Prognosis Of Diabetic Patients Research Articles

Relationship Between the Triglyceride-Glucose Index and Type 2 Diabetic Macroangiopathy: A Single-Center Retrospective Analysis.

The research explores the relationship between the triglyceride-glucose index (TyG index) and the macroangiopathy risk in single-center hospitalized type 2 diabetes mellitus (T2DM) patients and develops a risk prediction nomogram model. A total of 858 patients with T2DM were studied retrospectively. Lasso regression was used to eliminate unimportant factors, and multivariate logistic regression analysis was used to investigate the association between the TyG index and macrovascular disease in T2DM. A nomogram model was constructed to predict macrovascular disease in T2DM and tested using the bootstrap technique, and the efficacy of the nomogram model was investigated using ROC curves. The multivariate Cox proportional hazards model estimated the association between the TyG index and all-cause mortality. TyG index, high-density lipoprotein, red blood cell count, hypertension, history of taking ACEI/ARB drugs, and aortic calcification were closely related to macrovascular complications. In Cox proportional hazard model, the HRs of TyG index were 1.89 (95% confidence interval (CI) 1.29-2.76, p < 0.001) after adjusting for covariates. The risk of all-cause mortality in T2DM with macrovascular complications was significantly higher than in diabetic patients without vascular disease. In the ROC curve analysis, the cut-off value of the TyG index for macrovascular complications of T2DM was 9.31 (AUC: 0.702, 95% CI 0.67-0.74, p < 0.001). TyG index predicts future macrovascular disease in diabetic patients independently of known cardiovascular risk factors, suggesting that TyG index may be a useful marker for prognosis in diabetic patients.

Higher body mass index was associated with better prognosis in diabetic patients with stage II colorectal cancer

PurposeThe purpose of this study is to analyze the effect of body mass index (BMI) on patients with concurrent colorectal cancer (CRC) and type 2 diabetes mellitus (T2DM).MethodsPatients who underwent primary radical CRC surgery from Jan 2011 to Jan 2020 were retrospectively collected. The perioperative information, overall survival (OS) and disease-free survival (DFS) were compared between the higher BMI group and the lower BMI group.ResultsA total of 574 patients with concurrent CRC and T2DM were included in this study. The higher BMI group had higher portion of hypertension (p < 0.01) and coronary heart disease (CHD) (p < 0.01). Furthermore, the higher BMI group had better OS (p = 0.016) and DFS (p = 0.040) than the lower BMI group in stage II CRC. In multivariate analysis, age (OS: p = 0.002, HR = 2.016, 95% CI = 1.307–3.109/ DFS: p = 0.003, HR = 1.847, 95% CI = 1.230–2.772), TNM stage (OS: p < 0.01, HR = 1.667, 95% CI = 1.281–2.169/ DFS: p = 0.001, HR = 1.545, 95% CI = 1.207–1.977), overall complications (OS: p = 0.004, HR = 1.837, 95% CI = 1.218–2.880/ DFS: p = 0.006, HR = 1.783, 95% CI = 1.184–2.686) and major complications (OS: p = 0.005, HR = 2.819, 95% CI = 1.376–5.774/ DFS: p = 0.014, HR = 2.414, 95% CI = 1.196–4.870) were independent factors of OS and DFS. Moreover, BMI (p = 0.019, HR = 0.413, 95% CI = 0.197–0.864) was an independent factor of OS in stage II CRC.ConclusionHigher BMI was associated with better OS in diabetic patients with stage II CRC.

Herbal Supplementation to Improve Management of Diabetes Mellitus Patient Care: Current Progress

