Microvascular Complications In Type Research Articles

Abstract 140: Significant reduction in HbA1c levels among participants with poorly controlled type 2 diabetes on diabefly® digital therapeutics program using multidisciplinary approach

Background: Long-term hyperglycemia is a potential risk factor for both macro and microvascular complications in Type 2 diabetes. Digital therapeutics platform can be a highly accessible and cost-effective way in helping these patients with dietary, behavior change and fitness advice aimed towards better glycemic control.Aims and Objectives: To evaluate the effectiveness of Diabefly® digital therapeutics program using multidisciplinary approach in participants with type 2 diabetes mellitus having HbA1c ≥9%.Results: De-identified data of 49 participants using Diabefly® platform was analysed. The mean age was 46.12 years and 57.14% were females. At the end of 90 days, a significant mean reduction in HbA1C, body weight and body mass index (BMI) by 3.34%, 2.41 kg and 0.82 kg/m2 (p<0.001 for all) was observed respectively. 26 participants with complete data on waist circumference (WC) showed significant mean reduction by 4.89 cm (p<0.001). Among 21 participants with dietary data a significant mean reduction in carbohydrate and total calorie intake was observed after completion of the program (p<0.001).Conclusion: This study highlighted that the participants had a significant reduction in their HbA1c, body weight, BMI, WC, and intake of carbohydrate and total calories at the completion of the 90 days Diabefly® program thus making Digital therapeutics an indispensable tool for implementing lifestyle related behaviour change.

The relation between serum uric acid levels and diabetic peripheral neuropathy in type 2 diabetes in Guilan, north of Iran

BackgroundDiabetic peripheral neuropathy (DPN) is one of the most common chronic microvascular complications in type 2 diabetes mellitus (T2DM). Hence, the present study aimed to investigate the association between Serum Uric Acid (SUA) levels and diabetic peripheral polyneuropathy in patients with type 2 diabetes.MethodsWe performed this case–control study during 2019–2020 on individuals with diabetes referring to the Razi clinic of Rasht, in the north of Iran. Polyneuropathy in patients was assessed based on the Neuropathy Disability Score (NDS), Diabetic neuropathy symptom score (DNS) scoring system, and electromyography (EMG)/nerve conduction velocity (NCV). The inclusion criterion for the control group was normal EMG/NCV. Then, the patients were assessed for SUA level and also laboratory results.ResultsIn total, 230 patients with type 2 diabetes were examined. The mean SUA level in the DPN group was significantly higher compared to the control group (6.72 ± 1.75 vs. 4.57 ± 1.49 mg/dL). With increasing the SUA, the odds of developing neuropathy increased by 2.2 times (OR = 2.2). The risk factors for diabetic polyneuropathy included gender (male) (OR = 0.347), SBP (OR = 1.1), retinopathy (OR = 3.29), and microalbuminuria (OR = 4.44). The chance of developing polyneuropathy in patients with retinopathy was 3.3 times higher than in the control group, it was 4.4 times in microalbuminuria patients.ConclusionElevated SUA level increased the chance of developing peripheral polyneuropathy in a person with type 2 diabetes. SUA levels higher than 5.25 mg / dL expose a person with type 2 diabetes to developing peripheral polyneuropathy.

Machine Learning for Screening Microvascular Complications in Type 2 Diabetic Patients Using Demographic, Clinical, and Laboratory Profiles.

Microvascular complications are one of the key causes of mortality among type 2 diabetic patients. This study was sought to investigate the use of a novel machine learning approach for predicting these complications using only the patient demographic, clinical, and laboratory profiles. A total of 96 Bangladeshi participants with type 2 diabetes were recruited during their routine hospital visits. All patient profiles were assessed by using a chi-squared (χ2) test to statistically determine the most important markers in predicting three microvascular complications: cardiac autonomic neuropathy (CAN), diabetic peripheral neuropathy (DPN), and diabetic retinopathy (RET). A machine learning approach based on logistic regression, random forest (RF), and support vector machine (SVM) algorithms was then developed to ensure automated clinical testing for microvascular complications in diabetic patients. The highest prediction accuracies were obtained by RF using diastolic blood pressure, albumin–creatinine ratio, and gender for CAN testing (98.67%); microalbuminuria, smoking history, and hemoglobin A1C for DPN testing (67.78%); and hemoglobin A1C, microalbuminuria, and smoking history for RET testing (84.38%). This study suggests machine learning as a promising automated tool for predicting microvascular complications in diabetic patients using their profiles, which could help prevent those patients from further microvascular complications leading to early death.

