Well-controlled Diabetic Patients Research Articles

Poor Prestroke Glycemic Control Increases the Rate of Symptomatic Intracranial Hemorrhage after Mechanical Thrombectomy.

(1) Background: Diabetes is a well-established risk factor for acute ischemic stroke (AIS). This study evaluated the impact of prestroke glycemic control in diabetic patients on their 3-month clinical outcome after mechanical thrombectomy (MT). (2) Methods: AIS patients with a premorbid modified Rankin scale (mRS) score of 0-2 who were admitted within 6 h after stroke onset and treated with MT between January 2020 and August 2023 were retrospectively analyzed. The study evaluated the effect of prestroke glycemic control on the stroke severity, reperfusion rate, symptomatic intracranial hemorrhage (sICH) and favorable clinical outcome (modified Rankin scale score 0-2) at 3 months after endovascular treatment. (3) Results: A total of 364 patients were analyzed, with 275 cases of non-diabetes (ND), 66 of well-controlled diabetes (WCD) and 23 of poorly controlled diabetes (PCD). There was no significant difference in the baseline neurological deficit expressed according to the National Institutes of Health Stroke Scale among the three groups. The time from stroke onset to groin puncture was similar in the ND, WCD and PCD groups (median 215 min, 194.5 min and 222.5 min, respectively). There was no significant difference in the favorable 3-month clinical outcomes among these three groups (35.2% of ND patients, 42.4% of WCD patients and 39.1% of PCD patients) or full recovery (12.4% of ND patients, 11.0% of WCD patients and 17.4% of PCD patients). The rate of sICH was significantly higher in the PCD group as compared to the ND and WDP groups (21.7% of PCD patients versus 7.6% of ND patients, p = 0.038, and 6.0% of WCD patients, p = 0.046), but the 3-month mortality did not differ between the three groups (21.8% of ND group, 19.7% of WCD group and 26.1% of PCD group). (4) Conclusions: This study shows that poor prestroke glycemic control in AIS diabetic patients does not change the chance of a good clinical functional outcome after endovascular treatment. However, the increased risk of hemorrhagic complications in this group of patients should be considered.

Study of Glycemic Variability in Well-controlled Type 2 Diabetic Patients Using Continuous Glucose Monitoring System.

The world has changed tremendously for patients suffering from diabetes mellitus with the development of cutting-edge technologies like continuous glucose monitoring and flash glucose monitoring systems. Now, the details of constant fluctuations of glucose in their blood can be monitored not only by medical professionals but also by patients, and this is called glycemic variability (GV). Traditional metrics of glycemic control measurement, such as glycated hemoglobin (HbA1c), fail to reflect various short-term glycemic changes like postprandial hyperglycemia and hypoglycemic episodes, paving the way to the occurrence of various diabetic complications even in asymptomatic, well-controlled diabetic patients. This need for advanced management of diabetes and effective monitoring of these swings in blood glucose can be met by using a continuous glucose monitoring system (CGMS). To evaluate the extent of GV in well-controlled type 2 diabetes mellitus (T2DM) patients using a flash CGMS and to assess the correlation between GV and HbA1c. A hospital-based prospective observational study was carried out from May 2020 to Oct 2021 at the Department of Medicine, SMS Hospital, Jaipur, Rajasthan (India), after approval from the Ethics Committee of the institution. A total of 30 patients with well-controlled T2DM (HbA1c was ≥6.5, but ≤7.5) were included in the study using simple random techniques after written informed consent from patients. Patients were studied for glycemic excursions over a period of 7 days by using FreeStyle® Libre Pro™, which is a flash glucose monitoring system. The CGM sensor was attached to the left upper arm of the patient on day 0 and removed on day 7. The data recorded in the sensor was then retrieved using pre-installed computer software and analyzed using standard CGM metrics like standard deviation (SD), percentage coefficient of variation (%CV), time above range (TAR), time below range (TBR), and time in range (TIR), out of which %CV was used to quantify GV. %CV has been used to cluster patients into four cohorts from best to worst, namely: best/low CV ≤ 10%, intermediate CV from 10 to 20%, high CV from 20 to 30%, and very high CV of >30%. Scatterplots are used to establish correlations between various parameters. Data from a total of 30 patients were analyzed using CGMS and thus used for calculating standard CGM metrics; glucose readings every 15 minutes were recorded consecutively for 7-day periods, making it a total of 672 readings for each patient. Interpreting the CGM data of all 30 patients, the following results were found: the mean blood glucose of all cases is 134.925 ± 22.323 mg/dL, the mean SD of blood glucose of all cases is 35.348 ± 9.388 mg/dL, the mean of %CV of all cases is 26.376 ± 6.193%. CGM parameters of time are used in the form of percentages, and the following results were found: the mean of TAR, TBR, and TIR is 14.425 ± 13.211, 5.771 ± 6.808, and 82.594 ± 12.888%, respectively. Clustering the patients into cohorts, the proportion of patients exhibiting best/low %CV (10%) is 0, intermediate %CV (10-20%) is 16.67% (five out of 30 patients), high %CV (20-30%) is 50% (15 out of 30 patients) and very high %CV (>30%) is 33.33% (10 out of 30 patients). Also, there is no significant correlation found between HbA1c and %CV (ρ = 0.076, p-value = 0.690); a significant negative correlation was found between %CV and TIR (ρ = -0.604, p < 0.001S); a positive correlation of %CV with TAR and TBR is significant (ρ = 0.816, p-value of <0.001). Using a flash CGMS device and considering %CV as the parameter and primary measure of GV, the study demonstrated the overall instability of a person's glycemic control, making note of unrecognized events of hypoglycemia and hyperglycemia in asymptomatic well-controlled T2DM patients, revealing the overall volatile glycemic control. The most important finding of this study is that even those diabetics who are considered well-controlled experience a great degree of GV as assessed by CGM-derived metrics. This study also demonstrated that there is no significant correlation between HbA1c and GV, suggesting that patients may not have optimal control of their diabetes despite having "normal HbA1c" values; hence, GV can be considered an HbA1c-independent danger factor, having more harmful effects than sustained hyperglycemia in the growth of diabetic complications. So, by using CGM-derived metrics, the measurement of GV has the potential to complement HbA1c data. In this manner, a more comprehensive assessment of glycemic excursions can be provided for better treatment decisions, thereby facilitating optimal glycemic control, which is essential for reducing overall complications and promoting good quality of life.

