Presence Of T2DM Research Articles

Abstract 4138555: The ApoB/LDL-C Ratio Predicts Cardiovascular Events in Coronary Artery Disease Patients Independently of Type 2 Diabetes Status

A high ApoB/LDL-C ratio reflects small LDL particle size which like type 2 diabetes (T2DM) is associated with insulin resistance. Whether the ApoB/LDL-C ratio and the presence of T2DM are mutually independent predictors of cardiovascular events is unclear and is addressed in the present study. We enrolled a large high-risk cohort of 1200 patients with coronary artery disease. T2DM was diagnosed according to current ADA guidelines. Prospectively, cardiovascular events were recorded over a mean follow-up period of 10.5±4.9 years. At baseline, the ApoB/LDL-C ratio was significantly higher in patients with T2DM (n=422) than in subjects who did not have T2DM (0.81±0.18 vs. 0.74±0.15 p<0.001). During follow-up, 662 patients suffered cardiovascular events. The Apo B/LDL-C ratio predicted cardiovascular events in univariate analysis (HR=1.11 [1.03-1.20] p= 0.006), and the event rate was higher in patients with than in those without T2DM (62.2% vs. 52.3%; p=0.001). In a multivariate adjusted Cox regression model both the ApoB/LDL-C ratio and T2DM significantly predicted cardiovascular events in a mutually independent manner, with standardized adjusted HRs of 1.11 [1.03-1.20]; p=0.008 and 1.39 [1.18- 1.64]; p<0.001, respectively. We conclude that in subjects with coronary artery disease the ApoB/LDL-C and T2DM are mutually independent predictors of cardiovascular events.

The ApoB/LDL-C ratio predicts cardiovascular events in coronary artery disease patients independent of type 2 diabetes status

Abstract A high ApoB/LDL-C ratio reflects small LDL particle size which like type 2 diabetes (T2DM) is associated with insulin resistance. Whether the ApoB/LDL-C ratio and the presence of T2DM are mutually independent predictors of cardiovascular events is unclear and is addressed in the present study. We enrolled a large high-risk cohort of 1200 patients with coronary artery disease. T2DM was diagnosed according to current ADA guidelines. Prospectively, cardiovascular events were recorded over a mean follow-up period of 10.5±4.9 years. At baseline, the ApoB/LDL-C ratio was significantly higher in patients with T2DM (n=422) than in subjects who did not have T2DM (0.81±0.18 vs. 0.74±0.15 p<0.001). During follow-up, 662 patients suffered cardiovascular events. The Apo B/LDL-C ratio predicted cardiovascular events in univariate analysis (HR=1.11 [1.03-1.20] p= 0.006), and the event rate was higher in patients with than in those without T2DM (62.2% vs. 52.3%; p=0.001). In a multivariate adjusted Cox regression model both the ApoB/LDL-C ratio and T2DM significantly predicted cardiovascular events in a mutually independent manner, with standardized adjusted HRs of 1.11 [1.03-1.20]; p=0.008 and 1.39 [1.18- 1.64]; p<0.001, respectively. We conclude that in subjects with coronary artery disease the ApoB/LDL-C and T2DM are mutually independent predictors of cardiovascular events.

Changes in serum ghrelin and resistin levels after sleeve gastrectomy versus one anastomosis gastric bypass: prospective cohort study.

