Non-diabetic Group Research Articles

Unique Ultrastructural Alterations in the Placenta Associated With Macrosomia Induced by Gestational Diabetes Mellitus

Abstract Objective To investigate the morphological and ultrastructural alterations in placentas from pregnancies with gestational diabetes mellitus (GDM)–induced macrosomia, term nondiabetic macrosomia, and normal pregnancies. Methods Sixty full-term placentas were collected, and clinical data along with informed consent were obtained from pregnant women who underwent regular visit checks and delivered their newborns in Northwest Women’s and Children’s Hospital between May and December 2022. Placentas were divided into three equal groups: normal pregnancy (control group), nondiabetic macrosomia group, and macrosomia complicated with GDM (diabetic macrosomia) group. Gross morphological data of placentas were recorded, and placental samples were processed for examination of ultrastructural and stereological changes using transmission electron microscopy. Analysis of variance and chi-squared test were used to examine the differences among the three groups for continuous and categorical variables, respectively. Results The baseline characteristics of mothers and neonates did not differ across the three groups, except for a significantly higher birth weight in the diabetic macrosomia group (4172.00 ± 151.20 vs. 3192.00 ± 328.70, P < 0.001) and nondiabetic macrosomia group (4138.00 ± 115.20 vs. 3192.00 ± 328.70, P < 0.001) compared with control group. Examination of the placentas revealed that placental weight was also highest in the diabetic macrosomia group compared with control group (810.00 ± 15.81 vs. 490.00 ± 51.48, P < 0.001) and nondiabetic macrosomia group (810.00 ± 15.81 vs. 684.00 ± 62.69, P < 0.001), but the ratio of neonatal birth weight to placental weight (BW/PW) was significantly lower in the diabetic macrosomia group compared with that in the control group (5.15 ± 0.19 vs. 6.54 ± 0.63, P < 0.001) and nondiabetic macrosomia group (5.15 ± 0.19 vs. 6.09 ± 0.52, P < 0.001) group. In contrast, the BW/PW ratio in nondiabetic macrosomia did not differ significantly from that in the control group. Distinct ultrastructural changes in terminal villi and stereological alterations in microvilli were observed in the diabetic macrosomia group, including changes in the appearance of cytoplasmic organelles and the fetal capillary endothelium and thickness of the vasculo-syncytial membrane and basal membrane. Conclusion Significant ultrastructural and stereological alterations were discovered in the placentas from pregnant women with macrosomia induced by GDM. These alterations may be the response of the placenta to the hyperglycemia condition encountered during pregnancies complicated with GDM.

Worsening of Diabetes Control Measures and Decreased Kidney Function in Pre-Diabetic Kidney Donors Compared to Non-Diabetic Donors Whose BMI Before Kidney Donation was Above 30

The incidence of end-stage renal disease has increased dramatically over the past two decades. Kidney transplantation is the best treatment option for individuals with end-stage renal disease, and living donor kidney transplantation has significant advantages over deceased donor kidney transplantation. Although there are criteria for assessing living kidney donors, different medical centers handle certain medical problems differently. The aim of this study is to investigate how kidney donation affects renal biochemical indicators, blood pressure measurements, and glucose control in healthy young female adults without diabetes compared to a pre-diabetic group. A prospective cohort study recruited 142 female kidney donors, who were divided into two cohorts based on their diabetic history (pre-diabetic and non-diabetic). The participants were monitored for seven years after kidney donation. Key clinical and biochemical markers were measured before and after donation. The pre-diabetic group had higher mean values for blood pressure readings, body mass indices, Oral Glucose Tolerance Test, HbA1c (DCCT) (%), serum creatinine levels, proteinuria, and lower e-GFR compared to those in the non-diabetic group. All these findings were statistically significant. Pre-diabetic donors are at an increased risk for many adverse clinical and biochemical outcomes, including hypertension, glucose tolerance, and worsening kidney function tests and should be advised that their condition may worsen over time and can result in end-organ complications. If the donors decide to proceed, they should be closely and frequently monitored during both the short- and long-term periods.

Periodontitis in patients with diabetes and its association with diabetes-related complications. A register-based cohort study

ObjectiveTo evaluate the association between type 1 diabetes (T1D)/type 2 diabetes (T2D) and periodontitis and assess the influence of periodontitis on diabetes-related complications.DesignObservational study; longitudinal analysis of register data.SettingSwedish primary...

Non-ST Elevation Myocardial Infarction in Patients With Hypertensive Emergency.

