Marker Of Glycemic Control Research Articles

Characteristics of individuals who developed type 2 diabetes from prediabetes despite undergoing interventions, and evaluation of the performance of urinary myo-inositol as a risk factor for developing diabetes.

The aim of this study was to clarify the characteristics of individuals with prediabetes who developed type 2 diabetes despite undergoing interventions, and to evaluate the performance of urinary myo-inositol (UMI) as a noninvasive indicator for the risk of developing diabetes. A total of 51 individuals with prediabetes who underwent a 75-g oral glucose tolerance test, ΔUMI (the difference in the UMI : creatinine ratio between before and 120 min after 75-g glucose loading), fasting plasma glucose, insulin, hemoglobin A1c, noninvasive testing (age, body mass index, blood pressure) and general blood tests were measured at baseline, and underwent dietary/exercise guidance for 8 years were studied. A total of 31 participants developed diabetes in 8 years. At baseline, the group that developed diabetes was characterized by high ΔUMI, hemoglobin A1c, fasting plasma glucose and low high-density lipoprotein cholesterol, and insulinogenic index (I.I.). I.I and ΔUMI showed a higher correlation than fasting plasma glucose and hemoglobin A1c. Regarding diabetes onset within 8 years, Cox regression analysis of diabetes onset showed the baseline ΔUMI is an independent predictor, adjusted for the result of not only noninvasive markers, but also that of noninvasive and general blood markers. The log-rank test showed that all glycemic indicators were significantly associated with diabetes onset. Participants who developed type 2 diabetes from prediabetes despite undergoing interventions were characterized by high glycemic control markers and low I.I. As noninvasive measurement of ΔUMI is associated with I.I. and diabetes onset, it could be a useful indicator for identifying individuals with a high risk of diabetes onset.

Probiotics and Their Role in the Management of Type 2 Diabetes Mellitus (Short-Term Versus Long-Term Effect): A Systematic Review and Meta-Analysis.

Diabetes is a major economic burden and an illness with a rising incidence worldwide. Type 2 diabetes mellitus (T2DM), the most prevalent kind of diabetes, is characterized by insulin resistance and insufficient insulin production. Recent research has implicated gut microbiota dysbiosis as a contributing factor to T2DM pathogenesis. The present study employed a methodology based on randomized controlled trials (RCTs) to assess the therapeutic efficacy of probiotics in the treatment of T2DM. A thorough search was done in PubMed and Medline for articles written in English and published between 2017 and 2023. Studies were chosen based on predetermined inclusion criteria, and the search technique adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) principles. This study also employed a robust assessment instrument, widely recognized in the medical and health sciences, to evaluate the potential presence of bias within the selected research studies. Out of 96 identified articles, 22 RCTs met the eligibility criteria. Both short-term (8 weeks or less) and long-term (12 weeks or more) probiotic administrations were made. The results of the meta-analysis demonstrated a significant improvement in the homeostatic model assessment of insulin resistance (HOMA-IR) following the probiotic intervention (P=0.02) and considerably decreased glycated hemoglobin HbA1c levels (P=0.004) and fasting blood glucose (FBG) levels (P<0.0001) in T2DM patients compared to placebo. This research offers proof that probiotics are clinically effective in the treatment of T2DM. Probiotic supplementation demonstrated favorable effects on glycemic control markers. However, the findings from RCTs were heterogeneous, and some studies showed inconsistent results. To clarify the processes underlying the probiotics' therapeutic benefits and to determine the best probiotic strains, doses, and therapy durations, more research is required. Nevertheless, probiotics offer a promising therapeutic approach for T2DM management and warrant consideration as a potential adjunct therapy in clinical practice.

Comparative analysis of fructosamine and HbA1c as a glycemic control marker in Type 2 diabetes patients in a tertiary care hospital study

Background: Fructosamine (FA) is a marker of plasma glucose value that reveals the short-term glycemic level for 2–3 weeks. While measuring the plasma glucose level over 2–3 months with glycated hemoglobin (HbA1c) is a common practice. Aims and Objectives: This study aims to demonstrate the relationship between HbA1c and FA levels in Type II diabetes mellitus. Materials and Methods: This prospective and cross-sectional study was conducted from January 2021 to January 2022, involving Type 2 diabetic patients attending both inpatient and outpatient at Sree Balaji Medical College and Hospital, Chennai. HbA1C, FA, postprandial blood sugar (PPBS), and fasting blood sugar (FBS) were estimated. The collected data were analyzed with IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp). To assess the relationship between the variables, Pearson’s Correlation was used. Results: We analyzed 61 known Type 2 diabetic subjects in our study. Most patients were in the 51–60 age groups, with the mean age of the cohorts being 56.2 years, SD±10.1. There were 28 females and 33 in this study. Comparing HbA1c with FA, a statistically significant correlation was noted (P&lt;0.001), with a Pearson correlation value of 0.924. A similar strong positive correlation was also noted between HbA1c and FBS, PPBS, and FA, and PPBS. Conclusion: The link between FA and HbA1c is highlighted in this study. Since FA’s correlation with HbA1c is proven to be statistically significant, it can be utilized as an alternative to or addition to HbA1c in the assessment of blood glucose management.