Diabetes affects millions of patients round the world, with dancing complications, inclusion, cardiovascular diseases, neuropathie and rétinopathie. Howe ver, the progression of type 2 diabetes mellites might be slowed down and its health impact limited. Nevetheless, current anti-diabetic treatments have limitations and is not Enugu to significantly improve the cardiovascular prognosis of diabetic patients. This work focus on herbal supplement and nutrition as potentiel thérapies for type 2 diabètes mellitus. Actually, Herbal and nutritional supplémentation is required in the management of diabétiques patients, a binding shared unanimously by scientists. Récent diabetologists have come to the évidence that a therapeutic supplement consisting of nutrients and herbal is necessary to optimize the treatment of diabetes. The treatment of Type 2 diabetes mellitus, winch is very often Associate with overweight, is based on hygiene and dietetic measures and, where appropriate, on taking oral antidiabetics. This review describes the therapeutic arsenal of conventionnel oral antidiabetic drugs and emphasizes on innovative therapeutic option introduction herba medicine and nutrition to the management of diabetic patients. Recent studies showed interesting potential in the reduction of blood sugar for many herbal for example Cinnamon, also berberine has been linked to the reduction of blood glucose levels, insulin levels and showed to be as effective as metformin, the most commonly prescribed drug for diabetics, at controlling blood sugar levels in diabetics. Moreover, a medicinal plant or herbal mixture can provide multi-targeted therapeutic action due to its complex chemical composition with hundreds of active ingredients such as oligosaccharides, alkaloids, polyphenols, flavonoids, tannins and at the same time ensure safety for the patients. We conclude by the fact that herbal and nutritional supplementation can bring major and promising progress in order to improve the patient care, by slowing the progression of type 2 diabetes and limiting its complications.

Hyperglycemia induces gastric carcinoma proliferation and migration via the Pin1/BRD4 pathway

Diabetes is a potential risk factor for gastric cancer (GC). Pin1, a peptidyl–prolyl cis/trans isomerase, promotes GC cell proliferation and migration. The role and underlying mechanism of the Pin1/BRD4 axis in hyperglycemia-induced proliferation and migration of GC cells were analyzed in vivo and in vitro. Proliferation and migration of GC cells were measured; Pin1 and BRD4 expression of the cell cycle were determined. Pin1 and BRD4 were downregulated by transfecting Pin1 shRNA lentivirus into GC cells and JQ1-intervention GC cells. Tumor formation and lung metastasis were assessed in vivo. Inhibition of Pin1 and BRD4 significantly suppressed high-glucose (HG)-induced GC cell proliferation and migration. HG enhanced G1/S cell-cycle transition, associated with increased Pin1 and BRD4 expression. Silencing Pin1 significantly downregulated the expression of BRD4 and NAP1L1 and upregulated that of P21 in GC cells. In vivo studies indicated that hyperglycemia promotes tumor growth and lung metastasis by inducing Pin1 and BRD4 expression. Thus, Pin1/BRD4 plays an important role in hyperglycemia-promoted tumor growth. The significance of these findings toward improved prognosis of diabetic patients with GC cannot be underestimated.

Impact of Covid-19 on diabetic adults: systematic review

Aim : to identify which complications and prognosis of diabetic patients, hospitalized, who acquired COVID-19, through a systematic review. Methods : a systematic review based on the PRISMA flowchart, including cohort studies, available in Portuguese, English, Spanish, French, and Mandarin, published from 2019 to 2020, using the PICOS strategy, in the databases: PubMed, Web of Science, Scielo, Lilacs, Scopus and Science Direct, which in addition to the inclusion criteria after questionnaires to assess methodological quality and risk of bias. Results : of the 811 articles researched, 6 were included in this research. These studies showed that patients with COVID-19 and higher DM with worse prognosis, spent more time in the ICU, constantly needed indifference, greater complications when related to other comorbidities, high mortality rate, and glycemic control associated with advanced age directly affected patients. Outcomes even of non-diabetic subjects. Conclusion : this review identified the severity of the pathophysiological association is related to older age and biochemical and inflammatory factors linked to the two pathogens and that these subjects are more prone to specialized hospital care, which, however, result in high rates of hospital mortality.

The Significance of Systemic Immune-Inflammatory Index for Mortality Prediction in Diabetic Patients Treated with Off-Pump Coronary Artery Bypass Surgery.

