Mortality In Diabetic Patients Research Articles

Causes of Excess Mortality in Diabetes Patients Without Coronary Artery Disease: A Cohort Study Revealing Endocrinologic Contributions.

Diabetes mellitus (DM) patients without coronary artery disease (CAD) have a higher all-cause mortality rate than patients with neither DM nor CAD. We examined cause-specific death of DM patients with and without CAD. We conducted a cohort study of all patients who underwent CAG in Western Denmark between 2003 and 2016. Using Danish health registries, patients were followed for a maximum of 10 years and stratified according to their DM and CAD status. Outcomes included all-cause-, cancer-, circulatory-, and endocrinologic death. Ten-year cumulative risks were computed as well as adjusted and unadjusted hazard ratios (aHR and HR). A total of 132,432 patients (28,524 deaths, median follow-up of 6.2 years) were included. Compared to patients with neither DM nor CAD, DM patients without CAD had a higher 10-year risk of all-cause death (27.9% versus 19.7%, aHR 1.43 [95% CI 1.35-1.52]), cancer death (7.2% versus 5.4%, aHR 1.29 [95% CI 1.15-1.46]), circulatory death (9.1% versus 6.9%, aHR 1.35 [95% CI 1.22-1.49]), and endocrinologic death (3.9% versus 0.3%, aHR 14.02 [95% CI 10.95-17.95]). Among endocrinologic deaths, 87% were due to classical complications of DM, such as diabetic nephropathy and ketoacidosis, in DM patients without CAD. Diabetes patients without CAD exhibit a higher risk of all-cause mortality, driven primarily by elevated rates of cancer, circulatory, and endocrinologic deaths, particularly related to diabetic microvascular complications.

Long-Term Nitrogen Dioxide Exposure as a Possible 5-Year Mortality Risk Factor in Diabetic Patients Treated Using Off-Pump Surgical Revascularization-A Retrospective Analysis.

Background: There is mounting evidence that diabetic-related cardiac metabolism abnormalities with oxidative stress and inflammatory mechanism activation align with the functional impairments that result in atherosclerotic lesion formation. Among the possible non-traditional coronary lesion risk factors, environmental exposure may be significant, especially in diabetic patients. Methods: A total of 140 diabetic patients (115 (82%) males and 25 (18%) females) with a mean age of 65 (60-71) underwent surgical revascularization due to multivessel coronary disease. The possible all-cause mortality risk factors, including demographical and clinical factors followed by chronic air pollution exposure, were identified. Results: All patients were operated on using the off-pump technique and followed for 5.6 (5-6.1) years. The multivariable model for 5-year mortality prediction presented the nitrogen dioxide chronic exposure (HR: 3.99, 95% CI: 1.16-13.71, p = 0.028) and completeness of revascularization (HR: 0.19, 95% CI: 0.04-0.86, p = 0.031) as significant all-cause mortality risk factors. Conclusions: Ambient air pollutants such as an excessive chronic nitrogen dioxide concentration (>15 µg/m3) may increase 5-year all-cause mortality in diabetic patients following surgical revascularization.

Blood Glucose Dynamics in Diabetic Patients Undergoing Elective Surgery: A Descriptive-Analytical Cross-Sectional Investigation

Background: Major surgeries cause metabolic stress and insulin resistance, leading to postoperative hyperglycemia and increased morbidity and mortality in diabetic patients. Therefore, this study aimed to assess blood sugar level changes in diabetic patients undergoing elective surgery and its confounding factors. Methods: A cross-sectional study compared blood sugar levels (BS) in 100 diabetic patients undergoing elective surgeries. Demographic data, medical history, surgery type, and anesthetic technique were documented. Laboratory assessments included fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1C). Statistical analysis used SPSS software and nonparametric tests. Results: Postoperative blood sugar levels significantly increased compared to preoperative levels (mean change 11.40 ± 14.356 mg/dL). Age over 60 and general anesthesia were significant factors associated with elevated blood sugar. Conclusion: This study reveals a significant postoperative increase in blood glucose levels in diabetic patients, particularly those aged over 60 and under general anesthesia.

