non-DM Group Research Articles

Association between diabetes mellitus and cause of death in patients with tuberculosis: A Korean nationwide cohort study

Despite its significant impact on mortality, tuberculosis (TB)-diabetes mellitus (DM) co-prevalence has not been well-elucidated for the cause of death. We investigated the impact of DM on TB-related and non-TB-related deaths in patients with TB. This retrospective nationwide cohort study included patients diagnosed with TB between 2011 and 2017 in South Korea. We performed Fine and Gray regression model analyses to assess the mortality risk of DM classified by cause of death. Of 239,848 patients, 62,435 (26.0%) had DM, and 20,203 died during anti-TB treatment. Of all deaths, 47.9% (9,668) were caused by TB, and the remaining 52.1% (10,535) was attributed to various non-TB-related causes. The mortality rate was higher in the DM than in the non-DM groups in both men and women. DM was associated with a higher risk of TB-related (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 1.01–1.13) and non-TB-related (aHR 1.21, 95% CI 1.15–1.27) deaths in men; however, only a higher risk of non-TB-related deaths (aHR 1.29, 95% CI 1.20–1.38) in women. Our findings indicate that DM is independently associated with a greater risk of death during anti-TB treatment among patients with TB for both TB-related and non-TB-related deaths.

Sodium-glucose cotransporter-2 inhibitors improve clinical outcomes in patients with type 2 diabetes mellitus undergoing anthracycline-containing chemotherapy: an emulated target trial using nationwide cohort data in South Korea

Novel hypoglycemic agents, sodium-glucose cotransporter 2 inhibitors (SGLT2i), have shown protective effects against anthracycline (AC)-induced cardiotoxicity and exhibit partial anticancer effects in animal models. However, clinical evidence for this is scarce. This study aimed to evaluate whether SGLT2i improve the clinical outcomes of patients with type 2 diabetes mellitus (T2DM) undergoing AC-containing chemotherapy. A total of 81,572 patients who underwent AC chemotherapy between 2014 and 2021 were recruited from a nationwide Korean cohort. Patients were classified into three groups: patients with T2DM taking SGLT2i (n = 780) and other hypoglycemic agents excluding SGLT2i (non-SGLT2i; n = 3,455) during AC chemotherapy, and the non-DM group (n = 77,337). The clinical outcome was a composite of heart failure hospitalization, acute myocardial infarction, ischemic stroke, and death. After propensity score matching, 779 SGLT2i users were compared with 7800 non-DM patients and 2,337 non-SGLT2i users. The SGLT2i group had better composite outcomes compared with the non-DM group (adjusted hazard ratio [HR] = 0.35, 95% confidence interval [95% CI] = 0.25–0.51) and compared with the non-SGLT2i group (adjusted HR = 0.47, 95% CI = 0.32–0.69). In conclusion, SGLT2i may contribute to improving clinical outcomes in patients with T2DM undergoing AC-containing chemotherapy, through an emulated target trial using Korean nationwide cohort data.

Does diabetes affect outcome or reoperation rate after lumbar decompression or arthrodesis? A matched analysis of the Quality Outcomes Database data set.

Diabetes mellitus (DM) is a known risk factor for postsurgical and systemic complications after lumbar spinal surgery. Smaller studies have also demonstrated diminished improvements in patient-reported outcomes (PROs), with increased reoperation and readmission rates after lumbar surgery in patients with DM. The authors aimed to examine longer-term PROs in patients with DM undergoing lumbar decompression and/or arthrodesis for degenerative pathology. The Quality Outcomes Database was queried for patients undergoing elective lumbar decompression and/or arthrodesis for degenerative pathology. Patients were grouped into DM and non-DM groups and optimally matched in a 1:1 ratio on 31 baseline variables, including the number of operated levels. Outcomes of interest were readmissions and reoperations at 30 and 90 days after surgery in addition to improvements in Oswestry Disability Index, back pain, and leg pain scores and quality-adjusted life-years at 90 days after surgery. The matched decompression cohort comprised 7836 patients (3236 [41.3] females) with a mean age of 63.5 ± 12.6 years, and the matched arthrodesis cohort comprised 7336 patients (3907 [53.3%] females) with a mean age of 64.8 ± 10.3 years. In patients undergoing lumbar decompression, no significant differences in nonroutine discharge, length of stay (LOS), readmissions, reoperations, and PROs were observed. In patients undergoing lumbar arthrodesis, nonroutine discharge (15.7% vs 13.4%, p < 0.01), LOS (3.2 ± 2.0 vs 3.0 ± 3.5 days, p < 0.01), 30-day (6.5% vs 4.4%, p < 0.01) and 90-day (9.1% vs 7.0%, p < 0.01) readmission rates, and the 90-day reoperation rate (4.3% vs 3.2%, p = 0.01) were all significantly higher in the DM group. For DM patients undergoing lumbar arthrodesis, subgroup analyses demonstrated a significantly higher risk of poor surgical outcomes with the open approach. Patients with and without DM undergoing lumbar spinal decompression alone have comparable readmission and reoperation rates, while those undergoing arthrodesis procedures have a higher risk of poor surgical outcomes up to 90 days after surgery. Surgeons should target optimal DM control preoperatively, particularly for patients undergoing elective lumbar arthrodesis.

