Type 2 Diabetes Mellitus In Population Research Articles

Evaluation of eating disorders and their association with glycemic control and metabolic parameters in adult patients with type 2 diabetes mellitus

BackgroundThere is little data on the prevalence and effects of eating disorders in patients with T2DM. AimsTo evaluate the presence of eating disorders (ED) and their association with glycemic control and metabolic parameters in adult patients with type 2 diabetes mellitus (T2DM). MethodsA cross-sectional study was conducted in the endocrinology outpatient unit of our tertiary care centre between January 2017 to December 2018. Eating Attitudes Test (EAT-26) and Binge Eating Scale (BES) questionnaires were used to screen for ED in adults with T2DM (group 1) and controls without T2DM (group 2). Cut off scores ≥18 on BES was considered as a positive screen for Binge eating disorder in participants with and without T2DM. A score of ≥30 on EAT-26 was defined as abnormal for participants with T2DM and ≥20 for those without T2DM. Formal psychiatric assessment was done to diagnose ED in those who screened positive on the basis of scores on BES or EAT-26 or both. Demographic, anthropometric and relevant medical details like duration of treatment, glycemic control, complications were recorded. ResultsA total of 512 individuals (256 in each group) participated in this study. Out of these, 10.9% of individuals with T2DM and 14.1% of those without T2DM screened positive for ED, with no significant difference in the two groups. After a detailed psychiatric assessment, two patients (0.8%) in each group were confirmed to have ED. Participants with T2DM who were on thiazolidinediones had higher odds (2.2) of screening positive for an ED.(p = 0.03). ConclusionsOur study reveals that eating disorders are not very common in our clinical population of T2DM, and the prevalence is comparable to BMI matched individuals without T2DM. The prevalence rates of eating disorders are lower (in both controls and patients with T2DM) than those reported from developed western countries.

CDKAL1 (rs10946398) and TCF7L2 (rs7903146) gene polymorphisms and their association with risk of type-2 diabetes mellitus in population of Uttarakhand, India

PurposeType 2 diabetes mellitus (T2DM), a non- insulin dependent form of diabetes is predominantly the outcome of multivariate factors ranging from genetic, hereditary to environmental factors. CDKAL1 ((rs10946398)), gene play a permissive role in β-cell function by inhibiting activity of CDK5, the decrease of insulin gene expression. TCF7L2 ((rs7903146)) gene involved in the Wnt signalling pathway, has its direct effects on glucose-induced, which may risk prevalence of T2DM. The present study aims to understand the association of CDKAL1 and TCF7L2 Gene polymorphism in T2DM patients among the population of Uttarakhand, India. Materials and methodsThe present study included 400 T2DM subjects and 400 healthy controls. DNA extraction done from blood serum collected in plain vials and CDKAL1, TCF7L2 gene polymorphism was done by the PCR-RFLP method. ResultsSignificant differences were observed in BMI (kg/m2), FPG (mg/dl), PPG (mg/dl), HbA1c, FPI, systolic BP (mmHg), diastolic BP (mmHg) among the subjects and controls (all p < .0001). Genotypes of CDKAL1 and TCF7L2 genes among T2DM and healthy controls was found to be statistically significantly (p < .0001).Among the T2DM subjects, CDKAL1 genotypes GG, GC and CC were 32.5%, 60% and 7.5% while in healthy control, CDKAL1 genotypes GG, GC and CC were 58%, 39% and 3% respectively. Among the T2DM subjects, TCF7L2 genotype CC, CT and TT were 35%, 63% and TT 2.5% while in healthy control CC, CT, TT were 53%, 46% and 1% respectively. Higher heterozygous GC genotype and mutant CC genotype. Higher C allele frequency (0.37%) noticed in patients as compare to control C allele (0.22%). Odd ratio with 95% CI were calculated for CDKAL1, GC and CC had 2.79 (2.08–3.75) and 4.13 (2.08–8.20) risk taking GG as reference and TCF7L2, CT and TT had 2.09 (1.57–2.78), 3.04 (1.01–9.09) risk taking CC in T2DM subjects. ConclusionStudy concluded that CDKAL1 heterozygous GC, mutant CC were higher in among T2DM and TCF7L2 heterozygous CT, mutant TT were higher among T2DM subjects suggested connected with T2DM. Higher odds and relative risk was found with CDKAL1, TCF7L2 heterozygous GC, CT and mutant CC, TT genotypes respectively.