Effect of body mass index on mortality for diabetic patients with aortic stenosis.

Several studies suggest an "obesity paradox," associating obesity with better cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) or aortic stenosis (AS) compared to normal or underweight individuals. This study explores the impact of body mass index (BMI) on diabetic patients with AS. Between 2014 and 2019, patients with DM who underwent echocardiography were analyzed. Outcomes included all-cause mortality, cardiovascular, and non-cardiovascular death. Patients were categorized as underweight, normal weight, or obese based on BMI (<18.5, 18.5 to 27, and >27 kg/m2, respectively). Among 74,835 DM patients, 734 had AS. Normal weight comprised 65.5% (n=481), underweight 4.1% (N=30), and 30.4% were obese. Over a 6-year follow-up, underweight patients had significantly higher all-cause mortality (HR 1.96, 95% CI 1.22 - 3.14, p = 0.005), while obese patients had significantly lower mortality (HR 0.79, 95% CI 0.68 - 0.91, p=0.001) compared to the normal group. Regarding etiologies, underweight patients had a higher risk of non-cardiovascular death (HR 2.47, 95% CI 1.44-4.25, p = 0.001), while obese patients had a lower risk of cardiovascular death (HR 0.66, 95% CI 0.50-0.86, p=0.003). Subgroup analysis showed a consistent trend without significant interaction. BMI significantly impacts mortality in DM patients with AS. Being underweight is associated with worse non-cardiovascular death, while obesity is linked to improved cardiovascular death outcomes.

Smooth Muscle Cells-Expressed Bmal1 Regulates Vascular Calcification Independent of the Canonical Circadian Pathway.

Vascular calcification is a major cardiovascular issue that increases morbidity and mortality in diabetes patients. While dysregulation of the circadian master regulator Basic Helix-Loop-Helix ARNT-Like Protein 1 (Bmal1) in vascular smooth muscle cells (VSMC) under diabetic conditions has been suggested, its role in vascular calcification is unclear. In VSMC, Bmal1 was upregulated under high glucose treatment and in aortic tissues from a diabetic mouse model. RNA sequencing from isolated VSMC between Bmal1 deletion and wildtype mice indicated Bmal1's pro-calcification role. Indeed, reduced levels of the osteogenic master regulator, Runt-Related Transcription Factor 2 (Runx2), were found in Bmal1 deletion VSMC under diabetic conditions. Alizarin red staining showed reduced calcification in Bmal1 deletion VSMC in vitro and vascular rings ex vivo . Furthermore, in a diabetic mouse model, SMC-Bmal1 deletion showed reduced calcium deposition in aortas. Collectively, diabetes-upregulated circadian regulator Bmal1 in VSMC contributes to vascular calcification. Maintaining normal circadian regulation may improve vascular health in diabetes.

Ramulus Mori (Sangzhi) Alkaloids Alleviate Diabetic Nephropathy through Improving Gut Microbiota Disorder.

Diabetic nephropathy (DN), one of the leading causes of end-stage kidney failure worldwide, is closely associated with high mortality in diabetic patients. However, therapeutic drugs for DN are still lacking. Ramulus Mori alkaloids (SZ-A), an effective component of alkaloids extracted from Ramulus Mori, have been found to improve glucose and lipid metabolism to mitigate diabetes and obesity; however, few studies have focused on their effects on DN progression. Thus, we investigated the protective role of SZ-A on DN through 16S rRNA sequencing, non-targeted metabolomics, and fecal microbiota transplantation (FMT) experiments. To address our hypothesis, we established the DN mouse model by combining a high-fat diet (HFD) with streptozotocin (STZ) injection. Herein, we demonstrated that SZ-A supplementation was recalcitrant to renal injury in DN mice, improving glomerular morphology, reversing the blood biochemistry parameters, and ameliorating podocyte injury. Importantly, the composition of the gut microbiota altered after SZ-A treatment, especially with the elevated abundance of Dubosiella and the increased level of serum pentadecanoic acid. FMT experiments further revealed that the gut microbiota exerted critical effects in mediating the beneficial roles of SZ-A. In vitro experiments proved that pentadecanoic acid administration improved podocyte apoptosis induced by AGEs. Taken together, SZ-A play a renoprotective role, possibly through regulating the gut microbiota and promoting pentadecanoic acid production. Our current study lends support to more extensive clinical applications of SZ-A.

