Type 2 Diabetes Mellitus Patient Research Articles

Serum 25-Hydroxyvitamin D Levels in Type 2 Diabetes Patients in North China: Seasonality and the Association between Vitamin D Status and Glycosylated Hemoglobin Levels.

Previous studies have reported a correlation between vitamin D levels and seasonality in healthy populations. However, there are few studies on the seasonal variation in vitamin D levels and its relationship with glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM). The objective of this study was to investigate seasonal changes in serum 25-hydroxyvitamin D [25(OH)D] levels and the associations between these vitamin D concentrations and HbA1c levels in T2DM patients in Hebei, China. A cross-sectional study of 1,074 individuals with T2DM was conducted from May 2018 to September 2021. Levels of 25(OH)D in these patients were assessed based on both sex and season, and relevant clinical or laboratory variables that could impact vitamin D status were also considered. In the T2DM patient cohort, the mean blood 25(OH)D levels were 17.05 ng/mL. A total of 698 patients (65.0%) had insufficient serum 25(OH)D levels. The vitamin D deficiency rates were significantly higher in the winter and spring compared to the autumn (P < 0.05), indicating that seasonal fluctuations can have a significant impact on 25(OH)D levels. The levels of vitamin D inadequacy were highest in the winter (74%), and females were more likely than males to be deficient (73.4% vs. 59.5%, P < 0.001). In comparison to the winter and spring, both males and females showed higher 25(OH)D levels in the summer (P < 0.001). HbA1c levels were 8.9% higher in those with vitamin D deficiencies than in nondeficient patients (P < 0.001). HbA1c and vitamin D levels were negatively correlated (r = -0.119, P < 0.001). Vitamin D deficiencies are particularly prevalent among T2DM patients in Hebei, China, with exceptionally high rates in the winter and spring. Female T2DM patients were at an elevated risk of vitamin D deficiency, and vitamin D levels were negatively correlated with HbA1c.

Cognitive protection of sinomenine in type 2 diabetes mellitus through regulating the EGF/Nrf2/HO-1 signaling, the microbiota-gut-brain axis, and hippocampal neuron ferroptosis.

Recent years have witnessed a growing research interest in traditional Chinese medicine as a neuroprotective nutrient in the management of diabetic cognitive dysfunction. However, the underlying molecular mechanisms of sinomenine in mediating ferroptosis of hippocampal neurons have been poorly understood. This study sought to decipher the potential effect and molecular mechanism of sinomenine in the cognitive dysfunction following type 2 diabetes mellitus (T2DM). Multi-omics analysis was conducted to identify the microbiota-gut-brain axis in T2DM patient samples obtained from the publicly available database. In HT-22 cells, erastin was utilized to create a ferroptosis model, and streptozotocin was injected intraperitoneally to create a rat model of DM. It was noted that intestinal flora imbalance occurred in patients with T2DM-associated cognitive dysfunction. Sinomenine could reduce Erastin-induced hippocampus neuronal ferroptosis by increasing EGF expression. EGF protected hippocampal neurons against ferroptosis by activating the Nrf2/HO-1 signaling pathway. Furthermore, in vivo results confirmed that sinomenine blocked ferroptosis of hippocampal neurons and alleviated cognitive dysfunction in T2DM rats. Collectively, these results suggest that sinomenine confers neuroprotective effects by curtailing hippocampal neuron ferroptosis via the EGF/Nrf2/HO-1 signaling and microbiota-gut-brain axis. It may be a candidate for the treatment of diabetic cognitive dysfunction.

U-shaped association between serum IGF2BP3 and T2DM: A cross-sectional study in Chinese population.

To clarify the expression of N6-methyladenosine (m6 A) modulators involved in the pathogenesis of type 2 diabetes mellitus (T2DM). We further explored the association of serum insulin-like growth factor 2 mRNA-binding proteins 3 (IGF2BP3) levels and odds of T2DM in a high-risk population. The gene expression data set GSE25724 was obtained from the Gene Expression Omnibus, and a cluster heatmap was generated by using the R package ComplexHeatmap. Differential expression analysis for 13 m6 A RNA methylation regulators between nondiabetic controls and T2DM subjects was performed using an unpaired t test. A cross-sectional design, including 393 subjects (131 patients with newly diagnosed T2DM, 131 age- and sex-matched subjects with prediabetes, and 131 healthy controls), was carried out. The associations between serum IGF2BP3 concentrations and T2DM were modeled by restricted cubic spline and logistic regression models. Two upregulated (IGF2BP2 and IGF2BP3) and 5 downregulated (methyltransferase-like 3 [METTL3], alkylation repair homolog protein 1 [ALKBH1], YTH domain family 2 [YTHDF2], YTHDF3, and heterogeneous nuclear ribonucleoprotein [HNRNPC]) m6 A-related genes were found in islet samples of T2DM patients. A U-shaped association existed between serum IGF2BP3 levels and odds of T2DM according to cubic natural spline analysis models, after adjustment for body mass index, waist circumference, diastolic blood pressure, total cholesterol, and triglyeride. Multivariate logistic regression showed that progressively higher odds of T2DM were observed when serum IGF2BP3 levels were below 0.62 ng/mL (odds ratio 3.03 [95% confidence interval 1.23-7.47]) in model 4. Seven significantly altered m6 A RNA methylation genes were identified in T2DM. There was a U-shaped association between serum IGF2BP3 levels and odds of T2DM in the general Chinese adult population. This study provides important evidence for further examination of the role of m6 A RNA methylation, especially serum IGF2BP3 in T2DM risk assessment.

