T2DM Subjects Research Articles

Protective Effect of High Adherence to Mediterranean Diet on the Risk of Incident Type-2 Diabetes in Subjects with MAFLD: The Di@bet.es Study.

Background/Objectives: Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) increases the risk of Type-2 Diabetes (T2DM). The Mediterranean diet (MD) has shown advantages in the management of MAFLD and preventing co-morbidities; however, its relationship with T2DM development in MAFLD has been less investigated. We aimed to evaluate the association of MD adherence with the risk of incident T2DM in the Spanish adult population with MAFLD and according to their weight gain at 7.5 years follow-up. Methods: A cohort of 714 participants (without weight increment: 377; with weight increment: 337) from the Di@bet.es cohort study with MAFLD and without T2DM at baseline were investigated. Anthropometric, sociodemographic, clinical data, and a survey on habits were recorded. OGTT and fasting blood biochemistry determinations were made. Baseline adherence to MD was estimated by the adapted 14-point MEDAS questionnaire and categorized as high and low adherence. Results: In total, 98 people developed T2DM at follow-up. The high adherence to MD was inversely associated with the development of T2DM in both the overall population (0.52 [0.31-0.87]) and subjects without weight gain at follow-up (0.35 [0.16-0.78]). Conclusions: Our results suggest the protective effect of high adherence to MD regarding the risk of T2DM in subjects with MAFLD, with this health benefit being more evident in men with the absence of weight gain. These results support the recommendations for MD use in these patients.

Vascular and nerve biomarkers in thigh skin biopsies differentiate painful from painless diabetic peripheral neuropathy.

Identifying distinct mechanisms and biomarkers for painful diabetic peripheral neuropathy (DPN) is required for advancing the treatment of this major global unmet clinical need. We previously provided evidence in calf skin biopsies that disproportion between reduced sensory small nerve fibers and increased blood vessels may distinguish painful from non-painful DPN. We proposed that overexposure of the reduced nerve fibers in DPN to increased hypoxemia-induced vasculature and related algogenic factors, e.g., nerve growth factor (NGF), leads to neuropathic pain. To further investigate this proposed mechanism, we have now studied more proximal thigh skin biopsies, to see if the same disproportion between increased vasculature and decreased nerve fibers generally differentiates painful DPN from painless DPN. A total of 28 subjects with type 2 diabetes (T2DM) and 13 healthy volunteers (HV) underwent detailed clinical and neurophysiological assessments, based on the neuropathy composite score of the lower limbs [NIS(LL)] plus 7 tests. T2DM subjects were subsequently divided into three groups: painful DPN (n = 15), painless DPN (n = 7), and no DPN (n = 6). All subjects underwent skin punch biopsy from the upper lateral thigh 20 cm below the anterior iliac spine. Skin biopsies showed decreased PGP 9.5-positive intraepidermal nerve fiber (IENF) density in both painful DPN (p < 0.0001) and painless DPN (p = 0.001). Vascular marker von Willebrand Factor (vWF) density was markedly increased in painful DPN vs. other groups, including painless DPN (p = 0.01). There was a resulting significant decrease in the ratio of intraepidermal nerve fiber density to vasculature and PGP9.5 to vWF, in painful DPN vs. painless DPN (p = 0.05). These results were similar in pattern to those observed in these HV and T2DM groups previously in distal calf biopsies; however, the increase in vWF was much higher and nerve fiber density much lower in the calf than thigh for painful DPN. Thigh skin vWF density was significantly correlated with several metabolic (waist/hip ratio, HbA1c), clinical (e.g., pain score), and neurophysiological measures. This study supports our proposal that increased dermal vasculature, and its disproportionate ratio to reduced nociceptors, may help differentiate painful DPN from painless DPN. This disproportion is greater in the distal calf than the proximal thigh skin; hence, neuropathic pain in DPN is length-dependent and first localized to the distal lower limbs, mainly feet.

Diagnostic accuracy of salivary hemoglobin, lactate dehydrogenase and Interleukin-6 to determine chronic periodontitis and tooth loss in type 2 diabetics