B-034 Evaluation of the Analytical Performance of Sebia CAPI 3 HbA1c Assay

Abstract Background HbA1c has been the most important marker for glycemic control and for the diagnosis of diabetes mellitus. The NGSP has invested significant efforts in the standardization of the HbA1c assays, and several analytical methods have been developed. We evaluated the analytical performance of the Sebia CAPI 3 HbA1c assay, which is determined by capillary electrophoresis. Additionally, samples with and without hemoglobin variants are analyzed, and results are compared to two HPLC-based methods. Methods Control materials are used in the precision study, which are included in the Sebia CAPI 3 HbA1c kit (Lisses, France). Linearity study is assessed with the linearity materials from LGC Maine Standards (Cumberland Foreside, ME). Carryover is determined by the EP Evaluator (Colchester, VT) with total 21 aliquots of a high and a low HbA1c sample assayed in a specific order. Accuracy study is determined by whole blood patient samples without hemoglobin variants (n = 40) and with hemoglobin variants (n = 8, mostly with Hb S of 30–40%). Results from Sebia CAPI 3 are compared to the current laboratory method (BioRad Variant II Turbo) (Hercules, CA) and the TOSOH G8 (Tokyo, Japan). Both are HPLC-based methods. Results The within-run precision at a mean of 5.5% HbA1c has a CV at 1% (n = 24), and the between-run precision at the level of 5.5% and 8.7% HbA1c has a CV at 1% (n = 20) and 2% (n = 20), respectively. Linearity study demonstrates the analytical measuring range is between 3.1% and 20.8%, although each laboratory might establish its own clinical reportable range. Carryover is passed based on the automatically calculated error limit in EP Evaluator (3 times the SD of the Low-Low results). The accuracy study shows the Sebia results correlate well with percent bias at 2% for BioRad Variant II Turbo and 3% for TOSOH G8 in samples with (n = 8) and without (n = 40) hemoglobin variants. Conclusion The Sebia CAPI 3 HbA1c assay is based on capillary electrophoresis principle, which is a recognized method by NGSP. The assay has demonstrated good precision, a wide analytical measuring range and minimum carryover. The results are comparable to two HPLC-based methods and are well within the total allowable error of 6% by NGSP in samples with and without hemoglobin variant.

The Association of Dyslipidemia and Atherogenic Indices With Glycemic Control in Diabetic Dyslipidemia Patients: A Real-World Landscape.

Dyslipidemia is an important comorbid factor of type 2 diabetes mellitus (T2DM) that increases the risk of cardiovascular diseases. This study aimed to assess the pattern of dyslipidemia and atherogenic indices and determine its relation with glycemic control. A cross-sectional study enrolled 382 patients with diabetic dyslipidemia. The socio-demographics data, clinical features, and laboratory parameters were collected. The baseline lipid parameters such as total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and glycated hemoglobin (HbA1C) were measured. Atherogenic indices such as TC/HDL-C ratio, TG/HDL-C ratio, LDL-C/HDL-C ratio, non-HDL-C/HDL-C and atherogenic index of plasma(AIP) [log10 (TG/HDL-C)] were calculated. T2DM patients were classified into three groups based on the degree of glycemic control: Good glycemic control (HbA1C<7%), fair control (HbA1C 7-8%), and poor control (HbA1C>8%). The population's mean age was 48.60±6.15 years, with 145 (38%) males. We found mixed dyslipidemia as the most prevalent (36.1%) form of dyslipidemia in our patients. The most common pattern in atherogenic indices was AIP (94.2%). HbA1c was positively correlated with duration of diabetes (r=0.253, p<0.001). In multivariate logistic regression analysis, duration of diabetes (>10 years) was significantly associated with poor glycemic control with an odds ratio (OR) of 2.31(95% CI; 1.25-4.24, p=0.007). The present study indicated that neither the pattern of dyslipidemia nor the atherogenic indices were markers of poor glycemic control among South Indian patients attending our tertiary care institute. However, duration of diabetes was significantly associated with poor glycemic control.

