T2DM Patients Research Articles

Prognostic nomogram for uncontrolled type 2 diabetes using Thailand nation-wide cross-sectional studies.

Uncontrolled type 2 diabetes (T2DM) and limited hemoglobin A1c (HbA1c) levels examination are a burden in community hospitals in Thailand. The nomogram from the patients' information might be a practical solution to identify a high-risk group of diabetic complications. Thus, this study aimed to establish an effective prognostic nomogram for patients with uncontrolled T2DM. Sequential nationwide cross-sectional studies of T2DM patients in 2018 and 2015 were utilized for development and validation groups, respectively, with this chronological order aiming to capture recent trends during development and assess the nomogram's robustness across diverse timeframes. The predictive outcome was uncontrolled T2DM, defined as HbA1c ≥9%. The model was determined by multivariable regression analysis and established an effective prognostic nomogram. The receiver operating characteristic curve, Hosmer-Lemeshow goodness of fit test, and decision curve analysis (DCA) was applied to evaluate the performance of the nomogram. In 2018, 24% of the 38,568 participants in the development group had uncontrolled T2DM (defined as Hba1c ≥9%). The predictive nomogram of uncontrolled diabetes consisted of demographic characteristics, prescription medications, history of diabetic complications, and laboratory results (C-statistic of 0.77). The goodness of fit test and DCA showed good agreement between the result and clinical application for T2DM. The predictive nomogram demonstrates simplicity, accuracy, and valuable prediction to enhance diabetic care in resource-limited countries, including Thailand.

Matrix metallopeptidase 9 contributes to the beginning of plaque and is a potential biomarker for the early identification of atherosclerosis in asymptomatic patients with diabetes.

To determine the roles of matrix metallopeptidase-9 (MMP9) on human coronary artery smooth muscle cells (HCASMCs) in vitro, early beginning of atherosclerosis in vivo in diabetic mice, and drug naïve patients with diabetes. Active human MMP9 (act-hMMP9) was added to HCASMCs and the expressions of MCP-1, ICAM-1, and VCAM-1 were measured. Act-hMMP9 (n=16) or placebo (n=15) was administered to diabetic KK.Cg-Ay/J (KK) mice. Carotid artery inflammation and atherosclerosis measurements were made at 2 and 10 weeks after treatment. An observational study of newly diagnosed drug naïve patients with type 2 diabetes mellitus (T2DM n=234) and healthy matched controls (n=41) was performed and patients had ultrasound of carotid arteries and some had coronary computed tomography angiogram for the assessment of atherosclerosis. Serum MMP9 was measured and its correlation with carotid artery or coronary artery plaques was determined. In vitro, act-hMMP9 increased gene and protein expressions of MCP-1, ICAM-1, VCAM-1, and enhanced macrophage adhesion. Exogenous act-hMMP9 increased inflammation and initiated atherosclerosis in KK mice at 2 and 10 weeks: increased vessel wall thickness, lipid accumulation, and Galectin-3+ macrophage infiltration into the carotid arteries. In newly diagnosed T2DM patients, serum MMP9 correlated with carotid artery plaque size with a possible threshold cutoff point. In addition, serum MMP9 correlated with number of mixed plaques and grade of lumen stenosis in coronary arteries of patients with drug naïve T2DM. MMP9 may contribute to the initiation of atherosclerosis and may be a potential biomarker for the early identification of atherosclerosis in patients with diabetes. https://clinicaltrials.gov, identifier NCT04424706.

Analyzing the changing trend of corneal biomechanical properties under different influencing factors in T2DM patients

To analyze the changing trend of CH and CRF values under different influencing factors in T2DM patients. A total of 650 patients with T2DM were included. We discovered that the course of T2DM, smoking history, BMI, and FBG, DR, HbA1c, TC, TG, and LDL-C levels were common risk factors for T2DM, while HDL-C levels were a protective factor. Analyzing the CH and CRF values according to the course of diabetes, we discovered that as T2DM continued to persist, the values of CH and CRF gradually decreased. Moreover, with the increase in FBG levels and the accumulation of HbA1c, the values of CH and CRF gradually decreased. In addition, in patients with HbA1c (%) > 12, the values of CH and CRF decreased the most, falling by 1.85 ± 0.33 mmHg and 1.28 ± 0.69 mmHg, respectively. Compared with the non-DR group, the CH and CRF values gradually decreased in the mild-NPDR, moderate-NPDR, severe-NPDR and PDR groups, with the lowest CH and CRF values in the PDR group. In patients with T2DM, early measurement of corneal biomechanical properties to evaluate the change trend of CH and CRF values in different situations will help to identify and prevent diabetic keratopathy in a timely manner.