Incidence and costs of cardiovascular events in Spanish patients with type 2 diabetes mellitus: a comparison with general population, 2015.

IntroductionCardiovascular (CV) disease affects a high percentage of patients with type 2 diabetes mellitus (T2DM), especially in the hospital setting, impacting on mortality, complications, quality of life and use of health resources. The aim of this study was to estimate the incidence, mean length of hospital stay (LOHS) and costs attributable to hospital admissions due to CV events in patients with T2DM versus patients without diabetes mellitus (non-DM) in Spain.Research design and methodsRetrospective observational study based on the Spanish National Hospital Discharge Database for 2015. Hospital admissions for patients aged ≥35 years with a diagnosis of CV death, non-fatal acute myocardial infarction (AMI), non-fatal stroke, unstable angina, heart failure and revascularization were evaluated. The International Classification of Diseases, Ninth Revision (250.x0 or 250.x2) coding was used to classify records of patients with T2DM. For each CV complication, the hospital discharges of the two groups, T2DM and non-DM, were precisely matched and the number of hospital discharges, patients, LOHS and mean cost were quantified. Additional analyses assessed the robustness of the results.ResultsOf the 276 925 hospital discharges analyzed, 34.71% corresponded to patients with T2DM. A higher incidence was observed in all the CV complications studied in the T2DM population, with a relative risk exceeding 2 in all cases. The mean LOHS (days) was longer in the T2DM versus the non-DM group for: non-fatal AMI (7.63 vs 7.02, p<0.001), unstable angina (5.11 vs 4.78, p=0.009) and revascularization (7.96 vs 7.57, p<0.001). The mean cost per hospital discharge was higher in the T2DM versus the non-DM group for non-fatal AMI (€6891 vs €6876, p=0.029) and unstable angina (€3386 vs €3304, p<0.001).ConclusionsPatients with T2DM had a higher incidence and number of hospital admissions per patient due to CV events versus the non-DM population. This generates a significant clinical and economic burden given the longer admission stay and higher costs associated with some of these complications.

Effects of Omega-3 PUFA Supplementation on Insulin Resistance and Lipid Metabolism in Patients with T2DM: A Systematic Review and Meta-Analysis

Abstract Objectives Omega-3 PUFA could reduce the risk of metabolic syndrome and is beneficial to a wide range of chronic diseases, such as cardiovascular disease, type 2 diabetes mellitus (T2DM) and cancer. While, its effect on insulin sensitivity and lipid metabolism remains controversial. This meta-analysis summarizes the extant evidence between the supplement of Omega-3 PUFA and lipid metabolism and assesses whether Omega-3 PUFAs could improve the dyslipidemia in the T2DM population. Methods Databases including PubMed, Elsevier, and the Cochrane Library were searched until march 2019 for RCTs investigating the effect of Omega-3 PUFAs supplementation on lipid metabolism. Data were extracted using Rveman 5.3 statistical software and analyzed using a fixed effect model. The effect size is given in a standardized mean difference (SMD) and a 95% confidence interval (95% CI). Results A total of 26 cases of RCT were included in this paper. In the combined analysis, supplementation of omga-3 PUFA significantly affected the level of total cholesterol (TC), high density lipoprotein (HDL), insulin resistance (HOMA-IR) in patients with T2DM, in which HOMA-IR decreased 0.2, TG decreased 0.56 mg/dL, TC decreased 0.14 mg/dL, HDL increased 0.14 mg/dL. The changes in fasting insulin (FINS) and low density lipoprotein (LDL) index were statistically obvious, while they both showed decreasing trends. In the subgroup analysis based on intervention time and doses of Omega-3 PUFA, with the increase of intervention time and supplementary doses, the change trend of each index became more and more significant, and towards the better improvement in lipid metabolism. The sensitivity analysis indicated that the results were robust. Conclusions The addition of omega-3 PUFA may improve insulin sensitivity and lipid metabolism in the T2DM population, which may provide a dietary reference for diabetic patients characterized by these disorders. Funding Sources This work was funded by the Danone Dietary Nutrition Research and Education Fund (No. DIC2016–05).

