Mortality In Diabetic Patients Research Articles

Evaluation of the relation between HBA1C and MPV, PDW levels of patients with Type 2 diabetes admitted in internal medicine polyclinics.

Diabetes is a chronic, broad-spectrum metabolic disorder that requires continuous medical care, in which the organism cannot adequately benefit from carbohydrates, fats, and proteins due to insulin deficiency or defects in the effect of insulin. Vascular complications are considered to be the main cause of mortality in diabetic patients. Platelet activation plays a role in the development of vascular complications. The aim of this study was to evaluate the relationship between HbA1c, which is the parameters that we can evaluate in primary healthcare institutions, and increased Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) levels, which are thought to be a platelet activation markers in patients with Type 2 diabetes mellitus. In our study, the data for 600 patients who applied to Internal Medicine outpatient clinic of our hospital between January 01, 2022, and June 31, 2022, were obtained by examining their epicrisis through the hospital information management system. Six hundred patients, including 300 control group with HbA1c level below 6.5 and 100 patients each 7-8.5 8.5-10 and above 10, were included in the study. HbA1c, MPV, and PDW levels of the patients were recorded. Among 600 patients who applied to internal medicine polyclinics of our hospital between January 01, 2022, and June 31, 2022, 412 participants were female, while 188 participants were male. It was determined that the participants were 46.91±12.68 years old on average, the youngest participant was 18 years old and the oldest participant was 66 years old. It was determined that the mean HbA1c value of the participants participating in the study was 7.6±2.4, the lowest HbA1c value was 4.3, and the highest HbA1c value was 19.3. It was determined that the mean MPV value of the participants was 10.1±1.1, the lowest MPV value was 7.7, and the highest MPV value was 13.3. It was determined that the mean PDW value of the participants was 16.0±0.4, the lowest PDW value was 14.8, and the highest PDW value was 17.2. In this study, it was determined that MDV and PDW levels showed a statistically significant difference according to the HbA1c value ranges of the patient group. Accordingly, the MPV and PDW levels of the participants whose HbA1c value range is >10 are higher. It was observed that MPV and PDW levels increased as the HbA1c value range increased.

Prediction of Foot Ulcers Using Artificial Intelligence for Diabetic Patients at Cairo University Hospital, Egypt.

In Egypt, diabetic foot ulcers markedly contribute to the morbidity and mortality of diabetic patients. Accurately predicting the risk of diabetic foot ulcers could dramatically reduce the enormous burden of amputation. The aim of this study is to design an artificial intelligence-based artificial neural network and decision tree algorithms for the prediction of diabetic foot ulcers. A case-control study design was utilized to fulfill the aim of this study. The study was conducted at the National Institute of Diabetes and Endocrine Glands, Cairo University Hospital, Egypt. A purposive sample of 200 patients was included. The tool developed and used by the researchers was a structured interview questionnaire including three parts: Part I: demographic characteristics; Part II: medical data; and Part III: in vivo measurements. Artificial intelligence methods were used to achieve the aim of this study. The researchers used 19 significant attributes based on medical history and foot images that affect diabetic foot ulcers and then proposed two classifiers to predict the foot ulcer: a feedforward neural network and a decision tree. Finally, the researchers compared the results between the two classifiers, and the experimental results showed that the proposed artificial neural network outperformed a decision tree, achieving an accuracy of 97% in the automated prediction of diabetic foot ulcers. Artificial intelligence methods can be used to predict diabetic foot ulcers with high accuracy. The proposed technique utilizes two methods to predict the foot ulcer; after evaluating the two methods, the artificial neural network showed a higher improvement in performance than the decision tree algorithm. It is recommended that diabetic outpatient clinics develop health education and follow-up programs to prevent complications from diabetes.

Kliničke karakteristike i ishodi kod bolesnika sa dijabetesom i bez dijabetesa hospitalizovanih zbog kovida 19 - multicentrična studija poprečnog preseka sprovedena u jugozapadnom Iranu

