Nondiabetic Subjects Research Articles

The ENPP1 K121Q polymorphism is associated with obesity-related parameters in Iranian normoglycemic male subjects

Objectives: The K121Q polymorphism of the Ectoenzyme Nucleotide Pyrophosphate Phosphodiesterase 1 (ENPP1) gene has been variably associated with obesity in several populations. However, this association has not been studied in Iranian subjects. It was hypothesized that the K121Q variant might be associated with obesity and related risk factors in subjects with normal glucose tolerance and normal fasting glucose.
 Methods: The K121Q genotypes were determined by PCR-restriction fragment length polymorphism in 377 non-diabetic subjects.
 Results: In males, the frequency of the Q allele was 20.8% and 15.9% (p=0.269) in obese and non-obese subjects, respectively. The ENPP1 genotype (KQ+QQ) was not associated with systolic and diastolic blood pressure, triglyceride, cholesterol, LDL-C, HDL-C, HOMA-IR, or insulin levels in both genders. Male carriers of the KQ+QQ genotype had significantly higher values for BMI (p=0.079), waist (p=0.01), and WHR (p=0.006) than subjects with the KK genotype. Obesity-related parameters were not significantly different between obese and non-obese female subjects.
 Conclusion: Our results suggest that the ENPP1 121Q allele might be associated with obesity and related parameters only among Iranian normoglycemic male subjects.

Salivary and crevicular fluid proinflammatory cytokines and advanced glycation end products in patients with different glycemic levels undergoing fixed orthodontic treatment.

To examine whether patients with different blood glycemic levels undergoing fixed orthodontic therapy demonstrate changes in the biochemical profiles of crevicular fluid and salivary advanced glycation end products (AGEs) and proinflammatory cytokine levels in comparison with nondiabetic healthy subjects. Prediabetic subjects, subjects with type 2 diabetes mellitus (T2DM), and subjects without a diabetes mellitus diagnosis undergoing fixed orthodontic therapy with MBT prescription brackets (0.022-inch brackets and 0.019 × 0.025-inch stainless steel archwires) were included in the study. The following clinical periodontal parameters were evaluated: (1) plaque score (PS), (2) probing depth (PD), (3) bleeding on probing (BOP), and (4) clinical attachment loss. Crevicular fluid and saliva specimens were collected during regular orthodontic visits. Salivary and crevicular fluid tumor necrosis factor alpha, interleukin-6, ghrelin, resistin, AGEs, and receptor activator of nuclear factor κΒ ligand were evaluated using a human magnetic Luminex multiplex assay. BOP scores were significantly higher among T2DM subjects (19.2%) than among nondiabetic subjects (11.2%) and prediabetic subjects (15.9%). Comparable values were demonstrated by all three study groups regarding PD scores and PSs. T2DM subjects demonstrated higher scores for gingival crevicular fluid (GCF) chemokines than nondiabetic and prediabetic subjects. A statistically significant difference was found in the levels of AGEs and resistin among the three study groups. The scores revealed for the levels of GCF resistin and AGEs versus periodontal BOP demonstrated a significant positive association by the Pearson correlation test. T2DM patients demonstrated significantly higher levels of GCF resistin and AGEs during fixed orthodontic therapy. Chronic hyperglycemic patients undergoing orthodontic therapy demonstrated a proinflammatory response.

Immunological Quantitation of the Glycation Site Lysine-414 in Serum Albumin in Human Plasma Samples by Indirect ELISA Using Highly Specific Monoclonal Antibodies.

Diabetes mellitus, a metabolic disorder that is characterized by elevated blood glucose levels, is common throughout the world and its prevalence is steadily increasing. Early diagnosis and treatment are important to prevent acute complications and life-threatening long-term organ damage. Glycation sites in human serum albumin (HSA) are considered to be promising biomarkers of systemic glycemic status. This work aimed to develop a sensitive and clinically applicable ELISA for the quantification of glycation site Lys414 in HSA (HSAK414 ). The monoclonal antibodies (mAbs) were generated by immunizing mice with a glycated peptide. The established indirect ELISA based on mAb 50D8 (IgG1 isotype) yielded a limit of detection of 0.39 nmol/g HSA for HSAK414 with a linear dynamic range from 0.50 to 6.25 nmol/g glycated HSA. The inter- and intra-day assays with coefficients of variation less than 20 % indicated good assay performance and precision. Assay evaluation was based on plasma samples from diabetic and non-diabetic subjects with known HSAK414 glycation levels previously determined by LC-MS. Both data sets correlated very well. In conclusion, the generated mAb 50D8 and the established ELISA could be a valuable tool for the rapid quantitation of glycation site HSAK414 in plasma samples to evaluate its clinical relevance.