Role of social and other determinants of health in the effect of a multicomponent integrated care strategy on type 2 diabetes mellitus

BackgroundAlthough important advances in treatment strategies have been developed in type 2 diabetes mellitus (T2DM), large gaps exist in achieving glycemic control and preventing complications, particularly in low-and middle-income countries, which suggests a potential effect of social determinants of health (SDH, i.e., education level and socioeconomic status). However, few studies have determined the role of SDH and other determinants of health (ODH, i.e., diabetes knowledge and self-care scores) in achieving T2DM goals during effective multidisciplinary interventions. We aimed to examine a multicomponent integrated care (MIC) program on diabetes care goals and determine the effect of SDH and ODH on T2DM patients.MethodsA before-and-after design (a pretest, a 5-month intervention, and a follow-up) was used in a T2DM population from Mexico City. The SDH included education level and socioeconomic status; the ODH included diabetes knowledge, self-care scores, and deltas (i.e., differences between baseline and follow-up scores). The triple-target goal (glycated hemoglobin, blood pressure, and LDL-cholesterol) was established as a measurement of T2DM goals.ResultsThe DIABEMPIC (DIABetes EMPowerment and Improvement of Care) intervention (n = 498) reduced the glycated hemoglobin levels (mean reduction 2.65%, standard deviation [SD]: 2.02%) and cardiometabolic parameters; it also improved health-related quality of life. From 1.81% at baseline, 25.9% of participants (p-value< 0.001) achieved the triple-target goal. We found a significant association between education level (p-value = 0.010), diabetes knowledge at baseline (p-value = 0.004), and self-care scores at baseline (p-value = 0.033) in the delta (change between baseline and follow-up assessments) of HbA1c levels. Improvements (increase) in diabetes knowledge (p-value = 0.006) and self-care scores (p-value = 0.002) were also associated with greater reductions in HbA1c.ConclusionsMIC strategies in urban primary care settings contribute to control of T2DM. SDH, such as education level, and ODH (diabetes knowledge and self-care scores at baseline) play a key role in improving glycemic control in these settings.

Pathophysiology and Management of Type 2 Diabetes Mellitus Bone Fragility.

Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of bone fragility fractures compared to nondiabetic subjects. This increased fracture risk may occur despite normal or even increased values of bone mineral density (BMD), and poor bone quality is suggested to contribute to skeletal fragility in this population. These concepts explain why the only evaluation of BMD could not be considered an adequate tool for evaluating the risk of fracture in the individual T2DM patient. Unfortunately, nowadays, the bone quality could not be reliably evaluated in the routine clinical practice. On the other hand, getting further insight on the pathogenesis of T2DM-related bone fragility could consent to ameliorate both the detection of the patients at risk for fracture and their appropriate treatment. The pathophysiological mechanisms underlying the increased risk of fragility fractures in a T2DM population are complex. Indeed, in T2DM, bone health is negatively affected by several factors, such as inflammatory cytokines, muscle-derived hormones, incretins, hydrogen sulfide (H2S) production and cortisol secretion, peripheral activation, and sensitivity. All these factors may alter bone formation and resorption, collagen formation, and bone marrow adiposity, ultimately leading to reduced bone strength. Additional factors such as hypoglycemia and the consequent increased propensity for falls and the direct effects on bone and mineral metabolism of certain antidiabetic medications may contribute to the increased fracture risk in this population. The purpose of this review is to summarize the literature evidence that faces the pathophysiological mechanisms underlying bone fragility in T2DM patients.

Dietary Glycaemic Index and Type 2 Diabetes Mellitus: Potential Modulation of Gut Microbiota

Diet therapy is often the first-line approach in prevention and management of type 2 diabetes mellitus (T2DM). Adoption of low glycaemic index (GI) diet one of the recent dietary strategies to modulate glycaemic response in individuals with T2DM. Generally, diet has strong influence on the gut microbiota, which recently have been found to be associated with insulin resistance and the inflammatory response in diabetes. The possible modulation of the gut microbiota with dietary intervention is a topic of emerging interest, with limited evidence among T2DM population. In this review, we have narrated the available evidence and discussed the current knowledge about diet manipulation associated with dietary GI in order to shape the gut microbiota. As a conclusion, we have pointed out several key research directions that may have helpful impact on diet interventions with modulation of gut microbiota on the pathogenesis and therapeutic implications in T2DM.