Control Level of Type 2 Diabetes Mellitus in the Elderly Is Associated with Polypharmacy, Accompanied Comorbidities, and Various Increased Risks According to the Beers Criteria.

Comorbidity rates in the geriatric population have increased because of rising life expectancy; thus, patients have had to use more medications. Type 2 diabetes mellitus, one of the most common diseases, may influence the number of drugs used in geriatric patients. The present study was designed to investigate the association between the level of type 2 DM and polypharmacy. Fifty patients with type 2 diabetes over the age of 65 were included according to the inclusion criteria; 23 were well-controlled and 27 had poorly controlled diabetes. The groups were similar in terms of age, sex, WBC, Hb, Plt, AST, ALT, serum creatinine, fasting glucose, and eGFR levels. Patients with HbA1c values above 7.5 were classified as poorly controlled diabetes patients, and those below were considered well-controlled diabetes patients and were evaluated for inappropriate medication use. The number of medications used daily by the cases (p < 0.001), the number of concomitant diseases (p = 0.001), and the number of increased risks according to the Beers Criteria (p = 0.02) were observed to be high in poorly controlled type 2 diabetes mellitus subjects. HbA1c levels were related to the number of medications (r = 0.4, p = 0.004), comorbidities (r = 0.28, p = 0.04), and the number of increased risks according to the Beers Criteria (r = 0.31, p = 0.014). In conclusion, the number of medications used in patients with poorly controlled type 2 diabetes mellitus was found to be more elevated than in individuals with well-controlled type 2 diabetes mellitus. The HbA1c values varied among patients regarding polypharmacy, comorbidities, and increased risks according to the Beers Criteria.

Ischemia-Modified Albumin (IMA) for early detection of myocardial ischemia in acute coronary syndrome with type 2 diabetes mellitus: a case control study

Abstract Introduction: Evaluation of the patients who present to the hospital with a complaint of chest pain or other signs suggestive of acute coronary syndrome (ACS) is time-consuming, expensive, and difficult. Most of the biochemical markers are negative in early phase acute myocardial ischemia. Recent literature reports have shown more interest in a new biochemical marker which is Ischemia-modified albumin for the detection of myocardial injury. Objective: to estimate the level of ischemia-modified albumin (IMA) as a risk factor for cardiovascular disease in diabetes mellitus patients. Materials and methods: A case-control study was undertaken with sixty Type-2 diabetic patients as cases and sixty non-diabetic healthy subjects as controls. Demographic data (sex, age), an ECG and Biochemical data were collected. Blood for IMA and HbA1C levels was collected within two hours of arrival, and IMA risk marker testing was performed before any heparin/thrombolytic treatment was started. Controlled and uncontrolled diabetic patients were determined by the level of their HBA1c and comparison with the means of IMA level in their serum. Results: The IMA was significantly increased in diabetic patients compared to healthy controls, with cut off value (0.92 IU/L), and there is also a significant increase in IMA level in uncontrolled diabetic patients (Mean ± SD; 240.55 + 52.5) that presented with acute chest pain and have signs and symptoms of cardiac ischemia when compared with the well-controlled diabetic patients(Mean ± SD; 159.8 ± 60.4). Conclusion: Ischemic Modified Albumin (IMA) level was elevated significantly in uncontrolled diabetic patients with early signs of early myocardial ischemia. Additionally, IMA estimation may improve our ability to identify ischaemic patients who are missed by current diagnostic strategies, or more confidently rule out patients who do not have ACS.

