Macrovascular Complications Research Articles

Type 1 Diabetes Mellitus Clinical Profile and Follow-up: North Emirate Hospitals’ Experience

Background: Type 1 Diabetes mellitus (DM) is a chronic metabolic disorder in children and adolescents due to insulin deficiency. The disease is more common below 19 years of age with two peaks of incidence, one at 4-6 years and the other peak at early puberty (10-14 years). There is a gradual increase in the incidence of type 1 DM and a rise in incidence at 10,200 cases per year in the Middle East. Chronic type-1 diabetic patients develop microvascular and macrovascular complications. Methods: The present retrospective cross-sectional study aims to describe the experience on the clinical profile, morbidity profile, and comorbidities of Type1 DM in children below 15 years of age admitted to the SAQR and Fujairah hospitals in the Northern part of United Arab Emirates (UAE) from 1st January 2017 to 31st December 2019. The study material was the digital medical records of children below 15 years who got admitted to emergency and pediatric wards with type 1 Diabetes mellitus (T1DM) in SAQR and Fujairah hospitals. Results: Total admissions during the study period were 98. At the time of diagnosis, 12.2% of children were below five years of age, whereas 87.75% were more than five years. All 98 children were UAE nationals, of which 52% were males and 48% were females. 50% of our study population has a strong family history of either type 1 or type 2 diabetes mellitus, of which 12.2% of siblings of the study population had T1DM. The first symptoms in 58% and 57% of children were polyuria and polydipsia. Among 90 % of children under follow-up for three years, one child developed microalbuminuria, three developed systolic hypertension, and 8% were lost to follow-up. Conclusions: The present study highlights the need for future prospective studies in the UAE to know the actual burden of the disease with an emphasis on early screening.

The Prevalence of Peripheral Vascular Disease (PVD) and Its Correlation with Biochemical Parameters in Type 2 Diabetes Mellitus (T2DM) - A Tertiary Care Hospital Based Study in Eastern India

INTRODUCTION PVD, one of the major macrovascular complications of T2DM, usually begins at an earlier age and remains subclinical for a long duration. So early detection of PVD will help to assess its true prevalence and hence prevention of overt manifestation. OBJECTIVES To assess the true prevalence of PVD in T2 DM from Eastern India and its correlation with clinical and biochemical parameters METHODS It was a cross sectional study with consecutive diabetes patients attending OPD from 2015 January to 2016 July. Each was subjected to meticulous history, measurement of ABPI by handheld Doppler and various laboratory parameters. Patients having known vascular disease due to other causes were excluded. RESULTS Out of 103 patients, PVD was present in around 25% cases with positive association with age, male gender, and high body weight. Hypertension, hyperglycemic state (PPBS, HbA1C), total cholesterol, triglyceride and LDL independently increases the risk of PVD. Though low levels of HDL are a well-recognized risk factor for PVD, this was not reflected in study. CONCLUSION The true prevalence of PVD is higher in DM and ABPI can detect subclinical PVD much before its progression and overt manifestations

Changes in smoking status, amount of smoking and their relation to the risk of microvascular complications in men with diabetes mellitus.

Smoking is a definite risk factor for macrovascular complications in diabetes mellitus (DM). However, the effect of smoking on microvascular complications is inconclusive. Study participants were 26,673 diabetic men who received health check-up both in 2003-2004 and 2009, excluding women. Assessing smoking status (never, quitting and current) at 2003-2004 and 2009, changes in smoking status were categorised into 7 groups (never - never, never - quitting, never - current, quitting-quitting, quitting-current, current-quitting and current-current). Smoking amount was categorised into never, light (0-10 pack years), moderate (10-20 pack years), and heavy smoking (>20 pack years) based on 2009 data. They were followed-up until 2013 to identify incident microvascular complications. We calculated the adjusted hazard ratios (HR) and 95% confidence interval (CI) (adjusted HR [95% CI]) for incident microvascular complications according to changes in smoking status and smoking amount. Current-quitting (1.271 [1.050-1.538]), current-current (1.243 [1.070-1.444]) and heavy smoking (1.238 [1.078-1.422]) were associated with an increased risk of overall microvascular complications. The risk of nephropathy increased in current-current smoking (1.429 [1.098-1.860]) and heavy smoking (1.357 [1.061-1.734]). An increased risk of neuropathy was observed in current-quitting smoking (1.360 [1.076-1.719]), current-current smoking (1.237 [1.025-1.492]) and heavy smoking (1.246 [1.048-1.481]). However, we couldn't see the interpretable findings for the association between smoking and retinopathy. Lasting and heavy smoking increases the risk of microvascular complications, including nephropathy and neuropathy. Quitting smoking and reducing smoking amount are imperative in preventing microvascular complications in DM patients.

