment among individuals with T2DM. These results underscore the importance of achieving optimal glycaemic control as a means of preventing hearing impairment in this patient population. Further investigation is required to substantiate these findings through a comprehensive and longitudinal research approach.

Effects of fecal microbiota transplantation in metabolic syndrome: A meta-analysis of randomized controlled trials.

The prevalence of obesity and type 2 diabetes is rapidly increasing worldwide, posing serious threats to human health. This study aimed to evaluate the role of FMT in the treatment of obesity and/or metabolic syndrome and its impact on clinically important parameters. We searched Medline, Embase, and Cochrane Library databases up to April 31, 2022 and further assessed articles that met the eligibility criteria. Mean differences and 95% confidence intervals were used to analyze continuous data. The I2 statistic was used to measure study heterogeneity. Univariate meta-regression or subgroup analyses were performed to explore the covariates that might contribute to heterogeneity. Potential publication bias was assessed using the Egger's test. We used the GRADEpro guideline development tool to assess the quality of the evidence. Nine studies, comprising 303 participants, were included in the meta-analysis. In the short-term outcomes (<6 weeks after FMT), compared with the placebo group, patients in the FMT group had lower FBG (MD = -0.12 mmol/L, 95% Cl: -0.23, -0.01), HbA1c (MD = -0.37 mmol/mol, 95%Cl: -0.73, -0.01), and insulin levels (MD = -24.77 mmol/L, 95% Cl: -37.60, -11.94), and higher HDL cholesterol levels (MD = 0.07 mmol/L, 95% Cl: 0.02, 0.11). FMT, as an adjunctive therapy, does not produce any serious adverse effects and may be useful in the treatment of metabolic syndrome, especially in improving HbA1c, insulin sensitivity, and HDL cholesterol. However, there was no significant difference between the FMT group and the placebo group in terms of weight reduction.

Psychosocial Factors Associated with Well‐Being and HbA1c of People with Diabetes in Japan: A Structural Equation Model1

AbstractThe purpose of this study is to investigate psychosocial factors (independent and interdependent self‐construal, emotional support) that may influence the health and well‐being of people with diabetes in an interdependent culture. We conducted a cross‐sectional survey on outpatients of type 1 and type 2 diabetes mellitus in Japan (N = 180, age 22–88 years, M = 62.48 years), to examine their independent and interdependent self‐construal, perceived emotional support, and well‐being (interdependent happiness). HbA1c data was obtained from their recent health record via their endocrinologists. Correlation analyses and structural equation modeling (SEM) were conducted to examine the relation between these variables. Patients' well‐being correlated positively with age, independent self‐construal, perceived emotional support, and negatively with HbA1c levels, but did not correlate with interdependent self‐construal. SEM showed that, after controlling for age and gender, independence was related to perceived emotional support and well‐being, which were in turn related to lower HbA1c levels. Our research suggests that, for people with diabetes in Japan, independence rather than interdependence is associated with their psychological well‐being and health outcome.

Effect of Lixisenatide (Short-acting Glucagon-Like Peptide 1 Receptor Agonist) as an Add-on to Insulin in Lowering HbA1C among Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

