non-DM Group Research Articles

Primary Percutaneous Coronary Intervention in Patients With Type 2 Diabetes With Late/Very Late Stent Thrombosis and de novo Lesions: A Single-Center Observational Cohort Study of Clinical Outcomes and Influencing Factors.

Background: This study compared differences in the risk factors and clinical outcomes of primary percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) and non-DM patients with de novo lesions (DNLs) and late or very late stent thrombosis (LST/VLST).Methods: We used angiography to screen 4,151 patients with acute coronary syndrome for DNL and LST/VLST lesions. Overall, 3,941 patients were included in the analysis and were allocated to the DM (n = 1,286) or non-DM (n = 2,665) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke, within a median follow-up period of 698 days.Results: In the group with a total white blood cell count >10 × 109/L (P = 0.004), a neutral granular cell count >7 × 109/L (P = 0.030), and neutrophil–lymphocyte ratio >1.5 (P = 0.041), revascularization was better for DNL than for LST/VLST lesions. Among DM patients with DNLs, each unit increase in age was associated with a 53.6% increase in the risk of MACEs [hazard ratio (HR): 1.536, 95% confidence interval (CI), 1.300–1.815, P < 0.0001]. Older age (≥65 years) was associated with a significantly greater risk of MACEs (P < 0.0001). Furthermore, each standard deviation (SD) increase in the level of peak white blood cell counts was associated with a 50.1% increase in the risk of MACEs (HR, 1.501; 95% CI, 1.208–1.864; P = 0.0002). When stratifying the DM population with DNLs according to the D-dimer baseline and peak levels <0.5 vs. ≥0.5 mg/L, the high D-dimer group at baseline had a 2.066-fold higher risk of MACEs (P < 0.0001), and the high peak level D-dimer group had a 1.877-fold higher risk of MACEs (P = 0.001) compared to the low-level groups. Among DM patients with LST/VLST, each unit increase in age was associated with a 75.9% increase in the risk of MACEs (HR: 1.759, 95% CI, 1.052–2.940, P = 0.032). Furthermore, for each SD increase in the peak D-dimer level, the risk of MACEs increased by 59.7% (HR, 1.597; 95% CI, 1.110–2.295; P = 0.041).Conclusion: Following successful primary PCI, the measurement of baseline and peak D-dimer values may help identify individuals at high cardiovascular risk. This suggests a potential benefit of lowering D-dimer levels among T2DM patients with DNL. Furthermore, age and the peak D-dimer values may facilitate the risk stratification of T2DM patients with LST/VLST.

Diabetes mellitus aggravates ranolazine-induced ECG changes in rats.

Diabetes mellitus (DM) is known to affect the pharmacokinetics of drugs. In this study, we evaluated the effect of DM on the liver content of CYP 3A2 enzyme. We also explored the ECG changes after administration of ranolazine in non-DM and DM rats. First phase: 24 male Wistar rats were separated into 4 groups. The control group (n = 6) received normal saline and the DM groups (n = 18) were treated with a single dose (55mg/kg) of streptozocin (STZ; i.p. injection), then were held for 10, 20, and 30days, respectively. After study duration for each group, the liver CYP 3A2 protein content was determined using western blotting. Second phase: 48 male Wistar rats were classified into two groups of non-DM and DM; and each group was divided into 4 subgroups (n: 6). Experimental groups received oral doses of 20, 40, and 80mg/kg ranolazine. DM and non-DM control groups received normal saline. Treatment lasted for 28days, and then the ECG was recorded. Experimental DM induced by STZ caused a significant decrement in liver CYP3A2 protein content of rats on days 10 and 20 (P < 0.01), and 30 (P < 0.05) compared to the control animals. Significant increases in QT and corrected QT (QTc) intervals (P < 0.01), and bradycardia (P < 0.01) without any significant effect on PR and QRS intervals were observed in DM in comparison with non-DM groups after ranolazine treatment. In summary, DM induction in animals resulted in CYP 3A2 inhibition and the prolongation of QT and QTc interval as well as bradycardia after ranolazine treatment.

The Influence of Diabetes Mellitus on Rotator Cuff Repair: A Systematic Review and Meta-Analysis.

