Presence Of Type 2 Diabetes Mellitus Research Articles

Burden of Portal Hypertension Complications Is Greater in Liver Transplant Wait-Listed Registrants with End-Stage Liver Disease and Type 2 Diabetes.

Impact of type 2 diabetes mellitus (T2DM) in patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT) remains poorly defined. The objective of the present study is to evaluate the relationship between T2DM and clinical outcomes among patients with LT waitlist registrants. We hypothesize that the presence of T2DM will be associated with worse clinical outcomes. 593 patients adult (age 18years or older) who were registered for LT between 1/2010 and 1/2017 were included in this retrospective analysis. The impact of T2DM on liver-associated clinical events (LACE), survival, hospitalizations, need for renal replacement therapy, and likelihood of receiving LT were evaluated over a 12-month period. LACE was defined as variceal hemorrhage, hepatic encephalopathy, and ascites. Kaplan-Meier and Cox regression analysis were used to determine the association between T2DM and clinical outcomes. The baseline prevalence of T2DM was 32% (n = 191) and patients with T2DM were more likely to have esophageal varices (61% vs. 47%, p = 0.002) and history of variceal hemorrhage (23% vs. 16%, p = 0.03). The presence of T2DM was associated with increased risk of incident ascites (HR 1.91, 95% CI 1.11, 3.28, p = 0.019). Patients with T2DM were more likely to require hospitalizations (56% vs. 49%, p = 0.06), hospitalized with portal hypertension-related complications (22% vs. 14%; p = 0.026), and require renal replacement therapy during their hospitalization. Patients with T2DM were less likely to receive a LT (37% vs. 45%; p = 0.03). Regarding MELD labs, patients with T2DM had significantly lower bilirubin at each follow-up; however, no differences in INR and creatinine were noted. Patients with T2DM are at increased risk of clinical outcomes. This risk is not captured in MELD score, which may potentially negatively affect their likelihood of receiving LT.

Prediction of interactomic hub genes in PBMC cells in type 2 diabetes mellitus, dyslipidemia, and periodontitis

Background and objectiveIn recent years, the complex interplay between systemic health and oral well-being has emerged as a focal point for researchers and healthcare practitioners. Among the several important connections, the convergence of Type 2 Diabetes Mellitus (T2DM), dyslipidemia, chronic periodontitis, and peripheral blood mononuclear cells (PBMCs) is a remarkable example. These components collectively contribute to a network of interactions that extends beyond their domains, underscoring the intricate nature of human health. In the current study, bioinformatics analysis was utilized to predict the interactomic hub genes involved in type 2 diabetes mellitus (T2DM), dyslipidemia, and periodontitis and their relationships to peripheral blood mononuclear cells (PBMC) by machine learning algorithms.Materials and MethodsGene Expression Omnibus datasets were utilized to identify the genes linked to type 2 diabetes mellitus(T2DM), dyslipidemia, and Periodontitis (GSE156993).Gene Ontology (G.O.) Enrichr, Genemania, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were used for analysis for identification and functionalities of hub genes. The expression of hub D.E.G.s was confirmed, and an orange machine learning tool was used to predict the hub genes.ResultThe decision tree, AdaBoost, and Random Forest had an A.U.C. of 0.982, 1.000, and 0.991 in the R.O.C. curve. The AdaBoost model showed an accuracy of (1.000). The findings imply that the AdaBoost model showed a good predictive value and may support the clinical evaluation and assist in accurately detecting periodontitis associated with T2DM and dyslipidemia. Moreover, the genes with p-value < 0.05 and A.U.C.>0.90, which showed excellent predictive value, were thus considered hub genes.ConclusionThe hub genes and the D.E.G.s identified in the present study contribute immensely to the fundamentals of the molecular mechanisms occurring in the PBMC associated with the progression of periodontitis in the presence of T2DM and dyslipidemia. They may be considered potential biomarkers and offer novel therapeutic strategies for chronic inflammatory diseases.

