Non-diabetic Group Research Articles

Reasons of Hospitalization of Subjects with Type 2 Diabetes Compared to Non-diabetes General People: Experience from a Medical College Hospital of Dhaka City

ABSTRACT Context: Diabetes is one of the most common comorbidities among hospitalized patients; however, reasons of hospitalization among diabetes patients are not well studied in Bangladesh. Aims: The aim of this study was to determine the reasons of hospitalization among subjects with type 2 diabetes. Materials and Methods: This cross-section study was done among the patients who got admitted in the general medicine ward from June 2022 to May 2024. Samples were collected by consecutive convenient sampling. Patients, who got admitted with epidemic diseases, e.g., dengue fever and COVID-19 infections, were excluded from the study. Finally, we used data of 504 patients for analysis using SPSS version 23.0. Results: Infection is the most common cause of hospitalization for both diabetic and nondiabetic patients, though it was a little bit higher in the nondiabetes group (52.6% vs. 65.7%; P = 0.003). Among the infectious causes, genitourinary tract infection (54.9% vs. 29.7%; P < 0.0001) and respiratory tract infection (RTI) (24.8% vs. 21.8%; P < 0.0001) are most common for both groups and significantly more common among diabetes patients. Among the noninfectious causes of hospitalization, diabetes and its complications along with other endocrine diseases was the most common (19.2%), whereas gastrointestinal disease was the most common (30.2%) cause for hospitalization in the nondiabetes group. We also observed a significantly high frequency of hypertension, renal dysfunction, cardiovascular disease, and hypothyroidism in the diabetes group. Conclusion: Infection is the major cause of hospitalization for both diabetes and nondiabetes subjects. Genitourinary tract and RTI are the major forms of infection during hospitalization in diabetes subjects.

Diabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for type A aortic dissection: insight from the national readmission database

BackgroundPrevious studies have reported a protective effect of type 2 diabetes on the incidence and progression of aortic aneurysms. We investigated whether this protective effect extends to aortic dissections.MethodsData from the US Nationwide Readmission Database (2016–2019) were analyzed. Patients admitted for open surgery repair of acute type A aortic dissection (TAAD) were initially analyzed (index group). Those discharged alive were followed for up to 30 days (readmission group). The co-primary outcomes were in-hospital and 30-day mortality.ResultsBetween 2016 and 2019, 7,324 patients were admitted for open surgical repair of acute TAAD, of whom 965 (13.2%) had diabetes. Patients with diabetes were older and had a higher prevalence of obesity, hypertension, smoking, dyslipidemia, and chronic kidney disease (CKD). 15.2% of patients with diabetes and 14.6% without diabetes died; hence, diabetes did not have a significant impact on in-hospital mortality (adjusted odd ratio [aOR] = 1.02 [0.84–1.24]). Similarly, diabetes was not associated with a higher adjusted risk of atrial fibrillation (aOR = 1.03 [0.89–1.20]), stroke (aOR = 0.83 [0.55–1.26]), cardiogenic shock (aOR = 1.18 [0.98–1.42]), but increased the risk of acute renal failure (aOR = 1.20 [1.04–1.39]). Within 30 days of discharge, 154 (15.9%) patients with diabetes and 952 (15%) from the non-diabetes group were readmitted. Readmitted patients with diabetes were older and had a higher prevalence of cardiovascular comorbidities. We didn’t observe any significant difference in the adjusted risk of 30-day mortality between the diabetes and non-diabetes groups (adjusted hazard ratio [aHR] = 0.81 [0.41–1.60]). However, diabetes was associated with a lower risk of readmission (aHR = 0.81 [0.68–0.97]). Age was the most significant predictor of all outcomes. CKD was the most significant predictor of 30-day mortality, with the risk increasing five-fold in patients with diabetes (HR = 5.58 [2.58–6.62]. Cardiovascular-related conditions were the most common causes of readmission in both groups. However, respiratory-related conditions were more prevalent in the diabetes group compared to the non-diabetes group (19.5% vs. 13%, respectively, p = 0.032).ConclusionsDiabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for Type A aortic dissection.Graphical abstract

Assessment of the Utilization of Sodium–Glucose Cotransporter-2 Inhibitors in Patients Without Diabetes

