Microvascular Complications Of Type 2 Diabetes Mellitus Research Articles

Expression levels of serum vasohibin-1 in type 2 diabetes mellitus patients with different excretion rates of urinary albumin and its clinical significance

Objective To investigate the expression levels of serum vasohibin-1(VASH-1)in type 2 diabetes mellitus(T2DM)patients at different stages of urinary albumin to creatinineratio(UACR)and to attempt to investigate the relationship between VASH-1 and inflammation and fibrosis in the pathogenesis of diabetic nephropathy(DN), one of the microvascular complications of T2DM. Methods 486 patients with T2DMwere divided into four groups: normal albuminuria [UACR 300 mg/g, n=106], and clinical albuminuria hypertensive [UACR>300 mg/g, with hypertension, n=124] groups. Age, course, serum levels ofVASH1, inflammation markers(CRP, ESR)and fibrosis marker(TGF-β1)with other biochemical indicators were measured, and 130 normal control subjects were also included. Results Compared with normal control group, the levels of UACR, HbA1C, ESR, CRP, TGF-β1 and VASH-1 in groups ofnormal albuminuria, microalbuminuria, clinical albuminuria, and clinical albuminuria hypertensive were significantly higher(P<0.05). Pearson correlation analysis showed that levels of VASH-1 were positively correlated with UACR, HbA1C, ESR, CRPand TGF-β1(r=0.521, 0.261, 0.519, 0.523, 0.479, P<0.001), while multivariate regression analysis showed that levels of UACR, HbA1C, ESR, CRP and TGF-β1 were important factors affecting serum VASH-1 levels. Conclusion Serum levels of VASH-1 may become new biomarkers of early diagnosis of DN. Consequently, VASH-1 level may provide a new pattern and direction of inflammation and fibrosis for consideration in diabetic kidney damage. (Chin J Endocrinol Metab, 2016, 32: 647-651) Key words: Diabetic nephrophathy; Transforming growth factor--β1; Vasohibin-1

Burden and pattern of micro vascular complications in type 2 diabetes in a tertiary health institution in Nigeria.

Diabetes mellitus (DM) afflicts at least 5 million people in Nigeria, with more than 80% having type 2 diabetes mellitus (T2DM). Microvascular complications increase both morbidity and mortality inpatients with T2DM. The aims of this study were to report the burden of various microvascular complications in T2DM and to identify various factors associated with these complications in patients with T2DM attending the diabetes outpatients' clinic. Ninety (90) patients with T2DM who have attended diabetes clinic for at least 3 months were recruited for this study. Detailed history, physical examination and biochemical analysis was done in each of the patients. All patients underwent a detailed standard evaluation to detect diabetic retinopathy (fundoscopy), neuropathy (10g monofilament and/or diabetes neuropathy scores), and nephropathy (microalbuminuria, macroalbuminuria, serum creatinine and estimated glomerular filtration rate). There was high prevalence of microvascular complications among patients with T2DM. Almost half of patients with T2DM had some form of microvascular complications; diabetic neuropathy being the commonest (69.6%),followed by nephropathy (54.5%) and retinopathy (48.9%). The factors associated with developing these complications were increasing age, duration of diabetes, hypertension and dyslipidaemia for nephropathy and neuropathy. There is a high burden of microvascular complications in patients with type 2 diabetes. Age, male gender, hypertension, glycaemic control, BMI and duration of diabetes, and glycaemic control were factors associated with microvasular complications.

Relationship between vitamin D status and vascular complications in patients with type 2 diabetes mellitus

We aimed to investigate the association between serum 25-hydroxyvitamin D (25[OH]D) and microvascular complications in type 2 diabetes mellitus (T2DM) patients. It was hypothesized that lower 25(OH)D would be associated with increased microvascular complications in T2DM. A total of 257 T2DM patients (111 men, 146 women) who underwent diabetic microvascular complication (peripheral neuropathy, nephropathy, retinopathy) studies were recruited. Patients were categorized into 3 groups according to vitamin D status: vitamin D sufficient (n = 41, 25[OH]D ≥ 20 ng/mL), vitamin D insufficient (n = 132, 10 ≤ 25[OH]D < 20 ng/mL), and vitamin D deficient (n = 84, 25[OH]D < 10 ng/mL). In men, the prevalence of diabetic peripheral neuropathy (DPN) was significantly higher in patients with vitamin D deficiency than in those with insufficiency or sufficiency (38%, 11.7%, and 10%, respectively; P = .005). In addition, the prevalence of diabetic nephropathy (DN) was significantly higher in women with vitamin D deficiency than in the other 2 groups (40%, 20.6%, and 0%; P = .007). Compared with men in the vitamin D–sufficient group (reference), men in the vitamin D–deficient group had an increased risk of DPN after adjusting for confounding factors (odds ratio, 7.79; 95% confidence interval, 1.52-40.05). For women, when the vitamin D–sufficient group was used as a reference, those in the vitamin D–deficient group had an increased risk of DN after adjusting for confounding factors (odds ratio, 4.27; 95% confidence interval, 1.58-11.56). This present study found that a serum 25(OH)D level less than 10 ng/mL is independently associated with increased DPN in male patients and increased DN in female patients with T2DM.

