Risk Of Diabetic Complications Research Articles

Clinical Characteristics and Glycaemic Control in Adults Living with Type 1 Diabetes: A 1-Year Retrospective Chart Review at Two South African Public Sector Tertiary Hospitals

Abstract Background: An estimated 11.8% of the South African population are living with diabetes. There is a paucity of data related to the clinical characteristics and glycaemic control in people living with T1DM within the South African public healthcare sector. Objective: To describe the clinical characteristics and glycaemic control of people living with T1DM in a public health care setting. Methods: The study was an observational study conducted at two tertiary public sector hospitals in South Africa by means of a chart review. The study involved adults living with T1DM treated with human insulin for 12 months prior to the date of informed consent. Results: A total of 224 patients with T1DM were enrolled, with 190 (84.8%) from Chris Hani Baragwanath Academic Hospital and 34 (15.2%) from Klerksdorp Tshepong Hospital Complex. One patient withdrew consent, leaving a total analysed population of 223. Of the 223 patients, 37 (16.6%) were controlled (most recent glycosylated haemoglobin (HbA1c) < 7%) while the remainder 186 (83.4%) were uncontrolled (most recent HbA1c ≥ 7%). The mean age of the study group was 33 ± 9 years. The majority of participants were female (122 [54.7%]) and of black ethnicity (215 [96.4%]). The mean number of hypoglycaemic events per patient-year was 151.4 (SD ± 213.9). Diabetic ketoacidosis occurred more frequently in the uncontrolled group. Conclusion: The majority of patients in this study did not achieve target HbA1c, placing them at higher risk for long-term diabetes complications. Poor glycaemic control, leading to long term complications, as well as hypoglycaemia and diabetic ketoacidosis adds further strain to the resource constrained public healthcare in South Africa.

Sodium-glucose cotransporter 2 inhibitors and mitochondrial functions: state of the art.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a class of newly introduced antidiabetic drugs with potent hypoglycemic effects. Recent evidence suggests that these drugs have extraglycemic impacts and are therefore able to provide additional benefits beyond glucose lowering. Mitochondrial dysfunction is a central facet of many disorders that negatively impacts many tissues and organs, especially in the setting of diabetes. Therefore, it would be hugely beneficial if an antidiabetic drug could also provide mitochondrial benefits to improve cellular function and reduce the risk of diabetic complications. In this review, we have surveyed the literature for possible mitochondrial benefits of SGLT2is and we discuss the possible mechanisms involved.

Update of nutritional recommendations in the treatment of type 2 diabetes

Dietary management of type 2 diabetes is essential to improve glycaemic control et reduce risk of diabetes complications. Key recommendations for people with diabetes are largely similar to those for the general population. Overweight or obese diabetic persons should be supported with evidence-based treatments to achieve and maintain weight loss. A wide range of carbohydrate intakes are acceptable and diets with a low glycaemic index or low glycaemic load may be recommended, provided their composition is consistent with overall diet recommendations for dietary fibers, sugars, saturated fats and proteins. It is also important to consume minimally processed plant foods, such as whole grains, vegetables, whole fruits, legumes, while reducing the consumption of red and processed meats, sodium and sugar-sweetened beverages.

To Determine Frequency and Outcome of Dyslipidemia in Diabetic Foot Patients

Objective: To determine frequency and outcome of Dyslipidemia in Diabetic foot patient Study Design: Cross sectional study Place and Duration: Divisional Head Quarter Teaching (DHQ) Hospital Mirpur AJK from January 2021 to January 2022. Methodology: This study includes one hundred and thirty nine (139) patients with Type 2 diabetes and diabetic foot related complication. Patient diagnosed case of type2 DM on oral hypoglycemic agents or on insulin therapy of age >30 of either gender admitted with history of wound in lower limb confirmed on physical examination measuring ankle brachial pressure Index(ABPI) were evaluated for ulcer ,cellulitis and gangrene by using WAGNER's classification. Dyslipidemia is assessed in these patient by sending their fasting lipid profile and data is entered into specially designed Performa. Results: We found that majority of cases having abnormal lipid profile. Dyslipidemia with significant difference was found in diabetic foot patients, 54.7% (n=76) patients show HDL <35 ,56.1%(n=77 )have cholesterol >200mg/dl and 69.8%(n=97) have TAG>150mg/dl. 29.5% patient with diabetes have superficial ulcer, while deep ulcer, cellulitis, localized and extensive gangrene was found with percentage of 31.7% , 20.1% ,10.8%, 7.9% respectively . Conclusion: We concluded that Dyslipidemia is a modifiable risk factor for diabetic foot related complications. So diabetic patients must be advised regular Lipid Profile to decrease risk of diabetic foot related complication. Keywords: Diabetes Mellitus (DM), Dyslipidemia, Diabetic foot, PAD and neuropathy