Abstract 11795: CXCL5 Inhibition Recovers Neovascularization in Diabetes Mellitus

Introduction: Diabetes mellitus (DM) is a chronic inflammatory disease accompanied by dysfunction of vascular endothelial cells. Vascular complications are the main causes of death in patients with DM. CXCL5 is an inflammatory chemokine that upregulated in patients with type 2 DM. However, its role in diabetic vasculopathy was not clarified. This study aimed to explore the impacts and mechanistic insights of CXCL5 in neovasculogenesis in DM. Methods: Endothelial progenitor cells (EPCs) and human aortic endothelial cells (HAECs) were used in vitro. Streptozotocin-induced diabetic mice and dbdb mice were used as type 1 and type 2 DM models. CXCL5 knockout mice were also used to generate the diabetic animal model. The hindlimb ischemia surgery, matrigel plug assay, and aortic ring assay were conducted. Flow cytometry were used to evaluate the circulating number of EPCs. Results: CXCL5 concentrations were increased in plasma and EPCs culture medium from type 2 DM patients. CXCL5 inhibition by neutralizing antibody upregulated VEGF/SDF-1 expression and improved migration and tube formation abilities in EPCs from type 2 DM patients and high glucose-treated EPCs from non-diabetic subjects as well as HAECs. Intraperitoneal injection of CXCL5 neutralizing antibody increased circulating EPC number, enhanced capillary density, and recovered the blood flow after hindlimb ischemia surgery in both type 1 and type 2 diabetic animals. Protein levels of VEGF and SDF-1 in ischemic muscle were upregulated in the CXCL5 inhibition group. Additionally, diabetic mice injected with CXCL5 neutralizing antibody showed higher hemoglobin contents and neovascular branches in the matrigel plug assay and aortic ring assay, respectively. Importantly, CXCL5 knockout diabetic mice showed improved ischemia-induced angiogenesis and higher expression of angiogenic proteins in ischemic muscle compared with wild-type diabetic mice. Conclusion: CXCL5 inhibition can improve neovasculogenesis via protecting vascular endothelial function and upregulating angiogenic protein expressions in both type 1 and type 2 DM. Further clinical studies are needed to verify that CXCL5 may be a potential therapeutic target for DM vascular complications.

Abstract 12258: Ceramides Predict the Development of Type 2 Diabetes

Introduction: Ceramides recently have attracted interest as a marker of cardiovascular event risk. Hypothesis: We hypothesize that they play a role in the development of type 2 diabetes (T2DM). Methods: We analyzed the ceramide ratio Cer d18:18/Cer d 18:24:0 (CerRatio) in 894 consecutive Caucasian patients who were referred to angiography for the evaluation of established or suspected stable coronary artery disease (CAD). T2DM was diagnosed according to ADA criteria. The incidence of T2DM was recorded over a follow-up time of up to 16 years (median: 13 [8-14] years). Results: At baseline, the CerRatio was significantly higher in T2DM (n=239) than in non-diabetic patients (4.6e-2 vs. 3.9e-2, p<0.001). During follow-up, diabetes was newly diagnosed in 71 patients, i.e. in 11% of the initially non-diabetic subjects. The CerRatio strongly predicted the incidence of T2DM both univariately (standardized OR 1.47 [1.11-1.96]; p=0.008) and in a multivariately adjusted model (figure) comprising age, sex, BMI, the presence of significant CAD at angiography, and hemoglobin A1c (HbA1c; OR=1.45 [1.07-1.98]; p=0.018). Though the CerRatio was significantly correlated with BMI (r=0.138, p<0.001) and HbA1c (r=0.137, p<0.001), applying a mediation analysis revealed that BMI and HbA1c had only marginal indirect effects (5,7% and 3.6%, respectively) on the association of the CerRatio with T2DM incidence. Conclusions: We conclude that ceramides strongly and independently predict the development of diabetes.

Impact of diabetes mellitus on the frequency of post-operative complications after carotid endarterectomy.

There is significant controversy surrounding the link between diabetes mellitus and post-operative complications after carotid endarterectomy (CEA). The aim of this study was to identify the possible effects of diabetes on the frequency of post-operative complications after CEA. This prospective study was conducted at the Dedinje Clinic for Vascular Surgery, Belgrade. The patients who underwent CEA were divided into two groups: group A (37.7%) included 98 (35.1%) insulin-dependent and 181 (64.9%) insulin-independent diabetic patients, and group B (62.3%) comprised non-diabetic subjects. The pre-operative characteristics were similar, except for a greater prevalence of dyslipidaemia in patients with diabetes. Post-operative cardiac events occurred more often in patients with diabetes (3.6%) than in non-diabetic patients (1.1%) (p = 0.039); post-operative neurological events among patients with diabetes were 3.6% and among non-diabetics, 0.9% (p = 0.009). Peri-operative mortality rate was 2.5% in the diabetic group and 0.9% in the non-diabetic group. The total percentage of post-operative complications was two or more times higher in the diabetic group than the non-diabetic group (8.5 vs 18.3%, p < 0.001). Diabetes mellitus increased the surgical risk of CEA. Higher rates of mortality and post-operative complications were observed in patients being treated with oral antidiabetics than in those on insulin.