Prevalence and a correlation analysis of discoid meniscus and femoral trochlear dysplasia

BackgroundDiscoid meniscus (DM) and femoral trochlear dysplasia (FTD) are common knee disorders. Both as congenital malformation, whether there is a connection between them is unclear and the research on their prevalence in the general population is inadequate. This study aimed to investigate the prevalence of FTD and DM in the general population through a large sample size, and to explore the relationship between them.Study designRetrospective study.MethodsPatients undergoing knee magnetic resonance imaging (MRI) examinations at our outpatient clinic were screened and 1003 patients were enrolled in DM group with 989 patients in non-DM (NDM) group. The type of DM and FTD was classified with Watanabe classification and Dejour’s classification, respectively. The prevalence of FTD and DM in the general population and the relationship between them were evaluated.ResultsThe prevalence of DM and FTD was 10.0% and 14.5%, respectively. The overall percentage of FTD was higher in DM group (P < 0.001). The DM group has a higher percentage of all types of FTD except type D (P < 0.05), and a higher percentage of both low- and high-grade FTD (P < 0.001). There were 633 cases of type I DM and 370 cases of type II DM. The overall percentage of FTD was not significantly different between the two types (P = 0.106). No significant difference was detected for all types of FTD except type B (P < 0.05). The Type I DM group has a significant higher percentage of high-grade FTD than Type II group (P < 0.05).ConclusionPatients with a DM are more likely to have FTD regardless of the type of DM, while those with a type I DM are more prone to have a high grade FTD.

The Effect of Diabetes Mellitus on Cardiac Remodeling and Overall Clinical Outcomes in Patients With Acute Myocardial Infarction: A Single-Center Retrospective Study in Saudi Arabia.

Diabetes mellitus (DM) is a major chronic condition that is considered a strong indicator of poor cardiovascular outcomes, such as recurrent infarction and heart failure (HF), in individuals with acute myocardial infarction (AMI). However, the concept of left ventricular remodeling (LVR)following AMI in DM patients is not well understood and studied in Saudi Arabia. Thus, the aim of this study is to assess the association between LVR and DM in patients presenting with ST-elevation myocardial infarction (STEMI) who had reperfusion therapy with optimal medical therapy after percutaneous coronary intervention (PCI). In this retrospective cohort study, 171 patients diagnosed with AMI who visited King Faisal Cardiac Center in King Abdulaziz Medical City, National Guard Hospital, Jeddah, Saudi Arabia, were chosen via the convenience sampling method. The study included patients with AMI who received echocardiograms upon admission and during a follow-up period of six to 12 months. The patients were divided into two groups based on their diabetic status: diabetic (DM) and non-diabetic (non-DM). To collect the data, trained medical students supervised by the principal investigator used the patients' medical records. The study showed that DM patients were more likely to have a history of hypertension, dyslipidemia, smoking, and stress hyperglycemia and had a higher hospitalization rate compared to the non-DM group. Although there was no statistically significant difference (p=0.253), both groups had a higher incidence of the left main trunk and/or left anterior descending artery affected. Regarding the echocardiographic finding, there were no significant differences between the two groups in terms of left ventricular ejection fraction, left ventricular internal diameter at end-diastole, left ventricular internal diameter at end-systole, and interventricular septum thickness. This paper suggests that there is no significant correlation between DM and non-DM patients in terms of LVR after AMI. However, DM patients had a statistically significant increased risk of developing HF and valvular heart disease compared to non-DM patients after AMI.

