Prevalence Of Microvascular Complications Research Articles

Glycaemic control and microvascular complications among paediatric type 2 diabetes mellitus patients in Hong Kong at 2 years after diagnosis.

Type 2 diabetes mellitus (T2DM) is becoming increasingly common among children and adolescents worldwide, including those in Hong Kong. This study analysed the characteristics and prevalence of microvascular complications among paediatric T2DM patients in Hong Kong at diagnosis and 2 years after diagnosis. All patients aged <18 years who had been diagnosed with DM at public hospitals in Hong Kong were recruited into the Hong Kong Childhood Diabetes Registry. Data collected at diagnosis and 2 years after diagnosis were retrospectively retrieved from the Registry for patients diagnosed from 2014 to 2018. Median haemoglobin A1c (HbA1c) levels were 7.5% (n=203) at diagnosis and 6.5% (n=135) 2 years after diagnosis; 59.3% of patients achieved optimal glycaemic control (HbA1c level <7%) at 2 years. A higher HbA1c level at diagnosis was associated with worse glycaemic control at 2 years (correlation coefficient=0.39; P<0.001). The presence of dyslipidaemia (adjusted odds ratio [aOR]=3.19; P=0.033) and fatty liver (aOR=2.50; P=0.021) at 2 years were associated with suboptimal glycaemic control. Diabetic neuropathy and retinopathy were rare in our cohort, but 18.6% of patients developed microalbuminuria (MA) within 2 years after diagnosis. Patients with MA had a higher HbA1c level at 2 years (median: 7.2% vs 6.4%; P=0.037). Hypertension was a risk factor for MA at 2 years, independent of glycaemic control (aOR=4.61; P=0.008). These results highlight the importance of early diagnosis and holistic management (including co-morbidity management) for paediatric T2DM patients.

Hypomagnesemia in Patients with Type 2 Diabetes Mellitus.

Recent research has shown that low serum levels of magnesium are often linked to both microvascular and macrovascular complications in individuals with diabetes mellitus. Hence, monitoring of serum magnesium levels is needed in diabetic patients. Furthermore, the addition of magnesium through supplementation may present a novel therapeutic strategy for mitigating vascular complications in individuals with diabetes. To assess the prevalence of hypomagnesemia in type 2 diabetes mellitus patients and to assess the association between hypomagnesemia and microvascular complications of diabetes mellitus in a tertiary care hospital in North Kerala. An analytical cross-sectional study was conducted at a tertiary care hospital involving 230 diabetic patients receiving outpatient and inpatient care in the Department of Internal Medicine at Government Medical College, Kozhikode, Kerala. The study took place from January 2018 to December 2018, during which serum magnesium levels were assessed and analyzed in relation to the patients' microvascular complications and glycemic control. We observed that 19.13% of the participants had hypomagnesemia. This condition was found to be more common among older individuals with diabetes, as indicated by a p-value of 0.022. However, there were no significant differences in serum magnesium levels based on gender (p-value 0.18), body mass index (BMI) (p-value 0.223), or the duration of diabetes (p-value 0.36). The prevalence of diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy was higher in diabetics with hypomagnesemia than their counterparts with normal magnesium, with a p-value of 0.001, 0.001, and 0.001, respectively. There was a significant negative correlation obtained between serum magnesium and glycated hemoglobin (HbA1C) values (Pearson coefficient = -0.240 and p-value = <0.01) and fasting blood sugar (FBS) values (Pearson coefficient = -0.265 and p-value = <0.01). Hypomagnesemia is negatively correlated with HbA1C and FBS but not related to duration of diabetes and gender. The prevalence of microvascular complications was higher among the diabetics with hypomagnesemia.

The association of chronic complications with time in tight range and time in range in people with type 1 diabetes: a retrospective cross-sectional real-world study.

