Onset Of Diabetes Mellitus Research Articles

Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study.

There was limited data on treatment outcomes among patients with diabetic ketoacidosis (DKA) in Ethiopia. The aim of the study was to determine the treatment outcomes of DKA patients attending Debre Tabor General Hospital. A retrospective study was conducted at Debre Tabor General Hospital and data were collected from June 1 to June 30 of 2018. Participants included in the study were all diabetic patients with DKA admitted from August 2010 to May 31, 2018. The primary outcomes were the treatment outcomes of DKA including (in-hospital glycemic control, the length of hospital stay and in-hospital mortality). The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was presented in the form of means with standard deviation and binary regression was conducted to determine factors that affect length of hospital stay among DKA patients. 387 patients were included in the study. The mean age of patients was 33.30± 14.96 years. The most common precipitating factor of DKA was new onset diabetes mellitus 150(38.8%). The mean length of hospital stay was 4.64(±2.802) days. The mean plasma glucose at admission and discharge was 443.63(±103.33) and 172.94 (±80.60) mg/dL, respectively. The majority 370 (95.60%) of patients improved and discharged whereas 17 (4.40%) patients died in the hospital. Patients with mild and moderate DKA showed short hospital stay; AOR: 0.16 [0.03-0.78] and AOR:0.17[0.03-0.96] compared with severe DKA. Diabetic ketoacidosis precipitated by infection were nearly five times more likely to have long hospital stay than DKA precipitated by other causes; AOR: 4.59 [1.08-19.42]. In addition, serum glucose fluctuation during hospitalization increased the likelihood of long hospital stay, AOR: 2.15[1.76-2.63]. New onset type 1 diabetes was the major precipitating factor for DKA. Admitted DKA patients remained in hospital for a duration of approximately five days. About five out of hundred DKA patients ended up with death in the hospital. Infection, serum glucose fluctuations and severity of DKA were determinants of long hospital stay. Early prevention of precipitating factors and adequate management of DAK are warranted to reduce length of hospital stay and mortality.

Endoscopic or surgical treatment for necrotizing pancreatitis: Comprehensive systematic review and meta-analysis.

Background and study aims Treatment of necrotizing pancreatitis is changed over the past two decades with the availability of endoscopic, and minimally invasive surgical approaches. The aim of this systematic review was to assess outcomes of endoscopic drainage, and different types of surgical drainage approaches in necrotizing pancreatitis. Methods Medline, Embase, Scopus, and Web of Science were searched from 1998 to 2020 to assess outcomes in endoscopic drainage and various surgical drainage procedures. The assessed variables consisted of mortality, development of pancreatic or enteric fistula, new onset diabetes mellitus, and exocrine pancreatic insufficiency. Results One hundred seventy studies comprising 11,807 patients were included in the final analysis. The pooled mortality rate was 22 % (95 % confidence interval [CI]: 19%–26 %) in the open surgery (OS), 8 % (95 %CI:5 %–11 %) in minimally invasive surgery (MIS), 13 % (95 %CI: 9 %–18 %) in step-up approach, and 3 % (95 %CI:2 %–4 %) in the endoscopic drainage (ED). The pooled rate of fistula formation was 35 % (95 %CI:28 %–41 %) in the OS, 17 % (95 %CI: 12%–23 %) in MIS, 17 % (95 %CI: 9 %–27 %) in step-up approach, and 2 % (95 %CI: 0 %–4 %) in ED. There were 17 comparative studies comparing various surgical drainage methods with ED. The mortality rate was significantly lower in ED compared to OS (risk ratio [RR]: 30; 95 %CI: 0.20–0.45), and compared to MIS (RR: 0.40; 95 %CI: 0.26–0.6). Also, the rate of fistula formation was lower in ED compared to all other surgical drainage approaches. Conclusions This systematic review demonstrated lower rate of fistula formation with ED compared to various surgical drainage methods. A lower rate of mortality with ED was also observed in observational studies. PROSPERO Identifier: CRD42020139354

Impact of pre-transplant dialysis modality on kidney transplant outcomes: a systematic review and meta-analysis.

