Well-controlled Diabetes Research Articles

Visceral disseminated varicella zoster infection: a rare cause of acute abdomen in a patient with well-controlled diabetes mellitus\u2014a case report

BackgroundVisceral disseminated varicella zoster virus (VZV) infections frequently affect immunocompromised patients. Diabetes mellitus has been associated with VZV infection, and most cases of disseminated infection involve patients with poorly controlled blood glucose levels. It initially presents as severe abdominal pain, which is evaluated as an acute abdomen, however, the cause is typically unidentified due to unremarkable computed tomography (CT) findings. We report a case of visceral disseminated VZV infection in a patient with well-controlled diabetes mellitus with fat stranding around the celiac and superior mesenteric artery on CT.Case presentationA 61-year-old Japanese woman with well-controlled diabetes mellitus presented to the emergency department with severe abdominal pain that gradually worsened. She had stable vital signs and skin rashes, suggestive of varicella. Abdominal CT showed fat stranding around the celiac and superior mesenteric arteries. The patient tested positive for the VZV antigen and was diagnosed with a visceral disseminated VZV infection. Acyclovir was administered, and the patient was discharged on the 14th day.ConclusionsVisceral disseminated VZV infection may affect patients with well-controlled diabetes mellitus and causes acute abdomen. Periarterial fat stranding on CT is associated with abdominal pain due to visceral disseminated VZV infection.

Abnormal Newborn Screen During a Pandemic.

Abnormal Newborn Screen During a Pandemic.

Lower limb axonal mononeuropathies as sequelae of COVID-19: a case report and review of literature

BackgroundNeurological symptoms and complications of Coronavirus disease 2019 (COVID-19) were seldom discussed in the literature initially. Neurological symptoms such as headache, dizziness, anosmia, hypogeusia, and neuralgia are, however, now being reported commonly. Mononeuropathies are rare complications of COVID-19, with most cases associated with prolonged intensive care stay.Case presentationA 61-year-old gentleman with prior history of well-controlled diabetes and hypertension was recently treated for COVID-19 pneumonia with supplemental oxygen and positive pressure ventilation. He now presented with left-sided foot weakness two weeks after recovering from the viral illness. On examination he had normal bulk and tone and a power of 4/5 in proximal and distal muscles of bilateral lower limbs except for ankle dorsiflexion on the left which was 2/5. He also had absent ankle and knee reflexes bilaterally with bilateral flexor plantar reflexes. Since the patient had no back pain and the sensory system was normal, the lesion was localized to the peripheral nerves and a Nerve Conduction Studies and Electromyography (NCS/EMG) was done. NCS/EMG showed findings suggestive of axonal mononeuropathies. Relevant workup done to identify the cause of mononeuropathy was negative including infectious and autoimmune workup. Since diabetes was well-controlled and he had no intensive care stay his findings were presumed to be associated with resolving COVID-19 infection. The patient underwent aggressive daily physical therapy and has started to show improvement in symptoms.ConclusionsComplications such as mononeuropathies should be kept in mind in patients recovering from COVID-19 infection, since timely diagnosis can improve clinical outcomes in patients.

Obstructive sleep apnea is not associated with diabetic retinopathy in diabetes: a prospective case-control study.

Diabetic retinopathy (DR) is the most common ocular complication of type 2 diabetes mellitus (T2D) and is associated with diabetes duration, glycemic control, and hypertension (HTN). Obstructive sleep apnea (OSA) is frequent in T2D and isassociated with poor glycemic control. However, it is unclear if there is an association between OSA and DR. This study aimed to assess whetheror not the presence of OSA inpatients with T2D was associated with DR. In this prospective case-control study, consecutivepatients with DM attending the ophthalmology clinics were recruited to include patients with DR (cases) and without DR (controls). OSA was diagnosed by attended polysomnography (PSG). Blood pressure and a fasting morning blood sample, including glycosylated hemoglobin (HbA1c), were recorded. Patients were matched for age, body mass index (BMI), gender, and T2D duration. Thirty diabetic patients with DR were matched with 30 controls. In all patients, the prevalence of moderate-to-severe OSA was 57%. In the logistic regression analysis, DR was associated with increased HbA1c (OR 2.63, 95% CI 1.35-5.16, p = 0.004) but not with any PSG parameter. In the DR group, PSG parameters were not associated with the severity of ocular disease (non-proliferative, proliferative, presence/absence of macular edema). The proliferative aspect of DR was correlated with age (p = 0.017). DR occurred more frequently in uncontrolled diabetes compared to well-controlled diabetes (80% vs 38%, p = 0.029). Inpatients with T2D, the presence of DR is not associated with OSA, but with poorly controlled T2D.