The aim of this study was to evaluate the association of chronic complications with time in tight range (TITR: 3.9-7.8 mmol/l) and time in range (TIR: 3.9-10.0 mmol/l) in people with type 1 diabetes. The prevalence of microvascular complications (diabetic retinopathy, diabetic nephropathy and diabetic peripheral neuropathy [DPN]) and macrovascular complications according to sensor-measured TITR/TIR was analysed cross-sectionally in 808 adults with type 1 diabetes. Binary logistic regression was used to evaluate the association between TITR/TIR and the presence of complications without adjustment, with adjustment for HbA1c, and with adjustment for HbA1c and other confounding factors (sex, age, diabetes duration, BMI, BP, lipid profile, smoking, and use of statins and renin-angiotensin-aldosterone system inhibitors). The mean TITR and TIR were 33.9 ± 12.8% and 52.5 ± 15.0%, respectively. Overall, 46.0% had any microvascular complication (34.5% diabetic retinopathy, 23.8% diabetic nephropathy, 16.0% DPN) and 16.3% suffered from any macrovascular complication. The prevalence of any microvascular complication, diabetic retinopathy, diabetic nephropathy and a cerebrovascular accident (CVA) decreased with increasing TITR/TIR quartiles (all ptrend<0.05). Each 10% increase in TITR was associated with a lower incidence of any microvascular complication (OR 0.762; 95% CI 0.679, 0.855; p<0.001), diabetic retinopathy (OR 0.757; 95% CI 0.670, 0.856; p<0.001), background diabetic retinopathy (OR 0.760; 95% CI 0.655, 0.882; p<0.001), severe diabetic retinopathy (OR 0.854; 95% CI 0.731, 0.998; p=0.048), diabetic nephropathy (OR 0.799; 95% CI 0.699, 0.915; p<0.001), DPN (OR 0.837; 95% CI 0.717, 0.977; p=0.026) and CVA (OR 0.651; 95% CI 0.470, 0.902; p=0.010). The independent association of TITR with any microvascular complication (OR 0.867; 95% CI 0.762, 0.988; p=0.032), diabetic retinopathy (OR 0.837; 95% CI 0.731, 0.959; p=0.010), background diabetic retinopathy (OR 0.831; 95% CI 0.705, 0.979; p=0.027) and CVA (OR 0.619; 95% CI 0.426, 0.899; p=0.012) persisted after adjustment for HbA1c. Similar results were obtained when controlling for HbA1c and other confounding factors. TITR and TIR are inversely associated with the presence of microvascular complications and CVA in people with type 1 diabetes. Although this study was not designed to establish a causal relationship, this analysis adds validity to the use of TITR and TIR as key measures in glycaemic management. ClinicalTrials.gov NCT02601729 and NCT02898714.

Prevalence of Microvascular Complications and Associated Risk Factors among Diabetes Mellitus Patients Attending Nyeri County Referral Hospital, Kenya: A Cross-Sectional Study

Prevalence of Microvascular Complications and Associated Risk Factors among Diabetes Mellitus Patients Attending Nyeri County Referral Hospital, Kenya: A Cross-Sectional Study

Relationship between dietary patterns and diabetic microvascular complications in patients with type 2 diabetes mellitus.

This study aimed to investigate the relationship between different dietary patterns and diabetic microvascular complications in patients with type 2 diabetes mellitus. This study was conducted based on the Chinese Chronic Disease and its Risk Factor Surveillance System. A multi-stage stratified sampling method was used to randomly select two districts (Henghualing District, Taiyuan City, and Yuzi District, Jinzhong City) and two counties (Huguan County, Changzhi City, and Jiang County, Yuncheng City) from the chronic disease surveillance sites in Shanxi Province to collect general information, dietary records, physical measurements, and laboratory tests. In total, 1,227 patients were enrolled according to the study criteria. Factor analysis was performed to construct six dietary patterns, and the relationship between dietary pattern scores and type 2 diabetic microvascular complications was analysed using binary logistic regression after correcting for confounders. (1) Regarding the prevalence of type 2 diabetic microvascular complications and dietary characteristics, the prevalence of microvascular complications in patients with type 2 diabetes mellitus was 55.3% and was higher in urban than in rural areas. The prevalence of diabetic kidney disease (DKD), diabetic retinopathy, and diabetic peripheral neuropathy (DPN) were 21.4%, 12.7%, and 38.0%, respectively. (2) Six dietary patterns were constructed, namely, 'animal protein', 'coarse grains and plant protein', 'nuts and fruits', 'refined grains and vegetables', 'dairy', and 'added sugars', with factor contributions of 15.42%, 9.99%, 8.23%, 8.16%, 7.56%, and 7.28% respectively, explaining 56.64% of the total dietary variation. (3) After adjusting for confounding variables, the results of binary logistic regression indicated that patients in the highest quartile of dietary pattern scores for 'nuts and fruits' experienced a 43.3% lower risk of DKD compared to those in the lowest quartile [odds ratio (OR) = 0.567; 95% confidence interval (CI), 0.359-0.894; p < 0.001]. Similarly, patients in the highest quartile of dietary pattern scores for 'animal protein' had a 42.8% lower risk of DPN compared with those in the lowest quartile (OR = 0.572; 95% CI, 0.388-0.843; p < 0.05). The results of this study suggest that in patients with type 2 diabetes mellitus, a 'nuts and fruits' dietary pattern reduces the risk of DKD and an 'animal protein' dietary pattern reduces the risk of DPN.

Metabolic Syndrome in Type 2 Diabetes Mellitus Patients: Prevalence, Risk Factors, and Associated Microvascular Complications.

