Risk Factor For Macrovascular Complications Research Articles

Changes in smoking status, amount of smoking and their relation to the risk of microvascular complications in men with diabetes mellitus.

Smoking is a definite risk factor for macrovascular complications in diabetes mellitus (DM). However, the effect of smoking on microvascular complications is inconclusive. Study participants were 26,673 diabetic men who received health check-up both in 2003-2004 and 2009, excluding women. Assessing smoking status (never, quitting and current) at 2003-2004 and 2009, changes in smoking status were categorised into 7 groups (never - never, never - quitting, never - current, quitting-quitting, quitting-current, current-quitting and current-current). Smoking amount was categorised into never, light (0-10 pack years), moderate (10-20 pack years), and heavy smoking (>20 pack years) based on 2009 data. They were followed-up until 2013 to identify incident microvascular complications. We calculated the adjusted hazard ratios (HR) and 95% confidence interval (CI) (adjusted HR [95% CI]) for incident microvascular complications according to changes in smoking status and smoking amount. Current-quitting (1.271 [1.050-1.538]), current-current (1.243 [1.070-1.444]) and heavy smoking (1.238 [1.078-1.422]) were associated with an increased risk of overall microvascular complications. The risk of nephropathy increased in current-current smoking (1.429 [1.098-1.860]) and heavy smoking (1.357 [1.061-1.734]). An increased risk of neuropathy was observed in current-quitting smoking (1.360 [1.076-1.719]), current-current smoking (1.237 [1.025-1.492]) and heavy smoking (1.246 [1.048-1.481]). However, we couldn't see the interpretable findings for the association between smoking and retinopathy. Lasting and heavy smoking increases the risk of microvascular complications, including nephropathy and neuropathy. Quitting smoking and reducing smoking amount are imperative in preventing microvascular complications in DM patients.

277-LB: Weight Cycling Is Associated with ICU Admission and Mechanical Ventilation in Adults with Diabetes Hospitalized with COVID-19

Weight variability in diabetes is an emerging risk factor for macrovascular complications and mortality, potentially via increased inflammation. We examined the impact of pre-admission weight cycling (WC) on COVID-19-related outcomes, including in-hospital mortality, ICU admission, and mechanical ventilation (MV), using a large multicenter cohort. This study included 277 adults with diabetes hospitalized with COVID-19 (March 2020-February 2021) at 5 university hospitals in the eastern US (COVIDEastDM Consortium) with body weight measurements at 0, 6, and 12 months before admission. Weight change was considered significant if it exceeded 5% in each 6-month interval. The cohort was grouped into four weight categories: unchanged (n=57; reference group), weight loss (WL; n=88), weight gain (WG; n=50) and WC (n=32), and was 54.6% male, 58.6% White, 24.2% Black, 18.5% Hispanic, with mean (SD) age 65.1 (12.6) years and HbA1c 7.7 (2.0)%. During hospitalization, 41.9% subjects were admitted to the ICU, 25.1% received MV, and 15.0% died. Age was the strongest risk factor for mortality (OR = 1.08 [95% CI: 1.03-1.13), and the presence of pre-existing comorbidity for both ICU admission (OR = 2.58 [1.13-5.90]) and MV (OR = 3.89 [1.30-11.64]). In an adjusted model, WC, but not WL or WG, was associated with ICU admission (OR = 3.09 [1.11-8.59]) and MV ((OR = 4.59 [1.48-14.19]), but not with mortality (OR = 3.19 [0.76-13.32]). The glycemic gap, shown previously to be associated with increased MV and mortality, did not change the relationship between WC and outcomes. The WC group trended toward higher peak ESR (94.3±23.1 ml/h vs. 62.2±33.5 ml/h, P=0.044) and hsCRP levels (150.0±133.9 mg/L vs. 104.1±105.3 mg/L, P=0.142). Conclusion: Weight cycling is associated with ICU admission and mechanical ventilation in adults with diabetes and COVID-19. Our findings identify a unique vulnerability of individuals with diabetes and recent weight cycling. Disclosure Y. Kang: None. R. S. Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc. M. E. Mcdonnell: None. D. C. Simonson: Stock/Shareholder; Phase V Technologies, Inc., GI Windows. A. S. Chaugule: None. R. K. Garg: None. G. Gopalakrishnan: Research Support; Spruce Biosciences, Sparrow Pharmaceuticals Inc, Medtronic. K. Howard: None. J. Lebastchi: None. J. Mitri: Other Relationship; Novo Nordisk, Research Support; Kowa Company, Ltd. N. E. Palermo: Research Support; Dexcom, Inc.