Humoral factors and neural mechanisms play a central role in the pathogenesis of obesity and in weight loss following bariatric surgery. Although various hormones and adipokines, including ghrelin and resistin, are linked to obesity, studies analyzing the changes in fasting ghrelin and resistin levels in patients following one anastomosis gastric bypass (OAGB) are lacking. The authors aimed to investigate resistin and ghrelin levels before and after two commonly used bariatric procedures with different mechanisms of action: sleeve gastrectomy (SG) and OAGB. Fasting serum ghrelin and resistin levels were evaluated by using ELISA in a nonrandomized, prospective cohort study for the pattern of changes in the preoperative period and 1 week, 1 month, 3 months and, 12 months after surgery in age and sex-matched patients with BMI ≥40kg/m 2 undergoing either SG ( n =40) or OAGB ( n =40). Their relationships with demographic parameters such as body weight, BMI, presence of T2DM, HbA 1 C, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index were also evaluated. OAGB was superior in weight control compared to the SG group. There were significant differences in resistin and ghrelin levels between the OAGB and SG groups. Ghrelin decreased more in the SG group than the preoperative values. This change in ghrelin levels was more significant at 1 year after SG [preoperative mean (range) level of 334.2 (36.6-972.1) pg/ml decreased to 84 (9.1-227) pg/ml at 1 year] whereas in the OAGB group no significant change was observed [preoperative mean (range) level of 310 (146-548) pg/ml decreased to 264 (112-418) pg/ml at 1 year]. Resistin levels decreased in both groups, especially after 3 months and onward following both operations [the mean (range) resistin levels were 2.6 (0.87-5.4) ng/ml and decreased to 1.1 (0.5-2.4) ng/ml in the SG group vs 2.48 (0.89-6.43) ng/ml decreased to 0.72 (0.35-1.8) ng/ml in OAGB group at 1 year], which was in parallel with changes in HOMA-IR index, body weight, and BMI changes at 1st year. HOMA-IR index changes were similar, but more prominent after OAGB. OAGB was als3 three months and onward), and HOMA-IR changes. This is the first study to compare fasting ghrelin and resistin levels after OAGB and SG. Although similar changes were observed, ghrelin changes were more prominent after SG, whereas resistin were observed after OAGB. OAGB was superior in T2DM control, which was in parallel with weight loss, fasting resistin levels, and HOMA-IR changes suggesting a possible effect of resistin after OAGB in glucose metabolism and insulin resistance.

Small dense low density lipoprotein predominance in patients with type 2 diabetes mellitus using Mendelian randomization.

Patients with T2DM often suffer from CVD-related complications, significantly impacting morbidity and mortality rates. The upsurge in CVD prevalence among them is partly linked to sd LDL particles. Understanding the mechanisms behind elevated sd LDL levels is critical for preventing and managing cardiovascular complications in diabetes. MR was employed to identify instrumental variables and establish causality, exploring underlying mechanisms. Notably, T2DM itself, insulin resistance, and fasting glucose seemingly do not directly impact sd LDL levels. Instead, the presence of T2DM or insulin resistance, leading to reduced HDL cholesterol or elevated TG levels, directly contributes to subsequent sd LDL increases, indicating a comprehensive mediating effect. While LDL cholesterol levels correlate positively with sd LDL, they appear unaffected by T2DM or insulin resistance. Importantly, hypertension induced by T2DM or insulin resistance exhibits a positive effect on sd LDL reversal. Unlike T2DM or insulin resistance, blood glucose levels show no significant impact on all processes. It is hoped that these insights might influence the treatment of patients with diabetes and the management of blood parameters in clinical practice. Examining the effect of T2DM or insulin resistance on sd LDL within HDL cholesterol and triglycerides pathways might provide valuable insights for targeted cardiovascular treatments. Additionally, the study's exploration of the potential positive effects of elevated blood pressure on sd LDL reversal may introduce novel considerations for blood pressure management in patients with diabetes.

Association of T-wave electrocardiogram changes and type 2 diabetes: a cross-sectional sub-analysis of the MASHAD cohort population using the Minnesota coding system

BackgroundType 2 Diabetes Mellitus (T2DM) has become a major health concern with an increasing prevalence and is now one of the leading attributable causes of death globally. T2DM and cardiovascular disease are strongly associated and T2DM is an important independent risk factor for ischemic heart disease. T-wave abnormalities (TWA) on electrocardiogram (ECG) can indicate several pathologies including ischemia. In this study, we aimed to investigate the association between T2DM and T-wave changes using the Minnesota coding system.MethodsA cross-sectional study was conducted on the MASHAD cohort study population. All participants of the cohort population were enrolled in the study. 12-lead ECG and Minnesota coding system (codes 5–1 to 5–4) were utilized for T-wave observation and interpretation. Regression models were used for the final evaluation with a level of significance being considered at p < 0.05.ResultsA total of 9035 participants aged 35–65 years old were included in the study, of whom 1273 were diabetic. The prevalence of code 5–2, 5–3, major and minor TWA were significantly higher in diabetics (p < 0.05). However, following adjustment for age, gender, and hypertension, the presence of TWAs was not significantly associated with T2DM (p > 0.05). Hypertension, age, and body mass index were significantly associated with T2DM (p < 0.05).ConclusionsAlthough some T-wave abnormalities were more frequent in diabetics, they were not statistically associated with the presence of T2DM in our study.

