Risk Factors For Diabetes Mellitus Research Articles

Взаємозв’язок між депресивними розладами та станом когнітивної функції в пацієнтів похилого віку з цукровим діабетом 2-го типу

Актуальність. Депресія є фактором ризику виникнення цукрового діабету (ЦД) та негативно впливає на його перебіг, підвищуючи ризик розвитку ускладнень. Метою дослідження було оцінити стан когнітивної функції у хворих на ЦД 2-го типу похилого віку з депресивними розладами та без них. Матеріали та методи. Було обстежено 115 хворих на ЦД 2-го типу, із них жінок було 78, чоловіків — 37. Пацієнти були розподілені на дві групи: з депресивними розладами та без них. Оцінка депресивних виявів проводилася за допомогою самоопитувальника депресії. Оцінка когнітивних порушень здійснювалася зранку за допомогою таких методів: тесту «5 слів», шкали оцінки психічного статусу, батареї тестів на лобну дисфункцію, тесту малювання годинника. Результати. У 68,7 % хворих на ЦД 2-го типу похилого віку не відзначаються депресивні розлади за даними самоопитувальника депресії, легкі вияви спостерігались у 17,4 % обстежених, помірні — у 10,4 % та 3,5 % хворих мали тяжкі вияви депресії. У пацієнтів із депресивними розладами спостерігаються вірогідно гірші показники когнітивної функції. У хворих на ЦД із помірними та тяжкими виявами депресії стан когнітивної функції вірогідно гірший порівняно з пацієнтами, які мають легкі вияви депресії чи без депресивних розладів. Висновки. Необхідно проводити скринінг у всіх пацієнтів із ЦД 2-го типу на наявність депресивних розладів із метою профілактики порушень когнітивних функцій.

Left ventricular myocardial performance index in prediabetic patients without coronary artery disease

BackgroundPrediabetes is considered a major risk factor for diabetes mellitus (DM), leading to microvascular and cardiovascular disorders. Myocardial performance index (MPI) is a non-invasive Doppler method for the determination of global ventricular activity. We have not enough knowledge about the effect of prediabetes on the left ventricular (LV) function. We aimed to assess the MPI in prediabetic patients without coronary artery disease (CAD) utilizing echocardiography tissue Doppler imaging (TDI).ResultsWe conducted a randomized controlled study that included fifty prediabetic patients and fifty healthy participants as the control group. All the participants were subjected to laboratory tests and echocardiography TDI to evaluate the LV systolic and diastolic functionsWe found that the isovolumic relaxation time (IVRT) and MPI values were significantly increased in the prediabetic patients compared to the control group (P < 0.001). In contrast, left ventricular ejection time (ET) was significantly longer in the control group than in prediabetic patients.ConclusionPrediabetes may adversely affect the LV function as assessed by MPI. Screening for prediabetes and early intervention is required for the prevention of cardiovascular morbidity and mortality.

A proposal for the cutoff points of waist circumference values predictive of increased risk of Type 2 diabetes and hypertension in Arab adults

Introduction: Central obesity is an established risk factor for diabetes mellitus (DM) and hypertension. We aimed to identify people at the highest risk by ethnically adjusted waist circumference (WC) cutoff points. Subjects and Methods: Data were collected from a cross-sectional study of 4350 Saudi adults aged 15–64 years using a stratified, multistage, cluster random sampling. DM was based on known history or fasting blood glucose higher than 7.0 mmol/L, and hypertension was determined by having a systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg. WC was measured midway between the lower costal margin and iliac crest during the end-expiratory phase. Results: The mean age for all the study population was 36.6 + 13.0 years (35.6 ± 12.0 years for females; 37.5 ± 13.9 years for males). The mean WC was 95.2 + 14.01 cm for males and 89.9 + 12.6 cm for females (P &lt; 0.001). The prevalence of diabetes was 23.8% for all subjects. The prevalence of hypertension for all subjects was 25.5%. Receiver operator characteristics curves revealed that WC cutoff points for diabetes risk are 91 cm and 97 cm for women and men, respectively, and for hypertension are 90 cm and 97 cm for women and men, respectively. Conclusions: The present study proposes the obtained cutoffs to identify those at high risk for diabetes and hypertension in the Saudi population who can be considered candidates for preventive interventions.