Influence of hepatitis B virus on the prevalence of diabetes complications in patients with type2 diabetes.

Diabetes and hepatitis B are both global problems. The influence of diabetes on complications and prognosis of hepatitis B has been widely studied. However, the association between hepatitis B virus (HBV) infection and the prevalence of diabetes-related complications is less documented and is uncertain. This was a retrospective study. We collected information from a large clinical database. A total of 1,090 Chinese inpatients with type 2 diabetes were included. The participants were divided into two groups, including 135 patients with HBV infection and 955 patients without HBV infection. Patients with HBV infection were younger and had worse control of blood glucose than those without HBV infection. No significant difference was found in the prevalence of diabetic retinopathy, neuropathy, nephropathy, diabetic ketosis or diabetic ketoacidosis between the patients with HBV infection and the patients without HBV infection. The prevalence of macrovascular complications was 54.1% and 64.4% in diabetes patients complicated with HBV infection and without HBV infection, respectively. The P-value was <0.05. However, through the logistic regression analysis, we found HBV infection was not an independent risk factor for macrovascular complications of diabetes. There was no significant correlation between the prevalence of macrovascular complications, microvascular complications of diabetes, diabetic ketosis or diabetic ketoacidosis and HBV infection status.

Combined evaluation of arterial stiffness, glycemic control and hypertension for macrovascular complications in type 2 diabetes

BackgroundArterial stiffness, glycemic control and blood pressure are risk factors of macrovascular complications in type 2 diabetes. This study aimed to investigate the combined association of arterial stiffness, glycemic control and hypertension status with the occurrence of diabetic macrovascular complication.MethodsA total of 1870 patients of diabetes were enrolled from Beijing Health Management Cohort between 2008 and 2018 as baseline, and then followed for macrovascular complication onset. We proposed a composite risk score (0–4) by arterial stiffness severity, pool glycemic control and hypertension status. Cox model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).ResultsThe mean age (SD) of this population was 59.90 (12.29) years. During a median follow-up of 4.0 years, 359 (19.2%) patients developed macrovascular complication. Compared to the normal arterial stiffness and good glycemic control group, patients with severe arterial stiffness and pool glycemic control had the highest risk of macrovascular complications (HR: 2.73; 95% CI: 1.42–5.25). Similarly, those of severe arterial stiffness and hypertension had the highest risk (HR: 2.69; 95% CI: 1.61–4.50). Patients of the composite score > 2 had a significantly increased risk of macrovascular complication.ConclusionThis study suggested the clinical importance of combined evaluation of arterial stiffness, glycemic control and hypertension status for the risk stratification and management of macrovascular complication of type 2 diabetes.

Prevalence of long-term complications in inpatients with diabetes mellitus in China: a nationwide tertiary hospital-based study.

IntroductionThere is absence of national data to estimate the prevalence of long-term diabetic complications among inpatients with diabetes in tertiary hospitals in China.Research design and methodsUsing the national Hospital Quality Monitoring System database, inpatients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) were identified by the International Classification of Diseases-10 code, and the temporal trends of microvascular and macrovascular complications 2013–2017 were calculated, and then the risk factors were analysed by multivariate regression analysis.ResultsA total of 92 413 inpatients with T1DM and 6 094 038 inpatients with T2DM were identified in 2013–2017. The proportions of inpatients with microvascular complications in inpatients with T1DM and T2DM increased from 29.9% and 19.0% in 2013 to 31.6% and 21.0% in 2017, respectively. The proportions of inpatients with macrovascular complications in inpatients with T1DM and T2DM increased from 7.3% and 14.5% in 2013 to 13.2% and 18.4% in 2017, respectively. Hypertension and hyperlipidemia were risk factors for both microvascular and macrovascular complications. Among inpatients with T1DM, the adjusted ORs of microvascular complications increased in 40–49 age group and Northeast region, while older age, male and North region were risks factor for macrovascular complications. Among inpatients with T2DM, the ORs of microvascular complications increased in 40–49 age group, female, urban and North region, while older age, male, urban and Southwest region were risks factor for macrovascular complications.ConclusionsThe proportions of long-term complications of inpatients with diabetes in China increased in 2013–2017. Efforts are needed to improve the management of patients with diabetes in China.

Overt hypogonadism is a cardiovascular risk factor in type 2 diabetic males: An observational study.