Assessment of serum magnesium and correlation with glycemic control and complication in type 2 diabetes mellitus – A cross-sectional study in a tertiary care hospital in eastern zone of India

Background: Diabetes mellitus (DM) is an expanding global health problem. Type 2 DM (T2DM) patients account about 90% of total DM patients. Magnesium is important for different physiological mechanism. Hypomagnesemia is common in T2DM patient. Magnitude of hypomagnesemia is related with glycemic control and is associated with complications of T2DM. Aims and Objectives: Our aim of the study was to assess the prevalence of hypomagnesemia in patients of T2DM patients and to find their correlation with glycemic control and complications of T2DM patients in rural population of eastern zone of India. Materials and Methods: The hospital-based cross-sectional study includes 99 male and female DM patients between 15 and 60 years age. Fasting blood sugar, postprandial blood sugar, HbA1c, serum total magnesium, and urine albumin creatinine ratio were measured. Data were entered into Microsoft Excel spreadsheet and then analyzed by SPSS (version 25.0; SPSS Inc.) and GraphPad Prism (version 5.0). P &lt; 0.05 was considered statistically significant. Results: From our study, we observed that hypomagnesemia is common in T2DM patients. The magnitude of hypomagnesemia is correlated with glycemic control (P &lt; 0.0001). Moreover, hypomagnesemia is associated with diabetic kidney diseases (P &lt; 0.05). Conclusion: It can be concluded that serum magnesium should be monitored in all T2DM patients and should be managed appropriately because hypomagnesemia may induce complications in T2DM patients.

Case Study Presenting Remarkable Improvements of all Parameters in a Long-Term T2DM Patient with Multiple Chronic Comorbidities by Sugar fit’s -Tech/Ai-Driven Platform with Daily Personalised Life Coaching and Expert Medical Advice

Background: Type 2 diabetes mellitus (T2DM) is not only one of the leading causes of mortality, but its impact on healthcare costs and burden is becoming unsustainable each year. The quality of life and life expectancy are both significantly impacted by this chronic metabolic condition. To help control their blood glucose levels, patients with T2DM adhere to a self-management regimen as instructed by a professional. Various technological options are available now to help self-management. Methods: Here, we present a case of a 64-year-old female with insulin-dependent type 2 diabetes mellitus, multiple co-morbidities, depression, confined to her room, and inability to walk for about a year. After six months of the Sugar fit approach with daily-personalized life coaching, expert medical advice, tech-enabled, AI-driven model, she showed tremendous improvement in every parameter. Results: Before joining sugar fit, the patient was on 44 units of rapid insulin and 18 units of long-acting and oral anti-diabetic medications. The patient’s Hba1c at baseline was 8%; six months later, it is 6.8% with all rapid and long insulin stopped and oral meds essentially the same as before. She has reduced creatinine from 1.88 to 1.37 and triglycerides from 1015 to 448, respectively. Her BP medications have been reduced to 50%. She walks for 2 km every day and is socially active with resolved depression. She has lost 3 kgs of weight and 3 inches of waist circumference. Conclusions: The findings indicate that a tech-enabled, AI-driven model with intensive, personalized coaching, lifestyle modification, and expert physician guidance has shown remarkable results even in this particularly complicated case. The findings indicate that the personalized and individualized frequent lifestyle coaching and expert physician opinion enabled by superior technology and AI-driven Insights resulted in marked improvement of all parameters and significant medication reductions even in Diabetes of long duration with comorbidities