For end-stage renal disease (ESRD), patients receiving kidney transplantation, peritoneal dialysis (PD) and hemodialysis (HD) are both appropriate modes of pre-transplant dialysis. The aim of this review is to assess the impact of pre-transplant PD compared to HD on kidney transplant outcomes in ESRD patients. A comprehensive search in digital databases, like PubMed, SCOPUS and EMBASE and a manual search were conducted to identify cohort studies comparing the kidney transplant outcomes of both pre-transplant dialysis modalities. The data were subjected to both qualitative and quantitative analysis. A meta-analysis was carried out to calculate the effect estimate for patient survival, graft survival and delayed graft function, death-censored graft survival, acute rejection-free graft survival, graft vessel thrombosis, urological complications, surgical complications, any infections, and onset of diabetes after transplantation. The qualities of the included studies were judged by the New-castle Ottawa scale. The overall patient survival is shown to be better with patients who underwent pre-transplant PD compared to HD with OR 1.34 95% CI [1.11, 1.61], p = 0.002. Delayed graft function was found to be highly associated with HD compared to PD with OR 0.60 [0.52, 0.70], p<0.0001 with moderate heterogeneity (i2 = 48%). However, no difference was observed in terms of graft survival, complications, infections, and new onset of diabetes mellitus compared to patients undergoing pre-transplant HD. Within the limitations of the review, it can be concluded that ESRD patients undergoing pre-transplant PD were found to have better patient survival and lower incidence of delayed graft function.

IDF21-0546 Impact of alpha lipoic acid supplementation in metabolic parameters of patients with prediabetes

Background: Prediabetes, defined as IFG and/or IGT and/or HbA1c levels within 5.7–6.4% (39–47 mmol/mol), usually precedes the diagnosis of diabetes mellitus in adults and the in latest years its prevalence has been rising in numbers compared to the previous years, due to various factors. The importance of prediabetes diagnosis lies in the fact that if untreated it shows an increased rate of new onset diabetes mellitus type 2 and may also lead to the development of diabetes’ complications. Prediabetes, according to ADA, can and should be prevented through a series of diagnostic tests that have proven to be cost-effective and the use of the ADA Risk Test, and if developed there have been various treatment methods proposed, such as lifestyle modifications, use of metformin and certain dietary supplements that may take part in reducing insulin resistance, including chromium, alpha-lipoic acid (ALA), etc. Aim: Main aim of this study is to define whether alpha-lipoic acid (ALA) supplementation in adults with glucose metabolism abnormalities, defined as “prediabetes”, has an impact on their metabolic factors. The study was sponsored by “Medical Pharmaquality” Company. Method: This study included people aged 18–65, presenting at least one of ADA’s criteria for prediabetes diagnosis, leading a sedentary lifestyle, presenting with a BMI > 25 kg/m2 and showing no symptoms of depressive disorders. All subjects received a 600 mg ALA supplement daily for 90 days and they were tested for total blood count, Hba1C, fasting blood sugar and insulin levels, total cholesterol, HDL, LDL, triglycerides, fasting c-peptide, HOMA-IR, Matsuda index, AUC for glucose and insulin curves, body weight, BMI, fat percentage and visceral fat rating, before and after the intervention. Results: ALA supplementation seems to have a strong correlation with changes in total cholesterol levels (p = 0.005), HDL (p = 0.049) and c-peptide (p = 0.013). Furthermore, a statistically significant reduction in body weight was observed (p < 0.001), as well as in BMI (p < 0.001), fat percentage (p < 0.001) and visceral fat rating (p < 0.001). The rest of the tested variables did not exhibit statistically significant changes, following ALA supplementation. Discussion: The results of this study are in complete agreement with ALA’s perceived actions on the adipose tissue, although the strong correlation between ALA supplementation and visceral fat rating reduction has not been reported before. Additionally, the observed reduction in fasting c-peptide levels is a finding that supports the assumption that ALA can lead to reduction in resting hyperinsulinemia levels in prediabetes.

