Presence Of Macrovascular Complications Research Articles

Olfactory dysfunction in patients with type 2 diabetes mellitus.

diabetic complications and olfactory dysfunction (OD) in patients with type 2 diabetes mellitus (T2DM) seem related. This study aims to evaluate the prevalence of OD in T2DM patients and to analyze its relationship with diabetic complications. 130 T2DM patients and 100 comparable controls were enrolled. Olfaction was evaluated using the Extended Smell Test (TDI) and the Italian brief Questionnaire of Olfactory Disorders â€" Brief-IT-QOD. T2DM patients were divided into: "Group 1" patients with no complications, and "Group 2" patients with at least one diabetic complication. Non-parametric tests were used. Machine learning algorithms were applied to explore which variables were most important in predicting the presence of OD in T2DM. The prevalence of OD was significantly higher in Group 2 than in controls (71.4% vs 30%) and in Group 1 (71.4% vs 43.3%). However, when comparing the TDI scores between Group 1 and 2 the only significant difference was found for the discrimination scale and not for the identification and threshold scales. Brief-IT-QOD scores were significantly higher in Group 2 than in controls. The Random Forest and variable importance algorithms highlighted the relevance of LDL, glycated hemoglobin, type of complication (macrovascular) and age in determining OD in T2DM. The last three variables were included in a nomogram for the prediction of OD risk in T2DM. T2DM patients with diabetic complications are more frequently affected by OD. Poor glycemic control, LDL values, age and presence of macrovascular complications are the more important factors in determining OD in T2DM patients.

Risk Factors for Ten-Year Risk of Osteoporosis in Type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center Cross-sectional Study

<i>Background</i>: Type 2 diabetes mellitus (T2DM) is a major contributing factor to osteoporotic fractures via different mechanisms. This study assessed the ten-year risk of osteoporosis and associated factors for osteoporotic fractures in T2DM patients. <i>Methods</i>: Data from 175 type diabetes mellites (T2DM) patients over 40 years attending a diabetes clinic at Tikur Anbessa Specialized Hospital (TASH) were collected. Demographic information, diabetic complications, blood sugar levels, and other medical illnesses were collected by a structured questionnaire and from an electronic medical record system. The 10-year fracture risk assessment (FRAX) tool was used without bone mineral density (BMD) measurement. multivariate logistic regression was used to analyze factors associated with fragility fractures. <i>Results</i>: Half the participants were female, with a median age of 60. Most were married, well-educated, and urban residents. The median duration of diabetes was 11 years. The median FRAX score indicated a moderate 10-year risk of hip fracture (≥3%) and a high risk of major osteoporotic fracture (≥20%). Overall, 30.9% of patients had a high 10-year risk of osteoporotic fracture. The majority (78.3%) had macrovascular complications, with neuropathy, retinopathy, and nephropathy being the common ones. Higher FBS, higher HbA1c, and the presence of macrovascular complications were significantly associated with a higher risk of fractures. <i>Conclusion</i>: This study found a high prevalence (30.9%) of a 10-year risk of osteoporotic fractures in T2 DM patients. Poor glycemic control (higher HbA1c and FBS) and the presence of macrovascular complications were significantly associated with an increased 10-year osteoporotic fracture risk.

Noninvasive Liver Fibrosis Indices as Indicators of Microvascular and Macrovascular Complications in Type 2 Diabetes.