Objective: This systematic review and meta-analysis aimed to evaluate the effect of Lixisenatide, a short-acting glucagon-like peptide 1 receptor agonist, as an add-on therapy to insulin in patients with type 2 diabetes (T2DM). The primary outcome of interest was the change in HbA1c levels. Methods: A comprehensive literature search was conducted in major databases for relevant studies published up to the present. Seven studies were included in the quantitative data synthesis. The characteristics of the included studies, including intervention, design, duration, sample size, demographics, baseline characteristics, and outcome measures, were summarized in a descriptive manner. A pooled analysis was performed to assess the overall effect of Lixisenatide on HbA1c levels. Heterogeneity among the studies was evaluated, and sensitivity analyses were conducted when necessary. Results: The pooled analysis of the seven included studies demonstrated a significant reduction in HbA1c levels with Lixisenatide as an add-on therapy to insulin. The mean difference (MD) was -0.41% (95% CI: -0.55 to -0.28), indicating a clinically meaningful improvement in glycemic control. Although heterogeneity was observed among the studies (I² = 80%, p &lt; 0.0001), the overall effect estimate remained consistent. Conclusion: Our systematic review and meta-analysis provide robust evidence supporting the efficacy of Lixisenatide as an add-on therapy to insulin in lowering HbA1c levels in patients with T2DM. The significant reduction in HbA1c levels indicates mproved long-term glucose control, which is associated with reduced risks of diabetes-related complications. Clinicians should consider incorporating Lixisenatide into the treatment regimen of patients with T2DM who require additional glycemic control beyond insulin monotherapy. Further research is needed to explore secondary outcomes and safety profiles associated with Lixisenatide in this patient population. Key words: lixisenatide , add on therapy, insulin , glp-1 receptor agonist, Type 2 diabetes

A Case Study to Evaluate the Role of Trayaushnadi Vati in the Management of Madhumeha (Type 2 Diabetes Mellitus)

India is known as the diabetes capital of the world. By 2025, the country's diabetes population will have risen to 69.9 million, and by 2030, it will have risen to 80 million. This means that the developing country is anticipated to have a 266% gain. In the present study, a 35-years-old obese male patient came to the OPD with complaints of Daurbalyata (weakness), Atimutrata (increased frequency of micturition) and Atitrishna (excessive thirst) since seven days. The diagnosis leads to Madhumeha (Type 2 Diabetes mellitus) through physical findings and biochemical investigations. The treatment plan opted for was Trayaushnadi Vati with a change in diet and lifestyle. This case study emphasizes the usefulness of Ayurveda and it aims to detoxify, purify, strengthen and balance the body Dosha (regulatory functional factors of the body) of the body Dhatus (major structural components of the body) to attack the root cause and ensure complete healing. Several medicinal herbs appear to be as beneficial as traditional anti-diabetic medications in lowering HbA1c levels. To determine the benefits of prospective plant-based medicines on diabetes, rigorous trials with at least 3 months of follow-up are required.

Impact of prediabetes with a high risk of diabetes stratified by glycated hemoglobin level on the severity of coronavirus disease 2019 during admission.

Prediabetes with a glycated hemoglobin (HbA1c) level of 5.7 - 6.4% is associated with a poor prognosis of coronavirus disease 2019 (COVID-19), but whether the degree of glycemic control is associated with COVID-19 severity is unknown. The aim of this study was to evaluate the association between the degree of glycemic control and COVID-19 severity in patients with prediabetes. We reviewed 254 patients with COVID-19 admitted to our hospital between April 2020 and September 2021. Based on their HbA1c level, patients were classified into low (HbA1c level < 5.7%), moderate (HbA1c level, 5.7 - 5.9%), and high risk of diabetes (HbA1c level, 6.0 - 6.4%). The association between risk of diabetes and the worst COVID-19 symptom in terms of severity during admission was evaluated using binary logistic regression analysis. Seventy-one and 88 patients had moderate and high risks of diabetes, respectively. Sixty-three and seven patients presented severe (requiring non-invasive oxygen therapy) or critical (intensive care unit admission or artificial respiratory management) COVID-19. The multivariate logistic regression analysis showed that a high risk of diabetes was correlated with severe COVID-19 (P = 0.01) after adjusting for baseline characteristics, whereas a moderate risk of diabetes was not (P = 0.17). Prediabetes with a high risk of diabetes is associated with the worst COVID-19 symptom in terms of severity during admission. Our findings could aid in more efficient allocation of healthcare resources to a narrower population of prediabetic patients. The online version contains supplementary material available at 10.1007/s13340-023-00643-z.