Correlation of Lipid Profile and Apolipoprotein B/A-I Ratio with Insulin Resistance in Non-Diabetes Mellitus Subjects

Obesity is defined as an increase in total body mass due to excess fat, as measured by the body mass index. Obesity affects metabolism through factors such as insulin resistance, which triggers the development of chronic diseases. Lipid and ApoB/ApoA-I ratios can be considered additional assessments, especially in patients at high risk of cardiovascular diseases such as diabetes. This study aims to determine the relationship between lipid and ApoB/ApoA-I ratios with Homa-IR in in non-diabetes mellitus adult subjects. The method used in this study was a cross-sectional study involving a total of 80 non-diabetic adult subjects, consisting of 38 male and 42 female subjects. The results showed that there were significant differences between the ratios of CHOL/HDL, TG/HDL, ApoB/ApoA-I, and HOMA-IR in non-obese and obese non-DM adult subjects (4.64 ± 2.18 vs 5.23 ± 1.87, p = 0.045; 2.38 ± 1.20 vs. 3.18±1.77, p=0.013;0.58±0.17 vs. 0.66±0.17, p=0.035 and 1.47±0.80 vs. 3.34±4.37, p = 0.000), and there was no significant difference between LDL/HDL (p = 0.117). The correlation test results between the ratios of CHOL/HDL to HOMA-IR, LDL/HDL to HOMA-IR, TG/HDL to HOMA-IR, and ApoB/ApoA-I to HOMA-IR in non-DM adult subjects (p=0.05, r=0.308; p=0.037, r=0.233; p=0.000, r=0.402; p=0.19, r=0.261). This study concluded that there was a significant correlation between lipid and ApoB/ApoA-I ratios with Homa-IR in non-diabetes mellitus adult subjects.

Native low-density lipoproteins are priming signals of the NLRP3 inflammasome/interleukin-1β pathway in human adipose tissue and macrophages

Elevated plasma numbers of atherogenic apoB-lipoproteins (apoB), mostly as low-density lipoproteins (LDL), predict diabetes risk by unclear mechanisms. Upregulation of the NLRP3 inflammasome/interleukin-1 beta (IL-1β) system in white adipose tissue (WAT) is implicated in type 2 diabetes (T2D); however, metabolic signals that stimulate it remain unexplored. We hypothesized that (1) subjects with high-apoB have higher WAT IL-1β-secretion than subjects with low-apoB, (2) WAT IL-1β-secretion is associated with T2D risk factors, and (3) LDL prime and/or activate the WAT NLRP3 inflammasome. Forty non-diabetic subjects were assessed for T2D risk factors related to systemic and WAT glucose and fat metabolism. Regulation of the NLRP3 inflammasome was explored using LDL without/with the inflammasome’s priming and activation controls (LPS and ATP). LDL induced IL1B-expression and IL-1β-secretion in the presence of ATP in WAT and macrophages. Subjects with high-apoB had higher WAT IL-1β-secretion independently of covariates. The direction of association of LDL-induced WAT IL-1β-secretion to T2D risk factors was consistently pathological in high-apoB subjects only. Adjustment for IL-1β-secretion eliminated the association of plasma apoB with T2D risk factors. In conclusion, subjects with high-apoB have higher WAT IL-1β-secretion that may explain their risk for T2D and may be related to LDL-induced priming of the NLRP3 inflammasome.ClinicalTrials.gov (NCT04496154): Omega-3 to Reduce Diabetes Risk in Subjects With High Number of Particles That Carry "Bad Cholesterol" in the Blood—Full Text View—ClinicalTrials.gov.