We aimed to evaluate the effects of hypogonadism on metabolic and chronic complications in type 2 diabetic males. 261 nonobese males with type 2 diabetes aged 18-70 were involved in the study. Hypononadal males were divided into 2 groups as overt hypogonadism (total testosterone≤230ng/dl) and borderline hypogonadism (230-345ng/dl). The control group involved eugonadal diabetic males. Micro-macrovascular complications were recorded. 101 patients had hypogonadism (38.7%), and 160 patients were eugonadal (61.3%). Microvascular complication rate was not different, but macrovascular complication rate was significantly higher in hypogonadal males (42.6%/31.3%, p=0.042). Optimal glycosylated haemoglobin (HbA1c) achievement(<7%) was significantly lower in hypogonadal patients (20.8%/31.3%, p=0.043). Poor glycaemic control (HbA1c≥7%), presence of microvascular complication and increased triglyceride levels were independent risk factors for hypogonadism (OR: 1.5, p=0.044;OR:3.89,p=0.025 and OR: 1.0, p=0.016 respectively). Overt hypogonadism, hypertension, hypercholesterolaemia and severe hypoglycaemia were independent risk factors for macrovascular complications (OR: 1.0, p=0.027; OR:2.6, p=0.002; OR: 1.8, p=0.047 and OR: 1.0, p=0.007 respectively), diabetes duration (≥5years) and poor glycaemic control for microvascular complication (OR: 1.0, p=0.031 and OR:2.0, p=0.028). As a result, hypogonadism is frequent among diabetic males and poor glycaemic control may be an important contributing factor. Furthermore overt hypogonadism is an important cardiovascular risk marker. Therefore, ensuring eugonadism in diabetic patients may positively affect both glycaemic control and complications.

Relationship Between Time in Range, Glycemic Variability, HbA1c, and Complications in Adults With Type 1 Diabetes Mellitus.

Real-time continuous glucose monitoring (RT-CGM) provides information on glycemic variability (GV), time in range (TIR), and guidance to avoid hypoglycemia, thereby complimenting HbA1c for diabetes management. We investigated whether GV and TIR were independently associated with chronic and acute diabetes complications. Between September 2014 and January 2017, 515 subjects with type 1 diabetes using sensor-augmented pump therapy were followed for 24 months. The link between baseline HbA1c and CGM-derived glucometrics (TIR [70-180 mg/dL], coefficient of variation [CV], and SD) obtained from the first 2 weeks of RT-CGM use and the presence of complications was investigated. Complications were defined as: composite microvascular complications (presence of neuropathy, retinopathy, or nephropathy), macrovascular complications, and hospitalization for hypoglycemia and/or ketoacidosis. Individuals with microvascular complications were older (P < 0.001), had a longer diabetes duration (P < 0.001), a higher HbA1c (7.8 ± 0.9 vs 7.5 ± 0.9%, P < 0.001), and spent less time in range (60.4 ± 12.2 vs 63.9 ± 13.8%, P = 0.022) compared with those without microvascular complication. Diabetes duration (odds ratio [OR] = 1.12 [1.09-1.15], P < 0.001) and TIR (OR = 0.97 [0.95-0.99], P = 0.005) were independent risk factors for composite microvascular complications, whereas SD and CV were not. Age (OR = 1.08 [1.03-1.14], P = 0.003) and HbA1c (OR = 1.80 [1.02-3.14], P = 0.044) were risk factors for macrovascular complications. TIR (OR = 0.97 [0.95-0.99], P = 0.021) was the only independent risk factor for hospitalizations for hypoglycemia or ketoacidosis. Lower TIR was associated with the presence of composite microvascular complications and with hospitalization for hypoglycemia or ketoacidosis. TIR, SD, and CV were not associated with macrovascular complications.

The study of Mean Platelet Volume (MPV) as a Potential Risk Factor for Macrovascular Complications (Ischemic Heart Disease and Cerebrovascular Stroke) in Type 2 Diabetes Mellitus

