Parameters In Diabetic Patients Research Articles

Impaired strain in diabetic patients with stable coronary artery disease assessed by cardiac magnetic resonance

Abstract Background Type 2 diabetes mellitus (T2DM) can contribute or lead to myocardial structural derangement by multiple mechanisms, including ischemic cardiomyopathy and, more rarely and of difficult evaluation, diabetic cardiomyopathy. Early stages of myocardial dysfunction can be assessed by strain analysis with cardiac magnetic resonance feature tracking (CMR-FT), however, there is no studies that examined deformation parameters in diabetic patients with stablished coronary artery disease (CAD). Purpose We sought to compare the strain parameters of patients with and without T2DM with stable CAD. Methods Patients with stable multivessel CAD and preserved left ventricular ejection fraction (LVEF), included in the MASS V trial, underwent contrast-enhanced cardiac magnetic resonance before revascularization procedures. Patients were stratified according to T2DM diagnosis at baseline. Feature tracking was performed using short-axis cine images and 2- and 4-chamber long-axis images. The left ventricular endocardial and epicardial contours of the end diastole phase were manually delineated in all images. Automatically tracking contours were performed to calculate left ventricular global longitudinal (LVGLS), circumferential (LVGCS) and radial (LVGRS) strain (FIGURE 1). Results Of 202 patients studied, 88 (44%) were diabetic and 114 (56%) non-diabetic. Baseline characteristics were similar between groups (age 70 ± 10 vs 69 ± 11; 69% vs 68% males; LVEF 65 ± 13 vs 67 ± 9). Mean Syntax score was 21.2 ± 8.5 vs 20.4 ± 8.5 (P=0.52) in diabetic and non-diabetic, respectively. There were no differences in left ventricle volumes, mass and LVEF. Mean LGE mass was 2.3 ± 0.9 vs 1.9 ± 0.9 grams (P=0.32) respectively in T2DM and control groups. Strain values were all reduced in T2DM patients, as shown in FIGURE 2 (LVGLS: -15.5% ± 2.3% vs -17.5% ± 2.7%, P=0.02; LVGCS: -15.4% ± 2.6% vs -17.4% ± 3.0%, P=0.03; LVGCS: 25.9% ± 5.9% vs 29.5% ± 7.2%, P=0.01). Multivariable analyses adjusted for age, sex, BMI, hypertension, Syntax score and LGE mass showed no differences in the results. Conclusion In this study, T2DM was associated with impaired deformation parameters (decreased left ventricular global longitudinal, circumferential, and radial strain). These findings suggest myocardial dysfunction in diabetic patients when compared to control subjects in the setting of stable multivessel CAD.FIGURE 1FIGURE 2

Effects of empagliflozin and dapagliflozin on serum humanin, MOTS-c levels, nitrosative stress, and ferroptosis parameters in diabetic patients with heart failure

Sodium-glucose cotransporter 2 (SGLT2) inhibitors produce cardioprotective effects on heart failure (HF), even in the absence of diabetes. However, the underlying mechanisms of this cardioprotective effect remain unexplored. The purpose of this study was to examine the effects of SGLT2 inhibitors on serum MOTS-c, humanin levels, nitrosative stress, and ferroptosis parameters in diabetic patients with HF with reduced ejection fraction (HFrEF). A total of 74 adult diabetic patients with HFrEF and 37 healthy controls were included in this prospective study. Half of the patients were using SGLT2 inhibitors (empagliflozin or dapagliflozin) for at least two months. Serum nitric oxide and 3-nitrotyrosine levels were markedly higher in diabetic patients with HFrEF than the control (P < 0.001), but these elevations were inhibited with SGLT2 inhibitors. Although SGLT2 inhibitors had no marked effect on humanin levels, they significantly augmented MOTS-c levels when compared to the control. SGLT2 inhibitors augmented GPX4 but inhibited ACSL4 levels when compared to diabetic patients with HF. However, TFRC levels were increased in the patient group (P < 0.001 for all) but not modified with SGLT2 inhibitors. Our results suggest that increased nitrosative stress is significantly depressed by SGLT2 inhibitors. This study was the first to show that SGLT2 inhibitors can stimulate MOTS-c, but not humanin, in diabetic patients with HFrEF. SGLT2 inhibitors reduced ferroptosis through elevation of GPX4 and suppression of ACSL4 levels. Our data suggest that SGLT2 inhibitors could produce cardioprotective effects through relieving ferroptosis, inhibiting nitosative stress, and stimulating mitochondrial MOTS-c release.

