Mortality In Diabetic Patients Research Articles

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.

MCT4-dependent lactate transport: a novel mechanism for cardiac energy metabolism injury and inflammation in type 2 diabetes mellitus

Diabetic cardiomyopathy (DCM) is a major contributor to mortality in diabetic patients, characterized by a multifaceted pathogenesis and limited therapeutic options. While lactate, a byproduct of glycolysis, is known to be significantly elevated in type 2 diabetes, its specific role in DCM remains uncertain. This study reveals an abnormal upregulation of monocarboxylate transporter 4 (MCT4) on the plasma membrane of cardiomyocytes in type 2 diabetes, leading to excessive lactate efflux from these cells. The disruption in lactate transport homeostasis perturbs the intracellular lactate-pyruvate balance in cardiomyocytes, resulting in oxidative stress and inflammatory responses that exacerbate myocardial damage. Additionally, our findings suggest increased lactate efflux augments histone H4K12 lactylation in macrophages, facilitating inflammatory infiltration within the microenvironment. In vivo experiments have demonstrated that inhibiting MCT4 effectively alleviates myocardial oxidative stress and pathological damage, reduces inflammatory macrophage infiltration, and enhances cardiac function in type 2 diabetic mice. Furthermore, a clinical prediction model has been established, demonstrating a notable association between peripheral blood lactate levels and diastolic dysfunction in individuals with type 2 diabetes. This underscores the potential of lactate as a prognostic biomarker for DCM. Ultimately, our findings highlight the pivotal involvement of MCT4 in the dysregulation of cardiac energy metabolism and macrophage-mediated inflammation in type 2 diabetes. These insights offer novel perspectives on the pathogenesis of DCM and pave the way for the development of targeted therapeutic strategies against this debilitating condition.

Serum Uric Acid/Serum Creatinine Ratio and Cardiovascular Mortality in Diabetic Individuals-The Uric Acid Right for Heart Health (URRAH) Project.

Several studies have detected a direct association between serum uric acid (SUA) and cardiovascular (CV) risk. In consideration that SUA largely depends on kidney function, some studies explored the role of the serum creatinine (sCr)-normalized SUA (SUA/sCr) ratio in different settings. Previously, the URRAH (URic acid Right for heArt Health) Study has identified a cut-off value of this index to predict CV mortality at 5.35 Units. Therefore, given that no SUA/sCr ratio threshold for CV risk has been identified for patients with diabetes, we aimed to assess the relationship between this index and CV mortality and to validate this threshold in the URRAH subpopulation with diabetes; the URRAH participants with diabetes were studied (n = 2230). The risk of CV mortality was evaluated by the Kaplan-Meier estimator and Cox multivariate analysis. During a median follow-up of 9.2 years, 380 CV deaths occurred. A non-linear inverse association between baseline SUA/sCr ratio and risk of CV mortality was detected. In the whole sample, SUA/sCr ratio > 5.35 Units was not a significant predictor of CV mortality in diabetic patients. However, after stratification by kidney function, values > 5.35 Units were associated with a significantly higher mortality rate only in normal kidney function, while, in participants with overt kidney dysfunction, values of SUA/sCr ratio > 7.50 Units were associated with higher CV mortality. The SUA/sCr ratio threshold, previously proposed by the URRAH Study Group, is predictive of an increased risk of CV mortality in people with diabetes and preserved kidney function. While, in consideration of the strong association among kidney function, SUA, and CV mortality, a different cut-point was detected for diabetics with impaired kidney function. These data highlight the different predictive roles of SUA (and its interaction with kidney function) in CV risk, pointing out the difference in metabolic- and kidney-dependent SUA levels also in diabetic individuals.