Background. Diabetes is one of the most common diseases among hospitalized patients due to COVID-19. Therefore, this study aimed to identify the clinical characteristics of diabetic and non-diabetic patients with COVID-19 that may lead to death. Methods. A multicenter cross-sectional study was conducted among patients admitted to hospitals due to COVID-19. The data, including demographic data, symptoms and signs, underlying diseases, patient progress, and outcomes were obtained from 38 hospitals in the registry system of Khuzestan province (the southwest of Iran) between January 19, 2020 and March 8, 2021. The Cox proportional hazards regression was used to analyze the data. Results. Data from 23,447 hospitalized patients due to COVID-19 were included in the study. Four thousand three hundred and forty participants (18.5%) with a mean age of 62 years had diabetes and 14.72% of them died. A multivariable Cox regression showed that the variables of age (Hazard Ratio (HR) = 2.65; 95% CI: 1.78-3.95; P < 0.001), sex (HR = 1.16; 95% CI: 1.001 - 1.35; P = 0.049) and comorbidities such as cancer (HR = 1.89; 95% CI: 1.24 - 2.89; P = 0.003) and cardiovascular disease (HR = 1.2; 95% CI: 1.24 - 2.89; P = 0.032) were associated with mortality in diabetic patients with COVID-19. Conclusion. This study showed that COVID-19 mortality was higher in men, the elderly, and people with cardiovascular disease and cancer. Therefore, the management and prevention of COVID-19 in diabetic patients with these characteristics are vital.

Lipids-Diagnosis and therapy in diabetes mellitus (Update 2023)

Hyper- and dyslipidemia contribute to cardiovascular morbidity and mortality in diabetic patients. Pharmacological therapy to lower LDL cholesterol has convincingly shown to reduce cardiovascular risk in diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the use of lipid-lowering drugs in diabetic patients according to current scientific evidence.

Systemic therapy of inflammatory breast cancer with type 2 diabetes mellitus – Prevention of high risk of radiation-induced progression of tumor tissue cancer

Introduction. Cancer mortality in diabetic patients has been reported to increase moderately compared to non-diabetic patients. The aim of the study aimed to assess the findings and identify radiotherapy's role in the comprehensive care of diabetic IBC patients with various hyperglycemia correction strategies. Methods. Patients with diabetes have shown a higher risk of radiation-induced cancer progression for tumor tissue, especially for inflammatory form. For 7 patients, to continue systematic chemotherapy with a scheme change (consecutive anthracyclines-taxanes, 2-week interval) and insulin with individual scheme for hyperglycemia correction on the basis of glycemic control – 1st group, the other (7 patients) – 2nd group, was given radiotherapy to the breast gland and lymphatic drainage ways. 45–50 Grey was prescribed for 25-28 fractions (per 1.8-2.0 Grey), 46–50 Grey in 23-25 fractions were used for zones of regional metastasis and for hyperglycemia correction metformin 2000 mg/day PO divided q8-12hr with meal on the basis of glycemic control. Results. Assessed were the number of patients who qualified for surgery and overall survival for 24 months. 2nd group showed a superior response following resistance to prior systemic treatment. Thus, 5 (71.41%) of the 7 patients exhibited a consistent response – complete or partial regression. There were only 2 individuals (28.61%) who responded to treatment among the patients who maintained chemotherapy. Conclusions. Breast cancer of the aggressive IBC variety requires multidisciplinary treatment from breast surgery, medical, and radiation oncology. Patients with diabetes appear to experience more side effects from radiation therapy than patients without the disease. Hyperglycemia, higher total RT doses, and radiosensitizers are a few techniques that can improve the impact of RT on local-regional management. Local-regional control rates for IBC are increasing with an individual patient strategy. Metformin also improves insulin resistance and has anticancer benefits.

Study of the Echocardiographic Changes in Patients with Diabetic Nephropathy

Background: Diabetes mellitus (DM) is a metabolic disorder of multiple etiologies. Cardiovascular changes are one of the important macro vascular complications which are a major cause of mortality in diabetic patients with diabetic nephropathy. The aim of this work was to evaluate the structural and functional cardiovascular changes using echocardiography in diabetic patients with diabetic nephropathy (DN) in comparison with those without diabetic nephropathy. 
 Methods: This observational cross-sectional study was carried out on 60 diabetic patients with type 2 diabetes mellitus (T2DM) only or had T2DM with DN Patients were subdivided in to two equal groups: group A included patients without DN and group B included patients with DN. All patients were subjected to laboratory investigations, echocardiography (tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure measuring, left ventricular systolic and diastolic function assessment).
 Results: There was a significantly lower Hb and significantly higher creatinine level and AL/CR ratio in group B in comparison to group A. There was significantly higher number of sclerotic aortic valve patients, higher numbers of low TAPSE, higher estimated systolic pulmonary artery pressure (ESPAP), higher end diastolic diameter (EDD), higher end systolic diameter (ESD), heavier left ventricular mass and thicker posterior wall thickness in group B in comparison to group A (P ≤ 0.05). There was a positive relationship between AL/CR ratio and EDD, left ventricular mass, TAPSE, and posterior wall thickness, while negative relationship between it and ESD in the two studied groups, and it was found that high EPASP and sclerosis of the Aortic valve were more prevalent with DN group.
 Conclusions: Risks of cardiovascular events increase substantially with increasing stage of kidney disease in T2DM patients. Asymptomatic diabetic subjects are at high risk for major adverse cardiovascular events, such as those with, chronic diabetic kidney disease (DKD), or proteinuria.