Abstract Background Type 2 diabetes mellitus (T2DM) has reached global epidemic proportions, with more than 382 million people affected according to 2013 estimate. By 2035, its prevalence is expected to reach 471 million, meaning that 10% of the world’s population will have diabetes. Patients with diabetes often suffer from metabolic abnormalities, poor glycemic control, oxidative stress, insulin resistance, and low-grade inflammation. These conditions trigger vascular dysfunction, which predisposes them to atherothrombosis Objective The present study aimed to study the mean platelet volume (MPV) as a potential risk factor for ischemic heart disease and cerebrovascular stroke in type 2 diabetes. Methods The study was conducted on 150 subjects there ages ranged from 40 to 60 years old. They were divided into 4 groups: Group 1: included30 type 2 diabetic overweight or obese patients without previous history of myocardial infarction or cerebrovascular stroke. Then, they were subdivided into 2 subgroups: 1a) 15 diabetic non hypertensive patients. 1b) 15 diabetic hypertensive patients. Group 2: included A) 30 type 2 diabetic overweight or obese patients with recent cerebrovascular stroke. Then, they were subdivided into 2 subgroups: 2Aa) 15 diabetic non hypertensive patients. 2Ab) 15 diabetic hypertensive patients. B) 30 type 2 diabetic overweight or obese patients with acute myocardial infarction. Then, they were subdivided into 2 subgroups: 2Ba) 15 diabetic non hypertensive patients. 2Bb) 15 diabetic hypertensive patients. Group 3: 30 overweight or obese non-diabetic patients with acute myocardial infarction or recent cerebrovascular stroke. Then, they were subdivided into 3a) 15 patients with acute myocardial infarction. 3b) 15 patients with recent cerebrovascular stroke. Group 4: 30 Healthy control with matching age and sex and were subdivided into 2 subgroups: Control a) 15 lean subjects. Control b) 15 overweight or obese subjects. All subjects in this study were subjected to Full medical history taking. Thorough clinical examination (including weight, height, BMI, blood pressure). The following laboratory investigations were done: Fasting blood glucose, Two hour post prandial, HbA1c, Fasting insulin (for HOMA IR), Lipid profile (Total cholesterol-LDL-HDL-Triglycerides), Mean platelet volume and Liver and kidney function test. The following radiological investigation were done: Carotid ultrasonography for estimation of intima-media thickness and abdominal ultrasonography. Results As regards MPV, there was a high statistical significant difference between the studied groups (p-value&amp;lt;0.01), being the highest in group II (mean 11.93 ± 0.37 fl) followed by group III (10.77±1.69 fl), group I (10.67±1.98 fl) and group IV (8.83±0.98 fl). On comparing between every other groups there was a high statistical significant difference between group (I) &amp; (II) being higher in group II, (I) &amp; (IV) being higher in group I, (II) &amp; (III) being higher in group II, (II) &amp; (IV) being higher in group II and (III) &amp; (IV) being higher in group III (P value&amp;lt;0.01). However, there was a non-statistical significant difference between group (I) &amp; (III) regarding the MPV (P value&amp;gt;0.05). On comparing between hypertensive and non-hypertensive patients in each group as regard MPV, there were non-significant statistical difference. Conclusion MPV was higher in type 2 diabetic patients than healthy control. Moreover, MPV was significantly higher in type 2 diabetic patients with macrovascular complications. There was no significant difference between hypertensive and non hypertensive patients as regard MPV. There was no significant difference between obese and lean subjects as regard MPV. There was a positive significant correlation between MPV and markers of glycemic control in T2DM.

Studying the Relation between lipid profile and HbA1c in elderly patients with Type 2 Diabetes

Introduction: Diabetes mellitus is characterized by chronic hyperglycemia with disturbances in carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. Glucose and lipid metabolism are linked to each other. It is well known that dyslipidemia is considered a major risk factor for macrovascular complications in patients with type-2 diabetes mellitus. Recently, obesity-related metabolic syndrome has received widespread attention. The aim of the current study was to find out the correlation between HbA1c, lipid profile and BMI of elderly patients with type 2 Diabetes mellitus. Methods: A cross-sectional observational study was conducted in a sample consists of one hundred and sixty elderly patients with type 2 diabetes. Glycemic control, lipid profile, body mass index (BMI) were assessed. Results: There was a significant positive correlation between HbA1c and FBS with total cholesterol, LDL and triglycerides and a significant negative correlation with HDL. Also, there was a significant positive correlation between HbA1c and FBS with BMI. Conclusion: Increased levels of HbA1c, is associated with dyslipidemia and increased BMI.