Effects of circadian blood pressure patterns on development of microvascular complications in pediatric patients with type 1 diabetes mellitus.

Purpose The effects of circadian blood pressure (BP) alterations on the development and progression of microvascular complications in type 1 diabetes mellitus (T1DM) patients are unknown. We evaluated the effects of circadian BP alterations with development of microvascular complications during follow-up with patients with childhood-onset T1DM.Methods We investigated the medical records of 81 pediatric patients with T1DM who underwent 24-hour ambulatory BP monitoring (ABPM) between January 2009 and February 2010.Results Mean age at diagnosis and ABPM evaluation was 8.0±3.9 and 15.6±2.4 years, respectively. Hypertension (daytime, nighttime, and 24-hour mean hypertension) data were available in 42 patients. During the 8 years of follow-up after ABPM, microvascular complications occurred in 8 patients (diabetic retinopathy [DR] alone in 5, microalbuminuria alone in 2, and both in 1), of whom 7 had nondipper BP. Nighttime diastolic BP, nighttime mean arterial pressure, and glycated hemoglobin A (HbA1c) level were higher in patients with DR than in those without DR (P<0.05 for all). Daytime or nighttime BP and presence of dipper BP were not related to microvascular complications, but diabetic microvascular complications were more likely to occur in patients with an older age at diagnosis and higher HbA1c level. The proportion of patients with DR was higher in those with nondipper hypertension (83.3%) compared with dipper and nondipper normotension (0% and 16.7%, respectively; P=0.021).Conclusions As a predictor of microvascular complications, nondipper hypertension was not significant. Glycemic control rather than nondipper hypertension is the predominant factor determining DR in T1DM patients.

Plasma advanced glycation end products and the subsequent risk of microvascular complications in type 1 diabetes in the DCCT/EDIC

IntroductionTo assess impact of glycemic control on plasma protein-bound advanced glycation end products (pAGEs) and their association with subsequent microvascular disease.Research design and methodsEleven pAGEs were measured by liquid chromatography-mass...

Precision Diagnostic Approach to Predict 5-Year Risk for Microvascular Complications in Type 1 Diabetes

Precision Diagnostic Approach to Predict 5-Year Risk for Microvascular Complications in Type 1 Diabetes

Effectiveness of platelet indices in predicting type 2 diabetes mellitus microvascular complications

Objective - This study was conducted to evaluate the efficacy of platelet indices, namely mean platelet volume, platelet distribution width, plateletcrit and platelet count for prediction of microvascular complications of type 2 diabetes mellitus. Methods - A hospital-based, single-centre, observational, matched case-control study was conducted. A total of 120 diabetic cases and 120 non-diabetic controls were recruited and various biochemical parameters (fasting and post-prandial blood glucose, HbA1c, mean platelet volume, platelet distribution width, plateletcrit, platelet count and others) were measured. All diabetic cases were subjected for diagnosis of retinopathy, nephropathy or neuropathy. Statistical analyses were performed using unpaired t-test and Pearson’s correlation test. Results - The mean (±SD) age of the diabetic cases and controls were 59.8 (±11.2) years and 53.61 (±10.66) years, respectively. The overall male:female distribution was 64.2%:35.8% and 55.8%:44.2% in diabetic cases and controls, respectively. Platelet count and plateletcrit were found to be significantly higher in diabetic cases than controls (288741 (±97447)/µL vs. 255041 (±63883)/µL, p-value = 0.002; 0.234±0.072% vs. 0.201±0.043%, p-value = 0.0002). However, mean platelet volume and platelet distribution width in diabetic cases were not found to be significantly changed when compared to controls. Plateletcrit showed positive correlation with HbA1c with Pearson’s correlation coefficient of r=0.19 (p-value &lt;0.05). Mean platelet volume and platelet distribution width were found to be not-significantly correlated with HbA1c. Among diabetics, only plateletcrit was found to be significantly raised in cases with all complications compared to cases with no complication (p-value &lt;0.05). Conclusion - Plateletcrit and platelet count were found to be efficacious in forecasting the microvascular complications in type 2 diabetes.