Neovascularization restructuring patterns in diabetic patients with coronary in stent restenosis an in-vivo optical coherence tomography study

Abstract Background Patients with diabetes mellitus (DM) have an increased risk of in stent restenosis (ISR). Neovascularization (NV) is considered as a unique phathophysiological factor of ISR in diabetic patients. However, the structures of in vivo human coronary NV and their relationship with ISR, especially in diabetic patients remain unclear. In this study, we aimed to investigate the NV structure differentiation between patients with and without DM after coronary stent implantation using optical coherence tomography (OCT). Methods We included 136 patients with ISR (70 patients in DM group and 66 patients in non-DM group) who underwent optical coherence tomography during coronary angiography follow-up. NVs were manually segmented and three-dimensional (3D) rendering of OCT images was performed. NVs &amp;gt;1 mm were classified into longitudinal running and coral tree types according to their 3D structures. Results The popularity of the coral tree pattern NV in the DM group was 2.14-fold higher than in the non-DM group(p=0.012). 47.14% of patients in the DM group and 51.51% of patients in the non-DM group presented longitudinal NV (p = 0.610). The number of coral tree NV was relatively higher in DM patients than in the non-DM patients (p=0.019). However, the number of longitudinal NV showed no difference between the two group (p=0.872). The normalized NV volume of the DM group was significantly larger than the non-DM group (p=0.008). Normalized NV volume and DM were risk factors for coral tree NV formation in ISR lesions after adjustment for other factors. Conclusions NV with particular restructuring patterns, including longitudinal running and coral tree patterns, could be found in ISR lesions. NV with a coral tree pattern, which is leakier and more immature, is more frequently found in patients with DM. Accurate and feasible imaging modalities for NV might offer promising opportunities to evaluate NV and prevent progression of ISR in diabetic patients.Longitudinal running NV by OCT in neointA coral tree pattern NV in the non-calci

The relationship between diabetes, obesity and cardiovascular disease phenotypes: a UK Biobank cohort study

Abstract Background Obesity and diabetes mellitus (DM) frequently co-exist, yet their individual contributions to cardiovascular risk remain debated. Purpose We explored cardiovascular disease biomarkers, events and mortality in a large cohort stratified by body mass index (BMI) and DM. We hypothesised that DM with normal BMI is associated with a cardiovascular phenotype and event rate comparable to obesity without DM. Methods 451,355 UK Biobank participants were stratified by ethnicity-specific BMI categories (normal, overweight, obese) and DM status. We examined cardiovascular biomarkers including: carotid intima-media thickness (CIMT); arterial stiffness; left ventricular ejection fraction (LVEF) and cardiac contractility index (CCI). Poisson regression models estimated adjusted incidence rate ratios (IRR) for myocardial infarction, ischaemic stroke and cardiovascular death, with normal weight non-DM as comparator. Correlation matrices of Poisson model’s coefficients were used to assess correlations between covariates. Results 5% of participants had DM (10% normal weight, 34% overweight and 55% obese; versus 34%, 43% and 23%, respectively, in non-DM). In the non-DM group, overweight/obesity was associated with higher CIMT, arterial stiffness and CCI, and lower LVEF (p&amp;lt;0.05); these relationships were diminished in the DM group. Within BMI classes, DM was associated with adverse cardiovascular phenotype (p&amp;lt;0.05), particularly in the normal weight group. After 5,323,190 person-years follow-up, incident myocardial infarction, ischaemic stroke and cardiovascular mortality all rose across increasing BMI categories in the DM and non-DM groups (p&amp;lt;0.05). However, normal weight DM had higher cardiovascular mortality than obese non-DM (IRR 2.81 [95% confidence interval: 2.24-3.54] vs IRR 1.84 [1.70-1.98]). Pairwise correlation analysis demonstrated the strongest correlates of cardiovascular parameters were markers of adiposity; this was apparent in the DM and non-DM groups, although these remained modest with Pearson’s correlation coefficients of no more than 0.25. Conclusions Obesity and DM are additively associated with adverse cardiovascular biomarkers and mortality risk. Whilst adiposity metrics are more strongly correlated with cardiovascular biomarkers than diabetes-oriented metrics, both correlate weakly, suggesting other factors underpin the high cardiovascular risk of normal-weight diabetes. Ideal target range for metrics of adiposity may therefore be lower than currently proposed in people with DM.Table 1:Adjusted IRR of CV deathFigure 1:KM Curve for CV death

Comparison of plaque characteristics among different age groups in patients with acute coronary syndromes with or without diabetes

Abstract Background It has been reported that young patients with diabetes mellitus (DM) had a higher mortality rate after myocardial infarction. However, plaque characteristics among different age groups in patients with acute coronary syndromes (ACS) with or without DM are unknown. Purpose The aim of this study was to investigate the plaque characteristics among different age groups in ACS patients with or without DM in a large population. Methods Patients who presented with ACS and underwent preintervention OCT imaging were included. The culprit plaque was categorized as plaque rupture (PR), plaque erosion (PE) or calcified plaque (CP), and stratified by 5 age groups. Features of plaque vulnerability were also analyzed. Results Among 1394 patients, 482 (34.6%) had DM. DM patients had a higher prevalence of lipid-rich plaque (71.2% vs. 64.8%, p=0.016), macrophage (72.0% vs. 62.6%, p&amp;lt;0.001), and cholesterol crystal (27.6% vs. 19.7%, p&amp;lt;0.001) than non-DM patients. Non-DM patients showed a significant ascending trend with age in PR (p=0.004), lipid-rich plaque (p=0.018), whereas DM patients had a high prevalence of these vulnerable features at early age, which plateaued across the different age groups. Both DM and non-DM groups showed a significant decreasing trend in PE with age (non-DM patients, p&amp;lt;0.001; DM patients, p=0.020). Conclusions DM patients had a high prevalence of lipid-rich plaque and a high incidence of plaque rupture at early age. This pattern persisted across the different age groups.