The effect of Empagliflozin on echocardiographic parameters in diabetic patients after acute myocardial infarction: A systematic review and meta-analysis with trial sequential analysis.

Patients with diabetes mellitus (DM) are at higher risk of cardiovascular events, particularly acute myocardial infarction (MI). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) can improve cardiac outcomes among heart failure individuals, however, the effects on acute myocardial infarction remain unclear. This meta-analysis investigates the impact of empagliflozin in diabetic patients following acute myocardial infarction. We comprehensively searched PubMed, Scopus, Cochrane, and Web of Science through August 10th, 2023. We included studies comparing empagliflozin versus placebo in diabetes patients with acute myocardial infarction. We used Revman to report the data as mean difference (MD) and 95% confidence interval (CI), and our effect size with a random effects model. Additionally, we performed Trial Sequential Analysis (TSA) to test the robustness of the results. The study protocol was published on PROSPERO with ID: CRD42023447733. Five studies with a total of 751 patients were included in our analysis. Empagliflozin was effective to improve LVEF% (MD: 1.80, 95% CI [0.50, 3.10], p = 0.007), left ventricular end-diastolic volume (LVEDV) (MD: -9.93, 95% CI [-16.07, -3.80], p = 0.002), and left ventricular end-systolic volume (LVESV) (MD: -7.91, 95% CI [-11.93, -3.88], p = 0.0001). However, there was no difference between empagliflozin and placebo groups in terms of NT-pro BNP (MD: - 136.59, 95% CI [-293.43, 20.25], p = 0.09), and HbA1c (MD: -0.72, 95% CI [-1.73, 0.29], p = 0.16). Additionally, empagliflozin did not prevent hospitalization due to heart failure (RR: 0.59, 95% CI [0.16, 2.24], p = 0.44, I-squared = 0%), and mortality (RR: 1.34, 95% CI [0.15,11.90], p = 0.79, I-squared = 25%). Empagliflozin initiation in diabetic patients following acute MI may improve echocardiographic parameters. However, empagliflozin might not be effective in heart failure prevention and optimal glycemic control in this patient population. Further large-scale trials are warranted to ascertain our findings.

Association of H. pylori IgG and CagA-IgG with some immunological and biochemical parameters in diabetic patients.

Helicobacter pylori a gram-negative, microaerophilic, spiral-shaped, and flagellated bacteria whose primary reservoir is the human stomach. It can cause gastric and extra-gastric diseases. So the study aimed to find the relationship between infection with H. pylori and progression of type II diabetes with other immunological markers. Method This study was conducted in Kirkuk City from Nov. 2022 to Apr. 2023 and included 106 individuals, 26 as a control group and 80 patients (34 males and 46 females) with mean age 57.61 suffering from DMII with H. pylori stool antigen positive results (immunochromatographic test cassette). Five ml of venous blood samples were taken for the HbA1c test (immunodetection technique), fast serum glucose (Hexokinase/G-6-PDH), serum H. pylori IgG, H. pylori CagA IgG, Interlukin-1?, and Interleukin-10 analysis (Sandwich-ELISA technique). Results There was a positive correlation between H. pylori IgG titer and HbA1c levels (0.0321, P = 0.004). In addition, there was a positive correlation between the levels of IL-1? and the H. pylori CagA IgG (r =0.579, P = 0.000). While a negative correlation was found between HbA1c level and IL-10 concentration, (r = -0.500, P = 0.000), there was also a negative association between IL-1? and IL-10 concentrations (r = -0.485, P = 0.000). Conclusion: Through the results of this correlation, we suggest a relationship between H. pylori infection and DMII.

Assessing the Impact of Tropicamide on Anterior Segment Parameters in Diabetic Patients: A Randomized Clinical Trial.

