New-onset Diabetes Mellitus Research Articles

Heterogeneously elevated branched-chain/aromatic amino acids among new-onset type-2 diabetes mellitus patients are potentially skewed diabetes predictors.

The lack of specific predictors for type-2 diabetes mellitus (T2DM) severely impacts early intervention/prevention efforts. Elevated branched-chain amino acids (BCAAs: Isoleucine, leucine, valine) and aromatic amino acids (AAAs: Tyrosine, tryptophan, phenylalanine)) show high sensitivity and specificity in predicting diabetes in animals and predict T2DM 10-19 years before T2DM onset in clinical studies. However, improvement is needed to support its clinical utility. To evaluate the effects of body mass index (BMI) and sex on BCAAs/AAAs in new-onset T2DM individuals with varying body weight. Ninety-seven new-onset T2DM patients (< 12 mo) differing in BMI [normal weight (NW), n = 33, BMI = 22.23 ± 1.60; overweight, n = 42, BMI = 25.9 ± 1.07; obesity (OB), n = 22, BMI = 31.23 ± 2.31] from the First People's Hospital of Yunnan Province, Kunming, China, were studied. One-way and 2-way ANOVAs were conducted to determine the effects of BMI and sex on BCAAs/AAAs. Fasting serum AAAs, BCAAs, glutamate, and alanine were greater and high-density lipoprotein (HDL) was lower (P < 0.05, each) in OB-T2DM patients than in NW-T2DM patients, especially in male OB-T2DM patients. Arginine, histidine, leucine, methionine, and lysine were greater in male patients than in female patients. Moreover, histidine, alanine, glutamate, lysine, valine, methionine, leucine, isoleucine, tyrosine, phenylalanine, and tryptophan were significantly correlated with abdominal adiposity, body weight and BMI, whereas isoleucine, leucine and phenylalanine were negatively correlated with HDL. Heterogeneously elevated amino acids, especially BCAAs/AAAs, across new-onset T2DM patients in differing BMI categories revealed a potentially skewed prediction of T2DM development. The higher BCAA/AAA levels in obese T2DM patients would support T2DM prediction in obese individuals, whereas the lower levels of BCAAs/AAAs in NW-T2DM individuals may underestimate T2DM risk in NW individuals. This potentially skewed T2DM prediction should be considered when BCAAs/AAAs are to be used as the T2DM predictor.

Comparative analysis of hemodialysis and peritoneal dialysis on the risk of new onset diabetes mellitus

BackgroundDiabetes mellitus is a significant risk factor for cardiovascular events and mortality in dialysis patients. The impact of different dialysis modalities on the risk of new onset diabetes mellitus (NODM) remains a subject of debate. Previous studies did not adequately account for critical confounding factors such as pre-dialysis glycemic status, medication use, and nutritional status, which may influence the association between dialysis modality and NODM risk. MethodsWe conducted a retrospective cohort study of 1426 non-diabetic end-stage renal disease (ESRD) patients who underwent either hemodialysis (HD) or peritoneal dialysis (PD) at a single medical center. We used different statistical methods, adjusting for potential confounding factors, and accounted for competing risk of death. ResultsOver 12 years, 331 patients (23 %) developed NODM. After adjusting for potential confounding factors and mortality, PD patients had a significantly higher risk of NODM compared to HD patients (adjusted HR 1.52, p = 0.001). A propensity-matched cohort sensitivity analysis yielded similar results. Among patients with prediabetes, those receiving PD had a 2.93 times higher risk of developing NODM than those receiving HD (p for interaction <0.001), whereas no significant difference was observed among euglycemic patients. NODM was also associated with a 1.78 times increased risk of major cardiovascular events. ConclusionOur study provides evidence that PD treatment may increase the risk of NODM in ESRD patients, particularly among those with preexisting prediabetes. These findings highlight the importance of personalized treatment approaches, and nephrologists should consider prediabetes when choosing the dialysis modality for their patients.

Analysis of the Association Between Changes in the GGT/HDL-C Ratio and the Risk of Diabetes Mellitus Based on a Latent Class Growth Mixed Modeling: A Longitudinal Cohort Study of Adults in China.