Diabetes mellitus (DM) represents a complex carbohydrate metabolism disorder characterized by inflammatory over-reactivity. The study aimed to investigate the potential influence of postoperative inflammatory activation on mortality risk after off-pump coronary artery bypass grafting in diabetic patients. There were 510 patients treated with off-pump coronary artery bypass grafting due to stable complex coronary artery disease, including 175 patients with type-2 DM (T2DM.) The mean follow-up time was 3.7 +/− 1.5 years with a 9% all-cause mortality rate in the diabetic group. In multivariable analysis, preoperative comorbidities (stroke, peripheral artery disease, postoperative systemic inflammatory index >952, and postoperative left ventricle ejection fraction (LVEF) < 45%) were revealed as prognostic factors. The receiver operator characteristics curve analysis for postoperative calculations of systemic immune-inflammatory index (SII) appeared significant (AUC = 0.698, p = 0.008), yielding sensitivity of 68.75% and specificity of 71.07%. Systemic immune-inflammatory index (SII) can be regarded as a predictive marker for long-term prognosis in diabetic patients after off-pump coronary artery bypass grafting. The role of perioperative inflammatory activation may play a crucial role in mortality prediction.

Poor prognosis indicators of type-2 diabetic COVID-19 patients.

Diabetes is associated with a worse prognosis and a high risk of morbidity and mortality in COVID-19 patients. We aimed to evaluate the main factors involved in the poor prognosis in diabetic patients. A total of 984 patients diagnosed with COVID-19 admitted to the hospital were included in this study. Patients were first divided into type-2 diabetic (DM+) and non-diabetic (DM–) groups. The participants were analyzed based on the National Early Warning Score (NEWS) and on the Quick-Sequential Organ Failure Assessment (qSOFA) to find the best prognostic risk score for our study. The DM+ and DM– groups were divided into non-severe and severe groups. Comparative and correlative analyses were used to identify the physiological parameters that could be employed for creating a potential risk indicator for DM+ COVID-19 patients. We found a poorer prognosis for the DM+ COVID-19 patients with a higher ICU admission rate, mechanical ventilation rate, vasopressor use, dialysis, and longer treatment times compared with the DM– group. DM+ COVID-19 patients had increased plasma glucose, lactate, age, urea, NEWS, and D-dimer levels, herein referred to as the GLAUND set, and worse prognosis and outcomes when compared with infected DM– patients. The NEWS score was a better indicator for assessing COVID-19 severity in diabetic patients than the q-SOFA score. In conclusion, diabetic COVID-19 patients should be assessed with the NEWS score and GLAUND set for determining their prognosis COVID-19 prognosis.

Abstract 9820: WATCH-DM Risk Score is Associated with Functional Capacity and Prognosis in Diabetic Patients with Heart Failure with Preserved Ejection Fraction

Introduction: The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF) is frequent and associated with a higher mortality. WATCH-DM risk score is recently developed to predict the risk of HF among patients with T2DM using a machine learning approach (Segar et al, Diabetes Care 2019). Hypothesis: We hypothesized that WATCH-DM risk score would be associated with functional capacity and clinical outcomes in diabetic patients with HF with preserved ejection fraction (HFpEF). Methods: The PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study is a multicenter registration of patients hospitalized for acute decompensated HFpEF. Among 1095 patients registered between 2016 and 2020, 418 patients (38.2%) had T2DM (male gender 49.5%, age 80±9 years, HbA1c 6.8±1.0%). WATCH-DM risk score was calculated in each patient, using BMI, age, systolic/diastolic blood pressure, serum creatinine, HDL-C, fasting plasma glucose, QRS duration, history of myocardial infarction or coronary bypass graft, and patients were divided as the low to average (≤10 points), high (11-13 points) and very high (≥14 points) risk groups. We measured 6 minute walk distance (6MWD) and NT-proBNP before discharge. We followed the study patients for median of 386 days (IQR 221 to 729 days) to observe the major adverse cardiovascular events (MACE; composite of death, heart failure hospitalization and stroke). Results: The WATCH-DM score in the study patients were 12.8±3.1 points, and 108 patients (25.8 %) had low-average, 147 patients (35.2%) high, and 163 patients (39.0%) very high HF risk. There was significant difference in 6MWD (p=0.004) among the groups, and the low-average risk group had significantly longer 6MWD than the high risk group (p=0.049). NT-proBNP was lower in the low-average risk group than in other 2 groups. Cox proportional hazard model selected the WATCH-DM score as an independent predictor for MACE (p=0.006). Kaplan-Meier curve demonstrated that patients with the low-average risk had significantly lower incidence of MACE than the others (p=0.049). Conclusions: The WATCH-DM risk score predicted functional capacity and prognosis in diabetic patients with HFpEF.