A Comparative Analysis of Fractional Excretion of Sodium, Potassium and Magnesium among T2DM Patients with Increased Albuminuria and Normal Albuminuria in a Tertiary Care Hospital- An Observational Study

Background: T2DM often leads to diabetic kidney disease, a condition marked by change in GFR and urinary albumin excretion. The renal handling of key electrolytes like sodium, potassium, and magnesium plays a crucial role in the progression of renal tubulointerstitial damage in diabetic patients. Aim of the study: The aim of this study was to compare the fractional excretion of sodium, potassium and magnesium among T2DM patients with increased albuminuria and normal albuminuria. Methods: This observational study was conducted in Department of Nephrology, Chattogram, Bangladesh from February 2021 to January 2022. Total 125 patients with T2DM were included in this study. Result: Baseline characteristics showed no significant differences across the study groups. Biochemically, eGFR decreased non-significantly from 95.5 to 86.1 ml/min/1.73 m² across groups, while UACR significantly increased from 14.3 to 1056 mg/gm (P<0.001). FBG levels were similar, but 2hPPBG showed a significant decrease from 8.2 to 7.4 mmol/l (P=0.0041). HbA1C levels varied slightly. FENa, FEK, and FEMg showed significant differences across groups, with FENa ranging from 0.59% to 0.56% (P=0.0016), FEK from 9.4% to 6.9% (P=0.0358), and FEMg from 2.87% to 5.58% (P=0.001). Correlations revealed significant negative associations of eGFR with FENa, FEK, and FEMg, and a significant positive correlation of FEMg with UACR. No significant correlations were found between FBG, 2hPPBG, HbA1C, and the electrolytes excretion. Conclusion: Significant variations in the fractional excretion of sodium, potassium, and magnesium were observed. Higher eGFR was associated with lower electrolyte excretion, and a significant positive correlation was found between magnesium excretion and UACR.

Exploring T2DM Patients’ Motivation in Diabetic Self-care: a Qualitative Study

Motivation refers to the larger mental processes that guide individual behaviours. Self-care behaviours are crucial in aiding disease adaptation by improving treatment adherence, disease control, quality of life, and self-perceived health status. Diabetic patients have been shown to have fewer concerns about their health. Thus, this study aimed to explore the motivating factors of diabetes self-care (DSC) among people with Type 2 Diabetes Mellitus (T2DM). A qualitative approach was adopted to explore and better understand the motivation behind self-care among diabetic patients. In-depth interviews (IDI) were conducted with 21 patients from two government healthcare facilities in Selangor, namely Hospital Tengku Ampuan Rahimah, Klang and the Meru Health Clinic from November to December 2019. All the qualitative data were managed using the NVivo software and thematically analysed. In general, this study identified two major types of motivation: self-motivation and social- motivation. Under self-motivation, there were six significant sub-themes, i.e. perceived better health condition having received DM exposure, perceived importance of diet and medication, self or personal experience, fear of diabetes complications, perceived importance of lifestyle modification, and positive thinking. In addition, the results revealed five significant sub-themes in terms of social-motivation: family support, community support, others’ experiences, financial support, and employer support. Our findings demonstrated the importance of various motivating factors in providing self-care support to diabetic patients. A well-planned diabetes management programme should incorporate motivational support to encourage patients to better manage their conditions.