Prognostic value of creatinine-to-cystatin c ratio in patients with type 2 diabetes mellitus: a cohort study

BackgroundThe serum creatinine-to-cystatin C ratio (Scr/Scys) has been suggested as a surrogate marker of muscle mass and a predictor of adverse outcomes in many diseases. However, the prognostic value of Scr/Scys in patients with type 2 diabetes mellitus (T2DM) is unknown. The aim of this study is to assess the prognostic value of Scr/Scys in patients with T2DM.MethodsIn this retrospective observational study, we enrolled 3668 T2DM patients undergoing coronary angiography (CAG). Serum creatinine (Scr) and serum cystatin C (Scys) levels were measured at admission. The study population was separated into low muscle mass (low-MM) and normal muscle mass (normal-MM) groups by Scr/Scys cut-off point. The association between muscle mass and long-term all-cause mortality was examined using Cox regression analysis.ResultsDuring a median follow-up of 4.9 (3.0–7.1) years, a total of 352 (9.6%) patients died. The mortality was higher in patients with low-MM as compared with patients with normal-MM (11.1% vs. 7.3%; p < 0.001). Low muscle mass was associated with increased risk for long-term all-cause mortality, regardless of whether Scr/Scys were used as a continuous variable (adjusted hazard ratio: 1.08 [95% confidence interval (CI) 1.03 to 1.13]; p = 0.009) or a categorial variable (adjusted hazard ratio: 1.36 [95% CI 1.03 to 1.75]; p = 0.021).ConclusionLow muscle mass assessed by Scr/Scys was associated with increased risk of long-term all-cause mortality in diabetic patients.

Depot-specific adipose tissue modulation by SGLT2 inhibitors and GLP1 agonists mediates their cardioprotective effects in metabolic disease.

Sodium-glucose transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide 1 (GLP-1) receptor agonists are newer antidiabetic drug classes, which were recently shown to decrease cardiovascular (CV) morbidity and mortality in diabetic patients. CV benefits of these drugs could not be directly attributed to their blood glucose lowering capacity possibly implicating a pleotropic effect as a mediator of their impact on cardiovascular disease (CVD). Particularly, preclinical and clinical studies indicate that SGLT-2i(s) and GLP-1 receptor agonists are capable of differentially modulating distinct adipose pools reducing the accumulation of fat in some depots, promoting the healthy expansion of others, and/or enhancing their browning, leading to the suppression of the metabolically induced inflammatory processes. These changes are accompanied with improvements in markers of cardiac structure and injury, coronary and vascular endothelial healing and function, vascular remodeling, as well as reduction of atherogenesis. Here, through a summary of the available evidence, we bring forth our view that the observed CV benefit in response to SGLT-2i or GLP-1 agonists therapy might be driven by their ameliorative impact on adipose tissue inflammation.

Coping With Diabetes During the COVID-19 Lockdown in Saudi Arabia: Lessons Learned in the Post-pandemic Era.

Uncontrolled diabetes has appeared as one of the major risk factors for morbidity and mortality in diabetic patients with coronavirus disease 2019 (COVID-19). Alterations in dietary habits, physical inactivity, and inability to take advice from the physician are some of the contributing factors. This study aimed to assess the impact of the COVID-19 lockdown in Saudi Arabia on medication accessibility, medication adherence, lifestyle, and quality of life of diabetes patients. A cross-sectional observational study was conducted among diabetic patients using a self-reported questionnaire developed on an online platform (SurveyMonkey®). The survey was distributed through social media platforms (WhatsApp, Telegram). For those who were digitally illiterate, responses were collected by family members. The targeted population was type 1, type 2 and gestational diabetes patients. The analysis of the data was done using IBM SPSS Statistics, version 26. Four hundred forty-nine participants completed the survey. Most of the participants had type 2 diabetes (n=359; 79.8%) and were well educated (83.2%) with a high school degree and above. Complications from COVID-19 infection were reported in 12% (n=54) patients. During quarantine, 78.8% (n=354) of participants measured their blood glucose regularly. Results showed that during quarantine, 68.3% (n=311) participants skipped their scheduled follow-up whereas only 5.1% (n=23) of them took their medication inappropriately. This study reported good levels of self-monitoring of blood glucose levels, whereas patients' accessibility to seek healthcare services seemed to be interrupted. Further efforts are needed in the post-pandemic era to empower patients' self-care behaviors and utilize telehealth models to facilitate timely access to medical care.