Evaluation of anterior segment parameters is crucial in ophthalmic procedures such as intraocular surgeries and contact lens fitting. However, the use of tropicamide in diabetic patients presents challenges due to its potential impact on biometric measurements. This study aims to investigate and compare the effects of 0.5% and 1% tropicamide on anterior segment parameters in diabetic patients. This double-masked randomized clinical trial enrolled 98 patients with diabetes mellitus. Participants were randomly assigned to receive either 0.5% or 1% tropicamide. Anterior segment parameters were measured using Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany) before and 30 minutes after tropicamide administration. Parameters included anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), keratometry, central corneal thickness (CCT), white-to-white distance (WTW), and pupillary diameter (PD). Both concentrations of 0.5% and 1% tropicamide induced significant changes in anterior segment parameters. There was a notable increase in PD (2.99 ± 0.62, 3.11 ± 0.55, respectively, both P-values < 0.001), ACD (both 0.10 ± 0.05, both P-values < 0.001), ACV (16.69 ± 9.56, 17.51 ± 9.26, respectively, both P-values < 0.001), and WTW (0.06 ± 0.14,0.03 ± 0.30, respectively, both P-values < 0.001), along with a decrease in ACA (-3.50 ± 10.65, -3.30 ± 6.87, P-value< 0.001 and P-value=0.001,respectively), and CCT (-6.10 ± 8.06,-6.39 ± 9.97,respectively, both P-values < 0.001) post-dilation. However, no significant changes were observed in keratometry (front Km (-0.03 ± 0.19, -0.04 ± 0.21, respectively), back Km (0.01 ± 0.05, 0.004 ± 0.05, respectively), P-values> 0.05). Both concentrations of tropicamide exhibited comparable effects on anterior segment parameters in diabetic patients. These post-dilation changes should be considered for accurate intraocular lens power calculation and decision-making for cataract, phakic intraocular lens, and refractive surgeries.

The Effect of Diabetic Retinopathy and Blood Glucose Regulation on Corneal Biomechanical Parameters

Purpose The aim of this study was to evaluate the effects of different stages of diabetic retinopathy (DR) and metabolic control of blood glucose levels on corneal biomechanical parameters. Methods Diabetic patients were categorized into three groups: no DR group, nonproliferative DR (NPDR) group, and proliferative DR (PDR) group. Of the 141 eyes examined, 40 belonged to the control group, 34 to no DR group, 34 to NPDR group, and 33 to PDR group. Using an Ocular Response Analyzer to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc). IOP was assessed using a Tono-Pen, while central corneal thickness (CCT) was determined using an ultrasonic pachymeter. HbA1c levels were also recorded. We conducted comparisons among these groups across biomechanical parameters and IOP (tonopen), and CCT, while also investigating the impact of HbA1c levels on these parameters. Results Among any groups show a statistically significant difference in CCT, IOP (tonopen), CH, CRF, IOPg, and IOPcc. In diabetic patients, CRF, CTT, and IOPg values were significantly higher in those with HbA1c levels ≥ 7 mg/dl than in those with HbA1c levels < 7 mg/dl (p = 0.009, p = 0.013, p = 0.038), respectively, while there was no statistically significant difference in IOPcc, CH, and IOP (tonopen). Linear regression analysis showed that CH was positively associated with CCT (p < 0.001) and negatively associated with IOPcc (p < 0.001), while CRF was positively associated with CCT (p < 0.001), HbA1c (p < 0.05), and negatively associated with diagnosis of DR (p < 0.05). Conclusion This study underscores the influence of metabolic control, as reflected by HbA1c levels, on corneal biomechanical parameters in diabetic patients, emphasizing the importance of monitoring and managing glycemic control in this population.

Central Corneal Thickness and Endothelial Cell Changes in Diabetics and Age-Matched Non-diabetics in a Tertiary Care Hospital in Central India.