Altered Doppler Velocimetry of Fetal Middle Cerebral Artery in Singleton Pregnancies Complicated by Mild Well-Controlled Gestational Diabetes

Introduction: The aim of the present study was to evaluate fetal umbilical artery (UA) and middle cerebral artery (MCA) blood flow in patients with gestational diabetes (GD), in order to determine whether minimal anomalies of glucose metabolism may influence fetal placental function. Methods: UA and MCA flows were prospectively measured by transabdominal ultrasound in singleton pregnancies between 34 and 37 weeks of gestation. Results: The study included 35 women with GD and 217 nondiabetic patients. Middle cerebral pulsatility index (PI) was significantly higher in the GD group (mean MCA-PI = 1.82 ± 0.27 vs. 1.71 ± 0.26; p < 0.02). Likewise, MCA peak systolic velocity (MCA-PSV) was higher in the GD group compared to the non-GD group, though the difference was not significant (mean of MCA-PSV = 47.14 ± 8.45 vs. 47.09 ± 11.21; p = 0.98). UA-PI resulted higher in the non-GD group without significant differences (mean of UA-PI = 0.88 ± 0.14 vs. 0.86 ± 0.15; p = 0.32). Conclusions: Our study shows that even in cases of minimal metabolic derangements, GD is characterized by a significant variation in fetal Doppler velocimetry, particularly in the brain.

Hormonal patterns in men with prediabetes and diabetes in NHANES III: possible links with prostate cancer.

Pathways involving sex hormones and insulin-like growth factors (IGFs) have been proposed to explain, in part, the lower risk of prostate cancer among men with diabetes. To gain insights into potential biological mechanisms we explored differences in serum concentrations of sex hormones and IGFs across the trajectory from normoglycemia to prediabetes to poorly controlled diabetes. Using cross-sectional data from the National Health and Nutrition Examination Survey III we examined differences in levels of circulating sex hormones, sex hormone-binding globulin (SHBG), IGF-1, and IFG-binding protein 3 (IGFBP-3), according to diabetes status: no diabetes [n = 648], prediabetes [n = 578], undiagnosed diabetes [n = 106], well-controlled diabetes [n = 42], and poorly controlled diabetes [n = 56]. Adjusted geometric mean concentrations were derived using multivariable linear regression, adjusted for age, race, and other lifestyle factors. Total testosterone concentrations were lower among prediabetics (4.89ng/mL, 95% confidence interval (CI) 4.95-5.21) than men without prediabetes/diabetes (5.29ng/mL, 95% CI 5.06-5.53) but did not reduce further across diabetes groups. Concentrations of estradiol, estimated free testosterone, SHGB, IGF-1, and IGFBP-3 did not differ. While the ratio of IGF-1 to IGFBP-3 was lower among men with prediabetics and undiagnosed diabetes than men without prediabetes/diabetes, there was no trend across groups. A positive trend for the ratio of estradiol-to-testosterone levels was observed across groups (p trend = 0.045). Our findings do not provide clear support for either an androgen driven or IGF-driven pathway for the inverse association between diabetes and prostate cancer risk.

A Clinical Study to Assess the Severity of Periodontal Disease in Relation to Glycemic Status of Type II Diabetic Individuals.

Background:The study is done to find out the association between the glycemic status of Type II diabetic patients and the severity of periodontal disease (PD).Materials and Methods:Study groups included a total of 90 Type II diabetic individuals and were divided as Group I with well-controlled diabetics and Group II with poorly controlled diabetics based on glycosylated hemoglobin levels. The periodontal parameters of all patients, namely probing pocket depth, clinical attachment level, and bleeding on probing oral hygiene index-debris index score, were assessed. The collected data were subjected to statistical analysis.Results:The periodontal parameters of all patients with poor glycemic control were significantly higher than well-controlled group. There was a significant difference between all clinical parameters between groups with P < 0.001 indicating severe PD in poor glycemic status group.Conclusion:The severity of PD is related to glycemic status. The poorly controlled diabetic patients had severe periodontitis than well-controlled diabetic patients. Local factors such as dental plaque seem to have a major influence in disease progression.