Indian Diabetes Risk Score (IDRS): An effective tool to screen undiagnosed diabetes

Background: Diabetes is an insidious public health problem. India has the second largest number of adults living with diabetes worldwide (77 million). Indian Diabetes Risk Score (IDRS) is a simple, cost-effective and feasible tool for mass screening programme at community level. Aim &amp; Objective: To assess diabetes risk in adults aged 30 years and above and to identify high risk subjects for screening undiagnosed diabetes in an urban population of Meerut. Settings and Design: Community based cross-sectional study. Methods and Material: All adults who were ?30 years of age and non-diabetic were interviewed using pre-designed, pre-tested questionnaire for their socio-demographic profile and lifestyle. Fasting Blood glucose of all study subjects were done to screen undiagnosed diabetics. Statistical analysis used: Centers for Disease Control (CDC), Epi Info TM 7.2.3.1 was used. Pearson’s Chi Square were applied. Results: 33.4% were found to have high diabetes risk. Risk of diabetes increases with age. 7.6% of the study subjects were found to be diabetic and were unaware of their diabetic status. Physical inactivity and increasing waist circumference were found to be significantly associated with risk of diabetes. Diabetes risk was also significantly associated with positive family history. Conclusions: Screening and early identification of high risk individuals would help in early diagnosis and treatment to prevent or to delay the onset of diabetes mellitus and its complications.

The neonatal onset diabetes mellitus of Chinese neonate with congenital generalized lipodystrophy 2: a case report

BackgroundCongenital generalized lipodystrophy (CGL) is a clinically heterogeneous disorder characterized by near total absence of adipose tissue along with metabolic complications. Diabetes mellitus developed from CGL usually present between ages 15 and 20 years, and there are few reports in neonate.Case presentationIn this report, we described a rare clinical presentation of CGL in a 12-day-old Chinese female neonates with hyperglycemia, hyperlipidemia, and subsequently appeared diabetes, hepatomegaly and fatty liver. The two clinical-exome sequencing identified heterozygous null mutations (c.793C > T and c.565G > T) in BSCL2 gene which was inherited from father and mother respectively. To date, it was the firstly reported CGL patient with neonatal onset diabetes. The neonate was treated with antibiotic, insulin and deeply hydrolyzed formula milk to significantly decrease FBG and serum trigylcerides levels. ConclusionsOur case report analyzes the causes of early onset diabetes may relate with the locus of BSCL2 gene mutations and infection induction. It also suggests the importance of early identification, genetic analysis, and symptomatic treatment in the CGL, which are essential for improving the prognosis of children.

Relationship between onset age of type 2 diabetes mellitus and vascular complications based on propensity score matching analysis.

Aims/IntroductionTo assess the relationship between type 2 diabetes mellitus onset age and vascular complications in China.Materials and MethodsA retrospective review of 3,568 patients with type 2 diabetes mellitus using a propensity score‐matched (PSM) cohort analysis was carried out in two different age of onset groups (age 40 and 60 years). These groups were then subdivided into two groups, early‐onset diabetes (EOD40 and EOD60; the onset age before 40 and 60 years, respectively) and late‐onset diabetes (LOD40 and LOD60: the onset age after 40 and 60 years, respectively). Macrovascular and microvascular complications were analyzed before and after PSM.ResultsPatients categorized in both the early‐onset disease (EOD) groups had a higher risk of developing macro‐ and microvascular complications before PSM. After PSM, no differences existed between the EOD and late‐onset disease groups in the risk of macrovascular complications. Compared with the late‐onset disease group, the odds ratio of having a microvascular complication of diabetic retinopathy, chronic kidney disease and diabetic peripheral neuropathy in the 40‐year‐old EOD group increased to 2.906, 1.967 and 1.672 (P < 0.05), respectively. The odds ratio of diabetic retinopathy and diabetic peripheral neuropathy in the 60‐year‐old EOD group was 1.763 and 1.675 (P < 0.05), respectively.ConclusionsThe earlier the onset of type 2 diabetes mellitus, the higher risk of microvascular, but not necessarily macrovascular, complications. It is not too late to prevent diabetes at any age. Pre‐emptive microvascular treatment or preventative measures in EOD patients who do not yet show symptoms, might be beneficial.