BackgroundSalivary Hemoglobin (SH) has emerged as the mainstay non-invasive and a practicable screening method for Chronic Periodontitis. Current research aims to comprehensively assess the diagnostic value of Salivary Hb (SH) in comparison with Salivary IL-6 (SIL-6) and levels of Salivary lactate dehydrogenase enzyme (SLDH) amongst Type II Diabetes subjects having Chronic Periodontitis (CP) and associated tooth loss. Materials and methodsIn this cross-sectional comparative investigation, 240 individuals with at least 15 remaining teeth, ranging in age from 30 to 70, were chosen and Group I controls were defined as follows: healthy (HbA1c levels ≤6.4 %) with no CP; Group II included chronic periodontitis and non-T2DM (HbA1c ≤ 6.4 %); Group III included T2DM (HbA1c ≥ 6.5 %) and CP; and Group IV included T2DM (HbA1c ≥ 6.5 %) with periodontitis-related tooth loss. ELISA colorimetric assay was used to quantify the results using the unstimulated whole saliva of fasting participants. Tukey's post hoc test was used for statistical analysis following Analysis of Variance (ANOVA), and Sensitivity and Specificity were computed following the determination of the correlation coefficient. ResultsOne-way ANOVA comparing Biomarker levels across the four groups revealed a statistically significant difference (F = 68.013) (p = 0.0001). Tukey's multiple post hoc yielded a significant difference between groups with least mean average biomarker levels observed among the controls (Group1) and maximum with group IV. Diagnostic Accuracy to discriminate between CP in T2DM & Controls with SH surpassed that of SIL-6 & SLDH, Receiver operating characteristic (ROC) curve depicted an overall sensitivity of 67.62 %, specificity of 80 % and accuracy of 74 % in T2DM subjects with tooth loss for the identification and assessment of CP. ConclusionEstimates of Salivary Hemoglobin can assume an important role in comparison to SIL-6 & SLDH in determining the degree of periodontitis, including tooth loss, and identifying elevated glycemic levels. Advanced detection and monitoring can be ensured by routine use in dental offices and general practice.

Identification of plasma miR-4505, miR-4743-5p and miR-4750-3p as novel diagnostic biomarkers for coronary artery disease in patients with type 2 diabetes mellitus: a case-control study

BackgroundType 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are commonly coexisting clinical entities with still growing incidence worldwide. Recently, circulating microRNAs (miRNAs) have emerged as novel molecular players in cardiometabolic diseases. This study aimed to identify a specific miRNA signature as a candidate biomarker for CAD in T2DM and to delineate potential miRNA-dependent mechanisms contributing to diabetic atherosclerosis.MethodsA total of 38 plasma samples from T2DM patients with and without CAD, CAD patients and healthy controls were collected for expression profiling of 2,578 miRNAs using microarrays. To investigate the regulatory role of differentially expressed (DE)-miRNA target genes, functional annotation and pathway enrichment analyses were performed utilizing multiple bioinformatics tools. Then, protein-protein interaction networks were established leveraging the STRING database in Cytoscape software, followed by cluster analysis and hub gene identification. Reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) was carried out for microarray data validation in the larger replication cohort of 94 participants. Receiver operating characteristic analysis was applied to evaluate the diagnostic values of miRNAs. Multivariate logistic regression analysis was used to develop miRNA-based diagnostic models.ResultsIn the discovery stage, overexpression of hsa-miR-4505, hsa-miR-4743-5p, hsa-miR-6846-5p, and down-regulation of hsa-miR-3613-3p, hsa-miR-4668-5p, hsa-miR-4706, hsa-miR-6511b-5p, hsa-miR-6750-5p, hsa-miR-4750-3p, hsa-miR-320e, hsa-miR-4717-3p, hsa-miR-7850-5p were detected in T2DM-CAD patients. The DE-miRNA target genes were significantly enriched in calcium ion binding, regulation of actin cytoskeleton, and gene expression. hsa-miR-4505, hsa-miR-4743-5p, and hsa-miR-4750-3p were found to be involved in fatty acid metabolism, leukocyte transendothelial migration, and neurotrophin signaling pathway. Dysregulation of hsa-miR-4505, hsa-miR-4743-5p, and hsa-miR-4750-3p in T2DM-CAD patients compared with T2DM subjects and controls (all p < 0.001) was further confirmed by RT-qPCR. All validated miRNAs demonstrated good discriminatory values for T2DM-CAD (AUC = 0.833–0.876). The best performance in detecting CAD in T2DM was achieved for a combination of three miRNAs (AUC = 0.959, 100% sensitivity, 86.67% specificity).ConclusionsOur study revealed a unique profile of plasma-derived miRNAs in T2DM patients with CAD. Potential miRNA-regulated pathways were also identified, exploring the underlying pathogenesis of CAD in T2DM. We developed a specific three-miRNA panel of hsa-miR-4505, hsa-miR-4743-5p and hsa-miR-4750-3p, that could serve as a novel non-invasive biomarker for CAD in patients with T2DM.

Effect of Aromatic Herbs and Spices Present in the Mediterranean Diet on the Glycemic Profile in Type 2 Diabetes Subjects: A Systematic Review and Meta-Analysis.