Background Hypertensive emergencies represent high-cardiovascular-risk situations defined by severe increases in blood pressure. The prevalence of hypertension in non-ST elevation myocardial infarction (NSTEMI) is higher compared to STEMI and there is a lack of studies on NSTEMI patients with hypertensive emergencies. Patients with diabetes exhibited a higher rate of hypertensive emergencies. This study's primary aim was to investigate the coronary artery disease profile in hypertensive emergency patients withNSTEMI, and the secondary aim was to determine the impact of diabetes on the development of hypertensive emergencies. Methodology A total of 100 patients with NSTEMI and hypertensive emergency presenting to the hospital were enrolled in the study. The duration of the study was 24 months. The patients were also sub-grouped into diabetic and nondiabetic. Baseline characteristics were noted, and coronary angiogram and renal angiogram were also done. Based on variables, the chi-square test and t-test were employed to assess the significance. P-value < 0.05 was considered statistically significant. Results The mean age at presentation for patients with NSTEMI and hypertensive emergency was 58 years. Patients consuming alcohol were slightly higher (28, 28%) than those who smoked (23, 23%). Among all, 48 (48%) patients had diabetes. When considering the number of vessels, diabetic patients had more single-vessel diseases (18, 37.5%) and nondiabetic patients had more double-vessel diseases (15, 28.8%). The mean ejection fraction of the diabetic group was 56.1% ± 6.8% and the nondiabetic group was 54.2% ± 7.7%. Among all the patients, 52 (62.6%) used combination drugs, while 39 (46.9%) were on defaulter drugs. Conclusions Several risk factors like age, smoking, alcohol, and nonadherence to drugs were found to have an association with the occurrence of hypertensive emergency. Diabetes was found to be significantly associated with unfavorable coronary anatomy among the population.

Relationship Between the Hemoglobin, Albumin, Lymphocyte Count, Platelet Count (HALP) Score and Type 2 Diabetes Retinopathy.

To explore the correlation between hemoglobin, albumin, lymphocyte count, platelet count (HALP) score and type 2 diabetic retinopathy (DR). The study was conducted on 674 patients with type 2 diabetes (T2DM). According to the results of the fundus examination, they were divided into non-diabetic retinopathy group (NDR, n=388) and diabetic retinopathy group (DR, n=286). Collected patients baseline data, calculated HALP score, analyzed the correlation between HALP score and DR. In all patients, male patients and female patients, the HALP score of the DR group was lower than that of the NDR group (P<0.001), and the HALP score was negatively correlated with the incidence of DR (P<0.05). HALP score was independent risk factors for DR, regardless of gender. In male patients, HALP score and DR had a linear relationship, but in female patients, HALP score and DR showed a nonlinear relationship, and HALP score was more sensitive to the onset of DR in male patients. The combined diagnostic model of HALP score, course of disease, SBP and BUN was used to diagnose DR, and it was found that the diagnostic value was the highest among male patients, with AUC of 0.761, sensitivity of 58.3% and specificity of 80.3%. HALP score was an independent risk factor for DR, attention should be paid to monitoring HALP score, especially in male T2DM patients. The accuracy of HALP score, disease course, SBP and BUN combined model diagnosis of DR was high, which can become a biological indicator for early screening of DR.

Prevalence of toxoplasmosis in Iraqi patients with diabetic type 2

Background. The obligate intracellular protozoan parasite Toxoplasma gondii is a member of the phylum Apicomplexa. In people with impaired immune systems, it can result in opportunistic infections. Diabetes mellitus is regarded as a metabolic disease that raises the host's vulnerability to and risk from several infections, including T. gondii infection. The main object of this study is to ascertain the toxoplasmosis seroprevalence and correlation among Iraqi patients with type 2 diabetes. Methods. The level of Toxoplasma antibodies IgG, IgM, and IgA was measured in 109 samples of Iraqi diabetes type 2 patients using immunochromatography rapid test, CMIA, and ELISA. Eighty samples, considered to be a healthy control group, were collected from a private laboratory in Baghdad, Iraq, between March 2022 and June 2022, with an age range of 15 to 85 years. Results. Comparing the diabetes patient group to the non-diabetic control group, the results showed that the diabetic patient group had the highest mean glucose levels in their fasting test (174.55 ± 3.96 mg/dL), random test (216.89 ± 4.96 mg/dL), and HbA1C (7.1 ± 0.178), respectively. Furthermore, the study demonstrated that, in an immunochromatography fast test, the group of diabetic patients had the largest distribution of IgG anti-Toxoplasma when compared to the non-diabetic control group. Additionally, all samples were seronegative for anti-Toxoplasma IgM and IgA, with significant differences in CMIA and ELISA. However, 51/109 (46.79%) and 30/80 (37.5%) of the diabetes group and the non-diabetic group, respectively, showed seropositive for anti-Toxoplasma IgG. Conclusion. This study found that no acute toxoplasmosis detected in the studied cases while chronic toxoplasmosis detected among diabetic type 2 patients.