Corrigendum to “CMR Evaluation of Aortic Distensibility in Well-Controlled Diabetic Patients” [Heart, Lung and Circulation volume 31 supplement 3 (2022) S153

Corrigendum to “CMR Evaluation of Aortic Distensibility in Well-Controlled Diabetic Patients” [Heart, Lung and Circulation volume 31 supplement 3 (2022) S153

Home-Based Exercise During the Coronavirus Pandemic

Lockdown measures to control disease transmission were implemented at the start of the COVID-19 era, worsening the already existing sedentary lifestyle. Reduced physical activity (PA) and unhealthy eating habits have a negative impact on mental health in chronically ill patients, including diabetes patients. Mental illness, on the other hand, encourages a sedentary lifestyle, exacerbating all components of metabolic syndrome. While well-controlled diabetic patients with an HbA1c of less than 7% had a less severe clinical presentation and COVID-19 mortality rates, the favorable effect of PA on immunomodulation and immunoregulation should not be neglected. Given recent data indicating that a sedentary lifestyle is the third independent risk factor for COVID-19 complications and death (after advanced age and organ transplant), including regular PA has never been more vital. Since PA has a major impact on both glycemic control and mental health, implementing structured home-based activity programs could improve glycemic control and psychological well-being, hence positively impacting COVID-19 outcomes.

OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models

Abstract Objective Despite their normal to high bone mineral density, fracture risk was increased in patients with type 2 diabetes. Antidiabetic medications have been suspected to account for the excess risk partly. However, longitudinal comparative studies on the effects of various antidiabetic medications on fractures are limited. We aimed to evaluate the fracture risk of patients using various antidiabetic medications compared to those using metformin. Methods We included 6,694 patients aged ≥ 50 years from the common data model (CDM) database between 2008 and 2012, who used the same antidiabetic medications over a year. The patients were grouped as metformin, insulin, sulfonylurea, dipeptidyl-4-inhibitor (DPP4i)+metformin, insulin+metformin, sulfonylurea+insulin, sulfonylurea+metformin, DPP4i+sulfonylurea+insulin, and sulfonylurea+insulin+metformin. The risks of major osteoporotic fractures (MOF) and hip fractures in each group were analyzed using the Cox proportional hazards model compared with the metformin group as a reference. Results During a median follow-up duration of 6.1 years, the incidence rates of MOF and hip fracture were 8.36 and 1.53 per 1000 person-year. The mean age was 65.8 years, and 47.7% were women. Compared to metformin users, insulin users showed an increased risk of MOF (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28-3.02) and hip fracture (HR 3.06, 95% CI 1.21-7.77) after multivariate adjustments, including age, sex, body mass index (BMI), HbA1c, history of fracture, secondary osteoporosis, rheumatoid arthritis, cardiovascular, cerebrovascular disease, dementia, chronic kidney disease, use of steroid, proton pump inhibitor, and warfarin. Besides, the risk became insignificant in patients using a combination of insulin and metformin in both MOF (HR 1.32, 95% CI 0.77-2.27) and hip fracture risks (HR 2.68, 95% CI 0.56-12.80) after covariates adjustments. In subgroup analysis, insulin users harbored a significantly higher risk for MOF than metformin users only in patients withHbA1c &amp;lt; 7%, or BMI &amp;lt; 25 kg/m2. Conclusion From real-world data, we found that insulin users were at elevated risk of MOF and hip fracture compared to metformin users, which might be attenuated in users with a combination of insulin and metformin. The increased fracture risk in insulin users was exaggerated in non-obese and well-controlled diabetic patients, indicating the need for routine fracture risk assessment in these patients. Presentation: Saturday, June 11, 2022 11:45 a.m. - 12:00 p.m.

Comparison of the Response to Pulpal Sensibility Tests in Well-Controlled and Uncontrolled Type II Diabetes Mellitus Patients: A Cross-Sectional Study.