EMPOWERMENT OF DIABETES MELLITUS PATIENT DURING COVID-19 PANDEMIC ERA THROUGH ONLINE GATHERING

Introduction: In the COVID-19 pandemic, social restriction and lock-down policies were implemented. It has far-reaching implications in many sectors of life including health, particularly in patients with chronic diseases, one of which is Type-1 Diabetes Mellitus (T1DM). The purpose of this community service in the form of online gathering is to facilitate patients to ask questions and consult with pediatricians, due to the limitations of patients to consult directly due to the pandemic. Methods: Community service is conducted online for T1DM patients or their relatives on Sunday, September 26, 2021, from 12.00 - 13.30 WIB. The Community service was divided into several stages, including before, during, and after the online gathering. The T1DM patients or their relatives are participants in this community services. The topic are types of Diabetes Mellitus, clinical presentation, disease progression, the diagnostic process, and its management therapy of type 1 diabetes mellitus. Results: The community service was attended by 54 parents of T1DM patient. The online gathering goes smoothly, without being constrained by something. During the online gathering, subjects actively participate in every session during the online gathering. Several questions were asked by the participants and answered well by the speakers. Conclusion: This community services activities allow participant to be able to ask question about their problem according to diabetes mellitus. Participants can consult online with pediatricians. This online gathering has a limited time, so participants can be divided into several breakout rooms with several accompanying pediatricians, so that the QnA session can be done optimally.

High Prevalence of Demodex Infestation is Associated With Poor Blood Glucose Control in Type 2 Diabetes Mellitus: A Cross-Sectional Study in the Guangzhou Diabetic Eye Study.

The aim of this study was to investigate the association between type 2 diabetes mellitus (T2DM) and ocular Demodex mite infection. About 381 patients with T2DM from nearby communities were enrolled, and 163 age-matched and sex-matched nondiabetic patients from the cataract clinic were included as the control group. All subjects underwent personal history and demographic data collection, ocular examination, and lash sampling, followed by microscopic identification and counting of Demodex mites. Binocular fundus photography was performed for diabetic patients. Statistical correlation between ocular Demodex infestation and T2DM and blood glucose control status was performed. The Demodex mite infestation rate (62.5% vs. 44.8%, P < 0.001) and count [3 (0-12) vs. 2 (0-9.6), P = 0.01], especially of Demodex brevis (18.9% vs. 4.9%, P < 0.001) [0 (0-1) vs. 0 (0-0), P < 0.001], were significantly higher in the T2DM patient group than that in the control group. The ratio of Demodex brevis to Demodex folliculorum in the T2DM patient group was significantly higher than that in the control group (1:3 vs. 1:9, P < 0.001). Diabetic patients presented with more cylindrical dandruff (55.1% vs. 39.3%, P = 0.001). Ocular Demodex infestation was strongly associated with poor blood glucose control (HbA 1 c > 7%) (odds ratio = 1.82; 95% confidence interval, 1.12-2.94; P = 0.2) and female sex (odds ratio = 1.69, 95% confidence interval, 1.08-2.65, P = 0.02). No association was found between Demodex infestation and the severity of diabetic retinopathy. Patients with T2DM, especially those with poor blood glucose control, tend to have a higher prevalence of ocular Demodex infestation, suggesting that high blood glucose is a risk factor for demodicosis .

Renal Histologic Findings in Necropsies of Type 2 Diabetes Mellitus Patients

Background Very few studies have analyzed early histologic lesions of diabetic nephropathy (DN) in patients without signs of clinical involvement (microalbuminuria). In this study, we analyzed renal histologic lesions in necropsies of diabetic patients with or without previous signs of DN. Methods Histological material was analyzed from 21 autopsies of type 2 diabetes mellitus (T2DM) patients (9 with albuminuria and 12 without albuminuria) and 4 controls. Histologic lesions were evaluated according to the Tervaert classification. Results Kidneys of diabetic patients presented significantly higher scores in most histologic indices analyzed (glomerular basal membrane thickening, mild and severe mesangial expansion, nodular sclerosis, interstitial fibrosis, and tubular atrophy) than in nondiabetic controls (p < 0.01 in all cases). In contrast, no significant differences were detected between histologic scores when comparing the 21 diabetic patients with and without albuminuria. A significant percentage of cases without albuminuria showed moderate to severe histologic lesions, particularly severe mesangial expansion and severe glomerular vascular lesions. No significant differences were found in age, blood pressure, diabetes vintage, BMI, HbA1c, cholesterol, triglycerides, or treatments between the two (albuminuric vs. nonalbuminuric) T2DM patient groups. Conclusions Our data suggest that histologic lesions of DN are present in the early stages of the disease, even without albuminuria presence. More precise and earlier metabolic control is recommended in T2DM, and monitoring of risk factors can play a role in DN development.