Monosit-HDL Oranı: Diyabetik Hastaların Takibinde ve Diyabetik Nefropatinin Tanısında Kullanılabilir mi ?

Background and Aim: Diabetic nephropathy is the most common cause of end-stage renal disease and albuminuria is the earliest manifestation of diabetic nephropathy.Oxidative stress and inflammation caused by advanced glyco-oxidation end products contribute to micro and macrovascular complications of diabetes. Monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) is an essential indicator of inflammation and oxidative stress. In this study, we aimed to reveal the relationship between diabetes regulation and complications and MHR. Material and Method: A total of 182 subjects, including 152 patients with diabetes mellitus (DM) and 30 healthy controls, were included in this study. All data of the subjects were scanned retrospectively. The DM group was divided into two groups nephropathy (n=68) and non-nephropathy (n=84), with a limit of 30 mg/day for albuminuria. MHR was calculated by dividing the monocyte count by the HDL cholesterol count. Results: When patients with DM were divided into nephropathy and non-nephropathy, patients with nephropathy had higher MHR levels than the other group. We showed that MHR correlated with albuminuria, creatinine, and HbA1c in patients with diabetic nephropathy. In addition, in the regression analysis, albuminuria and MHR were predictors of DN, while MHR, age, and creatinine were found to be independent predictors of albuminuria. Conclusion: MHR, which is an easily calculated marker with simple laboratory tests, which is frequently requested in routine practice in the follow-up of diabetes patients, can help predict the regulation of diabetes and its kidney complications.

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.

Determinants and Stratification of Microvascular Complications of Type 2 Diabetes Mellitus.

Background Diabetes mellitus (DM) is a prevalent metabolic disorder characterized by high blood sugar levels. It is classified into type 1 (T1DM) and type 2 (T2DM), which have different mechanisms and complications. The global prevalence of diabetes, particularly T2DM, has increased significantly in recent decades, leading to a need for standardized data collection of macrovascular and microvascular complications to track disease progression and guide treatment options. This study aims to assess and correlate the prevalence and severity of microvascular complications in patients with T2DM. Methodology This observational, cross-sectional study was conducted at Poonam Multispeciality Hospital in Ahmedabad, India. A total of 4,123 diabetic patients admitted to the hospital were included. Information on sociodemographics and medical history was collected using standardized forms. Fundus photography and fluorescein angiography were performed to assess diabetic retinopathy, and estimated glomerular filtration rate and albumin-to-creatinine ratio were measured to evaluate renal function. Neurological examinations were conducted to score diabetic neuropathy. Chi-square tests were used to determine associations between medical history with diabetic retinopathy and nephropathy, and t-tests were used to compare diabetic neuropathy scores. Kendall's Tau correlation was used to determine correlations between diabetic retinopathy and nephropathy. P-values <0.05 were considered statistically significant. Results The overall prevalence of diabetic retinopathy, nephropathy, and neuropathy was 37.5%. Of the patients included, 47.9% had diabetic nephropathy and 28.9% had diabetic neuropathy. A significant association was observed between the severity of diabetic retinopathy and age, body mass index, duration of diabetes, and hemoglobin A1c (HbA1C) levels. Similarly, significant associations were found between these factors and the severity of diabetic nephropathy. Unpaired t-tests revealed significant differences in diabetic neuropathy examination scores based on the duration of diabetes and Hba1C levels. Moreover, correlation analysis indicated a low, positive correlation between diabetic retinopathy and diabetic nephropathy. Conclusions This study provides insights into the prevalence, severity, and associations of microvascular complications in patients with T2DM, contributing to the understanding and management of these conditions. Additionally, the research revealed a direct association between diabetic retinopathy and different stages of chronic kidney disease determined by the Kidney Disease Improving Global Outcome guidelines.