Prevalence of Microvascular Complications in Adolescents and Adults with Type 1 Diabetes

Objective: The aim of this work was to study the prevalence of microvascular complications in type 1 diabetes among the young adolescents and adults of Ahmedabad, Gujarat. Materials and Methods: This descriptive study was carried out at the diabetes care center from August 1, 2020 to March 31, 2021 by setting the inclusion criteria of patients with type 1 diabetes who had a history of at least 5 years or more and all adolescents and young adults who visited the clinic and who were willingly prepared to undergo for fundoscopy. Patients recently detected with type 1 diabetes and patients with previous retinal examination report and other forms of diabetes were excluded from the study. A total of 530 patients visited the clinic during this screening period, of which 125 patients took part in the screening. Microvascular complications screening consisted of fundoscopy and urine examination for microalbuminuria. Results: Of 125, 10 patients (8%) had diabetic retinopathy and 27 patients (21.6%) showed the presence of albumin in urine. The overall prevalence of microvascular complications was 29.6%. There were five patients with a positive history of both microvascular complications. The mean duration of diabetes was 19.6 years and the mean average glucose levels were 8.5% and 8.8%, respectively. Conclusion: We conclude that despite the higher glycemic values the chances of development of complications are negligible during the initial course of type 1 diabetes. With an increase in the duration of diabetes, the prevalence of complications is observed more. Hence, in addition to constant high glycemic values, the course of the disease is also a major responsible factor.

ASSOCIATION OF HYPOTHYROIDISM WITH MICROVASCULAR COMPLICATIONS AMONG PATIENTS OF TYPE-2 DIABETES MELLITUS

Introduction: Diabetes mellitus (DM) is common metabolic disorder leading to various complications including micro-vascular complication. Diabetes and thyroid dysfunction can result in abnormalities of one another, as both are strongly implicated in cellular metabolism. Aim of study was to establish any association between hypothyroidism and micro-vascular complications in patients of type 2 DM.&#x0D; Material and Methods: This Hospital based Cross sectional analytical Study was included 80 Euthyroid and 80 hypothyroid patients of type 2 DM. These patients were subjected to fundus examination (for retinopathy), urine for spot albumin and creatinine ratio and routine microscopy (for nephropathy), clinical examination and NCV (for neuropathy).&#x0D; Results: Age of patients ranged from 30 – 80 years. Most patients had duration of Diabetes &gt; 5 years. Diabetic retinopathy was found in 15% Euthyroid and 37.5% Hypothyroid diabetics (p=0.002). Neuropathy was more in Hypothyroid (35%) as compared to Euthyroid (12.5%) patients (p=0.003). Prevalence of Nephropathy was also significantly more (p=0.011) in Hypothyroids (60%) as compared to Euthyroid (38.75%).&#x0D; Conclusion: Significant association was found between hypothyroidism and micro vascular complications in type 2 Diabetes mellitus. Screening of diabetics for thyroid functions is essential to reduce morbidity.&#x0D; Keywords: Diabetes, thyroid, retinopathy, neuropathy, nephropathy

Abstract 13333: Systolic Blood Pressure Is An Independent Risk Factor For Diabetic Retinopathy In Both Hypertensive And Normotensive Patients

Introduction: Treatments with targets of systolic blood pressure (BP) &lt;140 mmHg reduce the onset, or decrease the progression of diabetic retinopathy (DR) - a most common microvascular complication in type 2 diabetic patients with established hypertension. However, the debate on further intensive vs. standard BP control targets in limiting the onset and progression of diabetic microvascular complications remains to be an area of controversy. We aimed to explore whether the extent to which systolic BP levels were associated with the presence of DR in type 2 diabetic patients with normal BP were similar to that in patients with coexisting hypertension. Hypothesis: We assessed the hypothesis that systolic BP levels were not associated with DR in normotensive patients. Methods: This was a baseline analysis of a cohort of adult Chinese patients diagnosed with type 2 diabetes who attended ophthalmoscopic exam with primary care referral in the context of a Specialist-Generalist Working Alliance in Guangzhou, China. A hospital-based, standardised investigation included a dilated, comprehensive eye examination, a measurement of BP values and anthropometric parameters, and a clinical laboratory test for haemoglobin A1c and lipid profiles. A binary logistic regression analysis was conducted to examine patient-level risk factors associated with DR. Results: The mean age of all study participants (N=2,510) was 64.8 years, and more than half were females. More than one in three patients (40.4%) were normotensive. The average duration of diabetes was 8.6 years, and one in five patients were clinically diagnosed with DR. A higher systolic BP level was significantly associated with DR (adjusted odds ratio [aOR]=1.019, 95%CI: 1.012-1.027; p&lt;0.001 for hypertensives, and aOR=1.020, 95%CI: 1.005-1.036; p=0.009 for normotensives), after adjusting for diabetes duration, sex, lifestyle behaviours, and HbA1c levels. Conclusions: In conclusion, we found that increased systolic BP level was an independent, significant risk factor associated with DR in both hypertensive and normotensive diabetic patients. Physicians, patients and caregivers are recommended to maintain regular monitoring of BP in all diabetic patients irrespective of the coexistence of hypertension.