Background Diabetes has become an epidemic, significantly impacting ocular health as one of its end-organ responses. Among the various ocular complications, alterations in corneal morphology stand out. Central corneal thickness (CCT) and endothelial cell function are vital parameters in assessing intraocular pressure, conducting pre-refractive surgery evaluations, and maintaining corneal transparency. Understanding these changes in diabetic individuals compared to non-diabetics is crucial for managing ocular health in this population. Aim and objective This study evaluates and compares CCT and endothelial cell changes between diabetic individuals and age-matched non-diabetics. By analyzing these parameters, the study seeks to provide insights into the impact of diabetes on corneal morphology and its implications for ocular health. Methods The study recruited 124 patients from the Ophthalmology Outpatient Department (OPD) at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi. A cross-sectional research design was employed to collect data over six months. Patients were carefully selected, and informed consent was obtained from all participants. CCT and endothelial cell parameters were assessed using specular microscopy, a non-invasive imaging technique. Statistical analysis was done using the software Statistical Package for the Social Sciences (SPSS) for inferential statistics, such as t-tests and ANOVA, and comparing parameters between diabetic and non-diabetic groups.Findings were interpreted based on both statistical significance and clinical relevance. Results In diabetic patients, the mean CCT was 547.91 µm, while it was 523.62 µm in non-diabetic individuals.The T statistic for this variable was 5.14, indicating a17 significant differencebetween the two groups. Similarly, significant differences were found between diabetics and non-diabetics for endothelial cell density, coefficient of variation, and hexagonality, as evidenced by their respective T statistics of 7.46, 5.17, and 4.91. Endothelial cell density averaged 2375 cells/mm2 in diabetics and 2666.95 cells/mm2 in non-diabetics. Additionally, the coefficient of variation was higher among people with diabetes (40.87%) compared to non-diabetics (35.09%). Hexagonality, a measure of endothelial cell shape, was lower in diabetic corneas (40.48%) than in non-diabetic corneas (46.46%). Conclusion The study observed significant differences in corneal morphology, including central thickness and endothelial cell changes, between diabetic and non-diabetic individuals. These findings underscore the impact of diabetes on ocular health and emphasize the importance of monitoring corneal parameters in diabetic patients. Understanding these changes can aid in better management and treatment strategies for ocular complications associated with diabetes.

Comparative Analysis of Retinal Structural and Angiographic Parameters in Diabetic Patients, Alzheimer's Disease Patients, and Healthy Controls: An OCT-Based Study.

Objective: This study aimed to investigate the potential connections between Alzheimer's Disease (AD) and diabetes. Methods: This is a cross-sectional study in which AD and diabetes patients sent by the Psychiatry and Diabetes Departments for ophthalmological screening were observed for inclusion/exclusion criteria. Patients were divided into two comparison groups. The first group (n=3) consisted of the age-matched normal and diabetic patient of the stage 3 AD disease participant. The second group (n=3) was for the stage 5 AD patient with diabetes and normal age-matched controls. Each patient underwent a full ophthalmological examination and SS-OCT (Swept Source-Ocular Computer Tomography) for retinal evaluation. Results: A total of 6 patients (12 eyes) were obtained, three men and three women. In the early AD group, the patient with diabetes showed lower macular thickness compared to other groups. In the nasal-inferior (NI) and temporal-superior (TS) ganglion cell layer (GCL), the AD patient showed statistically significant lower values compared to the other patients. In the moderately severe AD group, we found that the AD patient had lower retinal nerve fiber layer (RNFL) thickness on the temporal side compared to the rest of the patients and both the AD patient and diabetes patient showed lower RNFL thickness in the nasal-superior (NS) quadrant. Also, the foveal avascular zone (FAZ) area was statistically significantly lower for both the diabetes and AD patients compared to the healthy control. Conclusions: In conclusion, distinct retinal findings associated with AD and diabetes in young and elderly patients were revealed in our study. The clinical implications and potential interplay between these conditions need to be elucidated by further research. Abbreviations: AD = Alzheimer's Disease, SS-OCT = Swept Source - Ocular Computer Tomography, GCL = Ganglion cell layer, RNFL = Retinal nerve fiber layer, FAZ = foveal avascular zone.