Objective: Nonalcoholic fatty liver disease (NAFLD) is more prevalent in patients with obesity, diabetes, and metabolic syndrome, which are risk factors for nonalcoholic steatohepatitis and liver fibrosis. NAFLD is related to cardiovascular outcomes in diabetes. We aimed to investigate the relationship between diabetic complications and NAFLD fibrosis score (NFS) and Fibrosis-4 score (FIB-4). Methods: Three hundred patients with type 2 diabetes mellitus (T2DM) were retrospectively evaluated according to NAFLD diagnosis on ultrasound in outpatient clinic. Risk of advanced fibrosis was estimated using FIB-4 and NFS. Diabetic complications of the patients were noted. Results: Presence of diabetic retinopathy is related to FIB-4 (P = 0.001) and NFS (P < 0.001) scores. NFS score (P = 0.037), not FIB-4 (P = 0.517), is related to diabetic nephropathy. Among macrovascular complications, only coronary artery disease is related to NFS and FIB-4 scores (P = 0.037 and P = 0.004, respectively). Although we cannot establish any association between fasting blood glucose, glycosylated hemoglobin (HbA1c) values and noninvasive liver fibrosis scores (P > 0.05), diabetes duration, and age positively correlated with the FIB-4 score (P = 0.033, P = 0.001). In logistic regression analysis, NFS > 0.676 values are associated with increased rates of diabetic retinopathy, independent of age, sex, HbA1c, and duration diabetes (odds ratio: 1.155, P = 0.030). FIB-4 has no relation with microvascular complications according to logistic regression analysis (P > 0.05 for all). Neither FIB-4 nor NFS has an effect on the presence of macrovascular complications (P > 0.05 for all). Conclusion: Our findings suggest that increase in NFS score is associated with the presence of diabetic retinopathy, independent of confounding factors. Further studies are needed on the applicability of noninvasive fibrosis scores in monitoring the presence of diabetic microvascular and macrovascular complications.

Erythrocyte membrane fluidity: A novel biomarker of residual cardiovascular risk in type 2 diabetes.

Improving the composition of circulating fatty acids (FA) leads to a reduction in cardiovascular diseases (CVD) in high-risk individuals. The membrane fluidity of red blood cells (RBC), which reflects circulating FA status, may be a valid biomarker of cardiovascular (CV) risk in type 2 diabetes (T2D). Red blood cell membrane fluidity, quantified as general polarization (GP), was assessed in 234 subjects with T2D, 86 with prior major CVD. Based on GP distribution, a cut-off of .445 was used to divide the study cohort into two groups: the first with higher GP, called GEL, and the second, defined as lower GP (LGP). Lipidomic analysis was performed to evaluate FA composition of RBC membranes. Although with comparable CV risk factors, the LGP group had a greater percentage of patients with major CVD than the GEL group (40% vs 24%, respectively, p < .05). Moreover, in a logistic regression analysis, a lower GP value was independently associated with the presence of macrovascular complications. Lipidomic analysis showed a clear shift of LGP membranes towards a pro-inflammatory condition due to higher content of arachidonic acid and increased omega 6/omega 3 index. Increased membrane fluidity is associated with a higher CV risk in subjects with T2D. If confirmed in prospective studies, membrane fluidity could be a new biomarker for residual CV risk assessment in T2D.

POSTPRANDIAL HYPERTRIGLYCERIDEMIA AS A RISK FACTOR FOR MACROVASCULAR COMPLICATIONS IN TYPE 2 DIABETES MELLITUS

Diabetes mellitus is a common endocrine disorder characterized by chronic hyperglycemia, and disturbances of carbohydrate, fat and protein metabolism. The prevalence of diabetes has been increasing widely in India and worldwide. Diabetes is a cause of signicant mortality and morbidity due to macro and micro vascular complications. Dyslipidemia accompanying type 2 Diabetes plays an important role in pathogenesis of atherosclerotic vascular disease. Post prandial hypertriglyceridemia, irrespective of fasting triglyceride levels, has emerged as a signicant risk factor for symptomatic and asymptomatic macro vascular disease It is a case control study, conducted for a period of 1 year from November 2020 to October 2021, on patients visiting the Out-patient department of NRI institute of Medical Sciences, Sangivalasa, Visakhapatnam. The cases and controls were subjected to clinical and biochemical evaluation to detect presence of macro vascular complications. The cases were subjected to a high fat meal, and plasma triglycerides were measured two and four hours after a fat challenge. It was observed that post prandial hypertriglyceridemia correlated better than fasting triglycerides in patients with macro vascular complications. Persistent and signicant post prandial hypertriglyceridemia was observed in diabetic patients with macro vascular complications; and can be used as a marker for predicting vascular complications in type 2 Diabetes mellitus