Clinical Status of Patients with Type 2 Diabetes Patients at the Time of the Diagnosis

Background: Since patients with type 2diabetes are frequently misdiagnosed, provided inappropriate management, or poorly controlled, it is important to comprehend the wide range of clinical signs and symptoms associated with diabetes. Therefore, this study evaluated the overall clinical manifestations of patients with type 2 diabetes patients at the time of the diagnosis. Methods: This cross-sectional analytical study, conducted from January 2019 to December 2019, was a collaborative effort between the Department of Physiology at Rajshahi Medical College and Diabetic Association Hospital in Rajshahi. The primary aim was to investigate diabetes mellitus (DM) among patients presenting clinical symptoms suggestive of DM at the hospital's outpatient department (OPD). Following initial assessment, patients underwent an oral glucose tolerance test (OGTT) for definitive diagnosis. Once DM was confirmed, subjects were meticulously screened based on specific inclusion and exclusion criteria. Study group A comprised 80 diabetic subjects, while study group B included an equal number of age- and sex-matched non-diabetic subjects, drawn from hospital staff, patients' relatives, and volunteers, resulting in 80 participants in each group. Results: The study findings showed that overall mean age of the respondents were 52.61±7.70 years and majority were female. In DM2 group among all, a little higher of 4/5th (85%) of the respondents were non smoker and 4/5th (80%) were non tobacco user. Among the respondents only 4 of them were alcoholic. In DM group, the mean SBP was 128.88 mm HG with SD of 10.93 and the mean DBP was 78.25 with SD of 10.70. Plus, according to the measured systolic blood pressure 39 of the respondents belonged to normal, 95 showed prehypertensive and 26 showed hypertensive systolic blood pressure were found DM2 group. Besides that, high level of serum creatinine and serum uric level are seen in DM2 group comparing healthy group. Conclusion: This study ...........

Association between high sensitivity cardiac troponin and mortality risk in the non-diabetic population: findings from the National Health and Nutrition Examination Survey

ObjectiveWe investigated the association of high-sensitivity cardiac troponin (Hs-cTn) with all-cause and cardiovascular mortality in non-diabetic individuals.MethodsThis study included 10,393 participants without known diabetes and cardiovascular disease from the US National Health and Nutrition Examination Survey (NHANES). Serum Hs-cTnI and Hs-cTnT concentrations were measured. Prediabetes was defined as fasting blood glucose between 100 and 125 mg/dL or HbA1c between 5.7 and 6.4%. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality risk. Time-dependent receiver operating characteristics (tROC) curves were utilized to measure the predictive performance of the biomarkers. Net Reclassification Improvement (NRI) were calculated to estimate the improvement in risk classification for adding Hs-cTnT or Hs-cTnI to the standard models based on Framingham risk factors.ResultsThe mean age of the participants was 48.1 ± 19.1 years, with 53.3% being female and 25.8% being prediabetic. After multivariable adjustment, compared to those with Hs-cTnI concentration less than the limit of detection, the HRs (95% CIs) of the participants with Hs-cTnI concentration higher than the 99th upper reference limit were 1.74 (1.35, 2.24) for all-cause mortality and 2.10 (1.36, 3.24) for cardiovascular mortality. The corresponding HRs (95% CIs) for Hs-cTnT were 2.07 (1.53, 2.81) and 2.92 (1.47, 5.80) for all-cause and cardiovascular mortality. There was a significant interaction between prediabetes and Hs-cTnI on the mortality risk; a positive relationship was only observed in prediabetic individuals. No interaction was observed between prediabetes and Hs-cTnT on mortality risk. The Areas Under tROC indicated both Hs-cTnT and Hs-cTnI show better predictive performance in cardiovascular mortality than in all-cause mortality. NRI (95% CI) for adding Hs-cTnT to the standard model were 0.25 (0.21, 0.27) and 0.33 (0.26, 0.39) for all-cause and cardiovascular mortality. The corresponding NRI (95% CI) for Hs-cTnI were 0.04 (0, 0.06) and 0.07 (0.01, 0.13).ConclusionsElevated blood levels of Hs-cTnI and Hs-cTnT are associated with increased mortality. Measurement of Hs-cTnT in non-diabetic subjects, particularly those with prediabetes, may help identify individuals at an increased risk of cardiovascular disease and provide early and more intensive risk factor modification.

Association Between Arsenic Toxicity, AS3MT Gene Polymorphism and Onset of Type 2 Diabetes.

Arsenic (As) exposure in drinking water has become a serious public health issue. AS3MT gene is involved in the metabolism of arsenic, so a single nucleotide polymorphism in this gene may lead to the development of type 2 diabetes in arsenic-exposed areas. This study aimed to evaluate the association of the AS3MT gene with the development of type 2 diabetes in highly arsenic-exposed areas of Punjab, Pakistan. Total 200 samples equal in number from high arsenic exposed-areas of Lahore (Nishtar) and Kasur (Mustafa Abad) were collected. rs11191439 was utilized as an influential variable to evaluate the association between arsenic metabolism and diabetes status to find a single nucleotide polymorphism in the AS3MT gene. We observed the arsenic level in drinking water of the arsenic-exposed selected areas 115.54 ± 1.23µg/L and 96.88 ± 0.48µg/L, respectively. The As level in the urine of diabetics (98.54 ± 2.63µg/L and 56.38 ± 12.66µg/L) was higher as compared to non-diabetics (77.58 ± 1.8µg/L and 46.9 ± 8.95µg/L) of both affected areas, respectively. Correspondingly, the As level in the blood of diabetics (6.48 ± 0.08µg/L and 5.49 ± 1.43µg/L) and non-diabetics (6.22 ± 0.12µg/L and 5.26 ± 0.24µg/L) in the affected areas. Genotyping showed significant differences in the frequencies of alleles among cases and controls. Nevertheless, notable disparities in genotype distribution were observed in SNPs rs11191439 (T/C) (P < 0.05) and when comparing T2D patients and non-diabetic control subjects. The AS3MT gene and clinical parameters show a significant association with the affected people with diabetes living in arsenic-exposed areas.