Background: Sodium–glucose cotransporter-2 inhibitors (SGLT2Is) have demonstrated effects beyond glucose-lowering, leading to their approval for treating chronic heart failure (HF) in Japan. This study examines prescription trends for SGLT2Is in patients with diabetes versus those without diabetes, focusing on their backgrounds and HF treatment status of patients without diabetes who received SGLT2I after an HF diagnosis. Methods: Using data from DeSC Healthcare Inc., we analyzed patients aged 65 and above who received their first SGLT2I prescription between October 2014 and February 2023. Patients were classified into SGLT2I-treated diabetic and non-diabetic groups. We analyzed the annual prescription trends and compared the characteristics of both groups who started SGLT2I between 2022 and 2023. Additionally, we assessed the timing of SGLT2I initiation and the use of concomitant HF treatment in patients without diabetes after HF diagnosis. Results: The proportion of patients without diabetes receiving their first SGLT2I prescription has increased since 2021. Patients without diabetes receiving SGLT2Is were older, likely owing to aging-related diseases. In patients without a confirmed diabetes diagnosis, SGLT2I was most frequently initiated at the time of HF diagnosis. Mineralocorticoid receptor antagonists (MRAs) are the most common concomitant HF medications. The increase in SGLT2I prescriptions for patients without diabetes receiving SGLT2I since 2021, particularly in older individuals, suggests that SGLT2I is being initiated either at the time of HF diagnosis or in a stepwise manner. Conclusion: In Japan, MRA is commonly used as a concomitant medication in patients without diabetes receiving SGLT2I.

Decreased prevalence and altered clinical phenotype of systemic sclerosis and other autoimmune connective tissue diseases in type 1 and type 2 diabetes: A cross-sectional observational study.

Evidence has demonstrated that autoimmune diseases tend to coexist at a higher rate than expected, reflecting a common pathogenic pathway. In this study, we investigate the co-occurrence of systemic sclerosis, systemic lupus erythematosus, and Sjogren syndrome in patients with type 1 and type 2 diabetes mellitus. Our data were obtained using the 2019 Healthcare Cost and Utilization Project, and International Classification of Diseases, 10th Revision diagnosis codes were used to identify patients with systemic sclerosis, systemic lupus erythematosus, lupus nephritis, and Sjogren syndrome, as well as patients with type 1 and type 2 diabetes. We utilized Statistical Analysis System 9.4 for all analyses and included designated weight values to produce nationally representative estimates. The prevalence of systemic sclerosis among patients with type 1 diabetes mellitus and type 2 diabetes mellitus was significantly lower than that for the non-diabetes mellitus control group (0.0007% vs 0.09%, p-value = 0.0064 and 0.01% vs 0.07%, p-value < 0.0001), respectively. Similarly, there was a significant decrease in the prevalence of systemic sclerosis with lung involvement in patients with type 1 and type 2 diabetes mellitus, with a statically significant difference in type 2 diabetes mellitus versus nondiabetic group (0.001% vs 0.006%, p-value < 0.0001). We noted a similar pattern regarding the prevalence of systemic lupus erythematosus and lupus nephritis in patients with type 1 and 2 diabetes. Similarly, there was a significant decrease in the prevalence of Sjogren syndrome in patients with type 1 diabetes and type 2 diabetes. The collected data demonstrates an inverse relation between some autoimmune connective tissue diseases and diabetes. This suggests that these diseases and diabetes mellitus may have different immune pathogenesis. There was also a significantly lower incidence of organ complications such as lupus nephritis and systemic sclerosis lung disease among patients with diabetes, suggesting that diabetes and treatment of diabetes may alter the clinical expression of these disorders.

Correlation between admission hyperglycemia and postoperative pneumonia after hip fracture surgery: A propensity score-matched study

The association between admission hyperglycemia and postoperative pneumonia is unclear in hip fracture patients. We investigated the relationship between admission hyperglycemia and postoperative pneumonia after hip fracture surgery. This retrospective study analyzed data from 1,267 geriatric patients admitted for hip fractures. Patients were categorized into normoglycemic (< 6.10 mmol/L) and hyperglycemic (≥ 6.10 mmol/L) groups based on admission blood glucose levels. Multivariable logistic regression and propensity score matching (PSM) were used to control for potential confounding variables and estimate adjusted odds ratios and 95% confidence intervals for postoperative pneumonia (POP). We also examined the dose-dependent link between admission blood glucose and the likelihood of developing POP. Further analyses evaluated whether admission hyperglycemia has differing impacts on POP outcomes among hip fracture patients without diabetes (NDM) versus those with diabetes (DM). Additionally, subgroup analyses were conducted to assess the influence of other factors on the relationship between admission blood glucose and POP occurrence. Patients with admission hyperglycemia had significantly higher rates of POP compared to normoglycemic patients, both before (13.2% vs. 4.8%) and after (10.1% vs. 5.8%) PSM. Admission hyperglycemia is an independent risk factor of POP (OR = 2.64, 95% CI: 1.42–4.92, p = 0.002). The association persisted after PSM(OR = 2.90, 95% CI: 1.35–3.86, p = 0.016). Additionally, higher blood glucose levels correlated with a greater likelihood of developing POP. A dose–response relationship was observed between blood glucose levels and the risk of POP. Non-diabetic group patients with hyperglycemia were at higher risk of POP than diabetic group patients with hyperglycemia. Finally, the relationship between hyperglycemia and increased POP risk is modulated and influenced by the ASA classification of the patient. Admission hyperglycemia is an independent risk factor for POP after hip fracture surgery in the elderly. There is a dose–response relationship between admission blood glucose and the occurrence of POP, which is more significant in non-diabetic patients than diabetic patients.