Background The chronic macro and microvascular complications of diabetes mellitus pose serious health challenges. Metabolic syndrome (MetSy) is characterized by central obesity, glucose intolerance, hyperinsulinemia, low high-density lipoproteins (HDLs), high triglycerides (TGs), and hypertension. MetSy precedes or accompanies diabetes, and it has been linked to an increased risk of cardiovascular disease and premature death. This study aimed to estimate prevalence, identify risk factors, and evaluate associated microvascular complications among MetSy patients with type 2 diabetes mellitus (T2DM). Methodology Over the period of March 20, 2022, to March 31, 2023, a prospective cohort study was conducted at the Outdoor Clinic and Medicine Department of Sheikh Zayed Hospital, Rahim Yar Khan. Based on the International Diabetes Federation MetSy criteria, a total of 160 patients fulfilling the inclusion criteria were selected. A special proforma was used to obtain sociodemographic, clinical, and laboratory variables of MetSy in diabetic participants. Blood pressure and anthropometric measurements such as waist circumference (WC) and body mass index (BMI) were measured. Fasting venous blood was collected to analyze biochemical variables such as fasting blood sugar (FBS), TG, and high-density lipoprotein-cholesterol (HDL-C). The microvascular complications of T2DM were established using fundus ophthalmoscopy and neurological and kidney function assessments with the help oflaboratory tests. These variables were matched between MetSy and no MetSy groups along with the presence or absence of diabetes microvascular complications. This information was analyzed based on these assessments and patient interviews. Results Of the 160 T2DM patients, the mean age was 52 years with a predominance of females (51.8%) in the 50-59-year age group (56.8%). The average BMI for females was 29.38 ± 0.54 kg/m², and 32 (20%) had obesity. Females exhibited a large WC of 93.52 ± 1.58 cm, and 48 of 83 females had reported diabetes microvascular complications. A significant p-value was observed for hypertension, high TG, low HDL-C, large WC, obesity, BMI, age, and female gender on comparing diabetics with metabolic syndrome (MetSy+) and those without metabolic syndrome (MetSy-). The prevalence of microvascular complications in T2DM patients with MetSy+ was 52.5% compared with 47.5% in MetSy-. The prevalence of diabetic retinopathy was 24.9% (95% confidence interval (CI) = 20.3%-29.6%), nephropathy was 16.8% (95% CI = 12.8%-20.7%), and neuropathy was 10.8% (95% CI = 7.4%-13.3%). Conclusions The prevalence of MetSy observed among T2DM patients was 65%, with married obese females in the 50-59-year age group being more likely to be affected than males. Hypertension, poor glycemic control, high TG, low HDL-C, and greater anthropometric waist measurements and BMI were additional risk factors that tended to increase the MetSy burden in T2DM. Diabetic retinopathy, nephropathy, and neuropathy were the most prevalent microvascular complications of diabetes, and immediate attention is needed to stop their detrimental effects. Longer uncontrolled diabetes, increasing age, and hypertension were independent predictors of microvascular complications. To further reduce the risks of complications that threaten healthy aging and prognosis for these patients, MetSy screening, health education, and better diabetic management are crucial.

Control and complications of diabetes in urban primary care units in Thailand: a cross-sectional study

BackgroundPrimary health care system plays a central role in caring for persons with diabetes. Thai National Health Examination Survey (NHES) reports that only 40% of patients with type 2 diabetes mellitus (T2DM) achieve optimal glycemic control. We sought to evaluate the quality of diabetic care (QOC), prevalence of microvascular complications, and associated risk factors among T2DM patients treated at primary care units in urban areas in Thailand.MethodsA population-based, cross-sectional study of 488 T2DM patients aged over 35 years from 25 primary care units in Samutsakhon, Thailand was conducted during February 2018 to March 2019. Clinical targets of care (TOC) and processes of care (POC) were measured to evaluate QOC. Multivariate logistic regression models were applied to explore the association between risk factors and glycemic control.Results41.2% of women and 44.4% of men achieved hemoglobin A1C (A1C) < 53 mmol/mol, while 31.3% of women and 29.7% of men had poor glycemic control (A1C > 63 mmol/mol). 39 participants (8%) achieved all TOC and 318 participants (65.2%) achieved all POC. Significant risk factors for poor glycemic control included diabetes duration > 6 years (AOR = 1.83, 95% CI = 1.20–2.79), being overweight (AOR = 2.54, 95% CI = 1.58–4.08), obesity (AOR = 1.71, 95% CI = 1.05–2.89), triglycerides > 1.7 mmol/l (AOR = 1.81, 95% CI = 1.25–2.78), low density lipoprotein-cholesterol (LDL-C) ≥ 2.6 mmol/l (AOR = 1.55, 95% CI = 1.04–2.28). On the other hand, participants aged > 65 years (AOR = 0.25, 95% CI = 0.14–0.55) or achieved TOC indicators (AOR = 0.69, 95% CI = 0.43–0.89) were significantly associated with glycemic control. Diabetic retinopathy was significantly related to obesity (AOR = 2.21, 95% CI = 1.00–4.86), over waist circumference (AOR = 2.23, 95% CI = 0.77–2.31), and diastolic blood pressure > 90 mmHg (AOR = 1.81, 95% CI = 1.48–1.96).ConclusionAccess to essential diabetic screening in primary care units is crucial to determine status of disease control and guide disease management. Duration of T2DM, high body mass index, triglyceride and LDL-C were independently associated with poor glycemic control. Obesity was highly associated with diabetes retinopathy. Effort should be taken seriously toward monitoring these factors and providing effective care.

