Type 2 Diabetes Mellitus Cases Research Articles

Investigation of plasma asprosin and saliva levels in newly diagnosed type 2 diabetes mellitus patients treated with metformin.

Asprosin is a hormone that was first reported by Romere et al. [2016]. Its secretion is induced in the case of starvation. Asprosin promotes hepatic glucose release. There is no literature information available in humans to demonstrate how blood and saliva asprosin levels of patients with the newly identified type 2 diabetes mellitus (T2DM) changed after metformin treatment. We aim to examine these changes and contribute to the literature in this sense. A total of 60 individuals: 30 healthy volunteers and 30 newly identified cases of T2DM whose treatment had been initiated, were included in the investigation. Blood and saliva sample specimens were carefully taken from both groups. Saliva asprosin and serum levels were tested using the ELISA method. Immunohistochemical methods were used to test asprosin formation sites in salivary gland tissues. Similarly increased asprosin levels were observed in patients from the newly diagnosed T2DM group compared with the healthy control group (p = 0.003). In the newly defined T2DM group, blood asprosin levels decreased significantly after three months of metformin treatment (p = 0.032). In terms of saliva asprosin levels, when the healthy control group and the newly identified T2DM group were compared, saliva asprosin levels were found to be higher in the newly identified T2DM group (p < 0.001). With immunohistochemical staining, asprosin immunoreactivity was observed in the submandibular and parotid glands. In our study, serum and saliva asprosin levels increased significantly in the newly identified individuals with type 2 diabetes, which suggests that asprosin could form a critical risk related to T2DM. Higher asprosin levels are an important marker for predicting diabetes development, and that this hormone can be signified as a main or target molecule in the treatment of diabetes.

Pre- and post-diagnostic blood profiles of chlorinated persistent organic pollutants and metabolic markers in type 2 diabetes mellitus cases and controls; a pilot study

ObjectiveSeveral risk factors for type 2 diabetes mellitus (T2DM) are also associated with blood concentrations of persistent organic pollutants (POPs), and factors related to the disease may affect POP concentrations, and subsequent associations between POPs and T2DM. The purpose of this pilot study was to investigate the change in concentrations of lipids, hormones and POPs pre- and post-diagnosis in T2DM cases compared to healthy controls and their associations with T2DM. MethodsWe measured POPs, lipids, and thyroid and steroid hormones in plasma from 44 female cases collected prior to (pre-diagnostic) and following (post-diagnostic) T2DM diagnosis, and in 44 healthy female age-matched controls. We compared cross-sectional differences and longitudinal changes within and between matched cases and controls with t-tests and multivariable linear regression models. Associations between POP concentrations and T2DM were investigated using conditional logistic regression. ResultsBetween the pre- and post-diagnostic measurement, cases developed more favorable lipid profiles and the longitudinal changes in lipid-normalized concentrations of non-dioxin-like polychlorinated biphenyls (PCBs), dioxin-like PCBs, beta-hexachlorocyclohexane (HCH), HCB, and 1,1,1-trichloro-2,2-bis(4-chlorophenyl) ethane (p,p'-DDE) differed significantly between cases and controls. The longitudinal changes in POPs were mainly driven by changes in bodyweight, total lipids and T2DM status. Cases had significantly higher pre-diagnostic concentrations of POPs and triglycerides, and lower concentrations of high-density lipoprotein cholesterol and free thyroxin than controls. Pre-diagnostic POP concentrations were not significantly associated with incident T2DM, whereas several post-diagnostic POP concentrations were significantly positively associated with prevalent T2DM. ConclusionsThis pilot study suggests that factors related to T2DM affect blood concentrations of POPs and may partly explain the positive associations between POPs and T2DM.

Population attributable risk of excess weight, abdominal obesity and physical inactivity for type 2 diabetes in Chinese men and women.