The impact of diabetic polyneuropathy on toe grip strength in patients with type 2 diabetes mellitus: a cross-sectional study

PurposeType 2 diabetes mellitus (T2DM) and concomitant diabetic polyneuropathy (DPN) induce muscle weakness. Muscle weakness in the foot is associated with foot deformities and falls. However, factors affecting toe grip strength (TGS) are not well known. Therefore, the present study investigated factors related to TGS in patients with T2DM.MethodsThis was a cross-sectional study involving 100 patients with T2DM who were hospitalized for the treatment of T2DM and 50 healthy adults. The subjects were divided into three groups: a group of healthy subjects, a group of T2DM patients without DPN, and a group of T2DM patients with DPN. Hierarchical multiple regression analysis was performed with TGS and the TGS-to-weight ratio (TGS/Wt%) as dependent variables and with age, the presence of T2DM, and DPN as independent variables, and sex and BMI as confounders.ResultsThere were no significant differences in age or sex among the three groups. In the final regression analysis, age and presence of T2DM and DPN were associated in both models with TGS and TGS/Wt% as dependent variables.ConclusionDPN, T2DM, and age were found to be related to TGS. The findings of this study could contribute to healthcare providers developing foot care and rehabilitation programs for diabetic patients.Trial registrationThis study was registered with UMIN-CTR (UMIN000034320) on 1 November 2018.

Blood selectin levels as a predictive factor for diabetic retinopathy and diabetic macular edema in type 2 diabetes

Background: Diabetes mellitus (DM) is still a noninfectious global pandemic. Diabetic retinopathy (DR) is one of the most common and socially significant complications of both type 1 and type 2 diabetes. Predicting the probability of DR progression and potential diabetic macular edema (DME) development is still important. Currently available predictive models include a wide number of predictors, and such predictors as blood selectin levels seem to be promising. Purpose: To determine relationships between blood levels of selectins and DR progression and DME development in patients with T2DM, and to develop particular predictive models. Material and Methods: Of the 124 patients (124 eyes) involved into this study, 95 (95 eyes) had T2DM and retinopathy (group 1 of 29 eyes with mild non-proliferative DR (NPDR); group 2 of 35 eyes with moderate or severe non-proliferative NPDR; and group 3 of 31 eyes with proliferative DR (PDR)), and 29 (29 eyes) had no diabetes (controls). Patients underwent a routine eye examination and spectral domain optical coherence tomography (SD-OCT) to determine central retinal thickness (CRT). The presence of DME was based on an increased macular thickness in the Early Treatment Diabetic Retinopathy Study (ETDRS) subfields compared to the upper limit of normal for patient's age and gender. Enzyme-linked immunosorbent assay (ELISA) kits from Invitrogen Thermo Fisher Scientific (USA) were used to determine selectin levels in blood. Statistical analyses were conducted using MedStat and MedCalc v.15.1 (MedCalc Software bvba) software. Results: There was a statistically significant tendency for an increase in progression of DR to be accompanied by an increase in blood selectin levels. In the presence of DME, blood LS levels were statistically significantly increased in mild NPDR; blood PS levels, in PDR; and blood ES levels, in all stages of DR. A regression model for predicting the progression of DR was built. In the model developed, diabetes duration and blood selectin levels were positively correlated, while HbA1c level was inversely correlated with DR progression. The model was found to be adequate R2adjust = 0.84; F = 97.9, p less 0.001, demonstrating high correlation of the selected independent variables with the stage of DR. The calculated Y index may be considered a quantitative reflection of the severity of DR. A patient is predicted to have mild NPDR (with a prediction accuracy of 86.2%) if Y less 1.5, moderate of severe NPDR (with a prediction accuracy of 88.6%) if 1.5 less equal Y less 2.35, and PDR (with a prediction accuracy of 100%) if Y more equal 2.35. A regression model for predicting the development of DME was built, with CRT and blood ES level found to increase the risk of the development of DME. A high AUC value for the ROC curve (AUC = 0.97; 95% CI, 0.92-0.99) indicated a very strong correlation of the risk of DME development with the levels of selected independent variables. In addition, sensitivity and specificity values at the optimal cut-off point were 93.2% (95% CI, 83.5%-98.1%) and 92.3% (95% CI, 83.0%-97.5%), respectively. Conclusion: Our findings confirmed the current view that high blood selectin levels are important in the presence of T2DM and related to major pathogenetic mechanisms of microvascular complications, and blood selectin levels can be considered predictors of the progression of DR as well as the development of DME.