Fat Mass Accounts for Insulin Resistance Impact on Functional Decline and Mortality in Nondiabetic Older Adults

ObjectiveTo assess the potential role of body composition in the association of insulin resistance (IR) with functional decline and mortality in nondiabetic older persons. DesignLongitudinal population-based cohort of community-dwelling people from Toledo, Spain, aged 65 years or older. Setting and ParticipantsA total of 1114 nondiabetic persons from the Toledo Study of Healthy Aging cohort (mean age: 74.5, 56.10% female) with complete data at baseline were included. Only 914 participants had fully assessment of functional evaluation during the follow-up period. MethodsIR was determined by the homeostasis model assessment index (HOMA-IR) at baseline while frailty was assessed by the Frailty Trait Scale-5 (FTS-5) at baseline and after 2.99 years’ median follow-up period. A total of 319 participants experienced functional decline (2.5-point reduction in the FTS-5 score). A total of 143 deaths were recorded (6.31 years median follow-up) from the Spanish National Death Index. Body compositions were determined using dual-energy x-ray absorptiometry. Multivariate regression models analyzed the effect of HOMA-IR on outcomes, with age, sex, Charlson index, and number of medications included in the basic adjustment model. ResultsA 1-logaritmic unit increment in HOMA-IR increased the risk of functional decline after basic adjustment [odds ratio (95% confidence interval): 1.41 (1.09–1.83), P = .009]. This significant association was lost when further adjusted for total fat mass [1.14 (0.86–1.50)] and trunk fat mass [1.03 (0.77–1.37)], which accounted for 62.92% and 91.49% of the association. HOMA-IR was inversely associated with mortality risk [hazard ratio 0.66 (0.49–0.87), P = .0037], an association lost after adjustment for total fat mass [0.74 (0.55–1.01)] and trunk fat mass [0.80 (0.58–1.09)], accounting for 29.05% and 45.78% of the association. Adjustment by lean mass did not modify any of the associations. Conclusions and ImplicationsBody fat mass, especially in the trunk region, mediates the association of IR with functional decline and to a lesser extent with reduced risk of mortality in nondiabetic older subjects.

Relationship between nailfold capillaroscopy parameters and the severity of diabetic retinopathy

PurposeTo determine whether non-invasive measurements of the nailfold capillaries (NCs) are associated with the presence and severity of diabetic retinopathy (DR) in patients with type 2 diabetes.MethodsEighty-three eyes of 83 patients with type 2 diabetes were enrolled. Sixty-three age-matched non-diabetic subjects served as controls. Diabetic patients were classified by the severity of their DR: non-DR (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). We used nailfold capillaroscopy to measure NC parameters, including number, length, width, and turbidity.ResultsFour NC parameters in the diabetic patients were significantly lower than in the controls (all P < 0.001). There was a statistically significant decrease in the NC parameters along with the increasing severity of DR (number: P = 0.02; all others: P < 0.001). Logistic regression analysis revealed that combining the systemic characteristics of age, sex, systolic blood pressure, estimated glomerular filtration rate, hemoglobin A1c level, and history of hypertension and dyslipidemia could indicate the presence of DR and PDR (the area under the receiver operating characteristic curve [AUC] = 0.81, P = 0.006; AUC = 0.87, P = 0.001, respectively). Furthermore, the discriminative power of DR was significantly improved (P = 0.03) by adding NC length to the systemic findings (AUC = 0.89, P < 0.001).ConclusionNC measurement is a simple and non-invasive way to assess the risk of DR and its severity.