Longitudinal cohort analysis was performed to identify the association between changes in the gamma-glutamyl transferase (GGT)/high-density lipoprotein cholesterol (HDL-C) ratio trajectory and the risk of developing diabetes mellitus. This was a retrospective cohort study. We analyzed the latent trajectory classes of changes in the GGT/HDL-C ratio by applying a latent class mixture model with healthy individuals who underwent medical checkups from January 2017 to December 2021 as the study subjects. To analyze the effect of the GGT/HDL-C ratio trajectory classes on new-onset diabetes mellitus, we then applied a multivariate Cox proportional risk regression model. Statistical analysis was performed using the R-software with the LCMM package. The study cohort comprised 3410 participants. All participants were followed up for 5 years, and 95 developed diabetes (4-year incidence of 2.78%). By applying the latent class mixed model, we categorized participants into three trajectory groups: low-stability group (n = 2253), medium-increase group (n = 941), and high-increase group (n = 216). The Cox proportional risk regression model analysis showed that the hazard ratio (95% confidence interval) for the incidence of diabetes mellitus was 1.73 (1.04-2.87) in the medium-increase group and 3.96 (2.11-7.44) in the high-increase group. Moreover, we calculated the estimated model-based levels and linear slopes of the GGT/HDL-C ratios for each age group between 26 and 85 years at 10-year intervals, respectively. The results indicated the strongest correlation between the GGT/HDL-C ratio slope and diabetes in the 46-55 year age group, with an odds ratio of 1.51 (1.25-1.83). A large increase in the GGT/HDL-C ratio was highly associated with the risk of developing diabetes mellitus. This result suggests that vigilance for changes in the GGT/HDL-C ratio trajectory during community health screening can help identify potential patients with diabetes, enabling early intervention and treatment.

Comparative observational study between Atorvastatin and Rosuvastatin based on HbA1c levels of patients diagnosed with acute coronary syndrome and heart failure

Background: Our study aims to compare HbA1c levels in hospitalized acute coronary syndrome and heart failure patients treated with atorvastatin versus rosuvastatin Methods: This is a retrospective, prospective observational study in which the study population includes ACS and HF Hospitalized patients, the study subjects are divided based on patients prescribed with Atorvastatin and Rosuvastatin based on the medication chart, and those patients' previous history of statin use is collected from history chart, patient case notes, doctors notes, laboratory data is collected and documented in data collection form, lab data includes HbA1c, finally compared Atorvastatin and Rosuvastatin using excel and JASP descriptive analysis. Results: Overall, we collected data for 132 cases, of which 55% are males and 45% females, 59.10% are above 61 years of age, 39.39% are diagnosed with ACS and 23.48% are diagnosed with HF, among 67 patients who are using Atorvastatin, there was a significant mean decrease in HbA1c% from 8.359% to 7.901%, and among 65 Rosuvastatin users there was an increase in mean HbA1c% from 8.386% to 8.389%. Additionally for non-diabetic individuals, there was an increase in Hba1c% from 6.339% to 6.387%. Conclusions: We concluded that Atorvastatin is a more effective statin than Rosuvastatin which will reduce the risk of new-onset Diabetes Mellitus in non- diabetic individuals and reduce the risk of increasing complications of diabetes mellitus in patients who are Diabetic.

Combining bioinformatics and machine learning algorithms to identify and analyze shared biomarkers and pathways in COVID-19 convalescence and diabetes mellitus.

Most patients who had coronavirus disease 2019 (COVID-19) fully recovered, but many others experienced acute sequelae or persistent symptoms. It is possible that acute COVID-19 recovery is just the beginning of a chronic condition. Even after COVID-19 recovery, it may lead to the exacerbation of hyperglycemia process or a new onset of diabetes mellitus (DM). In this study, we used a combination of bioinformatics and machine learning algorithms to investigate shared pathways and biomarkers in DM and COVID-19 convalescence. Gene transcriptome datasets of COVID-19 convalescence and diabetes mellitus from Gene Expression Omnibus (GEO) were integrated using bioinformatics methods and differentially expressed genes (DEGs) were found using the R programme. These genes were also subjected to Gene Ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis to find potential pathways. The hub DEGs genes were then identified by combining protein-protein interaction (PPI) networks and machine learning algorithms. And transcription factors (TFs) and miRNAs were predicted for DM after COVID-19 convalescence. In addition, the inflammatory and immune status of diabetes after COVID-19 convalescence was assessed by single-sample gene set enrichment analysis (ssGSEA). In this study, we developed genetic diagnostic models for 6 core DEGs beteen type 1 DM (T1DM) and COVID-19 convalescence and 2 core DEGs between type 2 DM (T2DM) and COVID-19 convalescence and demonstrated statistically significant differences (p<0.05) and diagnostic validity in the validation set. Analysis of immune cell infiltration suggests that a variety of immune cells may be involved in the development of DM after COVID-19 convalescence. We identified a genetic diagnostic model for COVID-19 convalescence and DM containing 8 core DEGs and constructed a nomogram for the diagnosis of COVID-19 convalescence DM.