Endothelial cell Ass1 inhibits arteriosclerotic calcification in diabetes mellitus

Endothelial cell (EC) dysfunction is an important pathological feature of early calcification in diabetic plaques. Argininosuccinic synthase 1 (Ass1) is important in protecting EC activity. Therefore, this study aimed to explore the effect of endothelial Ass1 on calcification in diabetic plaques and its potential regulatory mechanism. In this study, serum Ass1 levels were measured in 84 patients, and the study showed that the serum Ass1 level in patients with diabetes was significantly decreased compared with the non-diabetic group, and the serum Ass1 level in patients with coronary artery calcification was significantly decreased compared with the non-coronary artery calcification group. The ApoE-/- mouse diabetic plaque calcification model and the mouse aortic endothelial cell (MAEC) calcification model were constructed, and the influence of endothelial cell Ass1 on diabetic plaque calcification was further investigated by adeno-associated virus and plasmid intervention. Molecular biology studies have shown that endothelial Ass1 overexpression can reduce plaque calcification and inhibit MAEC osteogenic differentiation in diabetic mice, and Ass1 has protective effects on EC and blood vessels in mice. 4D-label-free proteomic sequencing, bioinformatics analysis, and IP experiments were performed on ApoE-/- mouse aorta after adeno-associated virus intervention. It was found that the differential protein Ptk2b was closely related to vascular calcification (VC) and interacted with the target protein Ass1. The above studies indicate that endothelial Ass1 affects calcification formation in diabetic plaques, and the mechanism may be related to Ptk2b. Ass1 may be a new target for the treatment of diabetic VC.

Assessment of Oral Health Status among Children with Type I Diabetes Mellitus: A Cross-sectional Study.

Diabetes mellitus (DM) is among the four noncommunicable diseases. There are two types-type I and type II. The prevalence of type I DM in India is 0.26/1,000 population (1992). This study was carried out to assess dental caries status and gingival status. The study group was compared with the nondiabetic control group to find any association with metabolic control of the disease. A total sample size of 200 subjects was selected out of 100 patients referred to treat their poorly controlled type I diabetes mellitus at the tertiary hospital. Another 100 nondiabetic subjects were selected as controls. An oral clinical examination used a mouth mirror, dental explorer, visible light source, and cotton gauze. Decayed, missing, and filled teeth (DMFT), gingival index, plaque index, and calculus index were evaluated. Comparison of the gingival index between cases and control was found to be significant, where the p-value is <0.001. This points out that type I diabetic patients have more chance of gingival problems than others. The increased plaque index indicates the need to give more importance to oral health as it may lead to an increased calculus index in the future, leading to periodontal problems. It was found that glycosylated hemoglobin (HbA1c) is directly proportional to the gingival index. Maintaining good oral health through regular check-ups with dental experts and motivating and educating type I diabetic patients as they are more prone to dental issues. Thankappan N, Chandran V, Venugopal M, et al. Assessment of Oral Health Status among Children with Type I Diabetes Mellitus: A Cross-sectional Study. Int J Clin Pediatr Dent 2024;17(10):1124-1128.

The effects of modest intake of soy milk enriched with Lactobacillus casei and omega-3 on the testis parameters in diabetic rats: a stereological study.

Diabetes mellitus is a widely distributed endocrine disorder in the world. Altered reproductive function is a notable long-term consequence of type 1 diabetes mellitus (T1DM). In the current study, we assessed the effects of soya milk containing Lactobacillus casei and omega-3 on stereology of testes in type 1 diabetic rats. 30 male Sprague Dawley rats were randomly allocated into five groups. Streptozocin (STZ (60 mg/kg)) was applied for diabetes induction. The non-diabetic and diabetic control groups were fed with 1 ml of distilled water. Three treatment diabetic groups were fed 1 ml of Soy milk group (SM), Probiotic soy milk group (PSM), and Omega-3 probiotic soy milk group (OPSM) via intragastric gavage for 60 days. At the endpoint, the animals were sacrificed and serum luteinizing hormone (LH), Follicle-stimulating hormone (FSH), testosterone, MDA besides testicular, and seminal parameters were analyzed. The administration of soy milk supplemented with L. casei and omega-3 in diabetic rats elevated the concentrations of LH, FSH, testosterone, and reduced malondialdehyde (MDA). In addition, this combination improved sperm quality, enhanced the number of sperm with rapid progress, increased testis weight and volume, seminiferous tubule and germinal epithelium volume; and also augmented the number of spermatogonia, spermatocyte, round and long spermatids, Sertoli cells and Leydig cells. Supplementation with soy milk containing L. casei and omega-3 can inhibit T1DM-induced infertility rats through improving testicular parameters, enhancing sperm quality, and increasing Sertoli and Leydig cell number.