The nutritional value and health properties of tahini and tahini-based products

Tahini is an oily paste made from mechanically hulled, roasted and ground sesame, which is used as an ingredient in many traditional Middle Eastern recipes. It is rich in MUFAs, PUFAs, polyphenols, minerals and vitamins. Literature about the health effects of tahini consumption is limited since only two studies in human population and one study in animal model are available, so far. A 6-week supplementation with 28 g tahini in T2DM patients led to lower TG and hs-CRP and higher HDL-C levels. Additionally, consumption of 50 g tahini decreased plasma glucose and increased total phenolic content, urinary 8-iso-prostaglandin F2a and flow-mediated dilatation in healthy individuals postprandially. Moreover, in 40 male albino rats of Wistar strain, sesame butter decreased glucose and malondialdehyde and increased HDL-C and total antioxidant capacity compared to control. Hummus is a dip or spread made from boiled chickpeas, blended with tahini, lemon juice, olive oil, garlic and salt. It is rich in vitamins, minerals and different bioactive compounds including phytic acid, tannins, carotenoids, sterols, and other polyphenols. Hummus consumption has been positively related with weight management and glucose-insulin response. Halva is a low-moisture confectionery that contains tahini, sugar, citric acid and Saponaria officinalis root extract and its consumption has been found to ameliorate glycemic control. In conclusion, tahini could be beneficial regarding diabetes-induced inflammation, oxidative stress and endothelial function. Since more research is needed in order to confirm the aforementioned properties, tahini and tahini-based products seem to be a healthy choice, aiming at promoting healthy dietary patterns.

The effect of cognitive decline on the medication adherence in patients with type II diabetes mellitus

Background: Type II Diabetes Mellitus (T2DM) is a risk factor for decreased cognitive function that is rarely recognised by patients, apart from age and other factors. Objective: This study aims to assess the effect of decreased cognitive function on medication adherence in T2DM patients. Method: This study used a cross-sectional design conducted at the Pasar Minggu Community Health Center, Jakarta, Indonesia. Cognitive function was assessed using the validated Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina) questionnaire. Results: One hundred twenty-seven T2DM patients (75.6% female) with a mean age of 58.69 years were recruited. The proportion of T2DM patients with decreased cognitive function was quite high, namely 61%. The proportion of non-adherent patients in the group with decreased cognitive function (70.6%) was greater than in the normal group (29.4%). Decreased cognitive function significantly affected non-adherence in taking medication with aOR 3.744 (95% CI 1.485–9.442), p = 0.005, after controlling for age, education level, HbA1c value, and comorbid dyslipidemia. Conclusion: Patients with decreased cognitive function are 3.7 times more likely to be non-compliant with medication, regardless of age, education level, HbA1c value, and dyslipidemia. Special management is needed for T2DM patients with decreased cognitive function, such as caregiver assistance, education by pharmacists, and simpler drug regimes.

478 Magnetic Resonance Biomarkers of Metabolic Dysfunction-Associated Steatotic Liver Disease

OBJECTIVES/GOALS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major public health concern due to its increasing prevalence and association with type 2 diabetes mellitus. Non-invasive magnetic resonance-based biomarkers can aid in the monitoring of disease progression and identification of patients at risk for chronic liver disease. METHODS/STUDY POPULATION: Over 600 subjects will be recruited from the San Antonio Mexican American Family Study and from a second study, which consists of (i) T2DM patients diagnosed with either MASLD or metabolic dysfunction-associated steatohepatitis (MASH) or (ii) metabolically healthy controls. Hydrogen-1 MRS and diffusion-weighted MRI (DW-MRI) will be used to measure liver fat fraction and liver stiffness biomarkers, respectively. Several potential biomarkers of liver stiffness will be evaluated in vivo using the intravoxel incoherent motion (IVIM) model for DW-MRI. To further improve the diagnostic accuracy of patients with liver fibrosis, we will integrate MRI/MRS data with relevant clinical indicators of hepatic metabolism. Results will be compared to biopsy samples to evaluate the model’s diagnostic accuracy. RESULTS/ANTICIPATED RESULTS: Based on preliminary data, we predict that IVIM will be able to accurately diagnose hepatic fibrosis in patients with MASLD, allowing it to be implemented in clinics with high-field MRI units easily. Previous studies have shown correlations between IVIM estimates and fibrosis stages, however, none included additional clinical indicators of liver disease in their models. We have already found significant differences in metabolic measurements such as fasting plasma glucose and HbA1c levels. Additionally, the use of machine learning in developing these models has shown improvements in the ability to extract features from the data. The aim is to achieve high accuracy and robustness in the staging of liver fibrosis. DISCUSSION/SIGNIFICANCE: Over 100 million people in the US are affected by MASLD. Without treatment, it progresses from hepatic steatosis to MASH, fibrosis (liver stiffening), and ultimately to hepatic cirrhosis and hepatocellular carcinoma (HCC). Continued research efforts and clinical implementation of MRI and MRS are vital in combating the growing burden of MASLD.