Prevalence of and risk factors for diabetes mellitus in the school-attending adolescent population of the United Arab Emirates: a large cross-sectional study

ObjectivesThe prevalence of diabetes has reportedly increased among adolescents in low-income and middle-income countries of the Middle East and may be linked to social, demographic and economic contextual factors. This...

Sistematik Review: Faktor Resiko Obesitas terhadap Diabetes Mellitus Tipe 2 pada Remaja

Degenerative diseases or non-communicable diseases are caused by changes in lifestyle, especially changes in diet. One of the degenerative diseases is type 2 diabetes mellitus, characterized by insufficient insulin secretion, insulin resistance, and increased glucose production in the liver. Adolescence is a critical period, unhealthy dietary habits are one of the risky behaviors in adolescence, and an unhealthy diet in adolescents is one of the causes of obesity. Obesity is a hallmark of type 2 diabetes mellitus, and most adolescents with type 2 diabetes mellitus are obese at diagnosis. This study is a systematic review study with article search methodology through Google Scholar, PubMed, and Elsevier with the keywords Obesity as a Risk Factor for Type II Diabetes Mellitus in adolescents. There are 12 research articles identified. It is known that obsession in adolescents is a risk factor for diabetes mellitus—type 2 diabetes mellitus in adulthood. The importance of providing education that focuses on lifestyle changes that aim to reduce the level of overweight and obesity in children and adolescents as well as education is also given to all family members so that families understand the importance of lifestyle changes for the successful management of type 2 diabetes mellitus.

Contribution of Current Comorbid Conditions to Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass and Stroke Distribution in Carotid Artery Stenosis Groups.

The aim of this study was to contribute to the issue of "Who should we perform Doppler ultrasonography on?" and determine the contribution of comorbid diseases to the development of carotid artery stenosis (CAS) and preoperative CAS by examining comorbid diseases in patients undergoing coronary artery bypass graft operation (CABG) and also discussing the effect of carotid stenosis levels on postoperative stroke. Between 2011-2015, a total of 921 patients who underwent cardiac surgery retrospectively were examined. Of these, 594 CABG patients aged 60 and over who underwent preoperative carotid Doppler examination were analyzed. Sixty-five percent of patients were male, and 35% were female. The mean age was 69.3 years. Sixty-nine percent of patients were in the 0-29% stenosis group, 12.9% in the 30-49% group, 14.6% in the 50-69% group, 3% in the 70-99% group, and 0.3% in the 100% occlusion group. Peripheral artery disease (PAD), age, gender, and diabetes mellitus (DM) were found to have significant (P < 0.05) effects on the occurrence of CAS. CAS increased by 0.9% with an increase of one year in age, 10.8% with the presence of PAD, 3% with male sex, 3.8% with presence of chronic obstructive pulmonery disease (COPD), 1.9% with presence of left main coronary disease (LMCAD), and 0.9% with presence of hypertension. In the decision tree analysis, the rate of 50% and above CAS in the presence of PAH + DM and age older than 65 years was 62.5%. Cerebrovascular accident (CVA) distribution was 2.1% in the 0-29% group, 2.5% in the 30-49% group, 4.5% in the 50-69% group, and 11.1% in the 70-99% group. Postoperative CVA was not observed in 10 patients who underwent carotid endarterectomy (CE). Postoperative CVA developed in six patients with 50% or more stenosis who did not undergo CE. For the preoperative detection of CAS in patients undergoing CABG, the association of advanced age, PAD, DM, male gender, COPD, LMCAD, and hypertension risk factors should be considered. We suggest that carotid screening should be performed in those over 65 years of age and with PAD+DM. Studies with large populations are needed to observe the effects of aortic atherosclerosis load, surgical procedure, and unilateral/bilateral CAS presence on the development of stroke in patients with severe CAS and postoperative CVA.

Blastocyst Transfer: A Risk Factor for Gestational Diabetes Mellitus in Women Undergoing In Vitro Fertilization.