The relative and combined ability of stress hyperglycemia ratio and N-terminal pro-B-type natriuretic peptide to predict all-cause mortality in diabetic patients with multivessel coronary artery disease

BackgroundStress hyperglycemia ratio (SHR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are independently associated with increased mortality risk in diabetic patients with coronary artery disease (CAD). However, the role of these biomarkers in patients with diabetes and multivessel disease (MVD) remains unknown. The present study aimed to assess the relative and combined abilities of these biomarkers to predict all-cause mortality in patients with diabetes and MVD.MethodsThis study included 1148 diabetic patients with MVD who underwent coronary angiography at Tianjin Chest Hospital between January 2016 and December 2016. The patients were divided into four groups according to their SHR (SHR-L and SHR-H) and NT-proBNP (NT-proBNP-L and NT-proBNP-H) levels. The primary outcome was all-cause mortality. Multivariate Cox regression analyses were performed to evaluate the association of SHR and NT-proBNP levels with all-cause mortality.ResultsDuring a mean 4.2 year follow-up, 138 patients died. Multivariate analysis showed that SHR and NT-proBNP were strong independent predictors of all-cause mortality in diabetic patients with MVD (SHR: HR hazard ratio [2.171; 95%CI 1.566–3.008; P < 0.001; NT-proBNP: HR: 1.005; 95%CI 1.001–1.009; P = 0.009). Compared to patients in the first (SHR-L and NT-proBNP-L) group, patients in the fourth (SHR-H and NT-proBNP-H) group had the highest mortality risk (HR: 12.244; 95%CI 5.828–25.721; P < 0.001). The areas under the curve were 0.615(SHR) and 0.699(NT-proBNP) for all-cause mortality. Adding either marker to the original models significantly improved the C-statistic and integrated discrimination improvement values (all P < 0.05). Moreover, combining SHR and NT-proBNP levels into the original model provided maximal prognostic information.ConclusionsSHR and NT-proBNP independently and jointly predicted all-cause mortality in diabetic patients with MVD, suggesting that strategies to improve risk stratification in these patients should incorporate SHR and NT-porBNP into risk algorithms.

Degree of joint risk factor control and hazard of mortality in diabetes patients: a matched cohort study in UK Biobank

BackgroundDiabetes patients are at higher risk for mortality than the general population; however, little is known about whether the excess mortality risk associated with diabetes could be mitigated or nullified via controlling for risk factors.MethodsWe included 18,535 diabetes patients and 91,745 matched individuals without diabetes without baseline cancer or cardiovascular disease (CVD), followed up from 2006 to 2021. The main exposure was the number of optimized risk factors including glycated hemoglobin < 53 mmol/mole, systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg, no albuminuria, non-current smoking and low-density lipoprotein cholesterol (LDL-C) < 2.5 mmol/L. We used Cox proportional hazards models to explore the association of the degree of risk factor control with all-cause mortality, cancer mortality, CVD mortality and other mortality.ResultsEach additional risk factor control was associated with a 16, 10, 21 and 15% lower risk of all-cause mortality, cancer mortality, CVD mortality and other mortality, respectively. Optimal risk factors control (controlling 5 risk factors) was associated with a 50% (HR 0.50, 95% CI 0.41–0.62), 74% (HR 0.26, 95% CI 0.16–0.43) and 38% (HR 0.62, 95% CI 0.44–0.87) lower risk of all-cause mortality, CVD mortality and other mortality, respectively. Diabetes patients with 4, 3 and 5 or more controlled risk factors, respectively, showed no excess risk of all-cause mortality, cancer mortality and CVD mortality compared to matched non-diabetes patients.ConclusionsThe results from this study indicate that optimal risk factor control may eliminate diabetes-related excess risk of all-cause mortality, CVD mortality and other mortality.

Nonlinear association of the systemic immune-inflammatory index with mortality in diabetic patients.