Two-year results of laparoscopic sleeve gastrectomy and Roux-En-Y Gastric Bypass in patients with morbid obesity

Objective: To compare the long-term results of LSG and RYGB with a fixed restrictive component in patients with morbid obesity in terms of weight loss, control of associated diseases and the development of long-term complications, including sarcopenia.Materials and methods: our study included the results of treatment of 251 patients (153 LSG and 98 RYGB). The follow-up period was at least 24 months (median follow-up 38 months). The restrictive component was assessed 12 months after surgery using CT-volumetry. The size of the gastroenetroanastomosis was additionally measured using fibrogastroscopy in the RYGB group. The bioelectrical impedance analysis (BIA) was used to assess body composition and determine the skeletal muscle mass index (SMMI) initially and during control examinations in the postoperative period.Results: both groups obtained good results in terms of weight loss and control of associated diseases, however, RYGB shows some advantages in these parameters. On the other hand, in the RYGB group a higher rate of progression of signs of sarcopenia was detected (8.2% (including 3% of severe sarcopenia) vs 3.3% in the LSG group). Most patients who progressed to sarcopenia were older, had type 2 diabetes mellitus (T2DM), or had mild sarcopenia at baseline.Conclusions: RYGB demonstrates better results in terms of weight loss and control of associated diseases compared to LSG, however, in elderly patients, as well as in the presence of T2DM or signs of sarcopenia, it is advisable to choose operations without a pronounced malabsorptive effect.

Causal linkage between type 2 diabetes mellitus and inflammatory bowel disease: an integrated Mendelian randomization study and bioinformatics analysis.

Observational studies have indicated associations between type 2 diabetes mellitus (T2DM) and both colorectal cancer (CRC) and inflammatory bowel disease (IBD). However, the underlying causality and biological mechanisms between these associations remains unclear. We conducted a bidirectional Mendelian randomization (MR) analysis employing summary statistics from genome-wide association studies involving European individuals. The inverse variance weighting (IVW) method was the primary method used to assess causality. Additionally, we applied MR Egger, Weighted median, Simple mode, and Weighted mode to evaluate the robustness of the results. Outliers were identified and eliminated using the MR-PRESSO, while the MR-Egger intercept was used to assess the horizontal pleiotropic effects of single nucleotide polymorphisms (SNPs). The heterogeneity was evaluated using the Cochrane Q test, and sensitivity analysis was performed using leave-one-out method. The F statistic was calculated to evaluate weak instrumental variable bias. Finally, a pilot bioinformatics analysis was conducted to explore the underlying biological mechanisms between T2DM and IBD/UC. The IVW results demonstrated that T2DM significantly reduced risks of IBD (OR=0.885, 95% CI: 0.818-0.958, P=0.002) and ulcerative colitis (UC) (OR=0.887, 95% CI: 0.812-0.968, P=0.007). Although the 95% CIs of MR Egger, Weighted median, Simple mode, and Weighted mode were broad, the majority of their estimates were consistent with the direction of IVW. Despite significant heterogeneity among SNPs, no horizontal pleiotropy was observed. The leave-one-out analysis showed that the causality remained consistent after each SNP was removed, underscoring the reliability of the results. Reverse MR analysis indicated that genetic susceptibility to both CRC and IBD had no significant effect on the relative risk of T2DM. Ten hub genes were identified, which mainly enriched in pathways including maturity onset diabetes of the young, thyroid cancer, gastric acid secretion, longevity regulating pathway, melanogenesis, and pancreatic secretion. The presence of T2DM does not increase the risk of CRC or IBD. Moreover, T2DM might reduce risk of IBD, including UC. Conversely, the occurrence of CRC or IBD does not influence the risk of T2DM. The association between T2DM and IBD/UC may be related to the changes in multiple metabolic pathways and CTLA-4-mediated immune response.

Impact of type 2 diabetes mellitus on low-grade inflammation in patients with ST-elevated myocardial infarction