Association of diabetes mellitus with clinical outcomes in patients with different coronary artery stenosis

BackgroundIt has been demonstrated that patients with type 2 diabetes mellitus (DM) is associated with increased cardiovascular risk. However, little is known regarding the long-term prognosis in diabetic patients who experience mild-to-intermediate coronary artery stenosis (CAS). This study was to assess the clinical outcomes of diabetic patients with different severity of CAS.MethodsWe consecutively enrolled 10,940 patients hospitalized due to angina-like chest pain and followed up for major adverse cardiovascular events (MACEs) covering cardiac death, myocardial infarction, ischemic stroke, unplanned coronary revascularization and angina-related hospitalization. According to coronary angiography, patients were divided into non-obstructive CAS (NOCAS, < 50% stenosis), intermediate CAS (ICAS, 50–69% stenosis), and severe CAS (SCAS, 70–100% stenosis) subgroups, and were further categorized into six groups as NOCAS with DM and non-DM, ICAS with DM and non-DM, and SCAS with DM and non-DM.ResultsDuring a median follow-up of 40 months, 1,017 (11.1%) MACEs occurred. In patients with ICAS or SCAS, the incidence of events was higher when patients coexisted with DM (p < 0.05, respectively). In subgroup analyses, patients with ICAS and DM, SCAS and non-DM, SCAS and DM had increased risk of events [adjusted hazard ratio (HR): 1.709, 95% confidence interval (CI) 1.106–2.641, p = 0.016; HR: 1.911, 95% CI 1.460–2.501, p < 0.001; HR: 2.053, 95% CI 1.514–2.782, p < 0.001] compared to ones with NOCAS and non-DM. Besides, the Kaplan–Meier curves indicated the highest risk of MACEs in patients with SCAS and DM than others (p < 0.001).ConclusionsDiabetic patients with ICAS had the worse outcome, which was comparable to patients with SCAS alone.

Applying Logistic Regression to Predict Diabetic Nephropathy Based on Some Clinical and Paraclinical Characteristics of Type 2 Diabetic Patients

Applying Logistic Regression to Predict Diabetic Nephropathy Based on Some Clinical and Paraclinical Characteristics of Type 2 Diabetic Patients

Paradigm shift in heart failure treatment: are cardiologists ready to use gliflozins?

Despite recent advances in chronic heart failure (HF) therapy, the prognosis of HF patients remains poor, with high rates of HF rehospitalizations and death in the early months after discharge. This emphasizes the need for incorporating novel HF drugs, beyond the current approach (that of modulating the neurohumoral response). Recently, new antidiabetic oral medications (sodium-glucose cotransporter 2 inhibitors (SGLT2i)) have been shown to improve prognosis in diabetic patients with previous cardiovascular (CV) events or high CV risk profile. Data from DAPA-HF study showed that dapaglifozin is associated with a significant reduction in mortality and HF hospitalization as compared with placebo regardless of diabetes status. Recently, results from EMPEROR-Reduced HF trial were consistent with DAPA-HF trial findings, showing significant beneficial effect associated with empagliflozin use in a high-risk HF population with markedly reduced ejection fraction. Results from the HF with preserved ejection fraction trials using these same agents are eagerly awaited. This review summarizes the evidence for the use of gliflozins in HF treatment.

Cardiometabolic Therapy and Mortality in Very Old Patients With Diabetes Hospitalized due to COVID-19.