Assessment of erectile dysfunction and other sexual dysfunction in men with type 2 diabetes mellitus: A multicenter observational study in North India

BackgroundType 2 diabetes mellitus (T2DM) is one of the major contributing factors of sexual dysfunction in males. Given the presence of limited literature on prevalence of T2DM associated sexual dysfunction in North Indian population, the following study was conducted with aim of investigating the prevalence of ED. Materials and methodsA multicenter observational study was conducted across 11 centers in Lucknow, North India. A total of 460 patients were asked to fill a validated International Index of Erectile function (IIEF) Questionnaire, and sexual dysfunction was assessed based on scoring for erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction over a period of 4 weeks. Chi-Square analysis was performed to form an association between ED or OFD and other confounding factors. ResultsED and OFD were found to be prevalent in 32% and 43.3% of patients, respectively. Their presence correlated significantly with T2DM duration (ED, p = 0.0101; OFD, p = 002). In Indian context, the prevalence of ED was found to correlate with, presence of macrovascular complications and serum creatinine levels, whereas OFD significantly correlated with T2DM duration, macro– and microvascular complications among other factors. ConclusionThe prevalence of ED and OFD in men suffering from T2DM is on significant rise, considerably impacting the lives of millions of men worldwide. Thus, the findings of this study highlight the significance of taking follow-up of sexual discomfort and disorders by the clinicians during the visits.

Do Long-Term Complications of Type 2 Diabetes Increase Susceptibility to Geriatric Syndromes in Older Adults?

Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially frailty syndrome, are associated with diabetic complications, too. In this study, we aimed to evaluate the effect of macrovascular and microvascular complications of type 2 diabetes on frailty and other geriatric syndromes. In addition, the effect of these complications on quality of life was also reviewed. Materials and Methods: We conducted a cross-sectional study for four months. Comprehensive geriatric assessment tests were done on all patients. The Fried frailty index (FFI) was used for the evaluation of frailty syndrome. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), and Global Leadership Initiative on Malnutrition criteria (GLIM). The EWGSOP 2 criteria were used for the diagnosis of sarcopenia. Quality of life (QoL) was evaluated using the short form-36 (SF-36) questionnaire. Data analysis was done by SPSS version 22. Results: 237 females and 142 males with a mean age of 71.7 ± 6.1 years were included in the study. The frequency of macrovascular and microvascular complications was 41.4% and 68.1%, respectively. Frailty was found to be associated with macrovascular complications (p = 0.003). Handgrip strength, skeletal muscle mass index, and gait speed were decreased in the presence of macrovascular complications (p = 0.043, p < 0.001, p < 0.001). QoL was also decreased in patients with macrovascular complications (p = 0.003). Nutritional status and handgrip strength were negatively affected in patients with diabetic neuropathy (p = 0.019, p = 0.014). Polypharmacy was also found to be associated with macrovascular complications (p < 0.001, p < 0.001). Macrovascular complications were 2.5 times more common in malnourished patients according to GLIM and 3.2 times more common in patients with decreased gait speed. Conclusion: In this study, we observed that both macrovascular and microvascular complications of diabetes increase susceptibility to geriatric syndromes in elderly individuals. It could be useful to conduct prospective studies in which we can compare the effectiveness of treatment methods on this subject.

Characteristics of patients with hypertension in a population with type 2 diabetes mellitus. Results from the Turkish Nationwide SurvEy of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Hypertension Study)