Assessment of early kidney injury caused by asymptomatic bacteriuria in children with type 1 diabetes

IntroductionInfection is one of the most frequent causes of morbidity and mortality in diabetic patients. Some microorganisms become more virulent in a high glucose concentration. Diabetics are more likely to have asymptomatic and symptomatic bacteriuria. NGAL is secreted in high concentrations into the blood and urine within two hours of AKI.ObjectivesThe aim of the study is early detection of UTI in type1diabetic children through screening of their urine samples, and measurement of NGAL urinary levels in cases with asymptomatic bacteriuria for early detection of AKI to prevent serious complications.Patients and methodsOne thousand twenty-two known diabetic children on regular follow up in endocrine outpatient clinic at Minia Children University hospital were screened for UTI. From them only 52 diabetic children were diagnosed as asymptomatic bacteriuria (group I), 52 diabetic children with normal urine analysis (group II) and 52 apparently healthy children, age and sex matched, served as controls (group III). CBC, Renal function test, HbA1c, hs- CRP, Albumin/creatinine ratio, urine examination, urine culture, GFR and urinary NGAL were done to all children.ResultsThirty-seven females (71.2%) had asymptomatic bacteriuria, Hs CRP and urinary NGAL were significantly higher, while GFR was significantly lower in diabetic children with bacteriuria than the other two groups. For diabetic children with bacteriuria, (AUC) for NGAL was 1 with optimal cutoff value of > 44.1 (Sensitivity 100% and Specificity 100%) while AUC for hsCRP was 0.887 with optimal cutoff value of > 1 (Sensitivity 82.69% and Specificity 90.38%).ConclusionRoutine urine analysis should be done for all diabetic children even if they are asymptomatic. NGAL and hsCRP are non-invasive methods that could detect early renal injury in these patients thus, early, and proper management of UTI should be started to prevent renal injury.

ODP197 Familial Hypertriglyceridemia Initially Presenting with Hypertriglyceridemia-induced Pancreatitis: A Case Report

Abstract Case Presentation A 28 year old male with a past medical history of diabetes mellitus type 2 (T2DM) and hypertension presented to the emergency room with acute onset, progressive epigastric pain associated with nausea. The pain suddenly started earlier that day after a large meal. He denied alcohol use. He was previously on insulin Glargine 55 units nightly but was not using it for several months. Vitals signs were within normal limits, BMI was 38.5 kg/m 2 . Physical examination revealed marked epigastric tenderness and multiple yellow papules on the abdomen and extensor surfaces of extremities. Lab findings revealed WBC 14.3 k/mm cu, lipase 437 IU/L, triglycerides greater than 3000 mg/dl with VLDL greater than 3000 mg/dl. Computerized tomography of the abdomen was consistent with acute pancreatitis. He was diagnosed with familial hypertriglyceridemia presenting with hypertriglyceridemia-induced pancreatitis and was admitted to the intensive care unit (ICU). Treatment with regular insulin infusion was started. On day 3, triglyceride levels decreased to 543 mg/dl and insulin infusion was stopped. He reported symptomatic improvement and was able to tolerate oral diet. He was counseled on significance of lifestyle modifications and medication compliance and was discharged on Niacin, Omega 3, Fenofibrate, Ezetimibe, and Pravastatin with plans to follow up with an Endocrinologist. Discussion This case of a young male presenting with hypertriglyceridemia-induced pancreatitis due to underlying familial hypertriglyceridemia emphasizes the significance of comprehensive history taking and work up for patients initially presenting to the clinic with risk factors such as obesity and insulin resistance. Our patient classically had a history of T2DM, and as cardiovascular complications are the leading cause of mortality in diabetic patients, screening for and managing dyslipidemia is pivotal. Eruptive xanthomas are erythematous-yellow papules typically located on extensor surfaces which appear when triglyceride levels exceed 1500-2000 mg/dl. This characteristic skin finding led to a prompt suspicion for familial hypertriglyceridemia in our patient. Our patient was stabilized in the ICU and subsequently discharged on multiple oral agents. The current consensus is that single statin therapy is not recommended; however, further research is indicated to specify the optimal combination of triglyceride lowering agents based on the severity of hypertriglyceridemia. Presentation: No date and time listed