Incident Cancer Risk of Patients with Prevalent Type 2 Diabetes Mellitus in Hungary (Part 2).

(1) Background: Among the chronic complications of type 2 diabetes mellitus, cancer has become the leading cause of death in several countries. Our objective was to determine whether prevalent type 2 diabetes mellitus is associated with a higher incidence of cancer. (2) Methods: This study comprised a nationwide analysis conducted in Hungary. The study population was divided into two groups: a type 2 diabetes mellitus group vs. a non-diabetic group. The primary outcome was the risk related to overall cancer incidence; a key secondary outcome was the overall incidence of cancer in distinct study years; and a further outcome was the annual percent changes. (3) Results: The odds ratio related to the overall incidence of cancer was 2.50 (95% confidence interval: 2.46-2.55, p < 0.0001) in patients with diabetes as related to non-diabetic controls. The odds ratio was higher in males than in females [ORmales: 2.76 (2.70-2.82) vs. ORfemales: 2.27 (2.22-2.33), p < 0.05 for male-to-female comparison]. The annual cancer incidence rate declined in non-diabetic controls, but not in patients with diabetes [-1.79% (-2.07--1.52%), p < 0.0001] vs. -0.50% (-1.12-+0.10%), p = 0.0991]. Several types of cancer showed a decreasing tendency in non-diabetic controls, but not in patients with type 2 diabetes. (4) Conclusions: Type 2 diabetes is associated with a higher risk of cancer. While the cancer incidence decreased for non-diabetic individuals with time, it remained unchanged in patients with T2DM.

Hospital Outcome of Hypertensive Non-ST elevation Myocardial Infarction Patients in Diabetic and Non-Diabetic Groups

Objective: Acute myocardial infarction is one of the leading causes of all acute emergencies and is becoming an important public health problem in developing countries. Non-ST elevation myocardial infarction (NSTEMI) is more heterogeneous in its presentation and may be poorly characterized in clinical practice, leading to greater variation in diagnosis and treatment. Patients with diabetes and hypertension who develop an NSTEMI are at increased risk for poor hospital outcomes. This study aims to assess the differences between hypertensive diabetic and hypertensive non-diabetic patients with NSTEMI and to evaluate the prognostic impact of selected clinical and laboratory parameters on the occurrence of hospital complications. Methods: This was a cross-sectional analytical study. All the adult hypertensive patients of newly diagnosed NSTEMI with or without diabetes mellitus admitted to Ibrahim Cardiac Hospital &amp; Research Institute, Dhaka who fulfilled the inclusion and exclusion criteria were enrolled. The study population comprised 100 hypertensive patients with their first NSTEMI and were divided into two groups according to the presence of type 2 diabetes mellitus. Group I (n = 40) patients were diabetic and Group II (n = 60) were non-diabetic. The hospital outcome of the study population was recorded. The incidence of in-hospital adverse clinical events in the two groups was compared by using the odds ratio of the two binomial proportion analyses. Results: Among 100 hypertensive NSTEMI patients, 40% were diabetic (Group I) and 60% were non-diabetic (Group II). The mean age was 58.1±10.2 years in the case of the diabetic group (Group I) and 56.3±10.5 years in the non-diabetic group (Group II) ranging from 30-70 years. Male patients (66%) were predominant in the study. The most common clinical presentation was chest pain which was 77.5% in Group I and 83.3 % in Group II followed by sweating (12.5% and 16.7%), dyspnea (10.0% and 11.7%), syncope (5.0% and 6.7%) and atypical chest pain (2.5% and 3.3%) respectively. Smoking was the commonest risk factor which was 62.5% in Group I and 75% in Group II followed by dyslipidemia (32.5% and 36.7%), family history of IHD (30% and 23.3%) and obesity (22.5% and 13.3%) respectively. Diabetic hypertensive patients had significantly higher heart rates, hypertensive peaks, and more episodes of asymptomatic ST segment depression. The most common in-hospital complications were heart failure (30% and 16.7%), arrhythmias (22.5% and 6.7%), renal failure (10% and 5.0%), cerebral ischemia (7.5% and 1.7%), death (7.5% and 3.3%) and cardiogenic shock (5.0% and 3.3%) in Group I and Group II respectively. Conclusion: In-hospital adverse clinical events were more frequent in diabetic hypertensive individuals compared to non-diabetics.

Longitudinal Three-Year Associations of Dietary Fruit and Vegetable Intake with Serum hs-C-Reactive Protein in Adults with and without Type 1 Diabetes.

