Healthy Non-diabetic Individuals Research Articles

Discriminating between diabetic and non-diabetic patient’s blood serum using near-infrared Raman spectroscopy

The current study demonstrates the utilization of Raman spectroscopy, employing a laser system emitting @ 785 nm, and multivariate analysis for the accurate assessment of diabetes (glucose) in human blood sera. Raman spectra of sera samples collected from 40 patients of both genders of different age groups were acquired in the spectral range of 600–1800 cm−1. For comparison, the Raman spectra of non-diabetic healthy individuals were also obtained in the same spectral range. Apparent variations were found in normal and pathological samples at peak positions of 700 cm−1, 750 cm−1, 879 cm−1, 950 cm−1, band at 1004 cm−1 to 1006 cm−1, 1048 cm−1, 1060 cm−1, 1082 cm−1, 1091 cm−1, 1170 cm−1, 1247 cm−1, 1330 cm−1, 1333 cm−1, 1367 cm−1, 1659 cm−1 and 1745 cm−1. These variations are most likely due to variations in the concentration of amino-acid methionine, glycosylated, tryptophan, polysaccharides, phenylalanine, glycogen, glucose, carbohydrates, carbohydrates (C–O–H), tyrosine, guanine, typical phospholipids, guanine, phospholipid, cholesterol band, and triglycerides (fatty acids) respectively. For highlighting the spectral differences between the two data sets principal component analysis was used. The observed variations in Raman peaks provide an in-depth biochemical fingerprint of the samples and can be used as a biomarker for medical diagnosis effectively at the mass level.

Impaired polymorphonuclear neutrophil functions in diabetics

Background and objectives: Polymorphonuclear neutrophils (PMN) are the first line of host resistance against infections. Diabetics are prone to both bacterial and fungal infections. The present study evaluated the phagocytic and killing activity of PMN in diabetics. Material and methods: Females aged 30 to 50 years with and without diabetes mellitus were enrolled. Functions of PMN were assessed by determining the phagocytic rate, phagocytic index and killing of C. albicans by PMN. Results: A total of 36 diabetic patients and 15 age matched non-diabetic healthy individuals were enrolled. Phagocytosis and killing of C. albicans by PMN were significantly (p<0.05) lower in patients with diabetes mellitus compared to non-diabetic healthy individuals (86.5±14.6 vs. 94.5±4.2; 56.7±23.8 vs. 81.5±24.2). Conclusion: Phagocytic and killing functions of PMN were significantly reduced in patients with diabetes mellitus. IMC J Med Sci. 2024; 18(1):008. DOI: https://doi.org/10.55010/imcjms.18.008 *Correspondence:Tanzinah Nasrin, Microbiologist, Quality Control Laboratory, Department of Fisheries, Ministry of Fisheries and Livestock, Dhaka, Bangladesh. Email: tanzinahn8@gmail.com

Association of vascular endothelial growth factor a gene (VEGFA) polymorphisms, rs699947 and rs1570360, with diabetic retinopathy and altered VEGF secretion in the Pakistani patients with type 2 diabetes mellitus: a case-control study