Trends in glycemic control, cardiovascular risk factors and chronic complications of type 2 diabetes, 2012–2016, in a healthcare area of Barcelona

AimsThis study aimed to analyse the evolution of the metabolic control, cardiovascular risk factors and chronic complications in a Type 2 Diabetes (T2D) population in a healthcare area of Barcelona. MethodsWe carried out a comparative study of T2D patients (20.457) between 2012 and 2016 (data recorded in the “Electronic Clinical-Station in Primary Care”) concerning: age, gender, body mass index (BMI), arterial blood pressure (BP), HbA1c, LDL-Cholesterol, smoking, heart failure (HF), micro and macrovascular complications. ResultsAverage HbA1c was 6.9 % in 2012 and 7 % in 2016 (Non significant differences)(NS). In 2012, 57.9 % of patients presented proper glycaemic control, 42.8 % LDL-Cholesterol < 100 mg/dL and 76.9 % BP < 140/90 while in 2016 it was 61.2 % (NS), 59.2 % (p = 0.001) and 82.9 % (p = 0.016) respectively. No changes were found in BMI or active smoking. Significant increases were found in the prevalence of microvascular complications, HF and peripheral vasculopathy (PV). Patients with vascular diseases (PVD) and adequate metabolic control increased from 57.5 % to 62.7 % (p = 0.006). Albuminuria > 30 mg/g were more frequent among PVD. ConclusionsBetween 2012 and 2016 it was observed that, amongst our study population, glycaemic control was steady and cholesterol and BP levels were improved, while there was a significant increase of diabetic complications, HF and PV.

133-LB: Relationship of HbA1c and Glucose by Ethnicity in UK Biobank

The UK Biobank recruited 502,481 people aged 40 to 70 years who were invited to participate by post so not necessarily representative of the general population. The 405,363 participants with random glucose, HbA1c and the necessary demographic/clinical data were aged 56.5 (8.09) years, mean SD, with 54% female, and ethnicity 95.0% White W, 1.9 South Asian SA, 1.3% Black B, 0.9% Other O, 0.6% Mixed Background MB, and 0.3% Chinese C. Glucose was measured by hexokinase and HbA1c by BioRad VARIANT II TURBO analysers, reference range 20-42 mmol/mol in a dedicated central laboratory. Cohen's D statistic was used to compare glucose/HbA1c by ethnicity versus the largest group W. Mean glucose ranged from 5.04 to 5.41 mmol/L with HbA1c40.7 mmol/mol for SAversus36.0 for W (D=0.78 medium effect M) , B 39.3 (D=0.51 M) , O 38.4 (D=0.37 small S) , C 37.1 (D=0.17 very small V) &amp; MB 36.6 (D=0.09 V) , all p values &amp;lt;0.001. There were large differences by ethnicity in linear regression slopes for the glucose/HbA1c relationship when compared to W with correlation coefficient comparison Z-statistics for SA 16.74, B 8.69, O 10.94, C 8.96, all p&amp;lt;0.001, except for MB 2.56, p=0.01. Such ethnic differences in HbA1c have been reported previously and questions raised as whether different cut-offs should be used for diagnosis of diabetes. However, more information on the prevalence of microvascular complications and differences in haematological profiles is required for such modifications. Disclosure J. A. Williams: None. S. E. Manley: n / a. A. Karwath: None. R. A. Round: None. I. M. Stratton: None. S. Ghosh: Other Relationship; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk. S. Mostafa: None. G. Roberts: None. J. Webber: None. G. Gkoutos: None. Funding Medical Research Council (MR/S003991/1) , MRC HDR UK (HDRUK/CFC/01) , NIHR Birmingham ECMC, NIHR Birmingham SRMRC, Nanocommons H2020-EU (731032) , MAESTRIA (965286)

Predictors of blood glucose change and microvascular complications of type 2 diabetes mellitus patients in Felege Hiwot and Debre Markos referral hospital, North West Ethiopia