BackgroundGiven the high prevalence of type 2 diabetes mellitus (T2DM) in the Chinese population, it is necessary to estimate the T2DM incident attributable to obesity and physical inactivity.MethodsWe analyzed the data from the Shanghai Men’s and Women’s Health Studies, including 56,691 men and 70,849 women aged 40–74. The hazard ratios (HRs) and the population attributable risks (PARs) were calculated by Cox regression model and model-based estimation.ResultsA total of 3,315 male and 5,925 female cases were identified during 519,157 and 981,504 person-years, up to 31 December 2017. Excess weight, abdominal obesity were associated with the increased risks of T2DM both in women and men, while physical inactivity was only associated with an increased risk in men. A large proportion of T2DM incident cases can be attributed to excess body weight (women: 48.6%; men: 41.5%) and abdominal obesity (women: 50.4%; men: 30.3%). Physical activity was negatively associated with the risk of T2DM (Ptrend<0.01). The PARs adjusted for confounders were 3.6% for physical inactivity in men and 1.7% in women.ConclusionsExcess weight and abdominal obesity accounted for a large proportion of T2DM incident cases in men and women; a small part of T2DM cases were attributed to physical inactivity in men. Weight control is of great significance in curbing the epidemic of diabetes.

A Pathophysiology of Type 2 Diabetes Unrelated to Metabolic Syndrome

Clinically, type 2 diabetes mellitus (T2DM) is heterogeneous, but the prevailing pathophysiologic hypothesis nevertheless contends that components of metabolic syndrome are central to all cases of T2DM. Here, we re-evaluated this hypothesis. We conducted a cross-sectional analysis of 138 women from the monocenter, post gestational diabetes study PPSDiab, 73 of which had incident prediabetes or T2DM. Additionally, we examined all the 412 incident cases of T2DM in phases 3 to 9 of the Whitehall II study in comparison to healthy controls. Our analysis included a medical history, anthropometrics, oral glucose tolerance testing, and laboratory chemistry in both studies. Additional analyses from the PPSDiab Study consisted of cardiopulmonary exercise testing, magnetic resonance imaging, auto-antibody testing, and the exclusion of glucokinase maturity-onset diabetes of the young. We found that 33 (45%) of the women with prediabetes or T2DM in the PPSDiab study displayed no components of metabolic syndrome. They reached no point for metabolic syndrome in the National Cholesterol Education Program Adult Treatment Panel III score other than hyperglycemia and, moreover, had levels of liver fat content, plasma triglycerides, high-density lipoprotein cholesterol, c-reactive protein, and blood pressure that were comparable to healthy controls. In the Whitehall II study, 62 (15%) of the incident T2DM cases fulfilled the same criteria. In both studies, these cases without metabolic syndrome revealed insulin resistance and inadequately low insulin secretion. Our results contradict the hypothesis that components of metabolic syndrome are central to all cases of T2DM. Instead, they suggest the common occurrence of a second, unrelated pathophysiology.

Significant association of LXRβ (NR1H2) polymorphisms (rs28514894, rs2303044) with type 2 diabetes mellitus and laboratory characteristics.

To investigate if single-nucleotide polymorphisms (SNPs) in the NR1H2 gene encoding LXRβ contribute to the development of type-2 diabetes mellitus (T2DM) and whether genotypes of twoNR1H2 polymorphisms, rs28514894 and rs2303044, are associated with laboratory characteristics of T2DM patients. A total of 900 subjects (450 T2DM cases and 450 healthy subjects) of Iranian ancestry were genotyped for NR1H2 polymorphisms via ARMS-PCR and PCR-RFLP techniques. Our findings showed a significant correlation between both polymorphisms and increased risk of T2DM. The haplotype analysis showed an association between the C A haplotype with enhanced risk of T2DM. In T2DM patients, the mean level of HbA1C and BUN significantly differed among carriers of CC and TT genotypes of the rs28514894 polymorphism (P = 0.05 and P < 0.0001, respectively); while in the control group, no significant difference was noticed between subjects with these genotypes. The mean BUN levels also significantly differed among carriers of TC and TT genotypes of this variant in T2DM patients (P = 0.01) and controls (P = 0.04). As for rs2303044 polymorphism, only the mean BUN level significantly differed between GA and GG carriers in T2DM patients (P = 0.006). Compared with CT and TT genotypes, the CC genotype of rs28514894 polymorphism was more frequent in overweight T2DM patients ( 25 < body mass index < 30). The present research provided the first documents of the correlation of NR1H2 rs28514894 and rs2303044 polymorphisms with susceptibility to T2DM. Replicated case-control studies on larger populations are needed to validate these findings.