Diabetes mellitus and latent tuberculosis infection: an updated meta-analysis and systematic review

BackgroundPrevious studies have demonstrated an association between diabetes mellitus (DM) and latent tuberculosis infection (LTBI). This study was conducted to update the current understanding of the association between DM and LTBI. By conducting a systematic review and meta-analysis using adjusted odds ratios (aOR) or risk ratios (aRR), we aimed to further explore the association between DM and LTBI and provide essential reference for future research.MethodsWe conducted comprehensive searches in Embase, Cochrane Library, and PubMed without imposing any start date or language restrictions, up to July 19, 2022. Our study selection encompassed observational research that compared from LTBI positive rates in both DM and non-DM groups and reported aRR or aOR results. The quality of the included studies was assessed utilizing the Newcastle–Ottawa Scale. Pooled effect estimates were calculated using random-effects models, along with their associated 95% confidence intervals (CI).ResultsWe included 22 studies involving 68,256 subjects. Three cohort studies were eligible, with a pooled aRR of 1.26 (95% CI: 0.71–2.23). Nineteen cross-sectional studies were eligible, with a pooled aOR of 1.21 (95% CI: 1.14–1.29). The crude RR (cRR) pooled estimate for three cohort studies was 1.62 (95% CI: 1.03–2.57). Among the cross-sectional studies we included, sixteen studies provided crude ORs, and the crude OR (cOR) pooled estimate was 1.64 (95% CI: 1.36–1.97). In the diagnosis of diabetes, the pooled aOR of the HbA1c group was higher than that of self-reported group (pooled aOR: 1.56, 95% CI: 1.24–1.96 vs. 1.17, 95% CI: 1.06–1.28).ConclusionOur systematic review and meta-analysis suggest a positive association between DM and LTBI. Individuals with DM may have a higher risk of LTBI compared to those without DM. These findings provide important insights for future research and public health interventions in managing LTBI in diabetic populations.

Abstract 16295: Glucose Homeostasis and Frequency of Pre-Heart Failure in Hispanics/Latinos: Insights From the Echocardiographic Study of Latinos (ECHO SOL)

BACKGROUND: Diabetes Mellitus (DM) is an independent risk factor for heart failure (HF), yet research on the association of glucose homeostasis with pre-HF is limited. We assessed glucose homeostasis longitudinally in relation to prevalent and incident pre-HF in the Echocardiographic Study of Latinos, Echo-SOL. Methods: Serial echocardiograms from 1595 adults (mean age 56.4 years), 61% female, from Echo SOL were analyzed on average 4.3 years apart. Prevalent pre-HF was defined as the presence of one of the following parameters: LVEF &lt;50%, global longitudinal strain &gt; -15%, diastolic dysfunction ≥ grade 1, left ventricular mass index &gt;115 in men/&gt;95 in women, relative wall thickness &gt;0.42. Glucose homeostasis was assessed at baseline (2008-2011) by fasting plasma glucose (FGP), oral glucose tolerance test (OGTT), and hemoglobin A1C (A1C) and categorized as normal glucose tolerance [NGT]: FPG&lt;100 mg/dL, OGTT &lt;140 mg/dL, and A1C &lt;5.7%; prediabetes [PDM]: FPG 100-125 mg/dL, OGTT 140-199 mg/dL, or A1C 5.7-6.4%. Among those with prevalent DM, controlled DM [CDM] was defined as A1C &lt;7%, and uncontrolled DM [UDM] as A1C &gt;7%. Incident pre-HF was assessed at visit 2 (2014-2017) among those free of pre-HF at visit 1. Complex survey design is accounted for in all analyses. Results: Over time there was increased frequency of UDM with decreased frequency of NGT (Figure) . Prevalent pre-HF (72.5% overall) gradually increased as glucose homeostasis worsened: 50.5% NGT, 69.2% PDM, 78.3% CDM, 86% UDM, p value &lt;0.05. Incident pre-HF (56.2% overall) occurred more frequently among baseline dysregulated glucose categories: 65.5% PDM, 71.3% UDM, p value &lt;0.05. CONCLUSION: Pre-HF rates, in both the non-DM and DM groups, increase with worsening and uncontrolled glucose homeostasis. Early detection of antecedent PDM stages and uncontrolled diabetes may offer opportunities to prevent clinical HF.