Association of Urinary Nitrate With Diabetes Complication and Disease-Specific Mortality Among Adults With Hyperglycemia.

The hyperglycemia condition disrupts metabolism of nitrate/nitrite and nitric oxide, and dietary nitrate intake can restore nitric oxide homeostasis. This study aims to examine whether urinary nitrate is associated with diabetes complications and long-term survival among people with hyperglycemia. A total of 6208 people with hyperglycemia who participated in the National Health and Nutrition Examination Survey from 2005 to 2014 were enrolled. Diabetes complications included congestive heart failure, coronary heart disease, angina, stroke, myocardial infarction, diabetic retinopathy, and nephropathy. Mortality was obtained from the National Death Index until 2015. Urinary nitrate was measured by ion chromatography coupled with electrospray tandem mass spectrometry, which was log-transformed and categorized into tertiles. Logistic regression models and Cox proportional hazards models were respectively performed to assess the association of urinary nitrate with the risk of diabetes complications and disease-specific mortalities. After adjustment for potential confounders, including urinary perchlorate and thiocyanate, compared with the participants in the lowest tertile of nitrate, the participants in the highest tertile had lower risks of congestive heart failure (odds ratio [OR] 0.41; 95% CI, 0.27-0.60) and diabetic nephropathy (OR 0.50; 95% CI, 0.41-0.62). Meanwhile, during a total follow-up period of 41 463 person-years, the participants in the highest tertile had lower mortality risk of all-cause (hazard ratio [HR] 0.78; 95% CI, 0.62-0.97), cardiovascular disease (CVD) (HR 0.56; 95% CI, 0.37-0.84), and diabetes (HR 0.47; 95% CI, 0.24-0.90), which showed dose-dependent linear relationships (P for nonlinearity > 0.05). Moreover, no association between nitrate and cancer mortality was observed (HR 1.13; 95% CI, 0.71-1.80). Higher urinary nitrate is associated with lower risk of congestive heart failure and diabetic nephropathy, and lower risk of all-cause, CVD, and diabetes mortalities. These findings indicate that inorganic nitrate supplementation can be considered as a supplementary treatment for people with hyperglycemia.

Diabetic Foot Risk Assessment among Patients with Type 2 Diabetes in Kenya.

Screening for diabetic foot complications is often neglected, especially during routine and/or annual diabetes check-ups. We assessed the risk of diabetic foot complications among patients with type 2 diabetes in Kenya using the International Working Group on Diabetic Foot risk stratification guidelines to highlight the need for improved foot care. We conducted a descriptive cross-sectional study in Mathari National Teaching and Referral Hospital in Kenya between July and October 2015. Seven hundred patients with type 2 diabetes were identified and 147 were systematically sampled. A trained podiatrist examined patients, and urine and blood samples were taken for biochemical tests and assessed by the investigating team. In total, 44(29.9%) men and 103(70.1%) women were sampled; 75(51.0%) were aged over 55 years, 113(76.9%) were overweight/obese, 117(79.6%) had poor glycaemic control and 125(85%) had never had their feet screened for complications. Thirty participants (20.4%) were categorised as being at high risk for developing diabetic foot complications while 54(36.7%) had moderate risk, 53(36.1%) had low risk and 10(6.8%) had no risk. Compared to other risk groups, those with moderate risk for developing diabetic foot problems had higher mean levels of glycated haemoglobin (9.4%), albumin-creatinine ratio (50.3) and high-density lipoprotein cholesterol (1.4 mmol/L) at presentation. No other differences in clinical and laboratory profiles were noted. Our results show high rates of obesity, and poor glycaemic control in patients with type 2 diabetes and 56.5% of patients are categorised as being a moderate-to-high risk for foot problems. This highlights the need for healthcare professionals and patients in Kenya to be sensitised regarding the importance of foot screening to prevent lower-extremity complications.