BackgroundMicrovascular complications lead to disability, dependency, and accelerated morbidity and mortality. This study aimed to identify predictors of blood glucose change and time to microvascular complications among patients with type 2 diabetes.MethodsA retrospective cohort study was conducted among type 2 diabetes mellitus patients enrolled between December 2014 and December 2015 at Felege Hiwot and Debre Markos Referral Hospital. A total of 318 T2DM patients were included in the study. Joint modelling of longitudinal and survival analysis was employed to identify predictors of Blood Glucose Change and Microvascular Complications in Type 2 Diabetes Mellitus Patients.ResultsThe prevalence of microvascular complications in Type 2 diabetes patients was 26.3%, 95%confidence interval(CI):(21.5, 31.1). Of which, half of the patients developed a microvascular complication after 30 months from the onset of the follow-up. The significant predictors of developing microvascular complication were positive proteinurea (adjusted hazard ratio (AHR) = 1.418, 95%CI: 1.080, 1.861), Serum creatinine (AHR = 3.704, 95%CI: 1.992, 6.887), Weight (AHR = 1.058, 95%CI: 1.023, 1.094), and log fasting blood glucose(log(FBS))(AHR = 1.013, 95%CI: 1.010, 1.015). The predictors of fasting blood glucose progression were higher baseline FBS(est(estimate) = 0.002,95%CI:0.0018, 0.0022), Systolic blood pressure (SBP) (est = 0.003, 95%CI: 0.002, 0.004), diastolic blood pressure (DBP) (est = 0.002, 95%CI: 0.0002, 0.004), and age (est = 0.003, 95%CI: 0.001, 0.004).ConclusionThe progression of the fasting blood glucose level for rural patients was faster than for urban patients. Patients having higher baseline FBS, previous hypertension history, higher SBP, higher DBP, older age, and fewer visits to the hospital have a relatively more progressive change in blood sugar levels. Patients having higher triglyceride levels, positive proteinuria, higher fasting blood sugar, higher weight, and a lesser number of hospital visits have a higher risk of developing a complication. In response to this finding, an aggressive intervention that targets to prevent microvascular complications is required.

A Case of Gilbert Syndrome and Uncontrolled Diabetes Mellitus with Elevated HbA1C Improved with Individualized Homeopathic Medicine

Diabetes mellitus is one of the most common metabolic disorders in the present era from altered lifestyle. Glycosylated hemoglobin (HbA1C) is the most reliable blood parameter for diagnosis and prognosis of diabetes mellitus. Gilbert syndrome in diabetic patients lowers the prevalence of microvascular complications of diabetes mellitus. Even though Gilbert syndrome is a fortunate factor in this patient, progressive weight loss is the raising concern. From proteolysis and diuresis, kidneys can get damaged in course of time. Uncontrolled HbA1C again can increase the risk of complications of diabetes mellitus. In this case, HbA1C and weight loss with diabetes mellitus improved with an individualized homeopathic approach. Natrum Muriaticum was selected on a constitutional basis, and it was administered on an LM scale which helped the patient in bringing down blood parameters and managing weight loss of Diabetes.

Circulating GPIHBP1 levels and microvascular complications in patients with type 2 diabetes: A cross-sectional study

Glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1 (GPIHBP1) plays a crucial role in lipolytic processing. Previous studies have shown that GPIHBP1 mutations cause severe hypertriglyceridemia and that serum GPIHBP1 levels are marginally higher in patients with coronary heart disease; however, the role of GPIHBP1 in type 2 diabetes mellitus (T2DM) remains unknown. We investigated the association between circulating GPIHBP1 levels and the prevalence of microvascular complications in T2DM. A total of 237 subjects with T2DM and 235 non-diabetic control subjects were enrolled in this study. Their serum GPIHBP1 levels were evaluated using ELISA assays. Circulating GPIHBP1 levels were higher in patients with T2DM (952.7 pg/mL [761.3-1234.6], p < 0.0001) than in non-diabetic subjects (700.6 [570.8-829.6]), but did not differ in T2DM patients with or without hypertriglyceridemia. Serum GPIHBP1 levels were significantly higher in patients with T2DM with diabetic retinopathy (DR), diabetic nephropathy (DN), and microvascular complications than in those without these complications. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses revealed that the presence of microvascular complications, but not macrovascular complications, was independently associated with serum GPIHBP1 levels, which could predict the presence of diabetic microvascular complications. Elevated GPIHBP1 levels are associated with microvascular complications in T2DM and may help to predict their progression.

Prevalence of Microvascular Complications in Adolescents and Adults with Type 1 Diabetes

Objective: The aim of this work was to study the prevalence of microvascular complications in type 1 diabetes among the young adolescents and adults of Ahmedabad, Gujarat. Materials and Methods: This descriptive study was carried out at the diabetes care center from August 1, 2020 to March 31, 2021 by setting the inclusion criteria of patients with type 1 diabetes who had a history of at least 5 years or more and all adolescents and young adults who visited the clinic and who were willingly prepared to undergo for fundoscopy. Patients recently detected with type 1 diabetes and patients with previous retinal examination report and other forms of diabetes were excluded from the study. A total of 530 patients visited the clinic during this screening period, of which 125 patients took part in the screening. Microvascular complications screening consisted of fundoscopy and urine examination for microalbuminuria. Results: Of 125, 10 patients (8%) had diabetic retinopathy and 27 patients (21.6%) showed the presence of albumin in urine. The overall prevalence of microvascular complications was 29.6%. There were five patients with a positive history of both microvascular complications. The mean duration of diabetes was 19.6 years and the mean average glucose levels were 8.5% and 8.8%, respectively. Conclusion: We conclude that despite the higher glycemic values the chances of development of complications are negligible during the initial course of type 1 diabetes. With an increase in the duration of diabetes, the prevalence of complications is observed more. Hence, in addition to constant high glycemic values, the course of the disease is also a major responsible factor.