Effect of SARS-CoV-2 on glycemic control in post-COVID-19 diabetic patients.

To study the clinicodemographic profile, outcomes, and post-COVID change in glycemic control among treated COVID-19-infected patients with poorly controlled or well-controlled diabetes mellitus (DM). Adult COVID-19-infected patients who tested positive with rapid antigen test or RT-PCR admitted were included in this prospective observational study. Patients were divided into well-controlled and poorly controlled diabetes group based on HbA1c values at admission. Telephonic follow-up and HbA1c estimation was done after three months. Clinical and laboratory investigations performed were compared between both groups. Hazard ratios (HRs) for mortality risk in both well-controlled and poorly controlled COVID-19 patients with DM was done by Cox proportional hazard models. Out of 260 patients, 140 (53.84%) and 120 (46.15%) were poorly and well-controlled diabetics respectively. One hundred sixty-three patients (62.69%) were male, and the mean age was 52.67 ± 15.69 years. Severity, duration of hospital stay, steroid duration, insulin requirement and mean HbA1C, both at admission and after three months, were significantly higher in poorly controlled group than the well-controlled group (P < 0.005). With increase in age, the HR for all-cause mortality increased by 1.15 times (95% CI, 1.05-1.25; P = 0.0025) in well-controlled than poorly controlled group, whereas with increase in FBS at admission, the HR for all-cause mortality increased by 1.03 times in poorly controlled than well-controlled group (95% CI, 1.01-1.06; P = 0.0044). Our results show that well-controlled blood glucose levels or improved glycemic control are associated with a better outcome in patients with COVID-19 and pre-existing type 2 diabetes mellitus.

Combined Aerobic and Resistance Training Performed under Conditions of Normobaric Hypoxia and Normoxia Has the Same Impact on Metabolic Control in Men with Type 1 Diabetes.

(1) Background: The aim was to assess whether combined aerobic and resistance training performed under hypoxic and normoxic conditions had an impact on diabetes control, VO2max (maximum oxygen consumption), and echocardiological and anthropometric parameters in men with long-term type 1 diabetes. (2) Methods: Sixteen male participants (mean age: 37 years, mean HbA1c (glycated hemoglobin): 7.0%) were randomly assigned to two groups: training in normoxic conditions or training in conditions of altitude hypoxia. All subjects participated in 60 min combined aerobic and resistance training sessions twice a week for 6 weeks. At baseline and in the 6th week, echocardiography, incremental exercise test, and anthropometric and diabetes control parameters were assessed. (3) Results: After 6 weeks, there was no significant change in HbA1c value in any group. We noted a more stable glycemia profile during training in the hypoxia group (p > 0.05). Patients in the hypoxia group required less carbohydrates during training than in the normoxia group. A comparable increase in VO2max was observed in both groups (p > 0.05). There were no significant differences in cardiological and anthropometric parameters. (4) Conclusions: Combined aerobic and resistance training improved VO2max after 6 weeks regardless of the conditions of the experiments. This exercise is safe in terms of glycemic control in patients with well-controlled diabetes.

Risk Factors of Uncontrolled Hyperglycemia in Children and Adolescents with Type 1 Diabetes Mellitus