STUDY OF LIPID PROFILE IN DIABETIC MELLITUS IN TERTIARY CARE HOSPITAL

INTRODUCTION: Diabetes mellitus (DM) is a group of metabolic disorder which is characterized by increase blood glucose level resulting from defects in insulin secretion, insulin action or both and disturbances of carbohydrate, lipid and protein metabolism. Worldwide With an increasing incidence of DM may be a likely leading cause of morbidity and mortality in the future[i]. It is well known that dyslipidemia is a major risk factor for macrovascular complications with type-2 diabetes mellitus (T2DM) which affects 10%-73% of this population. It is well known that dyslipidemia is a major risk factor for macrovascular complications with type-2 diabetes mellitus (T2DM) which affects 10%-73% of this population. Dyslipidemia, hyperglycemia and hyperlipidemia are results of Insulin resistance and obesity combine cause and have additive cardiovascular risk. Therefore identification, critical evaluation and follow-up of serum lipid profile is important in DM continuously. One of the study showed that prevalence of dyslipidemia in diabetes mellitus is 95%. Major risk factor for Coronary Heart Disease is dyslipidemia. In DM patients cardiovascular disease is a cause of morbidity and mortality because of disturbance in lipoproteins i.e. serum triglycerides (TC) 69%, serum cholesterol 56.6%, Low Density Lipoprotein cholesterol (LDL) 77% and High Density Lipoprotein cholesterol (HDL) 71%.&#x0D; AIM: The main aim of this study is to know the lipid profile in Diabetics mellitus (DM). MATERIAL AND METHODS: Total 100 patients with DM were included in this study during the period of 1 year. During the study period 100 normal healthy people without DM were also included as control study. From all the patients detail histories were taken as well as relevant clinical examination with routine investigations were also done. All the patients were for at least 12-14 hours overnight fasting and 5ml venous blood was collected in a disposable syringe on next morning (before breakfast) for the serum lipid profile and fasting blood sugar.&#x0D; RESULT: In this study out of 100 diabetic patients 48 (48%) were males and 52 (52%) were females. 70% of DM patients showed high serum cholesterol level and all persons had normal serum cholesterol level in control group. 75% of DM patients showed high serum triglyceride level (&gt;150mg/dl). 39% of DM patients showed Serum LDL level was high (&gt;160 mg/dl). 85% of DM patients showed low (&lt;40 mg/dl) serum HDL value.&#x0D; CONCLUSION: In DM patients lipid abnormalities in diabetes are raised serum cholesterol, raised triglycerides, and raised serum LDL and low serum HDL. Therefore there is important impact of dyslipidemia on cardio vascular complications required complete attention throughout the course of disease. Hence early screening of diabetic patients for dyslipidemia and intervention is necessary to minimize the risk of cardiovascular diseases.&#x0D; KEYWORDS: Diabetes mellitus (DM), dyslipidemia, cholesterol, triglyceride&#x0D; &#x0D; &#x0D; Diabetes: facts and figures [Internet]. International Diabetes Federation. [cited 2016Jul14].&#x0D;

Regional differences of macrovascular disease in Northeast and South Germany: the population-based SHIP-TREND and KORA-F4 studies

BackgroundPrevious studies found regional differences in the prevalence and incidence of type 2 diabetes between Northeast and South of Germany. The aim of this study was to investigate if regional variations are also present for macrovascular disease in people with type 2 diabetes and in the general population. A further aim was to investigate if traditional risk factors of macrovascular complications can explain these regional variations.MethodsData of persons aged 30–79 from two regional population-based studies, SHIP-TREND (Northeast Germany, 2008–2012, n = 2539) and KORA-F4 (South Germany, 2006–2008, n = 2932), were analysed. Macrovascular disease was defined by self-reported previous myocardial infarction, stroke or coronary angiography. Multivariable logistic regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for prevalence of macrovascular disease in persons with type 2 diabetes and in the general population.ResultsThe prevalence of macrovascular disease in persons with type 2 diabetes and in the general population was considerably higher in the Northeast (SHIP-TREND: 32.8 and 12.0%) than in the South of Germany (KORA-F4: 24.9 and 8.8%), respectively. The odds of macrovascular disease in persons with type 2 diabetes was 1.66 (95% CI: 1.11–2.49) in the Northeast in comparison to the South after adjustment for sex, age, body mass index, hypertension, hyperlipidemia and smoking. In the general population, SHIP-TREND participants also had a significantly increased odds of macrovascular disease compared to KORA-F4 participants (OR = 1.63, 95% CI: 1.33–2.00). After excluding coronary angiography (myocardial infarction or stroke only), the ORs for region decreased in all models, but the difference between SHIP-TREND and KORA-F4 participants was still significant in the age- and sex-adjusted model for the general population (OR = 1.34, 95% CI: 1.01–1.78).ConclusionsThis study provides an indication for regional differences in macrovascular disease, which is not explained by traditional risk factors. Further examinations of other risk factors, such as regional deprivation or geographical variations in medical care services are needed.