Chronic low-grade inflammation has emerged as a hallmark of type 2 diabetes mellitus (T2DM), contributing significantly to the pathogenesis of various cardiovascular diseases, notably ST-elevated myocardial infarction (STEMI). The intricate interplay between inflammation and cardiovascular health in the context of T2DM has been a subject of intensive research in recent years. In particular, the development of various markers of inflammation has provided valuable tools for better understanding the complex relationship between low-grade inflammation and cardiovascular disease in T2DM. Elevated levels of these markers have been consistently associated with increased cardiovascular risk in patients with T2DM, indicating their potential as prognostic indicators. The aim of the study was to investigate the potential association between type 2 diabetes mellitus and low-grade inflammation markers in patients with ST-elevated myocardial infarction through a comparative analysis of systemic immune-inflammation indices, fibronectin, and soluble suppression of tumorogenesis-2 (sST2) levels in ST-elevated myocardial infarction patients with and without type 2 diabetes mellitus. We enrolled 158 patients diagnosed with STEMI who were admitted to the Ivano-Frankivsk Regional Clinical Cardiological Center. The study population was divided into three groups: 1 – consisting of 45 patients with both STEMI and T2DM, and the 2 – consisting of 34 patients with STEMI only, T2DM only group – 69 patients, Control group – 10 healthy patients. In summary, the findings from the study provide compelling evidence to support the notion that patients who suffer from both STEM and T2DM exhibit a more robust inflammatory response and higher platelet count, compared to those with STEMI alone. These results suggest that the presence of T2DM may exacerbate the pro-inflammatory and pro-thrombotic state that is typically associated with STEMI, thereby emphasizing the critical need for early intervention to prevent or mitigate inflammation and platelet activation in this particular patient population. Type 2 diabetes mellitus patients with ST-segment elevation myocardial infarction show higher levels of inflammation markers and fibronectin, indicating greater low-grade inflammation. Elevated levels of soluble suppression of tumorigenicity 2 suggest myocardial remodeling. Targeting low-grade inflammation could be a potential therapy for STEMI in T2DM patients.

Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitus

Introduction and ObjectivesCoronary chronic total occlusions (CTOs) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). However, the indication for percutaneous coronary intervention (PCI) and its clinical benefit in these patients remain controversial. MethodsA single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020. Patients were divided into two groups according to previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality. ResultsA total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome (total symptom recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs. T2DM 21.2%, p=0.194) in a two-year follow-up. Angina recurrence was significantly more frequent in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62–2.98). Myocardial infarction and all-cause mortality were also not different between groups (T2DM 1.5%, p=0.786 and 4.5%, p=0.352, respectively, on survival analysis). Independent predictors of all-cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85–0.99 and p=0.013, HR 0.96, 95% CI 0.93–0.99, respectively). ConclusionsT2DM did not influence outcomes in CTO patients undergoing PCI, and its presence should not be a limiting factor in deciding on CTO revascularization.

Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis.

Increasingly, SGLT2 inhibitors save patients with heart failure and comorbidities such as type-2 diabetes mellitus (T2DM) and chronic kidney disease (CKD); the inhibition of sodium-glucose cotransporter 2 (SGLT2) was first studied in patients with diabetes as a solution to lower glucose levels by preventing glucose reabsorption and facilitating its elimination; in the process, researchers took notice of how SGLT2 inhibitors also seemed to have beneficial cardiovascular effects in patients with both diabetes and cardiovascular disease. Our single-center prospective study assesses outcomes of post-coronary artery bypass grafting (CABG) rehabilitation and SLGT2 inhibition in CABG patients with/without T2DM and with/without CKD. One hundred twenty consecutive patients undergoing CABG were included in the analysis. Patients were divided into four subgroups: diabetes patients with chronic kidney disease (T2DM + CKD), diabetes patients without chronic kidney disease (T2DM-CKD), prediabetes patients with chronic kidney disease (PreD+CKD), and prediabetes patients without chronic kidney disease (PreD-CKD). Echocardiographic and laboratory investigations post-surgery (phase I) and 6 months later (phase II) included markers for cardiac ischemia, glycemic status, and renal function, and metabolic equivalents were investigated. One hundred twenty patients participated, mostly men, overweight/obese, hypertensive, smokers; 65 had T2DM (18 with CKD), and 55 were prediabetic (17 with CKD). The mean ejection fraction increased by 8.43% overall but significantly more in the prediabetes group compared to the T2DM group (10.14% vs. 6.98%, p < 0.05). Overall, mean heart-type fatty-acid-binding protein (H-FABP) levels returned to normal levels, dropping from 68.40 ng/mL to 4.82 ng/mL (p = 0.000), and troponin data were more nuanced relative to an overall, strongly significant decrease of 44,458 ng/L (p = 0.000). Troponin levels in patients with CKD dropped more, both in the presence of T2DM (by 82,500 ng/L, p = 0.000) and in patients without T2DM (by 73,294 ng/L, p = 0.047). As expected, the overall glycated hemoglobin (HbA1c) levels improved significantly in those with prediabetes (from 6.54% to 5.55%, p = 0.000); on the other hand, the mean HbA1c changed from 7.06% to 6.06% (p = 0.000) in T2DM, and the presence or absence of CKD did not seem to make any difference: T2DM+CKD 7.01-6.08% (p = 0.000), T2DM-CKD 7.08-6.04% (p = 0.000), PreD+CKD 5.66-4.98% (p = 0.014), and PreD-CKD 6.03-4.94% (p = 0.00). Compared to an overall gain of 11.51, the GFRs of patients with CKD improved by 18.93 (68.15-87.07%, p = 0.000) in the presence of established diabetes and 14.89 (64.75-79.64%, p = 0.000) in the prediabetes group. Regarding the patients' cardiac statuses, the results from our single-center analysis revealed a significant decrease in ischemic risk (H-FABP and hs-cTnI levels) with improvements in mean ejection fraction, glycemic status, and renal function in patients post-CABG with/without T2DM, with/without CKD, and with SGLT2 inhibitor dapagliflozin treatment while undergoing cardiac rehabilitation.

