Patients In Diabetes Mellitus Group Research Articles

Neovascularization restructuring patterns in diabetic patients with coronary in stent restenosis an in-vivo optical coherence tomography study

Abstract Background Patients with diabetes mellitus (DM) have an increased risk of in stent restenosis (ISR). Neovascularization (NV) is considered as a unique phathophysiological factor of ISR in diabetic patients. However, the structures of in vivo human coronary NV and their relationship with ISR, especially in diabetic patients remain unclear. In this study, we aimed to investigate the NV structure differentiation between patients with and without DM after coronary stent implantation using optical coherence tomography (OCT). Methods We included 136 patients with ISR (70 patients in DM group and 66 patients in non-DM group) who underwent optical coherence tomography during coronary angiography follow-up. NVs were manually segmented and three-dimensional (3D) rendering of OCT images was performed. NVs >1 mm were classified into longitudinal running and coral tree types according to their 3D structures. Results The popularity of the coral tree pattern NV in the DM group was 2.14-fold higher than in the non-DM group(p=0.012). 47.14% of patients in the DM group and 51.51% of patients in the non-DM group presented longitudinal NV (p = 0.610). The number of coral tree NV was relatively higher in DM patients than in the non-DM patients (p=0.019). However, the number of longitudinal NV showed no difference between the two group (p=0.872). The normalized NV volume of the DM group was significantly larger than the non-DM group (p=0.008). Normalized NV volume and DM were risk factors for coral tree NV formation in ISR lesions after adjustment for other factors. Conclusions NV with particular restructuring patterns, including longitudinal running and coral tree patterns, could be found in ISR lesions. NV with a coral tree pattern, which is leakier and more immature, is more frequently found in patients with DM. Accurate and feasible imaging modalities for NV might offer promising opportunities to evaluate NV and prevent progression of ISR in diabetic patients.Longitudinal running NV by OCT in neointA coral tree pattern NV in the non-calci

IS THERE A RELATIONSHIP BETWEEN NON-DIPPER PATTERN AND CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS WITH DIABETES?

Objective: To determine the influence of diabetes mellitus (DM) on circadian blood pressure rhythm and to investigate is there a relationship between non-dipper pattern (ND) and cardiovascular events (coronary artery disease - CAD, stroke) in patients with DM and arterial hypertension. Design and method: 184 consecutive hypertensive pts (92 men and 92 women, mean age 63.21 ± 12.62) were divided in two groups: 58 pts with type 2 diabetes mellitus (DM group) and 126 pts without diabetes (no-DM group). In all pts ambulatory blood pressure monitoring (AMBP) were performed. The values obtained by AMBP were compared between groups. ND pattern was defined as the absence of normal nocturnal fall of blood pressure (less than 10% and more than 20% compared to daily values). Results: Patients in DM group had higher systolic blood pressure (129.7 ± 17.4 vs 119.9 ± 11.5 mmHg, p = 0.001), higher values of the pulse pressure (58.7 ± 11.9 vs. 49.5 ± 9.0, p < 0.001) and larger burden of high blood pressure during AMBP (51.7% vs 22.2%, p = 0.001) in comparison to pts in no-DM group. Hyperlipidemia (84,5% vs. 70,6%; p < 0,05) and CAD (27,6% vs. 12,7%; p < 0,05) were more common in the DM than in no-DM group. Out of 184 hypertensive pts 129 pts were nod-dippers. There was borderline significant association between the ND pattern and CAD (20.9% vs. 9.1%, p = 0.058) but without significant association with stroke (6,2% vs 1,2%, p = 0.283). Prevalence of ND pattern was higher in DM group but without significant difference compared to no-DM group (75,9% vs 67,5%, ns). In patients with DM there was no significant association between ND pattern and CAD (31,8% vs 14,3%, p = 0,308) compared to dippers. Also, there was no significant association between ND pattern and stroke in pts with DM (6,8% vs 7,1%, ns). Conclusions: Our study showed that hypertensive pts with DM have inadequate regulation of blood pressure which results in higher values of systolic and pulse pressure and higher prevalence of non-dipping pattern than in hypertensive pts without DM, but failed to prove that there is a relationship between non-dipping pattern and cardiovascular events in patients with DM.

Clinical Findings in Diabetes Mellitus Patients with COVID-19.

Backgrounds Diabetes mellitus (DM) is one of the most common comorbidities in patients with coronavirus disease (COVID-19). We aim to summarize the clinical features of DM patients with COVID-19 and find out potential factors associated with severe disease. Methods In this retrospective, single-center study, the medical records of patients with COVID-19 in Changsha, Hunan, China, from January 21, 2020, to February 19, 2020, were reviewed. Epidemiological information, clinical features, and outcomes were compared between DM patients admitted to the intensive care unit (ICU) or not. Results A total of 241 patients confirmed with COVID-19 were enrolled, including 19 DM patients. There were more patients in DM group admitted to the ICU than non-DM group (36.8% vs. 15.8%, P = 0.045). Compared with non-DM group in the ICU, there were more female patients from DM group in the ICU (85.7% vs. 31.4%, P = 0.024). On admission, the mean level of glycated hemoglobin A1c (HbA1c) was higher in the ICU DM patients than that in the non-ICU DM patients (8.5% vs. 7.1%). There were more DM patients with proteinuria in the ICU group than the non-ICU group (57.1% vs. 33.3%). Twelve DM patients (63.2%) changed diabetic therapy during hospitalization, and all DM patients admitted to the ICU used insulin. As of March 14, all 19 DM patients have been discharged, and no death occurred. Conclusions DM patients with COVID-19 are vulnerable to severe disease, especially for female patients. High levels of HbA1c and proteinuria could be potential risk factors for severe COVID-19 in DM patients. In addition to timely systemic therapy, the control of blood glucose and proper diabetic therapy is essential to improve the prognosis of severe DM patients with COVID-19.