Metabolic and Metabo-Clinical Signatures of Type 2 Diabetes, Obesity, Retinopathy, and Dyslipidemia.

Macro- and microvascular complications of type 2 diabetes (T2D), obesity, and dyslipidemia share common metabolic pathways. In this study, using a total of 1,300 metabolites from 996 Qatari adults (57% with T2D) and 1,159 metabolites from an independent cohort of 2,618 individuals from the Qatar BioBank (11% with T2D), we identified 373 metabolites associated with T2D, obesity, retinopathy, dyslipidemia, and lipoprotein levels, 161 of which were novel. Novel metabolites included phospholipids, sphingolipids, lysolipids, fatty acids, dipeptides, and metabolites of the urea cycle and xanthine, steroid, and glutathione metabolism. The identified metabolites enrich pathways of oxidative stress, lipotoxicity, glucotoxicity, and proteolysis. Second, we identified 15 patterns we defined as "metabo-clinical signatures." These are clusters of patients with T2D who group together based on metabolite levels and reveal the same clustering in two or more clinical variables (obesity, LDL, HDL, triglycerides, and retinopathy). These signatures revealed metabolic pathways associated with different clinical patterns and identified patients with extreme (very high/low) clinical variables associated with extreme metabolite levels in specific pathways. Among our novel findings are the role of N-acetylmethionine in retinopathy in conjunction with dyslipidemia and the possible roles of N-acetylvaline and pyroglutamine in association with high cholesterol levels and kidney function.

Prognostic models of diabetic microvascular complications: a systematic review and meta-analysis

BackgroundMany prognostic models of diabetic microvascular complications have been developed, but their performances still varies. Therefore, we conducted a systematic review and meta-analysis to summarise the performances of the existing models.MethodsPrognostic models of diabetic microvascular complications were retrieved from PubMed and Scopus up to 31 December 2020. Studies were selected, if they developed or internally/externally validated models of any microvascular complication in type 2 diabetes (T2D).ResultsIn total, 71 studies were eligible, of which 32, 30 and 18 studies initially developed prognostic model for diabetic retinopathy (DR), chronic kidney disease (CKD) and end stage renal disease (ESRD) with the number of derived equations of 84, 96 and 51, respectively. Most models were derived-phases, some were internal and external validations. Common predictors were age, sex, HbA1c, diabetic duration, SBP and BMI. Traditional statistical models (i.e. Cox and logit regression) were mostly applied, otherwise machine learning. In cohorts, the discriminative performance in derived-logit was pooled with C statistics of 0.82 (0.73‑0.92) for DR and 0.78 (0.74‑0.83) for CKD. Pooled Cox regression yielded 0.75 (0.74‑0.77), 0.78 (0.74‑0.82) and 0.87 (0.84‑0.89) for DR, CKD and ESRD, respectively. External validation performances were sufficiently pooled with 0.81 (0.78‑0.83), 0.75 (0.67‑0.84) and 0.87 (0.85‑0.88) for DR, CKD and ESRD, respectively.ConclusionsSeveral prognostic models were developed, but less were externally validated. A few studies derived the models by using appropriate methods and were satisfactory reported. More external validations and impact analyses are required before applying these models in clinical practice.Systematic review registrationPROSPERO CRD42018105287

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Do Long-Term Complications of Type 2 Diabetes Increase Susceptibility to Geriatric Syndromes in Older Adults?

Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially frailty syndrome, are associated with diabetic complications, too. In this study, we aimed to evaluate the effect of macrovascular and microvascular complications of type 2 diabetes on frailty and other geriatric syndromes. In addition, the effect of these complications on quality of life was also reviewed. Materials and Methods: We conducted a cross-sectional study for four months. Comprehensive geriatric assessment tests were done on all patients. The Fried frailty index (FFI) was used for the evaluation of frailty syndrome. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), and Global Leadership Initiative on Malnutrition criteria (GLIM). The EWGSOP 2 criteria were used for the diagnosis of sarcopenia. Quality of life (QoL) was evaluated using the short form-36 (SF-36) questionnaire. Data analysis was done by SPSS version 22. Results: 237 females and 142 males with a mean age of 71.7 ± 6.1 years were included in the study. The frequency of macrovascular and microvascular complications was 41.4% and 68.1%, respectively. Frailty was found to be associated with macrovascular complications (p = 0.003). Handgrip strength, skeletal muscle mass index, and gait speed were decreased in the presence of macrovascular complications (p = 0.043, p < 0.001, p < 0.001). QoL was also decreased in patients with macrovascular complications (p = 0.003). Nutritional status and handgrip strength were negatively affected in patients with diabetic neuropathy (p = 0.019, p = 0.014). Polypharmacy was also found to be associated with macrovascular complications (p < 0.001, p < 0.001). Macrovascular complications were 2.5 times more common in malnourished patients according to GLIM and 3.2 times more common in patients with decreased gait speed. Conclusion: In this study, we observed that both macrovascular and microvascular complications of diabetes increase susceptibility to geriatric syndromes in elderly individuals. It could be useful to conduct prospective studies in which we can compare the effectiveness of treatment methods on this subject.

Correlation of serum delta-like ligand-4 level with the severity of diabetic retinopathy

BackgroundDiabetic retinopathy (DR) is one of the most serious microvascular complications of type 2 diabetes mellitus (T2DM). Delta-like ligand-4 (DLL4) maintains the normal physiological microenvironment of the retina. However, the relationship between the level of DLL4 and the severity of DR remains unclear.MethodsWe retrospectively analyzed serum DLL4 levels and other laboratory and clinical data in 94 T2DM patients (35 patients without DR [NDR], 32 with non-proliferative DR [NPDR], 27 with proliferative DR [PDR]), and 30 healthy controls.ResultsThe serum DLL4 level was significantly greater in the NDR group (43.38 ± 16.23 pg/mL), NPDR group (56.57 ± 25.89 pg/mL), and PDR group (74.97 ± 25.28 pg/mL) than in the healthy controls (29.9 ± 8.92 pg/mL; all p < 0.05). Among T2DM patients, the level of DLL4 increased as the severity of DR increased (p < 0.05). Logistic regression analysis demonstrated that DR was positively associated with DLL4, glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), and duration of T2DM (all p < 0.05). Consistently, receiver operating characteristic (ROC) curve analysis also indicated that DLL4 was a potential candidate biomarker for identifying the severity of DR.ConclusionsT2DM patients, especially those with DR, have increased serum levels of DLL4. DLL4 may be used as a biomarker and an independent risk factor for DR, and targeting DLL4 may be a potential therapy in patients with DR.

Association of Abnormal Brachial Index with Diabetic Nephropathy as an Independent Risk Factor for Coronary Arterial Disease in Type 2 Diabetic Patients - A Retrospective Single Centre Real-World Evidence Study in Indian Population

Objective: To study the association between ankle brachial index (ABI) and microvascular complications in Type 2 diabetes (T2DM) patients with the coronary arterial disease (CAD). Methodology: A retrospective study was carried out on 3,458 T2DM patients reportedly with CAD, G1 (n=33), and without CAD, G2 (n=3125), who had given the ABI test. ABI was defined as normal (1.0 - 1.4) and abnormal (&lt;1.0 and &gt;1.4). The logistic regression analysis was used to identify the determinants of CAD positive outcomes in T2DM patients. Results: Overall, patient percentage-wise CAD 10% (333), abnormal ABI 26% (913), neuropathy 37% (1278), nephropathy, 8% (293), and retinopathy &lt;1% (24). The ABI abnormality and CAD positives were higher in patients with nephropathy (32 and 20%) than in neuropathy (28 and 13%). Age-wise, 52 and 62% of neuropathy and nephropathy patients, respectively, were &gt;60 years and had shown increased ABI abnormality from age 50 years onwards. The logistic model had shown nephropathy patients, [OR-1.8 [1.26-2.58], - p-0.001] in association with abnormal ABI, [OR-1.27 [95% CI, 0.99–1.63], p- 0.057] predicted to have CAD positive outcomes. While neuropathy, OR-0.69, [0.54 - 0.90], and hypertension, OR-0.43 [0.33 - 0.57] were not contributing towards CAD in our study population. Conclusion: Type 2 diabetes patients with abnormal ABI were predicted to have a 27% increased odds ratio of CAD outcome and 80% in the presence of nephropathy. Thus, as part of comprehensive diabetes care, albuminuria screening along with ABI measurement is being suggested.