Homoeopathy for management of type 2 diabetes mellitus in a patient of major depressive disorder - A case report

Introduction: Major depressive disorder in diabetic individuals represents a multifactorial phenomenon resulting from interactions between biological and psychosocial factors, which may intensify the probability of developing type 2 diabetes mellitus (T2DM) in otherwise healthy individuals. Case Summary: A case of T2DM is reported in a 38-year-old woman suffering from major depressive disorder who was treated successfully with individualised homoeopathic medicines. The patient reported to the Lifestyle Disorders clinic of Homoeopathic Hospital, Noida, with recently diagnosed diabetes of 8 months. After individualised homoeopathic treatment, the patient's fasting plasma glucose, postprandial glucose, HbA1c levels, fasting plasma insulin and Hamilton Depression Rating Scale score were reduced within 6 months. The findings in this case report are encouraging and provide evidence in supporting the effectiveness of individualised Homoeopathy in reducing hyperglycaemia in a patient with major depressive disorder.

Interaction between Cadmium and Zinc Levels in the Biological Samples of Type 1 Diabetic Mellitus Children, Reside in Different Areas of Sindh, Pakistan

Type 1 Diabetes mellitus (T1DM) is one of the familiar childhood immune-mediated onsets and can lead to early mortalities and morbidities. It can arise at any stage, but the peak of occurrence is reported less than 18 years of age. T1DM cases in Pakistan were less than 2% of the total diabetic population. The current work designed to assess the concentration of cadmium (Cd) and zinc (Zn) in blood, scalp hair and serum samples of T1DM children, age ranged 1 - 14 years of both genders. For comparison purpose, the age-matched referent subjects of both genders were tested. The microwave-assisted acid digestion procedure was used to determine the elemental analysis in the biological samples of T1DM children and referent subjects. The resulted data of certified reference material of blood, scalp hair, and serum validated the certainty of the designed method. The analysis of Zn was performed by flame atomic absorption spectrometry, while the Cd contents were determined by electrothermal atomic absorption spectrometry. T1DM affected children of both genders have lower Zn level in the blood, scalp hair, and serum samples. Whereas, the levels of Cd were found to be higher in the biological samples of T1DM affected children as compared to referent subjects. The finding of the current study is a significant hypothesis for medical experts, to diagnose the deficiency of essential (Zn) and toxicity of heavy/toxic element (Cd) in the biological specimen of T1DM affected children.

Effect of long-term Yogic practices in type 2 diabetes mellitus: a single case study

Diabetes is a chronic noncommunicable disease for which there is not yet a cure. Type 2 diabetes mellitus (T2DM) is a heterogeneous metabolic disorder resulting from a defect in insulin secretion, insulin action, or both, resulting in abnormally high blood glucose levels. Madhumeha (Diabetes) described in Ayurveda texts is often compared with T2DM. Yoga, an ancient practice, is now emerging as a complementary therapy in noncommunicable diseases such as hypertension, diabetes, etc. In the present case study, a 51-year-old female patient with a known case of T2DM for the past one year presented with complaints of increased frequency urination, stress, burning sensation at soles, excessive sweating, hunger, thirst, and fatigue. A properly designed one-year Yoga module was provided to her by a certified Yoga trainer. Appropriate modifications were made in diet and lifestyle. After one year, fasting blood sugar dropped from 187 to 117 mg/dL and postprandial blood sugar dropped from 311 to 194 mg/dL. Weight reduced from 61 to 52 kg. The subjective symptoms also reduced remarkably. The results concluded that consistent long-term practice of a Yogic lifestyle can not only maintain the blood sugar levels of patients with diabetes but also improve the quality of life.