Corneal topographic indices of scheimpflug camera in type 2 diabetic and non-diabetic elderly populations

PurposeThe present study was conducted to determine the corneal topographic indices of Scheimpflug camera in type 2 diabetes patients without diabetic retinopathy (DR), DR and non-diabetic elderly populations.MethodsA total of 1105 participants were selected using random cluster sampling from Tehran, Iran and categorized into three groups including type 2 diabetes patients without diabetic retinopathy (DR), DR and non-diabetic. The diabetic group had HbA1c levels ≥ 6.4% with no other systemic problems. The non-diabetic participants had normal eye findings and no systemic diseases. The pachymetric progression index (PPI) values were measured using the Pentacam AXL.ResultsA total of 1105 participants including 429 diabetes patients (38.46% male) and 676 non-diabetic (38.76% male) subjects entered the study. Only PPIavg and PPImax were higher in the diabetics versus non-diabetics (P = 0.019 and 0.010, respectively). There was a significant difference in PPImax between the three groups (P = 0.036). There were significant differences only in index of vertical asymmetry (IVA), central keratoconus index (CKI), PPI average, and PPI max between different stages of diabetic retinopathy (DR) (P = 0.045, 0.005, 0.002, and 0.004, respectively). There was a significant difference in index of Surface Variance (ISV), index of vertical asymmetry (IVA), PPIavg, and PPImax between diabetes patients with and without DR (P = 0.016, 0.022, < 0.001, and < 0.001, respectively).ConclusionAccording to the results, diabetes and DR change several topographic indices. In addition, the HbA1c level may affect pachymetric progression index max. Therefore, special attention should be paid to these patients for different treatment strategies.

Subclinical right ventricular dysfunction in patients with asymptomatic type 2 diabetes mellitus: A cross-sectional study

BackgroundDiabetic cardiomyopathy, which involves both the right and left ventricles, progresses from a preclinical stage to overt heart failure. Detection of this entity at a preclinical stage could be crucial in intervening to halt its progression to overt heart failure. There is a paucity of literature on subclinical RV dysfunction in diabetic patients, and it is even rarer in the Indian literature. Our study intended to study this clinical entity through an echocardiographic assessment of asymptomatic patients. ObjectivesThis was a cross-sectional observational analytic study, comparing subclinical RV dysfunction in diabetic and non-diabetic subjects by using echocardiography as a primary objective, while the secondary objective of the study was to find out the correlation between RV dysfunction and the duration of diabetes mellitus and HbA1C levels. MethodsConventional echocardiography with tissue Doppler imaging (TDI) was used to measure nine different echocardiographic parameters in the diabetic and non-diabetic groups. All probable causes of RV dysfunction were excluded before enrolling the patients in the study. Unpaired t-test was used to compare the parameters between the two groups, and multivariate regression analysis was done taking into consideration age, duration of diabetes, and HbA1C levels as the independent variables, and echocardiographic parameters as the dependent variables. ResultsOut of the nine different echocardiographic parameters, Tricuspid annular plane systolic excursion (TAPSE), RV end diastolic diameter (RVEDD), Tricuspid peak late diastolic velocity (A), E/A ratio, RV basal segment peak myocardial systolic velocity (Sm), RV basal segment peak early diastolic velocity (Em), RV basal segment peak late diastolic velocity (Am), and E/Em ratio showed statistically significant differences between the two groups. These results show the presence of subclinical RV dysfunction in diabetic patients. TAPSE and E/A ratio showed a significant correlation with the duration of diabetes, while Em showed a significant correlation with HbA1C. ConclusionDiabetes mellitus is associated with subclinical systolic as well as diastolic RV dysfunction. In addition to helping identify people at high risk, the early recognition of RV dysfunction gives us a window of opportunity to take action and slow down the disease's course. This study emphasizes that the early identification of RV diastolic as well as systolic dysfunction in asymptomatic Type 2 diabetic patients can be a helpful tool in halting the progression of disease from subclinical to frank clinical cases, thereby preventing the morbidity and mortality associated with heart failure. Hence, it adds value to the pre-existing literature.

Serum Iron Profile in Type 2 Diabetes Mellitus

Background: Type 2 diabetes Mellitus is a major growing health issue worldwide. There is a strong relation between iron parameters and type 2 diabetes mellitus. Iron metabolism can directly or indirectly affect the occurrence and development of type 2 diabetes. Objectives: To observe serum levels in Type 2 Diabetes Mellitus patients. Methods: This cross sectional study was conducted from to in the Department of Physiology, Rangpur Medical College, Rangpur. For this study, total number of 150 subjects were selected among them 75 non-diabetic healthy subjects were included in group-A and 75 Type 2 Diabetes Mellitus patients were included in group-B. The subjects of group-A were selected from surrounding community of Rangpur district and subjects of Group-B were selected from Diabetic Association and from Outdoor of Endocrinology Department, Rangpur Medical College and Hospital, Rangpur. For statistical analysis independent sample “t”test was performed by computer based software SPSS- 23.0 version for windows. Results: Mean serum free iron concentration in Group A and Group B were 12.29±3.1 μmol/l and 15.24±6.8 respectively. Mean TIBC in Group A and Group B were 68.06±7.3 μmol/l and 56.89 ± 8.6 respectively. Mean serum ferritin concentration were 131±12.90 mg/ml and 170.50±15.1 respectively. The difference between serum iron, TIBC and ferritin between Group A and Group B were highly significant ( p _ 001 ). Conclusion: The results obtained from this study suggests that serum iron and serum ferritin were increased and TIBC was decreased in T2DM patients as compared to healthy control. J Rang Med Col. September 2023; Vol. 8, No. 2: 40-43