Renalase gene Glu37Asp polymorphism affects susceptibility to diabetic retinopathy in type 2 diabetes mellitus

AimsRenalase (RNLS) is an enzyme with monoamine oxidase activity that metabolizes circulating catecholamines. The RNLS gene Asp37Glu missense polymorphism (rs2296545) has been associated with hypertension, cardiac hypertrophy and dysfunction, and stroke. The purpose of our study was to investigate the potential involvement of this polymorphism in the microvascular complications of type 2 diabetes (T2DM).MethodsIn this case–control study, the polymorphism was genotyped in 860 patients with T2DM and 400 healthy controls. The genotype and allele distribution was compared in subgroups of patients: with diabetic nephropathy (DN+) (n = 405) versus DN− (independently of the presence of DR) and, similarly, patients with diabetic retinopathy (DR+) (n = 328) versus DR− (independently of the presence of DN).ResultsNo significant association was detected between analyzed polymorphism and DN. In contrast, the retinopathy subgroup showed a significantly higher frequency of G allele (OR 1.4, 95% CI 1.16–1.72, p = 0.0005) and GG genotype (OR 1.86, 95% CI 1.26–2.75, p = 0.001) than DR− patients. The effect of RNLS Glu37Asp polymorphism on DR remained significant after adjustments for age, gender, BMI, and duration of T2DM (p = 0.005).ConclusionsThis is the first study to investigate RNLS gene polymorphism in microvascular complications of T2DM. The results suggest that RNLS rs2296545 SNP might be considered a risk factor for diabetic retinopathy in T2DM patients. This can provide new insight into the role of renalase gene in the pathophysiology of microvascular complications of diabetes.

Serum Magnesium Is Inversely Associated With Heart Failure, Atrial Fibrillation, and Microvascular Complications in Type 2 Diabetes.

We investigated whether serum magnesium (Mg2+) was prospectively associated with macro- or microvascular complications and mediated by glycemic control (hemoglobin A1c [HbA1c]), in type 2 diabetes (T2D). We analyzed in 4,348 participants the association of serum Mg2+ with macrovascular disease and mortality (acute myocardial infarction [AMI], coronary heart disease [CHD], heart failure [HF], cerebrovascular accident [CVA], and peripheral arterial disease [PAD]), atrial fibrillation (AF), and microvascular complications (chronic kidney disease [CKD], diabetic retinopathy, and diabetic foot) using Cox regression, adjusted for confounders. Mediation analysis was performed to assess whether HbA1c mediated these associations. The average baseline serum Mg2+ concentration was 0.80 ± 0.08 mmol/L. During 6.1 years of follow-up, serum Mg2+ was inversely associated with major macrovascular, 0.87 (95% CI 0.76; 1.00); HF, 0.76 (95% CI 0.62; 0.93); and AF, 0.59 (95% CI 0.49; 0.72). Serum Mg2+ was not associated with AMI, CHD, CVA, and PAD. During 5.1 years of follow-up, serum Mg2+ was inversely associated with overall microvascular events, 0.85 (95% CI 0.78; 0.91); 0.89 (95% CI 0.82; 0.96) for CKD, 0.77 (95% CI 0.61; 0.98) for diabetic retinopathy, and 0.85 (95% CI 0.78; 0.92) for diabetic foot. HbA1c mediated the associations of serum Mg2+ with HF, overall microvascular events, diabetic retinopathy, and diabetic foot. Serum Mg2+ concentration is inversely associated with the risk to develop HF and AF and with the occurrence of CKD, diabetic retinopathy, and foot complications in T2D. Glycemic control partially mediated the association of serum Mg2+ with HF and microvascular complications.