444-P: Satisfaction with Information Regarding Pharmaceutic Therapy in Angiographied Coronary Patients with Type 2 Diabetes

Satisfaction with information regarding pharmaceutic therapy is important because it may strongly affect the appropriate use of drug therapy including medication adherence. No data on this parameter are available in the clinically important population of patients with type 2 diabetes (T2DM) undergoing coronary angiography. We therefore consecutively enrolled a cohort of 272 patients who underwent coronary angiography for the evaluation of suspected or established stable coronary artery disease (CAD) from March through December 2022. From our patients, 94 (34.4% of the total study population) had T2DM according to ADA criteria. Satisfaction with information regarding pharmaceutic therapy was measured using the validated Satisfaction with Information about Medicines Scale (SIMS-D) which consists of two sub-scales covering action and usage or potential problems, respectively. Further, health literacy, which includes the ability to understand and follow instructions for treatment was determined using the EU-HLS-Q16 questionnaire. SIMS-D questionnaires were returned by 196 (71.8%) and EU-HLS-Q16 by 229 (83.9%) patients. Median total SIMS-D scores did not differ significantly between T2DM patients and nondiabetic subjects (11, interquartile range (IQR) 9 vs. 9, IQR 8; p=0.383); independent of T2DM status patients scored significantly lower on items targeting satisfaction with information about potential problems of medication than the in sub-scales for action and usage (p&amp;lt;0.001). In analysis of covariance, health literacy independently of age and T2DM predicted SIMS-D (F=18.55; p&amp;lt;0.001). From our findings we conclude that satisfaction with information about medicines in angiographied coronary patients does not depend on the presence of T2DM but is significantly impacted by health literacy. Disclosure M. Ratz: None. J. Vogel: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. L. Sprenger: None. M. Maechler: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.

464-P: The Triglyceride–Glucose Index and Type 2 Diabetes Are Mutually Independent Predictors of Major Cardiovascular Events in Patients with Coronary Artery Disease

The triglyceride-glucose index (TyG) is a validated biomarker of insulin resistance. Its power to predict major cardiovascular events (MACE) in patients with established coronary artery disease (CAD) is unclear and is addressed in the present study. We enrolled 1032 consecutive patients with angiographically proven CAD. Prospectively, cardiovascular events were recorded over a mean follow-up period of 10.1±5.1 years. At baseline, the TyG index was significantly higher in patients with T2DM (n=346) than in nondiabetic subjects (9.3±0.7 vs. 8.7±0.5; p&amp;lt;0.001). During follow-up, 435 of our patients suffered MACE. The event rate was significantly higher in patients with T2DM than in nondiabetic subjects (48.7 vs. 39.4%; p=0.005). The TyG index in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index, and LDL cholesterol independently predicted MACE in the total study population (standardized adjusted HR 1.40 [1.20-1.65], p&amp;lt;0.001); HRs in patients with T2DM and in nondiabetic subjects were 1.51 [1.18-1.93], p=0.001 and 1.16 [0.89-1.50], p=0.271, respectively, with no evidence of an interaction between TyG and T2DM (p=0.440). With T2DM additionally entered into the regression model, TyG on tee total study population predicted MACE independently from the presence of T2DM (HR 1.32 [1.10-1.57], p=0.003) while T2DM remained independently predictive of MACE after adjustment for TyG (HR 1.29 [1.04-1.59]; p=0.020). From our data we conclude that the TyG index and T2DM are mutually independent predictors of MACE in patients with established CAD. Disclosure T. Plattner: None. A. Vonbank: None. A. Mader: None. L. Sprenger: None. M. Maechler: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None. C.H. Saely: None.

260-OR: The ApoB/LDL-C Ratio Predicts Major Cardiovascular Events in Cardiovascular Disease Patients Independent of Type 2 Diabetes Status

A high ApoB/LDL-C ratio reflects small LDL particle size which like type 2 diabetes (T2DM) is associated with insulin resistance. Whether the ApoB/LDL ratio and the presence of T2DM are mutually independent predictors of major cardiovascular events (MACE) is unclear and is addressed in the present study. We enrolled a large high risk cohort of 1689 patients with established cardiovascular disease (1391 patients with angiographically proven stable CAD and 298 patients with sonographically proven peripheral artery disease). T2DM was diagnosed according to current ADA guidelines. Prospectively, MACE including death from cardiovascular cause, non-fatal stroke and non-fatal myocardial infarction were recorded over a mean follow-up period of 9.6±5.1 years. At baseline, the ApoB/LDL-C ratio was significantly higher in patients with T2DM (n=561) than in subjects who did not have T2DM (0.82±0.19 vs. 0.74±0.15 p&amp;lt;0.001). During follow-up, 668 patients suffered MACE. The Apo B/LDL-C ratio predicted MACE in univariate analysis (HR=1.12 [1.04-1.20] p= 0.002), and the event rate was higher in patients with than in those without T2DM (49.1% vs. 34.9%; p&amp;lt;0.001). In a multivariate adjusted Cox regression model both the ApoB/LDL-C ratio and T2DM significantly predicted MACE in a mutually independent manner, with standardized adjusted HRs of 1.17 [1.05-1.30]; p=0.005 and 1.49 [1.26-1.75]; p&amp;lt;0.001, respectively. We conclude that in subjects with established cardiovascular disease the ApoB/LDL-C and T2DM are mutually independent predictors of MACE. Disclosure B.Larcher: None. C.H.Saely: None. M.Maechler: None. L.Sprenger: None. A.Mader: None. A.Vonbank: None. T.Plattner: None. A.Leiherer: None. A.Muendlein: None. H.Drexel: None.