Clinical outcomes after rotator cuff repair associated with diabetes mellitus (DM) are generally favorable, but no study has attempted to establish the influence of DM on outcomes after rotator cuff repair. To conduct a meta-analysis of clinical studies evaluating patient outcomes between people with DM and people without DM after rotator cuff repair. Meta-analysis. A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies about clinical outcomes after rotator cuff repair comparing people with DM and people without DM were included. Statistical analysis was performed with RevMan (v 5.3.3). Nine clinical studies that met the inclusion criteria were identified and included a total of 314 patients treated with DM and 1092 patients without DM. The failure rate was significantly higher in the DM group than in Non-DM group (23.97% compared with 16.60%, OR: 2.39; 95% CI, 1.69-3.37; p < 0.001). The postoperative retear rate and showed a significant difference between the two groups (24.5% and 13.7%; OR: 2.41; 95% CI, 1.57-3.71; p<0.001). The DM group showed a higher rate of postoperative unhealed cuff than the Non-DM group(41.81% and 25.23%; OR: 2.14; 95% CI, 1.69-3.37; p=0.01).Postoperative Range of motion(ROM) at 12 months after surgery show a significant difference in the range of external rotation between two groups (WMD: -6.02; 95% CI, -7.54 to -4.50; p<0.001). The preoperative Japanese Orthopaedic Association (JOA) score, the comparison of pre- and post-operative JOA scores showed a significant difference in the DM and Non-DM group(p<0.001). The postoperative JOA score, the pre- and post-operative muscle strength, the pre- and post-operative visual analog scale (VAS) show significant difference between the DM and Non-DM group(p<0.001). The postoperative infection rates, the rates of postoperative shoulder stiffness, the preoperative ROM, the postoperative ROM at 6 months, the postoperative ROM at 12 months of forward flexion and abduction, the American Shoulder and Elbow Surgeons score, the University of California, Los Angeles scores, and the preoperative Constant-Murley scores show no significant difference between the two groups. This meta-analysis indicates that DM may be relative to a higher rate of shoulder retear and cuff unhealing. However, patients with DM can achieve great clinical outcomes after cuff repair, compared to patients without DM.

The impact of diabetes mellitus on spinal fracture with diffuse idiopathic skeletal hyperostosis: A multicenter retrospective study

BackgroundPatients with diffuse idiopathic skeletal hyperostosis (DISH) are susceptible to spinal column injuries with neurological deterioration. Previous studies indicated that the prevalence of diabetes mellitus (DM) in patients with DISH was higher than that in patients without DISH. This study investigates the impact of DM on surgical outcomes for spinal fractures in patients with DISH. MethodsWe retrospectively evaluated 177 spinal fractures in patients with DISH (132 men and 45 women; mean age, 75 ± 10 years) who underwent surgery from a multicenter database. The subjects were classified into two groups according to the presence of DM. Perioperative complications, neurological status by Frankel grade, mortality rate, and status of surgical site infection (SSI) were compared between the two groups. ResultsDM was present in 28.2% (50/177) of the patients. The proportion of men was significantly higher in the DM group (DM group: 86.0% vs. non-DM group: 70.1%) (p = 0.03). The overall complication rate was 22.0% in the DM group and 19.7% in the non-DM group (p = 0.60). Poisson regression model revealed that SSI was significantly associated with DM (DM group: 10.0% vs. non-DM group: 2.4%, Relative risk: 4.5) (p = 0.048). Change in neurological status, mortality rate, instrumentation failure, and nonunion were similar between both groups. HbA1c and fasting blood glucose level (SSI group: 7.2% ± 1.2%, 201 ± 67 mg/dL vs. non-SSI group: 6.6% ± 1.1%, 167 ± 47 mg/dL) tended to be higher in patients with SSI; however, there was no significant difference. ConclusionsIn spinal fracture in patients with DISH, although DM was an associated factor for SSI with a relative risk of 4.5, DM did not negatively impact neurological recovery. Perioperative glycemic control may be useful for preventing SSI because fasting blood glucose level was high in patients with SSI.