Introduction Diabetes mellitus is a metabolic disorder in which impairment of sensory fibers would be anticipated. The present study would assess the dental pulp response to cold and EPT sensibility tests in patients with type 2 diabetes, both well-controlled and uncontrolled. Materials and Methods One hundred two maxillary central incisors, belonging to participants aged 35–67 years, were included in this survey. At last, 51 diabetic patients were allocated to each group of well-controlled (HbA1C < 7) and uncontrolled (HbA1C ≥ 7). Electric and cold pulpal vitality tests were conducted for all teeth. Statistical analysis was performed with Student's t-test, the chi-square test, and the multiple linear regression model. A P value less than 0.05 was considered significant. Results Based on the results of this study, the mean value of response to EPT was 4.51 ± 2.06 and 4.41 ± 1.85 in well-controlled and uncontrolled diabetic patients, respectively. Also, the pulpal responses to cold and EPT tests had no significant differences between the two groups (P > 0.05). Conclusion Tooth responses to the cold and EPT sensibility tests were not different in well-controlled and uncontrolled diabetic patients. Despite no statistically significant correlation, male diabetic patients in the uncontrolled group showed a lower sensory response threshold to EPT compared to a well-controlled group.

Association between high HDL cholesterol levels and mortality in well-controlled diabetic patients type 2

Background and Aims : Elevated levels of High-density lipoprotein cholesterol (HDL cholesterol) seem to protect against atheromatosis and its clinical sequelae, including myocardial infraction and stroke in diabetic patients type 2. To investigate whether high HDL cholesterol correlates with mortality rate in well controlled patients with Diabetes Mellitus.

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.

CORRELATION OF GLYCOSYLATED HEMOGLOBIN LEVELS WITH AUDITORY AND VISUAL REACTION TIME IN DIABETICS

Relevance. Diabetes mellitus is a group of metabolic disorders wherein hyperglycemia occurs either due to lack of insulin secretion and/or reduced insulin sensitivity of the tissues. One of the commonest complications of diabetes is neuropathy and its severity will depend on how long and how high the hyperglycemia has been prevalent. Chronic hyperglycemia in diabetes affects the peripheral nerves and slows psychomotor responses in persons who do not have proper glycemic control. This decreased psychomotor response because improper glycemic control affects the reaction time in diabetics.&#x0D; Objective: to assess and compare the auditory and visual reaction time in group-1 and group-2 diabetics and to correlate it with glycosylated hemoglobin (HbA1c) levels in both the groups.&#x0D; Methods. The study was conducted on 60 subjects aged between 40-50 years after obtaining the permission of the ethical committee of our institution. The group consisted of 60 well-controlled diabetic patients (HbA1c &lt; 7%) with a history of diabetes for 1-10 years attending the medical OPD of Basaveshwar teaching and general hospital, Gulbarga. Diabetics with HbA1c 5-6% were grouped as group-1 and those with HbA1c 6-7% as group 2. The visual reaction time for a green and red light and auditory reaction time for tone and click sound were measured by using reaction time apparatus 2x4, Anand agencies Pune. HbA1c was done by the micro-column method.&#x0D; Results. The visual and auditory reaction time of diabetics with HbA1c 5-6% was faster as compared to the diabetics with HbA1c 6-7% with P&lt; 0.001 and a statistically significant positive correlation was found between HbA1c levels and the visual and auditory reaction time.&#x0D; Conclusion. Poor glycemic control slows psychomotor responses and thus affects the visual and auditory reaction time.

Association of serum vitamin D level with glycemic control in patients with type 2 diabetes mellitus

Background and objective: Vitamin D deficiency appears to be related to the development of diabetes mellitus type 2 and metabolic syndrome. This study aimed to assess the association between the level of 25-hydroxy vitamin D{25(OH)D3 and the glycemic control in patients with type 2 diabetes. Methods: This case-control study involved 240 participants divided into two groups, 119 patients with type 2 diabetic mellitus and 120 healthy individuals as a control group. The study was conducted in Layla Qassim Diabetic Center in Erbil from March 2018 to March 2019. The data were collected from all the cases, including history and physical examination, using a specially designed questionnaire. From all cases, blood was taken, and samples were sent to the laboratory for serum vitamin D3 level estimation. Results: From the total of 240 participants, the mean age of cases was 54.04 ± 10.56 years and of controls was 53.12 ± 9.84 years. The mean serum vitamin D3 level of the cases was 9.21 ± 5.69ng/ml, and it was non-significantly (P = 0.3) higher than the control (8.61±4.57)ng/ml. Both groups were within the vitamin D deficient range. Vitamin D level was non-significantly deficient in 84 (70.6%) of diabetic patients compared to 89(73.6%) of control. There was a non-significant difference in vitamin D level in poorly controlled diabetic patients compared to well-controlled diabetic patients (P = 0.584). Conclusion: No significant association was detected between vitamin D level and glycemic control. Keywords: Type 2 diabetes mellitus; Vitamin D3 level; Glycemic control.