Alzheimer's disease pathology: pathways between chronic vascular risk factors and blood-brain barrier dysfunction in a cohort of patients with different types of dementia.

Blood brain barrier (BBB) breakdown is considered a potential mechanism of dementia. The Alzheimer's disease (AD) biomarkers and vascular factors are also associated with BBB permeability. In the present study, the combination effects of neuropathological biomarkers of AD and chronic vascular risk factors for BBB were investigated. The cerebrospinal fluid (CSF)/serum albumin ratio (Qalb), an indicator of BBB permeability, was measured in a total of 95 hospitalized dementia patients. The demographics, clinical information, and laboratory tests were collected from the inpatient records. The CSF neuropathological biomarkers of AD and apolipoprotein E (APOE) genotype were also collected. The mediation analysis model was used to calculate the associations among neuropathological biomarkers of AD (mediator), the Qalb, and chronic vascular risk factors. Three types of dementia, AD (n = 52), Lewy body dementia (LBD, n = 19), and frontotemporal lobar degeneration (n = 24), were included with a mean Qalb of 7.18 (± 4.36). The Qalb was significantly higher in dementia patients with type 2 diabetes mellitus (T2DM, p = 0.004) but did not differ based on the presence of APOE ε4 allele, CMBs, or amyloid/tau/neurodegeneration (ATN) framework. The Qalb was negatively associated with the levels of Aβ1-42 (B = -20.775, p = 0.009) and Aβ1-40 (B = -305.417, p = 0.005) and positively associated with the presence of T2DM (B = 3.382, p < 0.001) and the levels of glycosylated hemoglobin (GHb, B = 1.163, p < 0.001) and fasting blood glucose (FBG, B = 1.443, p < 0.001). GHb is a direct chronic vascular risk factor for higher Qalb (total effect B = 1.135, 95% CI: 0.611-1.659, p < 0.001). Ratios of Aβ1-42/Aβ1-40 or t-tau/Aβ1-42 were mediators of the association between the Qalb and GHb; the direct effect of GHb on the Qalb was 1.178 (95% CI: 0.662-1.694, p < 0.001). Glucose exposure can directly or indirectly affect BBB integrity through Aβ and tau, indicating glucose affects BBB breakdown and glucose stability plays an important role in dementia protection and management.

The Prevalence of Diabetes Mellitus Type 2 in Severe and Very Severe Chronic Obstructive Pulmonary Disease Patients

Background: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. There is evidence to support a connection between COPD and Diabetes mellitus type 2 (T2DM). T2DM affects 2-37% of COPD patients, with results being highly variable between studies. Objective :To determine the prevalence of T2DM in patients with severe and very severe stages of COPD and to assess the risk factors affecting the prevalence of T2DM among COPD patients. Methods: A cross sectional study was conducted on 140 patients with COPD attending Outpatient and Inpatient of Respiratory Unit at Baghdad Teaching Hospital. The data were collected between the 10th of October 2016 to the 10th of August 2017. These data included demographic parameters such as: age, sex, smoking habit, and respiratory parameters from history and clinical examination. Spirometry was used to assess the severity of COPD patients. Random blood sugar testing was used for identification of COPD patients having T2DM when they are not clear or not known as a case of T2DM previously. Results: The prevalence of T2DM among COPD patients was 19.38%; the prevalence of T2DM in those with severe stage was 10.9%, while in very severe stage was 35.4%. In comparison to women, men were more likely to have T2DM.The prevalence of T2DM increased in the elderly COPD patients (&gt;61 years), with high body mass index, and also increased more among current smokers followed by former smokers and never smokers. Lung function tests decline more in COPD patients with presence of T2DM. Conclusion: T2DM is more common among COPD patients, and its prevalence rose as the severity of the COPD patients' condition worsened. Additionally, T2DM patients are more likely to experience a decline in pulmonary function. Keywords: Diabetes mellitus type 2, chronic obstructive pulmonary disease, prevalence, random blood sugar Citation: Al-Ani NAH, Al-Obaidy MW. The prevalence of diabetes mellitus type 2 in severe and very severe chronic obstructive pulmonary disease patients. Iraqi JMS. 2022; 20(2): 269-277. doi: 10.22578/IJMS.20.2.15