BackgroundThe risk of developing gestational diabetes mellitus (GDM) is higher in women undergoing assisted reproductive treatment than in women conceiving spontaneously.ObjectivesTo determine whether the GDM risk after day-3 embryo transfer differs from the GDM risk after day-5 blastocyst transfer.MethodsProspective observational study in women becoming pregnant after first fresh embryo or blastocyst transfer.ResultsA total of 1579 women got pregnant and had live birth; 1300 women got day-3 embryo transfer only, whereas 279 women received at least 1 blastocyst. Of 1579 women, 252 developed GDM. Age, body mass index, baseline estradiol, baseline high-density lipoprotein, and progesterone on the day of human chorionic gonadotropin injection were not different in women receiving day-3 embryos only vs women receiving at least 1 blastocyst. The number and quality of retrieved oocytes were not different in women receiving day-3 embryo transfer from those receiving blastocysts. Our study confirmed already established GDM risk factors such as age and body mass index, baseline estradiol, and high-density lipoprotein, as well as progesterone after ovarian stimulation. We furthermore demonstrate that the GDM incidence in women receiving day-5 blastocyst transfer was significantly higher than those who received day-3 embryo transfer (21.15% vs 14.85%; P = 0.009). Considering confounding factors, we likewise saw that blastocyst transfer was an independent procedure-related GDM risk factor [P = 0.009, Exp (B): 1.56, 95% CI: 1.12-2.18].ConclusionBlastocyst transfer after in vitro fertilization/intracytoplasmic sperm injection increases the risk of developing GDM.

What can we learn from β-cell failure biomarker application in diabetes in childhood? A systematic review.

BACKGROUNDThe prevalence of diabetes as a catastrophic disease in childhood is growing in the world. The search for novel biomarkers of β-cell failure has been an elusive task because it requires several clinical and biochemical measurements in order to integrate the risk of metabolic syndrome.AIMTo determine which biomarkers are currently used to identify β-cell failure among children and adolescents with high risk factors for diabetes mellitus.METHODSThis systematic review was carried out using a modified version of the PICO protocol (Participants/Intervention/Comparison/Outcome). Once our research question was established, terms were individually researched on three different databases (PubMed, BIREME and Web of Science). The total articles obtained underwent a selection process from which the 78 most relevant articles were retrieved to undergo further analysis. They were assessed individually according to quality criteria.RESULTSFirst, we made the classification of the β-cell-failure biomarkers by the target tissue and the evolution of the disease, separating the biomarkers in relation to the types of diabetes. Second, we demonstrated that most biomarkers currently used as early signs of β-cell failure are those that concern local or systemic inflammation processes and oxidative stress as well as those related to endothelial dysfunction processes. Third, we explored the novelties of diabetes as a protein conformational disease and the novel biomarker called real human islet amyloid polypeptide amyloid oligomers. Finally, we ended with a discussion about the best practice of validation and individual control of using different types of biomarkers in type 1 and type 2 diabetes in order to assess the role they play in the progress of diabetes in childhood.CONCLUSIONThis review makes widely evident that most biomarkers currently used as early signs of β-cell failure are those that concern local or systemic inflammation processes and oxidative stress as well as those related to endothelial dysfunction processes. Landing in the clinical practice we propose that real human islet amyloid polypeptide amyloid oligomers is good for identifying patients with β-cell damage and potentially could substitute many biomarkers.

Association of abdominal muscle area and density with glucose regulation: The multi-ethnic study of atherosclerosis (MESA).