Beneficial Role of Vitamin D Supplementation on Thyroid Hormone Levels among T2DM Patients with Thyroid Disorders: Statistical Evaluation

Thyroid function is impaired by diabetes, resulting into thyroid disorders, accompanied by the alteration of thyroid-stimulating hormone (TSH) and thyroxine (T4) levels. The aim of this study was to investigate the role of vitamin D supplementation on TSH and total T4 levels in serum of Libyan patients suffering from type 2 diabetes mellitus (T2DM) with thyroid disorders. A total of 180 subjects were recruited and distributed into two groups: 80 participants in control group (43 females and 37 males), with an age range of 26-72 years, and 100 participants in T2DM patient group (54 females and 46 males), with an age range of 26-63 years. Each T2DM patient received a monthly intramuscular injection of 200000 ng/ml vitamin D for three months. Glucose, vitamin D, total T4 and TSH levels were determined in serum samples of healthy subjects and of T2DM patients (pre- and post-administration of vitamin D). After the T2DM group received vitamin D supplementation, the mean of vitamin D level increased in the T2DM, while the mean of glucose level decreased. Most importantly, the mean of total T4 level for patients increased significantly (p ˂ 0.05) from 1.34 to 8.23 mg/dL, both of which were lower than the control group mean 10.99 mg/dL. In contrast, the mean of TSH level for patients decreased significantly (p ˂ 0.05) from 11.77 to 2.71 mU/L, and both values were greater than the control group mean 2.01 mU/L. ANOVA results showed that age, gender, and body mass index had no significant individual interactions (p &gt; 0.05) with vitamin D supplementation on total T4 and TSH levels. Vitamin D supplementation had a beneficial role on total T4 and TSH levels in serum of Libyan T2DM patients with thyroid disorders. Keywords: T2DM, thyroid disorder, total T4, TSH, vitamin D supplementation, ANOVA, t test.

Patient Work Personas of Type 2 Diabetes-A Data-Driven Approach to Persona Development and Validation.

IntroductionMany have argued that a “one-size-fits-all” approach to designing digital health is not optimal and that personalisation is essential to achieve targeted outcomes. Yet, most digital health practitioners struggle to identify which design aspect require personalisation. Personas are commonly used to communicate patient needs in consumer-oriented digital health design, however there is often a lack of reproducible clarity on development process and few attempts to assess their accuracy against the targeted population. In this study, we present a transparent approach to designing and validating personas, as well as identifying aspects of “patient work,” defined as the combined total of work tasks required to manage one's health and the contextual factors influencing such tasks, that are sensitive to an individual's context and may require personalisation.MethodsA data-driven approach was used to develop and validate personas for people with Type 2 diabetes mellitus (T2DM), focusing on patient work. Eight different personas of T2DM patient work were constructed based physical activity, dietary control and contextual influences of 26 elderly Australian participants (median age = 72 years) via wearable camera footage, interviews, and self-reported diaries. These personas were validated for accuracy and perceived usefulness for design, both by the original participants and a younger (median age bracket = 45–54 years) independent online cohort f 131 T2DM patients from the United Kingdom and the United States.ResultsBoth the original participants and the independent online cohort reported the personas to be accurate representations of their patient work routines. For the independent online cohort, 74% (97/131) indicated personas stratified to their levels of exercise and diet control were similar to their patient work routines. Findings from both cohorts highlight aspects that may require personalisation include daily routine, use of time, and social context.ConclusionPersonas made for a specific purpose can be very accurate if developed from real-life data. Our personas retained their accuracy even when tested against an independent cohort, demonstrating their generalisability. Our data-driven approach clarified the often non-transparent process of persona development and validation, suggesting it is possible to systematically identify whether persona components are accurate or. and which aspects require more personalisation and tailoring.

In-silico works on the control of blood glucose level for different Type 1 Diabetes Mellitus Subjects using improved Hovorka equations

Background: One of the most common types of diabetes is Type 1 Diabetes Mellitus (T1DM) which causes high or low blood glucose levels (BGL) in a patient’s body. T1DM patients need to maintain their BGL in a safe glycemic range which is between 4.0 mmol/L to 7 mmol/L. Thus, it is high time to find the optimum insulin infusion rate into the patient’s body in achieving prolonged normoglycemic range. Methods: Previous workers had focused on employing the improved Hovorka equations via in-silico study using one T1DM patient’s data; however, in-silico works employing more actual patients’ data are yet to be explored. Hence, this study attempts to apply the improved Hovorka equations on three different T1DM subjects so as to simulate their BGL profiles based on daily stipulated meal disturbances, individual body weights and age group. Results: Results showed that the optimum insulin infusion rates required to regulate the BGL within safe glycemic range were at 0.1 U/min, 0.05 U/min and 0.0167 U/min for the case of patients 1, 2 and 3, respectively; provided that different amounts of meal intake (DG) were observed by each patient during breakfast, lunch and dinner times. Conclusion: In conclusion, this study had proven that the improved Hovorka equations can be used to simulate the meal disturbance effect on BGL for more T1DM patients. Keywords Blood glucose level; Closed-loop control system; Hovorka model; Meal disturbance; Type 1 diabetes mellitus

Molecular Mechanisms Underlying the Elevated Expression of a Potentially Type 2 Diabetes Mellitus Associated SCD1 Variant.