Glycated albumin to glycated hemoglobin ratio and mortality in diabetic patients on dialysis: a new association.

Hemoglobin A1c (A1c) and glycated albumin (GA) are two blood glycated proteins commonly used to monitor glycemic control in dialysis patients with diabetes. However, little is known about the association between the GA/A1c ratio and mortality in these populations. Here, we examine these associations using a nationwide cohort. We enrolled 28994 dialysis patients with diabetes who met our inclusion criteria (female, 32.9%; mean age, 67.4±11.6 years; mean dialysis duration, 6.3±5.8 years). After dividing the patients into groups based on GA/A1c quantiles and adjusting for 18 potential confounders, adjusted hazard ratios (HR) and 95% confidence limits were calculated for 3-year mortality and cause-specific mortalities. Additionally, propensity score matching analyses were used to compare mortalities between the low and high GA/A1c groups. After adjusting for possible confounders, significantly increased mortality was found in patients with GA/A1c ratios of 3.6-4.0 [HR 1.21 (1.10-1.34)] or higher [HR 1.43 (1.30-1.58)] than in those with GA/A1c ratios of 3.0-3.3. The risks of infectious and cardiovascular death were higher in these patients regardless of their nutritional status. In the propensity score matching analyses, significantly increased mortality was consistently found in those with a higher ratio (≥3.3) [HR 1.23 (1.14-1.33)] than in those with a lower ratio. The GA/A1c ratio was significantly associated with 3-year mortality, especially infectious and cardiovascular mortality, in dialysis patients with diabetes. This ratio may be a promising new clinical indicator of survival in these patients, independent of their current glycemic control and nutritional markers.

Endothelial derived miRNA-9 mediated cardiac fibrosis in diabetes and its regulation by ZFAS1.

Diabetic cardiomyopathy (DCM) is one of the most prevalent causes of morbidity and mortality in diabetic patients. Hyperglycemia induces increased expression/deposition of extracellular matrix (ECM) proteins including fibronectin (FN) and collagen (Col) and plays an important role in fibrosis in diabetic cardiomyopathy (DCM). The roles of RNAs including microRNA (miRNA) and long non-coding RNAs (lncRNA) have begun to be understood in many conditions. In this study, we investigated the role of a specific miRNA, miR-9, and its interactions with lncRNA ZFAS1 in mediating fibrosis in DCM. Treatment with 25 mM glucose (HG) decreased miR-9 expression and increased expressions of ZFAS1, ECM proteins and inflammatory markers, compared to 5 mM glucose (NG) in the HCMECs by using qRT-PCR. Glucose-induced upregulation of ECM proteins can be prevented by ZFAS1 siRNA or miR-9 mimic transfection. Luciferase assay was confirmed miR-9 binding to FN 3’-UTR. miR-9 expression can be regulated by ZFAS1 through polycomb repressive complex 2 (PRC2) components using RNA immunoprecipitation (RIP) and chromatin immunoprecipitation (ChIP) assays. In the in vivo experiment, hyperglycemia-induced the ECM production can be prevented by the miR-9 overexpression in the fibrosis in DCM. These studies showed a novel glucose-induced molecular mechanism in which ZFAS1 participates in the transcriptional regulation of ECM protein production in diabetes through miR-9.

Association of Serum Homocysteine with Cardiovascular and All-Cause Mortality in Adults with Diabetes: A Prospective Cohort Study.