Prevalence of Insulin Resistance and Metabolic Syndrome in Pediatric Patients with Type 1 Diabetes Mellitus and Its Association with Macrovascular Complications

Background Insulin resistance (IR) is an independent risk factor for the development of micro and macrovascular diseases in both type 2 diabetes (T2DM) and type 1 diabetes (T1DM) patients. Objective To assess the frequency of insulin resistance and metabolic syndrome among pediatric patients with T1DM and highlight the factors associated with both. Subjects and Methods Analytical cross-sectional study, including eighty (80) patients with T1DM divided into two equal groups according to body mass index(BMI) (Group1= 40 patients with normal BMI, Group 2= 40 obese or overweight patients). Both groups were subjected to: Detailed history, through clinical examination with special emphasis on assessment of Insulin Resistance and Metabolic Syndrome. Carotid intima media thickness (CMIT) was assessed as a marker of macrovascular complication. Results In group 2, (93%) of participants showed manifestations of metabolic syndrome Also, the same group showed significantly higher HbA1c (P &amp;lt; 0.05) and waist/ hip ratio (P &amp;lt; 0.05). Estimated glucose disposal rate formula (eGDR) (5.49 ± 3.53) were significantly lower in group 2 compared with group 1 (10.51 ± 2.20) (P &amp;lt; 0.05).The best cut-off value of eGDR for prediction of IR among patients with T1DM was &amp;lt; 7.15 mg/kg/min. CIMT was significantly higher in group 2 (0.93 ± 0.13) compared to group 1 (0.66 ± 0.09) (P &amp;lt; 0.05). Furthermore, there was a strong negative correlation between eGDR and CIMT. Conclusion Overweight and obese youth with T1DM had significantly higher prevalence of components of metabolic syndrome including insulin resistance. A specific novel finding of this study is the relationship between eGDR and macrovascular complications.

Effect of Fasting Ramadan on Different Laboratory Parameters on Type 2 Diabetic Mellitus Patients

Background Diabetes mellitus (DM) is one of the most common chronic diseases in nearly all countries, and continues to increase in numbers and significance, as changing lifestyles lead to reduced physical activity, and increased obesity. It has been estimated that by the year 2030, there will be 8.6 million adult with diabetes in Egypt, making it the country with the tenth largest population of diabetic in the world. Diabetes is associated with reduced life expectancy, significant morbidity due to micro and macro vascular complications and diminished quality of life. Objective To study the impact of Ramadan fasting on metabolic parameters and anthropometry in type 2 DM in Egypt. Patients and Methods This study was conducted on 80 type 2 diabetic patients who were intending to fast Ramadan. During Ramadan (2014) the average fasting hours were 15 h. Patients were recruited from the internal medicine outpatient clinic at Ain Shams University hospitals and from the nutrition institute. 6 Patients were under insulin treatment (Biphasic human insulin) &amp; 74 patients were under oral hypoglycemic treatment {52 on combination treatment sulfonylurea + metformin &amp; 9 on metformin only &amp;13 of them were on sulfonylurea only}. Results We found that there was a statistically significant increase as regard lipid profile (serum triglycerides, serum total cholesterol, LDL-cholesterol and HDL-cholesterol) in after Ramadan measurement. Also CVD risk parameters have untimely increased after Ramadan this parameters including (10 years risk (Framingham score) systolic and diastolic blood pressure). In addition (Creatinine, HOMA IR and fasting insulin) showed increased level in after Ramadan measurement which indicate deterioration of blood glucose parameters. There was no statistical significant changes seen as regard anthropometric measures (BMI, WHR) in pre Ramadan and after Ramadan measurement. Also there was no statistical significant changes regarding fasting, 2 hours plasma glucose, A1c levels between pre-Ramadan fasting &amp; after-Ramadan. In addition CRP and ACR showed no significant changes as regard measurement between before and after Ramadan. Conclusion Ramadan fasting appears to have significant effect on lipid profiles that could adversely impact cardiovascular outcome. These effects are mostly due to quality and quantity of food intake during Ramadan and the negative impact of sedentary life style. In addition the number of fasting days and period of daily fasting could affect glycemic control and renal function tests. Bad dietary habits, lack of exercise and irregular drug intake during Ramadan has a negative impact on glycemic control.