Charcot Reconstruction: Outcomes in Patients With and Without Diabetes

The objective of this study is to compare risk adjusted matched cohorts of Charcot neuroarthropathy patients who underwent osseous reconstruction with and without diabetes. The 2 groups were matched based on age, body mass index, hypertension, history of end-stage renal disease, and peripheral arterial disease. Bivariate analysis was performed for preoperative infection, location of Charcot breakdown, and post reconstruction outcomes, in patients with a minimum of 1 year follow-up period. Through bivariate analysis, presence of preoperative ulceration (p = .0499) was found to be statistically more likely in the patients with diabetes; whereas, delayed osseous union (p = .0050) and return to ambulation (p ≤ .0001) was statistically more likely in patients without diabetes. The nondiabetic Charcot patients were 17.6 folds more likely to return to ambulation (odds ratio [OR] 17.6 [95% confidence interval {CI} {3.5-87.6}]), and 16.4 folds more likely to have delayed union (OR 16.4 [95% CI {1.9-139.6)]). Subanalysis compared well-controlled diabetic and nondiabetic Charcot neuroarthropathy patients for same factors. Multivariate analysis, in the subanalysis, found return to ambulation was 15.1 times likely to occur in the nondiabetic CN cohort (OR 15.1 [95% CI 1.3-175.8]) compared to the well-controlled diabetic CN cohort.

Glucose Variability as Measured by Inter-measurement Percentage Change is Predictive of In-patient Mortality in Aneurysmal Subarachnoid Hemorrhage.

Critically ill aneurysmal subarachnoid hemorrhage (aSAH) patients suffer from systemic complications at a high rate. Hyperglycemia is a common intensive care unit (ICU) complication and has become a focus after aggressive glucose management was associated with improved ICU outcomes. Subsequent research has suggested that glucose variability, not a specific blood glucose range, may be a more appropriate clinical target. Glucose variability is highly correlated to poor outcomes in a wide spectrum of critically ill patients. Here, we investigate the changes between subsequent glucose values termed "inter-measurement difference," as an indicator of glucose variability and its association with outcomes in patients with aSAH. All SAH admissions to a single, tertiary referral center between 2002 and 2016 were screened. All aneurysmal cases who had more than 2 glucose measurements were included (n = 2451). We calculated several measures of variability, including simple variance, the average consecutive absolute change, average absolute change by time difference, within subject variance, median absolute deviation, and average or median consecutive absolute percentage change. Predictor variables also included admission Hunt and Hess grade, age, gender, cardiovascular risk factors, and surgical treatment. In-patient mortality was the main outcome measure. In a multiple regression analysis, nearly all forms of glucose variability calculations were found to be correlated with in-patient mortality. The consecutive absolute percentage change, however, was most predictive: OR 5.2 [1.4-19.8, CI 95%] for percentage change and 8.8 [1.8-43.6] for median change, when controlling for the defined predictors. Survival to ICU discharge was associated with lower glucose variability (consecutive absolute percentage change 17% ± 9%) compared with the group that did not survive to discharge (20% ± 15%, p < 0.01). Interestingly, this finding was not significant in patients with pre-admission poorly controlled diabetes as indicated by HbA1c (OR 0.45 [0.04-7.18], by percentage change). The effect is driven mostly by non-diabetic patients or those with well-controlled diabetes. Reduced glucose variability is highly correlated with in-patient survival and long-term mortality in aSAH patients. This finding was observed in the non-diabetic and well-controlled diabetic patients, suggesting a possible benefit for personalized glucose targets based on baseline HbA1c and minimizing variability. The inter-measure percentage change as an indicator of glucose variability is not only predictive of outcome, but is an easy-to-use tool that could be implemented in future clinical trials.