Previous characterisation of body composition as a type 2 diabetes mellitus (T2DM) risk factor has largely focused on adiposity, but less is known about the independent role of skeletal muscle. We examined associations between abdominal muscle and measures of glucose regulation. Cross-sectional analysis of 1,891 adults enrolled in the Multi-Ethnic Study of Atherosclerosis. Multivariable regression assessed associations between abdominal muscle area and density (measured by computed tomography) with fasting glucose, homeostasis model assessment of insulin resistance (HOMA-IR), and prevalent T2DM (fasting glucose ≥126mg/dL or medication use). In minimally adjusted models (age, sex, race/ethnicity, income), a 1-SD increment in abdominal muscle area was associated with higher HOMA-IR (β=0.20±SE 0.03; 95%CI: 0.15, 0.25; P<0.01) and odds of T2DM (OR=1.47; 95%CI: 1.18, 1.84; P<0.01), while higher density was associated with lower fasting glucose (-4.49±0.90; -6.26, -2.72; P<0.01), HOMA-IR (-0.16±0.02; -0.20, -0.12; P <0.01), and odds of T2DM (0.64; 0.52, 0.77; P <0.01). All associations persisted after adjustment for comorbidities and health behaviours. However, after controlling for height, BMI, and visceral adiposity, increasing muscle area became negatively associated with fasting glucose (-2.23±1.01; -4.22, -0.24; P=0.03), while density became positively associated with HOMA-IR (0.09±0.02; 0.05, 0.13; P<0.01). Increasing muscle density was associated with salutary markers of glucose regulation, but associations inverted with further adjustment for body size and visceral adiposity. Conversely, after full adjustment, increasing muscle area was associated with lower fasting glucose, suggesting some patients may benefit from muscle-building interventions.

The Predictive Effect of Health Examination in the Incidence of Diabetes Mellitus in Chinese Adults: A Population-Based Cohort Study.

Background The incidence of diabetes mellitus (DM) was increasing in recent years, and it is important to screen those nondiabetic populations through health examination to detect the potential risk factors for DM. We aimed to find the predictive effect of health examination on DM. Methods We used the public database from Rich Healthcare Group of China to evaluate the potential predictive effect of health examination in the onset of DM. The colinear regression was used for estimating the relationship between the dynamics of the health examination index and the incident year of DM. The time-dependent ROC was used to calculate the best cutoff in predicting DM in the follow-up year. The Kaplan-Meier method and Cox regression were used to evaluate the HR of related health examination. Results A total of 211,833 participant medical records were included in our study, with 4,172 participants diagnosing as DM in the following years (among 2-7 years). All the initial health examination was significantly different in participants' final diagnosing as DM to those without DM. We found a negative correlation between the incidence of years of DM and the average initial FPG (r = −0.1862, P < 0.001). Moreover, the initial FPG had a strong predictive effect in predicting the future incidence of DM (AUC = 0.961), and the cutoff was 5.21 mmol/L. Participants with a higher initial FPG (>5.21 mmol/L) had a 2.73-fold chance to develop as DM in follow-up (95%CI = 2.65–2.81, P < 0.001). Conclusion Initial FPG had a good predictive effect for detecting DM. The FPG should be controlled less than 5.21 mmol/L.

199. HbA1c and BMI are modifiable risk factors for reducing wound complications but do not influence risk of pseudarthrosis