Health-related quality of life and sleep quality among North Indian type 2 diabetes mellitus patients: evidence from a cross-sectional study

ObjectiveThe objective of this study is to measure the relationship between sleep quality and health-related quality of life (HRQOL), in Indian population with type 2 diabetes mellitus (T2DM). MethodsA cross-sectional study, included a total of 300 patients with T2DM. All participants were responding to the Pittsburgh Sleep Quality Index (PSQI) and European Quality of Life-5 Dimensions Questionnaire (EQ-5D). A PSQI global score ≥5 was defined as poor sleep quality. EQ-5D visual analogue scale (VAS), determining the overall health status. Logistic regression analysis was used to examine the association between PSQI and EQ-5D. All the study data were analysed using the SPSS software version 20.0. Values of p < 0.05 were considered statistically significant. ResultsThe mean age of included participants were 55.29. Majority of the participants (55.3%) were identified as “poor sleepers” and female (31.3%) contributing higher proportion. Poor sleepers had significantly lower the HRQoL (p < 0.001). After adjustment, poor sleep quality was significantly associated with a lower HRQoL; EQ-5D index (OR = 1.080, 95%, CI: 1.015–1.148, p < 0.05), and EQ-5D VAS (OR = 1.092, 95%, CI: 1.021–1.176, p < 0.01). Overall, the EQ-5D index and EQ-5D VAS were found to be an independent predictors of sleep quality. ConclusionsPoor sleep quality is prevalent in Indian T2DM population, and it imparts negative impact on several dimensions of EQ-5D that characterising the daily activities performance. Therefore, further real-world studies are needed to determine the causal relationship between T2DM patients and measure of objective sleep and their impact on health.

Beneficial Impact of Semicarbazide-Sensitive Amine Oxidase Inhibition on the Potential Cytotoxicity of Creatine Supplementation in Type 2 Diabetes Mellitus.

Creatine supplementation of the population with type 2 diabetes mellitus (T2DM) combined with an exercise program is known to be a possible therapy adjuvant with hypoglycemic effects. However, excessive administration of creatine leads to the production of methylamine which is deaminated by the enzyme semicarbazide-sensitive amine oxidase (SSAO) and as a result, cytotoxic compounds are produced. SSAO activity and reaction products are increased in the serum of T2DM patients. Creatine supplementation by diabetics will further augment the activity of SSAO. The current review aims to find a feasible way to ameliorate T2DM for patients who exercise and desire to consume creatine. Several natural agents present in food which are involved in the regulation of SSAO activity directly or indirectly are reviewed. Particularly, zinc-α2-glycoprotein (ZAG), zinc (Zn), copper (Cu), histamine/histidine, caffeine, iron (Fe), and vitamin D are discussed. Inhibiting SSAO activity by natural agents might reduce the potential adverse effects of creatine metabolism in population of T2DM.

Relationship Between AST/ALT Ratio and Peripheral Nerve Function in Type 2 Diabetes Mellitus

Background: The aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio is suggested to be related to the increased risks of many metabolic diseases, whereas its association with neurological function in type 2 diabetes mellitus (T2DM) has not been understood. In this study, we aim to investigate the relationships between serum liver enzymes (ALT, AST, the AST/ALT ratio, gamma-glutamyl transferase (GGT)) and peripheral nerve function in patients with T2DM. Methods: In Group 1, we analyzed the associations between parameters of nerve function and liver enzymes in 460 T2DM patients from rural area of Shanghai. Besides, the same methods were applied to another group of 828 T2DM subjects from urban area of Shanghai. Results: In Group 1, the AST/ALT ratio was significantly higher in patients with abnormal nerve conduction [Formula: see text]. The peripheral nerve function significantly declined with increasing tertiles of AST/ALT ratio ([Formula: see text]). After adjustment for all potential confounders, the ratio of AST/ALT was still negatively correlated with the composite Z-scores of conduction velocity (CV). In Group 2, similar significant associations were found between the AST/ALT ratio and peripheral nerve function after adjustment for covariates. Conclusions: In two independent T2DM populations, the AST/ALT ratio was independently and consistently related to peripheral nerve function. The AST/ALT ratio might be helpful to highlight T2DM patients at high risk for diabetic peripheral neuropathy.