208-OR: Fat Mass and Insulin Resistance Are Independent Risk Factors for Polyneuropathy in Non-DM Subjects Who Underwent Bariatric/Metabolic Surgery

Background: Obesity is an important risk factor for polyneuropathy (PN) in subjects with DM. However, PN can be detected in subjects without overt DM but with risk factors for DM such as metabolic syndrome. Therefore, it is worthy to investigate the prevalence of PN in obese subjects and to discover the underlying mechanisms of the association between obesity and PN. Methods: We analyzed the data of 184 subjects who underwent bariatric/metabolic surgery. PN was diagnosed when a Michigan Neuropathy Screening Instrument score was ≥ 2.5. Total body fat mass and percentage were measured by bioimpedance analysis, and visceral fat area (VFA) was quantified by computed tomography. According to DM status, obesity-related parameters were compared between subjects with PN and those without PN. The association between obesity-related parameters and PN was analyzed using logistic regression models. Results: Of 184 subjects (mean age, 39.1 years; mean BMI, 38.6 kg/m2), 39.7% were diagnosed with DM. The prevalence of PN was 9.0% in non-DM group and 21.9% in DM group. In non-DM group, subjects with PN showed higher HOMA-IR, fat mass, and VFA compared with those without PN. HOMA-IR (OR, 1.492; 95% CI, 1.110-2.005), fat mass (OR, 1.087; 95% CI, 1.008-1.171), and VFA (OR 1.013; 95% 1.001-1.024) were significantly associated with PN even after adjustment of known risk factors of PN. In DM group, subjects with PN showed higher body weight, BMI, waist circumference, and VFA compared with those without PN. However, after adjustment of known risk factors of PN, these obesity related parameters were not significantly associated with PN. Conclusion: Fat mass and insulin resistance might be independent risk factors in development of PN for obese subjects without DM. PN evaluation might be necessary in subjects with morbid obesity even before development of overt DM, and we need to investigate whether weight loss intervention can prevent or delay PN in obese subjects. Disclosure K. Kim: None. T. Oh: None. S. Choi: None. H. Jang: None.

MO838PARAOXONASE 1 GENE POLYMORPHISMS CONCERNING CARDIOVASCULAR MORTALITY IN CIGARETTE SMOKERS AND NON-SMOKERS TREATED WITH HEMODIALYSIS

Abstract Background and Aims Paraoxonase 1 gene (PON1) single nucleotide variants (SNVs), known as associated with lipoprotein peroxidation, are related to atherosclerotic diseases, including coronary heart disease (CHD). Cigarette smoking, causing increased susceptibility to lipoprotein oxidation, contributes to cardiovascular events, and its effects are linked with PON1 SNVs. We investigated the association of PON1 rs705379 (-108C&amp;gt;T), rs854560 (163A&amp;gt;T), and rs662 (575A&amp;gt;G) SNVs with cardiovascular mortality in maintenance hemodialysis (HD) patients concerning cigarette smoking status. Method In the HD group, there were 206 smokers and 659 non-smokers. Among all patients who died (n = 542), cardiovascular mortality was similar in smokers and non-smokers (59.0% vs. 59.3%, respectively). Deceased smokers were burning 20 (5 - 25) cigarettes daily. We obtained PON1 polymorphisms by HRM analysis (rs662) or predesigned TaqMan SNV Genotyping Assay (rs854560, rs705379). All cardiovascular, cardiac, CHD- and non-CHD-related deaths were analyzed in smokers and non-smokers concerning PON1 SNVs and DM status. The Kaplan-Meier method with the log-rank test and the Cox regression analyses were applied for the estimation of survival. If computed P-values were below 0.05, the adjustment for sex, age, and HDL-cholesterol was applied. We have shown only adjusted P-values for survival analyses. Results HD cigarette smokers, who died from cardiovascular diseases, were younger (63.5, 31.1 – 86.3 vs. 74.0, 26.8 – 95.9 years, P = 2.992e-10), predominantly men (70, 85.3% vs. 91, 38.1%, P = 1.5e-13), had more atherogenic serum lipid profile (atherogenic index estimated as the TG/HDL cholesterol ratio 4.90, 0.72 – 25.6 vs. 3.79, 0.66 – 49.7, P = 0.003; HDL-cholesterol level 34.8, 17.3 – 103 vs. 40.0, 7 – 103 mg/dL, P = 0.0004; TG 167.0, 48.8 – 652 vs. 149.8, 40.0 – 856 mg/dL, P = 0.034), but similar RRT duration compared to deceased HD non-smokers. Cigarette smoking status did not influence cardiovascular mortality either in DM or non-DM group. DM smokers showed similar cardiovascular mortality to non-DM smokers, but among HD non-smokers, DM patients demonstrated higher cardiovascular mortality than non-DM subjects (P = 0.029). Among all smokers, the rs705379 TT genotype was associated with all cardiovascular (P = 0.028), all cardiac (P = 0.046), and cardiac non-related with CHD (P = 0.001) mortality. The rs705379 TT genotype smokers, who died from cardiac reasons, showed a higher frequency of myocardial infarction than CC+CT bearers (66.7% vs. 29.2%, P = 0.047). Non-DM smokers showed similar qualitative significance to all smokers concerning all cardiovascular, all cardiac, and cardiac non-related with CHD death rates (P-values 0.011, 0.044, and 0.009, respectively). In DM non-smokers, the rs705379 T allele correlated with CHD related deaths (P = 0.020). The rs854560 T allele, compared to the AA genotype, was associated with lower cardiovascular mortality in non-DM smokers (P = 0.008). The rs854560 TT genotype showed a negative correlation with cardiac death non-related to CHD in all non-smokers (P = 0.079). In DM smokers, the rs662 G allele was associated with a higher risk of cardiac mortality (P = 0.005). In all non-smokers and non-DM non-smokers, the rs662 G allele correlated with cardiovascular deaths (P = 0.020 and P = 0.018, respectively). Conclusion The variant alleles of PON1 rs705379 (T) and rs662 (G) are associated with cardiac mortality in HD patients. The rs854560 variant allele (T) possessors present better cardiovascular survival than the AA genotype subjects. Cardiovascular mortality is not merely related to polymorphic variants known as associated with lower serum activity or concentration of paraoxonase, a PON1 protein product. Assessing PON1 SNVs enables the prediction of cardiovascular mortality risk in HD smokers and non-smokers and may help select patients for advanced prevention against cardiovascular diseases.