Efficacy and safety of HIMABERB® Berberine on glycemic control in patients with prediabetes: double-blind, placebo-controlled, and randomized pilot trial

BackgroundPrediabetes and diabetes involve alterations in glucose homeostasis, including increased fasting blood glucose and impaired glucose tolerance. Berberine has been identified as a potential regulator of glucose homeostasis with implications on the management of type 2 diabetes mellitus (DM). Given a paucity of data on berberine in prediabetes, evaluation of its effect in individuals with prediabetes may prove clinically valuable.ObjectiveThe present pilot study aimed to investigate the effect of daily oral berberine on markers of glycemic control and insulin resistance among individuals with prediabetes.MethodsA randomized, double-blinded, placebo-controlled trial was conducted for 12 weeks among 34 individuals with prediabetes as defined by the American Diabetes Association (fasting plasma glucose (FPG) between 5.6 and 6.9 mmol/L, glycosylated hemoglobin (HbA1c) between 5.7% and 6.4%, or 2-hour 75-gram oral glucose tolerance test (2 h-OGTT) between 7.8 and 11.1 mmol/L). HIMABERB® 500 mg was given three times daily to the treatment group, and placebo was administered three times daily to the control group. Glycemic control markers and physical parameters were evaluated for both groups on days 0, 28, 56, and 84. The glycemic control markers assessed included FPG, fasting insulin (FI), 2 h-OGTT, HbA1c, and homeostatic model assessment-insulin resistance (HOMA-IR). The observed outcomes were analyzed using independent t-test statistics to determine the significance of differences over time after treatment initiation and between treatment and control groups.ResultsSignificant decreases in all markers of glycemic control were observed in the treatment group at intermediate time points and the endpoint of the study compared to baseline levels and to the control group. For the treatment group, FPG decreased from 6.75 ± 0.23 mmol/L to 5.33 ± 0.28 mmol/L, FI from 9.81 ± 0.36 to 7.88 ± 0.52 mmol/L, 2 h-OGTT from 10.44 ± 0.52 to 8.12 ± 0.40 mmol/L, HbA1c from 6.40% ± 0.20–5.43% ± 0.21%, and HOMA-IR from 3.61 ± 0.31 to 2.41 ± 0.14. The decreases in glycemic control markers compared to the control group were clinically and statistically significant (p<10− 5). No severe adverse effects, kidney or liver toxicity were detected.ConclusionAfter 12 weeks, berberine (HIMABERB®) intervention in individuals with prediabetes significantly reduced glycemic control markers, with mean FPG and 2 h-OTGG being reduced to below prediabetic thresholds, supporting the investigation of the use of HIMABERB® for delaying progression to diabetes mellitus.Trial registrationhttp://ctri.nic.in(CTRI/2021/12/038751) (20/12/2021).

Glycemic Control and Mucormycosis during COVID-19 Pandemic in India a Study of Stage and Outcome.

Mucormycosis mostly targets immunocompromised patients or those with uncontrolled diabetes but is now an important complication after coronavirus disease 2019 (COVID-19) infection. The stage of mucormycosis at presentation greatly impacts its treatment course and prognosis. Prior research has failed to evaluate an association of patient factors, especially glycated hemoglobin (HbA1c) levels and random blood sugar (RBS) at presentation, with the stage and outcome of mucormycosis. To investigate the relationship between glycemic control and the stage of mucormycosis at presentation and to investigate various factors affecting mucormycosis outcome. All patients with clinicopathologically confirmed mucormycosis presenting to Safdarjung Hospital, New Delhi, during the COVID-19 pandemic were enrolled in the study. A questionnaire consisting of demographic information, comorbidities, history, and treatment of COVID-19 and diabetes was filled out at the time of admission. Blood glucose and HbA1c levels at presentation were noted. The above-noted parameters were compared with the stage and outcome of mucormycosis. The data obtained was analyzed. A total of 75 mucormycosis patients were enrolled in the study. The mean age of the participants was 45.17 years, and 85.33% of them survived the disease course. There was no statistically significant difference between the survivors and nonsurvivors concerning mean HbA1c and RBS levels. But there was a statistically significant correlation such that the stage of mucormycosis increased with progressive worsening glycemic control markers HbA1c and RBS. The most common comorbid condition was diabetes mellitus (72%); however, only coronary artery disease in the patient was significantly correlated with mortality. A history of COVID-19 infection was reported in 67.6% of the patients, but this was not significantly associated with mortality outcomes. Patients without a history of COVID-19 reported significantly higher RBS and HbA1c levels at presentation than the COVID-19-associated mucormycosis group. The study showed a positive correlation between the stage of mucormycosis and serum glycemic control markers at presentation. Clinicians must order blood sugar and HbA1c levels at presentation as cues for a better understanding of disease severity. A thorough clinical examination and history taking for patient risk factors predisposing to mucormycosis are also crucial since the presence of proptosis and coronary artery disease are significantly correlated with the mortality outcomes. The extent of poor glycemic control at presentation was not associated with mortality outcomes. How to cite this article: Sharma V, Kriplani K, Tuli IP, et al. Glycemic Control and Mucormycosis during COVID-19 Pandemic in India a Study of Stage and Outcome. J Assoc Physicians India 2023;71(9):61-66.