Assessment of Risk Factors for Fractures in Patients with Type 2 Diabetes over 60 Years Old: A Cross-Sectional Study from Northeast China.

Aims Previous evidence has demonstrated an increased fracture risk among the population with type 2 diabetes mellitus (T2DM). This study investigated the prevalence of bone fractures in elderly subjects (with and without type 2 diabetes) and identified any fracture risk factors, especially the risk factors for common known fractures in particular diabetic populations. Methods This cross-sectional study was conducted with community-dwelling people over 60 years old in nine communities from the city of Shenyang, which is the capital of Northeast China's Liaoning Province. A total of 3430 elderly adults (2201 females, mean ± standard deviation age 68.16 ± 6.1 years; 1229 males, 69.16 ± 6.7 years) were included. Our study measured the heel bone mineral density (BMD) and used the timed “up and go” (TUG) test and other indicators. In addition, we performed logistic regression analysis to explore the risk factors for fractures in the general population and the diabetic population and to analyze the differences. Results The results revealed that a total of 201 elderly persons (5.8%), with an average age of 70.05 ± 6.54 years, suffered from a history of fragility fractures, which affected more females (74.6%) than males (p = 0.001). The prevalence of fractures in the T2DM population was 7.3%, which was much higher than the 5.2% in non-T2DM population (p = 0.001). The prevalence of fractures in the T2DM population was 7.3%, which was much higher than the 5.2% in non-T2DM population (p = 0.001). The prevalence of fractures in the T2DM population was 7.3%, which was much higher than the 5.2% in non-T2DM population (p = 0.001). The prevalence of fractures in the T2DM population was 7.3%, which was much higher than the 5.2% in non-T2DM population (T‐score≤−2.5 (OR 1.750) were independent risk factors for fragility fractures in the non-T2DM population, but they were not risk factors in the T2DM population. Conclusions This study found that low BMD and slow TUG time were independent risk factors for fractures in non-T2DM patients, while no associations were found in the T2DM population. Patients with T2DM have a higher risk for fractures even when they have sufficient BMD and a short TUG time. TUG and BMD underestimated the risk for fractures in the T2DM population.

The safety and pharmacokinetics of metformin in patients with chronic liver disease

The FDA approved 'label' for metformin lists hepatic insufficiency as a risk for lactic acidosis. Little evidence supports this warning. To investigate the safety and pharmacokinetics of metformin in patients with chronic liver disease (CLD). Chronic liver disease patients with and without type 2 diabetes mellitus (T2DM) were studied by a cross-sectional survey of patients already prescribed metformin (n=34), and by a prospective study where metformin (500mg, immediate release, twice daily) for up to 6weeks was prescribed (n=24). Plasma metformin and lactate concentrations were monitored. Individual pharmacokinetics were obtained and compared to previously published values from healthy and T2DM populations without CLD. All plasma metformin and lactate concentrations remained below the putative safety thresholds (metformin, 5mg/L; lactate, 5mmol/L). Lactate concentrations were unrelated to average steady-state metformin concentrations. In patients with CLD, T2DM was associated with higher plasma lactate concentrations (48% higher than those without T2DM, P<0.0001). CLD patients with cirrhosis had 23% higher lactate concentrations than those without cirrhosis (P=0.01). The pharmacokinetics of metformin in CLD patients were similar to patients with T2DM and no liver disease. The ratio of apparent metformin clearance (CLMet /F) to creatinine clearance was marginally lower in CLD patients compared to healthy subjects (median, interquartile range; 12.6, 9.5-15.9 vs 14.9, 13.4-16.4; P=0.03). The pharmacokinetics of metformin are not altered sufficiently in CLD patients to raise concerns regarding unsafe concentrations of metformin. There were no unsafe plasma lactate concentrations observed in CLD patients receiving metformin (ACTRN12619001292167; ACTRN12619001348145).