The Mediterranean Diet (MedDiet) is the dietary pattern par excellence for managing and preventing metabolic diseases, such as Type 2 Diabetes (T2DM). The MedDiet incorporates spices and aromatic herbs, which are abundant sources of bioactive compounds. The aim of this study was to analyze the effect of all aromatic herbs and spices included in the MedDiet, such as black cumin, clove, parsley, saffron, thyme, ginger, black pepper, rosemary, turmeric, basil, oregano, and cinnamon, on the glycemic profile in T2DM subjects. PubMed, Web of Science, and Scopus databases were searched for interventional studies investigating the effect of these aromatic herbs and spices on the glycemic profile in T2DM subjects. This systematic review retrieved 6958 studies, of which 77 were included in the qualitative synthesis and 45 were included in the meta-analysis. Our results showed that cinnamon, turmeric, ginger, black cumin, and saffron significantly improved the fasting glucose levels in T2DM subjects. The most significant decreases in fasting glucose were achieved after supplementation with black cumin, followed by cinnamon and ginger, which achieved a decrease of between 27 and 17 mg/dL. Only ginger and black cumin reported a significant improvement in glycated hemoglobin, and only cinnamon and ginger showed a significant decrease in insulin.

Associations of asymptomatic coronary heart disease in a cohort of stable type 2 diabetic subjects in a tertiary health center in south eastern Nigeria: A cross sectional study

Background: Coronary heart disease (CHD) is a type of heart disease where the lumina of the major arteries of the heart (coronary arteries) are narrowed by a build-up of plaque with a resultant limitation of blood flow to and oxygenation of the heart. Coronary heart disease can pose a diagnostic challenge in diabetic subjects due to the fact that it is often asymptomatic with a resultant lack of overt clinical complaint by the patients. It is an important cause of diabetes-associated morbidity and mortality and also a huge contributor to the cost of diabetes care. Objective: To determine the association between CHD and age, sex, cigarette smoking, duration of diabetes, central obesity, glycaemic control, hypertension, chronic kidney disease (CKD), stroke, transient ischaemic attack (TIA), dyslipidaemia, lack of exercise and metabolic syndrome in type 2 diabetic subjects attending the diabetes outpatient clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi in South Eastern Nigeria. Materials and Methods: This was a cross-sectional, observational study comprising 136 clinically stable T2DM subjects that were asymptomatic of coronary heart disease. The participants had two contacts with the researcher. Firstly, all the participants were evaluated with resting ECG for the diagnosis of CHD, 30 subjects had CHD while 106 had not. Next, the 30 subjects that had CHD and 98 of the 106 that had not, were met a second time on another clinic visit where medical history was extracted and anthropometric measurements were done. Next, biochemical tests, which included fasting blood glucose (FBG), glycated haemoglobin (HbA1c), fasting lipid profile (FLP) and serum creatinine were done and the glomerular filtration rate estimated using the Modification of Diet in Renal Disease (MDRD) calculator. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25 (Chicago, IL, USA). The level of significance was set at p &lt; 0.05. Results: A total of 128 subjects completed the study and had their data analyzed. 30 subjects had CHD while 98 had not. There was significant association between CHD and TIA (p = 0.040), but no significant association between CHD and age (p = 0.959), sex (p = 0.679), educational status (p = 0.094), cigarette smoking (p = 1.000), duration of diabetes (p = 0.335), central obesity (p = 0.726), glycaemic control (p = 1.000), hypertension (p = 1.000), CKD (p = 0.570), stroke (p = 0.141), dyslipidaemia (p = 0.290), exercise (p = 0.641) and metabolic syndrome (p = 0.633) respectively among the subjects. Conclusion: There was a high prevalence of asymptomatic CHD among stable type 2 diabetic subject and with the exception of TIA, there was no significant association between CHD and all the other risk factors for CHD that were studied, although these risk factors were found more among the subjects that had CHD compared with those that had not.

Evaluation of miRNAs regulation of BDNF and IGF1 genes in T2DM insulin resistance in experimental models: bioinformatics based approach.

microRNAs (miRNAs) are recognized as diabetes mellitus type 2 (T2DM) biomarkers useful for disease metabolism comprehension and have great potential as therapeutics targets. BDNF and IGF1 increased expression are highly involved in the benefits of insulin and glucose paths, however, they are down-regulated in insulin resistance conditions, while their expression increase is correlated to the improvement of glucose and insulin metabolism. Studies suggest the microRNA regulation of these genes in several different contexts, providing a novel investigation approach for comprehending T2DM metabolism and revealing potential therapeutic targets. In the present study, we investigate in different animal models (human, rat, and mouse) miRNAs that target BDNF and IGF1 in skeletal muscle tissue with T2DM physiological conditions. Bioinformatics tools and databases were used to miRNA prediction, molecular homology, experimental validation of interactions, expression in the studied physiological condition, and network interaction. The findings showed three miRNAs candidates for IGF1(miR-29a, miR-29b, and miR-29c) and one for BDNF (miR-206). The experimental evaluations and the search for the expression in skeletal muscle from T2DM subjects confirmed the predicted interaction between miRNA-mRNA for miR-29b and miR-206 through human, rat, and mouse models. This interaction was reaffirmed in multiple network analyses. In conclusion, our results show the regulation relationship between miR-29b and miR-206 with the investigated genes, in several tissues, suggesting an inhibition pattern. Nevertheless, these data show a large number of possible interaction physiological processes, for future biotechnological prospects.