The Association of Neutrophil Lymphocyte Ratio and Glycemic Markers in Hemodialysis Patients

Background/aims: Neutrophil lymphocyte ratio was found to be as an inflammation marker in the preceding decade and recently related with glycemic indices in patients with diabetes mellitus. The target of this research was to explore the association of neutrophil lymphocyte ratio and glycemic indices in hemodialysis population. Methods: 177 hemodialysis patients (98 diabetic and 79 non-diabetic) aged 56.08±16.06 years were enrolled in this research. Neutrophil lymphocyte ratio was calculated and its association with predialysis glucose and HbA1c was studied. Results: NLR was positively correlated with predialysis glucose (p=0.000, r=0.338), body mass index (p=0.029, r=0.220), white blood cell (p=0.000, r=0.430), platelet (p=0.034, r=0.159), neutrophil (p=0.000, r=0.656) and C-reactive protein (p=0.00, r=0.377) levels. In non-diabetic hemodialysis group, predialysis glucose was still correlated with neutrophil lymphocyte ratio (p=0.047, r=0.224). Diabetics had higher predialysis glucose (185.94±81.11 vs 111.24±25.59, p=0.000) and neutrophil lymphocyte ratio (4.99±4.17 vs 2.82±1.23, p=0.000) compared to non-diabetics. Conclusion: This study revealed that predialysis glucose levels in hemodialysis patients are correlated with neutrophil lymphocyte ratio and hemodialysis patients with diabetes have higher neutrophil lymphocyte ratio levels. Neutrophil lymphocyte ratio should be recognized as a glycemic control marker along with traditional glycemic indices in HD patients.

Relationship among dietary intake of vitamin D, magnesium, and calcium, 25-hydroxyvitamin D levels, and glycemic control markers in individuals with type 2 diabetes

AimsTo investigate the associations of 25-hydroxyvitamin D (25(OH)D) concentrations, vitamin D intake, magnesium, and calcium with glycemic control in individuals with type 2 diabetes mellitus (T2DM). MethodsA total of 107 adult with T2DM, residing in the state of Sergipe/Brazil (latitude: 10°), were evaluated for serum concentrations of 25(OH)D, parathyroid hormone, fasting glucose, %HbA1c, insulin, C-peptide, total cholesterol and fractions, homeostasis of beta-cell function (HOMA-B), insulin sensitivity (HOMA-S) and resistance (HOMA-IR), anthropometry, body composition, and usual food intake. The results were analyzed according to 25(OH)D status (insufficient/deficient <30 ng/mL; adequate ≥30 ng/mL). Mann–Whitney, chi-square, and binary logistic regression tests were performed. P-value<0.05 was considered significant. ResultsThe median age and time to T2DM diagnosis were 49 and 5 years, respectively. High inadequacy was observed in the dietary intake of vitamin D, magnesium, and calcium. Higher HOMA-B values were observed in the vitamin D adequate group (p = 0.032) and higher fasting serum glucose concentrations (p = 0.012) and %body fat (p = 0.048) in the insufficient/deficient group, which had a higher chance of elevated serum glucose (odds ratio [OR]:2.937; p = 0.020) and HOMA-IR (OR:2.496; p = 0.045). ConclusionVitamin D deficiency is associated with poor glycemic control and insulin resistance, and these aspects are unrelated to inadequate dietary intake of vitamin D, magnesium, and calcium.

The Value of Fructosamine in Prediction of Angiographic Outcomes in Diabetic Patients Presented with Anterior STEMI Undergoing Their First Primary PCI

