Presence Of Diabetic Nephropathy Research Articles

Association between irisin and vascular complications of type 2 diabetic patients: a prospective case–control study

BackgroundDiabetes vascular complications are classified as either macrovascular (cardiovascular disease) or microvascular (nephropathy). These complications considerably raise the risk of morbidity and death. Irisin is a myokine that has been linked to metabolic disorders and cardiovascular disease. The purpose of this study was to look at the relationship between irisin and vascular complications among type 2 diabetic (T2DM) individuals. In this case–control study, the patients were put into four groups based on the occurrence of a diabetic cardiovascular complications and the presence of diabetic nephropathy into group 1: twenty T2DM cases without complications, group 2: twenty T2DM cases with diabetic nephropathy, group 3: twenty T2DM cases with cardiovascular complications, and group 4: thirty controls. History was taken, and clinical examination was done. Laboratory investigations (fasting blood glucose, 2-h postprandial blood glucose, HbA1C, cholesterol, triglycerides, HDL-C and LDL-C, serum urea and creatinine, albumin/creatinine ratio, eGFR, serum irisin) were analyzed.ResultsSerum level of irisin was significantly lower in T2DM patients than in control. Also, irisin level was significantly lower in diabetic cases with vascular complications versus those without complications. Irisin level had a negative correlation to BMI and lipid profile in diabetic cases and had a positive correlation to eGFR in diabetic patients with cardiovascular complications.ConclusionsIrisin level was significantly lower in T2DM patients than control and in diabetic patients with vascular complications than patients without complications. So, irisin may have a role as a marker of vascular complications in T2DM.

Assessment of dyspneic sensation in patients with type 2 diabetes.

Individuals with type 2 diabetes (T2D) should be considered a susceptible group for pulmonary dysfunction. So, we aimed to evaluate the sensation of breathlessness in this population by administering two well-validatedquestionnaires. This is a crosssectional study with 592 people without known respiratory disease (353 with T2D) who answered the modified Medical Research Council (mMRC) questionnaire. In addition, 47% also responded to the St George Respiratory Questionnaire, a specific instrument designed to be applied to patients with obstructive airway disease. Patients with T2D showed a higher mMRC score in comparison to the control group [1.0 (0.0 - 4.0) vs. 0.0 (0.0 - 4.0), p<0.001]. A higher prevalence of subjects with mMRC ≥2 was observed in T2D that in the control group (20.2% vs. 11.6%, p=0.004). Participants with T2D and mMRC ≥2 showed a higher HbA1c (8.2 ± 1.6% vs. 7.8 ± 1.6%, p=0.048), longer T2D evolution and higher prevalence of nephropathy. In the multivariate analysis, the presence of T2D [OR=1.95 (1.19 to 3.22), p=0.008] in all the population, and HbA1c [OR=1.19 (1.01 to 1.41), p=0.034] and the presence of diabetic nephropathy [OR=2.00 (1.14 to 3.52), p=0.015] in patients with T2D, predicted a mMRC ≥2. Finally, no differences were observed regarding the SGRQ score among groups. Patients with T2D showed a greater sensation of dyspnea than subjects with normal carbohydrate metabolism. Risk factors included poor metabolic control and the presence of renal disease.

Determinants of hypertension among diabetic patients in southern Ethiopia: a case-control study