Identifying Human PTP1B Enzyme Inhibitors from Marine Natural Products: Perspectives for Developing of Novel Insulin-Mimetic Drugs.

Diabetes mellitus (DM) represents a complex and multifactorial disease that causes metabolic disorders with acute and long-term serious complications. The onset of DM, with over 90% of cases of diabetes classified as type 2, implies several metabolic dysfunctions leading to consider DM a worldwide health problem. In this frame, protein tyrosine phosphatase 1B (PTP1B) and aldose reductase (AR) are two emerging targets involved in the development of type 2 diabetes mellitus (T2DM) and its chronic complications. Herein, we employed a marine-derived dual type inhibitor of these enzymes, phosphoeleganin, as chemical starting point to perform a fragment-based process in search for new inhibitors. Phosphoeleganin was both disassembled by its oxidative cleavage and used as model structure for the synthesis of a small library of functionalized derivatives as rationally designed analogues. Pharmacological screening supported by in silico docking analysis outlined the mechanism of action against PTP1B exerted by a phosphorylated fragment and a synthetic simplified analogue, which represent the most potent inhibitors in the library.

Abstract 114: WFS1 gene associated diabetes phenotypes and identification of a novel founder mutation in Southern India

Background: Wolfram Syndrome (WFS) is a rare, autosomal recessive, progressive disorder characterized by childhood-onset diabetes mellitus (DM), diabetes insipidus, optic atrophy, and sensorineural hearing loss (DIDMOAD). The confirmed early diagnosis of WFS is challenging due to the progressive nature of the disease and WFS1 rare heterozygous variants reported in young-onset DM, the need for comprehensive genetic screening for the early diagnosis of WFS and to characterize the phenotypic spectrum associated with diabetes mellitus.Aims and Objectives: To screen a comprehensive panel of seventeen monogenic diabetes genes in patients with DM, with a clinical suspicion of WFS/non autoimmune T1DM/Young onset DM patients who were tested negative for a MODY panel.Results: Fourteen patients positive for WFS1 variants identified by Next-generation sequencing. Ten patients were positive for homozygous WFS1 mutations, which includes a novel founder mutation WFS1 (NM_006005.3): c.1107_1108insA (p.Ala370SerfsTer173) in three families from south India. We have also identified rare heterozygous WFS1 variants in four patients with young onset diabetes.Conclusion: These findings project the need for NGS-based parallel multigene testing for early diagnosis of WFS and to identify heterozygous WFS1 variants implicated in young onset DM.

Early life Bacillus Calmette-Guerin vaccination and incidence of type 1, type 2, and latent autoimmune diabetes in adulthood