Efficacy of different prediabetes program models in improving clinical outcomes in people with prediabetes

AbstractBackground:Educational programs in general seem to have a clinically significant beneficial effect among the T2DM population in terms of improved glycaemic control. However, few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken.Objective:The present study evaluates for the first time, the differences in the effectiveness of the different educational programs [intensive lifestyle modification (Group Education Program, GEP), supervised education through social media (WhatsApp Education Group, WEP) and standard care via PHCCs (Control Group, CG)], among Saudi females with pre-diabetes.Methods:This was a 6-month, multi-center, 3-arm cluster, randomised, controlled (1:1:1), multi-intervention study conducted from July 2018 until March of 2019 in Riyadh, SA. A total of 1140 females from SA were cluster randomised equally to three groups, out of which only 253 [N = 100 GEP, N = 84 WEP and N = 69 CG] received intervention. Participants completed questionnaires including demographic, dietary and physical activity data. Anthropometrics, blood samples and dietary intake were collected at baseline and 6 months. A total of 120 [37 CG (age 50.9 ± 7.1 years; body mass index (BMI) 31.6 ± 5.8kg/m2), 40 GEP (age 42.9 ± 12.2 years; BMI 34.8 ± 9.0kg/m2) and 43 WEP (age 43.7 ± 8.1 years; BMI 30 ± 5.1kg/m2)] participants completed the study.Results:Haemoglobin A1c (HbA1c; primary endpoint) significantly improved in all groups over time, with no difference in between-group comparisons. Between group comparisons adjusted for age revealed a clinically significant reduction in BMI in favour of GEP (p = 0.02) post-intervention. A clinically significant reduction was also observed in favour of GEP in terms of weight (p = 0.003), waist circumference (p = 0.017), systolic and diastolic blood pressure (p-values &lt; 0.01), triglycerides (p &lt; 0.001) and caloric intake (p &lt; 0.005) over time.Conclusion:Prediabetes education programs of 6-month duration, whether delivered through an intensive lifestyle modification, social media or standard care, are equally efficacious in improving HbA1c levels among Saudi women with prediabetes, but intensive lifestyle is superior in terms of weight reduction and over-all cardiometabolic improvement.

Addition of New Therapeutic Agents to an Established Type 2 Diabetes Simulation Platform for Therapy Optimization: A Bayesian Model-Based Approach

Patients with type 2 diabetes mellitus (T2DM) typically take blood glucose level lowering oral or injectable therapeutic agents to treat their condition. Titration and timing of administration of these agents can be difficult under optimal conditions. Largely because of these challenging tasks, less than half of patients with T2DM under therapy are reaching desired glycemic targets. Computer simulations have been shown in both types of diabetes to be powerful tools to design and test optimal therapies. However, the diversity of available therapeutic agents makes the construction of such a platform challenging. In this manuscript, we present a methodology to integrate pharmacokinetics (PK) and pharmacodynamics (PD) of anti-diabetic drugs into an existing T2DM population simulation platform to optimize therapy dosage and timing, and inform clinical trial designs; the mixture of insulin glargine and a glucagon-like peptide 1 receptor agonist (GLP1-RA) was used as an example. The platform was augmented with several drug-specific new/modified sub-models and the associated parameter distributions were derived from various blood measurements collected during clinical studies. The joint model parameter distribution of the augmented platform was obtained by fitting simulated glucose profiles on 2000 days of glucose sensor data in a novel Bayesian framework. The resulting platform was then validated by reproducing glucose distributions from a large clinical study, originally excluded from the training data. Finally, simulation experiments of optimal administration timing of the studied mixture were run.

Association between serum homocysteine level and cognitive function in middle-aged type 2 diabetes mellitus patients.