It has been demonstrated that in diabetic patients, an elevated neutrophil-lymphocyte ratio (NLR) is independently connected with higher cardiovascular and all-cause mortality. It is unclear, however, if the systemic immune-inflammatory index (SII) and the mortality rate among diabetic patients are related. Investigating the linkage between SII and diabetes patients' risk of cardiovascular and all-cause death was the aim of the study. 4972 diabetics who were chosen from six rounds of the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2016 were the study's participants. The optimal SII threshold with the highest correlation with survival outcomes was identified by applying the Maximum Selection Ranking Statistical Method (MSRSM). To assess the relationship between SII and cardiovascular and all-cause mortality in diabetics, subgroup analysis and Cox regression modeling were employed. Furthermore, smoothed curve fitting was utilized to determine the nonlinear relationship of them. Over the course of a median follow-up of 69 months (interquartile range [IQR], 54-123 months), 1,172 (23.6%) of the 4,972 diabetic patients passed away. These deaths included 332 (6.7%) cardiovascular deaths and 840 (16.9%) non-cardiovascular deaths. Individuals were categorized into higher (>983.5714) and lower (≤983.5714) SII groups according to MSRSM. In multi-variable adjusted models, subjects with higher SII had a significantly increased chance of dying from cardiovascular disease (HR 2.05; 95% confidence interval (CI):1.42,2.97) and from all causes (HR 1.60; 95% CI:1.22,1.99). Kplan-Meier curves showed similar results. Subgroup studies based on age, sex, BMI, drinking, smoking, and hypertension revealed that the connection maintained intact. The previously stated variables and SII did not significantly interact (p interaction > 0.05). In diabetic patients, smooth curve fitting revealed a nonlinear correlation between SII and mortality. In diabetic patients, elevated SII is linked to higher cardiovascular and all-cause mortality.

Association of Demographic Characteristics and Laboratory Values in Diabetic Foot Infections Leading to Lower-Extremity Amputation.

Lower-extremity amputations are a common complication of poorly controlled diabetes and contribute to significant morbidity and mortality in diabetic patients. We sought to determine whether objective data points obtained on presentation or hospital admission, including white blood cell (WBC) count, hemoglobin A1c (HbA1c), C-reactive protein (CRP), and descriptive patient demographics allow for the ability to predict optimal amputation levels and outcomes of lower-extremity amputation in the diabetic population. A retrospective analysis of 162 patients was performed evaluating laboratory and descriptive values on hospital presentation for lower-extremity infection during a 16-year period. Occurrence of multiple amputations and level of amputation were assessed against laboratory values to determine whether these objective values would provide clinicians with a better understanding of amputations in the diabetic patient. The mean patient age was 60.6 years. A significantly higher percentage of patients who underwent amputations through the tibia and fibula or of the foot midtarsal were male compared with patients who underwent amputations of the thigh through femur. Patients who had amputations through the tibia and fibula had a significantly higher WBC count compared with patients who had a transmetatarsal amputation (P = .03). There was no significant difference in type or quantity of amputations when analyzing HbA1c and CRP levels. An admission WBC count may be used as a predictor of lower-extremity amputation level and outcomes in diabetic infections. Although a statistically significant difference was not found for CRP or HbA1c levels between amputation procedures and number of procedures performed, these values remain useful in managing lower-extremity infections in diabetic patients.

Morbidity and In-Hospital Mortality in Diabetic Patients Undergoing Cardiac Surgery: A Retrospective Cohort Study

Objective: To evaluate the impact of diabetes mellitus (DM) in hospital mortality and morbidity after cardiac surgery. Materials and Methods: The authors performed a retrospective cohort study in a tertiary medical center. One thousand two hundred fifteen patients had cardiac surgery between June 2015 and July 2021, divided into two groups, 824 non-diabetic, and 391 diabetic patients. Results: In-hospital mortality rates were comparable in diabetic and non-diabetic patients at 7.2% versus 6.6% (p=0.786). However, chronic kidney disease, high American Society of Anesthesiologists physical status, preoperative arrhythmias, and non-valvular surgery were statistically significant predictors of in-hospital mortality. In-hospital morbidities were higher in diabetic patients compared with non-diabetic patients (p&lt;0.001) with neurological complications at 11.3% versus 7% (p=0.018), pulmonary complications at 57.5% versus 37.9% (p&lt;0.001), renal complications at 39.4% versus 17.2% (p&lt;0.001), infectious complications at 15.9% versus 7.3% (p&lt;0.001), and arrhythmias at 26.6% versus 17.6 (p&lt;0.001). After risk adjustment, DM remained a risk factor for postoperative arrhythmias with an odds ratio of 1.63 (p=0.005), neurological complications with an odds ratio of 2.03 (p=0.007), pulmonary complications with an odds ratio of 1.96 (p&lt;0.001), infectious complications with an odds ratio of 2.76 (p&lt;0.001), and renal complications with an odds ratio of 2.78 (p&lt;0.001). Conclusion: Diabetic and non-diabetic patients have similar in-hospital mortality rates. DM was an independent predictor for postoperative complications. Keywords: Diabetic mellitus; Cardiac surgery; Mortality; Postoperative complications

Low molecular weight fucoidan restores diabetic endothelial glycocalyx by targeting neuraminidase2: A new therapy target in glycocalyx shedding.