AimsBacillus Calmette-Guerin (BCG) vaccination limits blood sugar elevations and autoimmunity. Previous studies focused on type 1 diabetes among children, despite possible effects on other phenotypes later in life. We studied associations between BCG vaccination and type 1, type 2 and latent autoimmune diabetes (LADA) in adulthood. MethodsA 1970–1974 birth cohort was linked with the BCG vaccination registry and administrative health data of Quebec. 396,118 people aged 22–44 years were followed-up for diabetes mellitus (DM) onset. Incident DM cases were subjects with ≥1 hospitalization or ≥2 physician claims related to DM over a 2-year period. Type 1 diabetes, type 2 diabetes, and LADA cases were individuals with ≥1 reimbursement of insulin, oral antidiabetic agent, or both. Cox proportional regressions were used to estimate hazard ratios (HR), adjusting for potential confounders. ResultsForty-four percent of subjects were BCG vaccinated, 88% of these before age 1. For type 1 diabetes, no association was found before 30 years old, but vaccinated subjects had a lower risk of this phenotype after age 30 (HRadj= 0.65, 95% CI: 0.44–0.95). BCG vaccination was associated with a lower risk of type 2 diabetes (HRadj=0.85, 95% CI: 0.79–0.92), whereas no association was observed for LADA (HRadj=1.30, 95% CI: 0.71–2.38). Results did not differ by sex. ConclusionsEarly life BCG vaccination was associated with lower risks of both type 1 and type 2 diabetes from early to middle adulthood, but not of LADA. Future studies should explore these long-term associations, while distinguishing diabetes phenotypes.

Comparison of New-Onset Diabetes Mellitus among Patients with Atrial Fibrillation or Atrial Flutter

ackground and objectives: The objective was to compare the rate of onset of diabetes mellitus (DM) in patients with atrial fibrillation (AF) as compared with atrial flutter (AFL).

Fatty liver with metabolic disorder, such as metabolic dysfunction-associated fatty liver disease, indicates high risk for developing diabetes mellitus.

IntroductionNonalcoholic fatty liver disease (NAFLD) is diagnosed after excluding other liver diseases. The pathogenesis of NAFLD when complicated by other liver diseases has not been established completely. Metabolic dysfunction‐associated fatty liver disease (MAFLD) involves more metabolic factors than NAFLD, regardless of complications with other diseases. This study aimed to clarify the effects of fatty liver occurring with metabolic disorders, such as MAFLD without diabetes mellitus (DM), on the development of DM.Materials and MethodsWe retrospectively assessed 9,459 participants who underwent two or more annual health check‐ups. The participants were divided into the MAFLD group (fatty liver disease with overweight/obesity or non‐overweight/obesity complicated by metabolic disorders), simple fatty liver group (fatty liver disease other than MAFLD group), metabolic disorder group (metabolic disorder without fatty liver disease), and normal group (all other participants).ResultsThe DM onset rates in the normal, simple fatty liver, metabolic disorder, and MAFLD groups were 0.51, 1.85, 2.52, and 7.36%, respectively. In the multivariate analysis, the MAFLD group showed a significantly higher risk of DM onset compared with other three groups (P < 0.01). Additionally, the risk of DM onset was significantly increased in fatty liver disease with overweight/obesity or pre‐diabetes (P < 0.01).ConclusionsFatty liver with metabolic disorders, such as MAFLD, can be used to identify patients with fatty liver disease who are at high risk of developing DM. Additionally, patients with fatty liver disease complicated with overweight/obesity or prediabetes are at an increased risk of DM onset and should receive more attention.

Impact of Successful HCV Eradication on Glycemic Control in Chronic HCV Patients with Type II Diabetes Mellitus