Moving goal posts: Definition of diabetes remission after bariatric surgery

The escalating twin pandemics of obesity and type 2 diabetes mellitus (T2DM) present a major global public health burden. Bariatric surgery is an effective treatment for obese patients with T2DM, as it not only causes weight loss, but also improves metabolic risk factors including glycemia, hypertension and dyslipidemia. Although several studies have shown impressive remission rates of T2DM following bariatric surgery, these studies have used different definitions of remission. In an attempt to solve the problem of inconsistent definitions, the American Diabetes Association and International Diabetes Federation, two large diabetes organizations, have developed standardized criteria for T2DM remission. These criteria are comprised of clinical parameters including glucose, lipid and blood pressure control and medication usage. Studies using these criteria have reported lower rates of remission than those previously reported using nonstandardized definitions. This review describes the existing literature on remission of T2DM following bariatric surgery, and emphasizes the importance of using the standardized definitions established in order to improve remission rates and thus reduce the incidence of the macrovascular and microvascular complications of T2DM.

Prevalence of Hypogonadism in Patients with Type 2 Diabetes Mellitus in an Asian Indian Study Group

To determine the prevalence of hypogonadism in Asian Indian patients with type 2 diabetes mellitus (T2DM) and to correlate it with components of the metabolic syndrome and microvascular complications of T2DM. One hundred consecutive male patients with T2DM between 25 and 50 years of age and 50 age-matched healthy adults without diabetes underwent assessment. Calculated free testosterone was derived by using serum total testosterone and sex hormone-binding globulin. Those patients with 2 calculated free testosterone values less than 64.8 pg/mL were diagnosed as having hypogonadism. Of the 100 patients with T2DM, 15 (15%) were found to have hypogonadism-7 of 29 (24%) between 31 and 40 years of age and 8 of 67 (12%) between 41 and 50 years old. None of the 4 patients between 25 and 30 years old had hypogonadism. Eleven patients (73%) had hypogonadotropic hypogonadism, and 4 (27%) had hypergonadotropic hypogonadism. Among the control subjects, the prevalence of hypogonadism was 10%. In comparison with Western data, we found a higher prevalence of hypogonadism in patients with T2DM, especially in those in the 4th decade of life. The prevalence of hypogonadism was higher in obese patients, although it did not reach statistical significance. No statistically significant correlation was observed between hypogonadism and age, duration of diabetes, glycemic control, androgen deficiency symptoms, or microvascular complications. The prevalence of hypogonadism was higher in the patients with diabetes than in the control subjects, although the difference did not reach statistical significance. There was no correlation of hypogonadism with components of the metabolic syndrome or microvascular complications of diabetes mellitus.

Metabolic Syndrome in Type 2 Diabetes Mellitus in Isfahan, Iran: Prevalence and Risk Factors

Our goal was to estimate the prevalence and risk factors of metabolic syndrome (MetSyn) in people with type 2 diabetes mellitus (T2DM) using routinely collected data from a clinical information system at Isfahan Endocrinology and Metabolism Research Centre, Iran. Consecutive diabetic patients (9889 total, 4164 male and 5725 female) from Isfahan Endocrinology and Metabolism Research Centre outpatient clinics, Iran, have been examined. The mean (SD) age of participants was 52.0 (10.9) years with a mean (standard deviation) duration of diabetes of 6.4 (6.4) years at initial registration. A modified National Cholesterol Education Program-Adult Treatment Panel III definition with body mass index instead of waist circumference was used for the MetSyn. The prevalence of MetSyn was 65.0% [95% confidence interval (CI) 64.0, 65.9], with higher rate in females than males (71.7 [95% CI: 70.5, 72.8] female and 55.8 [95% CI: 54.3, 57.3] male) and it was greater with older age. The age-adjusted prevalence rate of MetSyn was associated with female gender, duration of diabetes, fasting blood glucose, systolic and diastolic blood pressure, body mass index (BMI), smoking, proteinuria, insulin-treatment, triglyceride, cholesterol, HDL cholesterol, hypertension, and dyslipidemia. Using a stepwise binary logistic regression model, age, gender, fasting blood glucose, systolic and diastolic blood pressure, BMI, triglyceride, and cholesterol were significant predictors of MetSyn for T2DM patients. These data suggest MetSyn in this population of Iranian type 2 diabetic patients is common, and with an estimated prevalence of 65%, MetSyn clearly poses a formidable health threat to Iranian diabetic patients. Lifestyle interventions in T2DM subjects are needed in Iran to halt the burden of macro- and micro-vascular complications in T2DM.