BackgroundHypertension, among diabetic patients, is a worldwide public-health challenge and a number one modifiable risk factor for other cardiovascular diseases and death. The prevalence of hypertension among the diabetic population is nearly twice of nondiabetic patients. Screening and prevention of risk factors for hypertension based on evidence from local studies is required to minimize the burden of hypertension among diabetic patients. This study is aimed at assessing the determinants of hypertension among diabetic patients in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, 2022.MethodsFacility-based unmatched case-control study design was conducted from March 15 to April 15, 2022, at the outpatient diabetic clinic, Wolaita Sodo University Comprehensive Specialized Hospital. A total of 345 diabetic patients were selected using systematic random sampling techniques. Data were collected using a structured questionnaire by interviewing and extracting from the medical chart of patients. Bivariate logistic regression followed by multiple logistic analysis was used to identify the determinants of hypertension among diabetic patients. A p-value less than 0.05 is considered to be statistically significant.ResultsThe significant determinants of hypertension among diabetes patients were being overweight [AOR = 2.06, 95% CI (1.1, 3.89), P = 0.025], being obese [AOR = 2.64, 95% CI (1.22, 5.70), P = 0.013], lack of Moderate intensity exercise [AOR = 2.41, 95% CI (1.36,4.24), P = 0.002], age [AOR = 1.03, 95% CI (1.01, 1.06), P = 0.011], Type 2 diabetes mellitus [AOR = 5.05, 95% CI (1.28, 19.88), P = 0.021], duration of diabetes mellitus ≥ 6 years [AOR = 7.47, 95% CI (2.02, 27.57), P = 0.003], diabetic nephropathy [AOR = 3.87, 95% CI (1.13, 13.29), P = 0.032], and urban residence [AOR = 2.11, 95% CI (1.04,4.29), P = 0.04].ConclusionBeing overweight and obese, lack of moderate-intensity exercise, age, type 2 diabetes mellitus, duration of Diabetes ≥ 6 years, presence of diabetic nephropathy, and being urban residents were significant determinants of hypertension among diabetic patients. These risk factors can be targeted by health professionals for prevention and earlier detection of hypertension among diabetic patients.

Type 2 diabetes complications are associated with liver fibrosis independent of hemoglobin A1c

The association between type 2 diabetes, non-alcoholic fatty liver disease, and liver fibrosis is well established, but it is unknown whether complications of type 2 diabetes influence fibrosis levels. We defined the complications of type 2 diabetes by the presence of diabetic nephropathy, retinopathy, or neuropathy and aimed to evaluate their association with the degree of liver fibrosis measured by the fibrosis-4 (FIB-4) index. This is a cross-sectional study evaluating the association of type 2 diabetes complications with liver fibrosis. A total of 2389 participants were evaluated from a primary care practice. FIB-4 was evaluated as a continuous and categorical measure using linear and ordinal logistic regression. Patients with complications were older, had higher hemoglobin A1c, and a higher median FIB-4 score (1.34 vs. 1.12, P<0.001). On adjusted analysis, type 2 diabetes complications were associated with higher fibrosis by continuous FIB-4 score (Beta-coefficient: 0.23, 95% confidence interval [CI]: 0.004-1.65) and demonstrated increased odds of fibrosis by categorical FIB-4 score (odds ratio [OR]: 4.48, 95% CI: 1.7-11.8, P=0.003), independent of hemoglobin A1c level. The presence of type 2 diabetes complications is associated with the degree of liver fibrosis, independent of hemoglobin A1c level.

Association of Metabolic Syndrome and Other Factors with the Presence of Diabetic Nephropathy in Type 2 Diabetic Patients.

Diabetic nephropathy (DN) is a severe diabetes mellitus (DM) complication that contributes to medical and financial burdens. This study aimed to investigate risk factors for DN among type 2 diabetes mellitus (T2DM) patients by stratifying the participants based on the presence of metabolic syndrome (MetS). Between June 2017 and June 2022, Taiwan Hospital was chosen for this retrospective case-control study. Following the completion of a standardized interview and the donation of blood samples for this study, participants were divided into two groups according to whether they had MetS. We contrasted how the potential DN-related factors impacted these two groups. A total of 1212 patients were included, and 639 patients (52.7%) had MetS. Multivariable analysis showed that the level of educational qualifications, fasting glucose, and uric acid (UA) were associated with DN. However, chewing betel nut behavior, higher systolic blood pressure (SBP), and higher glycated hemoglobin (HbA1c) were found to be risk factors of DN among the patients who had both T2DM and MetS. Notably, betel nut chewing increased the chance of DN in T2DM patients with MetS. This study found that the level of education, chewing betel nut behavior, HbA1c, fasting glucose, SBP, and UA were significant risk factors for the development of DN in diabetic individuals with concurrent MetS. Our research reveals that managing the aforementioned risk factors is crucial to lowering the prevalence of DN, particularly in individuals with lower levels of education.

Decreased Urine N6-methyladenosine level is closely associated with the presence of diabetic nephropathy in type 2 diabetes mellitus.