<h3>BACKGROUND CONTEXT</h3> Patients with diabetes mellitus (DM) undergoing posterior spinal fusion (PSF) with elevated HbA1cs are at higher risk of postoperative complications than those with lower HbA1cs. DM patients with an HbA1c >7.05% are prone to postoperative complications such as wound complications (WC). Pseudarthrosis (PA) is another complication for PSF and requires further insight in determining risk factors for DM. <h3>PURPOSE</h3> To determine if DM patients with higher preoperative HbA1c levels will have higher rates of WC and PA. <h3>STUDY DESIGN/SETTING</h3> Single-center retrospective cohort study. <h3>PATIENT SAMPLE</h3> This study included 229 DM patients. <h3>OUTCOME MEASURES</h3> Patient demographics, osteopenia, preoperative HbA1c, WC, PA, and levels-fused (LF). <h3>METHODS</h3> Included: DM patients undergoing thoracolumbar PSF from 2014-2019 with preoperative HbA1C levels, and a minimum 1-year postoperative follow-up. PA was defined by the treating surgeon via clinical presentation, radiographs and postoperative CT scan with minimum 1-year postoperative interval. WC included dehiscence, seroma requiring aspiration or infection of the surgical site. Excluded: Patients undergoing LLIFs and ALIFs or diagnosed with prior pars fracture, spinal tumor, ankylosing spondylitis, fracture and infection. Relationships between complications and HbA1c were determined using t-test, chi-squared analyses and multivariate regressions (α=0.05). In risk factors, the cutoff HbA1C value as a predictor for multiple postoperative complications was identified via receiver operating characteristic (ROC) analyses using Youden's index. <h3>RESULTS</h3> A total of 229 patients met these criteria. Age (Normal: 65.4±11.0, PA: 63.0±8.2, p=0.249; Normal: 65.2±10.6, WC: 64.5±9.7, p=0.753), CCI (Normal: 4.6±2.0, PA: 4.0±1.2, p=0.06; Normal: 4.6±1.9., WC: 4.6±1.7, p=0.761), gender, percent female, (Normal: 57%, PA: 47%, p=0.286; Normal: 55%, WC: 58%, p=0.829), osteopenia (Normal: 3%, PA:3%, p=0.968; Normal: 3%, WC: 0.0%, p=0.377), and smoker status (Normal: 11%, PA: 16%, p=0.44; Normal: 11%, WC: 12%, p=0.915) did not have a significant impact in the tested postoperative complications. Mean HbA1c (7.6±1.5%, p=0.001), LF (3.9±3.2, p=0.024) and BMI (35.8±7.4, p=0.004) in patients with WC were significantly higher than those without WC (HbA1C: 6.8±1.0%; LF: 2.5±2.9 BMI: 31.7±6.7). HbA1c (OR: 1.7 [1.2-2.5], p=0.005), BMI (OR: 1.1 [1.0-1.2], p=0.007) and LF (OR: 1.1[1.1-1.3], p=0.031) was an independent risk factor WC. In those with PA, mean HbA1c (7.0±1.3, p=0.289) was not significantly higher than those without PA (HbA1C:7.0±1.1). HbA1c (OR: 1.039 [0.73-1.478], p=0.831) was not an independent risk factor for PA.ROC analyses demonstrated HbA1c>7.05% (AUC: 0.693[0.587-0.800], p=0.001], BMI>32.92 (AUC: 0.664[0.555-0.772], p=0.007) and >1.5 LF (AUC: 0.626[0.502-0.750], p=0.036) as fair predictive models for WC. <h3>CONCLUSIONS</h3> Preoperative HbA1C>7.05%, BMI>32.92 and LF>1.5 are independent risk factors of WC; however, neither of these are predictors for PA in diabetics who had PSF. Regardless, DM patients undergoing PSF should strive to lower their HbA1c<7.05% and BMI<32.92 before surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Effects of Structured lifestyle Modification on Cardiovascular Risk Factors in Type-2 Diabetes Mellitus: A Randomized Controlled Trial

Several clinical trials have shown that lifestyle modifications lower blood pressure, affect weight as well as lipid profile and lower risk factors for cardiovascular diseases. The study assessed the effect of structured lifestyle modification on cardiovascular risk factors amongst type 2 diabetic patients that attend the General Outpatient Clinic (GOPC) of Jos University Teaching Hospital (JUTH). The study was a randomized controlled trial on 352 participants at the GOPC of JUTH, from October 2015 to February 2016. The intervention offered was counselling on structured lifestyle modification in diet and exercise for a period of 12 weeks. The primary outcome measures were changes in blood pressure, weight and lipid profile. The data were analyzed using Epi Info version 3.5.3. There were significant differences between groups in favor of the intervention group; mean systolic blood pressure of -65 mmHg (t = 5.344; p = 0.017) and mean weight of -1.78kg (t = 2.452; p = 0.015). Structured lifestyle modification caused significant improvement on modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus attending the general outpatient clinic of the Jos University Teaching Hospital.

The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome: What should we care.