Introduction: Chronic HCV infection has been implicated as a risk factor for new onset diabetes mellitus type II and worsening of glycemic control in patients with already established Diabetes due to defined molecular mechanisms. The impact of successful HCV eradication with direct-acting antiviral agents (DAAs) on glycemic control in HCV patients with concomitant Diabetes mellitus is being assessed by several studies but still unclear due to scarce data in literature, which specifically address this aspect of DAAs. Objective: To study the impact of successful HCV eradication with DAAs based regimes on glycemic control in a cohort of Chronic HCV patients with concomitant Type II Diabetes Mellitus. Materials and Methods Study design: Descriptive Case series Study place: Department of Gastroenterology, Lahore General Hospital, Lahore. Duration: Six months i.e. 15-2-2021 to 15-8-2021 Data collection procedure: 110 patients, who fulfill the inclusion, were enrolled in the study.All patients of Hepatitis C received DAAs in the form of Oral Sofosbuvir 400 mg and Oral Daclatasvir 60 mg daily for 12 weeks without Ribavirin. Only Child Pugh class A and class B patients were included. Before starting treatment glycosylated haemoglobin (HbA1c) and Viral load by HCV RNA polymerase chain reaction was also checked. All the patients were followed at the end of treatment i.e. at 12 weeks( from the baseline ) and then three months after treatment (at 24 weeks), for viral load testing by HCV RNA polymerase chain reaction and HbA1c levels. Results: In this study 91% patients achieved sustained virological response and 83% of the patients achieved improved glycemic control after successful HCV eradication. Age (23-33: 16.5%, 34-44: 40.7%, 44-54: 29.7% p-value=0.728) and gender (Male: 39.6% &amp; Female: 60.4%, p-value=0.142) have no significant association with glycemic control of patients. Conclusion: Based on the findings of this study, it can be concluded that oral DAAs can help improving the glucose levels and glycemic control significantly in HCV patients with concomitant Type II diabetes mellitus and successful HCV eradication can prevent the long term complications of diabetes and may need dose reduction for insulin therapy in these patients Keywords: Glycemic control, dual-acting antiviral agents, chronic hepatitis C virus infection, Diabetes Mellitus

Effects of Statin Drugs on New Onset of Diabetes Mellitus in Post Menopausal Women

Background: Statin drugs are using all over the world for the treatment of hypercholesterolemia. There is hypothesis that post menopausal women who used statin drugs long time can develop the onset of type 2 diabetes mellitus because statin drugs inhibit the signal transduction of insulin by inhibiting oxidative phosphorylation resulting in decrease secretion of insulin leads to hyperglycemia. The aim of this study to estimate the effects of statin drugs on blood glucose level and HbA!c% in post menopausal women.&#x0D; Methodology: This case comparative study was done at LUMHS Jamshoro. The sampling was done by Non Probability method. Total number of150 subjects were divided in 2 group’s i.e group A (Control group) &amp; group B (Case study group). The fasting glucose level was measured by glucose oxidase method while HbA1c% &amp; serum cholesterol levels were determined by Kit method by using auto analyzer. The statistical analysis was done by SPSS 21 by applying ANOVA test for multiple variants. &#x0D; Results: The mean with S.D fasting blood glucose levels in control group was 78± 9.05 mg/dl while in case study group it was 134 ± 12.15mg/dl (p &lt;0.05), HbA1c% levels in control group was 5.3 ± 1.1% while in case study group it was 7.4 ± 1.3% (p&lt;0.05) and serum cholesterol in control group was 157± 9.75 mg/dl while in case study group it was 195 ± 8.78 mg/dl (p&lt;0.05) was significantly (P&lt;0.05). The glycemic index &amp; fasting blood glucose levels significantly observed elevated in post menopausal women who were use statin drugs since last three years&#x0D; Conclusion: This study concluded that there was significant relation of statin drugs on increasing of blood glucose levels so they can induce the onset of Type-2 Diabetes Mellitus.

COVID-19 associated rhino-orbital-cerebral mucormycosis-an institutional series.