Abstract 13859: The Omics Signature of Human Pericardial Fluid Exosomes Reveals the Therapeutic Potential of APAF-1 Inhibition in Ischemic Heart Disease

Background: The human pericardial fluid (PF) contains heart-derived small extracellular vesicles (sEVs) able to induce vascular responses via microRNA (miR) transfer. People with diabetes (DM) are particularly at risk of severe ischemic heart disease (IHD) and might require personalized therapeutic treatment. Hypothesis: The PF-sEVs molecular profiling supports the identification of clinical-relevant therapeutic targets. Aims: 1) To characterize PF-sEVs of IHD patients with/out type-2 DM (T2DM) in comparison to controls; 2) to validate the emerging therapeutic target candidates. Methods: PF samples (n=12/group) were collected during cardiac surgeries, namely CABG (for IHD with/out DM groups) and mitral valve repair (non-IHD, non-DM control group). sEVs were prepared (SEC), quality controlled (Nanosight and Exoview) and submitted to untargeted proteomics and microRNA array (Exiqon) or validation experiments. miRNA-target prediction methods and integration of proteomics and transcriptomics via networks identified differentially expressed pathogenic proteins and their putative endogenous miRNA regulators. The emerging dysregulated miRNA/protein axis was investigated in vitro and in mice with myocardial infarction (MI) and with/out diet-induced T2DM. Results: the PF-EVs of IHD patients with DM showed increased APAF-1 and reduced let-7b-5p, a miR which we have demonstrated to repress APAF-1 by direct 3’-UTR-binding. Exposure of endothelial cells (ECs) to DM and IHD-mimicking culture conditions increases APAF-1 level, triggering apoptosis and reducing angiogenesis. The phenotype of ECs kept under disease-mimicking conditions was rescued by APAF-1 silencing (siRNAs) and by supplementation with either healthy PF-EV or LNPs carrying let-7b-5p as sole miR cargo. The synthetic APAF-1 inhibitor ZYZ-488 improved post-MI cardiac function (Vevo3100 echocardiography), increased capillary density and reduced EC apoptosis in the peri-infarct area of diabetic and non-diabetic mice of both sexes. Conclusions: PF-EVs represent a novel and privileged source for the discovery of clinical-relevant therapeutic targets. APAF-1 inhibition holds value for post-ischemic cardiac protection and repair, including in diabetic people.

The impact of Diabetes in patients with lumbar stenosis – A propensity-score matched study on patient-reported outcomes after surgery

Study designRegistry-based cohort study. ObjectiveTo evaluate the impact of Diabetes (DM) on Patient-reported Outcomes (PROs) after surgery for lumbar spinal stenosis (LSS). MethodPatients from the Danish national spine registry, DaneSpine, scheduled for LSS surgery were identified. MRI of patients with and without DM was graded in regards to lumbar stenosis, disc degeneration (DD), muscular fat infiltration, and Modic changes. In addition, preoperative and two-year postoperative data were collected including PROs. Patients with DM were propensity-score matched (PSM) to non-DM patients. ResultsIn total, 296 patients were included, 41 DM and 255 non-DM. Of these, 27 patients from each group were successfully matched. The PSM DM group had less improvement and worse leg pain at two-year follow-up compared to the non-DM group, VAS 58 vs. 36 (p = 0.004). Physical disability was significantly worse at two-year follow-up in the DM group compared to the non-DM group, Oswestry Disability Index score of 38 vs. 29 (p = 0.05). On the preoperative MRI, the number of patients with severe grade LSS and severe fat infiltration in Multifidus muscles was significantly higher in the PSM DM group compared to the non-DM group, (p < 0.01). ConclusionPatients with concomitant LSS and DM have a significantly reduced improvement in leg pain, more physical disability, and worse leg pain scores at two-year follow-up post-surgery compared to patients without DM. In elderly patients with LSS, there should be an increased focus on DM and the clinically relevant threshold for spine surgery.

Effects of Liver Fibrosis on Islet Function in Patients with Chronic Hepatitis B Complicated with Impaired Fasting Glucose.