Weight Change and the Risk of Micro and Macro Vascular Complications of Diabetes: A Systematic Review.

Type 2 diabetes mellitus (T2DM) is a metabolic disease that can be a significant cause of cardiovascular disease (CVD), leading to macrovascular and microvascular diseases. Many researchers around the world have investigated the effects of weight change on micro and macro CVD in patients with T2DM. This study aimed to investigate the effect of weight change (weight gain and loss) on microvascular and macrovascular complications in patients with T2DM. We searched PubMed, Scopus and Google Scholar from the database until January 2023. We screened the title, abstract, and full text of articles, and after quality assessment, we extracted data from interrelated ones into this systematic review. Reviewing the results of 11 cohort studies with 219,839 individuals (T2DM patients) showed that weight loss caused an increase in the mortality rate in diabetic patients, while weight gain after diabetes diagnosis increased the risk of CVD, chronic kidney disease (CKD), microvascular disease, stroke and mortality. It should be noted that severe body weight variability increases the mortality rate and the risk of microvascular disease. Unlike other studies, one study showed that more than 5% weight gain positively affected CVD and coronary heart disease in T2DM patients. Generally, weight change in patients with T2DM is an essential sign of cardiovascular complications. According to our findings, the risk of cardiovascular complications in patients with weight loss is seen to be higher than in patients with weight gain. In regular patients with body mass index (BMI), stable weight in a healthy range is reported to decrease the risk of CVD.

The association between triglyceride glucose-body mass index and all-cause and cardiovascular mortality in diabetes patients: a retrospective study from NHANES database

The triglyceride glucose body mass index (TyG-BMI) is a potential indicator for insulin resistance, but its association with mortality in diabetic patients is unclear. This study investigates the relationship between TyG-BMI and all-cause and cardiovascular mortality in diabetics. The study included 3109 diabetic patients from the National Health and Nutrition Examination Survey (2001–2018). Mortality data were obtained from National Death Index records until 31 December 2019. Multivariate Cox models analyzed the association between TyG-BMI and mortality. Non-linear correlations were assessed using restricted cubic splines, and a two-piecewise Cox model evaluated the relationship on both sides of the inflection point. Over a median 7.25-year follow-up, 795 total and 238 cardiovascular deaths occurred. A U-shaped link was found between initial TyG-BMI and mortality in diabetic patients. Low TyG-BMI (< 279.67 for all-cause, < 270.19 for CVD) reduced death risks (all-cause: HR 0.77, 95% CI 0.69–0.86; CVD: HR 0.64, 95% CI 0.48–0.86). High TyG-BMI (> 279.67 for all-cause, > 270.19 for CVD) increased these risks (all-cause: HR 1.26, 95% CI 1.10–1.44; CVD: HR 1.33, 95% CI 1.06–1.68). In the NHANES study population, a U-shaped association was observed between the baseline TyG-BMI index and all-cause mortality or CVD in diabetic patients.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes: A retrospective cohort study.