Circulating microRNA-126 in patients with ischemic heart disease with type 2 diabetes mellitus and its relationship with glucometabolic disorders

The aim of the study was to investigate circulating microRNA-126-3p levels and its relationships with glucometabolic indices in patients with ischemic heart disease (IHD) and type 2 diabetes mellitus (Т2DM). Materials and methods. The study included 68 patients with stable coronary artery disease (CAD) and T2DM, 25 CAD patients without diabetes and 18 healthy individuals as a control. MiRNA126-3p was determined in blood plasma by real time polymerase chain reaction. Small nuclear RNA U6 was used as an endogenous control. Results. Circulating miRNA-126-3p levels in CAD patients both with T2DM (50.32 [19.54; 93.82]) and without diabetes (109.46 [49.52; 211.11]) were higher than in the controls (17.95 [13.74; 35.01]) (P = 0.018 and P &lt; 0.001). But in patients with T2DM, miRNA126-3p level was decreased in comparison with patients without diabetes (P &lt; 0.001). In patients with T2DM, miRNA-126-3p displayed a significant negative correlation with blood glucose level (R = -0.259, P = 0.037) and was correlated negatively with glycosylated hemoglobin (R = -0.246, Р = 0.056) and insulin resistance index HOMA-IR (R = -0.229, P = 0.082) reaching boundary level of statistical significance. In diabetic patients, lower miRNA-126-3p level (the 1st tertile) was associated with a significant increase in blood glucose level and HOMA-IR in comparison with the 3rd tertile (P = 0.011 and P = 0.041). According to the ROC-analysis, the decrease in miRNA-126-3p levels was significantly associated with the presence of T2DM in patients with САD: AUC was 0.734 (95 % CI: 0.631–0.822, P &lt; 0.001). Conclusions. Circulating miRNA-126-3p levels in CAD patients both with and without T2DM were increased compared to the controls, possibly due to compensatory mechanisms. However, in patients with T2DM, miRNA-126-3p expression was significantly lower than in patients without T2DM. The lowest miRNA-126-3p level in CAD patients with T2DM was associated with the significant elevation of blood glucose level and the increase in insulin resistance. MiRNA-126-3p may serve as potential biomarker for predicting and early diagnosis of T2DM in patients with CAD.

Sex-related disparities in the incidence and outcomes of infective endocarditis according to type 2 diabetes mellitus status in Spain, 2016–2020

BackgroundWe performed a study to assess sex-differences in incidence (2016–2020), clinical characteristics, use of therapeutic procedures, and in-hospital outcomes in patients with infective endocarditis (IE) according to T2DM status.MethodsOurs was a retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of hospitalizations for IE in men and women aged ≥ 40 years with and without T2DM. Propensity score matching (PSM) and multivariable logistic regression were used to compare subgroups according to sex and the presence of T2DM.ResultsFrom 2016 to 2020, IE was coded in 9,958 patients (66.79% men). T2DM was diagnosed in 2,668 (26.79%). The incidence of IE increased significantly from 15.29 cases per 100,000 persons with T2DM in 2016 to 17.69 in 2020 (p < 0.001). However, this increment was significant only among men with T2DM (19.47 cases per 100,000 in 2016 vs. 22.84 in 2020; p = 0.003). The age-adjusted incidence of IE was significantly higher in people with T2DM (both sexes) than in those without T2DM (IRR, 2.86; 95% CI, 2.74–2.99). The incidence of IE was higher in men with T2DM than in women with T2DM (adjusted IRR, 1.85; 95% CI, 1.54–3.31). After PSM, in-hospital mortality (IHM) was higher among T2DM women than matched T2DM men (22.65% vs. 18.0%; p = 0.018).The presence of T2DM was not associated with IHM in men or women.ConclusionsT2DM is associated with a higher incidence of hospitalization for IE. Findings for T2DM patients who had experienced IE differed by sex, with higher incidence rates and lower IHM in men than in women. T2DM was not associated to IHM in IE in men or in women.