BackgroundThe present survey aimed to find out the demographical and clinical characteristics of patients with hypertension in a population with type 2 diabetes mellitus (T2DM) in Turkey. MethodsPatients with T2DM who were followed-up in tertiary endocrine units for at least last one year were recruited. Demographic, clinical and biochemical data of the patients were collected. Hypertension was defined as taking anti-hypertensive medications or having office arterial blood pressure (ABP) ≥140/90 mmHg or home ABP ≥ 130/80 mmHg. ResultsA total of 4756 (58.9% women) diabetic patients were evaluated. The percentage of patients with hypertension was 67.5% (n = 3212). Although 87.4% (n = 2808) of hypertensive patients were under treatment, blood pressure was on target in 52.7% (n = 1479) of patients. Hypertension proportions were higher in woman (p = 0.001), older, more obese, and those who had longer diabetes duration, lower education levels, higher frequency of hypoglycemic events (all p < 0.001) and higher triglyceride levels (p = 0.003). LDL cholesterol level and the percentage of smokers were lower in hypertensive group than in non-hypertensive group (both p < 0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p < 0.001). In multivariate logistic regression analysis, being a woman (OR: 1.26, 95% CI: 1.04–1.51, p = 0.016), smoking (OR: 1.38, 95% CI: 1.05–1.80, p = 0.020), regular physical activity (OR: 1.24, 95% CI: 1.01–1.53, p = 0.039) and the presence of macrovascular complications (OR: 1.38 95% CI: 1.15–1.65, p = 0.001) were the significant predictors of good ABP regulation. The ratios of masked and white coat hypertension were 41.2% and 5.7%, respectively. ConclusionOur findings indicate that two-thirds (67.5%) of adult patients with T2DM have hypertension. Co-existence of hypertension increases the frequency of macro and microvascular diabetic complications in these patients. Despite the critical role of hypertension in morbidity and mortality, only half of the patients have favorable ABP levels. Masked hypertension seems to be another important issue in this population.

The Prognosis of Patients With Type 2 Diabetes and Nonalbuminuric Diabetic Kidney Disease Is Not Always Poor: Implication of the Effects of Coexisting Macrovascular Complications (JDDM 54).

Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing phenotype in patients with type 2 diabetes. However, it remains unclear whether its prognosis is poorer than that of other DKD phenotypes. A total of 2,953 Japanese patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, enrolled in an observational cohort study in 2004, were followed until 2015. On the basis of albuminuria (>30 mg/g creatinine) and reduced eGFR (<60 mL/min/1.73 m2) at baseline, participants were classified into the four DKD phenotypes-no-DKD, albuminuric DKD without reduced eGFR, nonalbuminuric DKD with reduced eGFR, and albuminuric DKD with reduced eGFR-to assess the risks of mortality, cardiovascular disease (CVD), and renal function decline. During the mean follow-up of 9.7 years, 113 patients died and 263 developed CVD. In nonalbuminuric DKD, the risks of death or CVD were not higher than those in no-DKD (adjusted hazard ratio 1.02 [95% CI 0.66, 1.60]) and the annual decline in eGFR was slower than in other DKD phenotypes. The risks of death or CVD in nonalbuminuric DKD without prior CVD were similar to those in no-DKD without prior CVD, whereas the risks in nonalbuminuric DKD with prior CVD as well as other DKD phenotypes were higher. Nonalbuminuric DKD did not have a higher risk of mortality, CVD events, or renal function decline than the other DKD phenotypes. In nonalbuminuric DKD, the presence of macrovascular complications may be a main determinant of prognosis rather than the renal phenotype.

Agonistic autoantibodies against B2-adrenergic receptors correlating with macrovascular disease in longstanding diabetes type 2.

Agonistic autoantibodies directed against adrenergic, endothelin, and angiotensin receptors are known as pathogenic factors in disease-causing vascular impairments such as Buergers' disease, dilatative cardiomyopathy, dementia, and preeclampsia. Diabetes mellitus also causes micro- and macrovascular damages, but pathogenesis is still not fully understood. Following indications for a pathogenic role of the mentioned antibodies from our preliminary investigations, we investigated the prevalence in a bigger cohort of patients with longstanding diabetes with or without diabetic complications. We included 200 patients in four groups (grouping due to duration of diabetes and presence of complications) from our university polyclinic with longstanding diabetes mellitus type 2 and evaluated the prevalence of the agonistic autoantibodies using ELISA technique. Antibodies directed against the alpha1-(39%), the first extracellular loop of the beta2-(34,5%), and the first extracellular loop of the beta1-adrenergic receptor (29,0%) were the most often detectable. With progression of diabetes and its complications, we found a decrease in the prevalence of the antibodies. Regression analyses revealed a positive association of antibodies against the first loop of the beta2-receptor and the presence of macrovascular complications. This investigation found mid frequent prevalence of agonistic autoantibodies in patients with longstanding diabetes mellitus type 2. The association between an antibody against one epitope and the presence of macrovascular complications may indicates a pathogenic linkage. This finding is inconsistent with our preliminary data and needs further evaluation, maybe by follow-up.