Correlation of dietary inflammation index and dietary pattern with mild cognitive impairment in patients with type 2 diabetes

ObjectiveWe aimed to determine the dietary patterns associated with mild cognitive impairment (MCI) in type 2 diabetes (T2DM) and the correlation of dietary inflammatory index (DII) with MCI. MethodsThe Montreal Cognitive Assessment (MoCA) was used to assess cognitive function. A semi-quantitative food frequency questionnaire was used to collect dietary data and calculate DII. Dietary patterns were determined by reduced-rank regression (RRR), grouping dietary pattern scores and DII into quartiles, with logistic regression for correlation analysis. Dose–response relationships between dietary pattern scores, DII and diabetic MCI were explored using restricted cubic splines (RCS). A mediation analysis was performed to investigate whether DII mediates the association between dietary patterns and MCI. ResultsIn the “Mediterranean-style dietary pattern”, the multivariable-adjusted odds ratio of having MCI was 0.37 (95% CI: 0.20–0.68; p for trend=0.002) in the highest versus lowest quartiles of the dietary score. In the “high-meat and low-vegetable pattern”, the multivariable-adjusted odds ratio of having MCI was 6.84 (95% CI: 3.58–13.10; p for trend<0.001) in the highest versus lowest quartiles of the dietary score. In the “Western-style dietary pattern”, the multivariable-adjusted odds ratio of having MCI was 2.48 (95% CI: 1.38–4.46; p for trend=0.001). The multivariable-adjusted odds ratio of having MCI was 3.99 (95% CI: 2.14–7.42; p for trend<0.001) in the highest versus lowest quartiles of DII.There is a non-linear dose–response relationship between the “high-meat and low-vegetable pattern” score and the prevalence of MCI, as well as the DII and the prevalence of MCI. The DII partially mediated the impact of the “Mediterranean-style dietary pattern” and the “high-meat and low-vegetable pattern” on MCI. ConclusionIn T2DM patients, greater adherence to the “Mediterranean-style dietary pattern” is associated with a lower probability of having MCI. However, excessive consumption of meat, especially red meat and processed meat, combined with a lack of vegetable intake, is associated with a higher probability of having MCI. Greater adherence to the “Western-style dietary pattern” is associated with a higher probability of having MCI. In addition, a pro-inflammatory diet is associated with a higher probability of having MCI, and DII partially mediates the impact of dietary patterns on MCI.

Comprehension of Long-Term Medications in Patient with Type 2 Diabetes Mellitus: A Kap Study

OBJECTIVES The study aimed to assess the comprehension of long-term medications in patients with Type 2 diabetes mellitus. METHODOLOGY A descriptive cross-sectional study was conducted in Khyber Teaching Hospital Peshawar, Pakistan, a region with potentially low literacy rates that could affect health outcomes. After acquiring approval from the Institutional Ethical Review Board, the study utilized an appropriately designed and validated questionnaire to collect data from 305 willing participants. The questionnaire assessed demographic information, comorbid conditions, and comprehension of long-term medications. RESULTSThe mean age of the patients was 58.52 ± 10.3 years, with a mean HbA1c of 9.15 ± 2.1%. Regarding T2DM treatment, 55.1% used oral anti-diabetic agents, 34.4% used insulin, and 10.2% used both. The complications were diabetic retinopathy (40.7%), chronic kidney disease (28.9%), diabetic foot ulcers (24.9%), cerebrovascular disease (16.7%), and cardiovascular disease (16.6%). Over 50% had T2DM for more than five years. Regarding affordability and access to healthcare, 8.2% couldn't afford medications, 44.9% occasionally missed medicines due to cost, and 74.4% had easy access to healthcare. Comorbidities included hypertension (47.5%) and dyslipidemia (12.8%). CONCLUSION Medication comprehension is crucial for T2DM patients’ health outcomes. Tailored interventions can improve glycemic control and reduce complications risk.

ASSOCIATION OF SERUM URIC ACID WITH DIABETES MELLITUS TYPE-2: A NARRATIVE REVIEW

Diabetes mellitus type 2 (T2DM) is a disease which imposes a great burden on the health resources of the emerging and developing world. It is a global pandemic which leads to chronic complications. Serum uric acid (SUA) is a biomarker that could be of value in detection of early complications and better prognosis in diabetic patients. SUA serves both as a causal factor and disease progression marker in DM, having a causal relationship with diabetic complications. This narrative review aims to determine the association between SUA and T2DM. Research articles from the year 2005 to 2023 were selected for this review. Literature search was conducted from PubMed and Google Scholar which resulted in short listing of 15 articles. It also reflects upon the diabetic complications associated with Hyperuricemia (HUA) and focuses on the health implications of HUA in T2DM patients. SUA and T2DM were negatively associated in 8 research studies and positively associated in 6 studies in which one revealed a partial association, one was prevalent in the female gender only, and one was negatively associated in uncontrolled DM. Another study was associated with both hypouricemia and HUA. Pak J Physiol 2024;20(1):52-7