Study on Association of Serum Uric Acid and Calcium with Insulin and its Resistance in Newly Diagnosed Type 2 Diabetes Mellitus Patients

Introduction: Type 2 Diabetes Mellitus (T2DM) is a multifactorial pathological condition associated with insulin resistance and insulin deficiency. Uric acid and calcium have shown inconsistent association with occurrence of diabetes. Aim: To evaluate the role of uric acid and calcium in development of T2DM. Materials and Methods: This was a case-control study conducted in Department of Biochemistry from March to November 2019 in Sriram Chandra Bhanja, Medical College and Hospital, Cuttack, Odisha, India. A 180 subjects undertaken with the objective of finding any association of serum uric acid and calcium with insulin and its resistance in newly diagnosed T2DM cases. Newly diagnosed T2DM patients were taken as cases. Age and sex matched healthy individuals were taken as controls. Fasting Plasma Glucose (FPG), serum insulin, serum uric acid and ionised calcium were measured in autoanalyser and insulin resistance was calculated using Homeostasis Model Assessment for Insulin Resistance (HOMA- IR). Other confounding risk factors for T2DM like Body Mass Index (BMI), family history was taken into account. Results: A significant positive correlation of serum uric acid with serum insulin (p=0.029) and its resistance (p=0.032) in cases. Serum calcium was negatively associated with insulin and its resistance in both cases and controls. Regression models showed serum uric acid as a strong independent risk factor for levels of insulin and its resistance. Conclusion: The findings of the study showed that regular evaluation of serum uric acid and calcium should be done in those who are at risk of developing T2DM. Larger prospective studies will be required for definite assessment.

Association of TCF7L2 gene polymorphisms, methylation, and gene-environment interaction with type 2 diabetes mellitus risk: A nested case-control study in the Rural Chinese Cohort Study.

To assess the associations of single-nucleotide polymorphisms (SNPs) and methylation of transcription factor 7-like 2 (TCF7L2) gene with type 2 diabetes mellitus (T2DM) risk and further explore the interactions among SNPs, methylation, and environmental factors involved in T2DM risk. We conducted a nested case-control study with 290 pairs of T2DM cases and matched controls. We genotyped 3 SNPs of TCF7L2 in all included participants and tested 14 CpG loci of TCF7L2 in 76 pairs of cases and controls. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for T2DM risk according to SNPs and methylation of TCF7L2. Multifactor dimensionality reduction (MDR) analysis was used to explore the potential TCF7L2 gene-environment interactions in T2DM risk. We found no statistically significant association between the TCF7L2 polymorphisms and T2DM risk. We observed significant positive associations of methylation at CpG5 and CpG7_8 with T2DM risk. For each 1% increase in DNA methylation at CpG5 and CpG7_8, T2DM risk increased 12% (OR 1.12, 95% CI 1.01-1.25) and 32% (OR 1.32, 95% CI 1.07-1.63), respectively. Additionally, MDR analyses identified significant SNP-environment interactions among rs290487, alcohol drinking, and hypertension and methylation-environment interactions among CpG5, CpG7_8 and hypertension (P <0.05). TCF7L2 polymorphisms were not independently associated with T2DM risk. However, TCF7L2 methylation were positively associated with T2DM risk in rural Chinese adults. Interactions among TCF7L2 polymorphisms, TCF7L2 methylation and environmental factors also suggest a possible etiologic pattern for T2DM.