Oral health-related quality of life in well-controlled diabetic patients of Modinagar city: A cross-sectional study

Background: Diabetes mellitus is a chronic metabolic disease, which is characterized by elevated levels of glucose in the blood. According to the International Diabetes Federation, around 366 million people are currently estimated to have diabetes. Aim: The aim of the study was to find out the association of oral health-related quality of life (OHRQoL) with diabetes among controlled diabetic patients of Modinagar city. Materials and Methods: This cross-sectional study with a sample of 163 respondents was conducted in a private hospital in Modinagar city, to assess the OHRQoL in a well-controlled diabetic patient. OHRQoL was estimated by the oral health impact profile-20 questionnaire. In addition, general health questionnaire (GHQ) – a 12-item questionnaire was included in this study to distinguish the impact of diabetes on general health of the patient. The analysis was performed using Statistical Package for the Social Sciences 21.0 (SPSS Inc., Chicago, IL, USA). Logistic regression was used to determine the association between OHRQoL and diabetes. Correlation between OHQoRL and GHQ was analyzed using Spearman's rho. P < 0.05 was considered statistically significant. Results: The study results showed that 93 patients (57.4%) had good and 69 patients (42.5%) had low OHRQoL. The study also found out a statistically significant association of OHRQoL with diabetes in case of age of the participants (2.375 [1.094–2.528], P = 0.029**), educational level (0.511 [0.268–0.974], P = 0.041**), and frequency of toothbrushing (0.446 [0.208–0.957], P = 0.038**), whereas its association with smoking status (0.527 [0.235–1.182]), duration of disease (0.757 [0.343–1.671]), and mouth dryness (0.692 [0.316–1.513]) was statistically nonsignificant. There was a highly significant correlation between the OHRQoL and general health of the participants (Spearman's rho [r (162) =0.996], whereP < 0.05). Conclusion: There is a good correlation between OHRQoL and general health among controlled diabetic patients. The association between diabetes and OHRQoL is confined only to some of the variables. The study findings emphasize the importance of oral health in maintaining the overall health of diabetic patients.

Study on periodontal status of patients with pre-diabetes

Objective: To investigate periodontal status of patients with pre-diabetes and evaluate the prevalence of periodontal pathogens in oral cavity. Methods: All the subjects were under regular care in urban area of Beijing, including 88 subjects with normal blood glucose (normal blood glucose group), 27 pre-diabetic patients (pre-diabetic group), 58 well-controlled diabetic patients (glucose well controlled group) and 72 poor-controlled diabetic patients (glucose poor controlled group). Whole unstimulated saliva samples were collected before periodontal examination. Periodontal parameters, including plaque index (PLI), probing depth (PD), bleeding index (BI), bleeding on probing (BOP) and clinical attachment loss (CAL), were examined at mesial-buccal and distal-lingual sites of each tooth. Number of missing teeth was recorded. DNA was extracted from the salivary deposition, Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Campylobacter rectus (Cr), and Prevotella nigrescens (Pn) were detected by using PCR method based on 16SrRNA. Periodontal status and prevalence and quantity of the pathogens under various blood glucose states were compared. Results: The PD scores of four groups had no statistical differences. The CAL [(2.29±1.35) mm] and the number of missing teeth[2.0 (7.0)] in pre-diabetic group were significantly lower than that in glucose poor controlled group [(3.07±1.45) mm, P=0.04 and 5.0 (10.0), P=0.04, respectively]. The number of missing teeth in pre-diabetic group [2.0 (7.0)] was significantly lower than that in glucose well controlled group [5.0 (9.0), P=0.02]. The percent of bleeding on probing [BOP(+)%] in pre-diabetic group [(63.89±20.03)%] was significantly higher than that in normal blood glucose group [(54.51±22.29)%, P=0.04] and glucose well controlled group [(53.12±21.77)%, P=0.03]. The prevalence of Pg in pre-diabetic group (81.5%) was significantly higher than that in glucose poor controlled group (54.2%, P=0.02). The prevalence of Tf in pre-diabetic group (96.3%) was significantly higher than that in glucose poor controlled group (76.4%, P=0.01). Meanwhile the quantity of Pg [1.58 (4.75)] and Tf [5.46 (7.77)] in pre-diabetic group were significantly higher than that in glucose poor controlled group [0.60 (1.87), P=0.01 and 1.63 (3.06), P<0.01, respectively]. The quantity of Pn [0.85 (1.68)] in pre-diabetic group was significantly higher than that in normal blood glucose group [0 (1.02), P=0.04]. Conclusions: Pre-diabetic patients showed severe periodontal infection and BOP(+)% than other three groups and had high risk-level of periodontitis.