Diabetic vascular complication is a leading cause of disability and mortality in diabetes patients. Low molecular weight fucoidan (LMWF) is a promising drug candidate for vascular complications. Glycocalyx injury predates the occurrence of diabetes vascular complications. Protecting glycocalyx from degradation relieves diabetic vascular complications. LMWF has the potential to protect the diabetes endothelial glycocalyx from shedding. The protective effect of LMWF on diabetic glycocalyx damage was investigated in db/db mice and Human Umbilical Vein Endothelial Cells (HUVEC) through transmission electron microscopy and WGA labelling. The effect of LMWF on glycocalyx degrading enzymes expression was investigated. Neuraminidase2 (NEU2) overexpression/knockdown was performed in HUVECs to verify the important role of NEU2 in glycocalyx homeostasis. The interaction between NEU2 and LMWF was detected by ELISA and surface plasmon resonance analysis (SPR). LMWF normalizes blood indexes including insulin, triglyceride, uric acid and reduces diabetes complications adverse events. LMWF alleviates diabetic endothelial glycocalyx damage in db/db mice kidney/aorta and high concentration glucose treated HUVECs. NEU2 is up-regulated in db/db mice and HUVECs with high concentration glucose. Overexpression/knockdown NEU2 results in glycocalyx shedding in HUVEC. Down-regulation and interaction of LMWF with NEU2 is a new therapy target in glycocalyx homeostasis. NEU2 was positively correlated with phosphorylated IR-β. NEU2 is an effective target for glycocalyx homeostasis and LMWF is a promising drug to alleviate vascular complications in diabetes by protecting endothelial glycocalyx.

Incidence and predictors of chronic kidney disease among patients with diabetes treated at governmental hospitals of Harari Region, eastern Ethiopia, 2022.

Chronic kidney disease (CKD) is the leading cause of morbidity and mortality in diabetic patients. However, limited evidence is available about its incidence and predictors in Ethiopia, specifically in the Harari region. A retrospective follow-up study was conducted among 520 diabetes patients who followed their treatment at governmental hospitals in the Harari region between 1 September 2012, and 30 May 2022. The risk of developing CKD was calculated with a 95% CI, and the risk was stratified by type of diabetes mellitus. Predictors of CKD were determined using the Gompertz regression model with the baseline Cox model. Data from 494 patients were included in the final analysis with 26 (5%) excluded. A total of 51 patients (10.32%) developed CKD over the 10-year follow-up period with an incidence rate of 2.16 cases (95% CI 1.64-2.84) per 100 person-years of observation. The risk of CKD was increased by three times (AHR: 3.09, 45 95% CI: 1.56, 6.14) among patients older than 60 years and by more than three times (AHR: 3.53, 95% CI: 1.43, 8.71) among patients with diabetes mellitus for longer than 5 years of stay with the diabetes mellitus. Moreover, the risk of CKD was increased four-fold among patients with high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL (AHR: 3.84, 95% CI, 1.80-8.18) and those with positive baseline proteinuria (AHR: 3.77, 95% CI: 1.43-8.71). We found that one in ten diabetic patients had developed CKD within 10 years of the diabetes mellitus diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level, and proteinuria had increased the hazards of developing CKD. We recommend a more focused follow-up of older adult patients with advanced disease status at baseline for optimal control of diabetes mellitus that prevents its furthering to CKD.

