Poor Diabetic Control Research Articles

Assessment of knowledge and risk factors about gestational diabetes mellitus among pregnant women in a tertiary care hospital

Proper Gestational diabetes mellitus (GDM) management is important for better health outcomes. Knowledge and education are key components for better treatment and diabetes control. In patients with GDM, poor health literacy may be there which is associated with poor diabetic control and require educational program to improve health outcomes. A risk factor is any characteristic of an individual that can increase the likelihood of developing a disease. Risk factor assessment is usually recommended in many populations in early pregnancy. The prospective study was conducted for 6 months to assess knowledge and risk factors associated with gestational diabetes in 58 pregnant women using KAP questionnaire from WINGS project. The study found that knowledge among non GDM patients was poor when compared to GDM patients. Family history and obesity were found to be the major risk factors for development of gestational diabetes. So the future direction should focus on early prediction and effective preventive measures before GDM develops. Therefore a need for patient counseling is essential to reduce the GDM patients in future.

Factors Affecting Glycemic Control in Type II Diabetic Patients

Background: Diabetes is a major public health problem that affects morbidity, fatality and health care resources. Many factors can influence diabetic control. Diabetic control remains the main goal in management of diabetes mellitus and the major therapeutic target for prevention of complications due to diabetes Objective: Is to assess factors affecting glycemic control among type 2 diabetic patients. Patients and Method: a cross sectional study was conducted on 200 diabetics at the Internal Medicine Department, Benha University hospital. A case record form was used including sociodemographic features, anthropometric measurements and metabolic disease profile. Results: Participants were classified according to their glycosylated hemoglobin level into good (7%) and poor (93%) diabetic control. There was a statistically significant association between diabetic control and diabetes duration (p < 0.001), exercise (p = 0.001) (OR (95% CI): 5.59 (1.77-17.62)), body mass index (p < 0.001). There was a statistically significant difference between those with poor and good diabetic control as regard LDL level (OR (95%CI): 50 (6.41-333.3)) (p < 0.001), total cholesterol level (p < 0.001), (median (range): (237 (178-320) and 100 (100-300)) respectively and the mean value of fasting blood sugar ((mean ± SD): 298.52± 55.97 and 170±37.41 respectively, p < 0.001)). Conclusions: Majority of participants had poor diabetic control. Diabetes duration, regular exercise, BMI, LDL and total cholesterol levels significantly affected glycemic control

Diabetes-related distress and daily cortisol output in people with Type 2 diabetes

AimsDiabetes-related distress is common in Type 2 Diabetes and is linked with poor diabetes control. However, mechanisms underlying this association are unclear. One pathway that could be involved is neuroendocrine dysfunction, as Type 2 Diabetes is associated with altered diurnal cortisol output. This study investigated the link between diabetes-related distress and diurnal cortisol output. Methods134 people with Type 2 Diabetes provided 5 cortisol samples over the course of a day. Multivariate linear regression models were used to assess whether overall and sub-domains of diabetes-related distress measured by the Diabetes Distress Scale, predicted cortisol parameters (waking cortisol, cortisol awakening response, cortisol slope and evening cortisol). ResultsPhysician-related distress was associated with greater waking (B = 2.747, p = .015) and evening cortisol (B = 1.375, p = .014), and a blunted cortisol awakening response (B = −3.472, p = .038) adjusting for age, sex, income, body mass index, smoking and time of awakening. No associations were detected for overall distress, emotional, interpersonal or regimen distress. ConclusionPhysician-related distress was associated with alterations in daily cortisol output. Longitudinal research is required to understand how physician-related distress is associated with diurnal cortisol patterning over time.

PET CT Brain for the Differential Diagnosis of Dementia -Indian Case Reports

India has been termed as Diabetic hub of the globe. Along with other complications, one of the underestimated complication is cognitive decline and memory loss associated with poor diabetes control. In the Indian context, structural imaging like MRI-Magnetic Resonance imaging is more commonly used in Neurological disorders such as stroke, head injury, Functional imaging of the human brain has been underutilized in the Indian scenario. One such technique is PET CT which has been typically used as a cancer biomarker in India. By virtue of current case study, we propose i) association between poor control of Diabetes and poor cognition ii) role of PET CT brain in differential diagnosis of Dementia. We present two case reports providing strong findings for utilization of PET CT brain in Dementia protocols.