Patients with chronic hepatitis B (CHB) and cirrhosis often have impaired fasting glucose (IFG). This study sought to investigate the impact of liver fibrosis on islet function in individuals diagnosed with CHB and IFG. Patients with chronic hepatitis B (CHB) and impaired fasting glucose (IFG) were selected for this study. They were divided into low-risk (L-R), intermediate-risk (M-R), and high-risk (H-R) liver fibrosis groups based on the FIB-4 score. The study compared islet function among different risk groups of liver fibrosis and analyze the correlation between liver fibrosis and islet function. Additionally, the patients were divided into a diabetes mellitus (DM) group and a non-DM (NDM) group based on the development of DM. The cumulative risk of progression to DM in patients with L-R, M-R, and H-R liver fibrosis was analyzed using the Kaplan-Meier method. Hazard ratios (HRs) and confidence intervals (CIs) were calculated for DM development through Cox regression analysis. In this study of 228 individuals, higher FIB-4 scores were observed in the DM group compared to the NDM group. Patients with H-R liver fibrosis displayed lower islet function and had a significantly higher risk of developing DM. The FIB-4 score and fasting plasma glucose (FPG) were identified as independent risk factors for DM progression in CHB patients with IFG. Among patients with CHB and IFG, the severity of liver fibrosis is associated with islet function, and the FIB-4 score is a significant risk factor for DM development.

Longitudinal associations of physical activity with inflammatory markers in US adults with and without type 1 diabetes

AimsTo investigate the longitudinal associations of different levels of moderate-to-vigorous physical activity (MVPA) with C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), and fibrinogen. MethodsWe conducted longitudinal analyses with data from the Coronary Artery Calcification in T1D (CACTI) cohort, which included individuals with type 1 diabetes (T1D, n = 563) and without diabetes mellitus (non-DM, n = 692) with ∼ 3 years follow-up. Individuals were divided into groups to perform two analyses: 1) those who performed any MVPA and those who were sedentary (0 mins/week) and 2) those who performed 1–149 mins/week, ≥150 mins/week, or who were sedentary. Mixed effect models with an unstructured covariance structure were applied. ResultsCompared to sedentary individuals, any MVPA was associated with a −2.96 % decrease in fibrinogen (p-value = 0.0043) and a −11.23 % decrease in PAI-1 (p-value = 0.0007) in combined analyses. Stratified analyses found 1–149 mins/week and ≥ 150 mins/week were associated with significant decreases in fibrinogen, −5.31 % and −3.44 %, respectively, in those with T1D. Both the non-DM and T1D groups had significant decreases in PAI-1 associated with ≥ 150 mins/week (-9.11 % and −16.96 %, respectively). ConclusionsOur findings highlight that meeting ≥ 150 mins/week of MVPA is inversely associated with inflammatory markers linked with increased CVD risk.

The impact of diabetes mellitus on hematopoietic stem cell mobilization, a-single center cohort study

BackgroundFactors such as age, underlying hematological disease, chemotherapy and radiotherapy used, and bone marrow infiltration may cause mobilization failure. Several preclinical observed that diabetes mellitus (DM) leads to profound remodeling of the hematopoietic stem cell (HSC) niche, resulting in the impaired release of HSCs. We aim to examine the effect of DM on HSC mobilization and to investigate whether there is a relationship between complications developing in the DM process and drugs used to treat DM and mobilization failure. MethodsIn Erciyes University Bone Marrow Transplantation Unit, 218 patients who underwent apheresis for stem cell mobilization between 2011 and 2021 were evaluated retrospectively. One hundred and nine patients had a diagnosis of DM, and 109 did not. ResultsMobilization failure developed in 17 (15.6 %) of the patients in the DM group, while it developed in 7 (6.4 %) patients in the non-DM group (p = 0.03). CD34+ stem cell count was 8.05 (1.3–30.2) × 106/kg in the DM group, while it was 8.2 (1.7–37.3) × 106/kg in the other group (p = 0.55). There was no statistically significant relationship between glucose and hemoglobin A1c levels and the amount of CD34+ cells (p = 0.83 and p = 0.14, respectively). Using sulfonylurea was the only independent predictor of mobilization failure (OR 5.75, 95 % CI: 1.38–24.05, p = 0.02). ConclusionDM should be considered a risk factor for mobilization failure. Further research is needed fully to understand the mechanisms underlying the mobilization failure effects of sulfonylureas and to develop strategies to improve stem cell mobilization in diabetic patients.