Disturbances in lipid metabolism related to excessive food intake and sedentary lifestyle are among major risk of various metabolic disorders. Stearoyl-CoA desaturase-1 (SCD1) has an essential role in these diseases, as it catalyzes the synthesis of unsaturated fatty acids, both supplying for fat storage and contributing to cellular defense against saturated fatty acid toxicity. Recent studies show that increased activity or over-expression of SCD1 is one of the contributing factors for type 2 diabetes mellitus (T2DM). We aimed to investigate the impact of the common missense rs2234970 (M224L) polymorphism on SCD1 function in transfected cells. We found a higher expression of the minor Leu224 variant, which can be attributed to a combination of mRNA and protein stabilization. The latter was further enhanced by various fatty acids. The increased level of Leu224 variant resulted in an elevated unsaturated: saturated fatty acid ratio, due to higher oleate and palmitoleate contents. Accumulation of Leu224 variant was found in a T2DM patient group, however, the difference was statistically not significant. In conclusion, the minor variant of rs2234970 polymorphism might contribute to the development of obesity-related metabolic disorders, including T2DM, through an increased intracellular level of SCD1.

In-silico works on the control of blood glucose level for different Type 1 Diabetes Mellitus Subjects using improved Hovorka equations

Background: One of the most common types of diabetes is Type 1 Diabetes Mellitus (T1DM) which causes high or low blood glucose levels (BGL) in a patient’s body. T1DM patients need to maintain their BGL in a safe glycemic range which is between 4.0 mmol/L to 7 mmol/L. Thus, it is high time to find the optimum insulin infusion rate into the patient’s body in achieving prolonged normoglycemic range. Methods: Previous workers had focused on employing the improved Hovorka equations via in-silico study using one T1DM patient’s data; however, in-silico works employing more actual patients’ data are yet to be explored. Hence, this study attempts to apply the improved Hovorka equations on three different T1DM subjects so as to simulate their BGL profiles based on daily stipulated meal disturbances, individual body weights and age group. Results: Results showed that the optimum insulin infusion rates required to regulate the BGL within safe glycemic range were at 0.1 U/min, 0.05 U/min and 0.0167 U/min for the case of patients 1, 2 and 3, respectively; provided that different amounts of meal intake (DG) were observed by each patient during breakfast, lunch and dinner times. Conclusion: In conclusion, this study had proven that the improved Hovorka equations can be used to simulate the meal disturbance effect on BGL for more T1DM patients. Keywords Blood glucose level; Closed-loop control system; Hovorka model; Meal disturbance; Type 1 diabetes mellitus

Differential Association of Selected Adipocytokines, Adiponectin, Leptin, Resistin, Visfatin and Chemerin, with the Pathogenesis and Progression of Type 2 Diabetes Mellitus (T2DM) in the Asir Region of Saudi Arabia: A Case Control Study.

Background: Sedentary lifestyles, urbanization and improvements in socio-economic status have had serious effects on the burden of diabetes across the world. Diabetes is one of the 10 leading causes of death globally, and individuals with diabetes have a 2–3-fold increased risk of all-cause mortality. Adipose tissue is increasingly understood as a highly active endocrine gland that secretes many biologically active substances, including adipocytokines. However, the exact and discrete pathophysiological links between obesity and T2DM are not yet fully elucidated. Methods: In the current study, we present the association of five diverse adipocytokines, adiponectin, leptin, resistin, visfatin and chemerin, with T2DM in 87 patients (46 males and 41 females) with type 2 diabetes mellitus and 85 healthy controls (44 males and 41 females) from the Asir region of Saudi Arabia. The patients were divided into four groups: normal BMI, overweight, obese and severely obese. The baseline biochemical characteristics, including HbA1c and anthropometric lipid indices, such as BMI and waist–hip ratio, were determined by standard procedures, whereas the selected adipokine levels were assayed by ELISA. Results: The results showed significantly decreased levels of adiponectin in the T2DM patients compared to the control group, and the decrease was more pronounced in obese and severely obese T2DM patients. Serum leptin levels were significantly higher in the females compared to the males in the controls as well as all the four groups of T2DM patients. In the male T2DM patients, a progressive increase was observed in the leptin levels as the BMI increased, although these only reached significantly altered levels in the obese and severely obese patients. The serum leptin levels were significantly higher in the severely obese female patients compared to the controls, patients with normal BMI, and overweight patients. The leptin/adiponectin ratio was significantly higher in the obese and severely obese patients compared to the controls, patients with normal BMI, and overweight patients in both genders. The serum resistin levels did not show any significant differences between the males and females in thr controls or in the T2DM groups, irrespective of the BMI status of the T2DM patients. The visfatin levels did not reveal any significant gender-based differences, but significantly higher levels of visfatin were observed in the T2DM patients, irrespective of their level of obesity, although the higher values were observed in the obese and highly obese patients. Similarly, the serum chemerin levels in the controls, as well as in T2DM patients, did not show any significant gender-based differences. However, in the T2DM patients, the chemerin levels showed a progressive increase, with the increase in BMI reaching highly significant levels in the obese and severely obese patients, respectively. Conclusion: In summary, it is concluded that significantly altered concentrations of four adipokines, adiponectin, leptin, visfatin and chemerin, were found in the T2DM patient group compared to the controls, with more pronounced alterations observed in the obese and highly obese patients. Thus, it can be surmised that these four adipokines play a profound role in the onset, progression and associated complications of T2DM. In view of the relatively small sample size in our study, future prospective studies are needed on a large sample size to explore the in-depth relationship between adipokines and T2DM.