Mucormycosis is almost always confined to the patients with altered host defenses amongst which diabetes is considered as the strongest risk factor. COVID-19 only been seen in severe cases but also in mild and moderate cases of SARS-CoV-2 infections. After preliminary clinical and radiological diagnosis, surgical management in the form of endoscopic sinus surgery, debridement, and orbital exenteration (8) was performed. Medical management in the form of antifungal therapy (amphotericin-B, posaconazole, and isavuconazole) was initiated. In this case series, 79 proven cases of COVID-19 associated rhino-orbital-cerebral mucormycosis were analyzed retrospectively from mid-April 2021 to mid-September 2021. 67 patients were known diabetics, whereas rest 12 had new onset diabetes mellitus. Of these 79 cases, 27 cases had the disease limited to sinuses (rhino-mucormycosis), 43 had orbital involvement also (rhino–orbital mucormycosis), and 9 had cerebral involvement as well (rhino–orbital–cerebral mucormycosis). During this time-period, a total of 14 mortalities occurred. Most of the patients were discharged after completion of amphotericin-B therapy and rest stayed little longer till their general condition improved. COVID-19 causes dysregulation and alteration of immune response in the body which predispose to invasive fungal infections. In addition, uncontrolled diabetes mellitus and corticosteroid treatment increase the risk of mucormycosis by many folds.

Diabetes and COVID-19; A Bidirectional Interplay.

There seems to be a bidirectional interplay between Diabetes mellitus (DM) and coronavirus disease 2019 (COVID-19). On the one hand, people with diabetes are at higher risk of fatal or critical care unit-treated COVID-19 as well as COVID-19 related health complications compared to individuals without diabetes. On the other hand, clinical data so far suggest that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may result in metabolic dysregulation and in impaired glucose homeostasis. In addition, emerging data on new onset DM in previously infected with SARS-CoV-2 patients, reinforce the hypothesis of a direct effect of SARS-CoV-2 on glucose metabolism. Attempting to find the culprit, we currently know that the pancreas and the endothelium have been found to express Angiotensin-converting enzyme 2 (ACE2) receptors, the main binding site of the virus. To move from bench to bedside, understanding the effects of COVID-19 on metabolism and glucose homeostasis is crucial to prevent and manage complications related to COVID-19 and support recovering patients. In this article we review the potential underlying pathophysiological mechanisms between COVID-19 and glucose dysregulation as well as the effects of antidiabetic treatment in patients with diabetes and COVID-19.

The Role of Placental Growth Factor in the Prediction of Carbohydrate and Thyroid Disorders during Pregnancy.

Background and objectives: To assess whether placental growth factor (PlGF) levels may have a predictive value for the onset of gestational diabetes mellitus (GDM) and thyroid dysfunction during pregnancy. Materials and Methods: This single-center retrospective analysis was conducted at the Specialized Hospital for Active Treatment in Obstetrics and Gynecology “Dr. Shterev”, Sofia, Bulgaria, from December 2017 to December 2019. Using pregnant women’s electronic records, we analyzed and compared the data of 412 women diagnosed with GDM and 250 women without evidence for carbohydrate disorders. Thyroid function was tested in all patients at the time of performing GDM screening. The following measurements were compared and assessed: body mass index (BMI), fasting blood glucose levels, thyroid-stimulating hormone levels (TSH), free thyroxine, and triiodothyronine (FT4 and FT3) levels, and serum placental growth factor (PlGF). The sensitivity and specificity of PlGF as a predictive marker for GDM and thyroid dysfunction were analyzed using receiver operating characteristic (ROC) curves. Results: There were no significant differences between GDM and control groups in terms of age and BMI (p > 0.05). In patients with established GDM, the PlGF corrected multiple of the median (MoM) was significantly higher compared to the control group (0.9 vs. 0.7, p < 0.001). The ROC-AUC for the prediction of GDM and thyroid dysfunction during pregnancy was 0.68 (95% CI 0.64–0.72) and 0.61 (95% CI 0.57–0.65), respectively. Conclusions: Our results underscore the potential role of PlGF as a biomarker in the prediction and diagnosis of GDM and thyroid dysfunction during pregnancy.

Clinical efficacy and safety outcomes of bempedoic acid for LDL-C lowering therapy in patients at high cardiovascular risk: a systematic review and meta-analysis

ObjectivesBempedoic acid (BA) is a novel oral low-density lipoprotein cholesterol lowering drug. This systematic review and meta-analysis aims to assess efficacy and safety for clinical outcomes in high cardiovascular (CV)...