Type 2 diabetes and risk of major cardiovascular events in peripheral artery disease versus coronary artery disease patients

Background and Aims : The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. How the incidence of major cardiovascular events (MACE) compares between PAD and CAD patients when analyses are stratified by the presence of T2DM is unclear.

NASH Presence is Associated with a Lower Weight Loss One and 2 Years After Bariatric Surgery in Women with Severe Obesity

Given that obesity is a major medical problem associated with non-alcoholic fatty liver disease and the lack of studies on postsurgery weight loss according to hepatic histology, we aimed to analyse weight loss indicators according to non-alcoholic steatohepatitis (NASH) presence one and 2years postsurgery. The weight loss pattern of 410 women with severe obesity (SO) was analysed after sleeve gastrectomy (SG, n = 191) and Roux-en-Y gastric bypass (RYGB, n = 219) according to NASH presence at baseline and at 12 and 24months postsurgery. Weight loss indicators: expected BMI (eBMI), excess BMI loss percentage (%EBMIL), total weight loss percentage (%TWL) and alterable weight loss percentage (%AWL). Unlike RYGB, after SG, a higher percentage of NASH patients do not reach the eBMI 2years postsurgery. %TWL and %AWL presented no differences after RYGB despite the presence of NASH. After SG, there is a worse ponderal evolution of all indicators analysed in the presence of NASH. Unlike SG, diabetic patients lose less weight than non-diabetic patients after RYGB. The presence of NASH in diabetics had no impact on weight loss indicators, but in non-diabetics, it had an impact, particularly in the SG group. The presence of NASH suggests a worse weight loss pattern through all the analysed indicators one and 2years after SG in women. The presence of T2DM appears to result in less weight loss after RYGB, but only non-diabetic women presenting NASH lose less weight that non-diabetic women in the absence of NASH after SG.

Poor Diagnostic Efficacy of Noninvasive Tests for Advanced Fibrosis in Obese or Younger Than 60 Diabetic NAFLD patients

Serum-based noninvasive tests (NITs) have been widely used to assess liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). However, the diagnostic efficacy of NITs across ranges of age, body mass index (BMI), and presence of type 2 diabetes (T2DM) may vary and have not been well-characterized. We analyzed 1489 patients with biopsy-proven NAFLD from 6 centers in Japan, Taiwan, and Korea. Using histology as the gold standard, we compared the areas under the receiver operating characteristic (AUROCs) of Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), and the new Hepamet fibrosis score (HFS), with a focus on performance in subgroups as stratified by age, BMI, and the presence of T2DM. By histology, 44.0% of the overall cohort (655/1489) had F2-4, and 20.6% (307/1489) had F3-4 fibrosis. FIB-4 had the highest AUROCs for both F2-4 (0.701 vs NFS 0.676 and HFS 0.682, P= .001) and F3-4 (0.767 vs NFS 0.736 and HFS 0.752, P= .002). However, for F3-4 fibrosis, the AUROCs of all 3 NITs were generally higher in older (>60 years), nonobese (BMI <25 kg/m2), and non-diabetic patients, although overall the best performance was observed with FIB-4 among nonobese (BMI<25) diabetic patients (AUROC, 0.92). The worst performance was observed in younger patients with T2DM for all NITs including FIB-4 (AUROC, 0.63-0.66). FIB-4 had higher diagnostic efficacy for F3-4 than NFS or HFS, but this varied greatly by age, BMI, and T2DM, with better performance in older, nonobese, and nondiabetic patients. However, all NITs including FIB-4 had unacceptably poor performance in young or obese diabetic patients.