IDF21-0426 Carbamylated LDL and soluble LOX-1 – potential serum biomarkers for coronary artery disease in type 2 diabetes mellitus

Background: Carbamylated low-density lipoprotein (cLDL) is the most abundant modified LDL isoform in human blood, but it has been investigated only in the context of chronic kidney disease since uremia provides a favourable chemical environment for this posttranslational modification. However, it has been discovered that the proinflammatory enzyme myeloperoxidase catalyses an alternative urea-independent mechanism of carbamylation. Most of the proatherogenic properties of cLDL are mediated by the scavenger lectin-like oxidized LDL receptor-1 (LOX-1). LOX-1 has been delineated as a critical player in vascular inflammation and in atherosclerotic plaque formation, destabilization, erosion and rupture. The cLDL-LOX-1 interaction triggers prooxidative and proinflammatory responses. Moreover, LOX-1 has also been identified as a receptor for C-reactive protein (CRP), a classic acute-phase reactant widely used in the clinical practice as a cardiovascular risk biomarker. The soluble form of LOX-1 (sLOX-1) reflects the expression of the membrane receptor and it has recently been suggested as a biomarker of vascular diseases. It is well-established that type 2 diabetes mellitus (T2DM) is a prominent risk factor for coronary artery disease (CAD) and inflammation is involved in the pathogenesis of both T2DM and atherosclerosis. However, the possible role and relationships between cLDL, sLOX-1 and CRP in T2DM with and without CAD have not been investigated yet. Aim: To explore the possible role of cLDL and sLOX-1 as potential biomarkers for CAD in T2DM patients and to evaluate the correlations between serum cLDL, sLOX-1 and high-sensitivity-CRP (hs-CRP). Method: The serum levels of cLDL, sLOX-1 and hs-CRP were measured by ELISA in 44 heathy controls, 67 patients with uncomplicated T2DM and 36 diabetic subjects complicated by CAD but without renal impairments. Results: Patients with uncomplicated T2DM had significantly higher serum levels of both cLDL and hs-CRP than the healthy controls, but lower in comparison to T2DM + CAD subjects. In contrast, there was no significant difference in sLOX-1 concentrations between T2DM patient and the healthy volunteers, but T2DM + CAD cohort had higher serum levels of sLOX-1 compared both to the control and uncomplicated T2DM groups. The receiver-operating characteristic analysis showed that cLDL and sLOX-1 had a significant potential to identify CAD among the diabetic patients with diagnostic sensitivity and specificity similar to those of hs-CRP. Elevated serum levels of cLDL and sLOX-1 were associated with a higher risk of CAD development among T2DM subjects (OR 4.07; 95% CI: 1.71 – 9.69, p = 0.001 and OR 2.82; 95% CI: 1.22 – 6.57, p = 0.014, respectively). Furthermore, the level of cLDL correlated positively and significantly with hs-CRP(r = 0.345, p = 0.039) and tended to correlate positively with sLOX-1 (r = 0.317, p = 0.059) only in T2DM + CAD subjects. Discussion: In conclusion, a positive feedback might exist between cLDL, CRP and LOX-1 and the interplay between them might be involved in the development of CAD in diabetic patients. The present study also elucidates the potential of cLDL and sLOX-1 as biomarkers for the diagnosis and risk assessment of CAD among T2DM population.

Investigation of angiotensin-1 converting enzyme 2 gene (G8790A) polymorphism in patients of type 2 diabetes mellitus with diabetic nephropathy in Pakistani population.