Urinary titin as a biomarker of sarcopenia in diabetes: a propensity score matching analysis.

Measuring urinary titin levels is expected to be useful in screening for muscle damage or injury in various diseases. We evaluated whether urinary titin levels were elevated in individuals with type 2 diabetes mellitus (T2DM) and how urinary titin levels were associated with the diagnosis of sarcopenia in T2DM. We performed a cross-sectional analysis of 114 controls and 515 patients with T2DM. Multivariate-adjusted models were used to determine the odds ratios (OR) of urinary titin cutoff values for diagnosing sarcopenia. Urinary titin levels were higher in the T2DM group than in the non-diabetes group after propensity score matching (median [IQR] 3.2 [2.3, 4.6] vs. 4.4 [2.7, 6.9] pmol/mg·creatinine). T2DM was associated with high titin levels after correction for comorbidities (odds ratio 2.46, 95% confidence interval (CI) 1.29-4.70, P = 0.006) but not after correction for sarcopenia-associated factors. Urinary titin levels above the cutoff value showed an odd ratio of 6.61 (age- and body mass index-adjusted, 1.26-34.6, P = 0.021) for the diagnosis of sarcopenia in men with T2DM aged ≥ 75 years. Results indicated that T2DM was associated with a high-titin state and that the urinary titin cutoff value could be useful for identifying candidates at high risk for sarcopenia, such as elderly men.

Abstract 4121568: The Influence of Cardiovascular Health on Atherosclerotic Cardiovascular Disease Progression and Life Expectancy Among Individuals with Type 2 Diabetes

Objective: This study aims to evaluate whether cardiovascular health (CVH) plays a similar role in the transition from a healthy state to atherosclerotic cardiovascular disease (ASCVD) and subsequent mortality rates in diabetic patients compared to those without diabetes. It also evaluates the effectiveness of CVH in reducing diabetes-related ASCVD risks and enhancing ASCVD-free life expectancy. Research design and methods: This cohort study included 176,669 adults from the UK Biobank, among whom 10,109 (22.3%) were diagnosed with type 2 diabetes mellitus (T2DM). CVH was assessed using the Life's Essential 8 score, encompassing diet, physical activity, smoking, sleep, BMI, blood lipids, blood glucose, and blood pressure. CVH scores were categorized into low, moderate, and high levels based on their distribution among diabetic patients. The main outcomes were the transitions from no ASCVD to the onset of ASCVD and then to mortality, as well as the ASCVD-free life expectancy. Results: In patients with T2DM, high CVH levels were associated with lower ASCVD risk (HR: 0.55, 95% CI: 0.45-0.68 for women; HR: 0.57, 95% CI: 0.50-0.65 for men) and reduced mortality in those with ASCVD (HR: 0.62, 95% CI: 0.39-0.98 for women; HR: 0.62, 95% CI: 0.48-0.79 for men), compared to the low CVH group. No significant difference in CVH's effect on ASCVD and mortality was observed between diabetic and non-diabetic groups. When compared with non-diabetic individuals, no excess risk was observed in incident ASCVD and post-ASCVD mortality among diabetic patients with high CVH. At the age of 40, women with low CVH were expected to live 38.5 years (38.0-39.1) free from ASCVD, which increased to 42.9 years (42.4-43.5) for those with high CVH, while non-diabetic women were predicted to have an ASCVD-free life expectancy of 44.1 years (43.5-44.6). For men at the age of 40, those with low CVH had an ASCVD-free life expectancy of 32.0 years (31.3-32.6), which rose to 37.9 years (37.4-38.6) with high CVH. Non-diabetic men were expected to live 38.3 years (37.7-39.0) free from ASCVD. Notably, life expectancy with ASCVD did not increase with higher CVH levels in both genders. Conclusions: Our findings suggest that the American Heart Association’s recommendations for promoting CVH, initially designed for the general population, are also beneficial for individuals with T2DM. Adopting these guidelines can help mitigate ASCVD progression and enhance life expectancy in diabetic patients.

F2-Isoprostanes Are Associated With Increased Fracture Risk in Type 2 Diabetes.