Evaluation of Some Hematological Parameters in Patients with Diabetes Mellitus Attending Abia State University Teaching Hospital Aba Based on Socio-Demographic Characteristics

The evaluation of lipid profile and some hematological parameters in diabetic patients attending Abia State Teaching Hospital Aba, was carried out. Venous blood samples were collected from 150 participants who gave consent. This comprises 100 diabetic patients as test and 50 healthy subjects as control. The plasma glucose and hemoglobin levels were determined using spectrophotometric methods. Data from this study were analyzed using statistical package for the social sciences (SPSS). Result shows that, platelet (395.44±72.11x109/l), prothrombin time (13.63±0.95secs) levels were higher in study population compared with control (176.18±25.26x109/l, 11.85±0.63secs, respectively) (p&lt;0.05 in each case). The hemoglobin (124.83±15.01g/l) was lower in diabetic patients compared with control (131.66±10.45g/l) (p&lt;0.05). From the findings, management of conditions related to cardiovascular disease, artherosclerotic disease, anemia and stress in diabetics may benefit patients if some hematological parameters are included as part of their routine laboratory investigations. Keywords: hematological parameters, coagulation, platelets, cardiovascular disease, diabetes mellitus

Interocular Symmetry of Choroidal Parameters in Patients with Diabetic Retinopathy with and without Diabetic Macular Edema.

This study focuses on the interocular comparison of choroidal parameters in diabetic patients with diabetic retinopathy (DR) with and without diabetic macular edema (DME), as well as in patients with unilateral DME (present in only one eye). The aim of this study was to determine the symmetry in order to obtain better insights into the pathophysiology of diabetic choroidopathy. This retrospective single-center cross-sectional study included 170 eyes from 85 patients (61 with DR and 24 controls), divided into subgroups depending on the presence of DME. The patients underwent fluorescein angiography and spectral domain optical coherence tomography examination, and the analysis included various choroidal parameters: choroidal thickness, volume, and the choroidal vascularity index (CVI). In terms of the choroidal thickness, one eye of a patient with DR, regardless of the presence, absence, or unilaterality of DME, may be treated as representative for that patient. CVI proved symmetrical for controls and patients with DR without DME. However, there was some asymmetry of CVI in patients with bilateral or unilateral DME. There was no straightforward relationship between choroidopathy and DME. Other mechanisms were also involved in the pathogenesis.

PREVALENCE OF LATENT TUBERCULOSIS IN DIABETIC AND NON-DIABETIC INDIVIDUALS IN A TERTIARY CARE CENTER: A COMPARATIVE STUDY

Aims and Objectives: The aims of this study were as follows: (1) To study the prevalence of latent tuberculosis (TB) in diabetic and non-diabetic population attending the tertiary care hospital. (2) To investigate the association between diabetes mellitus (DM) and latent TB, evaluating the prevalence of positive tuberculin tests and assessing glycemic parameters in diabetic patients with latent TB. Methods: This was a single-center, hospital-based, observational, and comparative study conducted in the department of general medicine of a tertiary care medical college. One hundred and thirty-six diabetic patients of either gender or 137 healthy individuals acting as control group were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were evaluated by detailed history and clinical examination. The diagnosis of latent TB was based on a positive tuberculin test without any clinical features of active TB. The prevalence of latent TB infection was compared in both the groups. p&lt;0.05 was taken as statistically significant. Results: Patients in both the groups were found to be comparable in terms of gender distribution and mean age. Predominant patients were found to have type 2 DM. The mean duration of DM was noted to be 91.58±60.68 months. The most common diagnoses of patients in non-diabetes group were COVID-19 (9.49%), neurological diseases (8.76%), infections (7.3%), acute myocardial infarction (6.57%), and iron deficiency anemia (5.84%). About 21.32% of cases in DM group were noted to have latent TB, while the proportion of latent TB was noted to be 7.30% in the non-diabetes group. The mean fasting blood sugar, mean post-prandial blood sugar, as well as mean HbA1c were significantly higher (p&lt;0.05) in the subgroup with latent TB versus the subgroup without latent TB. Conclusion: Individuals with diabetes mellitus were found to have increased risk of latent TB infection. In addition, male gender and elevated glycemic parameters were found to be key factors associated with latent tuberculous infection in diabetes.

MRI-Based Quantification of Pan-Alimentary Function and Motility in Subjects with Diabetes and Gastrointestinal Symptoms.