Study of high-sensitivity C-Reactive protein levels in subjects with type 2 diabetes mellitus

Introduction: The Diabetes mellitus was characterized by chronic hyperglycemia with disturbances of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The two broad categories of diabetes are type 1 and type 2. Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes. The role of elevated high sensitivity C-reactive protein (hs-CRP) as a risk marker for cardiovascular diseases, including coronary heart disease, stroke and peripheral arterial disease is well established through consistent results from a number of prospective studies. More recent data suggest that hs-CRP is superior to other markers of inflammation for risk evaluation. Materials and Methods: The present study was conducted over a period of one year on outpatients attending the General Medicine Department at Narayana General Hospital, Nellore. The study was undertaken on 50 type 2 Diabetes mellitus and 50 normal healthy controls. Both male and females in the age group of 35 – 70 years were included. Results: Fasting blood glucose, post prandial blood glucose, and hs-CRP levels was measured in 50 T2DM cases and 50 age matched healthy controls. The mean and standard deviation were calculated for all the Biochemical parameters. The significance between the groups were determined using Student t- test for Equality of means. The p-value of < 0.05 was considered significant. Conclusion: This study concludes that there is increase in hs-CRP levels in T2DM cases compared with controls. hs-CRP is an inflammatory marker and has role in atherosclerosis. From this study it is observed that there is moderate correlation between hs-CRP levels and it increases the risk of atherosclerosis. Keywords: Diabetes Mellitus, hs-CRP, Hyperglycemia, Inflammation.

Effect of cold stress on heart rate and blood pressure in healthy offspring with and without parental history of type2 diabetes mellitus

Introduction: The cold pressor test which is considered to be a sympatho-excitatory maneuver is a simple, noninvasive and validated test of sympathetic activation. The heart rate and blood pressure responses to CPT could be used as indicators of global sympathetic activation, and thus of cardiac status and autonomic function. Autonomic nervous system dysfunction at the subclinical level seems to be the predisposing condition that occurs far earlier before developing an overt diabetic condition. Aims: To evaluate the cardiac autonomic status and its reactivity among healthy offspring with and without parental history of Type2 Diabetes Mellitus (T2DM). To Compare the autonomic reactivity by recording Heart Rate (HR) and Blood pressure during and after CPT between healthy offspring with and without parental history of T2DM. Materials and Methods: This study consists of 40 healthy male subjects with family history of T2DM (cases) and 40 healthy male subjects without family history of T2DM (controls) in the age group of 18-25 years. HR and BP during and after CPT were compared between cases and controls. Results: Student t test (two tailed, independent) has been used to find the significance of study parameters on continuous scale between two groups. HR response to post CPT showed significant differences between two groups across all the time points. Controls showed higher HR than cases at all the time points. However, the reduction of HR with time was more gradual in controls. The graphical representation of SBP changes after CPT, shows fluctuation among cases before it reaches the stable value, whereas, in controls the decrease was at constant level. Conclusion: The results suggest there was altered autonomic reactivity to physical stress among the offspring with parental history of T2DM when compared to their counterparts and hence this points towards the fact that they are at a risk of developing future autonomic dysfunction and cardiovascular complications. Keyword

Elevated levels of plasma von Willebrand factor and increased urinary albumin excretion are possible markers for endothelial dysfunction in type 2 diabetes mellitus patients