Treatment Adherence and Its Associated Factors in Patients with Type 2 Diabetes: Results from the Rio de Janeiro Type 2 Diabetes Cohort Study.

Objectives To investigate treatment adherence in patients with type 2 diabetes and to evaluate its associated factors. Methods The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire was used to assess treatment adherence. Good adherence was defined as ≥5 days a week in each SDSCA item. Pain, emotional, and physical domains of the SF-36 quality of life questionnaire and the Canadian Occupational Performance Measure (COPM) were also evaluated. Multivariable logistic regressions explored the independent correlates of good general adherence and of specific items of the SDSCA (diet, exercise, and medications). Results Good adherence was 93.5% for medication use, 59.3% for foot care, 56.1% for blood glucose monitoring, 29.2% for diet, and 22.5% for exercise. Patients with general good adherence had lower BMI, better serum lipid profile, higher values of functional capacity, emotional and pain domains of SF-36, better occupational performance, and lower prevalence of pain or limitation in the upper and lower limbs than patients with worse adherence. The variables associated with good adherence were younger age, lower BMI, presence of macrovascular complications, better occupational performance and emotional domain of SF-36, and higher HDL cholesterol levels. The presence of pain/limitation in the upper limbs was associated with worse adherence. Good medication adherence was associated with longer diabetes duration, lower BMI, and lower HbA1c levels. Higher values of pain and emotional domains of the SF-36 and lower BMI were related to better exercise and diet adherence, while the presence of peripheral neuropathy and joint pain/limitation were associated with worse exercise adherence. Conclusions Emotional and physical performances are important determinants of good diabetic treatment adherence. Good adherence has beneficial impact on BMI, lipid, and glycemic control.

Temporal Trends in the Use of Sodium-Glucose Cotransporter 2 Inhibitors—The Global DISCOVER Study