The impact of type 2 diabetes mellitus (T2DM) on acute respiratory distress syndrome (ARDS) is debatable. T2DM was suspected to reduce the risk and complications of ARDS. However, during coronavirus disease 2019 (COVID-19), T2DM predisposed patients to ARDS, especially those who were on insulin at home. To evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes. We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database. Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus (DM) (IDDM) and non-insulin-dependent DM (NIDDM) groups. After applying exclusion criteria and matching over 20 variables, we compared cohorts for mortality, duration of mechanical ventilation, incidence of acute kidney injury (AKI), length of stay (LOS), hospitalization costs, and other clinical outcomes. Following 1:1 propensity score matching, the analysis included 274 patients in each group. Notably, no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates (32.8% vs 31.0%, P = 0.520), median hospital LOS (10 d, P = 0.537), requirement for mechanical ventilation, incidence rates of sepsis, pneumonia or AKI, median total hospitalization costs, or patient disposition upon discharge. Compared to alternative anti-diabetic medications, outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Predictors of Mortality among Intensive Care Unit (ICU) Hospitalized Diabetic Patients with COVID-19

Objective: Diabetic patients with COVID-19 are at the higher risk of clinical complications and intensive care unit (ICU) admission. There is limited information available on the risk factors of mortality in diabetic patients with COVID-19 admitted to the ICUs. The aim of this study was identifying the mortality risk factors in diabetic patients with COVID-19 who are admitted to the ICU. Materials and Methods: In this study, we conducted a descriptive-analytical observational analysis on 391 patients admitted to the ICU for 18 months. We assessed the demographic, clinical, pharmaceutical, laboratory and imaging data of diabetic patients and statistically analyzed them to identify mortality risk factors. Results: The study found 156 (39.89%) diabetic out of 391 patients. The group of diabetic patients had significantly higher rates of endotracheal intubation (P&lt; 0.001), mortality (P&lt; 0.001), and complications during hospitalization due to COVID-19, including secondary bacterial infections (P = 0.005), venous thrombosis (P = 0.008), and gastrointestinal bleeding (P = 0.011), compared to the nondiabetic patient. Conclusion: Patients with diabetes who also have COVID-19 tend to experience more severe clinical outcomes and a higher mortality rate when admitted to the intensive care unit. The likelihood of mortality in these patients is closely associated with factors such as stroke occurrence, oxygenation levels, and the presence of secondary infections at the time of admission.

U-shaped association between serum calcium and in-hospital mortality in diabetes patients with congestive heart failure: a cohort study

Previous studies have reported that the significant association between serum calcium and mortality substantially in patients, especially among those with intensive care unit (ICU). And In diabetes mellitus, congestive heart failure (CHF) is a significant comorbidity. We aim to evaluate the association between serum calcium levels and in-hospital mortality among patients with diabetes and congestive heart failure. The participants in this study were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. To scrutinize potential associations between serum calcium levels and in-hospital mortality, a comprehensive analysis encompassing multivariate logistic regression, cubic spline function model, threshold effect analysis, and subgroup analysis was performed. This retrospective cohort study encompassed 7063 patients, among whom the in-hospital mortality stood at 12.2%. In the multivariate logistic regression, adjusted odds ratios (ORs) were contrasted with the reference category Q6 (8.8–9.1 mg/dL) for serum calcium levels and in-hospital mortality. The adjusted ORs for Q1 (≤ 7.7 mg/dL), Q2 (7.7–8 mg/dL), and Q7 (≥ 9.1 mg/dL) were 1.69 (95% CI 1.17–2.44, p = 0.005), 1.62 (95% CI 1.11–2.36, p = 0.013), and 1.57 (95% CI 1.1–2.24, p = 0.012) respectively. The dose–response analysis uncovered a U-shaped relationship between serum calcium levels and in-hospital mortality in diabetic patients with heart failure. Subgroup analyses confirmed result stability notwithstanding the influence of diverse factors. Our investigation revealed a U-shaped correlation between serum calcium levels and in-hospital mortality in diabetes patients with congestive heart failure, pinpointing a significant inflection point at 9.05 mg/dL.