Screening of Type 2 Diabetes Patients of Khyber Pakhtunkhwa for CDKAL1 Variant (rs10946398)

Diabetes Mellitus Type 2 (T2DM) is a metabolic disorder influenced by environmental and genetic factors, with varied genetic predispositions across populations. Research on T2DM's genetic risk factors in the Pakistani community is limited. Objective: To explore the association between the CDKAL1 gene variant (rs10946398) and T2DM in the Khyber Pakhtunkhwa population in Pakistan. Methods: The study involved 100 T2DM patients and 100 controls, matched by age and gender, following specific inclusion and exclusion criteria. Sociodemographic data were collected alongside 3ml of whole blood for DNA extraction. The CDKAL1 gene was analyzed using PCR-based Sequence Restriction Fragment Length Polymorphism (RFLP), and the data were processed with SPSS version 26.0s. Results: Findings showed that 47% of cases were aged 39 to 59, with 94% having a family history of T2DM and 85% leading a sedentary lifestyle. A significant association was observed between the CDKAL1 rs10946398 variant and T2DM. The GC variant was linked to a fourfold increase in risk (OR: 4.833, CI: 1.197-19.509, P=0.027), and the CC variant had a twofold association (OR: 2.788, CI: 1.545-5.033, P=0.001). These associations persisted after adjusting for family history, age, socioeconomic factors, exercise, and diet. Conclusions: The study identified a significant correlation between the CDKAL1 rs10946398 variants and T2DM susceptibility in the Khyber Pakhtunkhwa population, emphasizing the role of genetic factors in the disease's prevalence within this community.

Relationship between Stress Levels and Body Mass Index on Blood Sugar Levels in Type 2 Diabetes Mellitus Patients in The Working Area of Puskesmas Gemarang

Background: Diabetes Mellitus (DM) is a disease that experiences chronic metabolic disorders as evidenced by an increase in blood glucose (hyperglycemia). This condition results in changes or disorders, both physical and psychological, in each sufferer. DM sufferers must depend on the diabetes therapy process. This results in problems, for example people suffering from DM are required to limit their diet, this makes people feel weak, every health problem can result in stressors. The factors that can influence the increase in DM, namely obesity or weight gain, are one of the symptoms of T2DM patients. Aims: The aim of this study was to analyze the relationship between stress levels and body mass index with blood sugar levels in type 2 diabetes mellitus patients in the Gemarang Community Health Center working area. Methods: The research method used is descriptive analytic with a cross sectional approach design. The sampling technique in this research was purposive sampling with a total of 47 samples. Results: The results of research using Spearman's rho test analysis show that there is a relationship between stress levels and blood sugar levels (p value = 0.009), and there is a relationship between body mass index and blood sugar levels (p value = 0.005). Conclusion: The conclusion is that there is a relationship between stress levels and body mass index and blood sugar levels in type 2 diabetes mellitus patients in the Gemarang Community Health Center working area.

Persistent epigenetic signals propel a senescence-associated secretory phenotype and trained innate immunity in CD34+ hematopoietic stem cells from diabetic patients