Predictive modeling for the development of diabetes mellitus using key factors in various machine learning approaches

AimsMachine learning (ML) approaches are beneficial when automatic identification of relevant features among numerous candidates is desired. We investigated the predictive ability of several ML models for new onset of diabetes mellitus. MethodsIn 10,248 subjects who received annual health examinations, 58 candidates including fatty liver index (FLI), which is calculated by using waist circumference, body mass index and levels of triglycerides and γ-glutamyl transferase, were used. ResultsDuring a 10-year follow-up period (mean period: 6.9 years), 322 subjects (6.5 %) in the training group (70 %, n=7,173) and 127 subjects (6.2 %) in the test group (30 %, n=3,075) had new onset of diabetes mellitus. Hemoglobin A1c, fasting glucose and FLI were identified as the top 3 predictors by random forest feature selection with 10-fold cross-validation. When hemoglobin A1c and FLI were used as the selected features, C-statistics analogous in receiver operating characteristic curve analysis in ML models including logistic regression, naïve Bayes, extreme gradient boosting and artificial neural network were 0.874, 0.869, 0.856 and 0.869, respectively. There was no significant difference in the discriminatory capacity among the ML models. ConclusionsML models incorporating hemoglobin A1c and FLI provide an accurate and straightforward approach for predicting the development of diabetes mellitus.

Association of bariatric surgery with indicated and unintended outcomes: An umbrella review and meta-analysis for risk-benefit assessment.

Bariatric surgery can cause numerous functional changes to recipients, some of which are unintended. However, a systematic evaluation of wide-angled health benefits and risks following bariatric surgery has not been conducted. We systematically evaluated published systematic reviews of randomized controlled trials and observational studies reporting the association between bariatric surgery and health outcomes. We performed subgroup analyses by surgery type and sensitivity analysis, excluding gastric band. Thirty systematic reviews and 82 meta-analyzed health outcomes were included in this review. A total of 66 (80%) health outcomes were significantly associated with bariatric surgery, of which 10 were adverse outcomes, including suicide, fracture, gastroesophageal reflux after sleeve gastrectomy, and neonatal morbidities. The other 56 outcomes were health benefits including new-onset diabetes mellitus (DM) (odds ratio [OR] =0.39; 95% confidence interval [CI] =0.19-0.79), hypertension (OR =0.36; 95% CI =0.33-0.40), dyslipidemia (OR =0.33; 95% CI =0.14-0.81), cancers (OR =0.65; 95% CI =0.53-0.80), cardiovascular diseases (CVDs), and women's health. Surgery is associated with reductions in all-cause mortality and death due to cancer, DM, and CVD. Bariatric surgery has both beneficial and harmful effects on a broader than expected array of patients' health outcomes. An expansion of the indication for bariatric surgery could be discussed to include a broader population with metabolic vulnerabilities.

A novel clinical model for risk prediction and stratification of new-onset diabetes mellitus after distal pancreatectomy.

The incidence of new-onset diabetes mellitus (NODM) after distal pancreatectomy (DP) remains high. Few studies have focused on NODM in patients with pancreatic benign or low-grade malignant lesions (PBLML). This study aimed to develop and validate an effective clinical model for risk prediction and stratification of NODM after DP in patients with PBLML. A follow-up survey was conducted to investigate NODM in patients without preoperative DM who underwent DP. Four hundred and forty-eight patients from Peking Union Medical College Hospital (PUMCH) and 178 from Guangdong Provincial People's Hospital (GDPH) met the inclusion criteria. They constituted the training cohort and the validation cohort, respectively. Univariate and multivariate Cox regression, as well as least absolute shrinkage and selection operator (LASSO) analyses, were used to identify the independent risk factors. The nomogram was constructed and verified. Concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis (DCA) were applied to assess its predictive performance and clinical utility. Accordingly, the optimal cut-off point was determined by maximally selected rank statistics method, and the cumulative risk curves for the high- and low-risk populations were plotted to evaluate the discrimination ability of the nomogram. The median follow-up duration was 42.8 months in the PUMCH cohort and 42.9 months in the GDPH cohort. The postoperative cumulative 5-year incidences of DM were 29.1% and 22.1%, respectively. Age, body mass index (BMI), length of pancreatic resection, intraoperative blood loss, and concomitant splenectomy were significant risk factors. The nomogram demonstrated significant predictive utility for post-pancreatectomy DM. The C-indexes of the nomogram were 0.739 and 0.719 in the training and validation cohorts, respectively. ROC curves demonstrated the predictive accuracy of the nomogram, and the calibration curves revealed that prediction results were in general agreement with the actual results. The considerable clinical applicability of the nomogram was certified by DCA. The optimal cut-off point for risk prediction value was 2.88, and the cumulative risk curves of each cohort showed significant differences between the high- and low-risk groups. The nomogram could predict and identify the NODM risk population, and provide guidance to physicians in monitoring and controlling blood glucose levels in PBLML patients after DP.