Correlation of Norepinephrine with some biochemical Parametric in Patients with type 2 diabetes mellitus.

Abstract&#x0D; Background: Type 2 diabetes is a chronic metabolic disorder characterized by high blood sugar levels (hyperglycemia) resulting from the body's reduced ability to produce or use insulin effectively. Insulin is a hormone that regulates blood sugar levels, and in type 2 diabetes, the body either does not produce enough insulin or becomes resistant to its effects. This causes a buildup of glucose in the bloodstream, which can eventually harm organs and tissues. This study was carried out on patients who attended the Diabetes and Endocrinology Specialist Center of Marjan City for Medical Education in Babil Province., all patients were diagnosed by a specialist physician. The practical side of the study was performed at the Clinical Chemistry Laboratory in the College of Medicine and College of Biotechnology, Al-Qadisiyah University.&#x0D; &#x0D; Objectives: Investigate the Correlation of Norepinephrine with some biochemical Parametric in patients with type 2 diabetes mellitus.&#x0D; Methods: The method used in this study Enzyme-Linked Immunosorbent Assay (ELISA).&#x0D; Results: In the metformin treatment group and the group not using antidiabetic treatment, there are weak associations between norepinephrine and insulin levels, but these associations are not statistically significant. In the diamicron MR treatment group, norepinephrine is significantly correlated with lower levels of fasting blood glucose and HbA1c.&#x0D; Conclusions: Norepinephrine dysregulation may be associated with type 2 diabetes, regardless of specific treatments, indicating a potential role of norepinephrine in the pathophysiology of the disease.

Investigation of the Effects of Chia-fortified Basisa on Diabetic Patients

It suggested that phytochemicals found in cereals, legumes and chia possess several health effects. Consequently, this study aimed to investigate the influences of chia-fortified basisa on type II diabetes, total cholesterol and triglycerides. Urea, creatinine, blood pressure and body mass index were also determined. Basisa is a cereal-legumes food that were prepared using wheat, chickpea, lentils, fenugreek, turmeric and cumin in measured ratios. Chia powder was added to basisa by 5 and 10%. The participants were diabetic (type II) with cholesterol and triglycerides elevation. They were divided into three groups according to the chia powder (0, 5 and 10%) used. The study were conducted for 90 days. The results indicated that groups who had basisa with chia had significantly (p ˂ 0.01) low levels of HbA1c, cholesterol, LDL, triglycerides, BMI and blood pressure compared to the control groups after 90 days of the study. Urea and creatinine levels were increased; however, their levels were still in the normal range. It can be concluded chia powder enhanced the positive effects of basisa on chronic diseases and obesity.

27-OR: Residual Beta-Cell Function Associates with Lower Glycaemic Variability and More Time in Range in Individuals with Type 1 Diabetes