Type-2 diabetes mellitus (T2DM) is strongly associated with various complications, including cognitive impairment. Diabetic complication is related with structural and functional changes of brain. Studies investigated that homocysteine as an independent risk factor of several organ complications. This marker might have a role in pathogenesis of cognitive impairment in T2DM patients. We aimed to know the association between serum homocysteine level and cognitive impairment in middle-aged T2DM populations. The study was a cross-sectional study involving 97 T2DM patients aged <60 years old. Cognitive assessment was based on validated Indonesian version of Montreal Cognitive Assessment (MoCA-INA) test. Besides, serum homocysteine level (Hcy) was measured based on standard laboratory assay. Filling out the questionnaire of MoCA-INA was conducted when patients came to take the blood sample. This study used independent t-test, chi-square and multivariate logistic regression model to analyze the data. There were 47 subjects (48.5%) with mild cognitive impairment (MCI). Delayed recall was the most impaired domain (94.8%). There was no significant mean difference of serum Hcy level in MCI and non-MCI group (11.99±3.27 μmol/L vs 12.36±4.07 μmol/L respectively, p = 0.62). Final model of logistic regression showed no association between serum Hcy and cognitive function after adjusting confounding variables (OR: 1.778; 95%CI: 0.69–4.54). Further investigation involving slight elderly T2DM patients with larger sample size should be conducted to confirm this finding.

The subgingival microbiome associated with periodontitis in type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is a systemic disease, predisposing patients to other inflammatory conditions including periodontitis. The subgingival microbiome, a key player in periodontitis pathogenesis, is not well characterized in T2DM population. To better understand whether the subgingival microbiome is different between T2DM and systemically healthy, nondiabetic (ND) subjects, we performed a longitudinal analysis of the subgingival microbiome in T2DM patients (n = 15) compared with ND subjects (n = 16). Using metagenomic shotgun sequencing, we investigated the microbiome in the healthy periodontal state, periodontitis state, and resolved state after treatment. We found that in the periodontitis state, the shift in the subgingival microbiome from the healthy state was less prominent in T2DM compared with ND subjects, yet the clinical signs of disease were similar for both. Furthermore, we revealed highly correlated presence of pathogenic species in relative abundance not only in the periodontitis state, but also in the healthy state in T2DM, suggesting an elevated risk of progression to periodontitis in this cohort. We further investigated the functional potentials of the subgingival microbiome and identified a set of microbial marker genes associated with the clinical states. These genes were significantly enriched in 21 pathways, some of which are associated with periodontitis and some potentially link T2DM and periodontitis. This study identified the longitudinal changes of the subgingival microbiome associated with periodontitis in T2DM and suggests that T2DM patients are more susceptible to shifts in the subgingival microbiome toward dysbiosis, potentially due to impaired host metabolic and immune regulation.

The mediated role of complement C3 in PM2.5 exposure and type 2 diabetes mellitus: an elderly panel study in Beijing, China.

Diabetes mellitus (DM) is a common chronic disease worldwide. Ambient air pollution has long been proven to be associated with type 2 diabetes mellitus (T2DM) progression, but the underlying mechanism is not clear yet. In addition, previous studies mainly focused on the prevention of healthy people against the incidence of T2DM. We designed a panel study including two follow-ups and enrolled 39 patients with T2DM living in Beijing. Linear mixed model was fitted to assess the association between two pairs of variables (ambient air pollution exposure and C3 levels, ambient air pollution exposures and T2DM index). Mediation analysis of C3 between ambient air pollution exposure and indicators of T2DM progression was conducted. We found that PM2.5 exposures is are negatively associated with serum complement C3. Given that C3 might act as a protector of pancreas β cell, PM2.5 exposures could accelerate disease in T2DM populations. No mediation effects were found. This study reveals that exposures to PM2.5 can cause progression of diseases among T2DM populations.

The effect of egg consumption on cardiometabolic health outcomes: an umbrella review.