BackgroundTo investigate the dynamic changes of urine N6-methyladenosine (m6A) levels in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN) and evaluate the clinical significance.MethodsFirst, the levels of urine m6A were examined and compared among 62 patients with T2DM, 70 patients with DN, and 52 age- and gender-matched normal glucose tolerant subjects (NGT) by using a MethyIFIashTM Urine m6A Quantification Kit. Subsequently, we compared the concentrations of urine m6A between different stages of DN. Moreover, statistical analysis was performed to evaluate the association of urine m6A with DN.ResultsThe levels of m6A were significantly decreased in patients with DN [(16.10 ± 6.48) ng/ml], compared with NGT [(23.12 ± 7.52) ng/ml, P < 0.0001] and patients with T2DM [(20.39 ± 7.16) ng/ml, P < 0.0001]. Moreover, the concentrations of urine m6A were obviously reduced with the deterioration of DN. Pearson rank correlation and regression analyses revealed that m6A was significantly associated with DN (P < 0.05). The areas under the receiver operator characteristics curve (AUC) were 0.783 (95% CI, 0.699 – 0.867, P < 0.0001) for the DN and NGT groups, and 0.737 (95% CI, 0.639 – 0.835, P < 0.0001) for the macroalbuminuria and normoalbuminuria groups, and the optimal cutoff value for m6A to distinguish the DN from NGT and the macroalbuminuria from normoalbuminuria cases was 0.4687 (diagnostic sensitivity, 71%; diagnostic specificity, 76%) and 0.4494 (diagnostic sensitivity, 79%; diagnostic specificity, 66%), respectively.ConclusionsThe levels of urine m6A are significantly decreased in patients with DN and change with the deterioration of DN, which could serve as a prospective biomarker for the diagnosis of DN.

IDF21-0459 Prevalence, clinical profile and follow up of asymptomatic bacteriuria (ASB) in patients with Type 2 Diabetes

Background: Patients with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) more often than those without DM. It is unclear, how the natural history of ASB in Type 2 Diabetes (T2D) patients behaves. Aim: The present study intended to study the prevalence, clinical profile, complications and follow up of ASB in T2D patients. Method: This was a cross sectional prospective study done on 400 T2D patients with no symptoms of urinary tract infection (UTI) and 200 healthy controls. Various clinical, biochemical parameters and urine examination and culture were monitored. All the ASB T2D patients were followed for 6 months with respect to number of UTIs, glycemic control and renal parameters. Results: The prevalence of ASB at baseline was significantly higher in T2D (17.5%) as compared to controls (10%). E. coli was the most common organism. T2D ASB patients were mostly postmenopausal females, uncontrolled diabetes and long duration of diabetes. Presence of diabetic nephropathy, HTN, CKD, UTI in previous year, uncontrolled BP, obesity, lower eGFR, proteinuria and glycosuria increased the risk of ASB in T2D patients. Of the 64 T2D ASB patients followed till 6 months, 14 (21.8%) developed symptomatic UTI. Postmenopausal state, uncontrolled diabetes, longer diabetes duration, presence of diabetic nephropathy and glycosuria significantly increased the risk of development of symptomatic UTI. ASB in T2D patients who develop UTI leads to worsening of glycemic control with no effect on renal function on follow up. Discussion: ASB in T2D patients can be consequences of or lead to uncontrolled glycemia. ASB patients who develop UTI leads to worsening of glycemic control but there was no effect on renal function on follow up.

Прогностические модели риска развития интрадиализной гипертензии: роль параметров артериальной ригидности

Study Objective: To define the predictive value of arterial stiffness parameters in the development of intradialytic hypertension (IDH) in patients undergoing long-term HD. Study Design: Prospective study. Material and Methods. The prospective study included 45 patients undergoing long-term HD. An IDH criterion was an increase in systolic blood pressure &gt;10 mm Hg after the HD in more than 4 out of 6 sessions during the period preceding 24-hour blood pressure monitoring (24BPM). Arterial stiffness parameters were assessed using a Vasotens-24 BPLab software package (by Peter Telegin, Russia). We recorded the demographics of patients and physical examination results, lab test results, duration of HD, concomitant cardiovascular diseases, and medications taken. For data analysis we used Statistics 26 application package (IBM SPSS). Study Results. The mean age of patients was 51 [41; 61] years old; HD duration was 4.5 [1.1; 7.8] years. IDH was recorded in 20 patients; the multivariate correlation analysis showed that IDH was associated with the patients’ age (HR = 3.78; 95% CI 1.29–11.04), with the augmentation index AIx (HR = 7.75; 95% CI 2.65–22.7). Inverse correlation was observed between IDH development and reflection wave transmission time — RWTT100–60 (HR = 0.27; 95% CI 0.14–0.53), presence of diabetic nephropathy (HR = 0.34; 95% CI 0.094–1.251), residual diuresis (HR = 0.43; 95% CI 0.21–0.87), and albumin level (HR = 0.12; 95% CI 0.02–0.79). Inclusion of arterial stiffness parameters into the mathematical model increased its predictive ability from AUC = 0.886 to AUC = 0.978. Conclusion. In this study, AIx ≥ –6.5% and RWTT100–60 ≤ 134.5 m/s were associated with a higher frequency of IDH, which can be a sign of the leading role of progressive artery stiffness in the development of intradialytic cardiovascular complications. Keywords: hemodialysis, intradialytic hypertension, arterial stiffness.