Effect of diabetes mellitus on long-term outcomes of surgical revascularization in patients with ischemic heart failure: a propensity score-matching study.

Background:Diabetes mellitus (DM) is an important risk factor in the long-term outcomes of surgical revascularization. However, few studies have focused on patients with ischemic heart failure (IHF) and DM, and the results are controversial. This study aimed to evaluate the effect of DM on the long-term outcomes of IHF patients undergoing coronary artery bypass grafting (CABG).Methods:In this propensity-matched study, data of IHF patients who underwent CABG in our hospital from January 2007 to December 2017 were analyzed. With a mean 73-month follow-up time, the patients were divided into two groups according to whether they had DM. The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death, stroke, recurrent myocardial infarction, and revascularization.Results:There was no significant difference in all-cause mortality between the two groups (5.8% vs. 4.1%, P = 0.216). The incidence of main adverse cardiovascular and cerebrovascular events (MACCE) in the secondary endpoint was significantly higher in the DM group than that in the non-DM group (10.4% vs. 8.1%, P = 0.023).Conclusions:DM can negatively affect the long-term outcomes of IHF patients undergoing CABG by significantly increasing the overall incidence of MACCE, though the long-term survival does not show a significant difference between the DM and non-DM patients.

Type 2 diabetes and the risk of colorectal polyps: A retrospective nationwide population-based study.

The incidence rates of type 2 diabetes mellitus (T2DM) and colorectal polyps have been increasing over the last decades. However, direct associations between T2DM and colorectal polyps have not been extensively reported. We will explore the relationship between T2DM and colorectal polyps.In the retrospective study, we classified DM and NonDM groups (control) from 993,516 people in Taiwan nationwide population insurance database from the period of 2000 to 2013. We collected data on income and comorbidities through the international classification of diseases, ninth revision—clinical modification (ICD-9-CM) codes.The T2DM group had a higher incidence rate of colorectal polyps (31.97%, 95% confidence interval [CI] = 30.97–33.28) than the control group (25.9%, 95% CI = 25.1–26.72), and the crude incidence ratio was 1.235 (95% CI = 1.174–1.300). In 13 years of follow-up (2000–2013), T2DM was linked to a significantly higher cumulative probability of colorectal polyps (log-rank test: P = .0001).Patients with T2DM had a 1.23-fold higher risk of new colorectal polyps than control patients in 13 years of follow-up. We explain the T2DM increases incidence for colorectal polyps in long term follow-up.