Fracture risk is higher in type 2 diabetes (T2D) for a given bone mineral density (BMD) level. Increased oxidative stress in T2D induces diabetic complications and may affect T2D bone fragility. To investigate whether the levels of plasma F2-isoprostanes, a reliable oxidative stress marker, are associated with incident clinical fracture risk in older adults with diabetes. An observational cohort study was conducted in a well-characterized cohort from Health, Aging, and Body Composition study. Older black and white ambulatory adults with baseline plasma F2-isoprostanes measurements (baseline age 70-79 years, T2D: N=132; non-diabetes: N=571) were selected from the study cohort of 3075 individuals. Incident clinical fractures. In the Cox proportional hazard model with multivariate adjustments (including BMD, medications, and other risk factors), a 93% increase in incident clinical fracture risk was significantly associated with each SD increase in log plasma F2-isoprostanes in the T2D group (HR: 1.93, 95% CI 1.26-2.95, p=0.002), but there was no evidence of an association in the non-diabetes group (HR: 0.98, 95% CI 0.81-1.18, p=0.79, p for interaction < 0.001). Log plasma F2-isoprostanes were moderately correlated with a decline in baseline total hip BMD (r=-0.25, p=0.003), and with a 4-year decrease in total hip BMD (r=-0.28, p=0.008) in T2D. There was no evidence of correlation between log plasma F2-isoprostanes and circulating glycoxidation markers or bone turnover markers in either group. Plasma F2-isoprostanes levels in individuals with diabetes are associated with increased incident clinical fracture risk independently of baseline BMD.

Type 2 diabetes and bone mineral density: A meta-analysis and systematic review.

Type 2 diabetes (T2D), a widespread chronic metabolic disorder, presents frequently in clinical settings. The relationship between T2D and bone mineral density (BMD) has been subject to ongoing investigation, yielding inconclusive results. A systematic literature search was conducted across several databases, including CNKI, VIP, CBM, Wanfang, PubMed, Cochrane Library, and Embase, targeting observational studies that explored the impact of microangiopathy associated with T2D on BMD or bone metabolism. The search spanned from the inception of each database to July 1, 2023. The Newcastle-Ottawa Scale was employed for quality assessment, and RevMan 5.3 software was utilized for data analysis. Stata 14.0 was used for the quantitative evaluation of publication bias regarding outcome measures. The inclusion criteria were met by 30 observational studies, comprising 6470 participants-3121 with diabetes and 3349 without. The meta-analysis revealed no significant difference in overall BMD between the nondiabetic and T2D groups (mean difference [MD] = -0.07, 95% confidence interval [CI] [-0.17, 0.03], Z = 1.45, P = .15). However, BMD at the lumbar vertebrae was significantly higher in nondiabetic individuals compared with those with T2D (MD = -0.14, 95% CI [-0.22, -0.06], Z = 3.32, P = 0.0009), as was the case with femoral neck BMD (MD = -0.11, 95% CI [-0.18, -0.04], Z = 3.08, P = .002). A difference in femoral neck BMD between nondiabetics and individuals with T2D approached but did not reach statistical significance (MD = -0.14, 95% CI [-0.27, 0.00], Z = 1.94, P = .05). An inverted funnel plot analysis suggested possible publication bias, as evidenced by an asymmetrical distribution of studies around the axis of symmetry, with overlap observed in several cases. The findings indicate a significant association between T2D and reduced BMD at critical sites such as the lumbar vertebrae and femoral neck, highlighting an increased risk of osteoporosis or osteoporotic fractures in these regions.

Semaglutide Ameliorates Diabetic Neuropathic Pain by Inhibiting Neuroinflammation in the Spinal Cord.

Male Wistar rats, each weighing between 300 and 350 g, were categorized into four groups: one non-diabetic sham group and three diabetic groups. The diabetic group received a single intraperitoneal injection of streptozotocin (STZ) at a dosage of 60 mg/kg to induce diabetic neuropathy. After 4 weeks of STZ injection, one diabetic group was given saline (vehicle), and the other two were treated with either 1× SEMA (1.44 mg/kg, orally) or 2× SEMA (2.88 mg/kg, orally). Following a 4-week course of oral drug treatment, behavioral, biochemical, and immunohistochemical analyses were carried out. The mechanical allodynia, thermal hyperalgesia, blood glucose, advanced glycation end products (AGEs), plasma HbA1C, and spinal inflammatory markers were evaluated. SEMA treatment significantly reduced both allodynia and hyperalgesia in the diabetic group. SEMA therapy had a limited impact on body weight restoration and blood glucose reduction. In diabetic rats, SEMA lowered the amounts of pro-inflammatory cytokines in the spinal cord and dorsal horn. It also lowered the activation of microglia and astrocytes in the dorsal horn. SEMA significantly reduced HbA1c and AGE levels in diabetic rats compared to the sham control group. These results indicate SEMA's neuroprotective benefits against diabetic neuropathic pain, most likely by reducing inflammation and oxidative stress by inhibiting astrocyte and microglial activity. Our findings suggest that we can repurpose GLP-1 agonists as potent anti-hyperalgesic and anti-inflammatory drugs to treat neuropathic pain without serious side effects.

Reliability and utility of blood glucose levels in the periodontal pockets of patients with type 2 diabetes mellitus: a cross-sectional study.