The influencing factors of gestational diabetes mellitus (GDM) in the polycystic ovary syndrome (PCOS) patients remain unclear, we aimed to investigate the risk factors of GDM in patients with PCOS, to provide reliable evidence for the prevention and treatment of GDM in PCOS patients.PCOS patients treated in our hospital from January 1, 2019 to October 31, 2020 were included. The personal and clinical treatment details of GDM and no GDM patients were analyzed. Logistic regressions were performed to analyze the factors influencing the occurrence of GDM.A total of 196 PCOS patients were included, the incidence of GDM in patients with PCOS was 23.98%. There were significant differences in the age, body mass index, insulin resistance index, fasting insulin, testosterone, androstenedione, and sex hormone-binding protein between GDM and no GDM patients with PCOS (all P < .05), and no significant differences in the family history of GDM, the history of adverse pregnancy, and multiple pregnancies were found (all P > .05). Age ≥30 years (odds ratio (OR) 2.418, 95% confidence interval (CI) 1.181–3.784), body mass index ≥24 kg/m2 (OR 1.973, 95%CI 1.266–3.121), insulin resistance index ≥22.69 (OR 2.491, 95%CI 1.193–4.043), fasting insulin ≥22.71 mIU/L (OR 2.508, 95%CI 1.166–5.057), testosterone ≥2.85 nmol/L (OR 1.821, 95%CI 1.104–2.762), androstenedione ≥6.63 nmol/L (OR 1.954, 95%CI 1.262–2.844), sex hormone-binding protein <64.22 nmol/L (OR 1.497, 95%CI 1.028–2.016) were the independent risk factors of GDM in patients with PCOS (all P < .05). The incidence of preeclampsia, premature delivery, premature rupture of membranes, polyhydramnios, and postpartum hemorrhage in the GDM group was significantly higher than that of the no-GDM group (all P < .05). There was no significant difference in the incidence of oligohydramnios between the 2 groups (P = .057).The incidence of GDM in PCOS patients is high, and the measures targeted at the risk factors are needed to reduce the occurrence of GDM in patients with PCOS.

Effect of Roux-en-Y gastric bypass versus medical therapy on type 2 diabetes mellitus and cardiovascular risk factors

Background and Aims: Obesity and type 2 diabetes mellitus (T2DM) are closely interlinked diseases and strongly associated with worldwide disability and death. It has been shown that weight loss is an effective strategy to improve the cardiovascular risk factors. Bariatric surgery, such as RYGB, is indicated in patients with a body mass index (BMI) greater than 40 kg/m2 or 35 kg/m2 along with comorbidities.

The Choline Metabolite TMAO Inhibits NETosis and Promotes Placental Development in GDM of Humans and Mice.

Choline metabolite trimethylamine N-oxide (TMAO) has been recognized as a risk factor of gestational diabetes mellitus (GDM), but its exact role in GDM has not been reported. In this study, we focused on the placenta development to reveal the role of TMAO in GDM. We found that the TMAO levels in peripheral and cord plasma were increased in women with GDM and that TMAO levels were positively correlated with newborn weight and placental thickness. Neutrophil extracellular traps (NETs) in the peripheral and cord plasma and the myeloperoxidase expression in the placenta of women with GDM also increased. NETs could inhibit the proliferation, migration, invasion, and angiogenesis of HTR-8/Svneo cells. However, TMAO not only could inhibit the formation of NETs but also could enhance the biological function of HTR-8/Svneo cells. With induction of GDM in NETs-deficient PAD4-/- and wild-type mice, the placental weight of PAD4-/- mice increased significantly. TMAO feeding also inhibited the formation of NETs and further increased the weight of the placenta and fetuses, and this increase did not affect the placental structure. Our data indicate that higher TMAO levels and the formation of abnormal NETs were associated with GDM. TMAO not only could promote the development of the placenta and fetuses but also could inhibit the formation of NETs.

Association of muscle mass and fat mass on low-density-lipoprotein cholesterol and triglyceride plasma concentration in children and adolescents.

Obesity has often been associated with high low-density-lipoprotein cholesterol (LDL-C) and triglyceride plasma concentrations, known risk factors for diabetes mellitus and cardiovascular disease. Study objective was to evaluate the association of LDL-C and triglyceride plasma concentration with muscle and fat mass in children and adolescents. We analyzed data of the National Health and Nutrition Examination Survey (1999-2004) to estimate lean muscle and fat mass assessed by dual-energy X-ray absorptiometry (DXA) of participants whose lipid profiles had been examined. Fat mass was operationalized by DXA-determined fat mass index (FMI). Muscle mass was assessed by appendicular lean mass index (aLMI). High LDL-C and triglyceride concentration was defined as above 130mg/dL. For the evaluation of the association of LDL-C and triglyceride plasma concentration with LMI and FMI Z-scores, the data of 2,487 children and adolescents (age 8-19 years) (984 females) were eligible. High aLMI showed no association with LDL-C or triglyceride concentration, but high FMI showed significant association with LDL-C and triglyceride plasma concentration in the bivariate regression analysis. Isolated muscle mass increase may not be protective against high LDL-C and triglycerides plasma levels in children and adolescents. Thus, exercise may lead to risk factor reduction mainly through fat mass reduction.