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce the risk of cardiovascular (CV) events in patients with type 2 diabetes (T2D), first demonstrated in the EMPA-REG OUTCOME trial (EMPA-REG). We examined trends in the use of SGLT2i during the first year of DISCOVER (NCT02322762), a 3-year observational study of patients with T2D initiating second-line glucose-lowering therapy in 37 countries. Methods: Patients who weren’t receiving an SGLT2i at first-line and who had data on glucose-lowering medications at baseline, 6 and 12 months were included (N = 11 706). We assessed the numbers and characteristics of patients who were initiated on an SGLT2i (initiation of second-line therapy at baseline, or later-line therapy during the first year of follow-up) overall and according to whether the date of initiation was before or after EMPA-REG. Results: Overall, 1138 patients were prescribed an SGLT2i at baseline or during follow-up (9.7%; across-country range: 0.0-68.9%). There were no substantial differences in patient characteristics among those who were prescribed an SGLT2i before or after EMPA-REG: 10.4% (before) and 14.4% (after) of patients had a history of macrovascular complications, compared with 12.9% of patients prescribed a different class of medication (p = 0.24). At baseline (initiation of second-line therapy), the proportion of patients who received an SGLT2i was higher when the initiation occurred after vs. before EMPA-REG (8.4% vs. 5.9%, p &amp;lt; 0.001). Conclusions: The overall proportion of patients prescribed an SGLT2i was low, but varied greatly across countries. SGLT2i use increased modestly after EMPA-REG. Although the CV benefits of SGLT2i use have been best demonstrated in people with established macrovascular disease, the clinical decision to prescribe these agents does not appear to be primarily driven by the presence of macrovascular complications. Disclosure M. Kosiborod: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Amgen Inc., Sanofi, Boehringer Ingelheim GmbH, GlaxoSmithKline plc., Glytec Systems, Merck &amp; Co., Inc., Novo Nordisk A/S, Janssen Pharmaceuticals, Inc., ZS Pharma, Inc., Intarcia Therapeutics, Inc., Novartis AG. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH. H. Chen: Employee; Self; AstraZeneca. J. Cid-Ruzafa: Employee; Self; Evidera. P. Fenici: Employee; Self; AstraZeneca. M.B. Gomes: Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck KGaA. N. Hammar: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. K. Khunti: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Sanofi-Aventis, Merck Sharp &amp; Dohme Corp., Novo Nordisk A/S. Consultant; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Takeda Development Centre Europe Ltd., Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novartis AG, Sanofi-Aventis, Pfizer Inc.. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Takeda Development Centre Europe Ltd., Servier. Research Support; Self; Novo Nordisk A/S. Consultant; Self; Pfizer Inc.. Research Support; Self; Novo Nordisk A/S. S. Pocock: Consultant; Self; AstraZeneca. M.V. Shestakova: None. I. Shimomura: Research Support; Self; Appliance Company, Panasonic Corporation. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Covidien Japan Inc.. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Eli Lilly Japan K.K., Eli Lilly Japan K.K., Kaken Pharmaceutical Co., Ltd.. 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Speaker's Bureau; Self; Teijin Pharma Limited. F. Surmont: Employee; Self; AstraZeneca. F. Tang: Research Support; Self; AstraZeneca. Employee; Self; Mid America Heart Institute. L. Ji: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Eli Lilly and Company, Bristol-Myers Squibb Company, Novartis AG, Novo Nordisk A/S, Merck &amp; Co., Inc., Bayer AG, Merck Sharp &amp; Dohme Corp., Takeda Development Center Asia, Pte. Ltd., Sanofi, Roche Pharma, Boehringer Ingelheim GmbH. Research Support; Self; AstraZeneca, Roche Pharma, Sanofi, Merck Sharp &amp; Dohme Corp., Novartis AG, Eli Lilly and Company, Bristol-Myers Squibb Company.

Serum vaspin concentration in elderly patients with type 2 diabetes mellitus and macrovascular complications

BackgroundAdipose tissue, an endocrine organ of the body, is involved in some obesity-related disease states such as insulin resistance, diabetes mellitus, and atherosclerosis. Vaspin is a novel adipocyte with insulin sensitizing effects. In this study, we planned to estimate serum vaspin concentrations as related to glycemic status and the presence of macrovascular complications among elderly patients with type-2 diabetes mellitus (T2DM).MethodsA total of 230 elderly patients with T2DM were evaluated. These patients were divided into two groups: patients without complications (T2DM group, n = 110), and patients with macrovascular complications (T2DM + MC group, n = 120). In addition, 60 healthy elderly subjects were enrolled and assigned into the control group (NC group). Relevant parameters were matched for age and gender ratio. Serum vaspin concentrations were measured by Enzyme-linked immunosorbent assay (ELISA). Anthropometric measurements, plasma glucose and HbA1C levels, insulin concentration, liver and kidney functions, and lipid profile were measured for each participant.ResultsSerum vaspin concentrations were significantly higher in the T2DM group than in the T2DM + MC group (F = 13.122, P < 0.01). These concentrations were also significantly higher among females, compared to males (T = 3.567, P < 0.05). Logistic regression analysis revealed that serum vaspin concentration, systolic blood pressure, HDL-C and T2DM duration were independent influencing factors for diabetic macrovascular complications.ConclusionSerum vaspin may be considered as a potential marker to assess the status of elderly patients with T2DM and the risk of developing serious macrovascular complications. Further prospective studies are warranted.Trial registrationChiCTR-OPC-14005698, retrospectively registered on 20 Dec. 2014.