Effect of Exercise Training on Peroxisome Proliferator-Activated Receptor γ (PPAR-γ) Level: A Systematic Review

Context: Peroxisome proliferator-activated receptor γ (PPAR-γ) plays a crucial role in regulating oxidative phosphorylation and energy utilization, both of which are diminished in obesity and type 2 diabetes (T2DM), major risk factors for cardiovascular disease (CVD). It is well established that exercise, as one of the significant modifiable lifestyle factors, is associated with the expression and activity of PPAR-γ-controlled genes. Evidence Acquisition: In this systematic review, we conducted comprehensive searches across various databases, including PubMed, ScienceDirect, and Google Scholar, for relevant literature published between January 2000 and May 2022. This study focused on published articles (in-vivo and human) in English. This review encompasses 16 studies (4 involving humans and 12 involving animals). Results: The findings from 14 studies indicated that various types of exercise programs, including regular exercise, resistance exercise, swimming, climbing, and treadmill running, effectively improved PPAR-γ levels in individuals with T2DM, obese populations, and healthy subjects. Only two studies reported no significant improvement in PPAR-γ levels following physical activity. Notably, all studies involving subjects with T2DM showed improved PPAR-γ levels after exercise training. Conclusions: Upon comparing various types of exercise training, the collected data suggest that all forms of aerobic exercise, regardless of their type and duration, have the potential to up-regulate PPAR-γ messenger ribonucleic acid (mRNA) expression. This study lays the foundation for further research into the association between different types of exercise training and PPAR-γ levels/activity across various human populations. However, given the limited number of human studies, further high-quality research is necessary to draw firm conclusions.

Assessment the Levels of Serum Ferritin and Some Biochemical Parameters in Type 2 Diabetic Subjects Attending A Tertiary Hospital in Bangladesh

Background: Type 2 diabetes (NIDDM) is the commonest form of diabetes constituting nearly 90% of the diabetic population in any country. Iron is an important mineral in normal physiological processes, and ferritin is a specialized iron storage protein, which reflects iron stores in the body. Iron overload is a risk factor for diabetes. The link between iron and diabetes was first recognized in pathologic conditions-hereditary hemochromatosis and thalassemia, but high levels of dietary iron also import diabetes risk. Iron plays a direct and causal role in diabetes pathogenesis mediated both by β-cell failure and insulin resistance. The objective of the study to evaluate serum ferritin level among type 2 diabetes patients. Method: A hospital based observational study a total of 240 subjects among them 60 male diabetes patients and 60 female diabetes patients were recruited. Serum ferritin level were checked in all participants. Results: The mean age of T2DM was 59  14 years and control group was 50  13 years. The BMI of each group was 27.52  2.6 and 24.80  2.4. Ferritin (ng/dL) level in T2 DM subjects was 231  36 and control subjects was 48  22. Serum ferritin level among the study subjects control vs T2 DM, t/p value (8.465/0.0001). Conclusion: From this study it was observed that ferritin level is significantly higher among type 2 diabetes patients.

Von Willebrand factor hyperactivity affects the outcome of lower limb revascularization in subjects with type 2 diabetes mellitus complicated by diabetic foot vasculopathy: An observational pilot study

Aim of this study is to evaluate any differences in VWF antigen, VWF activity and ADAMTS-13 activity before and after successful and non-successful Percutaneous Transluminal Angioplasty (PTA) in subjects with type 2 diabetes (T2DM) complicated by Chronic limb-threatening ischemia (CLTI) in diabetic foot vasculopathy. MethodsIn this prospective observational pilot study, we enrolled 35 T2DM subjects who underwent lower limb PTA. Transcutaneous oximetry was performed in all patients before and 6 weeks after PTA. The change in oxygen partial pressure (TcpO2) before and after PTA was expressed as TcpO2-delta (ΔTcpO2). VWF antigen, VWF activity and ADAMTS-13 activity were measured before and 6 weeks after PTA; changes were expressed as delta and ratio from baseline. ResultsSubjects with ∆TcpO2 < 15 mmHg presented higher ΔVWF activity (p = 0.050) and lower ADAMTS-13 activity ratio (p = 0.080). Subjects with ∆TcpO2 < 30 mmHg showed lower ADAMTS-13 activity Δ and ratio (p = 0.028). ConclusionsVWF antigen levels and VWF activity may potentially affect PTA outcome. Higher levels of VWF could derive from VWF release as consequence of PTA-induced mechanical endothelial damage and/or oxidative stress-induced modifications of VWF structure with impairment of VWF-ADAMTS13 interactions.