Background: In Iraqi children with type 1 diabetes mellitus, glycemic control levels and risk factors for uncontrolled hyperglycemia are unknown. The aim of the study to assess the factors that increase the risk of uncontrolled hyperglycemia in children and adolescents with type 1 diabetes mellitus, and identify levels of glycemic control in children and adolescents with type 1 diabetes mellitus.Methods: A cross-sectional study was carried out from September 21 2020 until the end of May 2021 to identify levels of glycemic control and assess the risk factors of uncontrolled hyperglycemia in children and adolescents with type 1 diabetes mellitus, for the study sample which was 209 type 1 diabetics, selected randomly from the visitors of a Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC). The American Diabetes Association assigned target HbA1c levels to patients based on their age groups. Comparison has been made of well-controlled patients and uncontrolled hyperglycemia patients. To assess each risk factor’s role in uncontrolled type 1 diabetes hyperglycemia, the Odds Ratios were calculated.Results: Only 17.2% of children and adolescents with type 1 diabetes mellitus were well-controlled diabetes. Better glycemic control was related to age &lt; 6 years, BMI, and duration of type 1 diabetes &lt;5 years. Glycemic control was not affected by gender, residence, socio-economic status. Conclusion: Type 1 diabetes mellitus glycemic control among children and adolescents in Al-Basra/southern Iraq varies widely, risking microvascular complications. In well-control type 1 diabetes mellitus patients, females were higher than males and in the age group (1-6) years, higher than the other age groups. While in uncontrolled patients with type 1 diabetes, about (57.2%) had an episode of diabetic ketoacidosis (DKA). The major risk factors for uncontrolled hyperglycemia are excessive sweet intake, fast food, and irregular meals

Influence of Pre-operative HbA1c on Bariatric Surgery Outcomes-the Sunderland (UK) Experience.

UK guidelines recommend an HbA1c < 8.5% prior to elective surgery. Optimisation of pre-operative glycaemic control can be often difficult. Aim to correlate the effect of pre-operative HbA1c on the peri-operative complication rates and whether elective bariatric surgery should be delayed in poorly controlled diabetics. Retrospective data of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass, one-anastomosis gastric bypass and laparoscopic sleeve gastrectomy during January 2014 and April 2018. Patients were categorised into group 1, non-diabetics with an HbA1c < 6.5%; group 2, well-controlled diabetics with HbA1c between 6.5 and 8.4%; and group 3, poorly controlled diabetics with HbA1c ≥ 8.5%. Primary outcome was peri-operative complication rates. Group 1 (n = 978), 81.8% female, median (i.q.r.) age 44.0 (34-52) years, median (i.q.r.) BMI 42.0 (38.7-46.7); group 2 (n = 350), 66.3% female, age 51.0 (45-59) years, BMI 41.8 (37.5-46.5); and group 3 (n = 90), 60% female, age 52.0 (45-56) years and BMI 41.4(36.9-44.8). Early complication rates in each group were low, 1.0% vs 1.7% vs 1.1% (p = 0.592). Mean length of stay was 2days across the groups (p > 0.05). There was no difference in 30-day re-admission rates between groups 2.8%, 2.9% and 3.3% (p = 0.983). At 6months and 1year, there was sustained and equal reduction in HbA1c in all groups (p < 0.05). Patients undergoing metabolic surgery for poorly controlled diabetes achieve non-inferior peri-operative outcomes. Hence, delaying metabolic surgery in an attempt to optimise diabetic control is not justifiable.

Periodontal Clinicoradiographic Status and Whole Saliva Soluble Urokinase Plasminogen Activation Receptor and Tumor Necrosis Factor Alpha Levels in Type-2 Diabetic and Non-diabetic Individuals.

The authors hypothesise that whole saliva soluble-urokinase-type plasminogen-activator receptor (suPAR) and tumor necrosis factor-alpha (TNF-α) levels are higher in patients with poorly-controlled than well-controlled type-2 diabetes mellitus (DM) and non-diabetic controls. The aim was to assess the periodontal clinicoradiographic status and whole-salivary suPAR and TNF-α levels in type-2 diabetic and non-diabetic individuals. Patients with and without type-2 DM were included. In all patients, hemoglobin A1c (HbA1c) levels were measured. Participants were divided into 4 groups. Group 1: patients with poorly controlled type-2 DM; group 2: patients with well-controlled type-2 DM; group 3: non-diabetic patients with periodontitis; group 4: non-diabetic patients without periodontitis. Clinicoradiographic periodontal parameters (plaque index [PI], gingival index [GI], clinical attachment loss [AL], probing depth [PD] and mesial and distal marginal bone loss [MBL]) were measured. The whole saliva total protein concentration (TPC) and suPAR as well as TNF-α levels were measured. The level of statistical significance was set at p < 0.01. One hundred patients (25 patients per group) were included. Scores of PI (p < 0.01), GI (p < 0.01), clinical AL (p < 0.01), PD (p < 0.01), number of missing teeth and mesial (p < 0.01) and distal (p < 0.01) MBL were statistically significantly higher in group 1 than in groups 2-4. Scores of PI, GI, clinical AL, PD, mesial and distal MBL, and numbers of missing teeth were higher in group 3 (p < 0.01) than in groups 2 and 4. The whole saliva TPC, suPAR and TNF-α levels were statistically significantly higher among patients in group 1 (p < 0.01) than in groups 2-4. Patients with poorly-controlled type-2 DM presented with poorer clinicoradiographic periodontal status and increased whole saliva levels of suPAR, TNF-α and TPC compared with patients with well-controlled type-2 DM and non-diabetic individuals.