Background Homocysteine (Hcy) was implicated in oxidative stress and diabetes biologically. However, the clinical evidence on the link between Hcy level and diabetes is limited and controversial. This study is aimed at investigating the association of serum Hcy with all-cause and cardiovascular mortality in diabetic patients. Methods Serum Hcy was measured among 2,286 adults with type 2 diabetes in NHANES 1999-2006. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% CIs for the association of Hcy with all-cause and cause-specific mortality. Results Over a median follow-up of 11.0 (interquartile range, 8.9-13.4) years, 952 of the 2286 patients with diabetes died, covering 269 (28.3%) cardiovascular deaths and 144 (15.2%) cancer deaths. Restricted cubic spline showed the linear relationship between Hcy and all-cause mortality risk. After multivariate adjustment, higher serum Hcy levels were independently associated with increased risk of all-cause and cardiovascular mortality. Compared with participants in the bottom tertile of Hcy, the multivariate-adjusted HRs and 95% CI for participants in the top quartile were 2.33 (1.64-3.30) for all-cause mortality (ptrend < 0.001), 2.24 (1.22-4.10) for CVD mortality (ptrend = 0.017), and 2.05 (0.90-4.69) for cancer mortality (ptrend = 0.096). The association with total mortality was especially stronger among patients with albuminuria. Serum Hcy significantly improved reclassification for 10-year mortality in diabetic patients (net reclassification index = 0.253 and integrated discrimination improvement = 0.011). Conclusions Serum Hcy was associated with risks of all-cause and cardiovascular mortality in diabetic adults. Our results suggested that Hcy was a promising biomarker in risk stratification among diabetic patients.

Impact of metformin on the all-cause mortality in diabetic patients hospitalized with acute heart failure

Abstract Introduction Although the hypothesis that metformin is beneficial for diabetic patients with heart failure (HF) has been steadily raised, there have been no solid data on the efficacy of metformin in acute HF patients. Purpose We investigated the impact of metformin on all-cause mortality in hospitalized acute HF patients with type 2 diabetes. Methods The Korean Acute Heart Failure registry enrolled patients hospitalized for acute HF from 2011 to 2014. Among this cohort, we analyzed patients with diabetes. We investigated all-cause mortality at 1 year after discharge. Propensity score matching (1:1 matching) and Cox proportional hazard models were used to assess difference in all-cause mortality. Results The study analyzed 1,976 diabetic patients (median age 72 years, mean left ventricular ejection fraction (LVEF) 34%, 54.5% male). Among them, 712 (36%) patients were on metformin. After 1:1 propensity score matching, 1,424 patients (712 metformin users vs. 712 non-users) were analyzed. During the median follow-up period of 11 months, 146 (21%) metformin non-users died and 108 (15%) metformin users died. Kaplan-Meier curves showed a higher all-cause mortality rate in non-users than in metformin users (Log-rank P=0.0025). After adjustment for clinically relevant variables, metformin was associated with lower risk for all-cause mortality (HR 0.713, 95% CI 0.551–0.922, P=0.01). In subgroup analyses, metformin use was significantly associated with a lower all-cause mortality in higher eGFR group (≥60 ml/min/1.73 m2, HR 0.531, 95% CI 0.357–0.790, P=0.002), but not in lower eGFR group (&amp;lt;60 ml/min/1.73 m2, HR 0.905, 95% CI 0.643–1.275, P=0.569, P-for-interaction=0.033). There was no significant interaction of metformin use for all-cause mortality between the subgroups with LVEF ≤40% and LVEF &amp;gt;40% (P-for-interaction=0.906). Conclusion Metformin use was associated with a lower risk for 1-year all-cause mortality in diabetic acute HF patients, especially in high eGFR group. Funding Acknowledgement Type of funding sources: None.