RANTES 59029A/G Polymorphisms Associated with Diabetic Compilations in Korean Patients with Type 2 Diabetes for over 15 Years.

Background: Polymorphisms in the RANTES gene are known to be associated with several diseases related to insulin resistance. In this study, we investigated the association between RANTES 59029A/G polymorphisms and the prevalence of diabetic complications relative to obesity in Korean patients who had type 2 diabetes (T2D) for over 15 years. Methods: A single-center, retrospective case-control study was performed. We included 271 patients with a duration of diabetes greater than 15 years. Polymerase chain reaction-restriction fragment length polymorphism was used to analyze RANTES polymorphisms, identifying genotypes as GG, AG, or AA. Obesity was defined using the body mass index with a cutoff value of 25 kg/m2. Both microvascular (retinopathy and nephropathy) and macrovascular (coronary artery disease and cerebrovascular disease) complications were evaluated. Results: The duration of T2D and hemoglobin A1c values at enrollment were 24.4 ± 5.0 years and 7.8 ± 1.6%, respectively, in the non-obese group, and 25.4 ± 6.1 years and 7.7 ± 1.7%, respectively, in the obese group. The prevalence of microvascular complications was significantly higher in the obese group compared with that in the non-obese group (83.5% vs. 72.0%, p = 0.039). Compared to the non-obese group, the obese group showed a higher proportion of the patients with AA or AG genotypes (64.3% vs. 84.5%, p = 0.001). Conclusions: The A allele of the RANTES gene is associated with obesity and may affect diabetic microvascular complications in patients with T2D for over 15 years.

Novel clusters of type 2 diabetes mellitus and their outcomes: relationship between pharmacological treatment and microvascular complications

Abstract Background Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes in adults being characterized by an ineffective use of insulin or inefficient production by the pancreas. This study aims to study the relationship between microvascular complications and pharmacological treatment for T2DM. Methods 191 participants (EG) with T2DM with the average of 70.3 years (SD = 8.3) and 36 with pre-diabetes (CG) with an average of 62 years (SD = 10.3) who participated in clinical trials at Clinical Research Unit in Cardiology of Coimbra Hospital and Universitary Centre without cognitive difficulties, were divided in 5 different clusters. These were established based on six different variables: body mass index (BMI), age of each individual, age at diagnosis of DMT2, glycated haemoglobin value (HbA1c), homeostatic model that estimates the function of β cells (HOMA2-B) and insulin resistance (HOMA2-IR). Results Cluster 1 presented pre-diabetic individuals (15.9%), while diabetic individuals were divided into clusters 2 (1.8%), 3 (17.6%), 4 (21.1%) and 5 (43.6%). Regarding the study of the prevalence of microvascular complications, it was concluded that only chronic kidney disease (CKD) was found in most different groups. For the prevalence of pharmacological treatment for DMT2, it was found that metformin was the most used drug. It was observed a relationship between previous CKD and metformin administration in clusters 3 (P = 0.0012; P &amp;lt; 0.05), 4 (P = 9.41E-5; P &amp;lt; 0.05) and 5 (P = 0.0004; P &amp;lt; 0.05). Conclusions It was possible to observe the existence of dependency relationships between pharmacological treatment and different microvascular complications for DMT2.

155-OR: Diabetes Complications and Cognitive Function in Youth with Type 1 and Type 2 Diabetes: The SEARCH for Diabetes in Youth Study