Introduction: A significant proportion of individuals with type 1 diabetes (T1D) have long-term preservation of beta-cell function. Residual beta-cell function (RBCF) is associated with fewer long-term complications and hypoglycemic events. Yet, little is known about the influence of RBCF on daily glycemic control. Therefore, we investigated the associations between RBCF and daily markers of glycemic control in individuals with T1D. Methods: In this cross-sectional study 500 individuals with T1D were included (41.0 ±14years), 64% female, HbA1c 55.6 ±12mmol/mol, median T1D duration 14 years [IQR: 6-29years]. As a validated marker of RBCF, postprandial urinary C-peptide/creatinine ratios (UCPCR) were measured. Time in euglycemic range (TIR) (3.9-10mmol/L) and hypoglycemic range (TUR) (&amp;lt;3.9-10mmol/L) were monitored 14 days prior to the study visit, with a continuous glucose monitoring device. Spearman correlations were calculated in Rstudio. Results: The median UCPCR was 0.03 (IQR: 0.00-0.88) nmol/mmol and strongly correlated with duration of T1D (r = -0.651, p &amp;lt; 0.001). Higher UCPCR correlated with longer TIR (r = 0.330, p &amp;lt; 0.001), lower mean glucose levels (r =-0.318, p=0.005) and shorter TUR (r= -0.237, p &amp;lt;0.001) and lower glucose variation (-0.356, p &amp;lt;0.001). In line, higher UCPCR associated with lower HbA1c levels (r= -0.183, p&amp;lt;0.001) and less 24-hour insulin use (r = -0.183, p = &amp;lt;0.001). The associations remained significant in linear regression models when adjusted for sex, age, plasma glucose and duration of diabetes. Conclusion: UCPCR correlates with more time in range, shorter time under range, and lower HbA1c levels in individuals with T1D. Beneficial effects of beta-cell preservation in T1D may therefore be attributable to less intermittent glucotoxicity and hypoglycaemic episodes. Disclosure C.Fuhri snethage: None. M.Nieuwdorp: Advisory Panel; caelus health. N.Hanssen: Consultant; Novo Nordisk, Research Support; Novo Nordisk. T.J.Mcdonald: None. E.Rampanelli: None. P.De groen: None. A.W.M.Schimmel: None. D.Van raalte: Consultant; Boehringer Ingelheim and Eli Lilly Alliance, AstraZeneca, Merck &amp; Co., Inc., Research Support; Boehringer Ingelheim and Eli Lilly Alliance, AstraZeneca, Merck &amp; Co., Inc. C.B.Brouwer: None. R.A.Oram: Consultant; Janssen Research &amp; Development, LLC, Research Support; Randox R &amp; D. B.O.Roep: None. Funding DNF DON Grant 2020 (2020.10.002)

1068-P: Correleations of HbA1c, Continuous Glucose Monitor (CGM) Use, Insurance Type, and Language in a Large Pediatric Diabetes Practice in Phoenix, Arizona

Background: Inequities among technology use in pediatric type 1 diabetes (T1D) patients remains prevalent. These disparities contribute to poor glycemic control. Method: This study was a retrospective chart review of HbA1C and CGM use by type of insurance, ethnicity and language spoken at home in 2022. Results: In a cohort of nearly 2000 T1D pediatric patients, differences were found in HbA1c levels between ethnicities (mean of 8.6% Hispanics and 8.1% non-Hispanics). However, when stratified by insurance type (Private vs Medicaid), the relationship of ethnicity to HbA1C levels was no longer present, suggesting insurance drives differences in HbA1C levels rather than ethnicity. The effects of insurance may in part be related to technology use. An average of 45% of patients with private insurance use CGMs, in comparison with 32% of those with Medicaid. The use of CGMs compared with non-use of CGMs had a positive effect on HbA1C (8.3% vs 9.0%). Conclusions: CGM use is associated with lower HbA1C levels in our practice. Patients on Medicaid had higher HbA1C levels and less use of CGM. Hispanic and non-English speaking patients were more likely to be on Medicaid, and to have higher HbA1C levels and lower use of CGMs. These findings highlight the need to reduce health inequities among these populations. Our clinic will aim to develop interventions to improve technology use and access in Medicaid, Hispanic, and non-English speaking populations. Disclosure L.Holzmeister: None. S.Chmelnik: None.