High-sensitivity C-reactive protein (hs-CRP) is a widely used clinical biomarker of systemic inflammation, implicated in many chronic conditions, including type 1 diabetes (T1D). Despite the increasing emphasis on dietary intake as a modifiable risk factor for systemic inflammation, the association of hs-CRP with fruit and vegetable consumption is relatively underexplored in T1D. To address this gap, we investigated the longitudinal associations of dietary pattern-derived fruit and vegetable scores with hs-CRP in adults with and without T1D. Additionally, we examined the impact of berry consumption as a distinct food group. Data were collected in the Coronary Artery Calcification in Type 1 Diabetes study over two visits that were three years apart. At each visit, participants completed a food frequency questionnaire, and hs-CRP was measured using a particle-enhanced immunonephelometric assay. Mixed effect models were used to examine the three-year association of fruit and vegetable scores with hs-CRP. Adjusted models found a significant inverse association between blueberry intake and hs-CRP in the nondiabetic (non-DM) group. Dietary Approaches to Stop Hypertension- and Alternative Healthy Eating Index-derived vegetable scores were also inversely associated with hs-CRP in the non-DM group (all p-values ≤ 0.05). Conversely, no significant associations were observed in the T1D group. In conclusion, dietary pattern-derived vegetable scores are inversely associated with hs-CRP in non-DM adults. Nonetheless, in T1D, chronic hyperglycemia and related metabolic abnormalities may override the cardioprotective features of these food groups at habitually consumed servings.

Diabetes is not a negative prognostic factor for 30-days mortality after surgery for acute type A aortic dissection.

The correlation between diabetes and aortic dissection is not fully understood yet, although in literature many studies have suggested that there may be an association between the two conditions. The purpose of this study is to evaluate whether diabetes represents a short- and long-term risk factor for mortality from type A acute aortic dissection. A total of 340 patients with the diagnosis of type A acute aortic dissection underwent aortic surgery between January 2002 and March 2023. The sample was divided into 2 cohorts according to the presence of diabetes (n = 34) or not (n = 306). The mean age was 66 (±12.4) years and 60.9% were male. The primary endpoint was 30-day mortality. Hospital mortality was 12 (35.3%) for the diabetes group and 70 (22.9%) for nondiabetes group (P = 0.098). Overall survival at 10 years was 48.3% [95% confidence interval (CI): 41.6-54.7%], while the 10-year survival for people with diabetes was 29.5% (95% CI: 13.2-47.9%) and for nondiabetes group 50.6% (95% CI: 43.4-57.3%) (Log-rank, P = 0.024). Diabetes was not found to be a risk factor associated with 30-day mortality in patients undergoing surgery for type A acute aortic dissection. It was a risk factor for long-term survival, but this may be related to diabetes complications.

Unraveling the enigma of sarcopenia and sarcopenic obesity in Indian adults with type 2 diabetes – a comparative cross-sectional study

BackgroundSarcopenia and sarcopenic obesity are growing concerns associated with increasing diabetes incidence, but data from Indian diabetic cohorts are limited. This study examined the prevalence and clinical factors associated with sarcopenia and sarcopenic obesity.MethodsIn this cross-sectional study, 750 participants aged 35–70 years were recruited by systematic stratification and a fixed quota sampling technique from medical camps and categorized into diabetic (n = 250), nondiabetic (n = 250), and obese nondiabetic (n = 250) groups. The assessments included questionnaires, muscle mass estimation by bioimpedance analysis, and blood tests. Sarcopenia was defined using the Asian Working Group consensus, and sarcopenic obesity was defined as sarcopenia with a BMI ≥ 25 kg/m2. Logistic regression was used to analyze risk factors.ResultsSarcopenia affected 60% of diabetic patients, 28% of nondiabetic patients, and 38% of nonobese nondiabetic patients (p < 0.001). The prevalence of sarcopenic obesity was 40%, 11%, and 30%, respectively (p < 0.001). Diabetes was associated with 2.3-fold greater odds (95% CI 1.1–4.7) of sarcopenia and 2.4-fold greater odds (1.1-5.0) of sarcopenic obesity after adjustment. A duration greater than 10 years, uncontrolled diabetes, age greater than 65 years, low physical activity, hypertension, and dyslipidemia also independently increased the odds.ConclusionIndian adults with type 2 diabetes have a high burden of sarcopenia and sarcopenic obesity. Early optimization of diabetes care and lifestyle changes are vital for preserving muscle health.

Endovascular Treatment of Abdominal Aortic Aneurysm: Impact of Diabetes on Endoleaks and Reintervention.