Objective: To investigate the association of vascular endothelial growth factor A gene polymorphisms 2578C/A (rs699947) and 1154G/A (rs1570360) with type 2 diabetes mellitus, diabetic retinopathy and serum vascular endothelial growth factor levels in Pakistani patients. Method: The case-control study was conducted from Jan 2017 to Dec 2018 after approval from the ethics review board of Riphah International University, Islamabad, Pakistan, and comprised type 2 diabetes mellitus patients of either gender with diabetic retinopathy in group A, and without diabetic retinopathy in group B. Non-diabetic healthy individuals were enrolled in control group C. Genotyping was done by amplification refractory mutation system-polymerase chain reaction and serum vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22. Results: Of the 450 subjects, 150(33.3%) were in each of the 3 groups. The mean age in group A was 58.16±9.42, in group B 56.25±8.5 years and in group C it was 55.90±10.90. The proportion of Punjabi ethnicity was significantly high in group B compared to other groups (p<0.05). There was no significant association of rs699947 and rs1570360 genotypic and allelic frequencies in group B compared to group A. Further, rs699947 AA genotype was significantly associated with proliferative diabetic retinopathy compared to group A (p<0.05). Minor allele A showed significant association in groups A and B compared to group C (p<0.05). Significantly raised serum vascular endothelial growth factor levels were found in group B compared to group A (p<0.05), and were associated with rs699947 and rs1570360 heterozygosity in group A (p<0.05). Also, rs699947 genotype showed significant association with groups A and B in Punjabi and Pathan ethnicities (p<0.05) and with Kashmiri ethnicity in group B (p<0.05). Conclusion: There was a strong association of vascular endothelial growth factor 2578C/A (rs699947) gene polymorphism with proliferative diabetic retinopathy in type 2 diabetic Pakistani patients, suggesting its role in the pathogenesis of this condition. Key Words: Diabetic retinopathy, Polymorphisms, Type 2 diabetes mellitus, Vascular endothelial growth factor A gene.

Vestibular evoked myogenic potentials and videonystagmography findings in type 2 diabetes mellitus patients with and without polyneuropathy

BackgroundVestibular impairment is a common pathology in patients with type 2 diabetes mellitus (DM) due to ischemia of the vestibular end organs and lysis of the myelin of the vestibular nerve. We aimed to evaluate function of the vestibular end organs and vestibular nerve in patients with type 2 DM with polyneuropathy and compare results to those of the patients without polyneuropathy.MethodThe participants consisted of three groups: thirty patients with type 2 diabetes mellitus without polyneuropathy (DM), thirty patients with type 2 diabetes mellitus with polyneuropathy (DPN), and thirty healthy non-diabetic individuals as the control group. Clinical examination, videonystagmography, cervical vestibular evoked myogenic potential(cVEMP), ocular vestibular evoked myogenic potential (oVEMP), Gans Sensory Organization Performance (SOP) test, and nerve conduction study were all performed on all groups.ResultsP1 and N1 cVEMP latencies and n1 and p1 oVEMP latencies were statistically significantly delayed in both the DM and DPN groups than the control. Also, amplitudes of P1-N1 and n1-p1 were statistically significantly lower in the DM and DPN groups than the control group. DPN patients had longer latencies and lower amplitude of the cVEMP and oVEMP response compared to diabetes patients without neuropathy. There was a statistically significant prevalence of BPPV in the DPN group compared to the control and DM groups. DPN included the following: 4 (13.3%) had vestibular pattern, 12 had polyneuropathic pattern, and 5 (16.7%) had vestibular and polyneuropathic pattern as regards the Gans Sensory Organization Performance (SOP) test.ConclusionVEMP is considered a promising objective tool in the assessment of the vestibular end organ disorders in patients with type 2 DM with and without polyneuropathy. Diabetics with prominent diabetic polyneuropathy showed higher vestibular impairment than diabetics without DPN, which may increase the risk of falling.

Correlation of Glycated Hemoglobin with Oxidative Stress in Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) has a heavy disease burden and is one of the leading causes of death worldwide. It is considered to be evolving from a complex and multifactorial metabolic disorder to an inflammatory condition. The strong link between hyperglycemia and oxidative stress has long been established. Oxidative stress leads to the generation of inflammatory mediators and reactive oxygen species, which results in an inflammatory state, which plays a key role in the pathogenesis of diabetic complications. We aimed to correlate the levels of Glycated Hemoglobin with Oxidative Stress.This cross-sectional study included 200 subjects, 100 were type 2 diabetic patients and 100 were healthy non-diabetic individuals. The data were analyzed using a t test. The results showed that as the Glycated Hb increased, the levels of FBS, MDA increased and Serum SOD, Glutathione and Catalase levels decreased. The results showed a positive correlation between HbA1c and fasting blood glucose (r = 0.417, p= 0.000) and MDA (r= 0.340, p=0.000). Whereas negative correlation was observed between HbA1c and other antioxidant parameters, SOD (r= 0.025, p=0.803) Catalase (r= 0.096, p= 0.342), Glutathione (r= -0.164, p= 0.103). It is hereby concluded for the present study that when glycated Hb increases the natural antioxidants that is SOD, catalase and glutathione decrease to combact the increased formation of ROS. Serum MDA, a marker of lipid peroxidation, increased with increased glycated Hb, and shows a positive correlation, indicating that lipid peroxidation increased, when glycation of Hb increased, thus depicting an increased chance of macrovascular complication in type 2 diabetics.