Post Prandial Hypertriglyceridemia As A Risk Factor for Macrovascular Complications In Type 2 Diabetes Mellitus

The study “postprandial hypertriglyceridemia as a risk factor for macro vascular complications in type 2 diabetes mellitus” was a case control study conducted on patients visiting the out patient department of Government Rajaji Hospital, Madurai. Sixty eight patients with type 2 diabetes mellitus and 22 healthy controls were included in the study. Selected patients and controls underwent clinical and biochemical evaluation including blood sugar, lipid profile and cardiac function to detect the presence of macro vascular complications of diabetes. Selected patients and subjects were subjected to a high fat meal and plasma triglycerides were measured two and four hours after fat challenge. It was observed that post load hypertriglyceridemia correlated better than fasting triglycerides in patients with macro vascular complications. It was also observed that persistent postprandial hypertriglyceridemia was observed in diabetic patients with complications.

What determines treatment satisfaction of patients with type 2 diabetes on insulin therapy? An observational study in eight European countries

ObjectivePatients with type 2 diabetes (T2DM) on insulin therapy are less satisfied with their diabetes treatment than those on oral hypoglycaemic therapies or lifestyle advice only. Determinants of satisfaction in...

All-cause mortality and its risk factors among type 1 and type 2 diabetes mellitus in a country facing diabetes epidemic

AimDiabetes mellitus is associated with an increased risk of premature death mainly secondary to macrovascular and microvascular complications. Mortality data from the Eastern Mediterranean region known for its high diabetes prevalence are lacking. We aimed to assess all-cause mortality and its predictors using large cohort from the Saudi National Diabetes Registry (SNDR). MethodsThe study population comprised of 40,827 individuals with type 1 and type 2 diabetes mellitus aged ⩾25years registered in SNDR between January 2007 and December 2013. All patients were followed until death, according to the date of death or reaching 100years of age or end of the study. Death was verified from the national civil affairs database. The general population during the study period was used as a reference for standardized mortality ratio (SMR) calculation. ResultsWith a total of 152,038 person-years of follow up, 2582 patients were deceased giving all-cause mortality rate of 16.98 per 1000 person-years and SMR (95% CI) of 1.93 (1.86–2.00). Mortality rates were higher among men and increased with age, while SMR attenuated with increasing age. The independent predictors for all-cause mortality were longer diabetes duration, presence of macrovascular complications, nephropathy, retinopathy, hypertension, male gender and older age, while morbid obesity and the presence of hyperlipidemia were associated with reduced risk. ConclusionsThe unexpectedly low mortality rate in this population would be associated with higher number of deaths as a result of the high prevalence of diabetes and its complications. Reducing the prevalence of diabetes and its complications would reduce the risk of mortality.

Clinical significance of barriers to blood glucose control in type 2 diabetes patients with insufficient glycemic control.

BackgroundThe purpose of this study was to assess actual barriers to blood glucose control in patients with type 2 diabetes mellitus and to investigate barrier-related factors in an exploratory manner.MethodsThis cross-sectional study assessed patients with type 2 diabetes mellitus treated as outpatients at medical institutions within Fukuoka Prefecture, Japan. Barriers to blood glucose control were examined in patients with glycated hemoglobin ≥6.9% using a nine-item questionnaire. Answers were also obtained from physicians in charge of the patients for seven of nine questions.ResultsSeven hundred and thirteen patients answered the questionnaire. Many physicians and patients described barriers that involved difficulty in complying with diet therapy. For six of the seven barriers, patient awareness was lower than physician awareness. Patient-reported lack of concern for diabetes mellitus was more prevalent among patients with macrovascular complications. Patients who reported difficulty in compliance with exercise therapy and fear of hypoglycemia were more likely to suffer from microvascular complications.ConclusionFor many of the barriers to blood glucose control, patients were less aware than physicians, suggesting that we need to take action to raise patient awareness. Of interest are the observations that the relevant barriers differed for macrovascular and microvascular complications and that the relationship between presence of macrovascular complications and lack of concern about diabetes mellitus.