Abstract Background Cardiovascular diseases are the leading most common cause of death in industrialized countries. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction and failure of different organs especially heart and blood vessels. Objective To study the predictive value of Fructosamine as a marker of short-term glycemic control over 2-3 weeks on the angiographic and clinical outcomes in diabetic patients presented with anterior STEMI in Ain shams university hospital. Patients and Methods This is an observational study recruiting 100 patients presented with anterior STEMI who underwent their first primary percutaneous coronary intervention (PPCI) from May 2020 to December 2020. Results Angiographic results of patients post PCI were as follows: Regarding Thrombolysis in myocardial infarction (TIMI Flow), 8 patients had TIMI flow 0, 18 had TIMI I, 27 had TIMI II and 37 had TIMI III flow. Regarding myocardial blush grade (MBG) 12 patients had MBG grade 0, 27 had grade I, 20 had grade II and 4 had grade III. During follow up for one-month, Major adverse cardiac events (MACE) occurred in 56% of patients. Measured serum Fructosamine levels were ranging between (233 to 557 µmoll/L) the results showed a strong correlation between serum Fructosamine and TIMI flow MBG. Patients with higher Fructosamine level had worsen TIMI flow and MBG and more occurrence of MACE in diabetic patients after PPCI. Conclusion High Fructosamine level can be used as a predictor for worse outcomes in diabetic patients presented with Anterior STEMI. Abbreviations STEMI: ST segment elevation myocardial infarction; PPCI: primary percutaneous coronary intervention; TIMI: Thrombolysis in myocardial infarction; MBG: Myocardial blush grade; DM: Diabetes Mellitus; MACE: Major adverse cardiac events

Preliminary evaluation of the impact of periodontal treatment on markers of glycaemic control in dogs with diabetes mellitus: A prospective, clinical case series.

Periodontal disease (PD) can adversely affect glycaemic control in humans. However, it is unknown if a similar association exists in dogs. Ten client-owned dogs with poorly regulated diabetes mellitus (DM) and PD were prospectively enrolled. A complete blood count, serum biochemistry, urinalysis and measurement of C-reactive protein, interleukin-6 (IL-6), tumour necrosis factor-α, haemoglobin A1c (HbA1c) and fructosamine concentrations were performed before periodontal treatment (PT) and monthly thereafter for 3 months. A periodontal disease severity score (PDSS) was determined during PT. The effects of time post-PT and PDSS on markers of inflammation and glycaemic control were determined by generalised estimating equation analysis. HbA1c (mean; 95% confidence interval [CI]) decreased 3 months post-PT (32.1mmol/mol; 21.1-43.1 mmol/molvs. 44.3mmol/mol; 36.4-52.0; p = 0.003). PDSS at enrolment was significantly (p = 0.031) positively associated with HbA1c concentration. Due to a significant (p < 0.001) interaction between PDSS and time post-PT in the analysis of fructosamine, dogs with low (1-3) PDSS and high (7-9) PDSS were analysed separately. Fructosamine (mean; 95% CI) significantly decreased 1 month post-PT (570μmol/L; 457-684 μmol/Lvs. 624μmol/L; 499-748; p = 0.001) in the high PDSS group but not in the low PDSS group. Fructosamine concentration upon enrolment and PDSS were correlated (r = 0.73, p = 0.017). IL-6 concentration significantly decreased 3 months post-PT (9.9 pg/mL; 8.5-11.3 pg/mLvs. 11.2 pg/mL; 9.7-12.7; p = 0.002). Limitations of the study included the small number of dogs, the lack of a control group and the inability to assess PDSS during follow-ups. These findings support a potential detrimental interaction between PD and DM. The apparent beneficial effect of PT on markers of glycaemic control was most conspicuous in dogs with more severe PD.

Leptin Decreases Gluconeogenesis and Gluconeogenic Substrate Availability in Patients With Lipodystrophy.

The effects of leptin, an adipocyte-derived hormone that signals overall energy sufficiency, can only be studied in leptin-deficient conditions. In patients with lipodystrophy, a rare disease and unique model of leptin deficiency, treatment with recombinant leptin (metreleptin) improves glycemia and decreases energy expenditure. We hypothesized that these improvements might be mediated by reduced gluconeogenesis (GNG), an energy-requiring process. To determine the effects of metreleptin on GNG and GNG substrates. This was a single-arm prospective study of metreleptin administration in 15 patients with lipodystrophy, 9 of whom had data on GNG (NIH, 2013-2018). We analyzed total GNG, insulin-mediated suppression of GNG, glycerol, palmitate, alanine, lactate, peripheral and hepatic insulin sensitivity, and markers of glycemia (eg, HbA1c, glucose, fasting insulin). Metreleptin administration decreased basal GNG, increased insulin-mediated suppression of GNG, and improved insulin sensitivity and markers of glycemic control. Metreleptin reduced carbon sources for GNG, including plasma alanine and lactate, and rate of appearance (Ra) of glycerol, and decreased Ra of palmitate, a driver of GNG. Glycerol and palmitate Ra correlated with GNG prior to but not during metreleptin administration. Alanine strongly correlated with GNG both before and during metreleptin administration. Metreleptin treatment in patients with lipodystrophy reduced GNG likely through decreased availability of carbon sources for gluconeogenesis, such as alanine, lactate, and glycerol. Associations between alanine and GNG persisted after metreleptin treatment while correlations with glycerol and palmitate Ra did not persist, suggesting reduced importance of lipolysis as a driver of GNG in the leptin-replete state.