Abnormal blood pressure dipping pattern: frequency, determinants, and correlates in Diabetes Mellitus patients in the Cardiovascular Health Risk Assessment in Diabetes Mellitus (CHiD) study.

Non-dipping status is associated with increased total and cardiovascular mortality in many disease conditions including diabetes mellitus. The pattern and its implications are not well described among Africans. This study was done to describe the frequency of abnormal blood pressure (BP) dipping among T2DM subjects, its determinants and correlates in Ogbomoso, Nigeria. This was a cross-sectional study done at the LAUTECH Teaching Hospital, Ogbomoso. One hundred individuals diagnosed with T2DM were recruited and they had 24-hour ambulatory BP monitoring, echocardiography, ECG, and carotid Doppler among other evaluations. Statistical analysis was done using SPSS 27.0 (Chicago Ill, USA). The mean age of the participants was 59.3 ± 10.8 years, mean body mass index 27.7 ± 5.9kg/m2 with a mean duration of diabetes of 7.52 ± 5.54 years. Abnormal BP dipping was present in 89% (consisting of 41% or reverse dippers and 48% non-dippers). T2DM subjects with abnormal dipping pattern were more likely to be females, had higher glycated haemoglobin, lower fractional shortening, higher left atrial volume and left ventricular mass index, and a higher DM duration than those with normal BP dipping status. The major determinants of abnormal dipping pattern were the duration of diabetes and low HDL-C concentration. Abnormal BP dipping pattern is highly prevalent in T2DM subjects, especially among females. Abnormal BP dipping was also associated with markers of increased cardiovascular risk such as impaired kidney function, left ventricular hypertrophy, postural hypotension, history of intermittent claudication, and presence of plaques on carotid Doppler studies. The online version contains supplementary material available at 10.1007/s40200-023-01337-8.

MUSCULOSKELETAL PAIN AND ITS NOCICEPTIVE OR NEUROPATHIC CHARACTERIZATION AMONGST NIGERIANS WITH TYPE 2 DIABETES MELLITUS

Purpose: The study determined the burden and characterized MSP among Nigerians with Type 2 Diabetes (T2DM) into nociceptive or neuropathic pain. Methods: A cross-sectional study of 207 consecutively recruited T2DM subjects to assess and characterize MSP as neuropathic or nociceptive with the use of Nordic Musculoskeletal and S-LANSS standardized Questionnaires. Results: Of the 207 participants, there were 147 (71%) females with mean age of 59.7± 11.7 years. About 94.2% and 79.2% reported pain in at least one joint within 12 months and 7-day preceding the study, respectively. Ankle/foot is the most common site/region of reported pain in both the preceding 12 months and 7-day (58.5% versus 49.5%) while the least over the same period was at the elbow (22.6% versus 12.6%). Only 48.3% of the participants had restrictions in their activities of daily living (ADL) with 62.3% received treatment for self-reported pain. MSP was characterized predominantly as neuropathic among 27.5% of the participants which was highest among participants (36%) whose ADL were limited because of MSP. Conclusion: High prevalence of MSP was found among Nigerians with T2DM, more commonly reported in the ankle/foot region of the body with one in every five classified as neuropathic pain.

Maximizing performance of linear model predictive control of glycemia for T1DM subjects

Maximizing performance of linear model predictive control of glycemia for T1DM subjects

Epicardial fat thickness in type 2 diabetes outpatient care

Background and aimVisceral fat is an independent predictor of the cardiovascular risk in subjects with type 2 diabetes (T2DM), but it is rarely assessed during an outpatient visit. Epicardial fat (EAT), the visceral fat of the heart, plays a role in coronary artery disease (CAD). EAT thickness can be clinically assessed with standard ultrasound. In this study we sought to evaluate the association of ambulatory ultrasound measured EAT thickness with CAD in asymptomatic well controlled T2DM subjects on metformin monotherapy during outpatient visits. Methods and resultsThis was single center, pragmatic study in 142 T2DM patients. Each subject underwent baseline ultrasound EAT thickness measurement, anthropometric and biomarkers. The incidence of CAD was detected after 1 year. At baseline, HbA1c was 6.7 % and BMI 34.9 kg/m2, EAT thickness was 8.3 ± 2.3 in women and 9.4 ± 2.4 mm in men, higher than threshold values for high cardiovascular risk. In multivariate models, EAT was the only statistically significant correlate of CAD at 1-year f/u (p = 0.04). ConclusionsPoint of care ultrasound measured EAT thickness is a good correlate of CAD in well controlled and asymptomatic T2DM subjects on metformin monotherapy. EAT thickness predicted CAD better than traditional risk factors, such as BMI, HbA1c, age, blood pressure or duration of diabetes.