Several studies have measured gingival blood glucose (GBG) levels, but few have confirmed systematic bias using Bland-Altman analysis. This study compared the effectiveness of GBG levels with that of fingertip blood glucose (FTBG) levels using Bland-Altman and receiver operating characteristic (ROC) analyses. A total of 15 healthy volunteers and 15 patients with type 2 diabetes were selected according to inclusion and exclusion criteria. Each group comprised eight male and seven female participants. The GBG and FTBG levels were measured using a self-monitoring blood glucose device after periodontal examination. Pearson's product‒moment correlation and simple linear regression analyses were performed. In addition, Bland‒Altman analysis was also performed to assess the degree of agreement between the two methods. ROC analysis was conducted to determine the sensitivity, specificity, and cutoff values for patients with diabetes. The area under the ROC curve (AUC) was used to identify significant differences. The mean GBG and FTBG levels were 120 ± 44.8 mg/dL and 137 ± 45.1, respectively, for the whole sample. The mean GBG and FTBG levels were 145 ± 47.2 mg/dL and 163 ± 49.1, respectively, in the diabetes group. The mean GBG and FTBG levels in the nondiabetes group were 95.3 ± 25.2 and 111 ± 18.8, respectively. Patients with diabetes were more likely to have a probing pocket depth (PPD) of ≥4 mm at the sampled site. Pearson's product‒moment correlation and simple linear regression analyses revealed a significant correlation between the GBG and FTBG measurements. Bland-Altman analysis revealed that GBG and FTBG measurements differed significantly among all participants; however, no significant differences were observed among the patients with diabetes (mean difference (MD) ± standard deviation (SD) = -18.1 ± 34.2, 95% confidence interval (CI) [-37.0 to 0.88]) or among the participants with a PPD of ≥4 mm (MD ± SD = -15.2 ± 30.4, 95% CI [-30.8 to 0.43]). The sensitivity, specificity, and cutoff values of the GBG measurements for detecting diabetes were 80%, 93%, and 123.5 mg/dL, respectively. The sensitivity, specificity, and cutoff values of the FTBG measurements for detecting diabetes were 73%, 87%, and 134.0 mg/dL, respectively. No significant differences were observed between the AUCs (0.078, 95% CI [-0.006 to 0.161]). The GBG measurements aligned with the FTBG measurements in the patients with diabetes and among the participants with a PPD of ≥4 mm. Patients with diabetes were more likely to have a PPD of ≥4 mm at the sampled site, GBG levels can be used to screen for type 2 diabetes in dental clinics.

Influence of Diabetes Mellitus on Neurological Recovery in Older Patients With Cervical Spinal Cord Injury Without Bone Injury: A Retrospective Multicenter Study.

Retrospective study. To investigate the impact of diabetes mellitus on neurological recovery and determine the relationship between moderate-severe diabetes and neurological recovery in patients with cervical spinal cord injury (CSCI) without bone injury. A retrospective study was conducted on 389 consecutive patients aged ≥65 years with CSCI without bone injury across 33 medical institutes. The patients were divided into a nondiabetic group (n = 270) and a diabetic group (n = 119). Neurological outcomes were compared between the two groups through propensity score matching. The impact of moderate-severe diabetes (defined as hemoglobin A1c ≥ 7.0% or requiring insulin treatment) on neurological recovery was evaluated through multiple linear regression analysis. Propensity score matching revealed no significant differences between the diabetic and nondiabetic groups in terms of American Spinal Injury Association (ASIA) impairment scale grade and mean total ASIA motor scores (AMS) at 6 months post-injury. Multiple linear regression analysis indicated that age on admission (B = -0.34; 95% confidence interval [CI], -0.59 to -0.08; P = 0.01), dementia (B = -16.50; 95% CI, -24.99 to -8.01; P < 0.01), and baseline total AMS (B = -0.62; 95% CI, -0.72 to -0.51; P < 0.01) were negative predictors of neurological recovery at 6 months post-injury. The presence of moderate-severe diabetes did not influence neurological recovery at 6 months post-injury. Diabetic patients with CSCI without bone injury achieved improvements in neurological function comparable to those of nondiabetic patients. Moderate-severe diabetes did not affect neurological recovery in patients with CSCI without bone injury.