Association of type 2 diabetes mellitus and mortality after coronary artery bypass graft surgery- a meta analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background- Recent studies have demonstrated the favorable cardiovascular outcomes of coronary artery bypass graft surgery (CABG) among patients with diabetes mellitus (DM). However, little is known regarding the impact of T2DM in patients undergoing CABG. We aimed to compare the long-term mortality following CABG in patients with and without T2DM. Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &amp;lt; 0.05.The primary outcome was all-cause mortality. Results-Sixteen studies with a total of 183,200 participants (DM = 51,474, Non-DM = 131,726) were included in our analysis. Average follow up was 3 years. Mean age was 56.7 and 54.8 in the DM and Non-DM groups respectively. A statistically significantly higher rate of mortality was observed in patients with T2DM (OR 1.54; 95%CI 1.40-1.69; p &amp;lt; 0.00001, I2 = 36)as opposed to patients without T2DM. Conclusion- Although CABG is the better revascularization strategy as opposed to PCI, Type 2 DM is an independent predictor for long-term mortality after CABG surgery. Abstract Figure.

Association between Diabetes Mellitus and Oral Health Status in Patients with Cardiovascular Diseases: A Nationwide Population-Based Study.

Diabetes mellitus (DM) can lead to poor oral health. However, oral health among diabetic patients with cardiovascular diseases (CVDs) is scarcely studied. This study aimed to elucidate the prevalence of oral health complications and the relationship between DM and oral health status in diabetic patients with CVDs. This retrospective nationwide cross-sectional study evaluated 3495 patients aged ≥40 years with CVD, with DM (n = 847) and without DM (n = 2648). The participant’s characteristics between the two groups were compared using the Chi-square test and t-test. Logistic regression analyses were performed to identify associations between DM and oral health status. The prevalence of periodontitis (54.3% vs. 43.2%) and <20 number of remaining teeth (30.9% vs. 22.8%) was significantly higher in the DM than in the non-DM group. In the multivariate regression analysis, the incidence of periodontitis was 1.4 times higher in the DM group than in the non-DM after adjusting for confounders; however, the number of remaining teeth and active caries were not associated with DM. In conclusion, the oral health status of patients with coexisting CVD and DM should be assessed closely and actively. Healthcare professionals should provide accessible dental care services and develop strategies to improve patients’ oral health.

Relation between Retinopathy and Progression of Coronary Artery Calcium in Individuals with Versus Without Diabetes Mellitus (From the Multi–Ethnic Study of Atherosclerosis)

Retinopathy is a microvascular complication of diabetes mellitus (DM); however, it is also increasingly recognized in persons without DM. The microvascular diseases may play a prominent role in coronary heart disease (CHD) development in individuals with DM. We performed the study to evaluate the relation between non-DM retinopathy and CHD and also the association between baseline retinopathy and incidence and progression of CHD in individuals with and without DM. We included 5709 subjects with and without DM from the Multi-Ethnic Study of Atherosclerosis, who had retinal photos and coronary artery calcium score (CACS) available. We studied the association between baseline retinopathy and incidence and progression of coronary artery calcification (CAC) in subjects with and without DM. In DM group, the presence of retinopathy was significantly associated with an increased rate of CAC (RR 1.3 (95% CI [1.02, 1.66]) after adjusting for age, sex, race, follow-up time, and CHD risk factors. In non-DM group, the presence of retinopathy was not significantly associated with increased risk of CAC, however, the interaction between presence of retinopathy and DM status was not statistically significant. Within the DM group with CAC present at baseline, the presence of retinopathy was significantly associated with greater CAC progression (113 Agatson units (AU) greater, (95% CI [51-174]). In the non-DM group with present CAC at baseline; the presence of retinopathy was associated with 24 (95% CI [-0.69, 48.76]) AU higher CAC progression. All findings were adjusted for CHD risk factors. In conclusion, after adjustment for major CHD risk factors, retinopathy was associated with progression of CAC in both DM and non-DM individuals. However, the association was stronger in those with DM.

Does diabetes mellitus predispose to both rotator cuff surgery and subsequent failure?