Background: Diabetes-induced gastrointestinal (GI) symptoms are common but difficult to correctly diagnose and manage. We used multi-segmental magnetic resonance imaging (MRI) to evaluate structural and functional GI parameters in diabetic patients and to study the association with their symptomatic presentation. Methods: Eighty-six participants (46 with diabetes and GI symptoms, 40 healthy controls) underwent baseline and post-meal MRI scans at multiple timepoints. Questionnaires were collected at inclusion and following the scans. Data were collected from the stomach, small bowel, and colon. Associations between symptoms and collected data were explored. Utilizing machine learning, we determined which features differentiated the two groups the most. Key Results: The patient group reported more symptoms at inclusion and during MRI scans. They showed 34% higher stomach volume at baseline, 40% larger small bowel volume, 30% smaller colon volume, and less small bowel motility postprandially. They also showed positive associations between gastric volume and satiety scores, gastric emptying time and reflux scores, and small bowel motility and constipation scores. No differences in gastric emptying were observed. Small bowel volume and motility were used as inputs to a classification tool that separated patients and controls with 76% accuracy. Conclusions: In this work, we studied structural and functional differences between patients with diabetes and GI symptoms and healthy controls and observed differences in stomach, small bowel, and colon volumes, as well as an adynamic small bowel in patients with diabetes and GI symptoms. Associations between recorded parameters and perceived symptoms were also explored and discussed.

Analysis of the relationship between serum sodium concentration and laboratory parameters in diabetic patients

Introduction: Diabetes is a chronic civilization disease that is associated with numerous complications and disturbances in laboratory parameters. One of the observed changes in laboratory studies of individuals suffering from diabetes is a significantly low level of sodium.&#x0D; Aim of study: The aim of study was to compare natremia with selected blood parameters determined on admission to hospital, and then to find correlation, if any, between those parameters.&#x0D; Materials and methods: We retrospectively reviewed the medical records of 169 patients with diagnosed type 2 diabetes and the average age of 72.43±11.62 years. We tested the correlation between natremia and: total, LDL and HDL cholesterol; creatinine; potassium; calcium; eGFRCKD-EPI and alanine aminotransferase levels in the patients. Statistical analysis was run on STATISTICA 13. The nonparametric Mann-Whitney, Spearmans’ rank correlation and the Shapiro-Wilk tests were used to analyse factors affecting laboratory test results for the patients, perform correlation analyses and check the conformity with normal distribution, respectively.&#x0D; Research results: A positive correlation was revealed between LDL level and natremia (p = 0.023), as well as between natremia and chloride ion concentration (p &lt; 0.001) in the patients’ blood. No correlation was found between natremia and sex, age, eGFRCKD-EPI, alanine aminotransferase, HDL cholesterol, triglycerides, creatinine, as well as calcium and potassium concentrations.&#x0D; Conclusions: Statistically significant correlations were found exclusively between LDL level and natremia, and between chloride and sodium concentrations. High LDL level was correlated with high natremia, which requires further research due to the scant literature. The sodium, potassium and chloride concentrations are known to be interconnected by the need to ensure the electrolyte balance, as seen in the Gamble diagram. The remaining parameters were not statistically significant.

Impact of the first COVID-19 lockdown in Austria on laboratory and mental parameters in diabetic patients: a retrospective analysis highlighting the importance of regular medical consultations in a patient cohort.

Due to the COVID-19 pandemic, the first lockdown was implemented in Austria for almost 7 weeks. In contrast to many other countries, medical consultations were permitted, either by telemedicine or at doctors' offices. Nevertheless, restrictions related to this lockdown could possibly cause an increased risk of deterioration in health, especially in diabetes. This study aimed to assess the impact of Austria's first lockdown on laboratory and mental parameters in a type-2 diabetes mellitus cohort. Overall 347 mainly elderly patients with type-2 diabetes (56% male; aged 63.7±10.1 years) were included in this retrospective practitioner-based analysis. Laboratory as well as mental parameters were compared from before and after the lockdown. The lockdown showed no significant effect on HbA1c levels. On the other hand, total cholesterol (P<0.001) and LDL cholesterol (P<0.001) levels improved significantly, whereas body weight (P<0.01) and mental well-being based on the EQ-5D-3L questionnaire (P<0.01) increased significantly in terms of worsening. Lack of movement and staying at home resulted in a significant weight gain and worsening of mental well-being in type-2 diabetes during the first lockdown in Austria. Thanks to regular medical consultations, laboratory parameters remained stable or even improved. Thus, routine health check-ups in mainly elderly type 2 diabetic patients are essential to minimize the deterioration of health conditions during lockdowns.