The effects of diabetes mellitus on peri-implant marginal bone loss in the posterior maxilla

Aim: The aim of this retrospective study was to evaluate the effects of Diabetes Mellitus on peri-implant marginal alveolar bone loss in sinus lifted well-controlled diabetic patients at long term.Materials and Methods: Thirty eight patients with 77 dental implants were included the study. The study consists of 2 groups; control group (C) and diabetes mellitus group (DM). The dental implants were placed after open window maxillary sinus lifting surgery at maxillary posterior region. After conventional loading process patients were followed periodically for bone loss and clinical parameters. The peri-implant marginal bone loss was assessed at minimum 3 years after functional loading. Standardized panoramic radiographs were obtained at the baseline and maintenance which were used for evaluating the marginal bone loss and clinical and anatomical crown to implant ratio. The Student-t test and Mann Whitney-U test were used to analyse any significant differences between two groups (p0.05). The Kruskal Wallis test was used for inter-group comparisons of parameters and Chi-square test, Fisher’s Exact Chi-square test and Continuity (Yates) correction were used to compare qualitative data. Spearman’s rho correlation analysis was used to examine the relationships between parameters with non-normal distribution.Results: A total of 77 dental implants were followed up for at least 36 months. The mean follow-up was 43.47±10.30 months. 2 implants were failed in DM group. The mean marginal bone loss in DM and C group were 1.35±1.22 mm and 0.91±1 mm respectively. There was no statistically significance in terms of marginal bone loss between the two groups (p>0.05).Conclusion: Within the limitations of this study, it was shown that long-term follow-up results of dental implants in well-controlled diabetic patients were similar to those of healthy individuals and DM did not increase the peri-implant marginal bone loss.

Mitochondrial NAD+/NADH Redox State and Diabetic Cardiomyopathy.

Significance: Diabetic cardiomyopathy (DCM) is a frequent complication occurring even in well-controlled asymptomatic diabetic patients, and it may advance to heart failure (HF).Recent Advances: The diabetic heart is characterized by a state of “metabolic rigidity” involving enhanced rates of fatty acid uptake and mitochondrial oxidation as the predominant energy source, and it exhibits mitochondrial electron transport chain defects. These alterations promote redox state changes evidenced by a decreased NAD+/NADH ratio associated with an increase in acetyl-CoA/CoA ratio. NAD+ is a co-substrate for deacetylases, sirtuins, and a critical molecule in metabolism and redox signaling; whereas acetyl-CoA promotes protein lysine acetylation, affecting mitochondrial integrity and causing epigenetic changes.Critical Issues: DCM lacks specific therapies with treatment only in later disease stages using standard, palliative HF interventions. Traditional therapy targeting neurohormonal signaling and hemodynamics failed to improve mortality rates. Though mitochondrial redox state changes occur in the heart with obesity and diabetes, how the mitochondrial NAD+/NADH redox couple connects the remodeled energy metabolism with mitochondrial and cytosolic antioxidant defense and nuclear epigenetic changes remains to be determined. Mitochondrial therapies targeting the mitochondrial NAD+/NADH redox ratio may alleviate cardiac dysfunction.Future Directions: Specific therapies must be supported by an optimal understanding of changes in mitochondrial redox state and how it influences other cellular compartments; this field has begun to surface as a therapeutic target for the diabetic heart. We propose an approach based on an alternate mitochondrial electron transport that normalizes the mitochondrial redox state and improves cardiac function in diabetes.