Background: Diabetes has a protective effect on abdominal aortic aneurysms (AAAs); however, there are contrasting reports on the impact of diabetes on endovascular aortic repair (EVAR) outcomes, endoleaks (ELs) being the major negative outcome. The present study characterizes ELs and their outcomes in AAA patients, diabetic or not. Methods: This single-center, retrospective, comparative study was carried out on 324 AAA patients who underwent elective EVARs between 2007 and 2016 at the University Hospital of Liège (Belgium). The primary endpoint was the incidence and effect of ELs on the evolution of the aneurysmal sac; the secondary endpoints were surgical reintervention and mortality rate. Diabetic and non-diabetic patients were compared with respect to various risk factors by logistic regression, while a Cox regression was used to analyze survival. Results: In AAA patients meeting the inclusion criteria (n = 248), 23% were diabetic. EL incidence was comparable (p = 0.74) in diabetic (38.7%) vs. non-diabetic (43.9%) patients. EL risk factors were age (HR = 1.04, p = 0.014) and fibrate intake (HR = 3.12, p = 0.043). A significant association was observed between ELs and aneurysm sac enlargement (p < 0.001), regardless of group (p = 0.46). Aneurysm sac regression per month for non-diabetic patients was -0.24 ± 0.013, while for diabetics it was -0.18 ± 0.027 (p = 0.059). Dyslipidemia (HR = 3.01, p = 0.0060) and sulfonylureas (HR = 8.43, p = 0.043) were associated with shorter EL duration, while diabetes (HR = 0.080, p = 0.038) and beta blockers (HR = 0.46, p = 0.036) were associated with longer EL duration. The likelihood of reoperation decreased with more recent surgery (OR = 0.90, p = 0.040), regardless of diabetic status. All-cause mortality was higher for the non-diabetic group (45.5% vs. 26.3%, p = 0.0096). Conclusions: Endoleak occurrence is a known risk factor for sac expansion. In diabetic patients, endoleaks lasted longer, and regression of the aneurysm sac tended to be slower. The number and type of reintervention was not related to the diabetic status of AAA patients, but overall survival was higher in patients with diabetes.

Anti-depressant effect of Naringenin-loaded hybridized nanoparticles in diabetic rats via PPARγ/NLRP3 pathway

Naringenin (NAR) has various biological activities but low bioavailability. The current study examines the effect of Naringenin-loaded hybridized nanoparticles (NAR-HNPs) and NAR on depression induced by streptozotocin (STZ) in rats. NAR-HNPs formula with the highest in vitro NAR released profile, lowest polydispersity index value (0.21 ± 0.02), highest entrapment efficiency (98.7 ± 2.01%), as well as an acceptable particle size and zeta potential of 415.2 ± 9.54 nm and 52.8 ± 1.04 mV, respectively, was considered the optimum formulation. It was characterized by differential scanning calorimetry, examined using a transmission electron microscope, and a stability study was conducted at different temperatures to monitor its stability efficiency showing that NAR-HNP formulation maintains stability at 4 °C. The selected formulation was subjected to an acute toxicological test, a pharmacokinetic analysis, and a Diabetes mellitus (DM) experimental model. STZ (50 mg/kg) given as a single i.p. rendered rats diabetic. Diabetic rat groups were allocated into 4 groups: one group received no treatment, while the remaining three received oral doses of unloaded HNPs, NAR (50 mg/kg), NAR-HNPs (50 mg/kg) and NAR (50 mg/kg) + peroxisome proliferator-activated receptor-γ (PPAR-γ) antagonist, GW9662 (1mg/kg, i.p.) for three weeks. Additional four non-diabetic rat groups received: distilled water (normal), free NAR, and NAR-HNPs, respectively for three weeks. NAR and NAR-HNPs reduced immobility time in forced swimming test and serum blood glucose while increasing serum insulin level. They also reduced cortical and hippocampal 5-hydroxyindoeacetic acid, 3,4-Dihydroxy-phenylacetic acid, malondialdehyde, NLR family pyrin domain containing-3 (NLRP3) and interleukin-1beta content while raised serotonin, nor-epinephrine, dopamine and glutathione level. PPAR-γ gene expression was elevated too. So, NAR and NAR-HNPs reduced DM-induced depression by influencing brain neurotransmitters and exhibiting anti-oxidant and anti-inflammatory effects through the activation PPAR-γ/ NLRP3 pathway. NAR-HNPs showed the best pharmacokinetic and therapeutic results.