BackgroundType 2 diabetes mellitus is a multifactorial disease that escalates the risk of other associated complications such as diabetic neuropathy, retinopathy, and nephropathy. Diabetic nephropathy is a microvascular condition that leads to end-stage renal disease (ESRD). There are several genes involved in disease development and it is a challenging task to investigate all of these. Nonetheless, identifying individual gene roles can assist in evaluating the combinatorial effects with other genes. Angiotensin-1 converting enzyme 2 (ACE2), is the key regulator of blood pressure in the Renin-Angiotensin-Aldosterone System that hydrolyzes angiotensin II (vasoconstrictor) into angiotensin 1–7 (vasodilator). The association of different variants of the ACE2 with the risk of type 2 diabetes mellitus has been determined in various populations with susceptibility to other complications. This study was aimed to investigate the association of Angiotensin-1 converting enzyme 2 polymorphism, G8790A, with the increased risk of type 2 diabetes mellitus (T2DM) development with the complication of diabetic nephropathy (DN) in the Pakistani population.MethodsIn this case-control study, a total of 100 healthy controls and 100 patients of type 2 diabetes mellitus aged > 40 years, having disease duration ≥ 10 years were compared. The G8790A polymorphism in ACE2 was analyzed by allele-specific polymerase chain reaction (AS-PCR). The urinary albumin excretion (UAE), urinary creatinine, and albumin to creatinine ratios (ACR) were determined to assess renal function status. Pearson bivariate correlation coefficients were calculated to investigate the relationship among all the parameters. Crude and adjusted odds ratios were found to determine any risk association between ACE2 G8790A polymorphisms and disease development. The p-values < 0.05 were considered significant.ResultsA homogeneity was obtained regarding the distribution of data by sex, BMI, diastolic blood pressure, pulse rate and urinary creatinine levels between case and control groups. The ACR showed a significant correlation with UAE (r = 0.524, p = 0.001), urinary creatinine (r = -0.375, p = 0.001) and random blood sugar levels (r = 0.323, p = 0.005) with the complication of diabetic nephropathy in T2DM patient. Females with the AA genotype had a 10-fold increased risk for the development of type 2 Diabetes (OR = 9.5 [95% CI = 2.00–21.63] p<0.002). Males having A allele showed a significant association for susceptibility of type 2 Diabetes (OR = 3.807 [95% CI = 1.657–8.747] p<0.002). However, none of the genotypes or alleles revealed an association for diabetic nephropathy in male and female patients. Urinary ACR was also found to be positively correlated with UAE (r = 0.642 p = 0.001 & 0.524, p = 0.001) and random blood sugar levels (r = 0.302, p = 0.002 & r = 0.323, p = 0.005) in T2DM and T2DM+DN groups, respectively.ConclusionThe study finding indicated that female AG/AA genotype and male A genotype of G8790A polymorphism in the ACE2 gene were associated with type 2 diabetes mellitus as a genetic risk factor but are not associated with diabetic nephropathy in the Pakistani population.

Correlation between Albuminuria Levels and Chitinase 3 like 1 Protein in Iraqi Patients with Type 2 Diabetes Mellitus

Diabetes mellitus (DM) is a metabolic diseases attributed to lack of insulin secretion, insulin activity, or both. The most serious medical problems in hyperglycemia is diabetic nephropathy (DN), originating from the aggregation of inflammatory cells in high numbers. Chitinase 3 like 1 protein (CH3L1P) is a new biomarker for chronic and severe inflammatory conditions. It has been suggested to have a role in the progress of diabetes-associated micro and macro-vascular complications. This paper aims to measure CH3L1P levels and examine their correlation with albuminuria levels in Iraqi patients with type 2 diabetes mellitus (T2DM). Our study involved 66 T2DM patients (41males and 25 females with age ranging from 30 to 70 years, who were distributed into three groups; (A1) normoalbuminuria, (A2) microalbuminuria and (A3) macroalbuminuria, each group consisting of twenty-two patients. The control (C) group involved 22 healthy individuals (11 males and 11 females). Whole blood was used to estimate Glycated hemoglobin (HbA1c), while serum was used to measure other biochemical parameters, and the urine to measure urine creatinin (U.CR), urine albumin (U.A) &amp; albumin to creatinine ratio (ACR). A quantitative sandwich enzyme-linked immunosorbent assay (ELISA) was used to determine serum CH3L1P level. Results revealed that the levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), HbA1c and fasting blood glucose (FBG) were significantly higher in the patients (A1, A2 and A3 groups) compared to C group (P&lt;0.001). Moreover, mean CH3L1P level significantly increased in the three T2DM patient group (A1, A2 and A3) (1327.20±294.44, 1434.82±305.26, 1602.90±409.50 pg/ml, respectively) as compared to the C group (626.81±103.15 pg/ml). CH3L1P levels in the blood were substantially higher in T2DM patients, with a clear correlation with the increase in albuminuria levels. As a result, it can be concluded that serum CH3L1P level may be used as an early detection marker of DN in T2DM patients.

COVID-19-Related Trends and Characteristics of Type 2 Diabetes Mellitus and Metabolic Syndrome.