BackgroundThe effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, especially very old patients, are not well-known. This work aims to analyze the association between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, and lipid-lowering drugs) and in-hospital mortality among patients ≥80 years with type 2 diabetes mellitus hospitalized for COVID-19.MethodsWe conducted a nationwide, multicenter, observational study in patients ≥80 years with type 2 diabetes mellitus hospitalized for COVID-19 between March 1 and May 29, 2020. The primary outcome measure was in-hospital mortality. A multivariate logistic regression analysis were performed to assess the association between preadmission cardiometabolic therapy and in-hospital mortality.ResultsOf the 2,763 patients ≥80 years old hospitalized due to COVID-19, 790 (28.6%) had T2DM. Of these patients, 385 (48.7%) died during admission. On the multivariate analysis, the use of dipeptidyl peptidase-4 inhibitors (AOR 0.502, 95%CI 0.309-0.815, p=0.005) and angiotensin receptor blockers (AOR 0.454, 95%CI 0.274-0.759, p=0.003) were independent protectors against in-hospital mortality whereas the use of acetylsalicylic acid was associated with higher in-hospital mortality (AOR 1.761, 95%CI 1.092-2.842, p=0.020). Other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins showed neutral association with in-hospital mortality.ConclusionsWe found important differences between cardiometabolic drugs and in-hospital mortality in older patients with type 2 diabetes mellitus hospitalized for COVID-19. Preadmission treatment with dipeptidyl peptidase-4 inhibitors and angiotensin receptor blockers could reduce in-hospital mortality; other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins seem to have a neutral effect; and acetylsalicylic acid could be associated with excess mortality.

SGLT2 inhibitor empagliflozin monotherapy alleviates renal oxidative stress in albino Wistar diabetic rats after myocardial infarction induction

Acute kidney injury (AKI) is a sudden insult of the kidney that happens within a short period of time, which is associated with poor prognosis in diabetic patients with myocardial infarction (MI). Subclinical AKI is a condition in which tubular damage biomarkers [Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1(KIM-1)] are positive even in the absence of elevated serum creatinine. Recent studies reported that SGLT-2 inhibitors could protect against subclinical AKI in diabetic patients by elevating the level of β-Hydroxybutyric acid (βOHB). This study aims to examine the reno-protective potential of empagliflozin (EMPA) against MI associated AKI in diabetic rats. Eighty Albino Wistar rats were divided into: (1) nondiabetic sham group (CS), (2) nondiabetic + myocardial infarction group (CM), (3) diabetic + myocardial infarction group (DM) and (4) diabetic + myocardial infarction + empagliflozin group (DME). At the end of the experiment, blood samples and kidneys were collected for biochemical analysis, histopathological, and immunohistochemical studies. After induction of myocardial infarction, there was a significant decrease in serum creatinine and NGAL levels in DME. After EMPA administration, mesangial matrix index and glomerular area were lowered in DME if compared to DM group. As a marker for tubular injury, we used anti-NGAL and anti-KIM-1 immunohistochemistry. Strong positive reaction was noticed in DM group if compared to DME group which showed weak positive reaction. Levels of renal mRNAs [NGAL; KIM-1; Nox-2,4; TLR-2,4; MyD88; TNF- α and IL-1 β, 18] in DME group were reduced significantly compared to DM group. In conclusion, empagliflozin can protect against subclinical acute kidney injury in diabetic albino Wistar rats after myocardial infarction induction, which could improve the clinical outcome of SGLT-2 inhibitors in diabetic patients.

THERAPEUTIC EFFECTS OF A SODIUM GLUCOSE COTRANSPORTER 2 INHIBITOR IN DIABETIC PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: Multiple large-scale clinical trials have indicated that sodium glucose cotransporter 2 (SGLT2) inhibitors reduce the incidence of cardiovascular events, the deterioration of renal function and mortality. However, the therapeutic effects of SGLT2 inhibitors are supposed to be limited in patients with reduced renal function considering the mechanism of their action. Design and method: In this study, a SGLT2 inhibitor, ipragliflozin was given to 30 type 2 diabetic patients with nephropathy whose estimated glomerular filtration rate (eGFR) was not lower than 30 mL/min/1.73m2. The treatment was continued for 3 to 4 months and the effects on body weight, blood pressure (BP) and laboratory data including renal function, albuminuria and plasma B-type natriuretic peptide (BNP) were evaluated. Results: After 3 to 4 months, hemoglobin A1c was decreased by 0.6 % (p &lt; 0.001), body weight was reduced by 1.8 kg (p &lt; 0.01) and blood pressure was lowered by -10/-6 mmHg (p &lt; 0.001/p &lt; 0.001). This was accompanied by reductions in serum uric acid (-0.7 mg/dL, p &lt; 0.001), triglycerides (-25 mg/dL, p = 0.028) and gamma-glutamyl transferase (-8 U/L, p = 0.001). On the other hand, plasma BNP was also decreased by 12 % (p = 0.020) and urinary albumin excretion was reduced by 23 % (p = 0.018) although the eGFR was not significantly changed. It is concluded that ipragliflozin is effective in lowering blood glucose even in patients with diabetic kidney disease and is beneficial in improving accompanying obesity and hypertension. In addition, ipragliflozin is thought to have favorable influences on the metabolisms of uric acid and lipids. Conclusions: These properties of ipragliflozin is expected to bring about protective effects against the progression of nephropathy and the development of cardiovascular disease resulting in the improvement of prognosis in diabetic patients with mild to moderate chronic kidney disease.