Effects of γ-aminobutyric acid supplementation on glucose control in adults with prediabetes: A double-blind, randomized, placebo-controlled trial

BackgroundGamma-aminobutyric acid (GABA) is mainly known as an endogenously produced neurotransmitter. However, GABA intake from dietary sources like tomatoes and fermented foods can be considerable. Studies in rodent models have shown beneficial effects of oral GABA supplementation on glucose homeostasis and cardiovascular health. Still, it is currently unknown whether oral GABA supplementation produces cardiometabolic benefits in humans. ObjectivesThis study aimed to investigate whether oral GABA supplementation can improve glucose homeostasis in individuals at risk of developing type 2 diabetes. MethodsIn a randomized, placebo-controlled, double-blind, parallel-arm trial, 52 individuals with prediabetes (classified by impaired glucose tolerance and/or impaired fasting glucose), aged 50 to 70 y with a body mass index ≥25 kg/m2 received either 500 mg GABA 3 times daily or a placebo for 95 days. The primary outcome was the effect of the intervention on glucose response after an OGTT. As exploratory secondary outcomes, markers of glycemic control (glycated hemoglobin, insulin, glucagon, mean amplitude of glycemic excursions, and standard deviation as measured with flash glucose monitoring), cardiovascular health (blood pressure, 24-h blood pressure, circulating triglycerides, cholesterol), and self-reported sleep quality were measured before and after the intervention. ResultsCompared with placebo, GABA supplementation for 95 days did not change the postprandial glucose response (0.21 mmol/L; 95% confidence interval: −0.252, 0.674; P = 0.364). After correction for the false discovery rate, all other outcomes (including fasting plasma GABA concentration) showed no significant effects from GABA intervention at a group level. ConclusionsGABA supplementation does not change the postprandial glucose response in individuals at risk of developing type 2 diabetes. However, based on findings in secondary outcome measures, further research is warranted in other study populations. Research could focus on the effects of GABA in individuals with advanced diabetes or other cardiometabolic disorders.This trial was registered at www.clinicaltrials.gov as NCT04303468.

A Cross-Sectional Study Investigating Lumbar Proprioception Impairments in Individuals with Type 2 Diabetes Mellitus: Correlations with Glycated Hemoglobin Levels.

Impaired proprioception is a recognized complication in individuals with type 2 diabetes mellitus (T2DM), contributing to balance deficits and increased risk of falls. However, limited research has focused on lumbar proprioception in this population. This study aimed to investigate lumbar proprioception in individuals with T2DM, as well as healthy individuals. Additionally, this study aimed to examine the correlation between lumbar proprioception and glycated hemoglobin (HbA1c) levels, which is a marker of long-term glycemic control in T2DM. A cross-sectional study was conducted, comparing lumbar joint reposition errors (JRE) between a T2DM group (n = 85) and a healthy group (n = 85). Lumbar JRE was assessed in flexion, extension, lateral bending left, and lateral bending right using a dual inclinometer device. HbA1c levels were measured as an indicator of glycemic control. Significant differences in lumbar JRE were found between the T2DM and healthy groups, with individuals with T2DM exhibiting larger JRE values, indicating impaired lumbar proprioception (p < 0.001). The correlation analysis revealed significant positive associations between HbA1c levels and lumbar JRE. Higher HbA1c levels were correlated with greater joint JRE in flexion (r = 0.49, p < 0.001), extension (r = 0.51, p < 0.001), left lateral bending (r = 0.45, p < 0.001), and right lateral bending (r = 0.48, p < 0.001) in the T2DM group. This study provides evidence of impaired lumbar proprioception in individuals with T2DM, as evidenced by larger lumbar JRE compared to the healthy group.

Effects of non-nutritive sweetened beverages versus water after a 12-week weight-loss program: A randomized controlled trial.

The aim of this study was to compare non-nutritive sweetened (NNS) beverages versus water for weight loss after a 12-week behavioral weight-management program. This is an ongoing, 2-year, parallel-group, open-label, controlled equivalence trial; week-12 data are reported. Adults with BMI of 27 to 35 kg/m2 who regularly drank cold beverages were randomized 1:1 to intention-to-treat water or NNS beverages while undergoing a weekly 12-week group behavioral weight-management program. Weight change to week 12 was the primary end point (equivalence: two-sided p > 0.05); changes in waist and hip circumference, blood pressure, glycemic control markers, fasting lipid profiles, liver function tests, hunger (visual analog scale), sugar and sweetener consumption, and activity levels were secondary end points. Overall, 493 participants were randomized (water: n = 246; NNS beverages: n = 247); 24.1% were NNS beverage naïve. Weight change was equivalent with water versus NNS beverages (-5.6 vs. -5.8 kg; difference [90% CI]: -0.2 kg [-0.7 to 0.4]). There were no significant differences between groups for secondary end points except reductions in waist circumference (greater with NNS beverages vs. water), glycated hemoglobin, and consumption of any type of sweetener (both greater with water vs. NNS beverages). Weight loss was equivalent with NNS beverages and water following a 12-week behavioral weight-management program.