Obesity and diabetic control as predictors for depression in adolescents with type 1 diabetes mellitus

ABSTRACT We aimed to screen for depression among a sample of adolescents with type 1 Diabetes Mellitus (T1DM) and to determine the impact of obesity and poor diabetic control as potential risk factors. One hundred adolescents with T1DM (aged between 14 and 18 years) were randomly selected and subjected to detailed history, physical examination, and laboratory investigations. BMI and Glycated Hemoglobin (HbA1c) were measured. The “PHQ-9“ questionnaire- Arabic version was used to screen for depression. We found that 51% of the sample was at moderate to severe risk for depression. There was a statistically significant association between the depression and older age and female gender. Depression severity was positively correlated with HbA1c, frequency of hospital admission, presence of diabetic complications and the degree of obesity. In this study, the best cut-off points that could predict depression in T1DM adolescent patients were: HbA1c of >10.1 or more, while the best cut-off point regarding BMI was found to be more than >22.3 Kg/m2. We can conclude adolescents with T1DM are at increased risk for depression especially females, with poor diabetic control and overweight problems.

The effects of cognitive behavioral therapy for insomnia in people with type 2 diabetes mellitus, pilot RCT part II: diabetes health outcomes

BackgroundPrevious studies have shown the negative impact of sleep disturbances, specifically insomnia symptoms, on glucose metabolism for people with type 2 diabetes (T2D). People with insomnia symptoms are at risk of poor glycemic control and suboptimal diabetes self-care behavior (DSCB). Investigating the impact of a safe and effective intervention for individuals with T2D and insomnia symptoms on diabetes’ health outcomes is needed. Therefore, the aim of this exploratory study is to examine the effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on glycemic control, DSCB, and fatigue.MethodsTwenty-eight participants with T2D and insomnia symptoms, after passing an eligibility criteria at a medical research center, were randomly assigned to CBT-I (n = 14) or Health Education (HE; n = 14). The CBT-I and HE groups received 6 weekly one-hour sessions. This Randomized Controlled Trial (RCT) used a non-inferiority framework to test the effectiveness of CBT-I. Validated assessments were administered at baseline and post-intervention to assess glycemic control, DSCB, and fatigue. A Wilcoxon signed-rank test was utilized to compare within-group changes from baseline to post-intervention. A Mann-Whitney test was utilized to measure the between-group differences. Linear regression was used to assess the association between the blood glucose level and the number of days in the CBT-I group.ResultsThe recruitment duration was from October 2018 to May 2019. A total of 13 participants completed the interventions in each group and are included in the final analysis. No adverse events, because of being a part of this RCT, were reported. CBT-I participants showed significantly greater improvement in glycemic control, DSCB, and fatigue. There was a significant association between the number of days in the CBT-I intervention with the blood glucose level before bedtime (B = -0.56, p = .009) and after awakening in the morning (B = -0.57, p = .007).ConclusionsThis study demonstrated a clinically meaningful effect of CBT-I on glycemic control in people with T2D and insomnia symptoms. Also, CBT-I positively impacted daytime functioning, including DSCB and fatigue. Future research is needed to investigate the long-term effects of CBT-I on laboratory tests of glycemic control and to understand the underlying mechanisms of any improvements.Trial registrationClinical Trials Registry (NCT03713996). Retrospectively registered on 22 October 2018,

Association of Evening Chronotype with Poor Control of Type 2 Diabetes: Roles of Sleep Duration and Insomnia Level.