The Management of Dyslipidaemia in Patients with Type 2 Diabetes Mellitus Receiving Lipid-Lowering Drugs: A Sub-Analysis of the CEPHEUS Findings

Dyslipidaemia is a risk factor for macrovascular complications in patients with type 2 diabetes mellitus (T2DM). Our aim was to assess the use of lipid lowering drugs (LLDs) in patients with T2DM and co-existing dyslipidaemia. A multicentre, non-interventional survey conducted in 6 Middle Eastern countries (Bahrain, Oman, Qatar, United Arab Emirates, Kingdom of Saudi Arabia and Kuwait). Patients with T2DM (n = 3338) taking LLD treatment for ≥3 months with no dose change for ≥6 weeks were enrolled. The mean age (SD) of T2DM patients was 56.6 ±10.6 years; the majority (99%) were on statin monotherapy. Only 48% of these patients achieved their low density lipoprotein cholesterol (LDL-C) goal and 67.7% of the patients had a high cardiovascular disease (CVD) risk according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines. Of those who achieved LDL-C goals (n=1589), approximately one-third were at very high CVD risk and the patients who had received statin monotherapy showed the highest proportion in LDL-C goal attainment, followed by those treated with fibrate monotherapy. In a multivariate logistic regression model, taking drugs daily (odds ratio, OR: 1.64, 95% CI 1.25, 2.15) and older age (OR: 1.09, 95% CI 1.01, 1.18) were significantly associated with better odds of attaining LDL-C target. In contrast, patients with higher levels of ApoA1 (OR: 0.73, 95% CI [0.67,0.79]), Metabolic Syndrome (OR: 0.64, 95% CI [0.53, 0.76]), higher CV risk (OR: 0.33, 95% CI 0.27, 0.41), those who forgot to take their medication (OR: 0.74, 95% CI 0.62,0.88) and those who stopped taking medication when cholesterol became normal (OR: 0.67, 95% CI 0.55,0.82) were significantly associated with lower odds of attaining LDL-C target. The results of this study highlight the suboptimal management of dyslipidaemia in T2DM patients at high and very high risk of CVD.

O‐GlcNAc Transferase Regulates Phenotypic Transformation of Vascular Smooth Muscle Cells in Response to Hyperglycemia

Risks of vascular complications are enhanced two‐to‐four fold in diabetes, accounting for increased morbidity and mortality in these patients. Hyperglycemia is an important risk factor for macrovascular complications associated with diabetes. Diabetic patients exhibit an increased incidence of vascular smooth muscle cell (VSMC) migration and proliferation, a hallmark of VSMC phenotypic switching from the quiescent contractile state to a synthetic proliferative phenotype. Hyperglycemia increases glucose flux through the hexosamine biosynthetic pathway triggering an enhanced signaling via O‐linked N‐acetylglucosamine (O‐GlcNAc) transferase (OGT), the key enzyme catalyzing addition of O‐GlcNAc moieties to proteins. Protein O‐GlcNAcylation is a unique post‐translational protein modification implicated in diabetes and related cardiovascular complications. Previous studies have suggested both cardio‐protective and cardio‐detrimental effects of protein O‐GlcNAcylation in diabetes. However, the precise role of OGT in the etiology of diabetic atherogenesis remains incompletely understood. The goal of the current study was to investigate whether OGT modulates VSMC transition to a de‐differentiated phenotype under hyperglycemic conditions. Immunoblotting experiments revealed that in primary cultures of human aortic smooth muscle cells (HASMC) in vitro, benzyl 2‐deoxy α‐D‐galactopyranoside (BG), a pharmacological inhibitor of OGT, decreased high glucose‐induced OGT and O‐GlcNAc protein expression, and this was accompanied with attenuated PCNA (proliferation marker), reduced vimentin (SM synthetic marker) and increased SM‐MHC (SM contractile marker) expression. Consistent with these findings, deletion of OGT using siRNA gene silencing significantly lowered protein O‐GlcNAc and PCNA expression in glucose‐stimulated HASMC compared with glucose‐treated cells transfected with control siRNA. Notably, under glucose‐stimulated conditions, OGT knockdown enhanced calponin (SM contractile marker) expression in HASMC transfected with OGT siRNA vs cells transfected with control siRNA. Finally, electrophoretic mobility shift assay (EMSA) revealed that specific OGT inhibitors (BG and ST045849) attenuated high glucose‐induced DNA‐binding activity of YY1 and Elk1 (transcriptional repressors of SM contractile phenotype) in HASMC compared to cells treated with glucose alone. Taken together, these data clearly demonstrate that loss of OGT inhibits VSMC phenotypic de‐differentiation in response to hyperglycemia, suggesting OGT as a potential therapeutic target in diabetic atherosclerosis.Support or Funding InformationAmerican Heart Association ‐ Grant‐in‐Aid 16GRNT31200034This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Analysis of Status and Risk Factors for Macrovascular Complications in Type 2 Diabetes Mellitus