Assessment of glycemic variability and lifestyle behaviors in healthy nondiabetic individuals according to the categories of body mass index.

There are limited data about the association between body mass index (BMI), glycemic variability (GV), and life-related factors in healthy nondiabetic adults. This cross-sectional study was carried out within our ethics committee-approved study called "Exploring the impact of nutrition advice on blood sugar and psychological status using continuous glucose monitoring (CGM) and wearable devices". Prediabetes was defined by the HbA1c level of 5.7-6.4% and /or fasting glucose level of 100-125 mg/dL. Glucose levels and daily steps were measured for 40 participants using Free Style Libre and Fitbit Inspire 2 under normal conditions for 14 days. Dietary intakes and eating behaviors were assessed using a brief-type self-administered dietary history questionnaire and a modified questionnaire from the Obesity Guidelines. All indices of GV were higher in the prediabetes group than in the healthy group, but a significant difference was observed only in mean amplitude of glycemic excursions (MAGE). In the multivariate analysis, only the presence of prediabetes showed a significant association with the risk of higher than median MAGE (Odds, 6.786; 95% CI, 1.596-28.858; P = 0.010). Additionally, the underweight (BMI < 18.5) group had significantly higher value in standard deviation (23.7 ± 3.5 vs 19.8 ± 3.7 mg/dL, P = 0.038) and coefficient variability (22.6 ± 4.6 vs 18.4 ± 3.2%, P = 0.015), compared to the normal group. This GV can be partially attributed to irregularity of eating habits. On the contrary, the overweight (BMI ≥ 25) group had the longest time above the 140 or 180 mg/dL range, which may be due to eating style and taking fewer steps (6394 ± 2337 vs 9749 ± 2408 steps, P = 0.013). Concurrent CGM with diet and activity monitoring could reduce postprandial hyperglycemia through assessment of diet and daily activity, especially in non- normal weight individuals.

1505-P: CD44 Knockdown in Human Adipocytes—Effect on Adipocyte Proliferation and Differentiation

Introduction: eGWAS implicates the immune-cell receptor CD44 as the top candidate gene in the molecular pathogenesis of T2D1. We have shown that in human adipose tissue, CD44 expression is associated with inflammatory gene expression, M1 macrophage phenotype, and systemic insulin resistance2. Here we sought to determine whether CD44 directly impairs adipocyte function via siRNA knockdown in human preadipocytes with quantification of proliferation, differentiation, and gene expression. Methods: Abdominal subcutaneous adipose tissue was harvested from five healthy nondiabetic obese individuals during bariatric surgery. Preadipocytes were isolated via collagenase digestion and seeded at 1×10^4 cells/well and treated with siRNA-CD44 or mock condition (control) using siRNA Maxi Transfection Reagents (Invitrogen). Cell proliferation was assayed by MTS (Promega) on Days 1, 2, 3 post transfection. Differentiation was induced at confluence (as described3), and cells were harvested at days 3, 6, 12 after confluence for gene expression and at day 12 for oil red O staining (total lipid uptake) and immunofluorescence microscopy (% differentiation = bodipy/dapi*100). Results: CD44 knockdown decreased preadipocyte proliferation and increased adipocyte differentiation and lipid uptake. Conclusion: CD44 may contribute to human insulin resistance by impairing adipocyte differentiation and fat storage. Disclosure H.Chen: None. N.R.Saini: None. E.M.Ayhan: None. T.Mclaughlin: Board Member; January, Inc., Research Support; Merck &amp; Co., Inc., Stock/Shareholder; Eiger Bio. Funding National Institutes of Health (1R21AI159024-01A1)

Assessment of serum and salivary visfatin levels in newly diagnosed patients of type-II DM.