BackgroundEvening chronotype is usually associated with insomnia and short sleep duration.ObjectivesTo investigate the independent association of chronotype with diabetes control.MethodsIn this cross-sectional study, 140 patients with type 2 diabetes were studied. The insomnia score was examined by a 7-item questionnaire. Also, chronotype was assessed by a 19-item questionnaire, and using the questionnaire, the patients were divided into three groups of morning, intermediate, and evening. This questionnaire has been developed for evaluating the preference for performing mental and physical activities at a special time of day. The Multivariate hierarchical analysis was applied for investigating the independent association of chronotype and glycated hemoglobin (HbA1c).ResultsThe fasting blood glucose and HbA1c levels were significantly different across all the three chronotype groups such that it had the highest value in the evening group and the lowest value in the morning group (FBS = 164.5 ± 34.1 mg/dL and HbA1c = 8.7% ± 1.7, in the evening group, and FBS = 132.7 ± 23.1 mg/dL and HbA1c = 6.9% ± 0.4 in the morning group, P < 0.001). The morning group had longer sleep duration and less insomnia than other groups. Results of the hierarchical regression analysis showed that the chronotype explained 28.4% of the variance of HbA1c. Results of the final model demonstrated that the chronotype had a relationship with HbA1c, independent of body mass index (BMI), time of going to bed, and insomnia score.ConclusionsEvening chronotype is associated with poorer control of diabetes, independent of BMI and sleep variables.

Risk of Dementia in Diabetic Patients with Hyperglycemic Crisis: A Nationwide Taiwanese Population-Based Cohort Study

Background: A hyperglycemic crisis episode (HCE) signifies poor control of diabetes and may increase the risk of dementia via microvascular and macrovascular injuries. Objectives: We conducted this study to clarify this issue, which remains unclear. Methods: Using the Taiwan National Health Insurance Database, we identified 9,466 diabetic patients with HCE and the identical number of diabetic patients without HCE who were matched by age and sex for this nationwide population-based cohort study. The risk of dementia was compared between the 2 cohorts by following up until 2014. Investigation of independent predictors of dementia was also done. Results: In the overall analysis, the risk of dementia between the 2 cohorts was not different. However, stratified analyses showed that patients with HCE had a higher risk of subsequent dementia in the age subgroup of 45−54 and 55–64 years (adjusted odds ratio [AOR]: 2.4, 95% confidence interval [CI]: 1.6–3.6, and AOR: 1.2, 95% CI: 1.0–1.5, respectively). In the overall analysis, older age, female sex, ≥3 HCEs, hypertension, hyperlipidemia, depression, cerebrovascular disease, Parkinson’s disease, and head injury were independent predictors. Conclusions: HCE increased the risk of dementia in diabetic patients aged 45–64 years. Dementia was predicted by ≥3 HCEs. Prevention of recurrent HCE, control of comorbidities, and close follow-up of cognitive decline and dementia are suggested in patients with HCE.

Illuminating Racial Inequity in Diabetes Control: Differences Based on Gender and Geography

The objective of this study is to describe racial differences in type 2 diabetes mellitus "diabetes" control among the adults in the USA, and to examine attributes that may exacerbate racial differences. Secondary analyses of data from the National Ambulatory Medical Care Survey (NAMCS) collected in years 2012-2014 in the USA. Study sample was limited to White or African American patients aged 25 or older and living with diabetes (n = 4106). Outcome measure, poor diabetes control, was based on lab values for HbA1c (> 7%). Covariates include demographics, insurance, comorbid conditions, and continuity of care and location (urban vs. rural). Overall, African Americans have 33% higher odds of poor diabetes control compared with Whites. Adjusted probability of poor diabetes control was 48% overall, 65% for African American women and 69% for African Americans living in rural areas. African Americans continue to have poorer diabetes control compared to Whites. This difference is exacerbated for African American women, and for all African Americans living in rural areas. Policy should include concentrated screening and treatment resources for African Americans in rural settings.

Suboptimal Blood Pressure Control, Associated Factors, and Choice of Antihypertensive Drugs among Type 2 Diabetic Patients at KCMC, Tanzania.