Study of Pentraxin-3 as an Early Marker of Diabetic Vascular Complications in Children and Adolescents with Type 1 Diabetes Mellitus

Background Vascular complications are the major cause of morbidity and mortality in diabetic patients. These can result from interactions between systemic metabolic abnormalities, such as hyperglycemia, dyslipidemia, genetic and epigenetic modulators, and local tissue responses to toxic metabolites. Aim of the Work To assess the role of PTX3 as an early marker of vascular complications in children and adolescents with type 1 diabetes mellitus and its correlation with metabolic control and its relation to hsCRP level. Patients and Methods Fifty adolescents with type 1 diabetes mellitus and 40 age and sex matched control group, Detailed history taking, full systemic examination were done, Patients also were investigated using HbA1c, lipid profile, ALT, Alb/Cr ratio in urine, PTX3, hsCRP and carotid intima media thickness (CIMT). An informed consent was obtained from patients, controls or their legal guardians before enrollment in the study. Inclusion criteria Patients with type 1 diabetes their age ranging from 5 to 18 years old with at least 5 years disease duration and on regular clinic visits and multiple daily insulin therapy . Exclusion criteria Patients with proven vascular complications and those with any clinical evidence of infection, hematological diseases, tumors, liver dysfunction, urinary tract disorders, connective tissue disease, or other autoimmune diseases, also patients with morbid obesity were excluded. Results PTX3 and hsCRP were significantly higher in patients compared to control group. A significant positive correlation between serum PTX3 and level of HbA1c%, level of Triglycerides (TG), level of Total Cholesterol was observed. Additionally, PTX3 and hsCRP levels were elevated in patients with elevated lipid profile (TG and Cholesterol) and high HbA1c% level in comparison with those with normal lipid profile and those with controlled HbA1c% level (p &amp;lt; 0.001). No significant difference was found between patients and control groups as regard CIMT. Conclusion . The increased levels of PTX3 and hsCRP in patients with uncontrolled diabetes even before development of both microvascular and macrovascular complications add a promising tool for their follow up and applying early protective measures.

AGEs promote atherosclerosis by increasing LDL transcytosis across endothelial cells via RAGE/NF-κB/Caveolin-1 pathway

ObjectiveTo elucidate the mechanism whereby advanced glycation end products (AGEs) accelerate atherosclerosis (AS) and to explore novel therapeutic strategies for atherosclerotic cardiovascular disease.Methods and resultsThe effect of AGEs on low-density lipoprotein (LDL) transcytosis across endothelial cells (ECs) was assessed using an in vitro model of LDL transcytosis. We observed that AGEs activated the receptor for advanced glycation end products (RAGE) on the surface of ECs and consequently upregulated Caveolin-1, which in turn increased caveolae-mediated LDL transcytosis and accelerated AS progression. Our molecular assessment revealed that AGEs activate the RAGE-NF-κB signaling, which then recruits the NF-κB subunit p65 to the RAGE promoter and consequently enhances RAGE transcription, thereby forming a positive feedback loop between the NF-κB signaling and RAGE expression. Increased NF-κB signaling ultimately upregulated Caveolin-1, promoting LDL transcytosis, and inhibition of RAGE suppressed AGE-induced LDL transcytosis. In ApoE−/− mice on a high-fat diet, atherosclerotic plaque formation was accelerated by AGEs but suppressed by EC-specific knockdown of RAGE.ConclusionAGEs accelerate the development of diabetes-related AS by increasing the LDL transcytosis in ECs through the activation of the RAGE/NF-κB/Caveolin-1 axis, which may be targeted to prevent or treat diabetic macrovascular complications.