English

BACKGROUND In diabetes mellitus microvascular damages at various end-organ frequently occurs and leads to development of diabetic nephropathy as well as diabetic retinopathy. Diabetic nephropathy ultimately causes end stage renal disease. Diabetic retinopathy even at its earlier stage is easily suspected by simple clinical examination in any ophthalmological clinic. We wanted to study the relationship between various stages of diabetic retinopathy with diabetic nephropathy. METHODS 1209 diagnosed patients of diabetic mellitus were screened for presence of diabetic retinopathy. First comprehensive ophthalmological examination including slit-lamp bimicroscopy and indirect ophthalmoscopy were done and then clinically typing of diabetic retinopathy according to ETDRS classification was done. Then all diagnosed case of diabetic retinopathy further examined for blood Glycosylated haemoglobin, blood urea and serum creatinine to detect diabetic nephropathy. RESULTS 273 patients were included in this study. Average age of patients was 64.6 years with mean duration of diabetes mellitus was 7.4 years. Patients suffering from severe NPDR and PDR had association with poor control of blood glycosylated haemoglobin. Patients with mild NPDR 31.1 %, Moderate NPDR 52.3 %, severe NPDR 67.4 % and in PDR 65.2 % patient had blood urea more than 40 mg / dl. In mild NPDR group 32.2 %, moderate NPDR 55.4 %, severe NPDR 67.4 % and in PDR group 63.9 % patients had serum creatinine more than 1.5 mg / dl. We have found statistically significant correlation between HbA1c level and severity of diabetic retinopathy. Prevalence of nephropathy increased with increments in the grade of retinopathy. CONCLUSIONS A significant number of patients with severe NPDR or PDR had increased blood urea and serum creatinine level. Clinical grading of diabetic retinopathy gives us a clue about the presence of diabetic nephropathy. As diagnosis of diabetic retinopathy is simple and straight forward clinical procedure and it can be done all ophthalmological se up, we recommend all patient with diabetic retinopathy must be screened for nephropathy. KEYWORDS Diabetic Retinopathy, Diabetic Nephropathy, Glycosylated Haemoglobin, Blood Urea, Serum Creatinine

β3-integrin Leu33Pro gain of function variant does not modulate inflammatory activity in human derived macrophages in diabetes.

Objective: We aimed to investigate the association between the Leu33Pro (rs5918) polymorphism in β3-integrin with diabetic complications and inflammatory function of macrophages depending on the genotype in subjects with diabetes mellitus.Material and methods: We determined the Leu33Pro polymorphism in 186 diabetic subjects and collected laboratory data. Monocytes from 24 patients were collected for macrophage differentiation to determine the inflammatory activity by treating with different stimulants.Results: We could demonstrate that human derived differentiated macrophages expressed β3‑integrin. Their secretory capacity upon inflammatory stimulation did not reveal any differences depending on the Leu33Pro variant. We found trends for an association of the polymorphism with the presence of diabetic nephropathy (p = 0.071), as well as with creatinine [1.32 mg/dL (1) vs. 0.98 mg/dL (0)] (p = 0.029 in recessive model) and glomerular filtration rate [75.6 ml/min ± 22 vs. 62.3 ml/min ± 25] (p = 0.076 in recessive model) as quantitative markers of kidney function.Conclusion: Despite the expression of β3‑integrin in human macrophages, the Leu33Pro polymorphism in β3‑integrin does not modify the inflammatory response upon stimulation but might play a role in the progression of diabetic nephropathy. Further studies are necessary to substantiate such a hypothesis.