FRI648 GLP-1RA And SGLT2i Treatments May Show Improved Depression Metrics In Diabetes Treatment

Abstract Disclosure: A. Jain: None. L. Esper: None. J. Powell: None. K. Meyer: None. S. Sen: None. Background: Depression is a widespread condition that develops due to a multitude of etiologies. Type 2 Diabetes (T2DM) is associated with several comorbidities, including depression. A class of T2DM medication, Glucagon-Like-peptide-1 receptor agonists (GLP1RA), acts on the hypothalamus, pancreas, and other systems to reduce weight and control blood sugar. GLP1RAs may play a positive role in improving depression by improving satiety and acting on brain centers responsible for anxiety and depression. We hypothesized that patients on GLP1RA would have lower depression scores than those on insulin/metformin standard regimen, or on SGLT2 inhibitors ( which serves as an active comparator) due to localized effects of SGLT2i in the renal cortex. This research will add to ongoing studies in our lab that examine different classes of diabetes medication in treating patients with increased cardiovascular or renal risk, with the goal of increasing the specificity by which endocrinologists prescribe particular classes of glycemic control medications. Methods: We conducted a retrospective observational chart analysis at the Washington DC VA Medical Center and compared the PHQ-9 scores of 50 T2DM patients selected at random over 6 weeks maintaining a consistent diabetes care regimen for 6 months. We observed n=9 GLP1RA, n=7 SGLT2i, and n=31 control subject records. 3 subjects on both medications were excluded from this analysis. We noted the PHQ-9 scores of subjects on active psychotropics, but those were not excluded from the study at this time. Results: Our cohort had a mean age of 61.8±12.5 years and mean A1C of 8.04±2.13%. These factors were evenly distributed between analysis groups. Our analysis showed that T2DM subjects on GLP1RA had PHQ-9 scores of 5.00±1.51. This wasn’t significantly lower than the control cohort (6.21±1.22, p=0.53), or SGLT2i cohort (3.85±1.24, p=0.57). Conclusion: Our preliminary analysis in a real-life clinical setting shows a trend indicating subjects on neither GLP1RA nor SGLT2i have higher depression scores than those on either one. However, we plan to continue reviewing records to see if this trend or differences between classes is significant. With a larger sample size, we also plan to include correlations between depression scores and efficacy of treatment. Continuing this research, particularly in a VAMC cohort at higher risk of depression, may provide insight into clinical decision making in T2DM patients with history or high risk for depression and related disorders. Presentation: Friday, June 16, 2023

Type 1 diabetes mellitus and Ramadan fasting: A case of adolescents and adults from Algeria

ObjectivesExperts suggest that people with type 1 diabetes (T1DM) should be discouraged from fasting during Ramadan, even though both adolescents and adults insist on performing their fast despite the jurisprudential excuse. The objective was to evaluate the behavior and attitudes of a population with T1DM during Ramadan and outside. Materials and methodsA descriptive study was carried out on 63 T1DM subjects at the level of two health establishments located in the city of Constantine (eastern Algeria). The interviews took place between April 13th and May 12th, 2021 during Ramadan. The R.3.2.4 software was used for the comparison tests. The significance level retained was 0.05. ResultsThe study involved 63 subjects with T1DM (30 females and 33 males) of whom 26 subjects aged<18 years and 37 subjects aged≥18 years (P=0.001). The mean age was 21.2±5.7 years (12–42 years). The average duration of pathology since diagnosis was 6.6±4.5 years. Glycated hemoglobin (Hb1Ac) was between 5.60% and 16.10% with an average of 8.1±0.2%. The results revealed that 28.6% of the patients practiced Ramadan fasting with an average of 13.8±10.4 days. Only 31.7% consulted their doctors before observing Ramadan, 77.8% controlled their blood sugar mainly before breaking the fast. COVID-19 affected 15.9% of subjects and hyperglycemia was the most recorded diabetes-related complication. ConclusionDespite the health risks, subjects with T1DM insisted on fasting during the month of Ramadan. Thence it is vital to adhere to a healthy lifestyle with early clinical monitoring.

Association of adipocyte size and SREBP-1c in visceral and subcutaneous adipose tissue in non-obese type 2 diabetes mellitus.