THE CARDIOPROTECTIVE EFFECTS OF EMPAGLIFLOZIN IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION AND TYPE 2 DIABETES MELLITUS

Introduction. Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome associated with significant morbidity and mortality. Type 2 diabetes mellitus (T2DM) often coexists in patients with HFpEF, further exacerbating the cardiovascular risk. Empagliflozin, a sodium-glucose cotransporter 2 inhibitor, has shown promising results in improving cardiovascular outcomes in patients with T2DM. However, the specific cardioprotective effects of empagliflozin in patients with HFpEF and T2DM remain to be elucidated.&#x0D; Aim. To assess the effect of empagliflozin on biochemical markers of heart failure in patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction.&#x0D; Materials and Methods. The study included 80 patients with HFpEF and T2DM, with 40 patients in the empagliflozin group and 40 patients in the control group. Baseline characteristics, including age, gender, blood pressure, body mass index, and cardiac markers (HbA1c, NT-proBNP, Galectin-3, and sST2), were assessed. Changes in glycemic control and cardiac markers were analyzed after the treatment period.&#x0D; Results. Baseline characteristics showed no significant differences between the two groups, indicating successful randomization. Post-treatment analysis revealed a numerical trend towards improved glycemic control in the empagliflozin group compared to the control group. Notably, empagliflozin treatment led to a significant reduction in NT-proBNP levels, indicating improved cardiac function and reduced cardiac stress. Furthermore, empagliflozin was associated with lower Galectin-3 and sST2 levels, suggesting potential benefits in mitigating cardiac fibrosis, remodeling, and inflammation.&#x0D; Conclusions. Empagliflozin treatment in patients with HFpEF and T2DM have multifaceted implications beyond glycemic control. The observed reductions in NT-proBNP, Galectin-3, and sST2 levels suggest potential improvements in cardiac function, fibrosis, remodeling, and inflammatory processes. These findings highlight the potential of empagliflozin as a therapeutic option for managing HFpEF and T2DM, offering the potential for comprehensive cardiovascular benefits in this patient population.

Relationship between Diabetes Mellitus and Serum Lathosterol and Campesterol Levels: The CACHE Study DM Analysis.

Risk of cardiovascular disease is increased in patients with diabetes mellitus (DM). Cholesterol metabolism (hepatic synthesis and intestinal absorption) is known to be associated with cardiovascular risk. Next, we examined the association of DM with cholesterol absorption/synthesis. The CACHE Consortium, which is comprised of 13 research groups in Japan possessing data of lathosterol (Latho, synthesis marker) and campesterol (Campe, absorption marker) measured by gas chromatography, compiled the clinical data using the REDCap system. Among the 3597 records, data from 2944 individuals were used for several analyses including this study. This study analyzed data from eligible 2182 individuals including 830 patients with DM; 42.2% were female, median age was 59 years, and median HbA1c of patients with DM was 7.0%. There was no difference in Latho between DM and non-DM individuals. Campe and Campe/Latho ratio were significantly lower in DM individuals than in non-DM individuals. When the associations of glycemic control markers with these markers were analyzed with multivariable-adjusted regression model using restricted cubic splines, Campe and Campe/Latho ratio showed inverse associations with glucose levels and HbA1c. However, Latho showed an inverted U-shaped association with plasma glucose, whereas Latho showed a U-shaped association with HbA1c. These associations remained even after excluding statin and/or ezetimibe users. We demonstrated that DM and hyperglycemia were independent factors for lower cholesterol absorption marker levels regardless of statin/ezetimibe use.