The status and risk factors for atherosclerosis (AS) were investigated and the sensitivity and accuracy of existing examine methods of AS were evaluated in patients with diabetes mellitus(T2DM). Ninety nine patients who diagnosed with the WHO 1999 criteria for T2DM were enrolled in this study, which were divided into atherosclerotic group(group A) and non-atherosclerosis group(group B). The clinical characteristics, including fasting plasma glucose(FPG), postprandial plasma glucose(PPG), total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), glycosylated hemoglobin A1c(HbAlc) and early examination methods of AS, including carotid intima-media thickness(CIMT), ankle brachial index(ABI) and pulse wave velocity (PWV) were recorded. The t-test, χ2 test or linear regression model were used for retrospective analyses then showed that the prevalence rate of carotid plaque was 29.3%( 29/99), there is no difference between the distribution of age and gender in the group with or without plaque (χ2 = 0.044, P>0.05; t = 0.850, P>0.05). It also demonstrated that systolic blood pressure(SBP), diastolic blood pressure (DBP), LDL-C, CIMT, history of smoke were significantly higher in plaques group than that of without plaques ( P＜0.05). Logistic analysis showed that LDL-C and CIMT were independent risk factors for incidence of cervical atheromatous plaques in type 2 diabetic patients (P＜0.05). The risk of AS has increased by 1.7 times by every unit of LDL-C, as well as increased by 13.8 times by every unit of CIMT. CIMT and PWV, but not ABI, are valuable for AS diagnosing. According to sensitivity and specificity, the best diagnostic value for CIMT is 0.9mm and for PWV is 1560.As a result, LDL-C and CIMT are independent risk factors for AS. Early intervention and controlling of risks factors will have clinical value for prevention and treatment of macrovascular diseases in T2DM. The corresponding cut-off points 1560 of PWV is better than 1400 for diagnosis of AS in this hospital.

The Constellation of Macrovascular Risk Factors in Early Onset T2DM: A Cross-Sectional Study in Xinjiang Province, China.

Background Despite a rapid popular of early onset type 2 diabetes (defined as diagnosis at <40 years old) recently, there is a lack of studies on this population in economically undeveloped area. We aimed to investigate the risk factors of macrovascular complications in the early onset T2DM patients in Xinjiang, China. Methods A cross-sectional survey of 1736 consecutive patients with T2DM was conducted. Macrovascular complications and risk factors were documented. Another nondiabetic population matched with age and sex was as a control group. Logistic regression analysis was performed to obtain odds ratios (OR) for macrovascular complications in early and late onset T2DM, respectively. Results The final analysis consisted of 1036 late onset and 219 early onset T2DM patients. The mean HbA1c in the early onset group was higher than that in the late onset group (9.1 ± 2.4% versus 8.3 ± 2.2%, P=0.039) despite a higher proportion of patients in the early onset group receiving insulin treatment (73.1% versus 58.7%, P < 0.001). Compared to the control, early onset patients had higher blood pressure and worse lipid profiles (all P < 0.01). More than half of the early onset T2DM patients already had macro- and microvascular complications, despite of their young age (39.5 ± 10.8) and short DM duration (6.6 ± 8.0). In the early onset group, women had a ~3-fold hazard of atherosclerotic plaques compared with men (OR 3.22, 95% CI 1.53–6.78). Conclusions Patients with early onset T2DM have worse glycemic control and higher burden of atherogenic risk factors. The prevalence of macro- and microvascular complications is astonishingly high in these young adults with T2DM. Moreover, young women with T2DM are more susceptible to cardiovascular complications than their male counterpart.

Prevalence of Chronic Complications, Their Risk Factors, and the Cardiovascular Risk Factors among Patients with Type 2 Diabetes Attending the Diabetic Clinic at a Tertiary Care Hospital in Sri Lanka.