Assessment of serum calcium, magnesium and zinc levels in patients with type 2 diabetes mellitus in the Ukrainian population

Background. The research deals with the provision of calcium, magnesium and zinc in patients with type 2 diabetes mellitus (T2DM). The purpose was to investigate the serum content of calcium, magnesium and zinc in patients with type 2 DM. Materials and methods. The open-label controlled study included 27 patients with T2DM. The control group consisted of 12 people without endocrine and somatic diseases. 70 % of patients had newly diagnosed DM; in others, the disease duration was up to 5 years. Most of the examined were of mature age, on average 61.83 ± 5.52 years for patients and 55.25 ± 5.52 years for controls. In the group with T2DM, women accounted for 62.96 %, among controls — 63.64 %. Anthropometric measurements and glucose indicators were determined according to a standard procedure. Concentrations of calcium, magnesium, zinc in serum were evaluated by atomic optical emission spectrometry with inductively coupled plasma (PerkinElmer Optima 2100 DV ICP-OES, USA) according to the original procedure approved by the Kundiiev Institute of Occupational Health of the NAMS of Ukraine. Results. The level of fasting blood sugar ranged from 7.1 to 17.2 mmol/l and indicated the presence of T2DM, glycated hemoglobin was from 7.1 to 11.2 %. According to anthropometric data, the group of patients almost completely corresponded to the control group. Although a slight increase in body weight and waist circumference was registered already at the stage of initial diabetes, the level of triglycerides increased significantly, and the level of high-density lipoprotein decreased. A significant reduction in the levels of calcium and magnesium in the blood serum of patients with T2DM was found. The zinc content was at the level of the lower edge of the reference value in 44 % of patients, in the control group — only in 16.6 % of cases. There were no significant differences in this indicator in the observation groups. A high correlation was found between the studied parameters in the blood, as well as an inverse correlation between the fasting glucose level and the content of calcium and magnesium. Conclusions. A significant decrease in the level of calcium and magnesium in the blood of Ukrainian patients with type 2 diabetes mellitus was found. There is a high correlation between serum calcium, magnesium and zinc levels in patients with T2DM. Significant risks of diabetes were revealed when the serum concentration of calcium and magnesium decreased.