Type II diabetes mellitus (T2DM) is a metabolic disorder. It is thought to be an autoinflammatory disease, as inflammatory mediators are associated with the progression of the disease. Visfatin, an adipokine, is linked to insulin resistance. We aimed to study serum and salivary visfatin levels, at the time of diagnosis of T2DM, in middle-aged individuals, in the context of other diagnostic parameters like fasting blood sugar (FBS), postprandial blood sugar (PPBS), and glycated haemoglobin A1c (HbA1c). Thirty newly diagnosed T2DM (Group-I, T2DM) patients and 30 healthy nondiabetic individuals (Group-II, health controls [HC]) matched for age and sex were studied. In both the groups, we assessed serum and salivary visfatin levels, and serum high-sensitivity C-reactive protein (hs-CRP) levels. We also compared serum and salivary visfatin levels and serum hs-CRP levels between Group-I and Group-II individuals. The correlation between the groups was tested using Pearson's correlation. A P- value < 0.001 was considered to be statistically significant. The data was tabulated using software MS Excel and analysed using IBM Statistical Package for the Social Sciences (SPSS) Version 22.0. A positive correlation with a value of 0.8836 and a P value of 0.001 was noted between serum and salivary visfatin of Group-I. This is the first study in the Indian scenario to study the serum and salivary visfatin in newly diagnosed T2DM individuals. Serum visfatin and hs-CRP levels increased in T2DM, thus defining the link between visfatin, inflammation and T2DM, but we failed to notice a positive correlation.

Free Fatty Acids from Type 2 Diabetes Mellitus Serum Remodel Mesenchymal Stem Cell Lipids, Hindering Differentiation into Primordial Germ Cells.

Type 2 diabetes mellitus (T2DM) adversely affects the essential characteristics of adipose tissue-derived mesenchymal stem cells (AdMSCs). Given that T2DM is associated with an altered serum free fatty acid (FFA) profile, we examined whether diabetic serum FFAs influence the viability, differentiation, and fatty acid composition of the major lipid fractions of human AdMSCs in vitro. Serum FFAs were isolated from 7 diabetic and 10 healthy nondiabetic female individuals. AdMSCs were cultured and differentiated into primordial germ cell-like cells (PGCLCs) in the presence of either diabetic or nondiabetic FFAs. Cell viability was assessed using trypan blue staining. Cell differentiation was evaluated by measuring the PGCLC transcriptional markers Blimp1 and Stella. Lipid fractionation and fatty acid quantification were performed using thin-layer chromatography and gas-liquid chromatography, respectively. Both diabetic and nondiabetic FFAs significantly reduced the viability of PGCLCs. The gene expression of both differentiation markers was significantly lower in cells exposed to diabetic FFAs than in those treated with nondiabetic FFAs. Saturated fatty acids were significantly increased and linoleic acid was significantly decreased in the cellular phospholipid fraction after exposure to diabetic FFAs. In contrast, monounsaturated fatty acids were reduced and linoleic acid was elevated in the cellular triglyceride fraction in response to diabetic FFAs. Such an altered serum FFA profile in patients with T2DM reduces the proliferation and differentiation potential of AdMSCs, presumably due to the aberrant distribution of fatty acids into cell phospholipids and triglycerides.

Below Which Threshold of Glycemic Variability Is There a Minimal Risk of Hypoglycemia in People with Type 2 Diabetes?

Not applicable for a commentary.