Estimation of Immunological and Physiological Parameters in Diabetic Patients with COVID-19

Estimation of Immunological and Physiological Parameters in Diabetic Patients with COVID-19

#6677 RELATIONSHIP BETWEEN CARDIAC TROPONIN LEVELS AND ECHOCARDIOGRAPHIC PARAMETERS IN DIABETICS WITH ADVANCED CHRONIC RENAL DISEASE (ACKD)

Abstract Background and Aims Cardiovascular disease is the leading cause of chronic kidney disease (CKD) death. On the other hand, elevated cardiac Troponin T (cTnT) levels are associated with cardiovascular events and mortality. Several studies have established an inverse association between CKD and cTnT, and knowledge of this association in diabetic patients would benefit their management. The objective of this study was to analyze the relationship between cTnT levels, renal function and echocardiographic parameters in diabetic patients with advanced chronic kidney disease (ACKD). Method A prospective study was carried out during one year of 180 patients attending for the first time for ACKD consultations, with an estimated glomerular filtration rate (eGFR) &amp;lt;30 ml/min/1.72 m2. The following data were analyzed: age, sex, diabetes, HBP, BMI, smoking, peripheral artery disease, coronary artery disease, non-age-adjusted Charlson index (non-age-CCI), eGFR by CKD EPI, ultrasensitive cTnT, Creatinine albumin ratio (ACR), C-reactive protein (CRP), ferritin, hemoglobin (Hb), ejection fraction (EF) and left ventricular hypertrophy (LVH), interventricular septum thickness (IVST) and left ventricular wall thickness (LVWT). Statistical tests were used according to the distribution of the variables. Results Baseline characteristics are summarized in Table 1. In the group of patients, when analyzing the presence or absence of diabetes, diabetic patients were significantly older, had higher troponin levels, a higher percentage of smoking, coronary artery disease, peripheral artery disease, non-age-CCI, IVST and LVH than non-diabetic patients. In diabetic patients, troponin levels correlated significantly with eGFR (0.03) and ACR (0.09), with ACR remaining as a predictive variable (0.003). It did not correlate with echocardiographic data. In non-diabetics, the correlation was significant with age and IVST and LVH (Table 2, Figure 1). In the multivariate analysis in diabetic patients, only the association remained with ACR (0.026) and in non-diabetics with eGFR (0.038) and IVST (0.004). Conclusion The cTnT levels are found to be higher in diabetic patients and with higher ACR, considering it as a therapeutic target to reduce cardiovascular risk since echocardiographic data would not discriminate this risk in this profile of patients.

An Overview of the Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Hematological Parameters in Diabetic Patients

Background: Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2-IS) have been shown to increase hemoglobin (Hb) levels, hematocrit, and erythrocyte count. It has also been found that these agents can potentially reduce the risk of anemia and minimize the need for erythropoiesis stimulating agents (ESA) and other treatments in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However the precise mechanism for such an effect is still conflicting. Aim: We aimed at providing an overview of the effects of SGLT2-IS on hematological parameters, specifically focusing on their potential to improve anemia and erythropoiesis in patients with diabetes mellitus (DM). Additionally the proposed mechanisms by which SGLT2-IS may improve Hb levels besides their clinical importance and future directions will also be highlighted. Results: Based on the obtained data from latest literatures, SGLT2-IS may improve the status of anemia and other linked abnormalities via their mild diuretic potential, effects on erythropoietin (EPO) production, and possible increase in renal oxygen delivery. Conclusion: SGLT2-IS may have a promising role in improving multiple aspects of blood, circulatory and renal systems health in patients with DM, beyond their primary glucose-lowering role.