A hydrogel based on Bletilla striata polysaccharide and hyaluronic acid topically administers tetramethylpyrazine for diabetic wound therapy

The delayed and incomplete wound healing often gives rise to the disability and mortality of diabetic patients. Conventional regimens are frequently inefficient to achieve diabetic wound recovery, and innovative alternatives are therefore needed to provide therapeutic benefits. Over the past decades, the advances in phytomedicines have revolutionized the field of wound healing and tissue regeneration. In the present study, tetramethylpyrazine (TMP), an alkaloid isolated from Ligusticum chuanxiong Hort, was applied for diabetic wound treatment. A hydrogel was developed using two biopolymers namely Bletilla striata polysaccharide (BSP) and hyaluronic acid (HA) for facilitating in situ administration of TMP on full-thickness wound in mice with streptozocin-induced diabetes. The resulting hydrogel formulation (termed TMP-BSP-HA) fulfilled inflammation attenuation, blood vessel growth, and collagen deposition. Consequently, TMP-BSP-HA significantly expedited diabetic wound healing relative to a TMP-loaded hydrogel formulation prepared by INTRASITE Gel (a commercial carboxymethylcellulose-based wound dressing). The present study demonstrates the pro-healing efficacy of TMP-BSP-HA, and provides a promising approach for diabetic wound therapy.

Clinical outcomes and risk factors for mortality in diabetic patients with staphylococcus aureus pneumonia: A case-control study

The study was conducted to investigate the clinical outcomes and mortality risk factors related to Staphylococcus aureus pneumonia in patients with and without diabetes mellitus (DM). This was a case-control study on 118 patients with S. aureus pneumonia hospitalized between April 2021 and May 2023. The results reveal that diabetic female patients were prone to acquire Staphylococcus aureus pneumonia than non DM group (66.7% vs. 36.6%, p = 0.003); DM patients have more comorbidities (4.64 ± 2.07 vs. 3.46 ± 1.85; p = 0.003) compared to non-DM patients. Clinical outcomes, including 30-day all-cause mortality and pneumonia-related complications, showed no significant difference between patients with and without DM (all p &gt; 0.05). Two independent risk factors for mortality in DM patients with S. aureus pneumonia are age &gt; 65 (OR = 0.09, 95%CI: 0.01-0.64, p = 0.017) and central nervous system disease (OR = 18.54, 95%CI: 1.81-190.07, p = 0.014). The relatively high mortality rate in DM patients, predominantly attributed to MRSA infection, underscores the importance of staying focus on the diagnosis and adopting an appropriate initial antibiotic treatment approach. It is crucial to particularly note individuals with multiple comorbidities, especially those with central nervous system diseases.

PRESCRIPTION AUDIT AND EFFECTS OF COMORBIDITIES ON INDOOR COVID-19 PATIENTS OF A TERTIARY CARE TEACHING HOSPITAL

Objective: Management of COVID-19 has been a challenge to the health-care system. The COVID-19 pandemic led to prescribing a greater number of drugs for curing the disease in the initial phase of the pandemic due to a lack of understanding of the pathophysiology of COVID-19, symptomatic treatment was given as no definite treatment was available. This presented an opportunity to assess prescribing practices during the pandemic. Methods: The study presents a retrospective cohort to assess 300 random prescriptions from indoor COVID-19 patients of a tertiary care teaching hospital. The parameters analyzed in the process of the prescription audit were patients’ demographics data, prescribing standards according to the World Health Organization core indicators, clinical diagnosis with the comorbid condition, legibility of handwriting, doctor’s name and signature, and outcome of the disease. Results: Out of 300 cases analyzed, a total of 298 (99.66%) prescriptions were with antimicrobialsa total of 55 (18.3%) patients received antivirals. 167 (55.67%) admitted patients having comorbidities such as hypertension (28%) and diabetes (24.3%). Conclusion: It is observed almost every patient has received antimicrobial in the form of antibiotic or antiviral. About 18.3% of patients received antiviral drugs. The effect of co-morbidity has a significant influence on the outcome of patients having COVID-19, as in this study, mortality rate in diabetic patients is higher up to 11.48% than in non-diabetics.