Sight-Threatening Thyroid Eye Disease: Role of Diabetes Mellitus and Interaction with Other Risk Factors

The aim of the study was to investigate whether diabetes mellitus (DM) is an independent risk factor in sight-threatening thyroid eye disease (ST-TED) and explore the interaction of DM with other known risk factors in TED. This was a retrospective cohort study and included 202 consecutive TED patients presenting between 2013 and 2019. Data collected included demography, history of smoking, thyroid dysmetabolism, and presence of DM, TED-duration, activity and severity, best-corrected visual acuity (BCVA), and follow-up. Primary outcome measure was development of ST-TED and secondary outcome measures included change in BCVA, activity, and bilateral ST-TED. Mean age of the cohort was 52.14 + 9.14 years and 74 (36%) were male. DM was present in 49 (24%) and a positive history of smoking in 65 (32%) TED patients. Cox's proportional hazards showed the presence of DM (hazard ratio [HR] 2.22; P = 0.02) and a positive history of smoking (HR 3.62; P = 0.003) were significant risk factors for development of ST-TED and dysthyroid optic neuropathy (DON). Older age was a risk factor (HR 1.05; P = 0.02) for DON. DM increased the risk of developing bilateral ST-TED (OR 4.14; P = 0.004). Median follow-up was 4 months (range 0.1-96 months). A linear mixed model to predict longitudinal interaction between risk factors, found TED patients in DM group were likely to have worsening of visual function and a positive history of smoking accentuated this adverse outcome. DM and smoking are major independent risk factors predictive of ST-TED. Coexisting DM either singularly or in combination with smoking may predict worsening of visual function in TED patients.

Predictability of airway evaluation indices in diabetic and nondiabetic patients requiring general anesthesia with endotracheal intubation

Introduction: Difficult airway management (intubation and/or ventilation) results in significant morbidity and mortality. In the present study, we evaluated various clinical parameters of airway assessment and their ability to predict difficult laryngoscopy and intubation in patients with diabetes mellitus (DM) compared to nondiabetic individuals. Methods: In this prospective comparative study, we enrolled an equal number of 110 patients in DM group and non-DM group. Patients were examined for body mass index (BMI), Modified Mallampati class (MMC), mouth opening, neck extension (NE), mobility of mandible by upper lip bite test, thyromental distance (TMD), collar size, palm print sign, and prayer sign. Primary outcome measure was Cormack and Lehane's grading on direct laryngoscopy. The comparison of quantitative and qualitative variables between the groups was done using unpaired Student's “t”-test and Chi-square test, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of each test were done. Results: In DM patients, sensitivity was highest for MMC followed by prayer sign, whereas specificity was highest for palm print, followed by TMD, BMI, prayer sign, and other predictors. In non-DM individuals, sensitivity was highest for MMC whereas specificity was highest for prayer sign, followed by TMD, palm print and NE, and other predictors. Conclusions: In DM patients, sensitivity and specificity was highest for MMC and palm print, respectively. In non-DM individuals, sensitivity was highest for MMC whereas specificity was highest for prayer sign. A combination of tests may predict difficult laryngoscopy.

The study of relationship between fasting plasma leptin, fasting plasma insulin and HOMA insulin resistance index in patients with schizophrenia treated chronically by antipsychotic agents

目的 研究长期服用抗精神病药物的慢性精神分裂症患者空腹血清瘦素、胰岛素水平和胰岛素抵抗及其之间的关系.方法 218例病程＞5年的慢性精神分裂症患者接受糖尿病流行病学调查,测定空腹血糖、餐后2h血糖、空腹瘦素(leptin)和空腹胰岛素(FINS)水平.根据血糖水平及糖尿病临床症状,分为糖尿病组(DM组)、血糖调节异常组(AGT组,包括IFG和IGT)和血糖正常组(NGT组,其中BMI＜26归为NGTa组;BMI≥26归为NGTb组).结果 DM组空腹瘦素[(30.05±10.76)ng/ml]、胰岛素[(13.35±4.99)pIu/ml]水平高于NGTa组[分别为(24.35±10.74)ng/ml、(10.86±3.30)μIu/ml;P＜0.05和P＜0.01];整体患者leptin与FINS呈显著正相关(r=0.210,P=0.005),进一步分组做相关分析,NGTa组、NGTb组leptin与FINS均呈显著正相关(r=0.277,P=0.014;r=0.457,P=0.017).整体患者leptin与HOMA胰岛素抵抗指数(HOMA-IR)呈显著正相关(r=0.231,P=0.002),分组后NGTa组leptin与HOMA-IR呈正相关(r=0.228,P=0.045).结论长期服用抗精神病药物(APS)可引起血leptin、FINS水平升高,当两者处于失平衡状态时,就会导致血糖调节异常及糖尿病,推测APS引起的瘦素水平增高可能参与了胰岛素抵抗,而导致糖尿病的发生。