Diabetes status modifies the long-term effect of lipoprotein-associated phospholipase A2 on major coronary events

Aims/hypothesisLipoprotein-associated phospholipase A2 (Lp-PLA2) activity has an independent prognostic association with major coronary events (MCE). However, no study has investigated whether type 2 diabetes status modifies the effect of Lp-PLA2 activity or inhibition on the risk of MCE. We investigate the interaction between diabetes status and Lp-PLA2 activity with risk of MCE. Subsequently, we test the resulting hypothesis that diabetes status will play a role in modifying the efficacy of an Lp-PLA2 inhibitor.MethodsA retrospective cohort study design was utilised in two study populations. Discovery analyses were performed in the Genetics of Diabetes Audit and Research in Tayside Scotland (GoDARTS) cohort based in Scotland, UK. Participants were categorised by type 2 diabetes control status: poorly controlled (HbA1c ≥ 48 mmol/mol or ≥6.5%) and well-controlled (HbA1c < 48 mmol/mol or <6.5%) diabetes (n = 7420). In a secondary analysis of the Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy (STABILITY) trial of Lp-PLA2 inhibitor (darapladib) efficacy, 15,828 participants were stratified post hoc by type 2 diabetes diagnosis status (diabetes or no diabetes) at time of recruitment. Lp-PLA2 activity was then divided into population-specific quartiles. MCE were determined from linked medical records in GoDARTS and trial records in STABILITY. First, the interaction between diabetes control status and Lp-PLA2 activity on the outcome of MCE was explored in GoDARTS. The effect was replicated in the placebo arm of STABILITY. The effect of Lp-PLA2 on MCE was then examined in models stratified by diabetes status. This helped determine participants at higher risk. Finally, the effect of Lp-PLA2 inhibition was assessed in STABILITY in the higher risk group. Cox proportional hazards models adjusted for confounders were used to assess associations.ResultsIn GoDARTS, a significant interaction between increased Lp-PLA2 activity (continuous and quartile divided) and diabetes control status was observed in the prediction of MCE (p < 0.0001). These effects were replicated in the placebo arm of STABILITY (p < 0.0001). In GoDARTS, stratified analyses showed that, among individuals with poorly controlled diabetes, the hazards of MCE for those with high (Q4) Lp-PLA2 activity was 1.19 compared with individuals with lower (Q1–3) Lp-PLA2 activity (95% CI 1.11, 1.38; p < 0.0001) and 1.35 (95% CI 1.16, 1.57; p < 0.0001) when compared with those with the lowest activity (Q1). Those in the higher risk group were identified as individuals with the highest Lp-PLA2 activity (Q4) and poorly controlled diabetes or diabetes. Based on these observations in untreated populations, we hypothesised that the Lp-PLA2 inhibitor would have more benefit in this higher risk group. In this risk group, Lp-PLA2 inhibitor use was associated with a 33% reduction in MCE compared with placebo (HR 0.67 [95% CI 0.50, 0.90]; p = 0.008). In contrast, Lp-PLA2 inhibitor showed no efficacy in individuals with low activity, regardless of diabetes status, or among those with no baseline diabetes and high Lp-PLA2 activity.Conclusions/interpretationThese results support the hypothesis that diabetes status modifies the association between Lp-PLA2 activity and MCE. These results suggest that cardiovascular morbidity and mortality associated with Lp-PLA2 activity is especially important in patients with type 2 diabetes, particularly those with worse glycaemic control. Further investigation of the effects of Lp-PLA2 inhibition in diabetes appears warranted.Data availabilitySTABILITY trial data are available from clinicaltrials.gov repository through the GlaxoSmithKline clinical study register https://clinicaltrials.gov/ct2/show/NCT00799903. GoDARTS datasets generated during and/or analysed during the current study are available following request to the GoDARTS Access Managements Group https://godarts.org/scientific-community/.Graphical abstract