1140-P: Increasing Insulin Pump Use in Youth with New-Onset T1D

Background: Insulin pump therapy is associated with enhanced quality of life (QoL) and lower HbA1c levels in youth with T1D. At our institution, we noted underutilization of insulin pumps and variability in prescribing practices. Thus, we led a quality improvement initiative to increase insulin pump use in youth age &amp;lt;18 years with new-onset T1D (duration &amp;lt;1 year) from baseline of 17% to &amp;gt;25% from January 2021 to November 2022. Methods: A series of Plan-Do-Study-Act cycles began at one of our three campuses with spread to all locations, including education of diabetes educators and providers about a newly created pump initiation algorithm with action plan for sick day management, standardized prescribing recommendations with intent to mitigate prescribing biases, early introduction of pumps by 90 days from diagnosis, and advanced scheduling of post-pump follow ups. Results: P-Chart (Figure 1) shows an increase in percentage of patients with new onset T1D on insulin pump therapy from a process average of 17% to 21%. Conclusion: Our QI efforts on standardizing the approach to pump therapy initiation and multidisciplinary education led to an increase in insulin pump uptake in our new-onset T1D cohort. We plan to evaluate improvement in HbA1c levels, pump related hospitalization rates, and impact on QoL in our patient cohort. Disclosure M.Vakharia: None. D.A.Buckingham: None. S.Lyons: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation. R.Y.Sonabend: None. G.K.Kim: None.

1218-P: All-Cause Mortality in Individuals Aged 65+ Years with Type 2 Diabetes With and Without Frailty—Clinical Utility of Electronic Frailty Index to Individualise HbA1c Targets

Frailty and type 2 diabetes (T2D) is fast becoming a clinical challenge especially in the elderly population. Despite clear guidance on the need to evaluate individualised HbA1c targets in connection with frailty status with mortality risk, there is a lack of formal evidence on these associations. To guide healthcare professionals in setting appropriate HbA1c targets, this study aimed to investigate the association between mortality in connection with electronic frailty index (eFI) and HbA1c, as well as exploring the clinical utility of eFI as a tool to individualise HbA1c targets in frail patients with T2D. Methods: We included patients with T2D aged 65+ within UK primary care electronic database (the Clinical Practice Research Datalink) and Hospital Episode Statistics from 2014-19. All-cause mortality (ACM) risk associated with 4 frailty groups (non-frail; mild; moderate and severe) (defined by electronic frailty index scores, eFI) and seven HbA1c groups at 1.0% intervals were assessed using multivariate Cox regression analysis adjusted for demographic and clinical characteristics. The reference group was defined as “non-frail” individuals with HbA1c 6.5-7.5%. Results: 179,723 individuals (mean±SD; age 74.8±7.6years, diabetes duration 7.3±6.1years, HbA1c 55.7±15.8mmol/mol) were followed for mean 1.7 years. Within all frailty groups, the risk of ACM was greatest at HbA1c&amp;lt;5.5%, with highest risk observed in moderate (HR 3.34; 95%CI 2.80, 3.99) and severe frailty (HR 3.27; 95%CI 2.73, 3.91) groups. In all groups, ACM risk increased with higher HbA1c levels compared to HbA1c 6.5-7.5% (a “U-shaped” curve). Conclusion: Both high and low HbA1c levels increase the risk of ACM for people 65+ with T2D and frailty in a “U-shaped” association between HbA1c and ACM. This study supports eFI as a useful tool to facilitate HbA1c target setting in older patients with T2D and to manage ACM risk. Disclosure T.S.J.Crabtree: Speaker's Bureau; Abbott Diabetes, Novo Nordisk, Lilly, Sanofi, Insulet Corporation. Y.Vinogradova: None. R.Aldafas: None. J.Gordon: Employee; Health Economics and Outcomes Research Ltd. I.R.Idris: None.

Uncovering Predictors of Lipid Goal Attainment in Type 2 Diabetes Outpatients Using Logic Learning Machine: Insights from the AMD Annals and AMD Artificial Intelligence Study Group.