Background Hypertension (HTN) can be present in up to two-thirds of patients living with diabetes mellitus (DM). It is a risk factor for the development of diabetes as well as complications like coronary artery disease (CAD), nephropathy, retinopathy, and neuropathy. Hypertension is treatable, and the degree to which it is controlled determines the risk of development of cardiovascular diseases and other complications in a given individual patient. Even though antihypertensive drugs are available and issued to hypertensive diabetic patients, the rate of control of HTN is often inadequate. The aim of this study was to assess the prevalence of suboptimal blood pressure (BP) control, its associated factors, and the choice of antihypertensive drugs among type 2 DM patients at Kilimanjaro Christian Medical Centre (KCMC). Methods A hospital-based cross-sectional study was conducted at the KCMC diabetes clinic from October 2018 to March 2019 among type 2 DM patients with HTN based on the inclusion criteria. Data were collected using structured questionnaires, and written informed consent was obtained. Suboptimal BP was defined as BP levels ≥ 140/90 mmHg according to the American Diabetes Association guideline published in 2018. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 25. Chi-square analysis was done to identify the independent predictors of BP control, and a p value of <0.05 was considered to be statistically significant. Results The data of 161 participants was analysed; the mean age was 63.9 ± 20.2 years, with the majority being females (67.1%). Despite all participants being on different classes of antihypertensives, 57.8% had suboptimal BP control. Among the participants with good BP control, 52.7% were on angiotensin-converting enzyme inhibitors (ACE-I). Poor diabetes control was observed in 50.1% participants as indicated by elevated glycated haemoglobin. Conclusion This study demonstrated that BP control in type 2 DM patients was suboptimal in more than half of the participants. The study showed that the use of ACE-I or angiotensin II receptor blockers (ARBs) in the majority of DM patients has a good impact in the control of blood pressure. The early initiation of ACE-I or ARBs among the diabetic patients will improve the optimal BP control.

Diabetic Distal Symmetrical Polyneuropathy: Correlation of Clinical, Laboratory, and Electrophysiologic Studies in Patients with Type 2 Diabetes Mellitus.

This cross-sectional study is aimed at determining the prevalence of distal symmetrical polyneuropathy (DSPN) and diabetic peripheral neuropathic pain (DPNP) in participants with type 2 diabetes mellitus (T2DM); finding the risk factors for DSPN and DPNP via biochemical tests; and correlating DSPN and DPNP with the results of electrophysiologic studies, quantitative sensory tests, and neurologic examination. The 145 participants with T2DM enrolled were divided into the DSPN (abnormal nerve conduction studies (NCS) with signs of polyneuropathy), subclinical DSPN (abnormal NCS without signs of polyneuropathy), minimal DSPN (normal NCS with signs of polyneuropathy), and no DSPN groups. The biochemical risk factors of diabetic peripheral neuropathy were investigated. Neurologic examinations, laboratory tests, NCS, vibration threshold tests, and thermal threshold tests were conducted. The modified Michigan Neuropathy Screening Instrument (mMNSI) and Douleur Neuropathique 4 were used to evaluate the severity of DSPN and DPNP, respectively. In all, 30% of participants had DSPN and 11% had DPNP. DSPN correlated strongly with male gender and higher glycohaemoglobin levels; NCS abnormality correlated with higher glycohaemoglobin levels; DSPN severity correlated with NCS of each stimulating nerve. DPNP commonly occurred with clinical and electrophysiologic evidence of DSPN. Symptomatic diabetic polyneuropathy significantly correlated with longer disease duration, higher glycohaemoglobin levels, and abnormal vibration tests. The thermal threshold test combined with nerve conduction tests could detect most of the patients with DSPN, subclinical DSPN, and minimal DSPN. Poor diabetic control was independently associated with the development of DSPN. DPNP was associated with DSPN. The combination of thermal threshold tests with NCS can potentially provide the diagnosis of DSPN.

Immunological Profile of Type II Egyptian Diabetic Patients

Background: Diabetes mellitus (DM) and its associated secondary complications are some of the leading induce of deaths worldwide. Aim: The aim of the study is to estimate changes in the levels of biochemical parameters as fasting blood sugar (FBS), postprandial blood sugar (PP2BS) and glycosylated hemoglobin (HbA1c); and immunological parameters as Complement proteins C3, Complement proteins C4, Immunoglobulin's (IgA, IgE, IgG, and IgM) and C-peptide of type 2 diabetic patients to obtain a full immunological and physiological profile for type 2 diabetes. Subjects and Methods: Blood samples from 25 type 2 diabetic patients and 5 healthy subjects were randomly selected from Banha University hospitals in Kalyubiyya, Egypt. Serum sugar and glycosylated hemoglobin were assayed by using chemical analyzer (chem 7). C3, C4, IgA, IgE, IgG, IgM and C-peptide were measured by ELISA Results: FBS, PP2BS, and HbA1c significant increase in type 2 diabetic patients compared to healthy subjects. C3, IgA, IgE, IgG, and C-peptide showed a significant increase in type 2 diabetic patients compared to healthy subjects. Conclusion: FBS, PP2BS, and HbA1c used as good tools for the diagnosis of diabetes mellitus. Type 2 diabetes in the current studied subjects is characterized by alternative pathway activation. Immunological biomarkers such as C3, IgA, IgE, and IgG were increased in type 2 diabetic patients by poor control of diabetes and long duration of disease.