Genetics of drug response in type 2 diabetes.

The introduction of several new drug groups into the treatment of type 2 diabetes in the past few decades leads to an increased requirement for an individualized treatment approach. A personalized treatment is important from the point of view of both efficacy and safety. Recent guidelines are based mainly on entirely phenotypic characteristics such as diabetes duration, presence of macrovascular complications, or risk of hypoglycemia with the use of individual drugs. So far, genetic knowledge is used to guide treatment in the monogenic forms of diabetes. With the accumulating pharmacogenetic evidence in type 2 diabetes, there are reasonable expectations that genetics might help in the adjustment of drug doses to reduce severe side effects, as well as to make better therapeutic choices among the drugs available for the treatment of diabetes.

Study the association of adiponectin with inflammation and hypercoagulability in case of type 2 diabetic subjects with renal dysfunction

AbstractAdiponectin is a 30-kDa polypeptide chiefly secreted by adipose tissue and plays a pivotal role in cardiovascular complication and kidney disease. The aim of this study was to find if there was any association of adiponectin with inflammation and hypercoagulability in case of type 2 diabetic subjects with renal dysfunction.From May 2012 to January 2014, 205 outpatients with normo, micro, and macroalbuminuria having type 2 diabetes (T2DM) were included in this study.We found a U-shaped association of adiponectin with albumin excretion. Macroalbuminuria showed a positive correlation with adiponectin (p < 0.0001). Plasma F1+2 was strongly associated with degree of renal failure (p < 0.001). CRP, IL6, TNFα, and pentosidine status showed a linear increase from normoalbuminuria and microalbuminuria to macroalbuminuria (p < 0.001, p < 0.0001).Monitoring adiponectin, pasma F1+2, inflammatory and oxidative stress markers provide a predictive value for presence of macrovascular complications in patients wit...

Abstract 17729: Cumulative Effect of Echocardiographic Markers of Elevated Left Ventricular Filling Pressure on Future Cardiovascular Events in Subjects with Diabetes

Background: Type 2 diabetes mellitus (T2DM) is a strong and independent risk factor for the development of major adverse cardiovascular events (MACE). An elevated left ventricular filling pressure (LVFP) measured by various echocardiographic (echo) parameters is associated with poor outcomes. This study investigated the cumulative effect of various echo measures of elevated LVFP and the risk of MACE. Methods: We prospectively recruited 1308 subjects (subs) (age 63.5± 11.7 years, 60% male) with T2DM attending a complications surveillance program at a single tertiary center (21 subs excluded due to inadequate echo imaging). Baseline resting echocardiogram was performed and subs were followed for a median of 4.4 years [interquartile range 3.2, 5.9]. Elevated LVFP was defined by the following echo measures: left atrial area &gt; 20cm2, peak early diastolic (dia) mitral velocity (E) to peak mitral annular velocity ratio ≥ 10, pulmonary vein (PV) peak dia velocity &gt; systolic velocity, peak PV atrial reversal &gt;35cm/s, PV atrial reversal duration minus late dia mitral inflow wave duration &gt;30msec and mitral E/A change &gt;/= 0.5 with Valsalva. The primary outcome was MACE defined as hospitalization for acute coronary syndrome, stroke or heart failure, coronary or peripheral vessel revascularization or death. Results: Over the follow-up period, 27% of subs experienced at least one MACE and 15% experienced heart failure or death. After adjusting for age, gender, presence of macrovascular complications and cardiovascular risk factors, each additional echo measure of elevated LVFP was associated with a 29% increased risk of MACE. After the same covariate adjustment, subs with &gt;3 measures of elevated LVFP had a higher hazard ratio of 2.7 (95% CI 1.9-3.8, P&lt;0.001) for MACE compared to subs with &lt;2 measures of elevated LVFP. Conclusions: Echo features of elevated LVFP predict future MACE. The presence of &gt;3 features of elevated LVFP is associated with poorer outcomes in T2DM.