Beyond Immunosuppression: The Intricate Relationship Between Tacrolimus and Microangiopathy.

Tacrolimus, widely known as Prograf, has become the preferred immunosuppressant for preventing graft rejection in solid organ transplant recipients, particularly in steroid-sparing regimens. Its efficacy and reduced risk of acute and chronic rejection compared to cyclosporine have made it the preferred treatment optionfor transplant patients. However, tacrolimus has drawbacks as it is associated with adverse effects, such as renal tubular necrosis, kidney failure, hypertension, metabolic acidosis, and new-onset diabetes mellitus. Among the less common but potentially severe complications is thrombotic microangiopathy linked to tacrolimus usage. Identifying and addressing this condition early on is crucial given its severity and potential complications. Manifestations of this microangiopathy can vary, encompassing renal, neurological, cardiac, and respiratory symptoms, and, in some cases, presenting as pancreatitis, intestinal ischemia, or skin abnormalities. Although conventional management often involves plasma exchange as the primary therapeutic option, recent insights into the pathophysiology have led to newer drugs, such as eculizumab and belatacept, offering promising outcomes. In this narrative review, we delve deeper into the underlying pathophysiological mechanisms of tacrolimus-induced thrombotic microangiopathy and aim to provide clinicians with valuable recommendations for efficient and timely treatment strategies. By understanding the complexities of this condition and staying abreast of the latest advancements in therapeutic options, healthcare providers can optimize patient outcomes and ensure safer tacrolimus administration in solid organ transplant recipients.

Impact of Direct Endoscopic Necrosectomy on Recurrence of Symptoms or Fluid Collections Following Successful Endoscopic Transmural Drainage of Walled-off Necrosis in Disconnected Pancreatic Duct

Abstract Background The impact of direct endoscopic necrosectomy (DEN) on risk of recurrence of symptoms or pancreatic fluid collections (PFCs) in patients with disconnected pancreatic duct (DPD) has not been previously evaluated. Objective To compare the risk of recurrence of PFC in patients with walled-off necrosis (WON) and DPD undergoing DEN with that of not requiring DEN and not having permanent indwelling plastic stents. Methods Retrospective analysis of database of patients with WON successfully treated with transmural metal stents over the past 5 years was done to identify patients with DPD and not having permanent indwelling transmural stents. These patients were divided into two groups: Group A: patients undergoing DEN and Group B: patients not requiring DEN. Results Seventeen patients required DEN (Group A; mean age 37.8 years) and 21 patients were successfully treated without DEN (Group B; mean age: 37.7 years). In Group A, none of the patients developed either recurrence of symptoms or PFC over a mean follow-up period of 7 months. In Group B, 5 of 21 (23.8%) patients developed either recurrence of pain (n = 2) or PFC (n = 3) over a mean follow-up period of 22 months. New-onset diabetes mellitus developed in five (29%) patients in Group A and two (9%) patients in Group B. None of the patients in either group developed steatorrhea. Conclusion Patients with WON and DPD treated with lumen apposing metal stent and requiring DEN seem to be having low risk of developing recurrence of pain or PFC.

New-onset diabetes mellitus after transplantation in patient undergoing a second kidney transplantation

New-onset diabetes mellitus after transplantation in patient undergoing a second kidney transplantation

Effect of exercise in incident atrial fibrillation among diabetes mellitus with different diabetes duration