Measures of optimal glucose “time in range” and variability using continuous glucose monitors in 4,805 healthy non-diabetic individuals is discriminatory of cardiovascular health risk

Measures of optimal glucose “time in range” and variability using continuous glucose monitors in 4,805 healthy non-diabetic individuals is discriminatory of cardiovascular health risk - Volume 81 Issue OCE1

The Role of Platelet Indices to Predict the Vascular Complication in Diabetic Patients in South Tamil Nadu

Background: Diabetic patients have larger young, more reactive and more agregable platelets. Platelet indices such as Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) are the indicators of increased platelet activity and considered as potential markers for diabetic vascular complications. This study aimed to estimate and compare Platelet count, MPV and PDW between (1) Diabetics patient and Controls (2) Diabetics under glycaemic control and not under glycaemic control. Methodology: This cross sectional study was conducted at, Tirunelveli Medical College, Tamil Nadu, India, during August 2015 to September 2017. In this study 100 diabetic patients and 100 controls were included. Inclusion criteria for diabetics were FBS &gt; 126 mg/dl, PPBS &gt; 200 mg/dl, and age between 35-65 years. Exclusion criteria for diabetics were age less than 35 and greater than 65 years. The criteria for controls include normal FBS, PPBS levels, and age from 35-65 years and without any thromboembolic conditions. Results: Data analysis was done using SPSS 19.0. MPV was significantly increased in (a) diabetics than healthy controls (b) diabetics under glycaemic control than diabetics not under glycaemic control. PDW showed significant difference between (a) diabetics and non-diabetic controls, (b) diabetics under glycaemic control and not under glycaemic control. There was no significance of platelet count among group A and group B. P value &lt; 0.05 was considered significant. Conclusion: In this study MPV and PDW were significantly increased in diabetic patients than non-diabetic healthy individuals and higher in diabetic patients not under glycaemic control than the diabetic under glycaemic control.

Evaluation of vitamin-D, calcium, and phosphorus levels among diabetes mellitus type 2 in malwa belt of Punjab

Background: Type-2 diabetes mellitus (T2DM) or noninsulin-dependent diabetes is an endocrinological disease of impaired metabolism of carbohydrates. T2DM is increasing both nationally and worldwide at an alarming rate. In intermediary metabolism, including enzyme activities, electrical gradients and cellular function Vitamin D, calcium and phosphorus play an important role. Disturbances in the levels of Vitamin D, calcium, and phosphorus were found to be associated with T2DM. The present study is aimed to evaluate the levels of Vitamin D, calcium, and phosphorus levels in 300 patients, of which 150 were nondiabetic healthy individuals (control) and 150 were T2DM patients. Materials and Methods: A volume of 5 ml of the blood sample was taken after 12 h of overnight fasting by complete aseptic means from the antecubital vein with the sterilized disposable syringe for fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), glycated hemoglobin, serum 25 hydroxy (OH) Vitamin D (25[OH]D), calcium, and phosphorus. Results: Of 150 type-2 diabetic and 150 nondiabetic group, there was a significant statistical difference between the diabetic and nondiabetic group for FPG (P < 0.001), PPPG (P < 0.001), 25(OH) D (P < 0.001), calcium (P < 0.001), and phosphorus (P < 0.001). 25(OH) D, calcium, and phosphorus levels were decreased in T2DM patients as compared to the control group. Conclusion: This study revealed that there is a significant decrease in the levels of Vitamin D, calcium, and phosphorus in Type-2 diabetic patients, which may be an important factor in the early onset of the disease in susceptible individuals.