Fetal cardiac geometry and function in pregnancies with well-controlled gestational diabetes mellitus using Fetal HQ

Objective To determine whether abnormal cardiac shape and ventricular global, transverse, and longitudinal contractility are present in fetuses of women with well-controlled GDM. Methods A prospective observational study was performed on 80 fetuses of women with well-controlled GDM and 90 control fetuses. Using Fetal HQ, a new speckle-tracking technique, cardiac shape, global contractility, transverse contractility, and longitudinal contractility were calculated. The number and percentage of fetuses with z score values below 5th or above 95th were computed. Results Compared with controls, there were no significant differences in the frequency of cardiac geometric abnormalities in GDM fetuses. Despite good glycemic control, 60.0% of fetuses in the well-controlled GDM group had one or more types of global, longitudinal, and transverse contractility abnormalities of one or both ventricles, but more frequent on the right ventricle (RV, 50%). The most frequent abnormality of the RV occurred in the transverse contractility (35%), followed by abnormalities of global contractility (25%), and longitudinal contractility (21.3%), compared with controls. The left ventricle (LV) analysis demonstrated that the percentage of study fetuses with only transverse contractility abnormality (18.8%) was significantly higher. Conclusions Despite good glycemic control, abnormal ventricular contractility was present in fetuses of women with GDM, but more frequent in the RV. For both the RV and LV, transverse ventricular contractility abnormality were more prevalent than abnormal global and longitudinal contractility. Fetuses of women with GDM should be evaluated for ventricular contractility abnormality and have more follow-ups despite good glycemic control.

1452A Cohort Study of Comorbidities of Diabetes in Regional Australia

Abstract Background Epidemic of diabetes mellitus and its complications poses a major global threat and the burden of type 2 DM (T2DM) is also a worldwide phenomenon. However, data to rationalize continuous health promotion at local context such as regional New South Wales are lacking, and this underscores the need for continued epidemiological study. This study investigated if poorly controlled T2DM coexists with comorbidities more than those with good glycaemic control. Methods This was a cohort study at a private General Practice in Orange NSW, Australia. The study involved 137 de-identified adults living with T2DM. HbA1c and other biochemical and haematological records were reviewed. Other data included clinical notes including comorbidities, and complications. The cohort was separated into 2 groups: well-controlled versus poor glycaemic control. The resulting data were analysed for frequency, using the statistical software for Microsoft Excel. Results There were 37/137 of the T2DM cohort with baseline HbA1c of ≤ 6.5%, implying 73% poor glycaemic control in the region, at first time of testing. According to the clinical notes, the well-controlled group showed 29.7% comorbidities, including 2.7% queried infection. Among the 100 cases with abnormal HbA1c, comorbidities were observed in 22% including 4% who had infections. Conclusions Our observation implies no less comorbidities in well-controlled diabetes. However, the higher percentage of infection among the poorly controlled group is confirmation of need for continuous health promotion among people living with diabetes. Key messages This primary health statistic suggests the need to monitor for comorbidities equally, whether poor or well-controlled diabetes

Associations of the Glycaemic Control of Diabetes with Dementia and Physical Function in Rural-Dwelling Older Chinese Adults: A Population-Based Study.