Identifying and treating lipid abnormalities is crucial for preventing cardiovascular disease in diabetic patients, yet only two-thirds of patients reach recommended cholesterol levels. Elucidating the factors associated with lipid goal attainment represents an unmet clinical need. To address this knowledge gap, we conducted a real-world analysis of the lipid profiles of 11.252 patients from the Annals of the Italian Association of Medical Diabetologists (AMD) database from 2005 to 2019. We used a Logic Learning Machine (LLM) to extract and classify the most relevant variables predicting the achievement of a low-density lipoprotein cholesterol (LDL-C) value lower than 100 mg/dL (2.60 mmol/L) within two years of the start of lipid-lowering therapy. Our analysis showed that 61.4% of the patients achieved the treatment goal. The LLM model demonstrated good predictive performance, with a precision of 0.78, accuracy of 0.69, recall of 0.70, F1 Score of 0.74, and ROC-AUC of 0.79. The most significant predictors of achieving the treatment goal were LDL-C values at the start of lipid-lowering therapy and their reduction after six months. Other predictors of a greater likelihood of reaching the target included high-density lipoprotein cholesterol, albuminuria, and body mass index at baseline, as well as younger age, male sex, more follow-up visits, no therapy discontinuation, higher Q-score, lower blood glucose and HbA1c levels, and the use of anti-hypertensive medication. At baseline, for each LDL-C range analysed, the LLM model also provided the minimum reduction that needs to be achieved by the next six-month visit to increase the likelihood of reaching the therapeutic goal within two years. These findings could serve as a useful tool to inform therapeutic decisions and to encourage further in-depth analysis and testing.

#6467 DETERMINANTS OF NON-DIABETIC KIDNEY DISEASES IN DIABETIC PATIENTS

Abstract Background and Aims While diabetic nephropathy is the main kidney disease in patients with type 2 diabetes mellitus, a variety of non-diabetic kidney diseases (NDKD) may also occur. The decision to order a biopsy in diabetic patients is not an easy one as diabetic kidney disease is itself a proteinuric condition. The main objective of this study is to define factors that may differentiate isolated diabetic nephropathy and non-diabetic kidney disease in diabetic patients. In addition, we also aimed to analyze the effects of treatment choices on renal and overall survival. Method The study was conducted at a university hospital, which served as a tertiary healthcare center. One hundred and three diabetic patients who underwent kidney biopsy were involved in the study. Demographic characteristics, physical examination findings, laboratory tests and kidney biopsy findings were retrospectively evaluated. Results According to kidney biopsy findings 30 patients (29,1%) had isolated diabetic nephropathy. NDKDs were present in 73 (70,9%) of the patients. 78,1% of the patients with NDKDs had non-diabetic glomerular diseases. Among glomerular diseases, focal segmental glomerulosclerosis (36,9%), IgA nephropathy (17,8%) and membranous nephropathy (13,7%) were the leading three diseases. The duration of diabetes (p=0,00), HBA1C level (p=0,00) and the amount of proteinuria (p=0,02) were higher in patients who had isolated diabetic nephropathy. Presence of diabetic retinopathy (p=0,00), concomitant vascular diseases (p=0,02) and the use of insulin treatment were also more often in patients with isolated diabetic nephropathy. Multivariate analysis revealed that patients with higher HBA1C levels and longer diabetes duration had more tendencies to have isolated diabetic nephropathy. Immunosuppressive treatments for glomerular diseases were administered in around 50% of the patients. However, renal and overall survivals were not different between patients who received immunosuppressive treatments and those who didn't. Conclusion A renal biopsy in diabetic patients might be preserved for those with shorter diabetes duration and lower HBA1C levels. As poor glycemic control and susceptibility to infections pose additional risks, immunosuppressive treatments might not always be beneficial.

Clinical and HLA genotype analysis of immune checkpoint inhibitor-associated diabetes mellitus: a single-center case series from China.