Serum Uric Acid as a Marker of Coronary Artery Disease in Type 2 Diabetes Mellitus Patients: An Observational Study

ABSTRACT Background: Cardiovascular disease is the most prevalent cause of morbidity and mortality in diabetic patients. Hypertension, obesity, and smoking are well-established risk factors for coronary artery disease (CAD) in diabetes. Hyperuricemia is an emerging risk factor for insulin resistance and cardiovascular disease. Our objective in the present study was to assess the association of serum uric acid with cardiovascular disease and its risk factors in type 2 diabetes mellitus. Methods: A cross-sectional study was carried out at a tertiary care hospital; a total of 100 patients who presented to the hospital with a diagnosis of type 2 diabetes mellitus were selected by simple random sampling technique and divided into two groups based on echocardiography and coronary angiography reports. Serum uric acid, glycosylated hemoglobin (HbA1c), lipid profile, and body mass index (BMI) measurements were performed. Data were analyzed into the SPSS version, and the Pearson coefficient was used to assess the association between uric acid and cardiovascular disease risk factors. P &lt;0.05 was considered statistically significant. Results: The mean uric acid is higher (6.79 ± 1.42 mg/dL) in diabetic patients with CAD compared to diabetics without CAD (4.82 ± 1.66 mg/dL). A positive correlation was found between serum uric acid, BMI, and lipid profile. Conclusion: Serum uric acid was significantly associated with the presence of CAD and CAD risk factors and can be used as a predictive marker for cardiovascular outcomes in type 2 diabetes mellitus.

Non-enzymatic glycation and diabetic kidney disease.

Chronic diabetes leads to various complications including diabetic kidney disease (DKD). DKD is a major microvascular complication and the leading cause of morbidity and mortality in diabetic patients. Varying degrees of proteinuria and reduced glomerular filtration rate are the cardinal clinical manifestations of DKD that eventually progress into end-stage renal disease. Histopathologically, DKD is characterized by renal hypertrophy, mesangial expansion, podocyte injury, glomerulosclerosis, and tubulointerstitial fibrosis, ultimately leading to renal replacement therapy. Amongst the many mechanisms, hyperglycemia contributes to the pathogenesis of DKD via a mechanism known as non-enzymatic glycation (NEG). NEG is the irreversible conjugation of reducing sugars onto a free amino group of proteins by a series of events, resulting in the formation of initial Schiff's base and an Amadori product and to a variety of advanced glycation end products (AGEs). AGEs interact with cognate receptors and evoke aberrant signaling cascades that execute adverse events such as oxidative stress, inflammation, phenotypic switch, complement activation, and cell death in different kidney cells. Elevated levels of AGEs and their receptors were associated with clinical and morphological manifestations of DKD. In this chapter, we discussed the mechanism of AGEs accumulation, AGEs-induced cellular and molecular events in the kidney and their impact on the pathogenesis of DKD. We have also reflected upon the possible options to curtail the AGEs accumulation and approaches to prevent AGEs mediated adverse renal outcomes.

Position Statement on the Appropriateness and Significance of Adding the Glycated Hemoglobin Test to the National Health Examination

The recent increase in the number of people with diabetes and the high incidence of complications carry a significant socioeconomic burden in addition to the disease burden and impact on personal health. Therefore, the Korean Diabetes Association and the Korean government have been making efforts to prevent the progression from pre-diabetes to diabetes through screening tests and to reduce diabetes complications and associated mortality in diabetic patients. Several studies in Korea have shown that glycated hemoglobin (HbA1c) provides complementary information to fasting plasma glucose (FPG) and improves clinical utility for diabetes screening. We hope that this consensus meeting will serve as an opportunity to identify additional diabetic patients who have not been diagnosed through a combination of FPG and HbA1c during a medical check-up. Our study is aimed to significantly reduce the lead time between diabetes onset and clinical diagnosis and initiation of diabetes treatment.