1047-P: Genetic Risk of Insulin Resistance Is Associated with Kidney Disease in Type 2 Diabetics and Nondiabetics

Background: Diabetic kidney disease (DKD) is a microvascular complication of type 2 diabetes (T2D) with significant variability in disease onset and progression. The objective of this study is to evaluate the role of genetic propensity to insulin resistance with kidney disease (KD) in individuals with and without T2D. Methods: A total of 373,487 unrelated European subjects (5.7% T2D) were selected from the UK Biobank. An insulin resistance polygenic risk score (IR-PRS) was constructed using 18 genome-wide significant SNPs from the latest GWAS for insulin resistance. A T2D-PRS was derived using 277 SNPs. Each PRS was categorized into high (&amp;gt;90thpercentile), mid (10th-90th), and low (&amp;lt; 10th) genetic risk groups. Ten KD phenotypes were constructed using eGFR and/or urine albumin cutoffs. T2D-stratified logistic regression models were run for IR-PRS and KD outcomes, adjusting for principal components, age, sex, education, Townsend Deprivation Index, BMI, hypertension, and statin use; similar models were run for T2D-PRS. Results: Among T2D, higher IR-PRS was associated with higher odds of DKD (Mid PRS: OR=5.20, 95% CI: 1.28-21.09; High PRS: OR = 4.17, 95% CI: 0.94-18.52; overall p=0.007) and macroalbuminuria (Mid PRS: OR = 2.05, 95% CI:1.12-3.77; High PRS: OR = 1.62, 95% CI: 0.80-3.27; overall p=0.02). Among nondiabetics, higher IR-PRS was associated with higher odds of microalbuminuria (Mid PRS: OR = 1.08, 95% CI: 1.02-1.15; High Risk: OR = 1.15, 95% CI: 1.06-1.25; overall p=0.006) and albuminuria groups (Mid Risk, OR=1.08, 95% CI: 1.01-1.14; High Risk, OR = 1.15, 95% CI: 1.06-1.24; overall p=0.004). No associations were observed with T2D-PRS. Conclusion: Genetic propensity for insulin resistance is associated with KD or its predisposition among subjects with and without T2D. In contrast, genetic risk of T2D is not associated with KD. Future work will focus on the replication of these results in independent cohorts. Disclosure A. C. Garduno: None. E. L. Richard: None. S. Cao: None. V. Thaker: None. R. Salem: None. Funding National Heart, Lung, and Blood Institute (1R00HL122515)

Analysis of Glycemic Control and Low-Density Lipoprotein Cholesterol with Glaucomatous Optic Neuropathy as a Microvascular Complication in Patients with Type 2 Diabetes Mellitus: A Cross-sectional Study in North Sumatera, Indonesia

BACKGROUND: Diabetes mellitus (DM) is an important health problem that induces microvascular complication such as retinopathy, nephropathy, and neuropathy. Ocular complications associated with type 2 DM are progressive and rapidly becoming the world’s most significant cause of morbidity and preventable with early detection and timely treatment. AIM: This study to analyze of glycemic control and low-density lipoprotein cholesterol (LDL-C) with glaucomatous optic neuropathy as a microvascular complication in patients with type 2 DM. MATERIALS AND METHODS: A prospective, analytical observational with cross-sectional study was conducted in Universitas Sumatera Utara Hospital and Satellite Hospital, Medan, Indonesia, from April 2020 to August 2020. The study included 66 participants with type 2 DM. The patients were investigated for hemoglobin A1c (HbA1c) level, LDL-C level, and ophthalmology examination including visual acuity (VA), intraocular pressure (IOP) measurement by Goldmann Applanation Tonometer, retinal nerve fiber layer (RNFL) thickness with spectral domain Optovue optical coherence tomography, and visual field defect with Octopus Perimeter. RESULTS: This study showed a significant correlation between HbA1c with VA (p = 0.030), IOP (p = 0.035), RNFL thickness (p = 0.002), visual field defect (p = 0.032), and duration of DM (p = 0.003) and showed significant correlation between LDL-C with VA (p = 0.048), IOP (p = 0.006), and duration of DM (p = 0.042). CONCLUSION: Higher HbA1c and LDL-C correlated with Glaucomatous Optic Neuropathy as a microvascular complication in type 2 DM. Advantage of research is still rarely studied.