To investigate the clinical characteristics and HLA genotypes of patients with immune checkpoint inhibitor-associated diabetes mellitus (ICI-DM) in China. We enrolled 23 patients with ICI-DM and 51 patients with type 1 diabetes (T1D). Clinical characteristics of the patients were collected. HLA-DRB1, HLA-DQA1, and HLA-DQB1 genotyping was conducted via next-generation sequencing. The ICI-DM patients had a male predominance (70.6%), a mean body mass index (BMI) of 21.2 ± 3.5 kg/m2, and a mean onset of ICI-DM in 5 (IQR, 3-9) cycles after ICI therapy. Most (78.3%) ICI-DM patients were treated with anti-PD-1, 78.3% presented with diabetic ketoacidosis, and all had low C-peptide levels and received multiple insulin injections. Compared to T1D patients, ICI-DM patients were significantly older (57.2 ± 12.4 vs 34.1 ± 15.7 years) and had higher blood glucose but lower HbA1c levels (P<0.05). Only two (8.7%) ICI-DM patients were positive for islet autoantibodies, which was lower than that in T1D patients (66.7%, P<0.001). A total of 59.1% (13/22) of ICI-DM patients were heterozygous for an HLA T1D risk haplotype, and DRB1*0901-DQA1*03-DQB1*0303 (DR9) and DRB1*0405-DQA1*03-DQB1*0401 were the major susceptible haplotypes. Compared to T1D, the susceptible DR3-DQA1*0501-DQB1*0201 (DR3) and DR9 haplotypes were less frequent (17.7% vs 2.3%; P=0.011 and 34.4% vs 15.9%; P=0.025), whereas the protective haplotypes (DRB1*1101-DQA1*05-DQB1*0301 and DRB1*1202-DQA1*0601-DQB1*0301) were more frequent in ICI-DM patients (2.1% vs 13.6%; P=0.006 and 4.2% vs 15.9%; P=0.017). None of the ICI-DM patients had T1D-associated high-risk genotypes DR3/DR3, DR3/DR9, and DR9/DR9. Among the 23 ICI-DM patients, 7 (30.4%) presented with ICI-associated fulminant type 1 diabetes (IFD), and 16 (69.6%) presented with ICI-associated type 1 diabetes (IT1D). Compared to IT1D patients, IFD patients exhibited marked hyperglycemia and low C-peptide and HbA1c levels (P<0.05). Up to 66.7% (4/6) of IFD patients were heterozygous for reported fulminant type 1 diabetes susceptibility HLA haplotypes (DRB1*0405-DQB1*0401 or DRB1*0901-DQB1*0303). ICI-DM shares similar clinical features with T1D, such as acute onset, poor islet function and insulin dependence. However, the lack of islet autoantibodies, the low frequencies of T1D susceptibility and high frequencies of protective HLA haplotypes indicate that ICI-DM represents a new model distinct from classical T1D.

Association of Glycemic Index Using HbA1c and Sensorineural Hearing Loss in Diabetes Mellitus Type 2 Patients: A Systematic Review and Meta-Analysis

ABSTRACT&#x0D; Objective: To systematically review the available evidence on the association of HBA1c levels and development of sensorineural hearing loss and to quantitatively analyze the available data on HBA1c levels in patients with type 2 diabetes mellitus and sensorineural hearing loss to determine an HbA1c level that may be associated with the risk of having sensorineural hearing loss.&#x0D; Methods:&#x0D; Design: Systematic Review and Meta-analysis Eligibility Criteria: Cross-sectional studies, or cohort studies which were limited to English language that investigated the correlation of glycemic index using HBA1c and sensorineural hearing loss among adult type 2 diabetic patients which were done from January 2010 to December 2021. Studies with no published outcome, incomplete data or that were ongoing as of August 1, 2022 were also excluded.&#x0D; Information Sources: MEDLINE (through PubMed), Cochrane Library, Scopus, Embase (through OVID@journal), Directory of Open Access Journals (DOAJ), Google Scholar and HERDIN Plus&#x0D; Risk of Bias: Risk of Bias was assessed using the Guidelines for Cochrane Collaboration Synthesis of Results: Results were presented using forest plots for representation.Results: A total of 8 studies were reviewed with 2,103 participants in all. Six articles compared hearing loss incidence between diabetic and non-diabetic patients. Overall, there were a total of 881 diabetic patients and 1222 non-diabetic patients. There was a significantly lower incidence of sensorineural hearing loss in non-diabetic patients with a risk ratio of 1.89, 95% CI [1.65, 2.16]. Three articles compared the HbA1c levels of diabetic patients with or without sensorineural hearing loss. Diabetic patients without sensorineural hearing loss had significantly lower HbA1c levels compared to those with sensorineural hearing loss with mean difference of 1.04, 95%CI [0.82, 1.25].Conclusion: In conclusion, this meta-analysis showed a higher prevalence rate of sensorineural hearing loss among patients with diabetes mellitus compared to non-diabetic patients. Moreover, poor glycemic control among diabetic patients with a glycemic index based on HbA1c of more than 8.3 (6.97-9.6) is associated with sensorineural hearing loss.