Causes of excess mortality in diabetes patients without coronary artery disease

Abstract Background Diabetes (DM) patients without coronary artery disease (CAD) by coronary angiography have a similar risk of myocardial infarction and cardiac death as non-DM patients without CAD. Yet, even with absence of CAD, patients with DM have higher mortality compared to non-DM patients. Aims To examine the underlying causes of death in patients undergoing coronary angiography depending on DM and CAD. Methods We included every patient with no previous history of CAD who underwent coronary angiography in Western Denmark between 2003–2016. Patients were stratified by DM and CAD and followed for a maximum of 10 years. We estimated the 10-year cumulative risk of all-cause death and cause-specific death. Causes of death were categorized as “cardiovascular”, “pulmonary”, “cancer”, “renal”, “bleeding-related”, and “other” based on ICD-10 codes listed as underlying causes of death obtained from death certificates. Deaths where DM was listed as the underlying cause of death (i.e. ICD-10 code DE1) were included in the category “other”. Results We included 132,432 patients, of whom 33% had neither DM nor CAD, 5% had DM only, 51% had CAD only, and 11% had both DM and CAD. Mean age was 64 years. Median follow-up was 6.3 year (inter-quartile range 3.8–10.0). During follow-up, 35,036 (26.5%) patients died. Patients with both DM and CAD had the highest 10-year mortality (47.4%, 95% CI 46.3–48.4), followed by CAD only (33.3%, 95% CI 32.8–33.7), DM only (30.7%, 95% CI 29.3–32.2), and patients with neither DM nor CAD (21.6%, 95% CI 21.1–22.1). The proportion of cardiovascular deaths were similar in patients with DM only (29.2%, 95% CI 27.0–31.5, Figure) and patients with neither DM nor CAD (29.7%, 95% CI 28.8–30.7). Patients with DM were more likely to die from causes categorized as “other” compared to patients with neither DM nor CAD [38.4% (95% CI 36.0–40.9) versus 30.2% (95% CI 29.3–31.2)]. Among patients with DM only, 43.7% of deaths classified as “other” were attributable to DM-related complications such as ketoacidosis and diabetic nephropathy. Conclusion Despite absence of CAD, DM remained associated with increased mortality. Excess mortality was primarily driven by patients dying of DM-related microvascular complications and ketoacidosis. Thus, despite absence of CAD, patients with DM require continued preventative measures to reduce DM-related mortality. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Aarhus University Hospital

Retinal artery occlusion as indicator of stroke in diabetes

Abstract Background Diabetes is associated with multiple complications in organs throughout the body, including an increased risk cardiovascular disease (1). Furthermore, an association between retinal artery occlusion and diabetes have been described as well (1,2). Early predictors of complications associated with diabetes would be useful for a better prognosis of the disease. Purpose Based on data from the Danish registries, the aim of this study was to investigate whether RAO is a predictor of stroke in diabetic patients. Methods We included 992 diabetic patients with incident RAO from the Danish National Patient Register with incident RAO between 1st of January 2000 and 31st of December 2018. Each of these cases were matched on age at index, sex, and time since diabetes diagnosis with 5 random diabetes patients with no subsequent diagnosis of RAO. Survival analyses were used to estimate and contrast the risk of stroke in diabetic RAO patients compared to diabetic patients with no prior diagnosis of RAO. The included analyses were all performed at 1 and 5-year follow-up. Results At 1-year follow-up, the incidence rate of stroke in diabetic RAO patients was 10.0 per 100 person years (PY) (95% CI: 8.13–12.10). The incidence for the controls at this time point was much lower at 1.82 per 100 PY (95% CI: 1.47–2.25). After 5-years of follow-up a large difference persisted, where the cumulative incidence was 19.3% (95% CI: 16.5–22.2%) for the RAO patients compared to 7.4% (95% CI: 6.5–8.2%) for the controls. The hazard rate ratio for stroke was 5.48 (95% CI: 4.06–7.39) after 1-year follow-up and 3.17 (95% CI: 2.60–3.86) after 5-year follow-up. The results support the use of RAO as a predictor of stroke in diabetic patients. Cardiovascular diseases contribute substantially to the morbidity and mortality in diabetic patients (3,4), underlining the need for especially a predictor of cardiovascular complications in these patients. To our knowledge, the predictive usage of RAO for cardiovascular complications in diabetic patients have not been investigated previously. Small occlusions, which could indicate systemic atherosclerosis, may not always be symptomatic. Therefore, the condition may not be diagnosed before more severe events occur. Conversely, RAO usually cause visual impairments, making RAO suitable as a potential predictor of subsequent cardiovascular events. The incidence rates of stroke suggest that diabetic RAO patients should be especially monitored the first year after their RAO diagnosis, but the monitoring would be beneficial even 5 years after the RAO diagnosis to continuously evaluate risk factors and instigate early intensified treatment. Conclusion The data of this study identified a substantial larger risk of stroke in diabetic RAO patients than diabetic patients with no RAO diagnosis, indicating RAO could be a predictor of stroke in diabetic patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Obel Family Foundation

Insulin Therapy Increases the Risk of Hypokalemia and Arrhythmia in Diabetic Patients with Coronary Heart Disease: A Retrospective Study in Wahidin Sudirohusodo General Hospital