Introduction: Globally, Type 2 Diabetes Mellitus (T2DM) prevalence is increasing. Endothelial dysfunction is known to be associated with T2DM. The aim of the present study is to assess endothelial dysfunction by measuring plasma levels of von Willebrand factor and urine albumin levels in patients with type 2 diabetes mellitus and in healthy subjects. Materials and Methods: This is a prospective, case-control study conducted in the department of physiology in association with department of Endocrinology, MS Ramaiah Memorial and Teaching Hospital, Bangalore. A total of 50 subjected were recruited into the study. Among them 25 were T2DM patients as cases and 25 age and sex matched healthy controls. Under aseptic conditions, After 12 hours of fasting 5 ml venous blood sample is collected and plasma is separated. The separated plasma sample was used for the estimation FBS, PPBS, von Willebrand factor (vWF). Urine sample is used for the estimation of urine albumin. Anthropometric parameters like blood pressure, height, weight and BMI was measured. Results: In the present study, systolic blood pressure, FBS, PPBS, von Willebrand factor, urine albumin levels were significantly increased in T2DM cases compared with healthy controls. Von Willebrand factor and urinary albumin levels showed a weak correlation in type 2 DM patients (r= - 0.245, p = 0.237) but such correlation was not observed in healthy subjects (r=0.212, p=0.310). Conclusion: In this study, von Willebrand factor(vWF) levels in plasma and urine albumin levels were increased significantly in T2DM patients compared to normals, which suggests that there is significant endothelial injury and vascular damage in T2DMPatients. Keywords: Cardiovascular diseases, Endothelial dysfunction, Type 2 diabetes mellitus, Von Willebrand factor.

Analysis of serum ferritin levels in non-diabetic, prediabetic and diabetic individuals

Introduction: Type 2 diabetes mellitus (T2DM) is characterized by impaired insulin secretion, insulin resistance or both. In the initial asymptomatic phase there is hyperinsulinemia, as insulin resistance progress and beta cell function deteriorates ‘Prediabetes’ an intermediate hyperglycemic state prone for diabetic complications ensues. A chronic sub-clinical inflammation is associated with insulin resistance and it can be assessed using a pro-inflammatory marker like serum ferritin. Aim: We intend to evaluate serum ferritin levels in normoglycemics, intermediate hyper glycemics and overt cases of T2DM and also to investigate if any correlation exists between blood glucose and serum ferritin levels at these three different stages of glycemia. Materials and Methods: In accordance with World health organisation guidelines, we inducted forty seven pre-diabetics and thirty seven T2DM patients in the first and second groups of our study respectively. Twenty three healthy controls constituted the third group. Serum ferritin, fasting and 2 hour postprandial blood glucose were estimated in all subjects. Results: The mean ± SD of Log serum ferritin levels in prediabetic, diabetic group and Controls groups are 4.21±0.96, 4.25±1.07 and 3.59±0.95µg/L respectively. Mean Log serum ferritin levels is significantly higher in pre-diabetics and diabetics with p=0.012. A positive and statistically significant association was noticed between serum ferritin and blood glucose levels when the subjects of the three groups were considered together (p=0.036) but not when the groups were considered separately. Conclusion: Serum ferritin levels are elevated in prediabetes and T2DM when compared to healthy controls and it reflects the inflammation associated with prediabetes and T2DM. Keywords: Blood glucose, Inflammation, Prediabetes, Serum ferritin, Type 2 diabetes mellitus.

Dietary iron intake and the risk of type 2 diabetes mellitus in middle-aged and older adults in urban China: a prospective cohort study.

The association between dietary Fe intake and diabetes risk remains inconsistent. We aimed to explore the association between dietary Fe intake and type 2 diabetes mellitus (T2DM) risk in middle-aged and older adults in urban China. This study used data from the Guangzhou Nutrition and Health Study, an on-going community-based prospective cohort study. Participants were recruited from 2008 to 2013 in Guangzhou community. A total of 2696 participants aged 40-75 years without T2DM at baseline were included in data analyses, with a median of 5·6 (interquartile range 4·1-5·9) years of follow-up. T2DM was identified by self-reported diagnosis, fasting glucose ≥ 7·0 mmol/l or glycosylated Hb ≥ 6·5 %. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % CI. We ascertained 205 incident T2DM cases during 13476 person-years. The adjusted HR for T2DM risk in the fourth quartile of haem Fe intake was 1·92 (95 % CI 1·07, 3·46; Ptrend = 0·010), compared with the first quartile intake. These significant associations were found in haem Fe intake from total meat (HR 2·74; 95 % CI 1·22, 6·15; Ptrend = 0·011) and haem Fe intake from red meat (HR 1·86; 95 % CI 1·01, 3·44; Ptrend = 0·034), but not haem Fe intake from processed meat, poultry or fish/shellfish. The association between dietary intake of total Fe or non-haem Fe with T2DM risk had no significance. Our findings suggested that higher dietary intake of haem Fe (especially from red meat), but not total Fe or non-haem Fe, was associated with greater T2DM risk in middle-aged and older adults.