Gestational diabetes mellitus and obesity: effects on offspring

Aim: to identify the risk factors for gestational diabetes mellitus (GDМ) and predictors of perinatal lesions of central nervous system (CNS) combined with GDМ and maternal obesity.Materials and Methods. А retrospective observational case-control non-combined study was conducted to determine GDМ risk factors and their effect on perinatal pathology in 250 women divided into 2 groups. The main group included 150 pregnant women diagnosed with GDМ, the control group – 100 pregnant women without carbohydrate metabolism disorders. An assessment of hereditary, obstetric and gynecological history, as well as somatic health was carried out. Patients from the main group were subdivided into smaller groups: 1А (n = 77) – mothers whose newborns postnatally exerted adverse perinatal outcomes associated with impacting maternal hyperglycemia, and 1В (n = 73) – mothers whose newborns were born healthy. CHAID method (Chi Squared Automatic Interaction Detection) was used to create an algorithm for predicting adverse perinatal outcomes in GDМ. Аt the second stage, a single-center prospective observational non-combined cohort study was conducted to assess an effect of maternal hyperglycemia on formation of perinatal CNS lesions. Pre-labor concentration of neuron-specific enolase (NSE) was measured in the amniotic fluid of full-term fetuses in the group of pregnant women with GDM (n = 33) and in the group of pregnant women lacking carbohydrate metabolism disorders (n = 42).Results. Obesity, late reproductive age, family history of type 2 diabetes mellitus, abortions, early reproductive losses, macrosomic delivery in history are the main risk factors for GDM development. An algorithm was developed that allowed to predict a risk of newborn perinatal pathology in mother with GDM with an overall percentage of correct predictions of 68.7 ± 3.8 %. Pre-labor concentration of NSE in the amniotic fluid of full-term fetuses was elevated by 1.68 times (p = 0.006) in women with combined GDM and obesity (5.56 [3.37–6.24] ng/ml) compared to pregnant women with normal weight lacking carbohydrate metabolism disorders (3.29 [1.49–4.89] ng/ml).Conclusion. Pregnant women with obesity and type 2 diabetes mellitus familial history were featured with most prominent potential of developing perinatal complications. Rise in amniotic fluid NSE level in patients with GDМ corroborates damage of fetal CNS during antenatal period. The maximum NSE level was found in women comorbid with GDM and obesity.

Biochemical investigation of human exposure to aflatoxin M1 and its association with risk factors of diabetes mellitus.

Recently, aflatoxin M1 (AFM1) has emerged as a major health concern owing to its exposure to human being via consumption of milk, dairy products, and food commodities, and this has a strong association with risk factors that may lead to the onset of type 2 diabetes mellitus (T2DM) and various other associated metabolic disorders. This study was conducted to investigate the exposure to AFM1 and its association with sociodemographic features and risk factors of T2DM. Urine and blood samples from 672 participants were collected to investigate the concentration of AFM1 in urine and glucose, glycosylated hemoglobin (HbA1c), insulin, α-amylase, dipeptidyl peptidase-IV (DPP-IV), free fatty acids (FFAs), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-chol), interleukine-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), creatinine, uric acid, blood urea nitrogen (BUN), aspartate aminotransferase (AST), and alanine transaminase (ALT) from the blood of study participants. Association of exposure to AFM1 with sociodemographic features and risk factors of T2DM was determined using person correlation coefficient (r), coefficient of determination (R2), and 95% confidence interval, and the level of significance (P<0.05) was measured by Student's unpaired t-test. Among the participants in which AFM1 was detected, 62.91% of participants were found to be diabetic and 37.09% of participants were found to be non-diabetic. Further to this, it was also found that concentration of AFM1 in the urine of diabetic participants was found to be higher (P<0.05) as compared to that in non-diabetic participants. Association of AFM1 exposure with risk factors of T2MD exhibits that exposure to AFM1 was responsible for the induction of inflammatory responses and oxidative stress that may lead to the onset of impaired insulin secretion and metabolism of carbohydrates and ultimately the onset of T2DM and associated metabolic disorders. Hence, it can be summarized that exposure to AFM1 is one of the causative factors that may lead to potentiate the several risk factors notably inflammatory responses and oxidative stress that ultimately induce the pathogenesis of T2DM and associated metabolic disorders. The key findings of this study suggest that human population who are at greater risk of AFM1 exposure can develop T2DM and other associated metabolic risk factors.