Clinical Experience of Using Telemedicine for the Management of Patients Using Continuous Subcutaneous Insulin Infusion in a Highly Complex Latin American Hospital

Continuous subcutaneous insulin infusion (CSII) has emerged as a potential solution for diabetes management during the pandemic, as it reduces the need for in-person visits and allows for remote monitoring of patients. Telemedicine has also become increasingly important in the management of diabetes during the pandemic, as it allows healthcare providers to provide remote consultations and support. Here, we discuss the implications of this approach for diabetes management beyond the pandemic, including the potential for increased access to care and improved patient outcomes. We performed a longitudinal observational study between 1 March 2020 and 31 December 2020 to evaluate glycemic parameters in diabetic patients with CSII in a telehealth service. Glycemic parameters were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability control. A total of 36 patients were included in the study, with 29 having type 1 diabetes and 6 having type 2 diabetes. The study found that the proportion of patients achieving target glucose variability and GMI remained unchanged during follow-up. However, in patients with type 2 diabetes, the time in target range increased from 70% to 80%, and the time in hyperglycemia decreased from 2% to 0%. The results of this study suggest that telemedicine is a strategy for maintaining glycemic control in patients using CSII. However, the lack of access to the internet and adequate telemonitoring devices make it difficult to use on a large scale in emerging countries like ours.

Metabolic control of diabetic patients assisted by private and public health care systems during the COVID-19 pandemic: A retrospective cohort study

AimsWe sought to analyze the impacts of social restriction measures imposed by the pandemic COVID-19 on the control of metabolic parameters in diabetic patients. MethodsWe accessed the medical records of patients who underwent clinical follow-up in the public and private health systems between July 2019 and June 2021. The sample consisted of 288 patients (111 adults and 177 older individuals). A two-way ANOVA mixed model was used to test the effects of intra- (time: baseline and after 24 months) and inter-subject factors. Linear regression analysis was used to predict the difference in body weight considering age, sex, HbA1c, health care system and insulin use. ResultsAmong adults, we observed an increase in body weight and LDL-c levels, especially for insulin users (p ≤ 0.05). Adults assisted by the public health care system showed higher HbA1c levels (p = 0.001). Among older individuals using insulin, blood glucose levels decreased (p = 0.019). Body weight decreased in those assisted by the private system (p = 0.005), while glycemia decreased for patients assisted by both health care systems (p = 0.043). The linear regression model confirmed that the increase in body weight was more pronounced in adults than in older individuals. ConclusionThe social restriction measures imposed by the pandemic affected the metabolic control of diabetic patients, especially adults assisted by the public health care system.

Evaluating Diagnostic Ultrasound of the Vagus Nerve as a Surrogate Marker for Autonomic Neuropathy in Diabetic Patients.

Background and Objectives: Diagnostic ultrasound of the vagus nerve has been used to examine different polyneuropathies, and it has been suggested to be useful as a marker of autonomic dysfunction in diabetic patients. Materials and Methods: We analyzed the cross-sectional area (CSA) of the right vagus nerve of 111 patients with type 2 diabetes in comparison to 104 healthy adults and 41 patients with CIDP (chronic inflammatory demyelinating polyneuropathy). In the diabetes group, sympathetic skin response (SSR) was measured as an indicator for autonomic neuropathy. Carotid intima-media thickness (CIMT) was measured as a surrogate for atherosclerosis. Clinical symptoms of polyneuropathy were assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Results: In total, 61.3% of the diabetes patients had clinical signs of polyneuropathy; 23.4% had no SSR at the feet as an indicator of autonomic neuropathy. Mean vagus nerve CSA did not differ in patients with and without diabetic polyneuropathy or in diabetic patients with and without SSR at the feet. No significant correlation was found between vagus nerve CSA and CIMT or SSR parameters in diabetic patients. Mean CSA of the right vagus nerve was slightly larger in diabetic patients (p = 0.028) and in patients with CIDP (p = 0.015) than in healthy controls. Conclusions: Effect sizes and mean differences were rather small so that a reliable diagnosis cannot be performed based on the vagus nerve measurement of a single person alone. Vagus nerve CSA seems not suitable as an indicator of autonomic dysfunction or cardiovascular risk in diabetic patients.