Diabetes incurs heavy burden to patients and the healthcare system. Assessment of disease burden is important in taking necessary precautions and management decisions. We aimed to determine the prevalence of macro- and microvascular complications, their risk factors, and coronary artery disease (CAD) risk factors among patients with type 2 diabetes mellitus (T2DM). A descriptive cross-sectional single-centre study was carried out among 3000 patients with T2DM attending the diabetic clinic at the National Hospital of Sri Lanka from January to July 2016. The study population had 72.7% females and 27.3% males. Mean age and disease duration were 58.3 ± 10.3 and 10.8 ± 7 years, respectively. Prevalence of CAD, stroke, and peripheral vascular disease were 10.6%, 1.1%, and 4.7% while diabetic retinopathy, neuropathy, nephropathy, diabetic foot, and lower extremity amputation (LEA) were 26.1%, 62.6%, 50.8%, 2.6%, and 1.3%, respectively. Prevalence of overweight/obesity, hypertension, dyslipidemia, and smoking were 80%, 77.6%, 76.7%, and 11%, respectively. Increased age, disease duration, and HBA1c were risk factors for microvascular disease and diabetic foot while age was the only risk factor for macrovascular complications. Occurrence of CAD, peripheral neuropathy, diabetic foot, and LEA was significantly higher among males than when compared to females. This study highlights the major burden of chronic complications and high prevalence of CAD risk factors in this population.

Prevalence of Macrovascular Complications and Their Associated Risk Factors Among Type 2 Diabetic Patients Attending In A Tertiary Level Hospital

Background: Macrovascular complications cause much of the serious morbidity and mortality in patients with diabetes. The aim of the study was to determine the prevalence and risk factors of different macrovascular complications among type 2 diabetic patients.Materials and Methods: We studied two fifty cases of type 2 diabetic patients in this cross-sectional study which was conducted in the out-patient department of BIRDEM hospital, Bangladesh. The randomly selected patients were evaluated for the presence of coronary heart diseases (CHD), stroke and peripheral vascular diseases (PVD) through the review of their registered diabetic guide book. We included sociodemographic information, blood pressure, anthropometry (height, weight, body mass index) and lipid profile of the patients. Glycaemic status was assessed by HbA1c (HbA1c was categorized into 3 groups) and plasma glucose levels. We used logistic regression analysis to determine and quantify the association of CHD, stroke and PVD with various risk factors. Results: Two hundred and fifty cases of type 2 diabetic patients (male 129 and female 121 were studied. The prevalence of macro-vascular complications was 28.8%. Among them CHD was 21.2% (95% CI: 16.13- 26.27%), stroke in 8.4% (95% CI: 4.96-11.84%) and PVD in 7.2% (95% CI: 4-10.4%). Logistic regression models showed that macrovascular complications were more common in females; the risk increased significantly with age, longer duration of diabetes, lacking of physical exercise, presence of hypertension, HbA1c, Fasting Blood Glucose (FBG) and blood glucose 2 hours ABF.Conclusions: CHD is the most common macrovascular complication among type 2 DM patients. Advanced age, longer duration of diabetes, hypertension, poor glycaemic control, lacking of physical exercise etc. are significant risk factors of macrovascular complications in type 2 diabetic patients.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 662-667

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

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

Potential benefit of (-)-epigallocatechin-3-gallate for macrovascular complications in diabetes.

Vascular problems are the most common complications in diabetes. Substantial evidence from epidemiological and pathophysiological studies show that hyperglycemia is a major risk factor for macrovascular complications in patients with diabetes. (-)-Epigallocatechin-3-gallate (EGCG), the major catechin derived from green tea, is known to exert a variety of cardiovascular beneficial effects. The protective effects of EGCG in diabetes are also evident. However, whether EGCG is beneficial against macrovascular complications that occur in diabetes remains unknown. Our previous studies demonstrated that treatment of EGCG inhibits high glucose-induced vascular smooth muscle cell proliferation and suppresses high glucose-mediated vascular inflammation in human umbilical vein endothelial cells. Therefore, we hypothesize that EGCG might be an effective potential candidate to reduce the macrovascular complications in diabetes.

Sugar and Type 2 diabetes.

Consumption of sugar, specifically sugar-sweetened beverages, has been widely held responsible by the media for the global rise in Type 2 diabetes (T2DM). Systematic reviews and dietary guidelines relating dietary sugars to T2DM. Weight gain and T2DM incidence are associated with diet and lifestyle patterns characterized by high consumptions of any sweetened beverages. High sugar intakes impair risk factors for macrovascular complications of T2DM. Much of the association between sugars and T2DM is eliminated by adjusting data for body mass index (BMI). However, BMI adjustment does not fully account for adiposity (r2=0.65-0.75). Excess sugar can promote weight gain, thus T2DM, through extra calories, but has no unique diabetogenic effect at physiological levels. Ethical concerns about caffeine added to sweetened beverages, undetectable by consumers, to increase consumption. Evidence needed for limiting dietary sugar below 10% energy intake.