The Association between Type-2 Diabetes Duration and Major Adverse Cardiac Events after Percutaneous Coronary Intervention

Background. Diabetes is an independent risk factor for coronary artery disease and portends adverse prognosis in diabetic patients undergoing percutaneous coronary intervention (PCI) compared to nondiabetic patients. Few studies are currently available regarding the relationship between diabetes duration and major adverse cardiac events (MACEs) post-PCI. This study is aimed at assessing the association between diabetes duration and major adverse cardiac events after PCI. Methods. A total of 302 cases of diabetic patients undergoing an elective PCI with drug-eluting stent (DES) deployment and or percutaneous transluminal coronary angioplasty (PTCA) using a drug-coated balloon (DCB) were prospectively studied. We divided patients into three groups based on diabetes duration: &lt;5 years group ( n = 165 ), 5–10 years’ group ( n = 72 ), and ≥10 years’ group ( n = 65 ). Angiographic and clinical follow-up were conducted 12 months after the procedures for all the patients and at any given time during the study when needed. Results. A significantly higher rate of myocardial infarction (MI) in diabetic patients with the longest diabetes duration (7.7% vs. 0% and 0.6%, P = 0.001 ) was observed compared with groups of shorter duration. Repeat coronary revascularization was found to be significantly higher in the &gt;10-year group than was it in groups with shorter duration of diabetes (23.1% vs. 19.4% and 9.10%, P = 0.03 ). After adjustment for confounding risk factors, longer diabetes duration remained an independent predictor of MI (hazard ratio (HR): 5.525, confidence interval (CI): 1.273-23.978, P = 0.022 ) and repeat revascularization (HR: 1.608, CI: 1.058-2.443, P = 0.026 ). Repeat revascularization was significantly related to the progression of nontreated lesions (De novo lesions 20% vs. 18% and 7.3%, P = 0.009 ) compared to previously treated lesions (target lesion revascularization (TLR) 3% vs. 1.3% and 2%, P = 0.774 ). However, all-cause mortality was not significantly different among the groups (3.1% vs. 5.6% and 0.6%, P = 0.06 , HR: 2.403, CI: 0.464-12.436, P = 0.293 ). Conclusion. Diabetes duration was associated with significant differences in major adverse cardiac events after the percutaneous coronary intervention; the longest diabetes duration portended higher rates of MACEs than shorter duration at the 12-month follow-up.

Double Regulation of Tonifying-Detoxifing on Elderly Diabetic Coronary Heart Disease After PCI