Abstract Background/Introduction In previous studies, level of exercise and AF risk seems to have nonlinear relationship. Vigorous physical activities have been considered as a risk factor of atrial fibrillation (AF). However, other studies have shown regular exercise to be associated with reduced incidence, symptoms, recurrence, and burden of AF. Conversely, a sedentary lifestyle is an important risk factor for the development of AF. Currently, the effect of exercise amount on the risk of AF among patients with diabetes mellitus (DM) according to diabetes duration has not been examined. Purpose This study aimed to evaluate the effect of exercise amount on incident AF among patients with DM using a nationwide population cohort. Methods The subjects with type 2 DM who underwent the Korean National Health Insurance Service health examination during 2015 and 2016 were identified. The study population was divided into four groups according to DM duration (new onset, less than 5 years, 5 to 10 years, and more than 10 years). Also, they were categorized into four groups according to the amount of exercise (0, &amp;lt;500, 500 to 1000, 1000-1500, and ≥1500 METs-Min per week). The study outcome was incident AF. Results A total of 2,392,486 subjects with a mean follow-up duration of 3.9 ± 0.9 years were enrolled (mean age 59.3 ± 12.0, female 39.8%). The mean DM duration was 5.3 ± 5.1 years, and the mean exercise amount was 643.0 ± 638.0 METs-min/week. 704,732 subjects were new-onset DM, 649,811 subjects had less than 5 years of DM duration, 464,870 subjects had DM duration between 5 to 10 years, and 573,073 subjects had more than 10 years of DM. As the DM duration became longer, age, the prevalence of comorbidities (hypertension, chronic kidney disease, chronic heart failure, prior myocardial infarction, prior stroke, and prior peripheral artery disease), the prevalence of more than three oral anti-diabetes medications, and insulin usage increased sequentially (all p&amp;lt;0.0001). In each DM duration group, the exercise amount of AF risk showed slightly different relationship. The new-onset DM group and DM duration 5 to 10 years groups showed the most reduced AF risk in exercise amounts 1000 -1500 METs-Min/week (adjusted hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.82-0.96 p=0.0016 and adjusted HR 0.83, 95% CI 0.77-0.89, p=0.0098, respectively). The DM duration less than 5 years and more than 10 years groups both showed the lowest risk in exercise ≥1500 METs-Min/week (adjusted HR 0.91, 95% CI 0.85-0.97; adjusted HR 0.85, 95% CI 0.81-0.90, both p&amp;lt;0.001). Conclusions Regular exercise of more than ≥1500 METs-Min/week did not increase the risk of AF risk in DM patients. It was associated with reduced AF risk in all DM patients except new-onset DM. Further study is needed to assess the biophysiological change regarding DM duration that could affect the AF risk.

Association of dietary salt intake with diabetes mellitus in the Japanese general population

Abstract Background/Introduction Excess salt intake, one of the most important modifiable factors in our lifestyle, has been reported to be a risk of cardiovascular morbidity and mortality. Several mechanisms underlying the development of cardiovascular disease after excess salt intake are proposed, among which hypertension has been established. Diabetes mellitus (DM) is also a risk factor of cardiovascular disease and, thus, there may be some association between excess salt intake and DM. Purpose The present study was designed to investigate possible relationship between dietary salt intake and DM in the general population. Methods Dietary salt intake was estimated using a spot urine sample in 16018 subjects (male=9642, 52.0±12.3 year-old) who visited our hospital for a yearly physical checkup from July 2008 to March 2019 (baseline). A cross-sectional analysis for the relationship between salt intake and DM was performed at baseline. Then, subjects without DM (n=14715, male=8651, 51.3±12.3 year-old) were followed up until March 2020 (median 2107 days) with the endpoint being the development of DM. DM was defined as fasting plasma glucose (FPG) ≥126mg/dL, HbA1c≥6.5% or the use of antidiabetic medications. Results A cross-sectional analysis revealed that salt intake in subjects was 8.67±1.98 g/day. Salt intake was significantly higher in subjects with (n=1280) than without DM (9.55±2.17 vs. 8.61±1.94 g/day). Multivariate regression analysis adjusted for age, gender, body weight, systolic blood pressure, pulse rate, serum creatinine, uric acid, FPG, LDL-cholesterol, triglyceride, current smoking and frequent alcohol drink showed that salt intake was associated with the presence of DM (r=0.027, p&amp;lt;0.001). In the follow-up study, 861 subjects developed DM (10.1 per 1000 person-year), with the incidence being more frequent in males than in females (11.7 vs. 7.6 per 1,000 person-year). The incidence of DM was increased across the quartiles of salt intake at baseline (7.5, 7.6, 10.5 and 14.8 per 1000 person-year). In analysis where salt intake at baseline was taken as continuous variables, non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of salt intake for the new onset of DM was 1.146 (1.109-1.184). Multivariate Cox-hazard analysis adjusted for possible risk factors showed that salt intake was a significant predictor for the future development of DM (HR: 1.037, 95%CI: 1.001-1.073), while additional adjustment for baseline body weight disappeared the statistical significance (HR: 0.994, 95%CI: 0.958-1.031). Conclusions Salt intake is associated with the development of DM and excess salt intake may predict future development of DM in the general population. Excess food intake which is usually accompanied by excess salt intake in individuals with increased body weight may be responsible for the development of DM. Maintenance of appropriate body weight as well as restriction of dietary salt may lead to the prevention from developing DM.