Vitamin D Levels and Diabetes Mellitus: A Study on Age, Sex, and Body Mass Index

Objective: The correlation between Body Mass Index (BMI) and vitamin D levels has garnered considerable attention in contemporary medical investigations. Vitamin D, an essential fat-soluble micronutrient, significantly influences bone health, immune system functionality, and various other physiological functions. The bioavailability of vitamin D may be affected by adiposity, which might result in possible deficits in persons with elevated body mass indices. The objective of this retrospective study conducted at a single center was to examine the potential relationship between BMI and diabetes mellitus (DM) with vitamin D serum levels in a cohort of 680 individuals, comprising 511 females and 169 males. Methods: The present study utilized a methodology in which medical records from a single facility were comprehensively reviewed to collect relevant information on BMI and blood 25-hydroxyvitamin D [25(OH)D] levels. The participants were classified into four distinct groups based on their BMI categories, which included normal weight, overweight, obese, and morbidly obese. Statistical methods were employed to investigate the relationship between BMI, diabetes mellitus (DM), age, and 25-hydroxyvitamin D (25(OH)D) levels. Furthermore, multivariate regression analysis was conducted to account for potential confounding variables such as age and gender. Results: The study included a sample of 680 individuals, comprising 511 women (75.1%) with an average age of 41 (±12) and 169 men (24.9%) with an average age of 38 (±13). Vitamin D levels in women were found to be 14±7 ng/mL, while in men, the levels measured at 16.6±7 ng/mL. The study identified a statistically significant difference in vitamin D levels between women and men (p&lt;0.001). The study's findings indicate that there was no significant correlation between vitamin D levels and age among all individuals (p=0.258). However, a significant albeit weak correlation was observed between vitamin D levels and BMI (p=0.002, R2=0.0141). The vitamin D levels of the obese group were measured to be 14±7 ng/mL, while the non-obese group had levels of 16±7 ng/mL. Statistical analysis revealed that vitamin D levels in the obese group were significantly lower compared to the non-obese group (p=0.012). When comparing vitamin D levels between individuals with and without diabetes mellitus (DM), it was observed that the mean vitamin D level was 13.8±6.3 ng/mL in the non-DM group and 16.6±7.6 ng/mL in the DM group. Statistical analysis revealed that vitamin D levels were significantly higher in the DM group (p=0.012). Conclusion: Our study's findings suggest a potential connection between low vitamin D levels and obesity, while factors such as diabetes, age, and gender do not seem to significantly impact this association.

Effect of pre-operative HbA1c and blood glucose level on the surgical site infection after lumbar instrumentation surgery

BackgroundThis study aims to investigate the effect of pre-operative hemoglobin A1c (HbA1c) and pre-operative blood glucose control on the rate of surgical site infection (SSI) after posterior lumbar instrumentation surgery in diabetes mellitus (DM) patients. MethodsA total of 1046 patients who had undergone posterior lumbar instrumentation surgery were reviewed. Based on pre-operative HbA1c, patients were divided into three groups: non-DM group, low HbA1c group (HbA1c < 7.0 % in DM) and high HbA1c group (≥7.0). As well, based on the status of blood glucose control in DM patients immediately before surgery, patients were divided into two groups: good control group (post-prandial blood glucose [PBG] < 200 mg/dl) and poor control group (≥200). The rate of SSI was compared among these groups. ResultsSSI occurred in 1.9 % in non-DM group, 2.4 % in low HbA1c group, and 9.3 % in high HbA1c group. Compared with non-DM group, high HbA1c group had significantly higher rate of SSI (p = 0.001). There was not statistically different between non-DM and low HbA1c groups (p = 0.550). SSI occurred in 2.2 % in good control group, and 10.2 % in poor control group. The rate of SSI was significantly lower in good control group (p = 0.013). ConclusionThis study showed that the rate of SSI after posterior lumbar instrumentation surgery tend to be higher in DM patients with high HbA1c. However, the rate might be reduced to the same level as that of non-DM group by lowering PBG to <200 mg/dl immediately before surgery.

Systemic Inflammatory Mediator Levels in Non-Proliferative Diabetic Retinopathy Patients with Diabetic Macular Edema

Purpose To study the systemic inflammatory mediator levels in non-proliferative diabetic retinopathy (NPDR) patients with diabetic macular edema (DME) and explore the correlation between systemic inflammatory mediators and DME. Methods In this prospective study, we included 25 patients without diabetes (control group) and 75 patients with type 2 diabetes mellitus (diabetic group). According to fundus examination, the diabetic group patients were divided into: diabetic patients without diabetic retinopathy (DR) (Non-DR group), NPDR patients without DME (Non-DME group), and NPDR patients with DME (DME group). Serum levels of a broad panel of inflammatory mediators were analysed by multiplex protein quantitative detection technology based on a flow cytometry detection system. Results The interferon-γ (IFN-γ) levels were significantly higher in DME group and Non-DME group as compared to control group (p = 0.023 and p = 0.033) and Non-DR group (p = 0.009 and p = 0.015). Significantly higher values were obtained in DME group and Non-DME group as compared to control group for the interleukin-8 (IL-8) (p = 0.003 and p = 0.003). The IL-23 levels were significantly elevated in DME group and Non-DR group than in Non-DME group (p = 0.013 and p = 0.004). The diabetic group had significantly higher serum levels of IL-8 and IL-33 (p = 0.001 and p = 0.011), and lower serum levels of tumor necrosis factor-α (TNF-α) (p = 0.027) in comparison with control group. Conclusions The changed levels of serum inflammatory mediators suggest that the systemic inflammatory mediators are involved in the pathogenesis of NPDR patients with DME. Such effects can guide clinical monitoring, diagnostic and therapeutic approaches for DME patients at an early stage.