Non-obese type 2 diabetes seems to be common in India; hence the current study tried to understand the pathogenesis of diabetes in this group focusing on the role of adipocytes especially abdominal fat compartment. Comparison was made between non-obese subjects with newly detected diabetes and those without diabetes, in relation to levels of adipogenic factor and adipokines in pre-adipocytes and mature adipocytes respectively. Non-obese subjects (BMI-18-25 Kg/m2) were consecutively selected of whom 15 had newly-detected, treatment naïve type 2 diabetes (HbA1% ≥6.5) while 25 were control (HbA1c% ≤5.6). We examined the expression of adipocyte differentiation factor - SREBP-1c from preadipocytes and adipocyte specific adipokines- HMW isoform and total adiponectin, leptin, FABP-4, TNF-α and IL-6 from adipocytesisolated from abdominal visceral and subcutaneous adipose tissues (VAT and SCAT) by RT-PCR and as well as from serum by ELISA. Size of cultured adipocytes was measured in a fully automated imaging system microscope. Both in SCAT and VAT, SREBP-1c and adiponectin had significantly lower expression along with increased mRNA level of inflammatory adipokinesdiabetes.Average adipocyte size and frequency of large(hypertrophied) adipocytes were comparatively higher in T2DM subjects and had significant negative correlation with SREBP-1c. HMW adiponectin level significantly reduced in the secretion from VAT and SCAT of T2DM subjects compared to control. Reduced expression of SREBP-1c in preadipocytes may lead to increased number of hypertrophied adipocytes in T2DM. Therefore, these dysfunctional hypertrophied adipocytes could cause imbalanced expression of insulin resistant and insulin sensitive adipokines.

869-P: Effect of Dapagliflozin on Renal Oxygen Delivery and Consumption in T2DM and NGT Subjects

Improved renal oxygenation is proposed as a potential reno-protective mechanism of SGLT2 inhibitors in T2DM. Bold-MRI studies in nondiabetic subjects showed no effect with dapagliflozin and improved renal cortical oxygenation with empagliflozin in T1DM. No studies have examined renal oxygenation in T2DM. We examined the effect of dapagliflozin (10 mg) on renal oxygen delivery and oxygen consumption in 7 T2DM (age=58±3 yrs, BMI = 30±1.8 kg/m2) and 7 NGT (age = 47±3.4 yrs, BMI = 28.6±1.6kg/m2) subjects who received a single dose of dapagliflozin or placebo. Renal vein (SvO2) and radial artery (SaO2) hemoglobin saturation were measured with i-STAT point of care analyzer and renal blood flow with PAH infusion before and 4 hours after dapagliflozin/placebo. At baseline arterial (CaO2, 19 ± 0.8 vs 19 ± 0.7 ml/dl, p=NS) and renal venous (CvO2, 16 ± 0.9 vs 18 ± 0.7 ml/dl, p=NS) oxygen Content were similar in DAPA and PLAC. Thus, there was no difference in renal oxygen delivery (478 ± 29 vs 533 ±27 ml/min/m2) between DAPA and PLAC groups. Following DAPA/PLAC renal plasma flow did not change, and there was no change in arterial (CaO2) (19 ± 0.8 vs 18.2 ± 0.7 ml/dl, p=NS) or renal venous (CvO2) (16 ± 0.9 vs 15.5 ± 0.9 ml/dl) oxygen content in DAPA or PLAC groups. Renal oxygen consumption following DAPA (67 ± 10 vs 78 ±13 ml/min/m2, p=NS) and PLAC (42 ± 8 vs 50 ± 6 ml/min/m2, p=NS) groups were not different versus baseline. Conclusion: A single acute dose of dapagliflozin does not alter renal oxygen delivery or consumption in T2DM or NGT subjects. Disclosure D. Tripathy: None. X. Chen: None. R. Chilton: None. A.A. Hansis-Diarte: None. M. Salehi: None. C. Solis-Herrera: None. E. Cersosimo: None. R.A. DeFronzo: Speaker's Bureau; AstraZeneca. Advisory Panel; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Novo Nordisk. Research Support; AstraZeneca, Boehringer-Ingelheim, Merck &amp; Co., Inc. Funding AstraZeneca

879-P: Cardiorenal Outcomes Associated with the Use of Dapagliflozin Compared with DPP-4 Inhibitors as Add-on Treatment in Uncontrolled DM2 Patients with Failure to Previous Treatment—A Retrospective, Real-Life Evaluation in México