P240 SHORT–TERM EFFECT OF SGLT2I ON ECHOCARDIOGRAPHIC PARAMETERS IN HFREF PATIENTS TREATED WITH ARNI

Abstract Background Treatment with Sacubitril / Valsartan (ARNI) in patients with heart failure and reduced ejection fraction (HFrEF) promotes significant improvement of left ventricular remodeling along with positive outcomes in terms of hospitalization for heart failure, quality of life and mortality. In a previous study we demonstrated that ARNI significantly modifies myocardial longitudinal strain (GLS), one of the most reliable markers of myocardial contractility. It is still debated whether this effect remains unchanged regardless of the presence of diabetes and if it can be further increased by SGLT2 inhibitors, which in turn have been shown to reduce hospitalizations for heart failure and cardiovascular mortality. Purpose of this ongoing study is to measure, in HFrEF patients with or without T2DM, treated with ARNI and SGLT2i, short–term changes (6 months follow up) of the main echocardiographic parameters, including GLS Methods We enrolled 40 outpatients (32 male, age 65 + 10 years, EF 29,7 + 6,5%) on optimized medical treatment with class I medications, including ARNI at the maximum tolerated dose (starting dose 75 + 15mg, maximum titrated dose 190 + 10mg). Population was then divided into three groups: group 1 (20 pts) without T2DM; group 2 (11 pts) with T2DMI; group 3 (9 pts) with T2DM on SGLT2i treatment (4 with empaglifozin 10 mg, 5 with dapaglifozin 10 mg). No hemodynamic or metabolic complications related with therapy were observed, and no patients needed discontinuation or down–titration of therapy All patient underwent echocardiographic study at baseline and after six–month follow–up. Conclusions This ongoing study confirms that, in HFrEF patients, ARNI positively modifies left ventricular contraction and remodeling, and this effect is still verified regardless of the presence of T2DM. The association with SGLT2i, conversely, does not appear to provide further positive benefits on remodeling.

The influence of diabetes mellitus on the peri-implant microflora: A cross-sectional study

BackgroundType 2 diabetes mellitus (T2DM) is an important systemic disease, predisposing patients to inflammatory conditions including periodontitis and peri-implantitis and negatively affects dental implant success through various mechanisms. This study aimed to compare clinical and microbiological findings of individuals with dental implants with or without T2DM. MethodsA total of 82 dental implants which were in function >3 years, were involved. The participants were divided into 2 groups; T2DM (n: 45 implants) and systemically healthy controls (n:37 implants). Periodontal indexes (Bleeding on probing (BOP), plaque index (PI), pocket depth (PD), and radiographic bone loss were recorded around implants in function >3 years. Subgingival microbiological samples were also collected from the peri-implant sites. Pathogens include Fusobacterium nucleatum, Camphylobacter rectus, Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans, Treponema denticola, Prevotella intermedia, Peptostreptococcus micros, Eikinella corrodens, Prevotella nigrescens were evaluated. ResultsPeri-implant heatlh was determined in systemically healthy (54.1%) and type 2 diabetes patients (24.4%). Peri-implantitis was also evident in systemically healthy (8.1%) and T2DM (35.6%) groups. No differences was found in shallow peri-implant pockets in both groups in terms of the prevelance of all evaluated bacteria (p > 0.05). However, C. rectus, P. gingivalis, A. actinomycetemcomitans and T. forsythia were isolated more frequently in deep peri-implant pockets in systemically healthy patients compared to T2DM patients (p < 0.05). ConclusionsEvaluted periodontal pathogens may not be affected by the presence of T2DM in implants. T2DM may not significantly alter the levels of specific periodontal pathogens in shallow and deep peri-implant pockets. C. rectus, P. gingivalis, A. actinomycetemcomitans and T. forsythia may be affected by T2DM in implants in deep pockets.

Ellagic acid regulates hyperglycemic state through modulation of pancreatic IL-6 and TNF- α immunoexpression

BackgroundType 2 diabetes (T2DM) is a chronic metabolic disorder. Although therapeutic pharmaceutical agents continue to advance, herbal medicines are potential complementary treatments for the promotion of glucose homeostasis, with minimal adverse effects. Conventionally, ellagic acid (EA) has been utilized for the therapy of a range of pathologies owing to its anti-inflammatory and anti-diabetic actions. ObjectiveThe aim of this study is to determine the activity of EA on serum α-amylase and lipase titers, and on pancreatic tumor necrosis factor-α (TNF-α), proliferating cell nuclear antigen (PCNA) and interleukin-6 (IL-6) concentrations using the streptozocin-induced T2DM rodent model. MethodsEA extract synthesized from fresh strawberry fruit was employed for therapy. 50 adults male Wistar rats were randomized into either control, EA, diabetic, co-treated or post- treated cohorts. ResultsEA diminished fasting blood glucose levels, altered lipase, amylase, IL-6, PCNA and TNF- α expression and enhanced islet cell renewal, insulin, and immunoreactivities. ConclusionInflammatory indicators are elevated in the presence of T2DM. Extract of EA has overall tissue reparative and safeguarding properties, as indicated by the augmented β- cell population and enhanced glucose homeostasis. Thus, EA may be an innovative treatment approach for the maintenance of normoglycemia in individuals with T2DM.