Moderate-intensity statin use for primary prevention for more than 5 years is associated with decreased all-cause mortality in 75 years and older

ObjectiveEvidence regarding the primary preventive effects of statin in the elderly is inadequate. This study aimed to determine the duration and intensity of statins beneficial in adults aged ≥75 years for primary prevention. MethodsThis is a retrospective longitudinal study, using the National Health Insurance Corporation-Senior Cohort data from 2002 to 2015. Exact block matching was used to select comparable subjects from statin users and non-users. ResultThe study subjects consisted of 685 pairs of statin non-users and users (total number of 1,370). During the follow-up (mean 8.7 years) period, the adjusted HR for mortality compared to non-user was 0.95 (p = 0.71) in low intensity statin users and 0.80 (p = 0.002) in the moderate intensity statin groups. The adjusted HR for MACE (Major Adverse Cardiovascular Events) compared to non-users was 1.10 (p = 0.39) in the low intensity statin group and 1.29 (p = 0.001) in the moderate intensity statin group. The risk of MACE disappeared five years after in moderate intensity statin users. Moderate intensity statin use was significantly associated with an increased risk of NODM (New Onset Diabetes Mellitus) (HR 1.50, p < 0.001) for up to three years, but the risk faded away after five years (HR 0.90, p = 0.52). ConclusionModerate intensity statins taken for five or more years for primary prevention would be associated with low risk of all-cause mortality in the 75+ years old. This result may support the evidence that initiation of statin for primary prevention in patients aged over 75 years is beneficial and tolerable.

Heart rate cut-offs to identify non-febrile children with dehydration and acute kidney injury

We hypothesized that the heart rate (HR) variation in an acute setting compared with HR in wellbeing status could be a good marker of both dehydration and acute kidney injury (AKI). Since HR in wellbeing status is unknown in most cases, we assumed as reliable surrogate the 50th percentile of HR according to age and gender. We evaluated if the estimated percentage of heart rate variation in acute setting compared with 50th percentile of HR (EHRV) could be marker of dehydration and AKI in children. Two independent cohorts, one prospective comprehending 185 children at type 1 diabetes mellitus onset (derivation) and one retrospective comprehending 151 children with acute gastroenteritis and pneumonia (validation), were used to develop and externally validate EHRV as predictor of the ≥ 5% dehydration and/or AKI composite outcome. Febrile patients were excluded. EHRV was calculated as ((HR at admission–50th percentile of HR)/HR at admission) × 100. The prevalences of ≥ 5% dehydration and AKI were 61.1% and 43.8% in the derivation and 34.4% and 24.5% in the validation cohort. For the ≥ 5% dehydration and/or AKI composite outcome, the area under receiver-operating characteristic curve of the EHRV in the derivation cohort was 0.69 (95%CI, 0.62–0.77; p < 0.001) and the best EHRV cut-off was > 24.5%. In the validation cohort, EHRV > 24.5% showed specificity = 100% (95%CI, 96.2–100.0), positive predictive value = 100%, and negative predictive value = 67.1% (95%CI, 64.7–69.5). The positive likelihood ratio was infinity, and odds ratio was not calculable because all the patients with EHRV > 24.5% showed ≥ 5% dehydration and/or AKI. Conclusions: EHRV appears a rather reliable marker of dehydration and AKI. Further validations could allow implementing EHRV in the clinical practice.What is Known:• Increased heart rate (HR) is an easily and quickly detectable sign of dehydration in childhood, but its cut-off to suspect dehydration or acute kidney injury (AKI) is not defined.What is New:• We found that a percentage of estimated HR variation in acute setting in comparison with 50th percentile of HR (EHRV)>24.5% predicted ≥5% dehydration and/or AKI in non-febrile patients.• We provide a one-page tool to suspect ≥5% dehydration and/or AKI on the basis of the HR. If furtherly validated, this tool could be implemented in the daily clinical practice.