Independent euglycaemic hyperinsulinaemic clamp studies validate clinically applicable formulae to estimate insulin sensitivity in people with type 1 diabetes

Background and aimLow insulin sensitivity (IS) increases Type 1 diabetes (T1D) complication risk and can be estimated by simple formulae developed from complex euglycemic hyperinsulinaemic clamp studies. We aimed to validate these formulae using independent clamp data. MethodsClamps were performed in 104 T1D adults. Measured glucose disposal rate (GDR) was correlated with eGDR and eLog10 M/I calculated by five IS formulae. ResultsCorrelations ranged between 0.23–0.40. Two IS formulae (by the authors), using age, sex, HDL-C, HbA1c, pulse pressure, BMI, and waist-hip-ratio had the highest correlation with measured GDR and the best performance in detecting low IS.

Cluster analysis of Thai patients with newly diagnosed type 2 diabetes mellitus to predict disease progression and treatment outcomes : A prospective cohort study

IntroductionType 2 diabetes mellitus (T2D) is highly heterogeneous in disease progression and risk of complications. This study aimed to categorize Thai T2D into subgroups using variables that are commonly available...

Statin Therapy is Associated with Higher Risk of Diabetic Complications: A Population-Based Cohort Study

BackgroundData regarding diabetic complications with chronic statin use among Asian population is very limited. Hence, we investigated diabetic progression in diabetic patients receiving statin therapy by evaluating the association with acute and chronic diabetic complications. MethodsThis retrospective population-based cohort study included patients aged 40 years or older who were diagnosed with type-2 diabetes mellitus (T2DM) in Hong Kong between January 1st, 2009 and December 31st, 2009 and followed up till December 31st, 2019. Patients were divided into statin users and non-users, and propensity score matching (PSM) was performed based on demographics, prior comorbidities, and medications. The study outcomes were new-onset Diabetic Ketoacidosis/ Hyperosmolar Hyperglycaemic State (DKA/HHS), new diabetic ophthalmological, neurological, and renal complications. ResultsAfter 1:1 PSM, the study cohort consisted of 3,247 statin users (48.6% male, age 65.03±11.99 years, mean follow-up 5.68±2.39 years) and 3,247 (50.5% male, age 63.20±12.15 years, mean follow-up 5.78±2.34 years) matched statin non-users. Cox proportional hazards model analyses showed that statin therapy was associated with a higher risk of new diabetic renal complications (HR: 1.44, [1.21-1.71], p<0.001), new diabetic ophthalmological complications (HR: 1.44, [1.19-1.73], p<0.001), and new diabetic neurological complications (HR: 1.47, [1.09-1.96], p<0.01), although it was not associated with a higher risk of DKA/HHS (HR: 1.31, [95% CI, 0.89-1.94], p=0.167). The statistical significance of the associations was not maintained under sensitivity analysis which involved excluding patients with previous coronary heart disease. ConclusionAmongst T2DM patients, statin use was associated with higher risk of developing chronic diabetic complications after PSM with multiple adjustments.

Abstract #1324693: Evaluation of Therapeutic Targets Achievements in Type 2 Diabetes Mellitus Patients Attending Governmental Hospital in Baghdad

Type 2 diabetes mellitus is a chronic preventable disorder. Its prevalence increasing in Iraq and worldwide. Achieving therapeutic target goals help to prevent acute diabetic-related complications and to minimize the risk of long-term diabetic complications. Many patients in Iraq depend on public hospitals for follow-up and treatment because it is free. The purpose of this study was to evaluate a sample of Iraqi patients with type 2 diabetes for achieving the therapeutic target goals of treatment.