Persistent organic pollutants-environmental risk factors for diabetes mellitus? - A population-based study.

Background:Globally, type-2 diabetes mellitus is increasing in epidemic proportions. A major cause of concern in India is the increasing incidence of cases, especially troubling is the observed increase in younger age groups with no risk factors. New evidence suggests that many environmental factors, such as air pollution, persistent organic pollutants (POPs), and environmental estrogens are implicated as risk factors for type-2 diabetes mellitus. Animal and human epidemiological studies have shown ubiquitous lipophilic substances, including POPs, are frequently associated with type-2 diabetes mellitus. Such studies have not been undertaken in Indian youth.Methods:This is a cross-sectional study that explored the association between POPs and type-2 diabetes mellitus in Indian urban and rural population. About 7 ml of venous blood was collected from all consenting patients and serum was separated immediately and was transported to the lab for further analysis. Serum levels of POPs, including organochlorine (OC) compounds and organophosphorus pesticides, were estimated using sample gas chromatography-mass spectrometry (GC-MS). The fasting blood sugar values and the serum levels of POPS were tested using Pearson correlation coefficient. The magnitude of increase in blood sugar corresponding to increase in POPs was analyzed using linear regression analysis. The odds ratios (ORs) were expressed at 95% confidence intervals (CIs).Results:Three OC pesticides and one organophosphate pesticide were strongly associated with increasing blood sugar levels after adjusting for age, sex, and body mass index – lindane (OR 4.95, 95% CI 1.03–23.73), DDT o, p' (OR 3.50, 95% CI 1.04–11.73), dimethoate (OR 19.31, 95% CI 4.22–88.37), and dichlorvas (OR 6.33, 95% CI 1.28–31.18).

Predictive significance of first trimester serum uric acid as risk factor for the gestational diabetes mellitus.

Objective: Determining the predictive significance of first trimester serum uric acid for the development of gestational diabetes mellitus (GDM) in pregnant women. Study Design: Case Control study. Setting: Department Gynecology and Obstetrics, Shaheed Muhtrama Benazir Bhutto Medical College Layari General Hospital Karachi. Period: March 2017 to December 2018. Material &amp; Methods: Sample of 172 pregnant women in first trimester (&lt;14 weeks gestation) were divided into; 72 controls and 72 cases through purposive sampling. Pregnant women with fasting blood glucose (FBG) ≥100 mg/dl were defined as GDM. FBG was estimated by hexokinase and uric acid by enzymatic method (uricase) using commercial colorimetric assay (Nikken Seal Co., Ltd, Japan). Data was analyzed on SPSS software 21.0 (IBM, Inc USA) at 95% CI. Results: Maternal age of control and cases was noted 30.23±1.47 and 30.14±1.41 years. Gestational age in controls was 9.80±2.23 weeks compared to 10.37±2.34 weeks in cases. Serum Uric acid in control was 3.19±0.49 mg/dl compared to 3.73±0.43 mg/dl in cases (P=0.0001). Logistic regression analysis model generated ROC curve shows excellent area under the curve (AUC) of 0.92 [95% CI (0.87-0.97)] with a diagnostic threshold of 3.91 mg/dl for uric acid. At this Uric acid threshold, the specificity and sensitivity was 96.4% and 69.7% respectively (P=0.0001). Conclusion: It is concluded first trimester serum uric acid may be used for predicting the future development of gestational diabetes mellitus.