Early intensification of therapy for type 2 diabetes mellitus and achievement of the target level of glycohemoglobin HbA&lt;sub&gt;1c&lt;/sub&gt; are necessary factors to reduce the risk of micro- and macrovascular complications

Control of type 2 diabetes mellitus (T2DM) requires multifactorial behavioral and pharmacological treatment to prevent the development or slow the progression of complications. The main characteristics of T2DM — hyperglycemia and insulin resistance, combined with oxidative stress, low-level inflammation, epigenetic changes, genetic predisposition, activation of the renin-angiotensin-aldosterone system, causing endothelial dysfunction, are responsible for the metabolic environment that increases vascular risk in patients. Almost all patients with type 2 diabetes are at high and very high cardiovascular risk. The largest studies of the late XX-early XXI centuries. demonstrated a significant reduction in complications with intensive care early in the course of the disease and a «legacy effect» with the long-term historical value of HbA1c control during their observational follow-ups. The decrease in HbA1c may also play a role in mediating the positive effect on cardiovascular risk observed with the use of new hypoglycemic agents. The desire for glycemic control and the desire for organ-specific protection are not mutually exclusive, but complementary. Reassessing individual glycemic goals and achieving them at regular intervals with early intensification of therapy is key to overcoming clinical inertia.

Impact of youth onset type 2 diabetes during pregnancy on microvascular and cardiac outcomes

AimsTo examine the impact of pregnancy on microvascular and cardiovascular measures in women with youth-onset T2D. MethodsMicrovascular and cardiovascular measures were compared in in a cohort of 116 women who experienced a pregnancy of ≥ 20 weeks gestation and 291 women who did not among women in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. ResultsCox regression models adjusted for participant characteristics at baseline including age, race/ethnicity, household income, diabetes duration, HbA1c (>6%), and BMI, demonstrated those who experienced pregnancy had 2.76 (1.38–5.49; p = 0.004) fold increased risk of hyperfiltration (eGFR ≥ 135 ml/min/1.73 m2), compared to those without a pregnancy. No differences were observed in rates of retinopathy (48.9% vs. 41.1%) or neuropathy (23.3% vs. 16.3%) in women who experienced pregnancy vs. women who did not, respectively. In fully adjusted models, pregnancy did not impact changes in echocardiographic or arterial stiffness compared to changes in women who were never pregnant. ConclusionsThese results indicate that pregnancy increases the risk of hyperfiltration in women with youth-onset T2D, but not other micro or macrovascular complications. The rates of vascular complications are very high in youth-onset T2D potentially obscuring micro- and macrovascular changes attributable to pregnancy.Clinical Trial Information: ClinicalTrials.gov numbers,NCT01364350andNCT02310724.

Effects of Melatonin on Glycemic Variability in Type 2 Diabetes Mellitus: Protocol for a Crossover, Double-Blind, Placebo-Controlled Trial.

Glycemic variability is recognized as a significant factor contributing to the development of micro- and macrovascular complications in individuals with type 2 diabetes mellitus (T2DM). Numerous studies have shown that melatonin, a hormone involved in regulating various biological rhythms, including those related to glucose regulation, such as hunger, satiety, sleep, and circadian hormone secretion (ie, cortisol, growth hormone, catecholamines, and insulin), is deficient in individuals with T2DM. This raises an important question: Could melatonin replacement potentially reduce glycemic variability in these patients? This warrants investigation as a novel approach to improving glycemic control and reducing the risk of complications associated with T2DM. We aimed to investigate whether melatonin replacement in individuals with T2DM who supposedly have melatonin deficiency can positively impact the regulation of insulin secretion rhythms and improve insulin sensitivity, ultimately resulting in a reduction in glycemic variability. This study will use a crossover, randomized, double-blind, placebo-controlled trial design. Patients with T2DM in group 1 will receive 3 mg of melatonin at 9:00 PM in the first week, undergo a washout period in the second week, and receive a placebo in the third week (melatonin-washout-placebo). Group 2 will be randomized to receive a placebo-washout-melatonin sequence (3 mg). Capillary blood glucose levels will be measured at 6 different times before and after meals during the last 3 days of the first and third weeks. The study aims to compare the mean differences in blood glucose levels and the coefficient of glycemic variability in patients receiving melatonin and placebo during the first and third weeks. After analyzing the initial results, the number of needed patients will be recalculated. If the recalculated number is higher than 30, new participants will be recruited. Thirty patients with T2DM will be randomized into the 2 groups: melatonin-washout-placebo or placebo-washout-melatonin. Participant recruitment took place between March 2023 to April 2023. In all, 30 participants were eligible and completed the study. We expect that patients will show different glycemic variability on the days they receive placebo or melatonin. Studies on melatonin and glycemic control have shown both positive and negative results. We hope that there will be a positive outcome regarding glycemic variability (ie, a reduction in glycemic variability), as melatonin has a well-described chronobiotic effect in the literature. This study aims to determine whether melatonin supplementation can effectively reduce glycemic variability in patients with T2DM. The crossover design is necessary due to the multiple variables involved in the circadian variations of glucose, including diet, physical activity, sleep parameters, and pharmacological treatments. The relatively low cost of melatonin and its potential role in reducing the severe complications associated with T2DM have motivated this research effort. Furthermore, the indiscriminate use of melatonin in current times makes conducting this study essential to evaluate the effect of this substance in patients with T2DM. Brazilian Registry of Clinical Trials RBR-6wg54rb; https://ensaiosclinicos.gov.br/rg/RBR-6wg54rb. DERR1-10.2196/47887.