Prediction of clinical events by liver stiffness and chronic kidney disease by NAFLD in patients with type-2 diabetes

Background & AimsNon-alcoholic fatty liver disease (NAFLD) is associated with poorer glycemic control and a higher risk of type-2 diabetes (T2D) complications, extrahepatic and cardiovascular disease (CVD). Our study aim was to evaluate the association between NAFLD, T2D complications, and the development of overall clinical events (OCE) (CV, liver-related, and mortality) in patients with T2D. MethodsProspective single-center study comprising T2D subjects with no history of CVD and non-T2D matched controls. Patients were selected from the Outpatient Diabetes Clinic of Vall d’Hebron Hospital and related primary care centers. Results186 diabetics and 57 controls were included. Amongst T2D, 124/186 subjects had NAFLD (66.6%). T2D-NAFLD subjects showed a heavier metabolic burden and higher median liver stiffness (5.6kPa [4.5–7.3] vs 4.8 [4.2–5.8]; p=0.004) compared to non-NAFLD diabetics. During a median follow-up of 5.6 years, 33 (17.7%) T2D patients developed OCE vs 4 (7.0%) controls (p=0.049). No differences were found for OCE between NAFLD and non-NAFLD diabetics (16.9% vs 19.4%; p=0.68). CV was the most reported outcome and only one liver event occurred. NAFLD diabetics showed more often chronic kidney disease (CKD), whereas T2D complications and subclinical CVD rates were similar. A higher liver stiffness, older age, and male gender were independently associated with OCE amongst the entire T2D population and NAFLD diabetics. ConclusionsNAFLD and liver stiffness were associated with CKD and clinical outcomes in diabetics, respectively. A hepatic evaluation is recommended to identify high-risk T2D patients that would benefit from early referral to specialized care.

Therapeutic Efficacy of Natural Product 'C-Phycocyanin' in Alleviating Streptozotocin-Induced Diabetes via the Inhibition of Glycation Reaction in Rats.

Diabetes is a long-term metabolic disorder characterized by persistently elevated blood sugar levels. Chronic hyperglycemia enhances glucose-protein interactions, leading to the formation of advanced glycation end products (AGEs), which form irreversible cross-links with a wide variety of macromolecules, and accumulate rapidly in the body tissues. Thus, the objective of this study was to assess the therapeutic properties of C-phycocyanin (C-PC) obtained from Plectonema species against oxidative stress, glycation, and type 2 diabetes mellitus (T2DM) in a streptozotocin (STZ)-induced diabetic Wistar rat. Forty-five days of C-PC administration decreased levels of triglycerides (TGs), blood glucose, glycosylated hemoglobin, (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), liver and kidney function indices, and raised body weight in diabetic rats. C-PC suppressed biochemical glycation markers, as well as serum carboxymethyllysine (CML) and fluorescent AGEs. Additionally, C-PC maintained the redox state by lowering lipid peroxidation and protein-bound carbonyl content (CC), enhancing the activity of high-density lipoprotein cholesterol (HDL-C) and renal antioxidant enzymes, and preserving retinal and renal histopathological characteristics. Thus, we infer that C-PC possesses antidiabetic and antiglycation effects in diabetic rats. C-PC may also act as an antidiabetic and antiglycation agent in vivo that may reduce the risk of secondary diabetic complications.

Diabetes duration and types of diabetes treatment in data-driven clusters of patients with diabetes

This study aimed to cluster patients with diabetes and explore the association between duration of diabetes and diabetes treatment choices in each cluster. A Two-Step cluster analysis was performed on 1332 Chinese patients with diabetes based on six parameters (glutamate decarboxylase antibodies, age at disease onset, body mass index, glycosylated hemoglobin, homeostatic model assessment 2 to estimate β-cell function and insulin resistance). Associations between the duration of diabetes and diabetes treatment choices in each cluster of patients were analyzed using Kaplan-Meier survival curves and logistic regression models. The following five replicable clusters were identified: severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD). There were significant differences in blood pressure, blood lipids, and diabetes-related complications among the clusters (all P < 0.05). Early in the course of disease (≤5 years), compared with the other subgroups, the SIRD, MOD, and MARD populations were more likely to receive non-insulin hypoglycemic agents for glycemic control. Among the non-insulin hypoglycemic drug options, SIRD had higher rates of receiving metformin, alpha-glucosidase inhibitor (AGI), and glucagon-like peptide-1 drug; the MOD and MARD groups both received metformin, AGI and sodium-glucose cotransporter 2 inhibitor (SGLT-2i) drug ratio was higher. While the SAID and SIDD groups were more inclined to receive insulin therapy than the other subgroups, with SAID being more pronounced. With prolonged disease course (>5 years), only the MOD group was able to accept non-insulin hypoglycemic drugs to control the blood sugar levels, and most of them are still treated with metformin, AGI, and SGLT-2i drugs. While the other four groups required insulin therapy, with SIDD being the most pronounced. Clustering of patients with diabetes with a data-driven approach yields consistent results. Each diabetes cluster has significantly different disease characteristics and risk of diabetes complications. With the development of the disease course, each cluster receives different hypoglycemic treatments.