Mexico is one of the three countries in Region of Americas with the highest prevalence (14.4%) of DM. We conducted a retrospective study in Mexico and compare Dapagliflozin effect in cardio-renal outcomes and metabolic control compared to DPP4-inhibitors (DPP4i) as added-on therapy in T2DM patients with failure to previous medications. Objectives: Compare proportion of patients achieving HbA1c below 7%, first appearance of eGFR below 60 ml/min, renal replacement therapy, heart failure hospitalization and death by the end of the 156-week observation period from index date. Inclusion Criteria: T2DM subjects ≥18 years old with failure to any previous antidiabetic medication and HbA1c% ≥7 that started Dapa or DPP4i as add-on to other antidiabetic drugs from August 2014 to December 2019. Statistical Methods and Analysis: A propensity score matching model (nearest neighbor algorithm) was used. Results: Of 1800 subjects, 267 met statistical matching criteria. There were no differences in basal characteristics of age, SBP, Creatinine Clearance, but DAPA group had higher basal HbA1c (8.54±1.45 vs 8.16±1.43, p&amp;lt;0.01). Patients in Dapa compared to DPP4i achieved A1c ≤7% in 49.8% vs 20% (p&amp;lt;0.01) by week 156. Creatinine clearance between groups favored DAPA after week 52 (76.07±18.52 vs 86.40±21.27, p&amp;lt;0.01), and persisted through week 156 (68.19±19.4 vs 88.45±19.73, p&amp;lt;0.01). By week 52, Incidental CKD was present in 5.8% of Dapa group and in 14.8% of DPP4i group, p=0.013 (OR 0.607, 95% IC 0.409-0.901), and by week 156 6.5% DAPA vs 27.6% DPP4i, p&amp;lt;0.01 (OR 0.275, 95% IC 0.191-396). There were no differences in HF hospitalizations. Conclusion: In patients with uncontrolled T2DM who have failed to previous antidiabetic therapies, the add-on of dapagliflozin significantly provides reductions of HbA1c, microalbuminuria and reduces the risk of CKD compared to DPP4i add-on. Disclosure D.Espinoza-peralta: None. S.C.Juarez-comboni: Employee; AstraZeneca. A.M.Rodríguez: Employee; AstraZeneca. J.Hernandez-alarcon: None. I.N.Lopez: None. J.Cetina-canto: None. M.E.Búrquez-gonzález: None. P.V.Paul: None. G.A.Bustamante: None. J.Garnica cuellar: None. L.G.Mireles-zavala: None.

1703-P: Attitude and Perception of People with Type 2 DM about Obesity—A Western Indian Perspective

Introduction: Obesity is a major contributor to the T2DM epidemic. The Lifetime risk ofT2DM is highest (86.0% [76.6, 91.5]%) among Indian people with obesity.1 We present data on the attitude and perception of T2DM Indian general public toward obesity and its management. Methods: This cross-sectional survey was conducted between October to November 2022at 30 diabetes care clinics in western India. Data was collected from consenting male and female subjects in the age group of ≥18 years, using a structured questionnaire. Descriptive statistics were used to analyze the survey data. Results: A total of 1248 subjects (males: females = 592:658) with a mean (SD) age of44.6 (14.8) years participated in this survey. Out of which 596 (47.8%) were subjects with T2DM, with a mean (SD) BMI of 29.9 (5.7) kg/m2. Out of 596 subjects with T2DM, 203 (34.1%) perceived their weight as normal, 305 (51.2%) as overweight, and 88 (14.8%) as persons with obesity. However, when categorized as per Asia-Pacific guidelines for obesity classification of BMI, 544 (91.4%) subjects with T2DM were found to be, overweight/persons with obesity. Out of these 544 subjects, diet consultations for weight loss 374 (68.8%), followed by gym membership 269 (49.4%) were the top two weight management programs they were aware of and 396 (72.8%) believed that eating less and moving more is a simple formula for weight loss. Though 303 (55.7%) subjects were aware of doctors-prescribed weight loss drugs, only 291 (53.5%) subjects were considering weight management and only 228 (41.9%) were willing to try these medicines. High blood pressure (41.2%) and knee pain/ mobility (12.9%), were the top two co-morbid conditions in subjects with T2DM found to be, overweight/persons with obesity. Conclusion: This survey revealed that knowledge about of impact of obesity is unsatisfactory in Indian T2DM subjects with overweight/obesity. Educating people about the benefits of weight management interventions can assist subjects with T2DM for optimal outcomes. Disclosure S.A.Patange: None. R.M.Rohatgi: None. S.Bhojane: None. B.L.Gonsalves: None. I.S.Hafizi: None. R.R.Yadav: None. R.T.Mulani: None. K.M.Nayak: None. M.H.Patel: None. A.Rajput: None. V.Saboo: None. R.R.Kovil: None. P.Sanghavi: None. S.A.Bagri: None. A.N.Singh: None. S.N.Dbritto: None. A.A.Jadhav: None. D.H.Punatar: None. A.R.Kothari: None. S.A.Aversekar: None. M.H.Patel: None. R.M.Surya shaikh: None. S.R.Tanna: None. I.Kuberan: None. T.P.Shah: None. A.S.Patange: None. D.Padhye: None. S.A.Karkhanis: None. A.R.Sanghvi: None. A.P.Gandhi: None.