Continuous glucose monitoring (CGM) for 308 older-age participants in an English birth cohort: variability and correlates

Introduction &amp; BackgroundEpochs of hyperglycaemia and hypoglycaemia may each increase risk of common chronic diseases and impair both cognitive and physical function even in people without diabetes. Older people may have greater frequency of adverse glycaemic excursions, partly due to disordered autonomic function and sleep quality. Data for older, non-diabetic people are however scant. Objectives &amp; Approach1) To describe blood glucose variability (completed) and 2) its socio-demographic and lifestyle correlates in a predominantly non-diabetic cohort of older adults (planned). Participants were recruited during 2021-2023 from an English birth cohort (the 1946 National Survey for Health and Development Study). They wore a continuous glucose monitor (Freestyle libre Abbott), which measured circulating glucose four times/hour, for seven days. Summary statistics and time outside range (4.4-7.8mmol/L) were calculated. Further information on glycaemic excursions and day-to-day variability will be gleaned using the R “iglu” package. For all CGM summary and excursion measures, future analyses will investigate: associations with HbA1c, socio-demographics, body composition, physical activity, diet and alcohol use. Results will be stratified by sleep/ wake time periods estimated from simultaneous actigraphy (Philips Actiwatch Spectrum Plus). Sensitivity analyses will exclude people taking hypo/ hyperglycaemic medications and those with diabetes. Relevance to Digital FootprintsDerived summary measures can be used by future studies to give insights into glycaemic variability as a population-level risk factor. This work will bring together multiple data sources, i.e. from CGM, actigraphy and baseline cohort data. ResultsParticipants were aged 75-76 years, 45% female and 10% had diagnosed diabetes; median (IQR) BMI was 26.8 (24.6-29.2) kg/m2. CGM data from 308 participants was collected, for a median (IQR) of 6.9 (6.7-7.6) days. Average glucose over the recording period was 5.7mmol/L (5.3-6.2mmol/L), standard deviation was 1.0mmol/L (0.8-1.3mmol/L), time outside range was 12.8% (6.2-24.7%) and 16% of participants spent ≥1 hour/day above and ≥1 hour/day below range. Conclusions &amp; ImplicationsCGM was feasible for this cohort of older adults, and demonstrated high levels of time outside range for a predominantly non-diabetic group. Future analysis will determine whether enhanced characterisation of glycaemic variability is a potentially more accurate tool for predicting future disease risk than isolated glucose measurements.

Longitudinal study on the change trend of serum alkaline phosphatase and its possible influencing factors in peritoneal dialysis patients

The aim of the study was to analyze the change trend of serum ALP over time and identify factors influencing its levels in peritoneal dialysis patients. Then to investigate the impact of serum ALP changes on calcium and phosphorus metabolism in single peritoneal dialysis center utilizing repeated measurement data. A retrospective cohort study was conducted with a total follow-up duration of 30 months. Serum ALP and other biomarkers, including calcium (Ca), phosphorus (P), 25(OH)D, intact parathyroid hormone (iPTH), albumin(ALB), and hemoglobin(Hb) were measured every 3 months. The generalized estimation equation (GEE) was utilized to analyze the change trend of serum ALP over time, and to assess whether there were differences in changes over time between different genders and different primary disease groups. Additionally, factors influencing serum ALP levels were analyzed, and the impact of serum ALP changes on calcium and phosphorus metabolism was also explored. A total of 34 patients were included in the study. Serum ALP and other indicators were measured repeatedly, with a maximum of 8 times and a minimum of 4 times. The median of serum ALP values at all measurement times for all selected patients was 89 U/L. The GEE analysis revealed that serum ALP gradually increased with time, and patients in diabetes group increased faster than those in non-diabetes group. A positive correlation was observed between serum ALP and dialysis duration, also between serum ALP and hemoglobin. However, variations in serum ALP did not significantly affect serum corrected calcium, phosphorus, or iPTH concentrations. The serum ALP levels of peritoneal dialysis patients increase gradually over time, and the concentrations are influenced by dialysis duration. The changes in serum ALP values do not have a significant impact on serum calcium, phosphorus, and iPTH levels.

Exploring auditory temporal resolution and dichotic listening skills among individuals with type 2 diabetes mellitus

The study aimed to explore the auditory temporal resolution and dichotic listening skills in patients with type 2 diabetes mellitus (T2DM) and identify associated health-related factors. Using a cross-sectional design, 87 adults with T2DM and 48 non-diabetic controls, all with normal hearing, participated. The two central auditory processing (CAP) skills were assessed through the Gaps-In-Noise (GIN) and Dichotic-Digits Listening (DDL) tests. T2DM participants underwent blood tests to measure various health-related factors. In the GIN test, the shortest gap threshold (GapTh) obtained across both ears was significantly higher in the diabetic group (9.1 ± 2.4 ms) compared to the non-diabetic group (7.5 ± 1.5 ms), and the score of correctly identified gaps (GapSc) in the diabetic group (45±11 %) was significantly lower than GapSc in the non-diabetic group (52±9 %), p < 0.001. In the DDL test, the free-recall score (73.8 ± 18.5 %) across both ears and the right-ear advantage (-1.3 ± 20.6 %) in the diabetic group were significantly lower than the free-recall score (85.8 ± 11.9 %) and right-ear advantage (6.9 ± 11.9 %) in the non-diabetic group, p < 0.005. Furthermore, the duration of diabetes, eGFR level, retinopathy, carotid plaque, fasting blood glucose level, and HDL-C (good cholesterol) level were factors significantly associated with performances in the GIN and/or DDL tests for T2DM participants. In conclusion, individuals with T2DM are at risk of reduced auditory processing skills in temporal resolution and dichotic listening, impacting their speech understanding. Six health-related factors were identified as significantly associated with CAP skills in T2DM patients.