BackgroundDiabetes mellitus (DM) may be associated with the etiology of rotator cuff disease; however, its effect on healing after surgical rotator cuff repair (RCR) is not well characterized. The purposes of this study are to analyze the association between DM and surgical RCR, the association between DM and revision RCR after RCR, and the association between DM and the cost of RCR.MethodsA retrospective analysis of claims data of privately and publicly insured subjects from the Truven Health MarketScan database from 2008 to 2017 was conducted, collecting RCR cases and controls matched for age, sex, year of RCR, and first and last year in the database. Multivariable logistic regression models were used to compare DM incidence within the RCR and control groups after adjusting for all matching variables plus region, insurance plan type, tobacco use, and Charlson comorbidity index (CCI). Cox proportional hazard models were used to compare rates of revision RCR between DM and non-DM groups after adjusting for patient age, sex, year of RCR, plan type, and CCI. Generalized estimating equations were used to analyze RCR cost, and exponentiated regression coefficients were reported to represent cost ratios.ResultsThe full analysis cohort consisted of 292,666 RCR cases and matched controls. The adjusted odds of having RCR surgery in diabetic patients was 48% higher (odds ratio = 1.48 [95% confidence interval {CI} 1.46 to 1.51], P < .001) than nondiabetics. DM was not significantly associated with revision RCR after RCR when adjusting for age, sex, region, plan type, tobacco use, year of RCR, and CCI (hazard ratio = 1.03, 95% CI 0.99 to 1.07, P = .17). Diabetes was associated with a higher cost of RCR by 3% (ratio = 1.03, 95% CI 1.02 to 1.03, P < .001).ConclusionsDiabetic patients are at a higher risk of undergoing RCR surgery; however, there is no association between DM and subsequent rotator cuff revision surgery.

The impact of baseline glomerular filtration rate on subsequent changes of glomerular filtration rate in patients with chronic kidney disease

Higher baseline glomerular filtration rate (GFR) may yield subsequent steeper GFR decline, especially in patients with diabetes mellitus (DM). However, this correlation in patients with chronic kidney disease (CKD) and the presence or absence of DM remains controversial. We conducted a longitudinal cohort study in a single medical center between 2011 and 2018. Participants with CKD stage 1 to 3A were enrolled and divided into DM groups and non-DM groups, and then followed up at least every 6 months. We used a linear mixed regression model with centering time variable to overcome the problem of mathematical coupling in the analysis of the relation between baseline GFR and the changes, and compared the results from correct and incorrect specifications of the mixed models. A total number of 1002 patients with 285 diabetic and 717 non-diabetic persons was identified. The linear mixed regression model revealed a significantly negative correlation between baseline GFR and subsequent GFR change rate in both diabetic group and non-diabetic group (r = − 0.44 [95% confidence interval [CI], − 0.69 to − 0.09]), but no statistical significance in non-diabetic group after within-subject mean centering of time variable (r = − 0.09 [95% CI, − 0.41 to 0.25]). Our study showed that higher baseline GFR was associated with a subsequent steeper GFR decline in the DM group but not in the non-DM group among patients with early-stage CKD. Exact model specifications should be described in detail to prevent from a spurious conclusion.

Sleep quality in post stroke patient with and without type 2 diabetes mellitus: A comparative study

BackgroundSleep problems are often found in post-stroke patients. Even though the correlation between sleep quality and stroke had been hugely proven, yet its relationship to diabetes mellitus (DM) has not been stated. This study was aimed to compare the sleep quality of patients after stroke, with and without type 2 DM. MethodThis was a comparative study with a cross-sectional approach, involving 40 ischemic stroke patients with less than six months of onset. Samples were divided into DM and non-DM group. Sleep quality was assessed through the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed by the Mann–Whitney Test and Chi-Square Test. ResultPSQI scores in ischemic stroke patients with DM were higher than without DM, with a significant correlation between PSQI scores and DM (p<0.05). ConclusionSleep quality is worse in an ischemic stroke patient with DM compared to those without DM.

The association of manganese superoxide dismutase gene polymorphism (Rs4880) with diabetic macular edema in a cohort of type 2 diabetic Egyptian patients

BackgroundDiabetic retinopathy (DR) and diabetic macular edema (DME) are the leading causes of blindness in patients with diabetes. Increasing numbers of people with diabetes worldwide suggest that DR and DME will continue to be major contributors to vision loss and associated functional impairment for years to come. Oxidative stress is a key participant in the development and progression of diabetes mellitus (DM) and its complications. Antioxidant status can affect vulnerability to oxidative damage, onset and progression of diabetes, and complications of diabetes. Manganese superoxide dismutase (Mn-SOD) is a key mitochondrial enzyme in cell defense against reactive oxygen species (ROS). DR and progression to DME have been associated with polymorphism in the second exon of the Mn-SOD gene at the 16th amino acid (Ala16Val) in the mitochondrial targeting sequence (MTS) of the protein. The study aimed to investigate the association between Ala16Val Mn-SOD gene polymorphism and the susceptibility to DR and DME in type 2 DM (T2DM).ResultsIn this study, 150 patients with type 2 DM were enrolled: 100 patients with DR with and without diabetic macular edema (DME) and 50 patients with type 2 diabetes with a duration of 10 years without DR. Ala16Val SNP of the Mn-SOD gene (rs4880) was detected by TaqMan real-time PCR. The results showed that the homozygous polymorphic variant VV between the DME group is significantly higher than the non-DME group (P 0.018) among the DR group.ConclusionMn SOD A16V polymorphism itself may not be associated with DR; meanwhile, it may be implicated in the pathogenesis of DME.