Abstract 14572: Polypharmacy and Major Adverse Events in Atrial Fibrillation: Observations From the Korea National Health Insurance Service Data

Introduction: Previous evidence suggests that atrial fibrillation (AF) patients who receive polypharmacy are at an increased risk of experiencing adverse events. In this study, we investigated the prevalence of polypharmacy, identified risk factors associated with polypharmacy, and assessed the impact of polypharmacy on clinical outcomes in a ‘real-world’ data. Methods: We included 451,368 participants without AF (54[48.0-63.0] years; 207,748[46.0%] female) in the Korea National Health Insurance Service-Health Screening (NHIS-HealS) cohort from 2002 to 2013. All concomitant drugs were carefully collected and recorded. Polypharmacy was defined as the intake of ≥5 concomitant drugs. All-cause death, ischemic strokes/transient ischemic attacks (TIAs), major bleeding, heart failure admission were recorded. Results: With up to 7.7 (6.8-8.3) years of follow-up and 768,306 person-years, 12,241 incident AF cases occurred. Among included AF patients (40.0% females, 63.0[54.0-70.0] years), the prevalence of polypharmacy was 30.9 % (3,784). In new-onset AF, older age (per 10 increases, OR 1.32, 95% CI 1.26-1.40), hypertension (OR 4.00, 95 % CI 3.62-4.43), diabetes mellitus (OR 3.25, 95 % CI 2.86-3.70), COPD (OR 3.00, 95% CI 2.51-3.57), ischemic stroke/TIA (OR 2.36, 95% CI 2.03-2.73), dementia (OR 2.30, 95% CI 1.06-4.98), ESRD or CKD (OR 1.97, 95% CI 1.38-2.82), and heart failure (OR 1.95, 95% CI 1.69-2.26) were independently associated to the polypharmacy. Patients with polypharmacy showed significantly higher incidence and risk of major bleeding (aHR 1.26, 95% CI 1.12-1.41). All-cause mortality showed higher incidence, the risk was higher but not statistically significant (aHR 1.11, 95 % CI 0.99-1.24). The risks of stroke and heart failure admission were not changed by polypharmacy. Conclusions: In this “real world” nationwide AF cohort, polypharmacy was highly prevalent and conditioned worse prognosis due to its association with major bleeding events.

Abstract 12489: Sex Differences in Incidence and Outcomes of Patients With New-Onset Post-Transplant Diabetes Mellitus After Heart Transplantation

Introduction: Post-transplant diabetes mellitus (PTDM) is a common complication following heart transplantation (HT), mostly commonly occurring in the first year after transplant. A few risk factors for the development of PTDM have been identified, including immunosuppressive medications such as calcineurin inhibitors and glucocorticoids. Some studies have suggested that among HT recipients, women have higher rates of acute rejection which may necessitate higher doses of steroids and further hyperglycemia. However, differences between sexes in the incidence of PTDM after HT have not been established. Methods: A retrospective review of patients who underwent HT at a large-volume center between January 1, 2010 and December 31, 2019 was performed. Patients undergoing re-transplantation or dual-organ transplantation were excluded. PTDM was defined as hemoglobin A1C≥6.5% or a random glucose &gt;200 after HT among patients with no prior history of DM. Predictors of PTDM by sex were analyzed with logistic regression, and post-transplant outcomes were analyzed with Chi-Square analysis. Results: Among 317 transplant patients without pre-transplant DM, 71 (22.4%) patients were identified who had PTDM: 24 females (33.7%), 47 males (66.2%). There were no statistically significant differences in baseline characteristics between males and females who developed PTDM including age, race, pre-transplant HTN, calcineurin or steroid dosing at 1 month and 1 year post-transplant. Baseline HTN (OR 2.9, [1.3, 6.7], p=0.009) and mean steroid dose over the first 2 years post-transplant (OR 1.2, [1.0, 1.3], p=0.006) were predictors of PTDM in females but not in males, and mean tacrolimus dose was a predictor in males (OR 1.1, [1.0, 1.2], p=0.001) but not in females. Time to PTDM diagnosis did not differ by sex (log-rank p=0.56). Additionally, post-transplant outcomes in patients with PTDM including acute cellular rejection, antibody-mediated rejection, coronary allograft vasculopathy and death did not differ by sex. Conclusion: PTDM is a common complication of HT. Our study suggests that risk factors for PTDM among HT recipients differ by sex. Future studies should investigate the mechanisms underlying these differences to further guide sex-specific post-HT care.