THU251 Diagnostic Performance For Predicting Hepatic And Peripheral Tissue Insulin Resistance In Young Adult Men Using 1Hour Post Load Serum Glucose And Insulin Levels A Pilot Study

Abstract Disclosure: A.J. Ledezma: None. C.F. Espinel Pachón: None. S.S. Perea: None. J.E. Caminos: None. Insulin resistance (RI) is a risk factor for prediabetes and DM2, and other non communicable diseases. Different studies have demonstrated that 1h post load serum glucose levels during an oral glucose test tolerance OGTT seem to be a better predictor of peripheral RI than 2h post load serum glucose among individuals without DM2. On the other hand, HOMA IR reflects primarily hepatic sensitivity/resistance, meanwhile, Matsuda index, may reflect both hepatic and peripheral tissue insulin sensitivity/resistance. Thus, this study aimed to evaluate the diagnostic performance, to identify hepatic and peripheral RI, of 1h post load serum glucose and insulin levels during an OGTT in young adult men, using ROC AUC analysis. This cross-sectional study was conducted on a total of 91 young adult men (18-31-year-olds), 47 healthy lean (BMI &amp;lt;25 kg/m2), and 44 obese nondiabetic subjects (BMI ≥30 kg/m2). Subjects underwent a standard 75g OGTT and blood samples were drawn at 0, 30, 60, and 120 min to obtain serum glucose and insulin levels. Clinical and anthropometric and biochemical variables were determined. Participants were classified as RI based on a predefined Matsuda index cutoff 4.3 value. Cut-offs, sensitivity, and specificity for glucose, insulin, and anthropometrics parameters were determined by AUC ROC analysis for predicting RI diagnosis, and Spearman´s correlation was established between biochemical variables and waist/height ratio and Delong test analysis. Our results showed that 1h post load glucose levels had higher sensitivity 84.1% vs 47.7% and AUC 83.9% [CI 95% 75.6; 92.1%] vs 72.4% [CI 95% 61.8%; 83.0%] than 2h post load during OGTT, however lower specificity was found 70.2% vs 89.4%. Additionally, 1h post load insulin levels had higher sensitivity 90.9% vs 77% and AUC 97.1% [CI 95% 94; 100%] vs 91.9% [CI 95% 86.3; 97.5%] than 2h post load during OGTT, without changes in specificity 97.9% vs 97.8%. It is important to highlight that waist/height ratio reached a 100% AUC 95% CI diagnostic performance for RI in our sample. Additionally, HOMA IR index 99.8% [CI 95% 99.1; 100%], 1/fasting insulin 100% [CI 95% 0.99; 100%], and fasting glucose/insulin ratio 99.7% [CI 95% 99.2; 100%], showed a high diagnostic performance for RI. In the Spearman correlation, Waist/height ratio presented a high correlation with respect to Matsuda -0.8672; p&amp;lt;0.01 G/I1H -0.7454; p&amp;lt;0.01, 1/I1H -0.7783; p&amp;lt; 0.01; Delong test, the best performance comparing 1H vs 2H, G1H/G2H with Z value 2.0668 and P 0.03 In conclusion, 1h post load glucose and insulin levels and the waist/height ratio show greater diagnostic performance than 2h post load for detecting peripheral tissue and hepatic RI in young men. Therefore, Cut-offs values of glucose and insulin levels 1h post load provide simple but useful test for early detection of different prevalent diseases related to RI. Presentation: Thursday, June 15, 2023