Association between symptoms of depression, diabetes complications and vascular risk factors in four European cohorts of individuals with type 1 diabetes – InterDiane Consortium

AimsTo investigate the association between depressive symptomatology and health markers in type 1 diabetes. MethodsFour countries from the InterDiane Consortium had adopted the Finnish Diabetic Nephropathy Study protocol, including the Beck Depression Inventory (BDI). Associations between depression symptomatology, diabetes complications (diabetic nephropathy, proliferative retinopathy, major adverse cardiovascular events [MACE]) and vascular risk factors (metabolic syndrome, body mass index, glycaemic control) were investigated. ResultsIn a sample of 1046 participants (Croatia n = 99; Finland n = 314; Latvia n = 315; Lithuania n = 318), 13.4% displayed symptoms of depression (BDI score ≥ 16) with no statistically significant difference in the prevalence of depression among the cohorts. The highest rates of diabetic nephropathy (37.1%) and proliferative retinopathy (36.3%) were observed in Lithuania. The rates of MACE and metabolic syndrome were highest in Finland. In joint analyses, individuals exhibiting depression symptomatology had higher HbA1c (79 vs. 72 mmol/mol, p < 0.001) and higher triglyceride concentration (1.67 vs. 1.28 mmol/l, p < 0.001), than those without. In the multivariable model, BDI score was positively associated with the presence of diabetic nephropathy, proliferative retinopathy, MACE, and metabolic syndrome and its triglyceride component. Moreover, BDI score was positively associated with the number of metabolic syndrome components, triglyceride concentration, and HbA1c. ConclusionsComorbid depression should be considered a relevant factor explaining metabolic problems and vascular outcomes. Causality cannot be inferred from this cross-sectional study.

Plasma phenylalanine and tyrosine and their interactions with diabetic nephropathy for risk of diabetic retinopathy in type 2 diabetes

ObjectiveTight control of hyperglycemia reduces risk of diabetic retinopathy (DR), but the residual risk remains high. This study aimed to explore relationships between plasma phenylalanine and tyrosine with DR in...

Prevalence and risk factors of baclofen neurotoxicity in patients with severely impaired renal function

Background/aimsThe most common adverse effect of baclofen, used for managing hiccups and spasticity, is neurotoxicity. As baclofen is primarily excreted by the kidneys, neurotoxicity is more likely to occur in patients with chronic kidney disease (CKD). We evaluated the risk factor for baclofen neurotoxicity and the recommended dosage for patients with severe CKD. MethodsIn this single-center retrospective study, we classified 401 patients with CKD as stage 4 (n=174), non-dialysis stage 5 (n=97), and on-dialysis (n=130). ResultsThe prevalence of baclofen-induced neurotoxicity in patients with severe CKD was 7.0% (28 of 401 patients). There was no significant difference in the presence of neurotoxicity when the patients were classified as CKD stage 4, stage 5, and dialysis patients. There were significant differences in serum albumin levels and the presence of diabetic nephropathy between the patients with neurotoxicity and those without. The results from a multiple logistic regression analysis showed that serum albumin was independently associated with baclofen neurotoxicity (p=0.007). The minimum daily dose for baclofen neurotoxicity was 10mg, 10mg, and 5mg in patients with CKD stages 4 and 5, and dialysis, respectively. ConclusionsIn this study, the prevalence of baclofen-induced neurotoxicity in patients with severe CKD was 7.0%. Serum albumin was identified as an independent risk factor for neurotoxicity. We recommend initially administering a daily dose of 7.5mg for patients with severe CKD stages 4 and 5, and a daily dose of 2.5mg for patients receiving dialysis.