BackgroundDiabetes-induced trained immunity contributes to the development of atherosclerosis and its complications. This study aimed to investigate in humans whether epigenetic signals involved in immune cell activation and inflammation are initiated in hematopoietic stem/progenitor cells (HSPCs) and transferred to differentiated progeny.Methods and resultsHigh glucose (HG)-exposure of cord blood (CB)-derived HSPCs induced a senescent-associated secretory phenotype (SASP) characterized by cell proliferation lowering, ROS production, telomere shortening, up-regulation of p21 and p27genes, upregulation of NFkB-p65 transcription factor and increased secretion of the inflammatory cytokines TNFα and IL6. Chromatin immunoprecipitation assay (ChIP) of p65 promoter revealed that H3K4me1 histone mark accumulation and methyltransferase SetD7 recruitment, along with the reduction of repressive H3K9me3 histone modification, were involved in NFkB-p65 upregulation of HG-HSPCs, as confirmed by increased RNA polymerase II engagement at gene level. The differentiation of HG-HSPCs into myeloid cells generated highly responsive monocytes, mainly composed of intermediate subsets (CD14hiCD16+), that like the cells from which they derive, were characterized by SASP features and similar epigenetic patterns at the p65 promoter. The clinical relevance of our findings was confirmed in sternal BM-derived HSPCs of T2DM patients. In line with our in vitro model, T2DM HSPCs were characterized by SASP profile and SETD7 upregulation. Additionally, they generated, after myeloid differentiation, senescent monocytes mainly composed of proinflammatory intermediates (CD14hiCD16+) characterized by H3K4me1 accumulation at NFkB-p65 promoter.ConclusionsHyperglycemia induces marked chromatin modifications in HSPCs, which, once transmitted to the cell progeny, contributes to persistent and pathogenic changes in immune cell function and composition.

Evaluating left atrial function changes by speckle tracking echocardiography in type 2 diabetes patients in Central Vietnam: a cross-sectional comparative study

BackgroundType 2 diabetes mellitus (T2DM) is a metabolic disorder that detrimentally affects multiple systems in the body, with a particular emphasis on the vascular and nervous systems. Despite its significant impact, limited studies have explored the influence of this condition on the left atrial (LA) function. To address this gap, our study utilized speckle tracking echocardiography (STE) to assess LA function in patients with T2DM in Central Vietnam.ResultsThe cross-sectional comparative study enrolled 134 subjects involving 66 patients with T2DM and 68 healthy individuals meeting the selection and exclusion criteria of the study. In our study, healthy individuals demonstrated higher values for LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct), measuring 38.75% ± 5.43%, 19.58% ± 5.91%, and 19.16% ± 4.98%, respectively. In contrast, the T2DM group exhibited lower values for LASr, LAScd, and LASct, which measured 31.2% ± 4.56%, 14.77% ± 6.3%, and 16.36% ± 4.82%, respectively (p < 0.05). T2DM patients with normal LA volume index (LAVI) and normal left ventricular mass index (LVMI), LASr, LAScd, and LASct results were 32.07% ± 5.28%, 16.28% ± 6.95%, and 15.64% ± 5.32%. respectively.ConclusionsSTE of the LA reveals a noteworthy reduction in reservoir, conduit, and contractile functions within the T2DM group when compared to the control group (p < 0.05). Furthermore, these impaired functions persist in T2DM patients even in the absence of increased LAVI and LVMI.

Prospective head-to-head comparison of non-invasive scores for diagnosis of fibrotic MASH in patients with type 2 diabetes

Non-invasive scores have been proposed to identify patients with fibrotic, metabolic dysfunction-associated steatohepatitis (MASH), who are at the highest risk of progression to complications of cirrhosis and may benefit from pharmacologic treatments. However, data in patients with type 2 diabetes (T2DM) are lacking. The aim of this multicenter prospective study was to perform a head-to-head comparison of FAST (FibroScan-aspartate aminotransferase [AST]), MAST (MRI-AST), MEFIB (magnetic resonance elastography [MRE] plus FIB-4), and FNI (fibrotic NASH index) for detecting fibrotic MASH in patients with T2DM. A total of 330 outpatients with T2DM and biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD) from the QUID-NASH study (NCT03634098), who underwent FibroScan, MRI-proton density fat fraction and MRE at the time of liver biopsy were studied. The main outcome was fibrotic MASH, defined as NAS ≥4 (with at least one point for each parameter) and fibrosis stage ≥2 (centrally reviewed). All data for score comparisons were available for 245 patients (median age 59 years, 65% male, median BMI 31kg/m2; fibrotic MASH in 39%). FAST and MAST had similar accuracy (AUROCs 0.81 vs. 0.79, p=0.41) but outperformed FNI (0.74; p=0.01) and MEFIB (0.68; p<0.0001). When using original cut-offs, MAST outperformed FAST, MEFIB and FNI when comparing the percentage of correctly classified patients, in whom liver biopsy would be avoided (69% vs. 48%, 46%, 39%, respectively; p<0.001). When using cut-offs specific to our population, FAST outperformed FNI and MAST (56% vs. 40%, and 38%, respectively; p<0.001). Our findings show that FAST, MAST, MEFIB and FNI are accurate non-invasive tools to identify patients with T2DM and fibrotic MASH in secondary/tertiary diabetes clinics. Cut-offs adapted to the T2DM population should be considered. Among patients with type 2 diabetes (T2DM), identifying those with metabolic dysfunction-associated steatohepatitis and significant fibrosis, who are the most at risk of developing clinical liver-related outcomes and who may benefit from pharmacologic treatments, is an unmet need. In this prospective multicenter study, we compared four non-invasive scores, three based on imaging (MRI or ultrasound technologies) and one on laboratory blood tests, for this purpose, using original and study-specific cut-offs. Our findings show that FAST, MAST, MEFIB and FNI are accurate non-invasive tools to identify patients with T2DM and fibrotic MASH in secondary/tertiary diabetes clinics. Cut-offs adapted to the T2DM population should be considered. NCT03634098.