Invited commentary

Preventing the advancement of or, better yet, reversing peripheral vascular occlusive disease could save many limbs and provide a better quality of life for our patients. The “magic bullet” of an individual agent placed locally to change the milieu sufficiently to improve collateral vascular development or to stimulate angiogenesis has not been successful to date. However, providing cells that can change the local milieu by providing a slurry of beneficial agents is more promising. Mesenchymal stem cells (MSCs) can provide stromal support and paracrine effects of potential benefit. Unfortunately, one group of patients who could benefit most are those with diabetes, and yet their MSCs (dMSCs) have a deficient expansion capacity. This paper tests the hypothesis that dMSCs have a reversible defect in the epidermal growth factor (EGF) receptor pathway that may blunt cell growth and survival. Human platelet lysate (PL), known to be rich in several growth factors including EGF, might reverse this deficiency, as might EGF alone. It tests whether dMSCs can provide angiogenic stimulus of human umbilical vein endothelial cells (ECs) and, therefore, be a viable regenerative treatment. The study demonstrates that MSCs from the bone marrow and adipose tissue of limbs of well-controlled, nonsmoking diabetic patients have similar population doublings and entered senescence after passage 11, confirming deficient expansion capacity. In addition, dMSCs do not express EGF in their secretome while demonstrating robust expression of other angiogens. Supplementing the dMSCs with PL increased phosphorylation of AKT to healthy MSC levels, whereas providing EGF alone increased only phosphorylated extracellular signal-regulated protein kinases 1 and 2 (ERK1/2) to similar levels as that of PL supplementation. MSC invasion increased over time, but there were inconsistent differences of invasion length and chemokine concentration across MSC types and patients. Both cell types were able to stimulate EC proliferation like standard EC growth media and in co-culture demonstrated longer EC sprouts. In contrast to past literature, this study confirms a lack of EGF expression by dMSCs, providing a deficiency that is cell culture modifiable. Adding EGF increased phosphorylated ERK1/2 levels but not pAKT levels, whereas PL increased both, which may be important because both AKT and ERK1/2 signaling pathways promote cell survival, proliferation, and sustained paracrine activity. The lack of EGF may explain the early senescence noted in the study, but exogenous EGF certainly does not fully correct deficient signaling pathways, whereas PL does better but likely not totally in considering prior studies by the same authors. Both types of dMSCs promote EC proliferation and sprouting, which supports the regenerative benefits of these cells if sufficient numbers for local injection are available. This study has limitations regarding sample size, potential lack of generalization (the population was nonsmoking, well-controlled diabetic patients), and potential bias because the control MSCs were from the iliac crest whereas the experimental MSCs were from the tibia. Provided is some detailed explanation as to how these limitations can be interpreted. Overall, this study is another step forward in the basic science wheel of evidence that will eventually lead to a clinical advancement in regenerative medicine aimed at limb salvage. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery the Society for Vascular Surgery. Reversible secretome and signaling defects in diabetic mesenchymal stem cells from peripheral arterial disease patientsJournal of Vascular SurgeryVol. 68Issue 6PreviewRegenerative medicine seeks to stall or to reverse the pathologic consequences of chronic diseases. Many people with diabetes have peripheral arterial disease (PAD), which increases their already high risk of major amputation. Cellular therapies are a promising regenerative medicine approach to PAD that can be used to focally inject regenerative cells to endangered tissue beds. Mesenchymal stem cells (MSCs) are known to promote tissue regeneration through stromal support and paracrine stimulation of new blood vessels (angiogenesis). Full-Text PDF Open Archive

Relationship between Nitrated High-Density Lipoproteins and Vascular Function in African-American Diabetic Patients

Previous studies have shown that HDL isolated from human atherosclerotic lesions and the blood of patients with established coronary artery disease contains elevated levels of nitrated apolipoprotein AI (NT-apoAI). The significance of NT-apoAI in the pathogenesis of vascular diabetic complications is not well understood. We aimed to evaluate the relationship between plasma NT-apoAI and vascular function in African-Americans diabetic patients. 125 patients with type 2 diabetes were enrolled over a 6 months period. Levels of plasma NT-apoAI was quantified by enzyme-linked immunosorbent assays (ELISA). Microvascular function was assessed by vascular reactivity index (VRI). Large artery stiffness was assessed by carotid-femoral pulse wave velocity (PWV). Carotid intima-media thickness (CIMT) was assessed by B-mode ultrasound image analysis. Patients population was divided in two groups (well-controlled: HbA1c ≤7.0%, N=54; poorly-controlled: HbA1c &amp;gt;7.0%, N=71). Mean age 60±8 years; 64% female; 80% had hypertension; 90% had dyslipidemia and 15% had CKD. Mean HbA1c levels were 8.1±2.2% and duration of diabetes was 10.29±3.79 years. NT-apoAI was negatively correlated with levels of apoAI and VRI in well-controlled patients but not in poorly-controlled patients (r= -0.298, p=0.025 and r= -0.265, p=0.042; respectively). Multi-regression analysis revealed that NT-apoAI was independently associated with VRI, but neither with PWV nor CIMT, after adjustment for independent variables such as age, gender, weight, hypertension, stroke, smoking, duration of diabetes, dyslipidemia, total cholesterol, HDLc, triglycerides, and LDLc (β= 0.001, p= 0.025; r2= 0.325 for the model). NT-apoAI, independently of other clinical variables, can predict microvascular dysfunction particularly in well-controlled diabetic patients. NT-apoAI could be used as marker to identify diabetic patients at risk of developing early vascular complications. Disclosure A.M. Adedayo: None. A. Eluwole: None. F. Tedla: None. A. Kremer: None. N. Mastrogiovanni: None. C. Rosenberg: None. P. Dreizen: None. J. LaRosa: None. L. Salciccioli: None. M. Boutjdir: None. M. Banerji: Speaker's Bureau; Self; Merck &amp; Co., Inc.. C. Brown: None. M. Salifu: None. J. Lazar: None. A. Bakillah: None.