Pre-hospital glycemia as a biomarker for in-hospital all-cause mortality in diabetic patients - a pilot study

BackgroundType 2 Diabetes Mellitus (T2DM) presents a significant healthcare challenge, with considerable economic ramifications. While blood glucose management and long-term metabolic target setting for home care and outpatient treatment follow established procedures, the approach for short-term targets during hospitalization varies due to a lack of clinical consensus. Our study aims to elucidate the impact of pre-hospitalization and intra-hospitalization glycemic indexes on in-hospital survival rates in individuals with T2DM, addressing this notable gap in the current literature.MethodsIn this pilot study involving 120 hospitalized diabetic patients, we used advanced machine learning and classical statistical methods to identify variables for predicting hospitalization outcomes. We first developed a 30-day mortality risk classifier leveraging AdaBoost-FAS, a state-of-the-art ensemble machine learning method for tabular data. We then analyzed the feature relevance to identify the key predictive variables among the glycemic and routine clinical variables the model bases its predictions on. Next, we conducted detailed statistical analyses to shed light on the relationship between such variables and mortality risk. Finally, based on such analyses, we introduced a novel index, the ratio of intra-hospital glycemic variability to pre-hospitalization glycemic mean, to better characterize and stratify the diabetic population.ResultsOur findings underscore the importance of personalized approaches to glycemic management during hospitalization. The introduced index, alongside advanced predictive modeling, provides valuable insights for optimizing patient care. In particular, together with in-hospital glycemic variability, it is able to discriminate between patients with higher and lower mortality rates, highlighting the importance of tightly controlling not only pre-hospital but also in-hospital glycemic levels.ConclusionsDespite the pilot nature and modest sample size, this study marks the beginning of exploration into personalized glycemic control for hospitalized patients with T2DM. Pre-hospital blood glucose levels and related variables derived from it can serve as biomarkers for all-cause mortality during hospitalization.

The triglyceride glucose index was nonlinearly associated with all-cause mortality in diabetic patients

Background and aimThe TyG index has been linked with cardiometabolic diseases. Our study aimed to investigate the specific relationship between the triglyceride and glucose index (TyG) and both all-cause and cardiovascular mortality in diabetic patients. Methods and resultsWe enrolled 3120 participants with diabetes from the National Health and Nutrition Examination Survey. The TyG index was calculated using the formula ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Hazard ratios (HRs) of TyG associated with mortality risk were assessed using Cox proportional hazard regression models. Over a follow-up period of 10.8 thousand person-years, we observed 768 all-cause deaths and 155 cardiovascular deaths. Compared to the reference quartile, the multivariate-adjusted hazard ratios and 95% confidence intervals for all-cause mortality were 1.02 (1.01–1.05; p = 0.008) in the fourth quartile. Dose-response analysis revealed a non-linear association. However, no significant associations were found between the TyG index and cardiovascular mortality. ConclusionsThe TyG index exhibited a non-linear association with the risk of all-cause mortality in diabetic patients.

Diabetes Mellitus and Pneumococcal Pneumonia.

Currently, there are more than 500 million people suffering from diabetes around the world. People aged 65 years or older are the most affected by this disease, and it is estimated that approximately 96% of diabetes cases worldwide are type 2 diabetes. People with diabetes mellitus are at an increased risk of infections such as pneumonia, due to a series of factors that may contribute to immune dysfunction, including hyperglycemia, inhibition of neutrophil chemotaxis, impaired cytokine production, phagocytic cell dysfunction, altered T cell-mediated immune responses and the co-existence of chronic comorbidities. Rates of infection, hospitalization and mortality in diabetic patients are reported to be higher than in the general population. Research into the risk of infectious diseases such as pneumonia in these patients is very important because it will help improve their management and treatment.