Advances in cardiovascular-related biomarkers to predict diabetic peripheral neuropathy.

Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes mellitus. One of the most common types is distal symmetric poly-neuropathy, which begins as bilateral symmetry pain and hyperesthesia and gradually progresses into hypoesthesia with nerve fibre disorder and is frequently accompanied by depression and anxiety. Notably, more than half of patients with DPN can be asymptomatic, which tends to delay early detection. Furthermore, the study of adverse outcomes showed that DPN is a prominent risk factor for foot ulceration, gangrene and nontraumatic amputation, which decreases quality of life. Thus, it is essential to develop convenient diagnostic biomarkers with high sensitivity for screening and early intervention. It has been reported that there may be common pathways for microvascular and macrovascular complications of diabetes. The pathogenesis of both disorders involves vascular endothelial dys-function. Emerging evidence indicates that traditional and novel cardiovascular-related biomarkers have the potential to characterize patients by subclinical disease status and improve risk prediction. Additionally, beyond traditional cardiovascular-related biomarkers, novel cardiovascular-related biomarkers have been linked to diabetes and its complications. In this review, we evaluate the association between major traditional and nontraditional car-diovascular-related biomarkers of DPN, such as cardiac troponin T, B-type natriuretic peptide, C-reactive protein, myeloperoxidase, and homocysteine, and assess the evidence for early risk factor-based management strategies to reduce the incidence and slow the progression of DPN.

The Impact of Continuity of Care on Health Indicators in Patients With Type 2 Diabetes Mellitus in Family Medicine Clinics in Riyadh.

Diabetes Mellitus Type 2 (DM2) is highly prevalent in Saudi Arabia, with many experiencing complications due to the disease.Family medicine physicians are usually the primary care providers responsible for the medical management of type 2 diabetes mellitus patients.Microvascular and macrovascular complications can occur if type 2 diabetes mellitusis poorly managed.Effective management of health indicators in patients with DM2 relating to glycated hemoglobin (HbA1c), low density lipoprotein cholesterol, blood pressure, and tobacco use is an essential part ofmedical care to prevent complications. Due to the projected increase in the number of patients with DM2, there is huge concern surrounding the management of this chronic illness that requires review.This study aims to evaluate the impact of continuity of care on health indicators among family medicine patients diagnosed with diabetes mellitus type 2 and to analyze the effect of continuity of care regarding the completion of age-appropriate preventive health screenings. This is a retrospective cohort study. Data collected from electronic medical records ofpatients 40-75 years of age that received care at the Family Medicine clinics that werediagnosed with type 2 diabetes mellitus with ≥4 clinic visits from January 1, 2017, to June 30, 2020, at King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia. Datacollected included demographic data, body mass index, smoking status, blood pressure, past medical history, preventive health screening completed, and laboratory results, including HbA1c and lipid profile.The continuity of care index and usual provider continuity score indices were calculated for the analysis to measure continuity of care. Three hundred and fifty-two patients were included in thestudy.Most of the patients were Saudi (74.15%), female (51.99%), and married (82.67%).In addition, 90.34% accounted for a high usual provider continuity of care score (UPCS), and 64.20% of the patients had a high continuity of care index (COCi). Younger age groups were significantly more prevalent in the high UPCS group (p=0.037). Additionally, patients of non-Saudi nationalities constituted a significantly larger proportion of the high UPCS group. Single patients showed high UPCS.Comorbidities were not different between the groups, except inflammatory joint disease, which was more common in the low COCi group.Preventative screening measures were also not different between the groups; however, the type of colon cancer screening differed, where patients with high COCi more frequently underwent colonoscopies (13.3% vs. 4.4%, p=0.015) instead of fecal occult blood tests. For the first time, we report the implications of the continuity of care for DM2 patients in Saudi Arabia and the Middle East. Continuity of care did not result in the improvement of health indicators or in the completion of preventive health screenings in diabetic patients. Further studies are needed in the region to confirm our findings and assess the association between continuity of care and patient health indicators impact.