Objective to investigate the effect of Huoxue Jiedu Jiangtang Recipe (HJJR) on cardiac remodeling and function prognosis in diabetic patients complicated with coronary heart disease (CHD) after percutaneous coronary intervention (PCI), and to explore its possible mechanism. Methods 92 diabetic patients with CHD who had received PCI therapy, were equally randomized into the treatment group (46) and the control group (46) from January 2016 to August 2016. The control group were given standardized western medicine, while treatment group received HJJR besides standardized treatment. The treating course were 2 months. Before and after treatment, the left ventricular morphology index [left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular posterior wall thickness (LVPWT), left ventricular end-diastolic ventricular septal thickness (LVEST)] and the cardiac function data [stroke volume (SV), left ventricular fractional shortening (FS), the cardiac index (CI), cardiac output (CO), maximum blood flow velocity of early diastolic/ atrium late diastolic (E/A), left ventricle ejection fraction (EF)] were detected with echocardiography. The serum levels of C-reactive protein (CRP), tumor necrosis factor-a (TNF-α), interleukin-6 (IL-6) and Angiotensin II (Ang II) were tested with enzyme linked immunosorbent assay (ELISA), and the clinical efficacy and 5-year survival rate were evaluated. Results The total clinical effective rate and 5-year survival ratio in treatment group were higher than those in control group (P<0.05). Serum inflammatory mediators (CRP, IL-6, TNF-α) and Ang II decreased more than that in the control group (all P<0.05); And in treatment group, the left ventricular morphology index (LVESD, LVEDD) decreased more than that in the control group, while the cardiac function indexes (∆ FS, CO, CI, SV, LVEF, E/A) were increased more in treatment group. Conclusion HJJR can hold back the deterioration of heart restructure, improve heart function, ameliorate prognosis and prolong living in diabetic CHD after PCI, and its partial therapeutic effects might come from its reducing the level of Ang II and anti-inflammatory function.

Abstract 311: One-year Outcomes of DPP-4 Inhibitor Treatment in Diabetic Patients After Contemporary Percutaneous Coronary Intervention - Ps Matching from Data of Multicenter Registry -

Introduction: Clinical prognosis in diabetic patients comorbid with coronary artery disease (CAD) remained poor, even in the current drug-eluting stent (DES) era. However, there has been a limited evidence about the prognosis in diabetic patients with CAD who were treated with dipeptidyl peptidase-4 inhibitors (DPP4i). Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent percutaneous coronary intervention (PCI) at 12 hospitals in Japan between 2017 and 2019. Among 1,905 registered patients who were followed up, we ultimately evaluated 615 diabetic patients. They were divided into two groups depending on the prescription of DPP4i at the hospital discharge after the index PCI; DPP4i group (n=287) and Non-DPP4i group (n=328). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, acute coronary syndrome, left ventricular ejection fraction, serum creatinine, insulin use, prescriptions of statin, beta blocker, aspirin, and ACE inhibitor/ARB. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, acute coronary syndrome, stent thrombosis, hospitalization due to heart failure and ischemic stroke. Results: Overall MACCE was observed in 70 patients (11.4%) during 364 days of median observation period. In unmatched patients, Kaplan-Meier analysis showed that patients in the DPP4i group showed a significantly lower MACCE rate than those in the Non-DPP4i group (Log-rank test, p=0.009, Figure A). In 284 PS-matched patients, patients in the DPP4i group still had lower MACCE rate than those in the non-DPP4i group (hazard ratio 0.39, 95% confidence interval 0.16-0.96, p=0.034, Figure B). Conclusion: Propensity-matching analysis showed that hyperglycemia control by DPP4i was associated with better 1-year clinical outcomes in diabetic patients after PCI in the contemporary DES era.

Abstract 14068: One-year Outcomes of Dpp-4 Inhibitor Treatment in Diabetic Patients After Contemporary Percutaneous Coronary Intervention - Ps Matching From Data of Multicenter Registry -

Introduction: Clinical prognosis in diabetic patients comorbid with coronary artery disease (CAD) remained poor, even in the current drug-eluting stent (DES) era. However, there has been a limited evidence about the prognosis in diabetic patients with CAD who were treated with dipeptidyl peptidase-4 inhibitors (DPP4i). Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent percutaneous coronary intervention (PCI) at 12 hospitals in Japan between 2017 and 2019. Among 1,905 registered patients who were followed up, we ultimately evaluated 615 diabetic patients. They were divided into two groups depending on the prescription of DPP4i at the hospital discharge after the index PCI; DPP4i group (n=287) and Non-DPP4i group (n=328). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, acute coronary syndrome, left ventricular ejection fraction, serum creatinine, insulin use, prescriptions of statin, beta blocker, aspirin, and ACE inhibitor/ARB. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, acute coronary syndrome, stent thrombosis, hospitalization due to heart failure and ischemic stroke. Results: Overall MACCE was observed in 70 patients (11.4%) during 364 days of median observation period. In unmatched patients, Kaplan-Meier analysis showed that patients in the DPP4i group showed a significantly lower MACCE rate than those in the Non-DPP4i group (Log-rank test, p=0.009, Figure A). In 284 PS-matched patients, patients in the DPP4i group still had lower MACCE rate than those in the non-DPP4i group (hazard ratio 0.39, 95% confidence interval 0.16-0.96, p=0.034, Figure B). Conclusion: Propensity-matching analysis showed that hyperglycemia control by DPP4i was associated with better 1-year clinical outcomes in diabetic patients after PCI in the contemporary DES era.