Real-World Effectiveness of Statin Therapy in Adult Asthma

Blood lipids affect airway inflammation in asthma. Although several studies have suggested anti-inflammatory effects of statins on asthmatic airways, further studies are needed to clarify the long-term effectiveness of statins on asthma control and whether they are an effective treatment option. To evaluate the long-term effectiveness of statins in the chronic management of adult asthma in real-world practice. Electronic medical record data spanning 28 years, collected from the Ajou University Medical Center in Korea, were used to conduct a retrospective study. Clinical outcomes were compared between patients with asthma who had maintained statin use (the statin group) and those not taking statins, whose blood lipid tests were always normal (the non-statin group). We performed propensity score matching and calculated hazard ratios with 95% CIs using the Cox proportional hazards model. Severe asthma exacerbation was the primary outcome; asthma exacerbation, asthma-related hospitalization, and new-onset type 2 diabetes mellitus and hypertension were secondary outcomes. After 1:1 propensity score matching, the statin and non-statin groups each included 545 adult patients with asthma. The risk of severe asthma exacerbations and asthma exacerbations was significantly lower in the statin group than in the non-statin group (hazard ratios [95% CI]= 0.57 [0.35-0.90] and 0.71 [0.52-0.96], respectively). There were no significant differences in the risk of asthma-related hospitalization or new-onset type 2 diabetes mellitus or hypertension between groups (0.76 [0.53-1.09], 2.33 [0.94-6.59], and 1.71 [0.95-3.17], respectively). Statin use is associated with a lower risk of asthma exacerbation, with better clinical outcomes in adult asthma.

COVID-19 Vaccination Prior to SARS-CoV-2 Infection Reduced Risk of Subsequent Diabetes Mellitus: A Real-World Investigation Using U.S. Electronic Health Records.

Previous studies have indicated a bidirectional correlation between diabetes and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, no investigation has comprehensively explored the potential of coronavirus disease 2019 (COVID-19) vaccination to reduce the risk of new-onset diabetes in infected individuals. In the first of 2 cohorts, we compared the risk of new-onset diabetes between individuals infected with SARS-CoV-2 and noninfected individuals (N = 1,562,606) using the TriNetX database to validate findings in prior literature. For the second cohort, we identified 83,829 vaccinated and 83,829 unvaccinated COVID-19 survivors from the same period. Diabetes, antihyperglycemic drug use, and a composite of both were defined as outcomes. We conducted Cox proportional hazard regression analysis for the estimation of hazard ratios (HRs) and 95% CIs. Kaplan-Meier analysis was conducted to calculate the incidence of new-onset diabetes. Subgroup analyses based on age (18-44, 45-64, ≥65 years), sex (female, male), race (White, Black or African American, Asian), and BMI categories (<19.9, 20-29, 30-39, ≥40), sensitivities analyses, and a dose-response analysis were conducted to validate the findings. The initial cohort of patients infected with SARS-CoV-2 had a 65% increased risk (HR 1.65; 95% CI 1.62-1.68) of developing new-onset diabetes relative to noninfected individuals. In the second cohort, we observed that vaccinated patients had a 21% lower risk of developing new-onset diabetes in comparison with unvaccinated COVID-19 survivors (HR 0.79; 95% CI 0.73-0.86). Subgroup analyses by sex, age, race, and BMI yielded similar results. These findings were consistent in sensitivity analyses and cross-validation with an independent data set from TriNetX. In conclusion, this study validates a 65% higher risk of new-onset diabetes in SARS-CoV-2-infected individuals compared to noninfected counterparts. Furthermore, COVID-19 survivors who received COVID-19 vaccinations experienced a reduced risk of new-onset diabetes, with a dose-dependent effect. Notably, the protective impact of COVID-19 vaccination is more pronounced among the Black/African American population than other ethnic groups. These findings emphasize the imperative of widespread vaccination to mitigate diabetes risk and the need for tailored strategies for diverse demographic groups to ensure equitable protection.

COVID-19 Infection and Diabetes

Abstract Background Hyperglycemia is one of the most important independent risk factors that affect the prognosis and outcome of COVID-19 patients. Coronavirus disease 2019 infection is associated with poor glycemic control. This study's objectives were to determine the effect of hyperglycemia on the prognosis and outcome of COVID-19 patients and to detect whether COVID-19 infection can induce new-onset diabetes. Patients and Methods This cohort study was carried out on 240 hospitalized Egyptian COVID-19 patients, at Zagazig University Hospital isolation intensive care unit, between March 2020 and March 2021. They compared patients with diabetes and uncontrolled hyperglycemia against each other and COVID-19 patients without diabetes or uncontrolled hyperglycemia. Baseline demographic data, clinical features, and laboratory analysis were collected. Clinical outcome was evaluated via hospital stay and survival rate. Patients with uncontrolled hyperglycemia and nondiabetic patients were followed up 1 year after the hospital discharge to detect the development of new-onset diabetes. Result The diabetic group had the highest creatinine level, and the nondiabetic group had a minor C-reactive protein and D-dimer. The difference is significant between diabetic and nondiabetic groups concerning hospital stay. The nondiabetic group had the shortest hospital stay. There is a statistically substantial relationship between mortality and the glycosylated hemoglobin, serum creatinine, C-reactive protein, D-dimer, and serum ferritin. A total of 46.6% of survivors in the uncontrolled hyperglycemic group and 3.4% in the nondiabetic group developed diabetes mellitus during follow-up. There is a statistically significant relationship between new-onset diabetes mellitus and D-dimer. Conclusions Coronavirus disease 2019 can induce diabetes mellitus in vulnerable patients (presented with uncontrolled hyperglycemia at admission). In addition, COVID-19 patients with diabetes or uncontrolled hyperglycemia have worse outcomes and poor prognoses.