Both type 1 (T1D) and type 2 diabetes (T2D) impart significant risk for cognitive dysfunction. Adults experiencing diabetes-related complications in particular, have pronounced cognitive deficits. It is unknown whether multiple diabetes complications co-occur with cognitive dysfunction, specifically in youth-onset T1D and T2D. Using data from the SEARCH for Diabetes in Youth cohort study, we examined clustering of diabetes type, complications, and performance on cognitive tests in young adults with youth-onset T1D or T2D. Cognition was assessed via the NIH Toolbox Cognition Battery and age-corrected scores for composite fluid cognition were used. Diabetes complications included retinopathy, microalbuminuria, arterial stiffness, peripheral neuropathy, and cardiac autonomic neuropathy (CAN). Hierarchical clustering was applied with 795 participants (T1D=635; T2D=160). Three clusters emerged. Cluster 1 (C1; n=154) had the lowest composite fluid cognition scores, compared with Clusters 2 (C2; n=603) and 3 (C3; n=38) (mean [SD] 84.3 [17.7], 96.9 [15.7], 97.3 [16.2]; p&amp;lt;0.001). Compared with C2/C3, participants in C1 were predominantly young adults with T2D (79% vs. 4.6% and 28.9%, respectively; p&amp;lt;0.001), with higher prevalence of microvascular complications including, peripheral neuropathy (24% vs. 6.1% and 15.8%; p&amp;lt;0.001), retinopathy (24% vs. 12.3% and 13.2%; p=0.001), and microalbuminuria (24.7% vs. 6.5% and 10.5%; p&amp;lt;0.001). Compared with C1/C3, participants in C2 were predominantly young adults with T1D (95.4% vs. 21.4% and 71.1%; p&amp;lt;0.001). Compared with C1/C2, C3 was unique, with all participants having CAN (100% vs. 1.3% and 0%; p&amp;lt;0.001) and the highest average composite fluid cognition scores. Our data suggest that co-occurrence of microvascular complications coincide with worse cognitive function, especially in youth-onset T2D. Further research would be valuable to explore the relationship between CAN and cognitive performance. Disclosure A. Shapiro: None. S. M. Marcovina: None. A. D. Liese: None. A. K. Mottl: Advisory Panel; Self; Bayer U. S. E. T. Jensen: None. G. Wilkening: None. A. Bellatorre: None. D. Dabelea: None. J. M. Stafford: None. R. Dagostino: Consultant; Self; AstraZeneca, Biogen, Daiichi Sankyo. A. S. Shah: None. E. M. Urbina: None. C. E. Barrett: None. C. Pihoker: None. Funding Centers for Disease Control and Prevention (00097, DP-05-069, DP-10-001, 1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); National Institute of Diabetes and Digestive and Kidney Diseases (1UC4DK108173); Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01DP000246, U18DP002714); University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01DP000247, U18DP000247-06A1); Cincinnati’s Children’s Hospital Medical Center (U18DP006134, U48/CCU519239, U01DP000248, 1U18DP002709); University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01DP000254, U18DP002708); Seattle Children’s Hospital (U18DP006136, U58/CCU019235-4, U01DP000244, U18DP002710-01); Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01DP000250, 200-2010-35171)

577-P: Complexity of Antidiabetic Medication Regimen Is Associated with Increased Diabetes-Related Distress in Patients with Type 2 Diabetes

Objective: Diabetes-related distress is present in a high proportion of people with type 2 diabetes mellitus (T2DM). We hypothesized that complexity of the antidiabetic medication regimen is a factor that increases diabetes-related distress. Research Design and Methods: We studied 74 consecutive patients with T2DM managed at a tertiary care center. Patients were screened for diabetes-related distress using the Diabetes Distress Scale-2 (DDS-2). A Diabetes Medication Complexity Scoring (DMCS) system was developed to objectively assess the diabetes medication complexity. Based on DMCS, participants were categorized into one of three groups: low (n = 26), moderate (n = 22) and high (n = 26) medication complexity. Results: The prevalence of diabetes-related distress (DDS-2 ≥6) was 34.6% in the low, 36.4% in the moderate, and 69.2% in the high complexity groups (χ2(2) = 7.75, p= 0.021). Complexity groups were similar on sociodemographic characteristics, diabetes duration, BMI and blood pressure as well as the prevalence of hypertension, hyperlipidemia and hypoglycemic episodes over the last year (ps&amp;gt;0.05). The prevalence of microvascular complications varied as a function of low (28%), moderate (45%), and high (76%) regimen complexity (χ2(2) = 11.8, p = 0.003). One-way ANOVA showed significant complexity group differences for HbA1c (F(2,70) = 5.47, p = 0.006) with higher HbA1c in the high and moderate complexity groups than in the low group. Analysis of covariance adjusting for HbA1c showed that DDS-2 significantly differed as a function of complexity group (F (2,69) = 3.93, p = .024). The model explained 16.2% of the variance in DDS-2 (R2 = 0.162). Post hoc analyses revealed that diabetes-related distress was significantly greater for the high (DDS-2 = 6.6) complexity group compared to the moderate complexity group (DDS-2 = 4.5) (p = .031). Conclusions: A complex antidiabetic medication regimen is associated with high levels of diabetes distress. Disclosure M. Luzuriaga: None. R. Leite: None. H. Ahmed: None. P. G. Saab: None. R. Garg: None.

Einsch\xe4tzungen zur Pr\xe4valenz mikrovaskul\xe4rer Folgeerkrankungen bei Diabetes mellitus in Deutschland. Analyse von Versichertendaten aller gesetzlichen Krankenkassen f\xfcr die Jahre 2012 und 2013