Association of visit-to-visit HbA1c variability with cardiovascular diseases in type 2 diabetes within or outside the target range of HbA1c.

Although a growing attention has been recently paid to the role of HbA1c variability in the risk of diabetic complications, the impact of HbA1c variability on cardiovascular diseases (CVD) in type 2 diabetes is still debated. The aim of the study is to investigate the association of HbA1c variability with CVD in individuals within or outside the target range of HbA1c. Using data from Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE), we enrolled 855 patients with type 2 diabetes in China. The primary outcomes included major macrovascular events and major microvascular events. Visit-to-visit HbA1c variability was expressed as the coefficient of variation (CV) of five measurements of HbA1c taken 3-24 months after treatment. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR). Among 855 patients in the intensive glucose treatment group, 563 and 292 patients were assigned to the group of "within the target range of HbA1c" (WTH) (updated mean HbA1c ≤ 7.0%) and "outside the target range of HbA1c" (OTH) (updated mean HbA1c > 7.0%), respectively. HbA1c variability was positively associated with the risk of major microvascular events in all patients and both the subgroups during a median follow-up period of 4.8 years. Particularly, the risk related to HbA1c variability was higher in patients in WTH group for the new or worsening nephropathy [aHR: 3.35; 95% confidence interval (CI): 1.05-10.74; P = 0.042]. This retrospective cohort study confirmed the positive correlation between HbA1c variability and major microvascular events, especially in subjects in WTH or OTH.

LBODP027 Detection Of Metabolic Syndrome In Adolescent With Explainable Artificial Intelligence: Which Place For Mean Blood Pressure?

Abstract Metabolic syndrome (MetS) definition in adolescents is complicated by the physiologic evolution with age and sexual maturation of the components of this syndrome. While screening for MetS in youth should be useful to assess current complications and prevent future ones, it is not simple in clinical practice due to the number of different definitions of MetS in adolescents, which are generally based for most of them on percentiles. The aim of this study was to check the validity of artificial intelligence (AI)-based scores in screening for MetS in adolescents, using new parameters identified with AI techniques and without using percentiles. This study included 1,086 adolescents (559 girls and 527 boys) aged 12 to 18 with BMI 21.2±3.9 kg/m2. All had anthropometric measurements taken and had blood tests. Mean blood pressure (MBP), and triglyceride glucose index (TyG) were calculated. AI techniques are characterized by their black-box nature. Explainable AI methods are used to extract the learned function. "Gini importance" techniques were tested and used to build new scores for the detection of MetS among children and adolescents. We used 2007 IDF and Cook definitions of MetS to test the validity of these scores. MetS prevalence was 0.9% and 2.2% according to IDF and Cook definitions, respectively. The most accurate AI scores (S-IDF, S-Cook) for the detection of MetS according to these definitions include age, waist circumference, MBP and TyG index: S-IDF= - 0.52×age + 0.48×WC - 0.51×TyG + 0.27×MBP; S-Cook= - 0.52×age + 0.48×WC - 0.51×TyG + 0.29×MBP. With cut-off levels of 51.35/51. 06, these AI scores offer AUC 0.91/0.93, specificity 81%/75%, and sensitivity 90%/100% for MetS detection. Furthermore, with a cut-off point of 92 mmHg, MBP alone offers a better specificity 85%/83% and sensitivity 80%/88%, AUC 0.89, than TyG index alone (100%/46% for specificity, 30%/88% for sensitivity) to detect MetS based on IDF and Cook definitions, and slightly lower performance than AI-scores. MBP was associated with the occurrence of type 2 diabetes (T2D) and cardiovascular disease among the general population; cardiovascular disease and cardiovascular mortality among patients with T2D; and a discriminatory ability as strong as for SBP and DBP in predicting T2D. However, we did not find in the literature similar studies in the pediatric population. TyG index has been assessed mainly in adults and in a few studies in adolescents, and recently proposed as an alternative marker of insulin resistance and a marker of high risk for diabetes and cardiovascular complications or events in both adult and pediatric populations. In this study, AI techniques have proven their ability to extract knowledge from data and come up with new scores based on simplified criteria in adolescents. It allowed us to reveal the MBP as a simple alternative marker for MetS screening in adolescents. Presentation: No date and time listed

Artificial intelligence based prediction models for individuals at risk of multiple diabetic complications: A systematic review of the literature.