This umbrella review provides an overview of the consistency and gaps in the evidence base on eggs and cardiometabolic health. PubMed, Web of Science, Cochrane Library, the Nutrition Evidence Systematic Review and Agency for Healthcare Research and Quality databases were screened for evidence-based reviews in English that assessed human studies on egg consumption and cardiometabolic outcomes. Seven systematic reviews and fifteen meta-analyses were identified, with eighteen of these published since 2015. Overall, the systematic reviews were of low quality, while meta-analyses were of moderate- to high-quality. No association of increased egg intake and risks of heart disease or stroke in the general population were found in the meta-analyses. Increased risk of heart failure was noted in two meta-analyses that analysed the same three cohort studies. Five recent meta-analyses reported no increased risk of type 2 diabetes mellitus (T2DM) in the general population, although increased risk in US-based populations only has been reported. Older (<2013) meta-analyses reported increased risks of cardiovascular disease (CVD) or heart disease in T2DM populations, and no recent evidence-based reviews were identified. Finally, only one meta-analysis reported intervention studies specifically on eggs and biomarkers (i.e. lipids), and the results contradicted those from observation studies. Recent evidence-based reviews conclude that increased egg consumption is not associated with CVD risk in the general population. More research is needed on the positive associations between egg consumption and heart failure and T2DM risk, as well as CVD risk in diabetics, before firm conclusions can be made.

Perbandingan profil lipid dengan hipertensi pada diabetes mellitus tipe 2 dengan atau tanpa hipertensi di RS H. Adam Malik, Medan, Indonesia

Background: Atherosclerosis is a complex process. It involve many pathological event including endotelial dysfunction, abnormal lipid metabolism, trombosit activation, trombosis, oxidative stres, activation smooth muscle in blood vessel. Recently, it is known that inflamation plays a role in every steps of atherosklerosis formation. Diabetes Mellitus (DM) is the main risk factor of cardiovascular disease. The epidemiology showed that cardiovasculer mortality 2 to 3 times higher compared to population without DM. This study aims to know the difference in lipid profile between type 2 diabetics’ patients with and without hypertension.Method: This is a cross sectional study, which was held in Patology Clinic Department FK-USU / H. Adam Malik Hospital, from Agustus 2017 to November 2017. Target population is type-2 DM. Data were analyzed using SPSS version 17 for windows.Result: It found 72 subject is 36 people as patient DM type 2 with hypertension and 36 people as control. According to statistic analysis found significant difference between total cholesterol, triglyceride, HDL and LDL in patients with DM type 2 and hypertension compared with patients with DM type 2 without hypertension (p &lt; 0,05).Conclusion: In this study we found there are significant positive increased level of total cholesterol, trigliseride, HDL and LDL and hypertension on type-2 DM population.

Incidence and Prevalence of Microvascular and Macrovascular Diseases and All-cause Mortality in Type 2 Diabetes Mellitus: A 10-year Study in a US Commercially Insured and Medicare Advantage Population

PurposeThe relationship between type 2 diabetes mellitus (T2DM) and increased microvascular and macrovascular disease and mortality is well established; however, data for the broad US T2DM population, especially by age, are limited. To help address this issue, we conducted a cohort study in a large national US commercially insured/Medicare Advantage population that incorporated a broad range of different age groups, including a large subset of younger individuals, during a 10-year study period. MethodsThis longitudinal study combined health plan claims and mortality data to identify incident T2DM patients and 1:1 directly matched non-DM controls. T2DM individuals (n = 13,883) were identified by a medical claim with a T2DM diagnosis or T2DM medication pharmacy claim in 2007; non-DM controls had no DM medical or pharmacy claims over the entire study period (January 1, 2006 to December 31, 2015). The outcomes assessed were incidence, prevalence, time to vascular disease and all-cause mortality, as well as age-stratified incidence and mortality based on Centers of Disease Control and Prevention–defined age strata. FindingsIndividuals with T2DM developed vascular disease at twice the rate as non-DM controls, 197 versus 98 per 1000 person-years, respectively. Vascular disease (composite) rates increased by age in T2DM/non-DM groups, 107.1/28.2 (18–44 years), 166.3/70.3 (45–64 years), and 391.0/199.7 (≥65 years) per 1000 person-years. The largest rate ratio was observed in younger individuals. All-cause mortality over follow-up was higher in T2DM individuals (27.5%) than in non-DM controls (19.6%). The largest increases in vascular disease prevalence and mortality among T2DM individuals were observed in the first year of follow-up. ImplicationsT2DM has a substantial effect on microvascular and macrovascular disease and all-cause mortality rates in all age groups. These outcomes appear to occur early after T2DM diagnosis, and have more pronounced, nearly fourfold, relative impact on younger individuals with T2DM compared to matched non-DM controls.