The association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and the risk of osteoporosis among U.S. adults: analysis of NHANES data

BackgroundOsteoporosis and atherosclerosis frequently afflict older adults, and recent insights suggest a deeper connection between these conditions that surpasses mere aging effects. The ratio of non-high-density to high-density lipoprotein cholesterol (NHHR) has emerged as a novel lipid marker for evaluating the risk of cardiovascular diseases. Nonetheless, investigations into the correlation of the NHHR with the risk of developing osteoporosis remain unexplored.MethodsWe collected NHHR and bone mineral density (BMD) data from 11,024 National Health and Nutrition Examination Survey (NHANES) participants between 2011 and 2018. Multivariate linear regression was employed to examine the correlation between BMD and NHHR. Smooth curves were employed to deal with the nonlinearity. To further account for the nonlinear link, we used a two-part linear regression model. The threshold effects were estimated using two components of a linear regression model. Subgroup and sensitivity analyses were carried out to ascertain the stability of the findings.ResultsWe discovered a negative relationship between the NHHR and lumbar spine BMD in all three models. An L-shaped curvilinear association existed between the NHHR and lumbar spine BMD, with a key inflection point of 6.91. The fully adjusted model showed that the BMD of the lumbar spine fell by 0.03 g/cm2 in those who were in the fourth quartile as opposed to the lowest quartile. The sensitivity analysis using unweighted logistic analysis verified the stability of the results. In addition, BMD in the nondiabetic group was more significantly affected by the negative effect of the NHHR in the subgroup analysis.ConclusionsAccording to this research, there appears to be a negative correlation between BMD and NHHR in US Adults. To clarify the precise physiological mechanisms by which the NHHR contributes to the onset of osteoporosis, more research is necessary.

Barefoot pressure distribution of diabetic patients and non-diabetic volunteer subjects after sensorimotor training with an unstable shoe construction

BackgroundForty-three percent of all diabetic foot ulcers occur under the medial forefoot due to a medial deviation of elevated pressures and premature forefoot ground contact in neuropathic diabetic patients. A 6-week sensorimotor training period with an unstable shoe construction reduces in-shoe peak pressures and contact times under the medial aspect of the forefoot. MethodsThe study was designed as a Randomised Control Trial with two diabetic groups (one served as intervention group and one as control group) and one non-diabetic intervention group. Measurements for barefoot pressure distribution and contact times were taken by means of an Emed® pressure measurement platform (Novel GmbH, Munich) before and after 6 weeks. During this time the diabetic and the non-diabetic intervention groups were required to wear an unstable shoe construction (Masai Barefoot Technology, MBT®) for at least four hours per day. FindingsResults for the non-diabetic intervention group showed significantly later contact times for the medial portion of the forefoot, resulting in shorter contact times. Peak pressure was also reduced under the medial aspect of the foot while it was increased under the lateral aspect of the foot. Changes for the diabetic intervention group followed the same pattern while the values of the diabetic control group shifted away from the reference values. InterpretationA 6-week sensorimotor training period with an unstable shoe construction can change barefoot peak pressures and contact times in non-diabetic subjects and in diabetic patients in the most endangered area, i.e. the medial forefoot.

Comparative assessment of the impact of renal denervation on blood pressure values in resistant hypertensive patients with and without type 2 diabetes