PurposeTo examine the associations of impaired fasting glucose (IFG) and glycaemic control of diabetes with dementia, global cognitive function and physical function among rural-dwelling Chinese older adults.Patients and MethodsThis population-based cross-sectional study included 4583 participants (age ≥65 years, 57.3% women) living in Yanlou Town, Yanggu County, western Shandong Province, China. In 2018, data were collected through interviews, clinical examinations, neuropsychological tests, and laboratory tests. Diabetes status was defined by self-reported physician-diagnosed diabetes, current use of antidiabetic agents, and fasting blood glucose tests. Global cognitive function was assessed using the Mini-Mental State Examination. Dementia was diagnosed following DSM-IV criteria, and Alzheimer’s disease (AD) was diagnosed following the National Institute on Aging-Alzheimer’s Association criteria. Physical function was assessed by the Short Physical Performance Battery. Data were analysed using multiple logistic and general linear regression models.ResultsIFG was found in 267 participants, and diabetes was diagnosed in 658 participants (257 with well-controlled diabetes, 401 with poorly controlled diabetes). Dementia was diagnosed in 166 participants (116 with AD), and physical functional impairment was found in 1973 participants. The multi-adjusted odds ratio (OR) of dementia associated with poorly controlled diabetes (vs without IFG or diabetes) was 2.41 (95% CI 1.52–3.84), and the OR of AD associated with poorly controlled diabetes was 2.32 (1.34–4.04). In addition, the adjusted OR of physical functional impairment was 1.40 (1.06–1.85) for well-controlled diabetes and 1.69 (1.35–2.12) for poorly controlled diabetes. However, IFG was not associated with cognitive or physical function.ConclusionThe glycaemic control status of diabetes patients was associated with cognitive impairment and physical functional impairment.

Epigenetic Changes in Neonates Born to Mothers With Gestational Diabetes Mellitus May Be Associated With Neonatal Hypoglycaemia.

The detection of epigenetic changes associated with neonatal hypoglycaemia may reveal the pathophysiology and predict the onset of future diseases in offspring. We hypothesized that neonatal hypoglycaemia reflects the in utero environment associated with maternal gestational diabetes mellitus. The aim of this study was to identify epigenetic changes associated with neonatal hypoglycaemia. The association between DNA methylation using Infinium HumanMethylation EPIC BeadChip and neonatal plasma glucose (PG) level at 1 h after birth in 128 offspring born at term to mothers with well-controlled gestational diabetes mellitus was investigated by robust linear regression analysis. Cord blood DNA methylation at 12 CpG sites was significantly associated with PG at 1 h after birth after adding infant sex, delivery method, gestational day, and blood cell compositions as covariates to the regression model. DNA methylation at two CpG sites near an alternative transcription start site of ZNF696 was significantly associated with the PG level at 1 h following birth (false discovery rate-adjusted P < 0.05). Methylation levels at these sites increased as neonatal PG levels at 1 h after birth decreased. In conclusion, gestational diabetes mellitus is associated with DNA methylation changes at the alternative transcription start site of ZNF696 in cord blood cells. This is the first report of DNA methylation changes associated with neonatal PG at 1 h after birth.

96-OR: Parameters of Glycemic Variability as Predictors of LGA in Pregnant Women with Well-Controlled Type 1 Diabetes (T1D)

Background: According to the current recommendations, pregnant patients with T1D are encouraged to use continuous glucose monitoring (CGM) systems. The use of CGM reduces the risk of LGA births and neonatal hypoglycemia. This study aimed to assess the influence of the parameters of glycemic variability on the risk of LGA births. Methods: The study cohort included 75 patients with T1D who were using CGM systems throughout pregnancy. The study population we divided into two subgroups: mothers of LGA and non-LGA newborns. We defined LGA as a birth weight above the 90th percentile. Calculated birthweight percentiles we adjusted for maternal weight, height, parity, and ethnicity, as well as the infant’s sex and gestational age. For each trimester separately and for the whole pregnancy, we calculated indicators of glucose variability, such as time spent in and above the target range (TIR, TAR). We also calculated the %CV, MODD, MAGE, GRADE, %GRADE hypo, %GRADE hyper, CONGA (1, 2h), LBGI, and HBGI. Results: The mean values of glycated haemoglobin in both groups met the criteria of well-controlled T1D in each trimester of pregnancy. Nevertheless, there were 25/75 infants with LGA. Only the 1st-trimester maternal HbA1c values were significantly higher in the group of LGA infants. However, in the LGA-mothers, mean glucose levels and TAR values were significantly increased in each trimester. Bivariate logistic regression revealed that the LGA risk was positively associated with %GRADE hyper, MODD, MAGE, and TAR, and negatively associated with LBGI, %GRADE hypo, and TIR. After the adjustments for the maternal age, pregestational BMI, gestational weight gain, and HbA1c values, only the relationships with the first trimester’s %GRADE hypo and %GRADE hyper as well as %GRADE hypo calculated for whole pregnancy remained significant. Conclusion: The parameters of glucose variability rather than HbA1c may help predict LGA infants, especially in patients with well-controlled diabetes. Disclosure R. Sibiak: None. B. Mrzewka-rogacz: None. U. Mantaj: None. P. Gutaj: None. E. Wender-ozegowska: Advisory Panel; Self; Novo Nordisk, Board Member; Self; Medtronic, Other Relationship; Self; Medtronic, Novo Nordisk.