Study of Serum Apelin and Insulin Resistance in Type 2 Diabetes Mellitus Patients With or Without Obesity.

Type 2 diabetes mellitus (T2DM) is a chronic disorder characterized by persistent hyperglycemia. Chronic hyperglycemia in diabetes mellitus can cause microvascular and macrovascular complications. Obesity is a major risk factor contributing to disease progression and complications of T2DM. Apelin is an adipokine having a compensatory role in reducing insulin resistance (IR)in morbidly obese individuals. This study was undertaken to find a correlation between Apelin, IR, and obesity. This case-control study included 180 participants, cases (n=90) having T2DM, and healthy controls (n=90). Further, the case and control groups were divided into group I (non-obese) and group II (obese) according to their body mass index (BMI) as per the Asia Pacific classification of BMI. Following obtainingconsent, anthropometrical measurements and blood parameters likeserum total lipid profile, fasting and postprandial glucose level, Apelin, and insulin were done,and results were analyzed statistically usingStatistical Package for the Social Sciences (SPSS) version 21(IBM Corp., Armonk, NY). A significantly higher Apelin level was observed in diabetes patients with obesity (265.16±11.0 pg/mL) as compared to non-obese (206.44±83.0 pg/mL). A positive correlation between serum Apelin levels and BMI was found (r=0.367, p=0.003). Homeostasis Model Assessment of IR (HOMA-IR) is increased in obese patients in comparison to the control group. A significant positive correlation between BMI and HOMA-IR (r=0.429, p=0.001) and Apelin and IR (r=0.742, p=0.000) was found in this study. On the basis of the finding of this study, we may conclude that Apelin has a role in improving insulin sensitivity in T2DM. Larger and multicentric studies are further required to discover the therapeutic role of Apelin in T2DM.

Assessment of Triglyceride–Glucose Index and Ratio in Patients with Type 2 Diabetes and Their Relation to Microvascular Complications

ABSTRACT Objective Triglyceride-based indices have gained much attention over the past few years. Relation of triglyceride – glucose (TyG) index with insulin resistance and diabetic macrovascular complications was thoroughly studied; nevertheless its relation to microvascular complications is still unclear. This provoked us to carry out the present study. Methods This cross-sectional study included 500 patients with type 2 diabetes (T2DM), who were enrolled from the outpatient clinic of the Diabetes and Metabolism Unit at Alexandria Main University Hospital. The equations utilized to calculate triglycerides-related indices were: TyG ratio = fasting triglycerides (mg/dL)/fasting glucose (mg/dL), and TyG index = logarithm of [fasting triglyceride (mg/dl) x fasting glucose (mg/dl)/2]. The diagnostic criteria set by the American Diabetes Association were followed to diagnose diabetic microvascular complications. Results In patients with T2DM, TyG index was significantly higher in patients with diabetic retinopathy, diabetic kidney disease, and diabetic peripheral neuropathy compared to those without complications (p < 0.001). TyG index was significantly positively correlated to diabetes duration, as well as triglyceride/high density lipoprotein ratio in the total sample (p < 0.001). Conclusion TyG index is an easy, cheap, and available marker for detection of microvascular complications in patients with T2DM.

Cancer and Diabetes: Predictive Factors in Patients with Metabolic Syndrome.