Association between stress hyperglycemia ratio and postoperative major adverse cardiovascular and cerebrovascular events in noncardiac surgeries: a large perioperative cohort study

BackgroundThere has been a concerning rise in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) following noncardiac surgeries (NCS), significantly impacting surgical outcomes and patient prognosis. Glucose metabolism abnormalities induced by stress response under acute medical conditions may be a risk factor for postoperative MACCE. This study aims to explore the association between stress hyperglycemia ratio (SHR) and postoperative MACCE in patients undergoing general anesthesia for NCS.MethodsThere were 12,899 patients in this perioperative cohort study. The primary outcome was MACCE within 30 days postoperatively, defined as angina, acute myocardial infarction, cardiac arrest, arrhythmia, heart failure, stroke, or in-hospital all-cause mortality. Kaplan-Meier curves visualized the cumulative incidence of MACCE. Cox proportional hazard models were utilized to assess the association between the risk of MACCE and different SHR groups. Restricted cubic spline analyses were conducted to explore potential nonlinear relationships. Additionally, exploratory subgroup analyses and sensitivity analyses were performed.ResultsA total of 592 (4.59%) participants experienced MACCE within 30 days after surgery, and 1,045 (8.10%) within 90 days. After adjusting for confounding factors, compared to the SHR T2 group, the risk of MACCE within 30 days after surgery increased by 1.34 times (95% CI 1.08–1.66) in the T3 group and by 1.35 times (95% CI 1.08–1.68) in the T1 group respectively. In the non-diabetes group, the risk of MACCE within 30 days after surgery increased by 1.60 times (95% CI 1.21–2.12) in the T3 group and by 1.61 times (95% CI 1.21–2.14) in the T1 group respectively, while no statistically significant increase in risk was observed in the diabetes group. Similar results were observed within 90 days after surgery in the non-diabetes group. Additionally, a statistically significant U-shaped nonlinear relationship was observed in the non-diabetes group (30 days: P for nonlinear = 0.010; 90 days: P for nonlinear = 0.008).ConclusionIn this large perioperative cohort study, we observed that both higher and lower SHR were associated with an increased risk of MACCE within 30 and 90 days after NCS, especially in patients without diabetes. These findings suggest that SHR potentially plays a key role in stratifying cardiovascular and cerebrovascular risk after NCS.

Relationship Between Fasting C-Peptide to Diabetes Duration Ratio (FCP/DD) and Diabetic Peripheral Neuropathy.

To explore the correlation between fasting C-peptide to diabetes duration ratio (FCP/DD) and diabetic peripheral neuropathy (DPN). The study was conducted on 816 patients with type 2 diabetes (T2DM). Subjects were classified into a diabetic peripheral neuropathy group (DPN, n=408) and a non-diabetic peripheral neuropathy group (NDPN, n=408) depending on the presence of DPN. Collected patients' baseline data, calculated the FCP/DD ratio, and analyzed the correlation between FCP/DD and DPN. A comparative analysis of general characteristics revealed that the DPN group exhibited higher values for age, DD, proportion of hypertension, proportion of DN, and proportion of DR compared to the NDPN group, Conversely, the DPN group demonstrated lower proportions of eGFR, FCP/DD, FCP, and fatty liver relative to the NDPN group, with all differences achieving statistical significance (P < 0.05). Compared to the high FCP/DD group, the low FCP/DD group exhibited higher values in age, DD, the proportion of DPN, DN, DR, and hypertension, as well as elevated levels of HDL-C and NEUT (P<0.05). Conversely, the low FCP/DD group demonstrated a lower proportion of patients who smoked and those with fatty liver, along with reduced BMI, ALB, FBG, UA, eGFR, TC, TG, and LDL-C levels (P < 0.05). In patients with T2DM, after adjusting for confounding factors, high levels of FCP/DD were found to be a protective factor for DPN (P < 0.05). The area under the curve of the FCP/DD Model predicting DPN (AUC=0.737) was higher than that of single FCP (AUC=0.587), DD (AUC=0.665). The high FCP/DD ratio was a protective factor for T2DM with DPN. Additionally, the FCP/DD ratio was found to be a better predictor for the occurrence of DPN in T2DM compared to FCP and DD alone.

Gender differences in the relationship between depressive symptoms and diabetes associated with cognitive-affective symptoms.

Despite the frequent co-occurrence of depression and diabetes, gender differences in their relationship remain unclear. This exploratory study examined if gender modifies the association between depressive symptoms, prediabetes and diabetes with cognitive-affective and somatic depressive symptom clusters. Cross-sectional analyses were conducted on 29 619 participants from the 2007-2018 National Health and Nutrition Examination Survey. Depressive symptoms were measured by the nine-item Patient Health Questionnaire. Multiple logistic regression was used to analyse the relationship between depressive symptoms and diabetes. Multiple linear regression was used to analyse the relationship between depressive symptom clusters and diabetes. The odds of having depressive symptoms were greater in those with diabetes compared to those without. Similarly, total symptom cluster scores were higher in participants with diabetes. Statistically significant diabetes-gender interactions were found in the cognitive-affective symptom cluster model. Mean cognitive-affective symptom scores were higher for females with diabetes (coefficient = 0.23, CI: 0.10, 0.36, P = 0.001) than males with diabetes (coefficient = -0.05, CI: -0.16, 0.07, P = 0.434) when compared to the non-diabetic groups. Diabetes was associated with higher cognitive-affective symptom scores in females than in males. Future studies should examine gender differences in causal pathways and how diabetic states interact with gender and influence symptom profiles.