Colchicine and diabetes in patients with chronic coronary artery disease: insights from the LoDoCo2 randomized controlled trial.

Despite optimal treatment, patients with chronic coronary artery disease (CAD) and diabetes mellitus (DM) are at high risk of cardiovascular events, emphasizing the need for new treatment options. The Low-Dose Colchicine 2 (LoDoCo2) trial demonstrated that colchicine reduces cardiovascular risk in patients with chronic CAD. This analysis determines the efficacy of colchicine in patients with chronic CAD and DM as well as the effect of colchicine on the development of new-onset type 2 diabetes mellitus (T2DM). The LoDoCo2 trial randomized 5,522 patients to placebo or colchicine 0.5 mg once daily, with a median follow-up of 28.6 months. The primary composite endpoint was cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven revascularization. The effect of its treatment in patients with and without DM was evaluated by including an interaction term in the model. A total of 1,007 participants (18.2%) had T2DM at baseline. The adjusted hazard ratio (HR) [(95% confidence interval (CI)] for the primary endpoint in the T2DM group was 1.52 (1.15-2.01, p < 0.01) compared with the group without T2DM. The HR for the treatment effect on the primary endpoint was 0.87 (0.61-1.25) in participants with T2DM and 0.64 (0.51-0.80) in participants without diabetes (pinteraction = 0.14). The incidence of new-onset T2DM was 1.5% (34 out of 2,270) in the colchicine group and 2.2% (49 out of 2,245) in the placebo group (p = 0.10). In conclusion, based on the current evidence, the beneficial effects of colchicine on cardiovascular endpoints are consistent regardless of DM status. The potential benefits of colchicine in preventing new-onset DM need further investigation. These findings are only hypothesis-generating and require larger prospective trials to confirm the results.

FRI592 Pediatric Diabetes Mellitus And The COVID-19 Pandemic

Abstract Disclosure: F.I. Cooper: None. A. Thokalath: None. S. Chalise: None. N. Vyas: None. S. Gurnurkar: None. Introduction: Evidence suggests that during the COVID-19 pandemic, adults had delayed detection of diabetes mellitus (DM) and its complications as well as an increase in the severity of DM symptoms. Our retrospective study aimed to determine the difference in prevalence of new onset DM and to compare the severity of diabetic ketoacidosis (DKA) in these children prior to and during the COVID-19 pandemic at Nemours Children’s Health in Orlando, FL. Methods: Chart review was performed on children with new onset DM (type 1 and 2) pre-pandemic and during the pandemic (9/1/2017-9/1/2022). 509 participants met inclusion criteria. Demographic information and laboratory data were collected. One sample proportions test was used to compare the proportion of new onset DM diagnoses and severity of presentation. Chi square test was used to test association of demographics with DM onset and DKA status. Statistical significance was set at p&amp;lt;0.05 and all analyses were run on IBM SPSS 28.0. Results: A greater number of pediatric DM diagnoses were made during the COVID-19 pandemic when compared to pre-pandemic [295 vs 214 (p&amp;lt;0.001)]. More patients presented in DKA at initial diagnosis during the pandemic compared to pre-pandemic (52% vs 48%, p=0.046). There was no significant difference in DKA severity between the pre-pandemic and pandemic groups (p=0.179). There was a significant difference in the average Hemoglobin A1C at diagnosis between COVID-19 unknown and COVID-19 negative group (12% vs. 10.6%, p&amp;lt;0.05). Conclusion: Our study found that more children were diagnosed with DM during the COVID-19 pandemic compared to an equal length of time pre-pandemic. We also found that the prevalence of DKA among those with new-onset DM was higher during the pandemic period. It is speculated that SARS-CoV-2 can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells. Additional studies are needed to investigate this mechanism specifically among children with new onset DM. Presentation: Friday, June 16, 2023