Effect of diabetes control status on the progression of Parkinson's disease: A prospective study.

ObjectiveTo evaluate whether the control status of type 2 diabetes mellitus (DM) influences the progression of Parkinson’s disease (PD).MethodsWe conducted a prospective cohort study from March 2009 to August 2020. Patients at baseline were categorized into DM and non‐DM groups, and those with DM were further classified into the well and poorly controlled DM groups based on the 7.0% of glycated hemoglobin (HbA1C) levels. Multivariate Cox proportional hazards regression models were used to explore the predictors for PD‐related outcomes by hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsOf the 379 patients enrolled, 49 (12.9%) had DM, and 22 of DM (44.9%) were poorly controlled. The adjusted HRs were 2.060 (95% CI 1.165‐3.641) for United Rating Scale (UPDRS) III score increased ≥14 in the poorly controlled‐DM group, and 1.066 (95% CI 0.572‐1.986) in the well‐controlled DM group, relative to the non‐DM group (p trend = 0.025), after adjusting for sex, age, age of onset, body mass index, and UPDRS III and Montreal Cognitive Assessment (MoCA) scores at baseline. The adjusted HRs were 2.079 (95% CI 1.212‐3.566) for reaching Hoehn & Yahr stage ≥3 in the poorly controlled DM group, and 0.879 (95% CI 0.413‐1.871) in the well‐controlled DM group, compared with the non‐DM group (p trend = 0.021). Time to death or time to MoCA 3‐point decrease were not significantly different among the three groups.InterpretationPoorly controlled DM is an independent risk factor contributing to motor progression in PD. Our study highlights the importance of adequate control of diabetes in PD.

Pilot study of contrast-free MRI reveals significantly impaired calf skeletal muscle perfusion in diabetes with incompressible peripheral arteries.

Patients with diabetes mellitus (DM) are more likely to have densely calcified lesions in the below-the-knee tibial arteries. However, the relationship between peripheral arterial calcification and local skeletal muscle perfusion has not been explored. Thirty subjects were prospectively recruited into three groups in this pilot study: (1) Non-DM: 10 people without DM; (2) DM, ABI < 1.3: 10 people with DM and normal ankle-brachial index (ABI) (0.9-1.3); and (3) DM, ABI ⩾ 1.3: 10 people with DM and ABI ⩾ 1.3. All subjects underwent calf perfusion measurements at rest and during an isometric plantarflexion contraction exercise within the magnetic resonance imaging (MRI) system. The noncontrast MRI techniques were applied to quantitatively assess skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in medial gastrocnemius and soleus muscles. Both SMBF and SMOEF reserves were calculated as the ratio of the exercise value to the resting value. Exercise SMBF and SMOEF values in the medial gastrocnemius muscle were lower in the two DM groups than in the non-DM group (p < 0.05). The SMBF reserve in medial gastrocnemius was significantly lower in the DM, ABI ⩾ 1.3 group compared to the DM, ABI < 1.3 group (p < 0.05). This study demonstrates that people with DM and calcified arteries had lower perfusion in gastrocnemius muscle compared to those without DM and those with DM and a normal ABI.