BackgroundAlthough there have been several studies associating obesity with severe coronavirus disease 2019 (COVID-19) outcomes, the potential impact of the pandemic on type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) incidence is less clear. Furthermore, reports on the characteristics of these patients during the pandemic have been scarce.ObjectivesThe purpose of this retrospective study was 1) to explore the impact of the COVID-19 pandemic on T2DM and MetS incidence, and 2) to describe sex-based differences in the characteristics of T2DM and MetS patients during the COVID-19 pandemic.MethodsUsing electronic health records (EHRs) obtained from the USA-based TriNetX research database (TriNetX, Cambridge, MA), the incidence and the total number of patients with “T2DM (ICD-10-CM: E11)” and “MetS (ICD-10-CM: E88.81)” prior to and during the COVID-19 pandemic were determined. Aggregate lab data from EHRs were extracted and statistical analyses on the lab values and patient demographics including sex, race/ethnicity, and comorbidities were performed.ResultsAfter analyzing T2DM and MetS patient data from 2018, 2019, and 2020, we observed a considerable decrease in both T2DM and MetS incidence, with data in April 2020 exhibiting the largest decrease when compared to other months. Furthermore, monthly male T2DM and MetS patients’ lab data revealed worsening parameters in April 2020, such as hemoglobin A1c (HbA1C) and blood glucose, when compared to females. Demographic data during 2020 revealed that male T2DM and MetS patients had a significantly higher prevalence of comorbidities including hypertension, ischemic heart disease, and heart failure, but female T2DM and MetS patients had significantly higher asthma comorbidity.ConclusionsDuring 2020, there was a marked decrease in T2DM and MetS diagnosis. Due to a lack of screening, these data may suggest a subsequent increase in T2DM and MetS-related heart disease in the future and may magnify the existing sex-related differences identified in these patients.

High remnant cholesterol level is relevant to diabetic retinopathy in type 2 diabetes mellitus

BackgroundDiabetic retinopathy (DR) is the primary oculopathy causing blindness in diabetic patients. Currently, there is increasing interest in the role of lipids in the development of diabetic retinopathy, but it remains controversial. Remnant cholesterol (RC) is an inexpensive and easily measurable lipid parameter; however, the relationship between RC and DR in type 2 diabetes mellitus (T2DM) has not been elucidated. This research investigates the relevance between RC levels and DR severity while building a risk prediction model about DR.MethodsIn this single-centre retrospective cross-sectional study. Each hospitalised T2DM patient had no oral lipid-lowering drugs in the past three months, and coronary angiography showed epicardial coronary artery stenosis of less than 50% and completed seven-field stereo photographs, fluorescein fundus angiography, and optical coherence tomography detection. The RC value is calculated according to the internationally recognised formula. Binary logistic regression was used to correct confounding factors, and the receiver operating characteristic (ROC) analysis was used to identify risk factors and assess the nomogram’s diagnostic efficiency.ResultsA total of 456 T2DM patients were included in the study. The RC levels in the DR team was higher [0.74 (0.60–1.12) mmo/l vs 0.54 (0.31–0.83) mmol/l P < 0.001] in the non-DR team. After adjusting for confounding elements, RC levels are still associated with DR risk (OR = 5.623 95%CI: 2.996–10.556 P < 0.001). The ratio of DR in every stage (except mild non-proliferative diabetic retinopathy) and DME in the high RC level team were further increased compared to the low-level team (all P < 0.001). After ROC analysis, the overall risk of DR was predicted by a nomogram constructed for RC, diabetes duration, and the neutrophil-lymphocyte ratio as 0.758 (95%CI 0.714–0.802 P < 0.001).ConclusionsHigh RC levels may be a potential risk factor for diabetic retinopathy, and the nomogram does better predict DR. Despite these essential findings, the limitation of this study is that it is single-centred and small sample size analysis.

Effect of one Year of Yoga Therapy on Glycemic Control among Patients with Type 2 Diabetes Mellitus

Context: India is well-endowed in using yoga therapy for the management of type 2 diabetes mellitus (T2DM) which is a safe, effective, and easy-to-learn alternative treatment that can be practiced by elderly and persons with disabilities. Aim: Effect of 1 year of yoga therapy on glycemic control among patients having T2DM: A randomized controlled trial (RCT). Settings and Design: RCT conducted at and Urban Health Centre (UHC) for 1 year. Materials and Methods: One hundred and twenty diagnosed and registered for T2DM from UHC enrolled as participants who were divided into exercise and yoga interventional group by computer-generated, randomized number sequence method. The yogic practice was advised to 60 study participants and the reaming 60 participants were advised to do exercises for 1 year. The glycemic outcome was evaluated by Random Blood Sugar (RBS) and HbA1c which were examined at baseline, 6 months, and at the end of 1 year. Statistical Analysis Used: Paired and unpaired (independent) t-test. Generalized estimating equations models were performed on the glycemic control variables to assess the differences between the two intervention groups. Results: The post hoc analysis of 120 T2DM patient's data inferred that yoga and exercise have shown statistically significant (P &lt; 0.05) effect on reducing HbA1C. However, no statistically significant difference (P &gt; 0.05) was observed when the yoga group was compared with the exercise group on glycemic control (reducing HbA1c). Conclusions: Yoga is as effective as exercise, hence people with morbidities or who are unable to go for exercise can practice yoga at home which will help them for proper control of HbA1c and RBS.