Dietary Fiber Consumption and Colorectal Cancer: A Case-Control Study

Background: Colorectal cancer (CRC) is an increasingly imperative cause of morbidity and mortality. This study aimed to determine the association between dietary fiber consumption and CRC. Methods: This age- and sex-matched case-control study was conducted from July 2020 to June 2021 at the Combined Military Hospital (CMH) and the National Institute of Cancer Research and Hospital (NICRH) in Dhaka. A total of 102 cases and 102 controls were selected through purposive sampling. Cases were adult patients diagnosed with CRC, while controls were individuals without cancer. Data were collected using a pretested semistructured questionnaire and checklist, which included information on socio-demographic characteristics, colorectal cancer attributes, and dietary fiber consumption. Face-to-face interviews were conducted to collect data from both cases and controls. Results: The mean (±SD) age of the cases and controls were 44.7±13.9 years and 45.6±13.3 years, respectively, with a male-female ratio of 1:1.3 in both groups. A significantly higher proportion of cases (53.9%) lived in joint families compared to controls (39.2%) (p=0.035). Type 2 diabetes mellitus (T2DM) was significantly more prevalent in cases (27.5%) than in controls (15.7%) (p=0.041) among the comorbid conditions. Majority of the cases (72.5%) consumed low dietary fiber (&lt;25 grams/day), while three-fifths of the controls (67.6%) consumed normal to high dietary fiber daily (p&lt;0.001). After adjusting for the type of family, residence, and presence of T2DM, participants who consumed low dietary fiber were found to be 7 times more likely to develop CRC than those who consumed normal or high dietary fiber (OR=7.003, 95% CI = 3.616-13.565, p&lt;0.001) based on binary logistic regression. Conclusion: The findings of this study suggest that low dietary fiber consumption is associated with an increased risk of CRC. Specific measures that could be taken to promote a high-fiber diet include increasing awareness through public health campaigns, providing nutrition education, and ensuring that healthy food options are readily available and accessible to people from all socioeconomic backgrounds. JOPSOM 2021; 41(1):1-7

Type 2 Diabetes Comorbidity and Cognitive Decline in Patients with Alzheimer's Disease.

Although insulin dysregulation and resistance likely participate in Alzheimer's disease (AD) etiologies, little is known about the correlation between type 2 diabetes mellitus (T2DM) and the progression of cognitive decline in patients with AD. To determine whether AD patients with T2DM experience more rapid cognitive decline than those without T2DM. All cognitive performance data and the presence or absence of T2DM comorbidity in patients with AD were derived from the US National Alzheimer's Coordinating Center's (NACC) Uniform Data Set (UDS). A search of the UDS identified 3,055 participants with AD who had more than one epoch completed. The data set culled clinically diagnosed AD dementia patients who were assessed for diabetes type identified during at least 1 visit. These patients were divided into 2 groups based on whether they had a diagnosis of T2DM. The data from these groups were then analyzed for differences in cognitive decline based on neuropsychological test battery scores and a Clinician Dementia Rating using a general linear model. Comparisons of the mean scores for 16 selected tests from the neuropsychological test battery showed no significant differences in baseline scores and scores at subsequent visits between the T2DM and nondiabetic groups. The results revealed no differences in cognitive decline metrics over the course of 5 visits in either study group. These data indicate that the presence of T2DM does not increase the rate of cognitive decline in AD. This finding contradicts expected disease burden and will need to be explored further.

IMBALANCE BETWEEN OSTEOSYNTHESIS AND ENDOGENOUS CHRONIC STRESS IN PATIENTS WITH TYPE 2 DIABETES

Osteocalcin (OC) is a component of phenotypic characteristics, associated with carbohydrate and lipid metabolism. Of interest is the phenotype of type 2 diabetes mellitus (T2DM) without obesity, which may be associated with impaired levels of counter-insulin hormones.&#x0D; 87 patients with T2DM (age 40-78, females/males – 41/46) were examined. Anthropometric parameters and body composition were assessed by the bioelectrical impedance. OC, cortisol, dehydroepiandrosterone sulfate (DHEA-S) blood levels, and the ratio of cortisol/DHEA-S as indicator of the body stress resistance, were measured. Patients were divided into 4 quartiles, depending on the serum OC level, that were significantly different from each other.&#x0D; Cortisol/DHEA-S ratio was significantly different between the first (lowest OC level) and the fourth quartiles (highest OC level) and between the second, third and fourth quartiles. Visceral fat level was the highest in the first OC quartile, and the lowest in the fourth quartile. When comparing the percentage of total fat between quartiles, no significant difference was found, which may indicate the importance of visceral fat in the formation of metabolic phenotypic changes in the presence of T2DM.&#x0D; The lowest serum OC level was observed in patients with the greatest intensity of chronic endogenous stress, which is manifested by glucocorticoid function increase according to the cortisol/DHEA-S ratio. It is assumed, that local hypercorticism is the cause of stem cell differentiation into adipocytes, which leads to the formation of a diabetes phenotype with the accumulation of visceral fat without general obesity and the slowing of osteosynthesis with a decrease of the OC level.