Handgrip Strength in Patients With Type 2 Diabetes Mellitus

Background: Handgrip strength can be used to determine an individual's muscular strength objectively. It is a valid indicator of the disability index. Type 2 diabetes mellitus has a negative impact on skeletal muscles and handgrip strength. The goal of this study was to compare type 2 diabetic patients' handgrip strength to that of apparently healthy non-diabetic individuals. Materials and Method: This cross-sectional study was carried out in the Department of Physiology, Sylhet M.A.G Osmani Medical College in collaboration with Outpatient Department of Endocrinology, Sylhet M.A.G Osmani Medical College Hospital and Outpatient Department of Sylhet Diabetic Hospital during the period from January 2017 to December 2017. A total of 100 type 2 diabetic patients who had been diagnosed for at least 5 years were selected, as well as 100 age and sex matched apparently healthy non-diabetic controls. The Jamar Hydraulic Hand Dynamometer was used to measure the handgrip strength of all subjects. All the collected data were compiled and analyzed using the Statistical Package for Social Science (SPSS) Version 22.0. Results: The mean handgrip strength of the diabetics (60.62 ± 18.98 lb) was significantly lower than non-diabetics (74.80 ± 21.61 lb) (p&lt;0.001). A significant negative correlation was found between handgrip strength and duration of diabetes (r=–0.270, p=0.007). Conclusion: Handgrip strength is lowered in patients with type 2 diabetes compared to the non-diabetic group and correlates negatively with diabetes duration. Reduced handgrip strength may lead to the development of impairment in the future, resulting in decreased productivity.

Comparison of choroidal thickness in eyes of diabetic patients with eyes of healthy individuals using optical coherence tomography in a tertiary care hospital.

ABSTRACTObjectives:To compare the choroidal thickness in eyes of diabetic patients with eyes of age matched controls using optical coherence tomography in a tertiary care hospital.Methods:This Cross sectional study was conducted at the Department of Ophthalmology, Jinnah Postgraduate Medical Centre Karachi, for six months from13thJanuary 2020 to13thJuly 2020. The study group comprised of 44 patients with 88 eyes. Patients who fulfill the inclusion criteria that is age ranging from 35 to 80years, either gender, known case of diabetes mellitus and having any type of diabetic retinopathy (HbA1c >7), non-diabetic healthy individuals (HbA1c < 7) and those giving informed consent were included in the study. However, patients having active ocular infections, history of myocardial infarction, stroke, uveitis, any ocular surgery, lasers, intravitreal injections, poor fundus view and not giving consent were excluded. A pre-designed proforma was filled. A baseline ocular examination was performed and choroidal thickness was assessed from retinal pigment epithelium to choroid sclera junction in diabetic and healthy participants of the study group using high resolution Swept source OCT (DRI-OCT-2 Triton; Topcon).Results:The average age of the patients was 39.41±15.95 years. According to our study mean central subfoveal choroidal thickness in diabetic eyes was 268.5 ± 66.22 (95% CI 240 – 297) and in non-diabetic healthy participants it was 339.3 ± 71.49 (95% CI 308 – 369) with a p-value of 0.001. However, average choroidal thickness was 261.8 ± 61.93 (95% CI 235 – 288) and 336.0 ± 74.35 (95% CI 304 – 367) in diabetic and non-diabetic healthy population with a p-value of 0.001. Choroidal thickness comparison between gender in diabetic and non-diabetic population also showed similar trend.Conclusion:In this study, mean central choroidal thickness as well as average choroidal thickness was significantly reduced in eyes having diabetic retinopathy as compared to participants with non-diabetic healthy eyes. These findings indicate that changes in choroid may be a probable route in the pathogenesis of diabetic retinopathy.

Plasma Level of Macromolecules and Mathematical Calculation of Potential Energy in Type 2 Diabetic Individuals at NAUTH, Nnewi, Nigeria