1313-P: The Prevalences of NAFLD and Liver Fibrosis Are High in Individuals with Type 1 Diabetes and Increase with Disease Progression

Introduction: Approximately 30% of the global population has nonalcoholic fatty liver disease (NAFLD). This can result in nonalcoholic steatohepatitis (NASH) and liver fibrosis (2% in general population). NAFLD with fibrosis increases overall morbidity and mortality significantly. T2D increases the risk of fibrosis progression in NAFLD, but little is known about NAFLD in T1D. Therefore, the aim of this study was to assess the prevalence of NAFLD and liver fibrosis in T1D. Methods: In this cross-sectional study 453 individuals with T1D were included for analyses (41.0 ±14years old, 64% female, HbA1c 55.6 ±12mmol/mol, median T1D duration 14 [IQR: 6-29] years. Participants underwent a FibroScan® to assess liver stiffness, with a cut-off of 238 dB/m for steatosis and 7.0 kPa for fibrosis. Data analyses was performed in R studio, using a Students T- or Mann-Whitney U test, as appropriate. Results: Prevalence of liver steatosis was 29.5% and fibrosis was 7.7%. Steatosis was significantly higher in individuals with longer T1D duration (median:15 [IQR:7-25] vs. 23 [9-33] years), higher 24-hour insulin dose (34 [24-47] vs. 46 [33-62] units), higher BMI (mean 24.3±SD 3.5 vs. 27.9±4.6 kg/m2), higher CRP levels (1.0 [0.5-2.1] vs. 1.6 [0.8, 3.7] mg/L), higher triglyceride levels (0.6±0.3 vs. 0.8±0.5 mmol/L) and lower TIR (67 [51-82] vs. 62 [48-75] %). Presence of fibrosis was associated with a longer duration of T1D (16 [7-27] vs. 30 [20-39] years) a higher 24-hour insulin (36.0 [26-50] vs. 42 [34-63] units), higher BMI (25.1±4.1 vs. 27.8±4.6 kg/m2), higher CRP levels (1.2 [0.6-2.4] vs 1.5 [0.8-3.9] mg/L) and lower TIR (67 [51, 8] vs. 58 [46, 71] %). Conclusion: The prevalence of NAFLD and liver fibrosis was 7.7% in individuals with T1D. Duration of T1D, markers of insulin resistance, glycemic control and inflammation are likely contributors to this high prevalence and more attention should be paid to this possible complication. Disclosure C. Fuhri Snethage: None. A.S. Meijnikman: None. P. de Groen: None. C. Callender: None. E. Rampanelli: None. C.B. Brouwer: 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. M. Nieuwdorp: Advisory Panel; caelus health. N. Hanssen: Research Support; Novo Nordisk. Consultant; Novo Nordisk. Funding DNF DON Grant 2020 (2020.10.002)

782-P: Efficacy of Tirzepatide in People with Young-Onset T2D in the SURPASS Program

Young-onset T2D, defined as diagnosed before age 40, presents with a more aggressive disease course, faster beta-cell deterioration and reduced response to diabetes treatment compared to later-onset T2D. Tirzepatide (TZP), a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptor agonist, was recently approved for the treatment of type 2 diabetes (T2D). This post-hoc analysis assessed the effect of tirzepatide on glycemic control, body weight (BW) and cardiometabolic markers in participants with young-onset T2D from the SURPASS program. Changes from baseline in mean HbA1c, BW, waist circumference (WC), and cardiometabolic markers including lipids, and blood pressure (BP) were compared in participants with young-onset (N=873, 20.5%) vs later-onset T2D (N=3394, 79.5%) at Week 40 (SURPASS-1, -2, -5) or Week 52 (SURPASS-3). No differential treatment effect was observed for participants with young- vs later-onset T2D. Tirzepatide treatment led to similar improvements in HbA1c and BW in both subgroups at Week 40/52 for all TZP doses (Figure). Furthermore, TZP (all doses) improved WC, lipids (triglycerides and HDL) and systolic BP similarly between the two groups. In conclusion, tirzepatide treatment led to similar improvements in HbA1c, BW and cardiometabolic markers (WC, lipids, SBP) in participants regardless of having young-onset or later-onset T2D. Disclosure P.Zeitler: Consultant; Eli Lilly and Company, Boehringer Ingelheim Inc., Johnson &amp; Johnson. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. M.J.Davies: Advisory Panel; Lilly, Boehringer-Ingelheim, Novo Nordisk, Sanofi, Lexicon Pharmaceuticals, Inc., Pfizer Inc., Medtronic, ShouTi Pharma Inc., Consultant; Lilly, Boehringer-Ingelheim, Novo Nordisk, Sanofi, Research Support; AstraZeneca, Novo Nordisk, Sanofi-Aventis U.S., Boehringer-Ingelheim, Janssen Pharmaceuticals, Inc., Speaker's Bureau; Lilly, Boehringer-Ingelheim, Novo Nordisk, AstraZeneca, Napp Pharmaceuticals Limited, Novartis, Sanofi. B.Bergman: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. V.Thieu: None. C.Nicolay: Employee; Eli Lilly and Company. S.Allen: None. C.Lee: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company

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)