Prognostic significance of catestatin in patients with primary hypertension and type 2 diabetes mellitus

The aim of this study was to determine predictors of cardiovascular complications of arterial hypertension (AH) and type 2 diabetes mellitus (T2DM) and investigate the prognostic potential of catestatin (CST) and relaxin-2 (RLN-2) in this patient population. Materials and methods. The research was performed in accordance with all ethical principles of the Declaration of Helsinki. All study participants signed a written informed consent. This study involved 106 patients with primary hypertension and 30 healthy volunteers. 55 hypertensive patients had comorbid T2DM. Plasma CST and RLN-2 levels were measured by an enzyme-linked immunosorbent assay. Major adverse cardiovascular events (MACE) were collected during 12-month follow-up via telephone interviews at visits in months 3, 6, 9, and 12. The end points of this study were acute myocardial infarction, ischemic stroke, acute heart failure and cardiac death. Statistical data analysis was performed using the SPSS 25.0 statistical software. Results. 13 end-points were registered in patients with AH during the 12-month follow-up period, but the difference in frequency of MACE occurrence between patients with AH and T2DM and hypertensive patients without T2DM was insignificant (p=0.181). The Cox proportional hazard model indicated CST (p=0.01), but not RLN-2 (p=0.20), as an independent predictor of MACE in hypertensive patients. Age (p=0.01), AH duration (p=0.03), presence of T2DM (p=0.03), HOMA-IR index (p=0.02), insulin (p=0.02) and uric acid levels (p=0.02) were also established as independent factors of end-points occurrence. Conclusions. CST is an independent factor for predicting cardiovascular complications of AH, which allows us to consider it as a prognostic biomarker in patients with AH, especially hypertensive patients with comorbidity T2DM

The interplay between chronic hepatitis B and diabetes mellitus: A narrative and concise review.

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder among individuals with chronic hepatitis B (CHB), contributing to additional adverse impacts on both hepatic and extrahepatic systems. Existing evidence suggests a potential positive association between CHB and the development of insulin resistance and T2DM. The presence of T2DM in CHB patients is associated with an increased risk of liver fibrosis, cirrhosis, decompensation, and hepatocellular carcinoma (HCC) occurrence. Moreover, it elevates the risk of non-liver cancers and all-cause mortality in this population. T2DM also serves as the key element in metabolic dysfunction-associated steatotic liver disease, which is prevalent in the CHB population. Although specific guidelines for managing T2DM in CHB patients have not been proposed, some studies indicated that intensive glycemic control may benefit the prognosis of these patients. Additionally, specific antidiabetic agents, such as metformin and thiazolidinediones, promise to reduce HCC risk. However, unresolved questions, including the optimal glycemic control target and the selection of antidiabetic agents for CHB patients, remain and thus warrant further investigations through well-designed prospective trials. Implementing a standardized protocol encompassing regular monitoring, risk stratification, and early intervention using a multidisciplinary framework may improve the outcomes of diabetic CHB patients.

RS3480 Polymorphism of FNDC5/Irisin Is Associated with Type 2 Diabetes Mellitus in Maya-Mestizo Women.

Objective: To investigate the possible association between rs3480 and rs16835198 of the fibronectin type III domain containing 5 (FNDC5)/Irisin and their haplotypes with the presence of type 2 diabetes mellitus (T2DM) in Maya-Mestizo women. Methods: We studied 547 postmenopausal women of Maya-Mestizo origin. The diagnosis of T2DM was based on the criteria of the American Diabetes Association. DNA was obtained from blood leukocytes. rs3480 and rs16835198 of FNDC5/Irisin were studied using real-time polymerase chain reaction allelic discrimination. Deviations from Hardy-Weinberg equilibrium and alleles differences, as well as genotype frequencies between groups, were assessed by χ2 tests. Using logistic regression analysis, the odds ratio and 95% confidence intervals were calculated to estimate the association between both polymorphisms of FNDC5/Irisin and the presence of T2DM. Pairwise linkage disequilibrium between polymorphisms was calculated by direct correlation r2, and haplotype analysis was conducted. Results: We found that the G-allele of rs3480, as well as under a dominant model, this polymorphism was significantly associated with T2DM (P = 0.028 and P = 0.003, respectively). Besides, one haplotype was associated with T2DM (P = 0.035). Conclusions: Our results suggest that the FNDC5/Irisin rs3480, and one haplotype formed by rs3480 and rs16835198 were associated with the risk of presenting T2DM in Maya-Mestizo women.