Background: Cardiovascular disease is the most common cause of morbidity and mortality in diabetic patients. Patients with Diabetes Mellitus (DM) often require insulin therapy to control hyperglycemia, yet, it is associated with the risk of hypokalemia and dysrhythmia. Objectives: To evaluate the prevalence and the risk of hypokalemia and arrhythmia due to insulin therapy in DM patients with Coronary Heart Disease (CHD) comorbidity. Material and Methods: The study was conducted retrospectively based on medical record data from January 2021 to December 2021 in Wahidin Sudirohusodo general hospital. The inclusion criteria include the out-hospital patients diagnosed with DM with CHD comorbidity. The patients were divided into 2 groups, those who received insulin and those who received oral antidiabetic drugs (OAD). Hypokalemia was defined if an electrolyte characterized by a low serum potassium concentration with a normal range of 3.5 – 5.0 mEq/L. Arrhythmia was defined if abnormal changes in a regular heartbeat, including an irregular heartbeat, a skipped heartbeat, a fast heart rate (tachycardia), or a slow heart rate (bradycardia). Results: The data were obtained from 322 patients’ medical record, 161 was treated with insulin, and 161 received OAD. The insulin-treated patients had a significantly lower blood potassium level compared to the OAD group. The insulin group had 63,40% incidents of hypokalemia, while in the OAD group only 16,80% experienced hypokalemia (p&lt;0.05). The presence of arrhythmia was detected in 63,40 % of insulin-treated patients, while only 29,80% had arrhythmia in the OAD group (p&lt;0,05). Conclusions: Insulin Therapy in DM patients with coronary heart disease can increase the incidence of hypokalemia, which may result in arrhythmia in patients with coronary heart disease.

Outcome of Renal Transplantation in Patients With Diabetes Mellitus: A Single-Center Experience

BackgroundAn increasing proportion of kidney recipients have diabetes mellitus (DM). Some concerns have been raised about the kidney transplantation results in diabetic patients. Therefore, we assessed the effect of DM on morbidity and mortality of diabetic patients with renal transplantation. MethodsWe retrospectively studied adult patients with and without DM who underwent living donor transplantation between 2007 and 2016. Information concerning demographic and clinical data were retrospectively analyzed by reviewing the patient files. ResultsOf the 1536 transplant recipients, 126 (8%) had diabetes mellitus (mean age 49.4 ± 11.8) and 525 patients were evaluated in the non-diabetic control group (mean age 36.2 ± 15.9). The diabetic and non-diabetic patient groups had a mean follow-up after kidney transplantation 42.5 months (0.27-101.7 months) and 58.8 ± 10.6 months, respectively. In the diabetic patient group, only 3 patients had lost graft and 13 patients were exitus. Three patients had lost graft and 5 patients were exitus in non-diabetic patient group. Cardiac death (54.5%) was the most common cause of mortality in diabetic group. The 6-year patient and graft survival rates are 84.9% and 95.3%; 97.5% and 97.2% in the diabetic and non-diabetic patient groups, respectively. ConclusionsBoth infection and cardiovascular diseases increase morbidity and mortality in renal transplant patients with diabetes mellitus. The mortality risk of diabetic patients after renal transplantation is higher than the non-diabetic kidney recipients. Therefore, diabetic patients need meticulous cardiac evaluation before renal transplantation and a close follow-up, in terms of infection, after transplantation.

Clinical Overview of Ureum Levels in Type II Diabetes Mellitus Patients Infected by COVID-19 Pandemic

Pneumonia caused by Coronavirus Disease (Covid-19) first appeared in Wuhan. Diabetes mellitus becomes one of the main risk factors for a person infected with the Covid-19 virus because it is susceptible to infection. Chronic complications in the form of diabetic nephropathy caused by diabetes can also increase the severity and mortality in diabetic patients infected with the Covid-19 virus. This study aims to determine the clinical overview of ureum levels in Covid-19-infected diabetes mellitus patients treated at Efarina Pangkalan Kerinci Hospital. This study was conducted from July to September 2021 at the Laboratory of Efarina Pangkalan Kerinci Hospital. This type of research is descriptive analytics. This examination uses a light intensity measurement method using an autoanalizer with a sample of 30 samples taken at random. The results of the examination of ureum levels in Diabetic Mellitus patients infected with the Covid-19 pandemic at Efarina Pangkalan Kerinci Hospital obtained results that increased by 13 samples (43%) and normal ureum levels by as many as 17 samples (57%). For this reason, patients are advised to conduct regular health checks, eat healthy foods and comply with the 5M health protocol to prevent the transmission of the Covid-19 virus.