The aim of this review is to examine the effectiveness of artificial intelligence in predicting multimorbid diabetes-related complications. In diabetic patients, several complications are often present, which have a significant impact on the quality of life; therefore, it is crucial to predict the level of risk for diabetes and its complications. International databases PubMed, CINAHL, MEDLINE and Scopus were searched using the terms artificial intelligence, diabetes mellitus and prediction of complications to identify studies on the effectiveness of artificial intelligence for predicting multimorbid diabetes-related complications. The results were organized by outcomes to allow more efficient comparison. Based on the inclusion/exclusion criteria, 11 articles were included in the final analysis. The most frequently predicted complications were diabetic neuropathy (n = 7). Authors included from two to a maximum of 14 complications. The most commonly used prediction models were penalized regression, random forest and Naïve Bayes model neural network. The use of artificial intelligence can predict the risks of diabetes complications with greater precision based on available multidimensional datasets and provides an important tool for nurses working in preventive health care. Using artificial intelligence contributes to a better quality of care, better autonomy of patients in diabetes management and reduction of complications, costs of medical care and mortality.

Blood Glucose, HbA1c Level, and its Correlation with VEGF-A (+405G/C) Polymorphism as Biomarker Predicts the Risk of Retinopathy and Nephropathy in Type 2 Diabetic Patients.

Diabetes-related vascular complications linked to increase in the expression of VEGF and its receptors. It helps to accelerate tissue damage inflicted by hyperglycemia, which is potential risk for diabetic complications. The study aimed to assess VEGF genetic polymorphism and its correlation with glucose and HbA1C level among Sudanese patients with diabetic retinopathy and nephropathy. A case-control study was conducted among a total of 252 subjects and divided into four groups of 63 subjects each. Glucose and HBA1c were measured then the VEGF gene was amplified using polymerase chain reaction. The data were analyzed using SPSS. The HBA1c, and blood glucose levels had significantly (P value≤0.00001) highest mean in the DR group, DN group followed by DM. There is a non-significant correlation between VEGF Genotypes and HbA1c, and blood glucose levels (P value≤0.102, 0.173) Patients with GC genotypes will be 74.6%, and 54% higher at risk to develop DR, and DN respectively and 40 % lower at risk to develop DM than those without GC genotype. While patients with CC genotypes will be 22.2% higher at risk of developing DM and 9.5%, 12.2% higher at risk of developing DR and DN respectively. The VEGF +405G/C gene polymorphism is linked to diabetic retinopathy, and diabetic nephropathy in type 2 Sudanese diabetics, and the presence of the GC genotypes and G allele is a significant predictor for retinopathy. There is no significant relation between HbA1C serum levels, blood glucose, and the VEGF +405G/C gene polymorphism.

Association of cardiovascular health with diabetic complications, all-cause mortality, and life expectancy among people with type 2 diabetes