The Impact of Social and Clinical Complexity on Diabetes Control Measures.

In an age of value-based payment, primary care providers are increasingly scrutinized on performance metrics that assess quality of care, including the outcomes of their patient population in key areas such as diabetes control. Although such measures often adjust for patient clinical risk factors or clinical complexity, most do not account for the social complexity of patient populations, despite research demonstrating the strong association between social factors and health. Using patient electronic health record data from 2 large community health center networks serving safety net patients, we assessed the effect of both clinical and social risk factors on poor glucose control among diabetics. Logistic regression results were used to estimate the impact of adjusting for both clinical and social complexity on provider performance metrics. Clinical complexity was measured at the patient-level using the Charlson Comorbidity Index. Social complexity was measured at the community-level using the Social Deprivation Index. Clinical complexity alone was not consistently associated with poor diabetes control (ie, HbA1c > 9%) in diabetic patients with HbA1c testing during the study period. However, increasing social complexity was significantly associated with higher rates of poor diabetic control in both cohorts. After adding adjustment for social complexity down to the national median score, our models suggest that approximately 25% of providers would have 1 to 2% improvement in the assessment of their diabetes control measures, with 45% showing a 2 to 5% improvement, and 5% showing more than a 5% improvement. Providers caring for patients with greater social risk factors may benefit from having their performance metrics adjusted for the social complexity of their patient populations.

MAMOGRAPHIC CHANGES IN TYPE II DIABETIC PATIENTS

Introduction: Type 2 diabetes is a metabolic disorder, specified by resistance and insufficient production of insulin, the result of which is hyperglycemia, which is the cause of complications that can be classified into microvascular and macrovascular, in addition to changes of mixed etiology, such as changes inflammatory tissues of the breast, which increases the risk of breast cancer. Specifically, these factors are linked to changes in breast density due to proliferation, apoptosis, and differentiation of breast tissue, the latter associated with parity, menopause, body mass index, and hypoglycemic agents. At the moment, few studies have evaluated the association of the development of breast cancer in diabetic patients, a world level Danish studies stand out, which has found an association between diabetes with changes in breast density, unfortunately in Latin America, no similar studies have been found and it is here that the present study becomes important, since its long-term impact will help us to better understand this relationship with cancer development, in order to seek preventive measures. Methodology: An observational study was carried out, which included 115 patients diagnosed with type II diabetes, who attended the general outpatient consultation. The data collection was carried out by means of collection cards, whose sources of information were the medical records, an Excel database was designed, which is imported into SPSS and Epi7, the qualitative variables are presented in tables of Frequency and quantitative variables are analyzed with measures of central tendency and dispersion. For multivariate analysis, 2x2 tables are used in the case of qualitative variables and tabulated averages in the case of quantitative variables. Results: A qualitative analysis was carried out, observing that the average value is higher in the BIRADS IV-V group, despite the fact that the quantitative analysis reveals a weak but significant direct proportional relationship, it was also possible to appreciate when performing the qualitative analysis, that the probability to present more severe BIRADS is 4.6 times greater in patients with poor controls OR 4.6 (1.2-16.8); p0.009. It could be seen in the stratified analysis that the use of combined therapy is a protective factor for patients with poor control of diabetes to develop BIRADS IV / V (OR 0.3846 / 0.0778-1.9005 / p 0.38 ); on the contrary, in the group of patients with adequate control this relationship is reversed (OR 3,857 / 0.3211-46.3260 / p0.6). The other associations did not present statistical relevance. Conclusion: No relationship was established between microvascular alterations, the use of one or another therapeutic scheme with mammographic changes, however, the value of glycated hemoglobin was outside the appropriate range if it was associated with mammographic changes, especially with BIRADS III and IV. The correlation found between poor glycemic control with more suggestive breast findings (BIRADS IV-V) of cancer becomes important, suggesting that inadequate glycemic control is still a frequent problem in this population despite the wide possibilities of therapeutic management.