Impact of diabetes mellitus on in-hospital mortality in adult patients with COVID-19: a systematic review and meta-analysis

BackgroundThe novel coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020, placing the heavy burden on the health systems all over the world. The population that particularly has been affected by the pandemic is the group of patients suffering from diabetes mellitus. Having taken the public health in considerations, we have decided to perform a systematic review and meta-analysis of diabetes mellitus on in-hospital mortality in patients with COVID-19.MethodsA systematic literature review (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane) including all published clinical trials or observational studies published till December 10, 2020, was performed using following terms “diabetes mellitus” OR “diabetes” OR “DM” AND “survival” OR “mortality” AND “SARS-CoV-2” OR “COVID-19”.ResultsNineteen studies were included out of the 7327 initially identified studies. Mortality of DM patients vs non-DM patients was 21.3 versus 6.1%, respectively (OR = 2.39; 95%CI: 1.65, 3.64; P < 0.001), while severe disease in DM and non-DM group varied and amounted to 34.8% versus 22.8% (OR = 1.43; 95%CI: 0.82, 2.50; P = 0.20). In the DM group, the complications were observed far more often when compared with non-DM group, both in acute respiratory distress (31.4 vs. 17.2%; OR = 2.38; 95%CI:1.80, 3.13; P < 0.001), acute cardiac injury (22.0% vs. 12.8%; OR = 2.59; 95%CI: 1.81, 3.73; P < 0.001), and acute kidney injury (19.1 vs. 10.2%; OR = 1.97; 95%CI: 1.36, 2.85; P < 0.001).ConclusionsBased on the findings, we shall conclude that diabetes is an independent risk factor of the severity of COVID-19 in-hospital settings; therefore, patients with diabetes shall aim to reduce the exposure to the potential infection of COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00592-021-01701-1.

The Impact of Diabetes Mellitus and Glycemia on Myocardial Recovery

<h3>Purpose</h3> Diabetes mellitus (DM) is prevalent among advanced heart failure (HF) patients, however its effect on the potential of left ventricular assist device (LVAD)-mediated cardiac recovery has not been described. <h3>Methods</h3> Consecutive advanced chronic HF patients (N=425) requiring durable continuous-flow LVAD were prospectively evaluated. After excluding patients with acute HF etiologies or post-LVAD follow up <3 months, 336 patients were included. Patients with history of DM and/or pre-LVAD HbA1c ≥6.5 comprised the DM group (n=142), while those with no history of DM and a pre-LVAD HbA1c <6.5 comprised the non-DM group (n=194). Diabetics with a pre-LVAD HbA1c <7 were considered well-controlled (n=72) and those with a pre-LVAD HbA1c ≥7 not well-controlled (n=70). Relative changes between pre- and post-LVAD LVEF and LVEDD, were calculated. Cardiac recovery was defined as post-LVAD LVEF ≥40% and LVEDD <6.0cm. <h3>Results</h3> Baseline characteristics of the 2 groups are shown in the <b>Table</b>. Cardiac functional and structural improvement, as evidenced by relative LVEF and LVEDD changes, was more prominent in non-DM compared to DM patients, and in well- compared to not well-controlled DM patients <b>(Figure)</b>. Overall, DM patients were less likely to experience cardiac recovery (8.4% vs 17.5%; p=0.032), while on LVAD support. This remained significant in a multivariate logistic regression after controlling for potential confounders. <h3>Conclusion</h3> The presence of DM, and notably not well-controlled DM, appears to negatively affect the potential for LVAD-induced myocardial recovery. Further research is needed to investigate the dynamic cardiac metabolism in HF with DM.

Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

AimsType 2 diabetes mellitus (T2DM) is a risk factor for severe COVID-19. Our aim was to compare the clinical outcomes of patients with and without T2DM during the first hit of COVID-19 in Istanbul. MethodsA retrospective population-based study was conducted including all consecutive adult symptomatic COVID-19 cases. Patients were confirmed with rt-PCR; treated and monitored in accordance with standard protocols. The primary endpoints were hospitalization and 30-day mortality. ResultsOf the 93,571 patients, 22.6% had T2DM, with older age and higher BMI. Propensity Score matched evaluation resulted in significantly higher rates of hospitalization (1.5-fold), 30-day mortality (1.6-fold), and pneumonia (1.4-fold). They revealed more severe laboratory deviations, comorbidities, and frequent drug usage than the Non-DM group. In T2DM age, pneumonia, hypertension, obesity, and insulin-based therapies were associated with an increased likelihood of hospitalization; whereas age, male gender, lymphopenia, obesity, and insulin treatment were considerably associated with higher odds of death. ConclusionsCOVID-19 patients with T2DM had worse clinical outcomes with higher hospitalization and 30-day mortality rates than those without diabetes. Compared to most territories of the world, COVID-19 mortality was much lower in Istanbul, which may be associated with accessible healthcare provision and the younger structure of the population.