Probiotic Chewing Gums for Adjuctive Treatment of Periodontitis in Diabetics

INTRODUCTION; The treatment of Periodontal disease in Diabetic subjects should also focus on lowering blood glucose levels, which might act as an adjuvant to conventional Periodontal treatment. In the form of Probiotics, Bacterial therapy offers a dual role in controlling blood glycemic levels and reducing colonization of oral bacteria. This study aimed to evaluate the efficacy of probiotics in managing Periodontitis among Diabetic and Non-Diabetic subjects. METHODOLOGY; This study was designed as a randomized, double-blinded clinical trial among Diabetic and Non-diabetic subjects with Periodontitis. Twenty-four subjects in each Diabetic and non-diabetic group were randomly assigned into two probiotic test sub-groups and one placebo sub-group. Lactobacillus fermentum MCC2760 and Bifidobacterium longum NCIM5684 probiotic chewing gums were provided to subjects in test groups to use twice a day for 30 days. Supragingival plaque samples were collected at baseline and 30 days to analyze total bacterial count and subgingival plaque for P.gingivalis, A.actinomycetemcomitans through qPCR. Clinical parameters were recorded at baseline, 30, 45, and 90 days. RESULTS; After 30 days, a significant reduction in PI, GI, PPD, and Gingival bleeding Index was observed in SRP and SRP+Probiotic groups. There is a significant reduction in total bacterial count among probiotic groups compared to placebo. PCR analysis revealed non-significant reduction of p.gingivalis and A.actinomycetemcomitans in test groups. Intergroup comparison between Diabetic and Non-diabetic groups did not show any significant differences either in clinical or microbial parameters. CONCLUSION; Probiotic functional foods can be delivered as an adjunct to SRP to manage Periodontitis in systemically compromised subjects. Long-time use of probiotics is recommended to maintain the recolonization of bacteria in periodontal tissues.

Impact of type 2 diabetes on surgical site infections and prognosis post orthopaedic surgery: A systematic review and meta-analysis.

The escalating prevalence of type 2 diabetes raises concerns about adverse postoperative outcomes like surgical site infections (SSIs) and deep vein thrombosis (DVT) in orthopaedic surgeries. This meta-analysis aims to resolve inconclusive evidence by systematically quantifying the risks in type 2 diabetic patients compared to non-diabetic individuals. The meta-analysis was conducted adhering to the PRISMA guidelines and based on the PICO framework. Four primary databases were searched: PubMed, Embase, Web of Science and the Cochrane Library, with no temporal restrictions. Studies included were either prospective or retrospective cohort studies published in English or Chinese, which assessed orthopaedic surgical outcomes among adult type 2 diabetic and non-diabetic patients. The meta-analysis employed the Newcastle-Ottawa Scale for quality assessment and used both fixed-effect and random-effects models for statistical analysis based on the level of heterogeneity. Out of 951 identified articles, nine studies met the inclusion criteria. The odds ratio (OR) for developing postoperative SSIs among diabetic patients was 1.63 (95% CI: 1.19-2.22), indicating a significantly elevated risk compared to non-diabetic subjects. Conversely, no statistically significant difference in the risk of postoperative DVT was found between the two groups (OR: 0.82; 95% CI: 0.55-1.22). Sensitivity analysis confirmed the stability of these outcomes. Patients with type 2 diabetes are at a higher risk of developing SSIs post orthopaedic surgery compared to non-diabetic individuals. However, both groups demonstrated comparable risks for developing postoperative DVT.

Long-Lasting Control of LDL Cholesterol Induces a 40% Reduction in the Incidence of Cardiovascular Events: New Insights from a 7-Year Study

Recent studies have yielded controversial results on the long-term effects of statins on the risk of cardiovascular (CV) events. To fill this knowledge gap, we assessed the relationship between low-density lipoprotein cholesterol (LDL-C) levels and CV events in hypertensive patients without previous CV events and naïve to antidyslipidemic treatment within the "Campania Salute Network" in Southern Italy. We studied 725 hypertensive patients with a mean follow-up of 85.4 ± 25.7 months. We stratified our cohort into three groups based on LDL cholesterol (LDL-C) levels in mg/dl: group 1) patients showing during the follow-up a mean LDL-C value ≤100 mg/dl in absence of statin therapy; group 2) statin-treated patients with LDL ≤100 mg/dl; and group 3) patients with LDL-C >100 mg/dl. No significant difference among the groups was observed in terms of demographic and clinical characteristics and medications. The incidence of first CV events was 5.7% in group 1, 6.0% in group 2, and 11.9% in group 3 (P < 0.05 vs. group 1 and group 2). A stable long-term satisfactory control of LDL-C plasma concentration (≤100 mg/dl) reduced the incidence of major CV events from one event every 58.6 patients per year to one event every 115.9 patients per year. These findings were confirmed in a Cox regression analysis, adjusting for potential confounding factors. Collectively, our data demonstrate that a 7-year stable control of LDL-C reduces the incidence of CV events by 40%. SIGNIFICANCE STATEMENT: There are several discrepancies between Mendelian studies and other investigations concerning the actual effects of reduction of plasma concentration of low-density lipoprotein (LDL) cholesterol on the incidence of major cardiovascular events. Taken together, our data in nondiabetic subjects show that a 7-year stable control of LDL cholesterol induces a ∼40% reduction of the incidence of cardiovascular events.