Randomized clinical trial data confirm the effectiveness of renal artery denervation (RDN) not only among hypertensive patients, but also in other pathologies associated with increased SNS activity, such as type 2 diabetes, heart failure and others. Aim. Evaluation of the impact of RDN on blood pressure values in two categories of patients - resistant hypertension with and without type 2 diabetes. Materials and methods. The randomized prospective clinical study was designed that enrolled 250 resistant hypertensive patients divided into two equal groups of 125 patients depending to the presence of DM. The patients in the first two subgroups of each group were given standardized treatment supplemented with SNS blockers Moxonidine and Bisorpolol , while patients from subgroups III and VI underwent RDN. Patients were evaluated by dynamic ambulatory BP monitoring for a period of 3 years. Results. Authentic reduction of office SBP and DBP was noted starting from 6 months of assessment in all research groups, the comparative analysis of dynamics of office SBP at all stages of evaluation demonstrating a clear superiority of groups of minimally invasive treatment by RDN versus pharmacological treatment with the SNS blockers Moxonidine and Bisoprolol in improving these parameters. At the same time, a statistically significant reduction in the average values of SBP and DBP 24 hours was recorded in both the pharmacological and interventional treatment groups independent ofthe presence of type 2 diabetes, the maximum antihypertensive effect being expressed at 36 months of evaluation. Diabetic and non-diabetic patient groups undergoing RDN demonstrated superiority to both pharmacotherapeutic regimens at all follow-up stages.Conclusions. The obtained results demonstrated the comparable antihypertensive efficacy of RDN in resistant hypertensive patients with or without type 2 diabetes. At the same time, the groups of diabetic and non-diabetic patients undergoing RDN showed superiority over both pharmacotherapeutic regimens with SNS blockers in reducing blood pressure values, the beneficial effect being maintained for a three-year follow-up period.

#2209 Hypoglycemia induced by hemodialysis in diabetic and non-diabetic patients, how to prevent it? A prospective study

Abstract Background and Aims Hemodialysis-induced hypoglycemia, a documented complication associated with adverse clinical outcomes, including mortality, is linked to factors such as impaired gluconeogenesis, inadequate nutritional status, reduced insulin clearance, glucose loss to the dialysate, and autonomic neuropathy. Glycemic variability is recognized as an independent risk factor for morbidity and mortality. This study aims to investigate the incidence of hypoglycemia during hemodialysis (HD) by exploring protocol-related factors and their impact, such as in-nutrition during HD. Additionally, the study seeks to examine the relationship between nutritional and inflammatory statuses and variations in intradialytic glycemia in both diabetic and non-diabetic patients. Method This prospective study, conducted between September and December 2023, examined the glycemic profiles of HD patients at a hospital HD program. All patients undergo hemodialysis with a dialysate containing 100 mg/dL of glucose. Plasma glucose levels were assessed at the start, 2:30 hours post-initiation, and the end of sessions. Following the 2:30-hour mark, patients received a meal (523 Kcal). Glycose variability was computed by averaging blood glucose differences across all sessions. Data collected included demographics, hemodialysis specifics, and lab results. Inflammatory and nutritional statuses were evaluated using lab tests at the study's beginning and conclusion [ferritin, protein C reactive (PCR), interleukin 6 (IL-6) and albuminemia, urea, creatinemia, cholesterol, respectively]. Anthropometric measurements and bioimpedance assessments were performed, with values averaged for better representation. Categorical variables are shown with frequencies/percentages, and continuous variables with means/standard deviations or medians/interquartile ranges for skewed distributions. The study used repeated measures ANOVA for glycemic profiles, correlation analyses for outcome influences on glycemia, and parametric/non-parametric tests for relations in diabetic and non-diabetic groups. Significance was set at p&amp;lt;0.05, analyzed with SPSS version 29 for Mac OS 13. Results 63 patients, 67.2% (n=43) were males, the medium age was 72.0±11.8 and 50.8% (n=32) had diabetes. Among 9072 measurements, hypoglycemia was observed in 0.07% (n=6) of diabetic patients and 0.01% (n=1) in non-diabetic individual. The initial blood glucose measurement was 139.5±260.0 mg/dL, the second was 117.05±35 mg/dL, and the third was 132.8±21.3 mg/dL. Significant differences were observed in all measurements [F (1.17, 73.58)=23.62; p&amp;lt;0.001]. The mean glycemic variation between the first and second measurements was 23.8±46.0 mg/dL, and for the third measurement was 5.5±71.5 mg/dL. There was no significant correlation found between glycemic and nutritional parameters neither between inflammatory parameters. In the subgroup analysis comparing diabetic and non-diabetic patients, the diabetic group demonstrated lower serum creatinine levels (6.8±2.7 mg/dL) and total cholesterol (137.4±35.6 mg/dL), coupled with a higher Charlson Index (8.2±1.7). These differences were statistically significant (p=0.055, p=0.035, p&amp;lt;0.001). In the subsequent analysis, no other statistically significant associations were observed. Conclusion Contrary to what is described in the literature, the studied population exhibited a very low incidence of hypoglycemic events. This underscores the importance of nutrition during HD, along with the use of a glucose-containing dialysate, as an effective preventive measure against intradialytic hypoglycemia. Careful consideration of these factors is warranted to prevent adverse health consequences for our patients. It is plausible that diabetic patients may face an elevated risk of malnutrition, necessitating heightened concern and a more proactive preventive approach.