Development and validation of a risk score nomogram model to predict the risk of 5-year all-cause mortality in diabetic patients with hypertension: A study based on NHANES data

BackgroundThe present study aimed to develop and validate a prediction nomogram model for 5-year all-cause mortality in diabetic patients with hypertension. MethodsData were extracted from the National Health and Nutrition Examination Survey (NHANES). A total of 3291 diabetic patients with hypertension in the NHANES cycles for 1999–2014 were selected and randomly assigned at a ratio of 8:2 to the training cohort (n = 2633) and validation cohort (n = 658). Multivariable Cox regression was conducted to establish a visual nomogram model for predicting the risk of 5-year all-cause mortality. Receiver operating characteristic curves and C-indexes were used to evaluate the discriminant ability of the prediction nomogram model for all-cause mortality. Survival curves were created using the Kaplan–Meier method and compared by the log-rank test. ResultsThe nomogram model included eight independent predictors: age, sex, education status, marital status, smoking, serum albumin, blood urea nitrogen, and previous cardiovascular disease. The C-indexes for the model in the training and validation cohorts were 0.76 (95% confidence interval: 0.73–0.79, p < 0.001) and 0.75 (95% confidence interval: 0.69–0.81, p < 0.001), respectively. The calibration curves indicated that the model had satisfactory consistency in the two cohorts. The risk of all-cause mortality gradually increased as the tertiles of the nomogram model score increased (log-rank test, p < 0.001). ConclusionThe newly developed nomogram model, a readily useable and efficient tool to predict the risk of 5-year all-cause mortality in diabetic patients with hypertension, provides a novel risk stratification method for individualized intervention.

Knowledge, Attitude and Practice of Diabetic Patients About Symptoms of Hypoglycaemia in Atbara Teaching Hospital, December 2022 – October 2023

Introduction: Diabetes mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia, which can increase the risk of micro and macro vascular complications. Hypoglycemia strongly associated with increase mortality in diabetic patients. The American Diabetes Association defines the hypoglycaemia as “any abnormally low plasma glucose concentration that exposes the subject to potential harm”, and proposes a threshold of &amp;lt;70 mg/dl. Prevention of hypoglycaemia can occur if much efforts spent in patient education regarding risk factors, food &amp; physical activity, warning signs, and treatment of hypoglycaemia at an early stage. Objective: To identify Knowledge, Attitude and Practice of Diabetic patients about symptoms of Hypoglycaemia at Atbara teaching hospital. Method: A descriptive cross-sectional hospital-based study done in Atbara teaching hospital, River Nile state, Sudan. From December 2022 – October 2023. The study population were all diabetic patients who presented to the hospital during the period of the study. Exclusion criteria was severely ill patient or those who refuse to participate in the study. With total coverage sample size was 200. The data was collected by interviewing the respondents through close ended questionnaire. The collected data was analyzed by using SPSS. Result: The male to female ratio equal one. With the predominant age between 20 to 35. Most of the participants HBA1c were between 7%-10%. The duration of diabetes was not exceeding 10 years in 44% of the participants. Majority were on oral hypoglycemic drugs with good adherence to it. Tremor is the most reported symptoms of hypoglycemia. With most of the participants deal with the symptoms by them self. Conclusion: Over all the participants show acceptable level of knowledge toward hypoglycemia. Expressed through that most of them deal with the symptoms immediately by them self. Attitude of the participant need to be more investigated in the future with further studies.

The regulatory role of miRNA and lncRNA on autophagy in diabetic nephropathy

Diabetic nephropathy (DN) is a serious complication of diabetes that causes glomerular sclerosis and end-stage renal disease, leading to ascending morbidity and mortality in diabetic patients. Excessive accumulation of aberrantly modified proteins or damaged organelles, such as advanced glycation end-products, dysfunctional mitochondria, and inflammasomes is associated with the pathogenesis of DN. As one of the main degradation pathways, autophagy recycles toxic substances to maintain cellular homeostasis and autophagy dysregulation plays a crucial role in DN progression. MicroRNA (miRNA) and long non-coding RNA (lncRNA) are non-coding RNA (ncRNA) molecules that regulate gene expression and have been implicated in both physiological and pathological conditions. Recent studies have revealed that autophagy-regulating miRNA and lncRNA have been involved in pathological processes of DN, including renal cell injury, mitochondrial dysfunction, inflammation, and renal fibrosis. This review summarizes the role of autophagy in DN and emphasizes the modulation of miRNA and lncRNA on autophagy during disease progression, for the development of promising interventions by targeting these ncRNAs in this disease.