The Need And Benefit of Implementing Telemedicine in Clinical Practice

The Need And Benefit of Implementing Telemedicine in Clinical Practice

A Single Injection of a Liver-Directed A20 Gene Therapy Yields Long-Term Glycemic Control in Diabetic Mice to Reduce Vascular Complications

Diabetic patients suffer a two- to four-fold higher incidence of coronary artery disease and stroke and >10-fold higher incidence of peripheral vascular disease. Poor glycemic control is the most significant risk factor for heightened vascular complications in diabetes. At the molecular level, we showed increased vascular complications in patients with poor diabetes control relate to inadequate expression of the anti-inflammatory and atheroprotective molecule, A20. Hyperglycemia causes post-translational O-glycosylation of A20, targeting it for ubiquitination and degradation. Strict and sustained control of blood glucose by intensive insulin therapy and lifestyle modifications decrease vascular risk in diabetic patients. Unfortunately, few patients successfully comply with these stringent guidelines. Our objective was to explore a novel, safer and easier-to-implement means of controlling blood glucose. Our data indicate that liver-directed gene therapy of the A20 gene can achieve this goal. Seven-week-old C57BL/6 mice were rendered diabetic via five consecutive injections of streptozotocin. Six weeks after diabetes was established, we intravenously injected rAd.A20 or control α-galactosidase (rAd.αgal), measured glycemia weekly and performed a glucose tolerance test (GTT). Tissue/plasma was harvested on 10, 30, and 100 days after the mice achieved euglycemia. Remarkably, 80% of the A20-treated, but none of the α-gal-treated mice became euglycemic or significantly improved their glycemia within the first week after treatment. This result was sustained with >70% of these mice remaining euglycemic at 100 days. GTT curves either normalized (10 days) or significantly improved (30 and 100 days) in euglycemic A20-treated mice. Normalization of glycemia and GTT in A20-treated mice did not associate with increased insulin levels, but with higher intrahepatic and circulating levels of lipocalin 13 (LCN13). LCN13, a transporter protein, regulates glucose metabolism through insulin-dependent and -independent mechanisms. Increased LCN13 mRNA levels in A20-treated livers had decreased levels of gluconeogenic enzymes, PEPCK and G6Pase, and increased expression of the glucose transporters GLUT1 and two in the liver, along with GLUT1 and four in skeletal muscles. The latter correlated with higher glycogen storage in livers and skeletal muscles. Liver-directed A20 gene therapy Results in sustained glycemic control in diabetic mice. This remarkable effect is insulin-independent and can be attributed to A20-mediated upregulation of LCN13, a glucose metabolism regulator, predicting efficacy in both type 1 and type 2 diabetes. Recent development of clinically safe gene therapy vectors predict clinical translatability of this novel therapy to reduce the debilitating vascular complications of diabetes.

1168-P: Effectiveness of a Comprehensive Diabetes Program for Patients with Poorly Controlled Diabetes in an Academic Health Care System: The Emory Diabetes Management Program