Evaluation of the Relationship between Salivary Lipids, Proteins and Total Antioxidant Capacity with Gingival Health Status in Type-1 Diabetic Children.

Statement of the Problem: Alteration in salivary composition and its effect on the oral cavity in diabetic child patients remains equivocal.Purpose: This study was performed to assess the relationship between salivary factors and gingival status in children with type-1 diabetes mellitus (DM).Material and Method: In this cross-sectional study, 120 subjects aged 6-16 years (60 well-controlled and poorly-controlled diabetics and 60 healthy individuals) were examined to determine the gingival index (GI) and plaque index (PI). The unstimulated saliva samples were collected to measure the salivary triglyceride, cholesterol, albumin, α-amylase, total protein levels by the laboratory kits. Total antioxidant capacity and the free radicals scavenger index were measured by the Ferric Reducing Ability Of Plasma (FRAP) and 1,1-Diphenyl-2-picryl-hydrazyl (DPPH) assays, respectively. Data were analyzed by parametric and non-parametric, Pearson correlation, and t tests at a 5% error level.Results: GI of diabetics was significantly higher than that of healthy individuals (1.51± 0.71 and 0.9±0.81, respectively, p< 0.001). No significant difference was found between the PI of diabetics compared to healthy volunteers (1.59±0.69, 1.63±0.74, respectively). The levels of salivary triglyceride and cholesterol, albumin and total proteins in healthy subjects were significantly higher than that in people with DM (p< 0.001). A significantly more salivary α-amylase activity was found in diabetics compared to non-diabetics (p< 0.001). No significant differences were found between diabetic and non-diabetic subjects in terms of DPPH (95.5, 95.9%, respectively) and FRAP (9.77±0.13, 9.78±0.12 (µmol/mL), respectively).Conclusion: More gingival inflammation and salivary α-amylase activity and lower level of salivary lipids, albumin, and total proteins were found in diabetic patients, but there was no association between the level of lipids, proteins, and the total antioxidant capacity of saliva with periodontal health indicators in patients with DM and healthy individuals.

Umbilical cord blood metabolomics: association with intrauterine hyperglycemia.

Intrauterine hyperglycemia can harm a fetus's growth and development, and this can be seen in the umbilical cord blood metabolism disorder. However, the metabolites and metabolic mechanisms involved in the condition remain unknown. Targeted metabolomics using liquid chromatography and MetaboAnalyst were conducted in this study to explore differences in metabolites and metabolic pathways between individuals with hyperglycemia or well-controlled gestational diabetes mellitus (GDM) and healthy controls. Univariate analysis found that the hyperglycemic and healthy control groups differed in 30 metabolites, while the well-controlled GDM and the healthy control groups differed only in three metabolites-ursodeoxycholic acid, docosahexaenoic acid, and 8,11,14-eicosatrienoic acid. Most of these metabolic variations were negatively associated with neonatal weights. Further research showed that the variations in the metabolites were primarily associated with the metabolic pathways of linoleic acid (LA) and alpha-linolenic acid (ALA). Gestational hyperglycemia and well-controlled GDM, which may play a major role by inhibiting the LA and ALA metabolic pathways, have detrimental effects on cord blood metabolism. The main point of this paper is that intrauterine hyperglycemia has a negative effect on cord blood metabolism mainly through the linoleic acid and alpha-linolenic acid metabolic pathways. This is a study to report a new association between well-controlled GDM and cord blood metabolism. This study provides a possible explanation for the association between intrauterine hyperglycemia and neonatal adverse birth outcomes.