The Influence of MTHFR C677T Variants on Neuropathy Risk Among T2dm Patients Receiving Monotherapy Metformin

Neuropathy is the most common microvascular complication among type 2 diabetes mellitus (T2DM). Metformin consumption increases neuropathy risk. The Methylenetetrahydrofolate reductase (MTHFR) enzyme has confirmed its role in neuropathy. Metformin and MTHFR could decrease folate and induce hyperhomoscysteine. One of the common variants of the MTHFR gene is C677T and its located in the exon area. This study aimed to observe the association between variant C677T in the MTHFR gene and the risk of neuropathy among newly diagnosed T2DM patients with naive metformin. This cross-sectional study recruited 103 patients. The neuropathy risk was examined according to medical judgment through Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) criteria. Genotyping C677T was performed using PCR-RFLP. This study found only one patient has a homozygote mutant, but more than 50% of patients were detected with allele mutants. There were no statistical differences in patient characteristics between CC and CT genotypes (p&gt;0.05). Association between C677T and neuropathy risk was not significant statistically, either in the genotype model (p=0.97), allele model (p=0.82), and dominant model (p=0.91). There was still no significant association after adjusting for several confounding factors. We conclude that C677T in our population did not influence neuropathy risk. More specific criteria and laboratory parameters indicated neuropathy should be examined in the future study.&#x0D; Keywords: MTHFR, neuropathy, metformin, and T2DM

Diet, Physical Activity, and Their Impact on Chronic Diseases (Hypertension and T2DM) among North-Eastern Morocco’s Population

Morocco is a country in “nutritional transition”, with a traditional Mediterranean food model that is increasingly moving towards a Western model. To study this transition, we aimed to determine the prevalence of chronic diseases (hypertension and T2DM) and their associated factors such as food consumption and physical activity in an adult population in two provinces in the eastern region (Berkane and Nador). A food frequency and physical activity analysis questionnaire (IPAQ International Physical Activity Questionnaire) was used. The results showed a total prevalence of T2DM of 23% and of hypertension of 18%, of which 12% were new cases of T2DM and 6% were incidentally discovered hypertensives. A dietary imbalance was observed more in type 2 diabetics than in hypertensives, either through overconsumption of fatty products, red meats (p=0.006), dairy products (p=0.0001), and sweet products (p=0.015) or through underconsumption of fruit and vegetables (p=0.043) and cereals (p=0.004). In total, 47% of our respondents were strongly adherent to the Mediterranean diet, compared with 53% who were poor adherents. Adherence was unequal among T2DM and hypertensive patients (46.15% vs. 39%). According to the IPAQ questionnaire, 57% were inactive and the vast majority 98% were sedentary. The same trend was observed in diabetics and hypertensives, who were inactive in 44% and 59% respectively, and more sedentary in 98% of cases of T2DM and 99% of cases of arterial hypertension. This study shows an imbalance in the diet of the general and specific populations, either through over- or under-consumption of certain food products. Adherence to the Mediterranean diet was high in 47% of cases, suggesting that the remaining 53% were adopting a Western diet and that this community was inactive and highly sedentary, putting them at greater risk of chronic disease in the future.