Diabetes mellitus is associated with neutered metabolism and higher Energy Expenditure. This study aimed on the use of Adenosine diphosphate (ADP), Flavin adenine dinucleotide (FAD), AcetylCo-enzyme A (ACA) and Nicotinamide Adenine Dinucleotide (NADH) as an index of energy utilization, storage and energy balance in Diabetic individuals. This is a longitudinal, prospective, case-controlled study involving seventy seven (77) diabetic individuals newly diagnosed attending diabetic clinic of Nnamdi Azikiwe University University Teaching Hospital (NAUTH) aged 18-60 years both male and female not on anti-diabetic drug, were enrolled in the study as test subjects and thirty six (36) apparently healthy non-diabetic individuals both male and female as control subjects. ADP, FAD, ACA and NADH were estimated by enzyme linked immunosorbent assay (ELISA), while, energy balance from macromolecules was determined by calculation. The data obtained were subjected to statistical analysis using SPSS software application (version 21.0) and the results expressed as mean ± standard deviation. The Plasma Adenosine diphosphate (ADP), Flavin adenine dinucleotide (FAD), AcetylCo-enzymeA (ACA) and Nicotinamide Adenine Dinucleotide (NADH), were significantly lower (P&lt;0.05) in both Diabetic pre-treatment and diabetic post-treatment group compared with control groups. Furthermore, the plasma level of ACA and NADH were significantly lower (P&lt;0.05) in DM pre-treatment group compared with DM post-treatment group. While, the plasma concentration of ADP was significantly lower in DM post-treatment groups compared with DM pre-treatment groups. However, the Calculated energy from Macromolecules was lower (P&lt;0.05) in DM groups compared with control group. Meanwhile, the calculated energy from Macromolecules in DM pre-treatment was significantly lower (P&lt;0.05) compared with DM post-treatment. In conclusion, the significant changes in the biochemical parameters measured suggest altered metabolism, increased energy expenditure and energy deficit/energy imbalance in diabetic subjects resulting from increased energy expenditure. Hence, energy from macromolecules such as ADP, FAD, ACA and NADH can be used to predict early energy deficit and manage energy imbalance in diabetic individuals.

Fasting Ketonuria and the Risk of Incident Nonalcoholic Fatty Liver Disease With and Without Liver Fibrosis in Nondiabetic Adults.

Dietary carbohydrate restriction or ketogenic diets are known to be beneficial in preventing liver fat accumulation. However, the effect of ketonemia on the risk of nonalcoholic fatty liver disease (NAFLD) in nondiabetic population is largely unknown. We investigated the association between fasting ketonuria and the risk of incident NAFLD in healthy adults. A cohort of 153,076 nondiabetic Koreans with no hepatic steatosis and low probability of fibrosis at baseline was followed for a median of 4.1 years. The outcome was incident hepatic steatosis with or without liver fibrosis, and it was assessed by liver ultrasound and noninvasive fibrosis indices, including fibrosis-4 and the NAFLD fibrosis score (NFS). Parametric proportional hazard models were used to estimate hazard ratios (HRs) for outcome according to ketonuria status. Within 677,702.1 person-years of follow-up, 31,079 subjects developed hepatic steatosis. Compared with no ketonuria (reference), fasting ketonuria was significantly associated with a decreased risk of incident hepatic steatosis, with multivariable-adjusted HRs (95% confidence interval) of 0.81 (0.78-0.84). The corresponding HRs for incident hepatic steatosis with intermediate-to-high NFS were 0.79 (0.69-0.90). Similar associations were observed replacing NFS with fibrosis-4. In addition, the presence of persistent ketonuria at both baseline and subsequent visit was associated with the greatest decrease in the adjusted HR for incident NAFLD. Ketonuria was associated with a reduced risk of developing incident hepatic steatosis with and without intermediate-to-high probability of advanced fibrosis in a large cohort of nondiabetic healthy individuals. The role of hyperketonemia in the prevention of NAFLD requires further exploration.

Does N-Carboxymethyl Lysine Serve as a Prognostic Biomarker of Diabetic Nephropathy?