Identification of miRNA Targeting Genes Involved in Hyperlipidemia as a Therapeutic Strategy for Cardiovascular Diseases

Hyperlipidemia is a common metabolic disorder and one of the independent risk factors for the onset of cardiovascular diseases (CVDs). CVDs are the leading cause of mortality in diabetic patients globally. In recent years, compelling evidence suggested that aberrant miRNA expression has been implicated in the pathophysiology of many diseases and is considered a prognostic biomarker for early diagnosis of heart diseases. Therefore, analysis of hyperlipidemia-related miRNAs is a potential approach to selectively inhibit or activate specific genes for therapeutic purposes. We identified and screened a set of hyperlipidemia and CVDs associated genes by the genetic testing registry (GTR) of NCBI. Furthermore, we predicted highly conserved putative miRNAs that target genes through binding at 8mer units by using bioinformatics repositories Targetscan, miRBase, and miRanda. Insilico miRNAs profiling of shortlisted genes revealed the target miRNAs; ACTN4 (miR-153-3p), ADCY3 (miR-3681-3p/ 216a-3p/ 128-3p/ 873-5p.1/ 92b-3p), LEP (miR-532-5p/ 29b-3p/ 29a-3p/ 29c-3p/ 125b-5p/ 125a-5p. GHR (miR-151a-3p/ 19a-3p/ 19b-3p/ 143-3p/15b-5p/ 15a-5p/ 195-5p), LPL(miR-27a-3p/ 27b-3p/ 29b-3p/, 29a-3p/ 29c-3p) LRP6 (miR-183-5p.1/ 124-3p.2/ 506-3p/ 3681-3p/ 128-3p/ 216a-3p/ 27a-3p/ 27b-3p/ 543/ 140-3p.1PCSK9 (miR-202-5p/155-5p), USF1 (miR-338-3p/ 296-5p), TNFRSF1B (miR-7/4458miR-4500), HMCN1(miR-29c-3p/ 29b-3p/ 29a-3p/ 199a-5p/ 199b-5p), KDM3A(miR-140-3p.1/ 30a-5p/ 30d-5p/ 30c-5p/ 30b-5p/ 30e-5p/ 542-3p), SEC61A1(miR-218-5p/ 331-3p), ADD1(miR-27b-3p/ 27a-3p/ 299-3p/ 448), PPARGC1B(miR-30e-5p/ 30a-5p/ 30d-5p/ 30c-5p/ 30b-5p/ 449b-5p/ 449a/ 34c-5p/ 30/ 27a-3p/ 27b-3p/ SH2B1(miR-142-3p.1/ 136-5p), PPARA (miR-19a-3p/ 19b-3p/ 9-5p/ 101-3p.2/ 4262/ 181c-5p/ 181d-5p/ 181b-5p/ 181a-5p/ 506-3p/ 124-3p.2). Conclusively, our predicted microRNAs may provide better insights towards miRNA-based treatment strategies against CVDs.

Association of Cardiac Valve Calcification and 1-year Mortality after Lower-extremity Amputation in Diabetic Patients: A Retrospective Study.

Cardiac valve calcification predisposes patients to a higher risk of adverse cardiovascular events. This study aimed to investigate the association between cardiac valve calcification and 1-year mortality in diabetic patients after lower-extremity amputation. This was a retrospective study conducted on the clinical data of diabetic patients who underwent lower-extremity amputation admitted to the Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China for diabetic foot ulcers needed lower extremity amputation surgery between July 2017 and March 2021. Detailed preoperative medical assessments were performed and recorded. Cardiac valve calcification was assessed using echocardiography at baseline. Oneyear follow-up assessments were conducted and included clinical visits, hospital record assessments, and telephone reviews to obtain the survival status of patients. Ninety-three diabetic patients participated in the study. The 1-year follow-up mortality rate after amputation was 24.7%. Compared to the survival group, the prevalence of cardiac valve calcification and the Revised Cardiac Risk Index (RCRI) were higher in the mortality group. In the Cox regression analysis, cardiac valvular calcification (HR=3.427, 95% CI=1.125- 10.443, p =0.030) was found to be an independent predictor of all-cause mortality after amputation. In addition, the patients with both aortic valve calcification and mitral annular calcification had a higher all-cause mortality rate (50%). Receiver operator characteristic curve analysis showed a stronger predictive ability when using a combination of calcified valve number and RCRI (AUC=0.786 95%, CI=0.676-0.896, p =0.000). In diabetic patients after lower-extremity amputation, cardiac valve calcification was associated with all-cause mortality during 1-year follow-up. Combination of calcified valve number and RCRI score showed a stronger predictive value for mortality.