A growing number of epidemiological studies have suggested that diabetes mellitus may increase cancer risk and is implicated in numerous other metabolic and inflammatory disorders. The increase in proinflammatory cytokines plays a major role in insulin resistance and leads to hypoalbuminemia and micro- and macrovascular diabetes complications, including kidney disease and anemia. This study aimed to investigate the utility of carcinoembryonic antigen (CEA), C-reactive protein (CRP), serum albumin level, hemoglobin, and lactate dehydrogenase (LDH) as biomarkers for cancer risk, and the biological implications of diabetes on the evolution and prognosis of oncological patients. We conducted a retrospective, longitudinal, observational study on a total group of 434 patients, of which 217 were diagnosed with a form of cancer and type two diabetes as a comorbidity, and the other 217 were a control group without diabetes. These patients were admitted to the oncology clinic. In subgroups, the same number of patients was considered, depending on the location of the oncological pathology. Anemia, hypoalbuminemia, elevated lactate dehydrogenase, glycated hemoglobin, and C-reactive protein levels are more pronounced in subjects with type two diabetes and cancer. The presence of diabetes negatively affects the clinical and biological prognosis of cancer patients.

Evidence that methylglyoxal and receptor for advanced glycation end products are implicated in bladder dysfunction of obese diabetic ob/ob mice.

Glycolytic overload in diabetes causes large accumulation of the highly reactive dicarbonyl compound methylglyoxal (MGO) and overproduction of advanced glycation end products (AGEs), which interact with their receptors (RAGE), leading to diabetes-associated macrovascular complications. The bladder is an organ that stays most in contact with dicarbonyl species, but little is known about the importance of the MGO-AGEs-RAGE pathway to diabetes-associated bladder dysfunction. Here, we aimed to investigate the role of the MGO-AGEs-RAGE pathway in bladder dysfunction of diabetic male and female ob/ob mice compared with wild-type (WT) lean mice. Diabetic ob/ob mice were treated with the AGE breaker alagebrium (ALT-711, 1 mg/kg) for 8 wk in drinking water. Compared with WT animals, male and female ob/ob mice showed marked hyperglycemia and insulin resistance, whereas fluid intake remained unaltered. Levels of total AGEs, MGO-derived hydroimidazolone 1, and RAGE in bladder tissues, as well as fluorescent AGEs in serum, were significantly elevated in ob/ob mice of either sex. Collagen content was also markedly elevated in the bladders of ob/ob mice. Void spot assays in filter paper in conscious mice revealed significant increases in total void volume and volume per void in ob/ob mice with no alterations of spot number. Treatment with ALT-711 significantly reduced the levels of MGO, AGEs, RAGE, and collagen content in ob/ob mice. In addition, ALT-711 treatment normalized the volume per void and increased the number of spots in ob/ob mice. Activation of AGEs-RAGE pathways by MGO in the bladder wall may contribute to the pathogenesis of diabetes-associated bladder dysfunction.NEW & NOTEWORTHY The involvement of methylglyoxal (MGO) and advanced glycation end products (AGEs) in bladder dysfunction of diabetic ob/ob mice treated with the AGE breaker ALT-711 was investigated here. Diabetic mice exhibited high levels of MGO, AGEs, receptor for AGEs (RAGE), and collagen in serum and/or bladder tissues along with increased volume per void, all of which were reduced by ALT-711. Activation of the MGO-AGEs-RAGE pathway in the bladder wall contributes to the pathogenesis of diabetes-associated bladder dysfunction.

Association of oral health with risk of incident micro and macrovascular complications: A prospective cohort study of 24,862 people with diabetes

AimsTo investigate the association between self-reported oral health and incident micro and macrovascular diabetes complications. MethodsThis prospective cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The participants were 24,862 men and women, aged ≥45 years, with diabetes at baseline (2006–2009). The oral health of participants was assessed by questionnaire. Incident diabetes complications were determined using hospitalisation data and claims for medical services up until 2019. Hazard ratios for the association between oral health and incident complications were calculated using multivariable cox proportional hazards models. ResultsAlmost 60 % of participants had <20 teeth, and 38 % rated their teeth and gums as fair or poor. Compared with those with ≥20 teeth, those with 0 teeth had an increased risk of cardiovascular disease (aHR 1.24, 95 % CI: 1.15, 1.35), lower limb (aHR 1.22, 95 % CI: 1.11, 1.33) and kidney (aHR 1.19, 95 % CI: 1.11, 1.29) complications. Individuals with 1–9 teeth had an increased risk of eye complications (aHR 1.14, 95 % CI: 1.07, 1.22). The associations were generally consistent for poor self-rated teeth and gums. ConclusionsSelf-reported oral health measures may be a marker of elevated risk of complications in people with diabetes.