Introduction: The occurrence and progression of diabetic nephropathy to end stage disease mandates an early detection of kidney damage. Glycation and oxidation injury form an essential element in the evolution of diabetic complications both microvascular and macrovascular. Aim: To study the trends in the N-Carboxymethyl lysine levels in various stages of diabetic nephropathy and assess its efficacy as a prognostic marker for diabetic nephropathy. Materials and Methods: The study included 125 Type 2 diabetic individuals- 45 patients with normoalbuminuria, 40 patients having microalbuminuria and 40 with macroalbuminuria {based on the Albumin-Creatinine Ratio (ACR)}. Forty five non-diabetic healthy individuals were included as a control group. Serum N-carboxymethyl lysine quantification was done for all the study participants and compared and correlated with other parameters across various groups. Results: The fasting and postprandial sugar, glycosylated haemoglobin, triglycerides, duration of diabetes, systolic and diastolic blood pressure, Body Mass Index (BMI), all were strong risk factors for Diabetic Kidney Disease (DKD) progression which significantly correlated positively with microalbumin and urine ACR (uACR) and negatively with Glomerular Filtration Rate (GFR). The serum N-carboxymethyl lysine was observed to be significantly increased as the ACR increased and in comparison to the controls, respectively (p-value &lt;0.001). The GFR showed significant negative correlation with levels of serum N-carboxymethyl lysine whereas positively correlated with fasting and postprandial sugar, glycosylated haemoglobin, triglyceride levels, duration of diabetes, systolic and diastolic blood pressure, BMI, microalbumin and uACR. Conclusion: N-carboxymethyl lysine in serum can serve as an early marker for diabetic nephropathy and its progression and severity.

Keyes Triad in Type 2 Diabetes Mellitus: A Microbiological Study.

Background:With the increasing prevalence of type 2 diabetes mellitus (DM), there is a need to assess if the elevated salivary glucose levels provide an environment conducive to the growth of cariogenic microorganisms specifically Streptocooccus mutans and Lactobacillus acidophilus.Materials and Methods:Forty-five patients were divided into three groups consisting of patients with type 2 DM with caries, patients with type 2 DM without caries and age-matched healthy nondiabetic individuals (control). Saliva samples were subjected to semiautomatic salivary glucose estimation by the glucose oxidase-peroxidase method, using the Tulip glucose estimation kit. Swabs were immediately inoculated onto Mitis Salivarius Bacitracin agar and Man Rogosa Sharpe agar.Results:In Group A, statistically significant positive correlation was found between S. mutans and salivary glucose (r = 0.858) as well as L. acidophilus and salivary glucose (r = 0.853). In Group B, a statistically significant positive correlation was found only between S. mutans and salivary glucose (r = 0.705) and not between L. acidophilus and salivary glucose (r = 0.387). The control group did not show a statistically significant correlation.Conclusion:It is established that salivary glucose levels reflect the diabetic state of an individual. The salivary glucose level predicted a 1.7 times higher caries susceptibility in a diabetic, as shown by results in this study. Salivary glucose causes an increase in the cariogenic load in diabetic patients, thus warranting a modification of the Keyes triad.

Effectiveness of Salivary Glucose in Diagnosing Gestational Diabetes Mellitus.

Context:Frequent monitoring of glucose is important in the management of diabetes. A noninvasive painless technique was used to detect glucose levels with the use of saliva as a diagnostic fluid.Aims:The aim of our study was to correlate the blood glucose levels with stimulated and unstimulated salivary samples and also to assess the reliability of using salivary glucose in diagnosing and monitoring the blood glucose levels in gestational diabetic patients.Settings and Design:The study was conducted among 100 clinically healthy nondiabetic individuals and 99 individuals suffering from gestational diabetes mellitus (GDM).Subjects and Methods:Fasting blood glucose estimation and postprandial salivary glucose estimation were done in stimulated and unstimulated salivary samples using glucose oxidase/peroxidase method.Statistical Analysis Used:Data obtained were subjected to normality test, and P ≤ 0.05 was considered to be statistically significant. The correlation between blood and salivary glucose levels was evaluated using Pearson's correlation test.Results:A positive correlation was obtained for stimulated and unstimulated salivary samples in fasting and postprandial conditions. Linear regression analysis and receiver operating characteristic curve were plotted, and the optimal cutoff value for unstimulated and stimulated salivary glucose under fasting conditions was 5.1 mg/dl and 5.4 mg/dl, respectively. The optimal cutoff value for unstimulated and stimulated salivary glucose was 8.8 mg/dl and 9.3 mg/dl, respectively, in postprandial conditions.Conclusions:Saliva appears to be a reliable biofluid to assess the blood glucose levels and can definitely be a reliable alternative to blood glucose in GDM patients.