Serum Uric Acid Levels Are Related to Diabetic Peripheral Neuropathy, Especially for Motor Conduction Velocity of Tibial Nerve in Type 2 Diabetes Mellitus Patients.

Oxidative stress is one of the most critical factors that contribute to the pathogenesis of neuronal damage, including diabetic peripheral neuropathy (DPN). Uric acid is a kind of natural antioxidant that plays a major role in the antioxidant capacity against oxidative stress. Here, we aim to determine the role of serum uric acid (SUA) in the DPN of patients with type 2 diabetes mellitus (T2DM). Patients and Methods. 106 patients with T2DM were recruited and divided into the DPN group and the control group. Clinical parameters, especially for motor nerve fiber conduction velocity and sensory nerve fiber conduction velocity, were collected. Differences between T2DM patients with and without DPN were compared. Correlation and regression analyses were performed to explore the association between SUA and DPN. Compare with 57 patients with DPN, 49 patients without DPN showed lower HbA1c and elevated SUA levels. Additionally, SUA levels are negatively associated with the motor conduction velocity of tibial nerve with or without adjusting for HbA1c. Besides, it is suggested that decreased SUA levels may influence the motor conduction speed of the tibial nerve by multiple linear regression analysis. Moreover, we demonstrated that decreased SUA level is a risk factor for DPN in patients with T2DM by binary logistic regression analysis. Lower SUA is a risk factor for DPN in patients with T2DM. Additionally, decreased SUA may influence the damage of peripheral neuropathy, especially for motor conduction velocity of the tibial nerve.

The role of sodium-glucose cotransporter type 2 inhibitors on the path to cardiovascular well-being in type 2 diabetes mellitus and chronic kidney disease

SGLT-2 inhibitors first emerged as a new class of oral hypoglycemic drugs with modest efficacy in lowering HbA 1c levels, which were also capable of inducing weight loss and lowering blood pressure without a significant risk of hypoglycemia. However, an analysis of the results of studies conducted to assess cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) during iSGLT-2 therapy showed evidence of nephroprotection, which led to the initiation of trials on renal outcomes. The data obtained showed that the protective effects of iSGLT-2 against cardiovascular and renal complications of type 2 diabetes do not directly depend on their hypoglycemic activity, while their particular clinical significance is demonstrated in reducing the risk of hospitalization for heart failure (HF), progression of diabetic kidney disease (RDK), as well as a reduction in the incidence of major adverse cardiovascular events (MACE).Today it is known that against the background of diabetic nephropathy, cardiovascular consequences become more serious. CKD patients with diabetes are more likely to die from cardiovascular causes than from end-stage renal disease. Diabetic kidney disease appears to be not only a marker of increased cardiovascular risk, but also involved in the pathogenesis of cardiovascular disease. An increase in traditional risk factors such as hypertension, hyperlipidemia, and obesity cannot fully explain the worse cardiovascular and fatal outcomes in CKD.This review will focus on the role of iSGLT-2 in the outcomes of type 2 DM complicated by the development of CKD, and will highlight the putative mechanisms of the nephroprotective action of this group of drugs.