Abstract 16507: Complex Percutaneous Coronary Intervention Features Worsen Prognosis in Diabetic Patients: Insights From a Large Single-center Registry

Introduction: Despite the increasing number of complex percutaneous coronary interventions (CPCI), data regarding outcomes following CPCI in patients with diabetes mellitus (DM) are scarce. Hypothesis: Compared to the general population, diabetic patients undergoing CPCI have worse prognosis. Methods: We analyzed data of patients who underwent PCI in a tertiary-care center between 2009 and 2017. Patients were divided into 2 groups (CPCI and non-CPCI) stratified by presence of DM. CPCI was defined as having ≥1 of the following: stent length &gt;60 mm, ≥3 stents implanted, ≥3 lesions, ≥3 target vessels, bifurcation with ≥2 stents, or chronic total occlusion. The main outcome was major adverse cardiac events (MACE), a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR) at 1 year. Results: Out of 20,412 patients included, 5,038 (24.7%) underwent CPCI. Patients with DM constituted 46.5% (n=9,494) of the overall cohort and 44.5% (n=2,240) of CPCI group. Among patients undergoing CPCI, diabetics were younger, more likely to be female, and had more cardiovascular risk factors (kidney disease, dyslipidemia, and hypertension) than non-diabetics. In addition, diabetic patients had more advanced coronary disease (multivessel disease, high syntax score, and longer lesion length). At 1 year, diabetic patients had higher risk of MACE than non-diabetic, regardless of PCI complexity ( Figure 1 ). Nonetheless, there was a significant interaction between CPCI and diabetes in terms of mortality at 1 year (p-interaction=0.009). In contrast, compared to non-diabetics, a higher risk of TVR ( adj HR 1.49, 95% CI [1.24 - 1.78], p &lt;0.001) and bleeding ( adj HR 1.45, 95% CI [1.05 - 1.98], p=0.02) was observed in diabetics undergoing non-CPCI but not CPCI. Conclusion: Diabetic patients are at higher risk of MACE than the general population regardless of PCI complexity. Yet, 1-year mortality is substantially higher in diabetics undergoing CPCI than non-CPCI.

Clinical Features and Hearing Outcomes of Sudden Sensorineural Hearing Loss in Diabetic Patients.

Background and ObjectivesThis study aimed to evaluate the clinical features and the clinical factors associated with prognosis of sudden sensorineural hearing loss (SSNHL) in diabetic patients.Subjects and MethodsForty-nine diabetic with unilateral SSNHL were retrospectively included. All patients received systemic high dose steroid therapy within one month after onset and had more than one month of follow-up audiogram. The basic characteristics of the patients, initial and follow-up audiograms, laboratory data, and methods of steroid treatment were collected.ResultsCompared to reference values in healthy subjects, 79%, 55%, and 45% of the patients had higher values of mean neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR), respectively. Older patients had significantly less degree of hearing loss, but they also had significantly worse hearing thresholds in the unaffected ear. After steroid treatment, less than half patients (47%) showed hearing recovery. Simultaneous intratympanic dexamethasone (ITD) injections with systemic steroid did not confer an additional hearing gain or an earlier recovery rate in diabetic patients with SSNHL. In the multivariate analysis, initial hearing thresholds of affected ear and timing of steroid treatment were significantly associated with hearing prognosis in diabetic patients with SSNHL.ConclusionsDiabetic patients with SSNHL tended to have increased NLR, LMR, and PLR, which are reported to be associated with microvascular angiopathy. Simultaneous ITD injections to improve hearing recovery in diabetic patients with SSNHL seems unnecessary.