Amino-acid amendment of Arginine-325-Tryptophan in rs13266634 genetic polymorphism studies of the SLC30A8 gene with type 2 diabetes-mellitus patients featuring a positive family history in the Saudi population

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder with chronic hyperglycemia. Genome-wide association studies (GWAS) have identified many genes and, among them, solute carrier family 30 member 8 (SLC30A8) was one of the important genes linked to the development of T2DM risk. The relationship between T2DM and the SLC30A8 gene is linked through zinc, which plays a key role in the storage and secretion of insulin. The rs13266634 polymorphism includes a strong genetic association in case-control and meta-analysis studies of the global population. The aim of this current study was to scrutinize the genetic relationship between the rs13266634 polymorphism in the SLC30A8 gene with T2DM subjects selected with a family history in the Saudi population. This study involved 120 cases of diagnosed T2DM and 120 confirmed healthy controls that were recruited to screen rs13266634 polymorphisms through a genotyping analysis followed by PCR and RFLP analysis. Baseline characteristics between cases and controls have been evaluated with Student’s t-test. The study results confirmed the genetic association between the allele (p = 0.001), genotypes (CT = 0.005 and TT = 0.03), and various genetic patterns of inheritance (p = 0.001 and p = 0.02). Both analysis of variance (ANOVA) and binary logistic regression analysis revealed non-signiifcant association with T2DM cases and biochemical parameters (p > 0.05). In conclusion, the current results have confirmed the strong genetic association between T2DM cases and controls in the Saudi population with rs13266634 polymorphisms of the SLC30A8 gene.

Hypertriglyceridemic Waist Phenotype and Lipid Accumulation Product: Two Comprehensive Obese Indicators of Waist Circumference and Triglyceride to Predict Type 2 Diabetes Mellitus in Chinese Population.

Purpose To determine whether hypertriglyceridemic waist (HTGW) and high lipid accumulation product (LAP) preceded the incidence of type 2 diabetes mellitus (T2DM), and to investigate the interactions of HTGW and LAP with other components of metabolic syndrome on the risk of T2DM. Methods A total of 15,717 eligible participants without baseline T2DM and aged 35 and over were included from a Chinese rural cohort. Cox proportional hazards regression models were used to estimate the association of HTGW and LAP with the incidence of T2DM, and the restricted cubic spline model was used to evaluate the dose-response association. Results Overall, 867 new T2DM cases were diagnosed after 7.77 years of follow-up. Participants with HTGW had a higher hazard ratio for T2DM (hazard ratio (HR): 6.249, 95% confidence interval (CI): 5.199-7.511) after adjustment for potential confounders. The risk of incident T2DM was increased with quartiles 3 and 4 versus quartile 1 of LAP, and the adjusted HRs (95% CIs) were 2.903 (2.226-3.784) and 6.298 (4.911-8.077), respectively. There were additive interactions of HTGW (synergy index (SI): 1.678, 95% CI: 1.358-2.072) and high LAP (SI: 1.701, 95% CI: 1.406-2.059) with increased fasting plasma glucose (FPG) on the risk of T2DM. Additionally, a nonlinear (P nonlinear < 0.001) dose-response association was found between LAP and T2DM. Conclusion The subjects with HTGW and high LAP were at high risk of developing T2DM, and the association between LAP and the risk of T2DM may be nonlinear. Our study further demonstrates additive interactions of HTGW and high LAP with increased FPG on the risk of T2DM.