Reduced reactive hyperemia of the brachial artery in diabetic patients assessed by repeated measurements: The FMD-J B study.

Type 2 diabetes mellitus (T2DM) is a major cause of microvascular dysfunction. However, its effect on blood flow patterns during ischemic demand has not been adequately elucidated. In this study, we investigated the hypothesis that microvascular dysfunction in patients with T2DM manifests as brachial reactive hyperemia (BRH), defined as the ratio of peak blood flow velocities in a brachial artery before and after forearm cuff occlusion. The study enrolled 943 subjects (men, n = 152 [T2DM] and n = 371 [non-T2DM]; women, n = 107 [T2DM] and n = 313 [non-T2DM], respectively) with no history of cardiovascular disease. Semiautomatic measurements were obtained three times at 1.5-year intervals to confirm the reproducibility of factors involved in BRH for each sex. An age-adjusted mixed model demonstrated attenuated BRH in the presence of T2DM in both men (p = 0.022) and women (p = 0.031) throughout the study period. Post hoc analysis showed that the estimated BRH was significantly attenuated in patients with T2DM regardless of sex, except at baseline in women. In multivariate regression analysis, T2DM was a negative predictor of BRH at every measurement in men. For women, BRH was more strongly associated with alcohol consumption. Repeated measurements analysis revealed that T2DM was associated with attenuated postocclusion reactive hyperemia.

#5365 T2DM MODIFIES THE RELATIONSHIP BETWEEN CAC AND ADVERSE KIDNEY OUTCOME IN PATIENTS WITH CKD

Abstract Background and Aims Kidney function decline faster in patients with type 2 diabetes mellitus (T2DM) than in those without. We previously showed that coronary artery calcification (CAC) is a strong risk of adverse kidney outcome. Here, we examined whether T2DM could modify the relationship between CAC and the progression of chronic kidney disease (CKD). Method 2067 participants from the KoreaN Cohort Study for Outcome in Patients With CKD were enrolled. The main exposures were T2DM and CAC. The primary outcome was CKD progression defined as a composite of a 50% decline in estimated glomerular filtration rate or kidney failure with replacement therapy. Multivariable cause-specific hazard function was employed to determine the association between the main exposures and the primary outcome. Results During 8633 person-years of follow-up, the primary outcome occurred in 565 (27.3%) participants. In the multivariable cause-specific hazard model, both T2DM and CAC Agatston score (CACS) &amp;gt;0 were associated with a 1.80- and a 1.41-fold increased risk of CKD progression compared with counterparts. There was a significant interaction between T2DM and CAC for the primary outcome. In patients without T2DM, CACS &amp;gt;0 was not associated with the primary outcome compared with CACS of 0. However, in patients with T2DM, CACS &amp;gt;0 was associated with a significantly higher risk of CKD progression (adjusted hazard ratio, 2.12; 95% confidence interval, 1.64-2.75). In addition, a 1-SD increase in CACS was associated with 1.11-fold higher risk of CKD progression. Notably, this association was also significant in patients with T2DM who had CACS of 0. The slope of eGFR decline was steeper in patients with T2DM and the magnitude of decline was greater when CACS &amp;gt;0. Conclusion CAC were more strongly associated with risk of CKD progression in patients with T2DM than in those without. Thus, clinical implication of CAC may differ depending on the presence of T2DM.

Femoral bone mineral density at the time of hip fracture is higher in women with versus without type 2 diabetes mellitus: a cross-sectional study.