Prevalence and risk factors of baclofen neurotoxicity in patients with severely impaired renal function

Background/aimsThe most common adverse effect of baclofen, used for managing hiccups and spasticity, is neurotoxicity. As baclofen is primarily excreted by the kidneys, neurotoxicity is more likely to occur in patients with chronic kidney disease (CKD). We evaluated the risk factor for baclofen neurotoxicity and the recommended dosage for patients with severe CKD. MethodsIn this single-center retrospective study, we classified 401 patients with CKD as stage 4 (n=174), non-dialysis stage 5 (n=97), and on-dialysis (n=130). ResultsThe prevalence of baclofen-induced neurotoxicity in patients with severe CKD was 7.0% (28 of 401 patients). There was no significant difference in the presence of neurotoxicity when the patients were classified as CKD stage 4, stage 5, and dialysis patients. There were significant differences in serum albumin levels and the presence of diabetic nephropathy between the patients with neurotoxicity and those without. The results from a multiple logistic regression analysis showed that serum albumin was independently associated with baclofen neurotoxicity (p=0.007). The minimum daily dose for baclofen neurotoxicity was 10mg, 10mg, and 5mg in patients with CKD stages 4 and 5, and dialysis, respectively. ConclusionsIn this study, the prevalence of baclofen-induced neurotoxicity in patients with severe CKD was 7.0%. Serum albumin was identified as an independent risk factor for neurotoxicity. We recommend initially administering a daily dose of 7.5mg for patients with severe CKD stages 4 and 5, and a daily dose of 2.5mg for patients receiving dialysis.

528-P: Relationship between Bone Mineral Density and Diabetic Nephropathy in Adults with Type 1 Diabetes

Objective: Osteoporosis is typically identified as a disease of postmenopausal women, however; it has been observed that in patients with type 1 diabetes (T1D) fractures associated with osteoporosis four to six times more common, in both sexes and at an early age (≈ 50 years). The objective of this study was to find associations between the bone mineral density (BMD), T-score and Z-score at the femoral neck, hip and spine and selected characteristics of patients with T1D. Methods: BMD of patients with T1D was evaluated with DXA (GE Healthcare Lunar). A correlation analysis was performed to identify associations between glycated hemoglobin, 25-hydroxyvitamin D concentration, years since diagnosis and diabetic, estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Results: We included 43 patients, with a mean age of 38.1 years, the mean BMD in the femoral neck was 0.94±0.13, in the hip 0.93±0.14 and the spine 1.11±0.13. We observed a negative correlation between the years since diagnosis of T1D and the BMD and T-score in the femoral neck and hip. There was a negative correlation between the ACR and the BMD, T-score and Z-score in the femoral neck and total hip and a positive correlation between the eGFR and the BMD and T-score in the femoral neck and hip. Conclusions: In this study we identify some factors that might impact and decrease the BMD in patients with T1D including long time since diagnosis, older age of patients and presence of diabetic nephropathy. The ACR could be an indicator of early bone metabolic changes in patients with T1D. Further studies are required to confirm this association and to define the optimal age for BMD evaluation in patients with T1D. Disclosure C. Lara: None. F. Rodriguez: None. T. Viveros-Ruiz: None. P. Almeda-Valdes: None. D. Uribe: None. B. Rivas: None. N. Ramirez Pedraza: None. J.A. Garay Mora: None.

SUN-655 Helicobacter Pylori Infection Is Not Associated with Diabetes Among a Cohort of Diabetic Patients in Alexandria City, Egypt

: Helicobacter Pylori infection is one of the most common bacterial infections in Egypt. A mounting body of evidence suggests the association of H Pylori infection with diabetes. H.Pylori is implicated in increasing insulin resistance and promoting chronic inflammation, resulting in the development of diabetes. This study aimed to estimate the prevalence of H.Pylori infection among a cohort of patients with diabetes in Alexandria city, Egypt and the possible role of this condition in the control of the glycemic profile. We also investigated the correlation between H.pylori infection and the presence of diabetes-related complications (diabetic nephropathy and retinopathy). The study was conducted on 300 subjects classified into three groups; Group (I): 100 patients with type 2 diabetes, Group (II): 100 subjects with type 1 diabetes, Group (III): 100 non-diabetic control subjects. Participants were subjected to detailed history taking and thorough clinical examination. Routine laboratory investigations were done, including HbA1c and fasting plasma glucose. Stool antigen test, on- site Helicobacter Pylori Ag Rapid Test-cassette was done. The mean duration of diabetes in type 2 diabetes was 8.18±5.87 years, while the mean duration in type 1 was 4.88± 3.02 years, which was statistically significante (p< 0.05). The results of the presented study showed that there was no significant difference in the prevalence of Helicobacter Pylori infection between type 1 and type 2 patients with diabetes (31% Vs 38%, p=0.298), moreover; after adjustment for age, there was no significant difference in the prevalence of Helicobacter Pylori infection among either group with diabetes (Group 1 and group 2) compared to the control group, (p= 0.756 and 0.066) respectively. There was no statistically significant association between the presence of Helicobacter Pylori infection in both type 1 and type 2 diabetes, and an elevated HbA1c level above 6.5%.(p= 0.772 and p=0.524) respectively. The prevalence of diabetic nephropathy in patients with type 2 and type 1 diabetes was 5% and 3% respectively, which was non-statistically significant (p=0.721). While the prevalence of diabetic retinopathy was 11% among patients with type 2 compared to 1% among patients with type 1 diabetes, which was statistically significant (p=0.003). There was no statistically significant correlation between Helicobacter Pylori infection and the presence of diabetic nephropathy or diabetic retinopathy. Helicobacter Pylori infection was not associated with diabetes and did not affect the HbA1c level. Helicobacter Pylori infection was not correlated to the presence of either diabetic nephropathy or diabetic retinopathy among both patients with type 2 and type 1 diabetes.Nothing to Disclose: MA, MM, AHNo Sources of Research Support