The Emory Diabetes Management Program (DMP) is a four-core chronic care management model including 1) specialized ambulatory program led by educators and advanced practitioners, 2) inpatient care protocols, 3) education of healthcare professionals through webinars, live sessions and “train-the-trainer” program, and 4) surveillance and data sharing/monitoring. The DMP goal is to reduce the percentage of patients within the Emory Healthcare System with A1c &amp;gt;9% to &amp;lt;15%. We report our results from 02/01/18 to 01/31/2019. Among 27,061 patients, the overall % of patients with A1c &amp;gt;9% reduced from 20.5% to 17.2%, with improvement observed in all clinic operating units-- primary care (19.4 to 16.2%), family medicine (24.2% to 21.9%) and endocrinology (23.3 to 18.8%). Among 922 patients referred to the specialized ambulatory program (core 1), 644 participated (DMP) and 278 declined participation (No-DMP). DMP participants had greater improvement in A1c from baseline (-1.3%±2.5 vs. -0.5%±2.1, p&amp;lt;0.01), and a reduction in % of patients with A1c &amp;gt;9% by 26% (from 64% to 38%) vs. 12% (from 61% to 49%) compared to No-DMP group, p&amp;lt;0.01. The Emory-DMP, is an effective population management program for improving diabetes care, with significant reduction in the number of patients with poor control diabetes. Disclosure R.J. Galindo: Advisory Panel; Self; Lilly Diabetes. Consultant; Self; Valeritas, Inc. Research Support; Self; Novo Nordisk Inc. Other Relationship; Self; UpToDate. L. Peng: None. Z.T. Smith: None. S. Jacobs: None. M.K. Khosravanipour: None. F.E. Turton: None. C.M. Masi: None. G.J. Esper: None. B. Wylde: None. P.A. Castellano: Advisory Panel; Self; American Association of Medical Colleges. Board Member; Self; Vizient Inc. G.E. Umpierrez: None.

1506-P: Nonalcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes Mellitus (T2DM) Patients in India: A Real-World Perspective

Objective: NAFLD is highly prevalent in T2 DM patients. In addition to diabetes, factors like age (&amp;gt; 45 years), obesity (body mass index &amp;gt; 30 kg/m2), dyslipidemia, hypertriglyceridemia, hypertension and poor control of diabetes contribute to higher risk of having NAFLD. Therefore, the study was designed to evaluate the profile of T2DM patients with NAFLD in India alongwith determining high risk factors for having NAFLD. Methodology: Ultrasonographic (USG) records (1985) of patients with available liver function test (LFT) reports were analyzed after excluding alcoholic liver disease (ALD) and other known causes of liver injury. Various clinical and diagnostic parameters were assessed. Univariate and multivariate logistic regression was used to determine significant risk factors (P value &amp;lt;0.05). Results: Out of 1985 patients, 72.24% patients had NAFLD. Most were males (65%), &amp;gt;40 years (82.99%) and obese/overweight (92%). Most had normal SGOT (89.33%) and SGPT (74%) levels. The ratio of SGOT/SGPT was less than 1 in 77.20% patients. Most (51.62%) patients had poor control of diabetes (HbA1c &amp;gt;7.5%). Dyslipidemia and hypertriglyceridemia were seen in 80% and 48.16% patients. On univariate logistic regression analysis, age (P&amp;lt;0.001), uric acid (P&amp;lt;0.05), SGOT (P&amp;lt;0.001), SGPT (P&amp;lt;0.001), triglycerides (P&amp;lt;0.001), HDL (P&amp;lt;0.001) and LDL (P&amp;lt;0.001) levels were significantly associated. On multivariate analysis, only HDL (P&amp;lt;0.001), SGOT (P&amp;lt;0.001), SGPT (P&amp;lt;0.001) and SGOT/SGPT ratio (P&amp;lt;0.001) were significantly associated. A predictive algorithm using the above was designed and validated. Conclusion: NAFLD was seen to be highly prevalent in diabetes patients in India. Most of these patients had normal LFT values which highlight the need for routine screening and management of these patients, especially those with high risk factors. Disclosure V. Singh: None. M. Singh: None. H. Patidar: None.

Emerging Phenotype of Severe Acute Respiratory Syndrome-Coronavirus 2–associated Pancreatitis

Emerging Phenotype of Severe Acute Respiratory Syndrome-Coronavirus 2–associated Pancreatitis

Diabetes and COVID-19: A Review.

Coronavirus Disease 2019 (COVID-19) is an emerging disease and since its first identification in Wuhan, China, in December 2019, there has been a rapid increase in cases and deaths across the world. COVID-19 has been shown to have an immense impact in infected persons with diabetes, worsening their outcome, especially in elderly, smokers, obese, those having CVD, CKD, poor glycemic control and long duration of diabetes. In this review we summarize the current understanding of `the impact of COVID-19 on diabetes and discusses the pathophysiological mechanisms and management of diabetes and its complication in this scenario.