Diabetes related phenotypes and their influence on outcomes of patients with corona virus disease 2019 (COVID-19)

IntroductionDiabetes mellitus (DM) is associated with severe forms of COVID-19 but little is known about the diabetes—related phenotype considering pre-admission, on-admission and data covering the entire hospitalization period.MethodsWe analyzed COVID-19 inpatients (n = 3327) aged 61.2(48.2–71.4) years attended from March to September 2020 in a public hospital.ResultsDM group (n = 1218) differed from Non-DM group (n = 2109) by higher age, body mass index (BMI), systolic blood pressure and lower O2 saturation on admission. Gender, ethnicity and COVID-19-related symptoms were similar. Glucose and several markers of inflammation, tissue injury and organ dysfunction were higher among patients with diabetes: troponin, lactate dehydrogenase, creatine phosphokinase (CPK), C-reactive protein (CRP), lactate, brain natriuretic peptide, urea, creatinine, sodium, potassium but lower albumin levels. Hospital (12 × 11 days) and intensive care unit permanence (10 × 9 days) were similar but DM group needed more vasoactive, anticoagulant and anti-platelet drugs, oxygen therapy, endotracheal intubation and dialysis. Lethality was higher in patients with diabetes (39.3% × 30.7%) and increased with glucose levels and age, in male sex and with BMI < 30 kg/m2 in both groups (obesity paradox). It was lower with previous treatment with ACEi/BRA in both groups. Ethnicity and education level did not result in different outcomes between groups. Higher frequency of comorbidities (hypertension, cardiovascular/renal disease, stroke), of inflammatory (higher leucocyte number, RCP, LDH, troponin) and renal markers (urea, creatinine, potassium levels and lower sodium, magnesium) differentiated lethality risk between patients with and without diabetes.ConclusionsComorbidities, inflammatory markers and renal disfunction but not Covid-19-related symptoms, obesity, ethnicity and education level differentiated lethality risk between patients with and without diabetes.

Different effects of medications for hypertension on renal function between patients with and without diabetes mellitus undergoing percutaneous coronary intervention: a retrospective single-center cohort study

BackgroundDiabetes mellitus (DM) and hypertension are well-known atherosclerosis risk factors. Furthermore, renal dysfunction is a crucial risk factor for patients with coronary artery disease (CAD), and managing renal function in these patients is complicated because of comorbid conditions and potential side effects during treatment. Therefore, this study aimed to investigate the effect of medications for hypertension on renal function after percutaneous coronary intervention (PCI) between patients with and without DM with statins.MethodsIn 297 consecutive patients undergoing PCI for stable angina pectoris, cystatin C (CysC) was evaluated at baseline and 9 months after PCI, and the percent change in CysC (%CysC) was calculated. The association of worsening renal function (WRF: %CysC ≥ 0) and baseline characteristics, including medications, was assessed.ResultsAmong 297 hypertensive patients with statins, 196 and 101 were with and without DM, respectively. Angiotensin-converting enzyme inhibitor (ACEI), angiotensin II receptor blocker, and β-blocker were prescribed in 56 (29%), 82 (42%), and 91 (46%) patients in the DM group, and 20 (20%), 52 (51%), and 52 (51%) in the non-DM group, respectively. The patients with WRF after PCI were 100 (51%) and 59 (58%) in the DM and non-DM groups (p = 0.261). Additionally, the %CysC had no significant differences between groups [median: 0%, interquartile range (IQR): -7.9% to 8.5% vs. median: 1.1%, IQR: -6.6% to 9.6%, p = 0.521]. Multivariate logistic analysis for WRF using relevant factors from univariate analysis showed that only β-blocker [odds ratio (OR): 2.76, 95% confidence interval (CI): 1.03–7.90, p = 0.048] was independently associated with WRF in the DM group whereas ACEI (OR: 0.07, 95% CI: 0.01–0.47, p = 0.012) was negatively correlated with WRF in the non-DM group.ConclusionThe β-blocker was the independent risk factor for WRF in patients with DM in the late phase after PCI for stable angina pectoris, while the use of ACEI had a renoprotective effect in patients without DM.