ZusammenfassungHintergrundDatengrundlagen für systematische, fortlaufende Analysen zur Häufigkeit mikrovaskulärer Komplikationen von Diabetes mellitus in Deutschland sind bislang nur begrenzt vorhanden. Erstmals wurde geprüft, ob Versichertendaten aller gesetzlichen Krankenversicherungen (GKV) nach Datentransparenzverordnung hierfür geeignet sind.MethodeAnalysiert wurden die GKV-Versichertendaten der Berichtsjahre 2012 und 2013. Die Bezugspopulation wurde identifiziert: Versicherte mit Diabetes, definiert als Dokumentation mindestens zweier ambulanter oder einer stationären Diabetesdiagnose gemäß der Internationalen Klassifikation der Krankheiten (ICD-Codes E10–E14). Komplikationen wurden anhand folgender ICD-Codes definiert: Nephropathie (N08.3), Retinopathie (H36.0), Polyneuropathie (G63.2), diabetisches Fußsyndrom (DFS; E10-14.74, E10-14.75), chronische Niereninsuffizienz (N18.-) und Dialysebehandlung (Z49.1, Z49.2, Z99.2). Die Ergebnisse wurden mit Prävalenzschätzungen aus Routine- und Registerdaten in Deutschland und im Ausland verglichen.ErgebnisseIm Jahr 2013 wurde für 6,6 Mio. GKV-Versicherte ein Diabetes dokumentiert (2012: 6,5 Mio.). Die chronische Niereninsuffizienz stellte die häufigste Komplikation im Jahr 2013 dar (15,0 %), gefolgt von diabetischer Polyneuropathie (13,5 %), Nephropathie (7,6 %), Retinopathie (7,0 %), DFS (6,1 %) und Dialysebehandlung (0,56 %). Während Ergebnisse zu diabetischer Retinopathie, Nephropathie und Polyneuropathie im Vergleich zu anderen Prävalenzschätzungen für Personen mit Typ-2-Diabetes niedriger ausfielen, sind diese zu Niereninsuffizienz, Dialysebehandlung und DFS vergleichbar.SchlussfolgerungVerstetigte Analysen der GKV-Daten sind von hohem Wert für die Diabetes-Surveillance, erfordern jedoch vertiefende Analysen zur Überprüfung und Vereinheitlichung von Falldefinitionen und Dokumentationsverhalten.

1514-P: Suboptimal Glycemic Control and High Prevalence of Diabetes Complications in Adults with Type 1 Diabetes (T1D) in the SAGE Study

Poor glycemic control is a risk factor for many diabetes-related complications, but global real-world data on diabetes management in adults with T1D is limited. SAGE was a multinational, observational, cross-sectional study to describe glycemic control of participants aged ≥26 years with T1D for ≥1 year. Of 3858 participants from 17 countries, 54.6% were female, with mean (standard deviation [SD]) age 47.4 (14.0) years, T1D duration 20.7 (12.6) years, and age at T1D onset 26.7 (14.4) years. Childhood-onset T1D was most common (48%) in the 26-44 years age group. Mean (SD) HbA1c was 7.95 (1.42) % (63.4 [15.6] mmol/mol), and similar across predefined age groups (Table). Only 20.9% of participants reached their individualized HbA1c target. Prevalence of microvascular complications was 36-63%, increasing with age and duration of diabetes. Incidence of diabetic ketoacidosis was similar in all age groups and consistent with previous reports. SAGE shows that the prevalence of microvascular complications remains high, affecting over half of the study population aged ≥65 years, and is more prevalent in those with a longer duration of diabetes. Disclosure E. Renard: Board Member; Self; Abbott, Insulet Corporation, Novo Nordisk A/S, Roche Diabetes Care. Consultant; Self; Air Liquide, Eli Lilly and Company, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. Z. Bosnyak: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. F. Lauand: Employee; Self; Sanofi. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi. H. Ikegami: None. J. Kesavadev: Speaker’s Bureau; Self; Biocon, Novo Nordisk Inc., Sanofi-Aventis. A.G. Vianna: Board Member; Self; Abbott, Medtronic, Novo Nordisk A/S. Research Support; Self; Sanofi. Speaker’s Bureau; Self; Lilly Diabetes. Funding Sanofi

Micro Vascular Complications and Associated Factors Among Type Two Diabetic Patients in Adigrat and Wkuro General Hospitals, Northern Ethiopia: A Retrospective Cross-Sectional Study

Background: Diabetes mellitus is the primary reason of death in developed countries and becoming an epidemic with serious complications in developing countries. Therefore, the aim of this study was to assess micro vascular complications and associated factors among type two diabetic patients in Adigrat and wkuro general hospitals, Northern Ethiopia. Methods: An institutional based retrospective cross-sectional study design with record review of 420 diabetic patients was conducted at Adigrat and wkuro general hospitals from April –June/2019. Simple random sampling technique was used. Binary and multivariable logistic regression analysis were used to see the association of independent variables to the outcome variable at a P<0.05. Results: A total of 420 study participants were included in the study. The prevalence of micro vascular complications of type two diabetic patients was 19.5%. The predictor variables for micro vascular complications were sex [AOR (95%CI): 0.44(0.25, 0.77)], systolic blood pressure >140mmhg [AOR (95%CI): 6.9(1.71, 27.71)], LDL-C >100 mg/dl [AOR (95%CI): 3.7(2.002, 6.76)], positive protein urea [AOR (95%CI): 3.2(1.74, 5.99)] and TGL>150 mg/dl [AOR (95%CI): 2.2(1.04, 4.58)]. Conclusion: The prevalence of micro vascular complications was burden of public health. The health care providers should be control the identified factors through effective interventions.