Prediction of Diabetic Nephropathy from the Relationship between Fatigue, Sleep and Quality of Life

Fatigue and poor sleep quality are the most common clinical complaints of people with diabetes mellitus (DM). These complaints are early signs of DM and are closely related to diabetic control and the presence of complications, which lead to a decline in the quality of life. Therefore, an accurate measurement of the relationship between fatigue, sleep status, and the complication of DM nephropathy could lead to a specific definition of fatigue and an appropriate medical treatment. This study recruited 307 people with Type 2 diabetes from two medical centers in Northern Taiwan through a questionnaire survey and a retrospective investigation of medical records. In an attempt to identify the related factors and accurately predict diabetic nephropathy, we applied hybrid research methods, integrated biostatistics, and feature selection methods in data mining and machine learning to compare and verify the results. Consequently, the results demonstrated that patients with diabetic nephropathy have a higher fatigue level and Charlson comorbidity index (CCI) score than without neuropathy, the presence of neuropathy leads to poor sleep quality, lower quality of life, and poor metabolism. Furthermore, by considering feature selection in selecting representative features or variables, we achieved consistence results with a support vector machine (SVM) classifier and merely ten representative factors and a prediction accuracy as high as 74% in predicting the presence of diabetic nephropathy.

Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy

Pregnant women with diabetes mellitus (DM) are at high risk for hypertensive disorder of pregnancy (HDP). Women with poor control DM sometimes have heavy-for-dates infants. However, women with HDP sometimes have light-for-dates infants. We aim to clarify the relationship between glycemic control and fetal growth in women with DM and/or subsequent HDP. Of 7893 women gave singleton birth at or after 22 gestational weeks, we enrolled 154 women with type 1 DM (T1DM) or type 2 DM (T2DM) whose infants did not have fetal abnormalities. Among women with T1DM or T2DM, characteristics of the three groups (with HDP, without HDP, and with chronic hypertension [CH]) were compared. No women with T1DM had CH, but 19 (17.4%) of 109 with T2DM did. HDP incidence was similar between women with T1DM (22.2%) and T2DM without CH (16.7%). Among women with T1DM, the incidences of fetal growth restriction (FGR) with and without HDP were similar. However, among women with T2DM without CH, this incidence was significantly higher among those with HDP (33.3%) than among those without HDP (5.3%), was significantly more common with HbA1c levels at first trimester ≥ 7.2% (33.3%) than with those < 7.2% (5.6%), and significantly more numerous without pre-pregnancy therapies for DM (23.3%) than with them (3.3%). Among women with T2DM and HDP, those with FGR had smaller placenta SDs and higher insulin dosages at delivery than those without light-for-dates. In multivariate analysis, the presence of diabetic nephropathy was a predictor of T1DM and HDP (P = 0.0105), whereas HbA1c levels ≥ 7.2% before pregnancy was a predictor of T2DM and HDP (P = 0.0009). Insulin dosage ≥ 50U/day at delivery (P = 0.0297) and the presence of HDP (P = 0.0116) independently predicted T2DM, HDP, and FGR development. Insufficient pre-pregnancy treatment of DM increased the risk of HDP.