BackgroundWe aimed to assess the impact of healthy cardiovascular health (CVH) on diabetic complications, mortality, and life expectancy among people with type 2 diabetes and to explore whether inflammation marker mediate these associations.MethodsThis prospective cohort study included 33,236 participants (aged 40–72) with type 2 diabetes from the UK Biobank with annual follow-up from 2006 to 2010 to 2020. Type 2 diabetes was ascertained from self-report, glycated hemoglobin ≥ 6.5%, hospital inpatient registry, or glucose-lowering medication use. Information on mortality was derived from the national death registry. Favorable CVH metrics consisted of non-smoker, regular physical activity, a healthy diet, non-overweight, untreated resting blood pressure < 120/<80 mm Hg, and untreated total cholesterol < 200 mg/dL. Participants were categorized into three groups according to the number of favorable CVH metrics: unfavorable (0 or 1); intermediate (any 2 or 3); and favorable (4 or more). Inflammation marker, as measured by C-reactive protein (CRP), was assessed at baseline and categorized as low (≤ 3 mg/L) and high (> 3 mg/L). Data were analyzed using Cox regression models, flexible parametric survival models, and mediation models.ResultsDuring the follow-up (median: 11.7 years), 3133 (9.4%) cases of diabetes complications and 4701 (14.1%) deaths occurred. Compared to unfavorable CVH, favorable CVH was associated with a reduced risk of diabetes complications (HR, 0.35; 95% CI, 0.26–0.47) and all-cause mortality (HR, 0.53; 95% CI, 0.43–0.65). In participants with unfavorable CVH, life expectancy at age 45 had a significantly reduction of 7.20 (95% CI, 5.48–8.92) years compared to those with a favorable CVH. Among people with type 2 diabetes, the proportions of diabetes complications and all-cause mortality that would be reduced by promoting the favorable CVH was 61.5% and 39.1%, respectively. CRP level mediated 14.3% and 29.7% of the associations between CVH and diabetic complication and all-cause mortality, respectively.ConclusionA favorable CVH was associated with lower risk of diabetes complications and mortality risk, and was associated with a longer life expectancy among people with type 2 diabetes. This association may be in part accounted for by inflammatory processes. Our findings highlight the importance of favorable CVH for the prevention of diabetic complications and all-cause mortality among people with type 2 diabetes, and underscores the need to monitor inflammation among people with unfavorable CVH.

“CERDIK” Healthy Lifestyle for Reducing Complications of Diabetes Mellitus

Background: Diabetes mellitus that is not handled properly raises severe complications such as heart attack, stroke, infection of heavy legs or ulcers, kidney failure, sexual dysfunction, and eye disorders. The government recommends adopting healthy living behaviors with regular health checks, getting rid of cigarette smoke, diligent physical activity, a healthy and balanced diet, adequate rest, and stress management (CERDIK) to prevent and control diabetes complications. &#x0D; Methods: The population in this study were people with diabetes mellitus and the sample consisted of 32 respondents who were selected by purposive sampling with inclusion criteria. The CERDIK implementation is given once a week for one month. The risk of diabetes complications is calculated using the FINRISC Instrument (Fennish Diabetes Risk Score). Hypothesis Testing using the Paired Sample Test.&#x0D; Results: The results of this study show the majority of the females, reaching 75% with the most dominant age &lt;45 years, 53.1%. The normal dominant waist circumference was 62.5%, the history of hypertension reached 56.2%, and increased blood sugar reached 59.4%. Most of the BMI was normal (81.3%), had a family history of DM (71.9%), 81.2% ate fruits and vegetables, and did 87.5% of physical activity. DM complications are effectively reduced with CERDIK (ρ=0.000). &#x0D; Conclusion: The risk of complications of diabetes mellitus can be prevented through a healthy lifestyle by routinely and regularly conducting regular health checks, avoiding and not smoking, being diligent and regular in exercising, consuming healthy foods with balanced calories, adequate rest, and being able to maintain a healthy lifestyle while managing stress.

The Effect of Smoking Cessation on Body Weight and Other Metabolic Parameters with Focus on People with Type 2 Diabetes Mellitus.

Smokers with diabetes mellitus substantially lower their risks of microvascular and macrovascular diabetic complications, in particular cardiovascular disease, by quitting smoking. However, subsequent post-smoking-cessation weight gain may attenuate some of the beneficial effects of smoking cessation and discourage attempts to quit. Weight gain can temporarily exacerbate diabetes and deteriorate glycemic control and metabolic profile. The molecular mechanisms by which quitting smoking leads to weight gain are largely associated with the removal of nicotine’s effects on the central nervous system. This review addresses mechanisms of post-smoking-cessation weight gain, by reviewing the effects of nicotine on appetite, food intake, eating behaviour, energy expenditure, fat oxidation and appetite-regulating peptides. We also highlight correlations between post-cessation weight gain and risk of type 2 diabetes, consequences of weight gain in people with type 2 diabetes and the role of pharmacotherapies, which combine treatment of nicotine addiction and promotion of weight control.