To compare femoral bone mineral density (BMD) levels in hip-fracture women with versus without type 2 diabetes mellitus (T2DM). We hypothesized that BMD levels could be higher in the women with T2DM than in controls and we aimed to quantify the BMD discrepancy associated with the presence of T2DM. At a median of 20days after the occurrence of an original hip fracture due to fragility we measured BMD by dual-energy x-ray absorptiometry at the non-fractured femur. We studied 751 women with subacute hip fracture. Femoral BMD was significantly higher in the 111 women with T2DM than in the 640 without diabetes: mean T-score between-group difference was 0.50, (95% CI from 0.30 to 0.69, P < 0.001). The association between the presence of T2DM and femoral BMD persisted after adjustment for age, body mass index, hip-fracture type, neurologic diseases, parathyroid hormone, 25-hydroxyvitamin D and estimated glomerular filtration rate (P < 0.001). For a woman without versus with T2DM, the adjusted odds ratio to have a femoral BMD T-score below the threshold of -2.5 was 2.13 (95% CI from 1.33 to 3.42, P = 0.002). Fragility fractures of the hip occurred in women with T2DM at a femoral BMD level higher than in control women. In the clinical assessment of fracture risk, we support the adjustment based on the 0.5 BMD T-score difference between women with and without T2DM, although further data from robust longitudinal studies is needed to validate the BMD-based adjustment of fracture risk estimation.

Association between Serum Amyloid A Levels and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

To date, consistent data have not been reported on the association between serum amyloid A (SAA) levels and type 2 diabetes mellitus (T2DM). The purpose of this study was to systematically summarize their relationship. Databases including PubMed, Cochrane Library, Embase, Web of Science, and MEDLINE were searched until August 2021. Cross-sectional and case-control studies were included. Twenty-one studies with 1,780 cases and 2,070 controls were identified. SAA levels were significantly higher in T2DM patients than in healthy groups (standardized mean difference [SMD], 0.68; 95% confidence interval [CI], 0.39 to 0.98). A subgroup analysis showed that the mean age of participants and the continent that participants were from were related to differences in SAA levels between cases and controls. Furthermore, in T2DM patients, SAA levels were positively associated with body mass index (r=0.34; 95% CI, 0.03 to 0.66), triglycerides (r=0.12; 95% CI, 0.01 to 0.24), fasting plasma glucose (r=0.26; 95% CI, 0.07 to 0.45), hemoglobin A1c (r=0.24; 95% CI, 0.16 to 0.33), homeostasis model assessment for insulin resistance (r=0.22; 95% CI, 0.10 to 0.34), C-reactive protein (r=0.77; 95% CI, 0.62 to 0.91), and interleukin-6 (r=0.42; 95% CI, 0.31 to 0.54), but negatively linked with highdensity lipoprotein cholesterol (r=-0.23; 95% CI, -0.44 to -0.03). The meta-analysis suggests that high SAA levels may be associated with the presence of T2DM, as well as lipid metabolism homeostasis and the inflammatory response.

Obesity in HFpEF with and without diabetes - Risk factor or innocent bystander?

Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear. This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM. This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM and survival was assessed. 6,744 individuals with HFpEF were included, of which 1,702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4kg/m2 vs. 27.1kg/m2, p<0.001), higher NT-proBNP values (864mg/dl vs. 724mg/dl, p<0.001) and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1-Q3: 20-80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared to those without T2DM, with a mortality rate of 39.2% and 26.7% respectively (p<0.001). In the overall cohort, using the BMI category 22.5 to 24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI <22.5kg/m2 (HR: 1.27 [CI 1.09-1.48], p=0.003) and decreased in BMI categories ≥25kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM. Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI-based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.

Bilateral carpal tunnel syndrome and motor dysfunction caused by gout and type 2 diabetes: A case report

Carpal tunnel syndrome (CTS) has been associated with gout and type 2 diabetes mellitus (T2DM). However, due to insufficient clinical understanding of gout-related CTS and reliance on the diagnostic importance of elevated serum uric acid levels, such cases are prone to missed diagnosis, misdiagnosis, and delayed treatment. In addition, the effect of T2DM on gout - induced carpal tunnel syndrome has not been reported. Herein, we present an unusual case of CTS and motor dysfunction caused by miliary tophaceous gout and T2DM. The patient presented to the hand and foot clinic with paresthesia of the fingers of both hands, especially at night. The patient was diagnosed with type 2 diabetes a month ago. Ultrasonography revealed bilateral transverse carpal ligament thickening with median nerve compression during hospitalization. The patient was successfully treated with carpal tunnel decompression and tendon release. The postoperative pathological examination revealed typical gout nodules. This case suggests that the presence of T2DM could accelerate tophi formation and worsen CTS symptoms, although no definitive proof in this regard has been described previously. Tophi formation may most likely cause the co-occurrence of CTS and flexor dysfunction in gout and incipient diabetes patients.