MALONDIALDEHYDE IN TYPE 2 DIABETICS AND ASSOCIATION WITH CARDIOVASCULAR RISK FACTORS

Background: Type 2 diabetes mellitus (T2DM) is a progressive chronicdisease with high prevalence all over the world. It is expected to have 693million people affected by diabetes by 2045. Many body systems areaffected due to complications of DM with major effect on thecardiovascular system. Dyslipidemia is one of the major risk factors forcardiovascular disease in diabetes mellitus. Malondialdehyde (MDA) is ahighly toxic end product formed by lipid oxidation that mediates its toxiceffects due to its high reactivity particularly towards proteins and DNA.Malondialdehyde interacts both irreversibly and reversibly with proteinsand phospholipids causing profound effects, especially in the collagen ofthe cardiovascular system. Normally, MDA level remains within normalvalues due to antioxidant effects, but in DM these protective effects aredisrupted.Objective: Measure serum Malondialdehyde level as a marker of lipidperoxidation in type 2 diabetic patients and its association with othercardiovascular risk factors.Patients and methods: The study included 40 diabetic patients recruitedfrom Outpatient Diabetes Clinic at Alexandria Main University Hospitalin addition to healthy 40 healthy subjects as a control group. Basic data,clinical examination and laboratory analysis were obtained from all thesubjects within the two groups. Serum Malondialdehyde (MDA) wasmeasured in the participants within the two groups by using ELISA kit.Results: The mean serum MDA level was statistically significant higherin the diabetic cases as compared to the controls (Median MDA was30.72nmol /ml in cases and 25.16 nmol /ml in the control). There is asignificant increase in serum MDA level with increasing the risk of CVdisease in the whole study subjects and in the diabetic cases. In the casesgroup MDA shows positive correlation with all the study parametersexcept high density lipoproteins (HDL) where it revealed negativecorrelation. BY ROC curve analysis, a cutoff point more than > 26.57 had62.5% sensitivity, 70% specificity, 66.4 % positive predictive value (PPV)and 72.5% negative predictive value (NPV).Conclusion: Malondialdehyde is a non-invasive biomarker that could beutilized in differentiation of T2DM cases form healthy controls in additionfor identifying the high-risk diabetic patients for cardiovascular disease(CVD). However, further large-scale studies are recommended toaccurately determine its sensitivity and specificity.

Characterizing the type 2 diabetes mellitus epidemic in Jordan up to 2050

We aimed to characterize the type 2 diabetes mellitus (T2DM) epidemic and the role of key risk factors in Jordan between 1990–2050, and to forecast the T2DM-related costs. A recently-developed population-level T2DM mathematical model was adapted and applied to Jordan. The model was fitted to six population-based survey data collected between 1990 and 2017. T2DM prevalence was 14.0% in 1990, and projected to be 16.0% in 2020, and 20.6% in 2050. The total predicted number of T2DM cases were 218,326 (12,313 were new cases) in 1990, 702,326 (36,941 were new cases) in 2020, and 1.9 million (79,419 were new cases) in 2050. Out of Jordan’s total health expenditure, 19.0% in 1990, 21.1% in 2020, and 25.2% in 2050 was forecasted to be spent on T2DM. The proportion of T2DM incident cases attributed to obesity was 55.6% in 1990, 59.5% in 2020, and 62.6% in 2050. Meanwhile, the combined contribution of smoking and physical inactivity hovered around 5% between 1990 and 2050. Jordan’s T2DM epidemic is predicted to grow sizably in the next three decades, driven by population ageing and high and increasing obesity levels. The national strategy to prevent T2DM needs to be strengthened by focusing it on preventive interventions targeting T2DM and key risk factors.

Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients.

Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients. Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged ≥65 years who received ≥2 prescriptions for antidiabetic drugs were identified as “T2DM patients.” Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or “non-high cost.” Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created. Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7,627 versus €4,401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19,577 and >€2,563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having ≥5 comorbidities and renal impairment. Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.