A Comparative Study on the Impact of Fasting on Blood Glucose and Blood Pressure Among Diabetic and Non-Diabetic Individuals During Ramadan, Kurdistan Region, Iraq

Objective: The primary aim of this research was to evaluate the differential effects of regular and fasting dietary patterns on blood glucose levels and blood pressure among diabetic patients and non-diabetic control group. A comprehensive analysis was conducted to compare physiological responses on fasting versus non-fasting days during the holy Ramadan month. Methods: This observational study involved 92 participants, with a subset of 38 diabetic patients and 54 non-diabetic control group, aged 19-76 years, who were observed on regular and fasting days. Participants were monitored for pre-prandial, postprandial, evening blood sugar, and fasting blood glucose levels, as well as blood pressure. Statistical analysis was performed using paired sample t-tests to compare mean ± SD between regular and fasting days of both groups. The study cohort consisted of male and female adults diagnosed with type 1 or type 2 diabetes. Exclusion criteria included individuals under 18 years, pregnant women, and patients unable to fast during the study period. Results: Statistical analysis revealed significant differences in fasting blood glucose levels during Ramadan compared to non-fasting days. In the diabetic group, significant changes were observed in fasting blood glucose levels during Ramadan compared to after Ramadan ( postprandial blood sugar p=0.04, evening blood sugar p=0.019). In contrast, the non-diabetic group also showed significant changes in blood glucose levels during Ramadan compared to after Ramadan (postprandial blood sugar p=0.001, evening blood sugar p=0.020). Blood pressure showed no significant differences between these periods, suggesting that fasting does not alter blood pressure significantly in diabetic individuals. Additionally, a two-way ANOVA demonstrated significant dietary influences on post-Iftar glucose levels in non-diabetics (p&lt;0.001), but not in diabetics, suggesting differential metabolic responses to dietary intake during Ramadan. These findings emphasize the critical need for personalized dietary management and continuous monitoring to optimize diabetic care during fasting. Conclusion: Fasting significantly influences blood glucose levels in diabeticand non-diabetic individuals but does not affect blood pressure. This study underscores the necessity for personalized medical guidance and balanced meal planning to minimize complications and enhance diabetes management during fasting. Further research is warranted to explore the long-term effects of different fasting practices on diabetic health outcomes.

Assessment of cardiac and skeletal muscle metabolites using 1H-MRS and chemical-shift encoded magnetic resonance imaging: Impact of diabetes, RAGE, and DIAPH1.

Diabetes affects metabolism and metabolite concentrations in multiple organs. Previous preclinical studies have shown that receptor for advanced glycation end products (RAGE, gene symbol Ager) and its cytoplasmic domain binding partner, Diaphanous-1 (DIAPH1), are key mediators of diabetic micro- and macro-vascular complications. In this study, we used 1H-Magnetic Resonance Spectroscopy (MRS) and chemical shift encoded (CSE) Magnetic Resonance Imaging (MRI) to investigate the metabolite and water-fat fraction in the heart and hind limb muscle in a murine model of type 1 diabetes (T1D) and to determine if the metabolite changes in the heart and hind limb are influenced by (a) deletion of Ager or Diaph1 and (b) pharmacological blockade of RAGE-DIAPH1 interaction in mice. Nine cohorts of male mice, with six mice per cohort, were used: wild type non-diabetic control mice (WT-NDM), WT-diabetic (WT-DM) mice, Ager knockout non-diabetic (RKO-NDM) and diabetic mice (RKO-DM), Diaph1 knockout non-diabetic (DKO-NDM), and diabetic mice (DKO-DM), WT-NDM mice treated with vehicle, WT-DM mice treated with vehicle, and WT-DM mice treated with RAGE229 (antagonist of RAGE-DIAPH1 interaction). A Point Resolved Spectroscopy (PRESS) sequence for 1H-MRS, and multi-echo gradient recalled echo (GRE) for CSE were employed. Triglycerides, and free fatty acids in the heart and hind limb obtained from MRS and MRI were compared to those measured using biochemical assays. Two-sided t-test, non-parametric Kruskal-Wallis Test, and one-way ANOVA were employed for statistical analysis. We report that the results were well-correlated with significant differences using MRI and biochemical assays between WT-NDM and WT-DM, as well as within the non-diabetic groups, and within the diabetic groups. Deletion of Ager or Diaph1, or treatment with RAGE229 attenuated diabetes-associated increases in triglycerides in the heart and hind limb in mice. These results suggest that the employment of 1H-MRS/MRI is a feasible non-invasive modality to monitor metabolic dysfunction in T1D and the metabolic consequences of interventions that block RAGE and DIAPH1.