Haplotype-based association study of TCF7L2 gene variants with the development of diabetic retinopathy in an Iranian population

ABSTRACT Background Diabetic retinopathy (DR) is recognized as one of the most prevalent complications of diabetes and a major cause of morbidity. Transcription factor 7-like 2 (TCF7L2), a pivotal component in the Wnt-signaling pathway, plays a significant role in β-cell development, blood-glucose homeostasis, cell survival, cell migration, and cell proliferation. Thus, this study aimed to assess the association between TCF7L2 variants (rs7903146, rs11196205, and rs12255372) with DR in a population-based association study. Materials and Methods DNA was extracted from whole blood of all subjects by salting-out procedure. Total 524 T2DM patients including 234 T2DM individuals without DR and 290 T2DM individuals with DR were genotyped by TaqMan assay technology. Clinical characteristics of subjects were conducted to evaluate the plausible association between TCF7L2 variants and DR with univariate linear regression analysis. Results Demographic analysis between case and control groups revealed significant differences in FBS, HbA1c, lipidemia, heart disease, and family history of T2DM (p < 0.05). No significant difference was observed in either genotypes distribution or allele frequency (p > 0.05) between T2DM individuals with and without DR in any models of inheritance. Genotype-phenotype association showed no significant association. Result of analysis indicated that HbAlc with adjusted OR of 1.8 (p < 0.0001) and first-degree relatives of family history with adjusted OR of 3.04 (p < 0.0001) were significantly associated with DR. Finally, haplotype analysis showed no noticeable association. Conclusion In conclusion, there was no significant genetic association between rs7903146, rs11196205, and rs12255372 with DR among T2DM Iranians; however, these variants may play unknown roles in other populations.

Abstract 2169: Dietary inflammatory potential and mortality among patients with MAFLD

Abstract Background: Inflammation is important in metabolic dysfunction-associated fatty liver disease (MAFLD) development and progression. However, evidence regarding the influence of dietary inflammatory potential and mortality among people with MAFLD is rare. This study aimed to elucidate the association of the energy-density dietary inflammatory index (E-DII) with all-cause and cause-specific mortality among MAFLD patients. Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) (1988-1994, 1999-2010). MAFLD was defined as the evidence of hepatic steatosis with ≥1 of the following: type 2 diabetes (T2DM), overweight/obesity (OW, BMI ≥ 25 kg/m2), or lean metabolic dysregulation (MD). Dietary intake was assessed through 24-hour dietary recalls. E-DII scores and component intakes were divided into tertiles, with T1 as the reference. Through linkage to National Death Index by December 31, 2019, mortality from all cause, cardiovascular disease (CVD), and cancer were identified. Multivariable Cox proportional hazards regression model and restricted cubic splines (RCS) were used to analyze the association between dietary inflammatory potential and mortality among MAFLD and its subtypes patients. Results: A total of 6537 MAFLD patients were included in the present analysis. During the median follow-up of 16.8 years, 2281 total deaths (534 cancer-related, 750 CVD-related) were documented. Compared to high dietary inflammatory potential, low dietary inflammatory potential presented a inverse association with all-cause mortality risk in MAFLD patients (HR T2 vs. T1 = 0.83, 95% CI = 0.72-0.95, HR T3 vs. T1 = 0.88, 95% CI = 0.76-1.01, P trend = 0.092) and OW subtype patients (HR T2 vs. T1 = 0.77, 95% CI = 0.63-0.93, HR T3 vs. T1 = 0.76, 95% CI = 0.63-0.92, P trend = 0.009). No significant benefit was observed among T2DM and MD subtype patients. Further component analysis found that eicosapentaenoic acid (EPA) (HR = 0.74, 95% CI = 0.66-0.83), docosapentaenoic acid (DPA) (HR = 0.72, 95% CI = 0.65-0.80), docosahexaenoic acid (DHA) (HR = 0.85, 95% CI = 0.65-0.80), and linoleic acid (HR = 0.86, 95% CI = 0.79-0.94) were linked with reduced cancer mortality risk in MAFLD patients. Further RCS analyses found that the effect pattern of EPA, DPA, and DHA on both all-cause and cause-specific mortality was presented as “J shaped” (P non-linear &amp;lt; 0.05). Similar results were observed for all-cause and CVD mortality among both MAFLD and OW subtype patients. When excluding participants who died within five years, consistent results were presented. Conclusions: The findings of this study suggest that keep low-inflammatory dietary pattern, especially appropriate level of PUFAs component (EPA, DPA, and DHA) intake were associated with a lower risk of cancer mortality in MAFLD patients. These findings may inform future public health guidelines regarding specific dietary consumption, and liver-related health promotion. Citation Format: Zhangyan Lyu, Yacong Zhang, Wenxuan Li, Guoijn Si, Kexin Chen. Dietary inflammatory potential and mortality among patients with MAFLD [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2169.