VARIABILITY OF ARTERIAL BLOOD PRESSURE IN CHILDREN WITH DIABETES MELLITUS AND OBESITY

INTRODUCTION: The activity of the cardiovascular system has a clear to the circadian rhythms of a child's body. Daily fluctuations in blood pressure in normal conditions and in pathology is a physiological phenomenon which can play a significant role in developing arterial hypertension and even in the occurrence of fatal cardiovascular states such as heart attacks, strokes, and sudden cardiac arrest activities. Ambulatory blood pressure monitoring is recognized as a necessary instrumental investigation for diagnosis and management of patients with arterial hypertension and especially in children from high risk groups such as diabetics and obesity it may be even more important for hypertension diagnostics than in adults.&#x0D; AIM: The objective of the study was to analyze the features of circadian oscillations of blood pressure and heart rate variability in children with diabetes mellitus and hypothalamic syndrome with obesity.&#x0D; METHODS: Research included 76 children aged 10 to 18 years: 52 children with endocrine pathology (diabetes and obesity) and 24 clinically healthy persons. The peculiarities of nutrition, sleep, and the definition of the chronotype using the Horn-Ostberg questionnaire were carried out. The functional state of the cardiovascular systems was determined by single office measurement and by ambulatory blood pressure monitoring.&#x0D; FINDINGS AND RESULTS: Ambulatory blood pressure monitoring revealed a number of differences between the groups of children. In diabetic patients, daytime systolic blood pressure was higher with increased variability, while the night blood pressure was significantly lower and with significantly less variability, compared to other groups. Attention is drawn to the higher level of diastolic blood pressure and lower variability at night in obese children.&#x0D; CONCLUSIONS: Daily fluctuations of arterial pressure in children with diabetes and obesity differ from healthy persons depending on the type of disease and could be regarded as result of circadian biorhythms disruption. In obese persons it appears in the form of nocturnal SBP and DBP elevation but with index of variability compared to the control group. In diabetic children the circadian BP rhythms deviations appear in form of SBP elevation during the day with higher index of its variability. Their BP changes were associated with the presence of diabetic nephropathy and proteinuria.

Prevalence and risk factors of diabetic peripheral neuropathy in patients with Type 2 diabetes mellitus

Background: Diabetic peripheral neuropathy (DPN) is common among people with diabetes and can result in foot ulceration and amputation. Objective: The objective of the study is to estimate the prevalence and risk factors of DPN among patients with Type 2 diabetes mellitus (T2DM) at a diabetes clinic in Benghazi Medical Center (BMC), Benghazi, Libya. Patients and Methods: Three hundred and sixty-seven patients with T2DM (127 [34.6%] males and 240 [65.4%] females) were included in this cross-sectional study. The patients aged ≥18 years, and they attended the outpatient diabetes clinics at BMC from May 2015 to October 2016, for routine follow-up. Patients with T1DM, gestational diabetes, and latent autoimmune diabetes in adults were excluded. Data including gender, age, type of DM, duration of DM, history of smoking, history of hypertension, weight, height, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, creatinine, and urea were obtained by a prepared pro forma. Peripheral neuropathy was diagnosed in the presence of numbness, paresthesia, 10-g monofilament examination, and loss of vibration and joint position sensations. The relationship between DPN and its risk factors, in addition to independent predictors of DPN, was explored using multiple forward stepwise logistic regression and presented as an odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of DPN was 30.5% in the studied group. A statistical significant association found between DPN and age (P = 0.014), duration of DM (P &lt; 0.001), macrovascular complications of DM (P &lt; 0.001), diabetic retinopathy (P = 0.001), diabetic nephropathy (P &lt; 0.001), poor glycemic control (high HbA1c) (P &lt; 0.001), hypertension (P = 0.011), uncontrolled blood pressure (≥140/90 mmHg) (P = 0.007), and insulin treatment (P &lt; 0.001). Multiple forward stepwise logistic regression analyses revealed two independent risk factors influencing DPN: diabetic nephropathy (OR = 1.976, 95% CI: 1.289–3.027) (P = 0.009) and insulin treatment (OR = 3.430, 95% CI: 2.021–5.821), (P &lt; 0.001). Conclusions: The overall prevalence rate of DPN in this study was 30.5% among patients with T2DM. It increases with the presence of diabetic nephropathy and insulin treatment.