POSTPRANDIAL HYPERTRIGLYCERIDEMIA AS A RISK FACTOR FOR MACROVASCULAR COMPLICATIONS IN TYPE 2 DIABETES MELLITUS

Diabetes mellitus is a common endocrine disorder characterized by chronic hyperglycemia, and disturbances of carbohydrate, fat and protein metabolism. The prevalence of diabetes has been increasing widely in India and worldwide. Diabetes is a cause of significant mortality and morbidity due to macro and micro vascular complications. Dyslipidemia accompanying type 2 Diabetes plays an important role in pathogenesis of atherosclerotic vascular disease. Post prandial hypertriglyceridemia, irrespective of fasting triglyceride levels, has emerged as a significant risk factor for symptomatic and asymptomatic macro vascular disease It is a case control study, conducted for a period of 1 year from November 2020 to October 2021, on patients visiting the Out-patient department of NRI institute of Medical Sciences, Sangivalasa, Visakhapatnam. The cases and controls were subjected to clinical and biochemical evaluation to detect presence of macro vascular complications. The cases were subjected to a high fat meal, and plasma triglycerides were measured two and four hours after a fat challenge. It was observed that post prandial hypertriglyceridemia correlated better than fasting triglycerides in patients with macro vascular complications. Persistent and significant post prandial hypertriglyceridemia was observed in diabetic patients with macro vascular complications; and can be used as a marker for predicting vascular complications in type 2 Diabetes mellitus.

Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea: A nationwide retrospective cohort / 中西医结合学报

OBJECTIVE@#The main aim of this study is to investigate whether acupuncture could be an effective complementary treatment for reducing the risk of macrovascular complications in diabetic patients currently taking antidiabetic medications using a nationwide population-based database.@*METHODS@#We conducted a retrospective cohort study to assess the efficacy of acupuncture on cardiovascular complications in diabetic patients using data from patients between 40 and 79 years of age, newly diagnosed with diabetes between 2003 and 2006, found in the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea. From the data, we identified 21,232 diabetic patients who were taking antidiabetic medication between 2003 and 2006. The selected patients were divided into two groups-those who received acupuncture at least three times and those who received no acupuncture (non-acupuncture) in the year following their diagnosis of diabetes. After 1:1 propensity score matching (PSM), each group had 3350 patients, and the observation ceased at the occurrence of a major adverse cardiovascular event (MACE), which was defined as either myocardial infarction, stroke, or death due to cardiovascular cause.@*RESULTS@#After PSM, the acupuncture group had a lower incidence of MACE (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.81-0.94; P = 0.0003) and all-cause mortality (HR: 0.77; 95% CI: 0.70-0.84; P < 0.0001) than the non-acupuncture group; the HRs for stroke-related mortality (HR: 0.75; 95% CI: 0.56-1.00; P = 0.0485), ischemic heart disease mortality (HR: 0.53; 95% CI: 0.34-0.84; P = 0.006) and circulatory system disease mortality (HR: 0.67; 95% CI: 0.55-0.82; P < 0.0001) were lower in the acupuncture group than in the non-acupuncture group in the secondary analysis.@*CONCLUSION@#Our results indicate that diabetic patients receiving acupuncture treatment might have a lower risk of MACE, all-cause mortality and cardiovascular mortality. This population-based retrospective study suggests beneficial effects of acupuncture in preventing macrovascular complications associated with diabetes. These findings call for further prospective cohort or experimental studies on acupuncture treatment for cardiovascular complications of diabetes. Please cite this article as: Jung H, Won T, Kim GY, Jang J, Yeo S, Lim S. Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea: A nationwide retrospective cohort. J Integr Med. 2023; 21(2): 176-183.

Predictors of Pharmacotherapy and Quality of Life Among Patients With Diabetic Foot Syndrome: A Cross-Sectional Study from a Tertiary Care Hospital in India

Objective: To assess the patterns and predictors of pharmacotherapy and QOL in DFS patients in an Indian tertiary care hospital. Methods: A cross-sectional study was conducted among inpatients with DFS. Data on sociodemographic and clinical factors, pharmacotherapy, clinical outcomes, and QOL were analyzed using the chi-squared test, independent sample t-test, and binary logistic regression. Results: We screened 3284 inpatients and included consecutive 87 (2.7%) DFS patients. The mean age was 56.08 ± 11.05 years, with a male preponderance (75.8%). Mean HbA1c was 9.9 ± 2.483. About 75% of patients received insulin, and polypharmacy was noticed in 82.7%. About 67.8% of DFS patients had other vascular complications of diabetes, with diabetic retinopathy being the most common in 89%. Amputations were noticed in 32.1% of patients. Overall, poor QOL was seen in 79.3% of patients. The mean scores for different domains were as follows: physical, 41.51 ± 14.15; psychological, 42.90 ± 11.16; social relationships, 43.06 ± 19.36; and environment, 47.17 ± 13. The presence of complications from diabetes was a significant predictor of the utilization of antihypertensives (OR: 2.92, CI [1.09, 7.79], P = 0.03) and poor QOL (OR: 4.54, CI [0.965, 21.41], P = 0.05). Conclusion: DFS patients in this study were found to be younger with poor glycemic control and other vascular complications of diabetes. The presence of other complications of diabetes in DFS patients was found to be a predictor of pharmacotherapy and poor QOL.

Long-term follow-up results of radiotherapy combined with transcatheter arterial chemoembolization and tyrosine kinase inhibitor in patients with hepatocellular carcinoma showing macrovascular invasion / 中华放射医学与防护杂志

Objective:To assess the long-term follow-up results of intensity-modulated radiotherapy (IMRT) combined with transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitor (TKI) in patients with hepatocellular carcinoma (HCC) showing macrovascular invasion (MVI).Methods:A retrospective analysis was conducted for 63 patients with HCC showing MVI without distant metastasis treated in Peking University Cancer Hospital from October 2015 to October 2018. Among them 28 patients were treated with IMRT combined with TACE and sorafenib (Group A) and 35 patients were treated with IMRT combined with TACE (Group B). Propensity score matching (PSM) was applied to assess the progression-free survival (PFS) and the overall survival (OS) of both groups.Results:The median follow-up time was 62 months. Before PSM, the median OS of group A and B were 19.0 months and 15.2 months ( χ2=3.15, P=0.076), respectively, and the median PFS of groups A (10.7 months) was longer than that of group B (8.6 months; χ2=3.99, P=0.046). After PSM, the median OS of group A (30.6 months) was significantly longer than that of group B (15.2 months; χ2=5.34, P=0.023), and the PFS of groups A (12.5 months) was still longer than that of group B (8.3 months; χ2=4.79, P=0.026). In the whole group, 10 patients (15.9%) suffered from grade-3 hematologic toxicity, and seven patients (11.1%) experienced grade-3 hepatic toxicity. The incidence of skin reactions, hand-foot syndrome, and diarrhea in group A was higher than that in group B, but all these adverse events were grade 1-2. Moreover, no grade-4 adverse events, radiation-induced liver disease, and treatment-related mortality occurred in both groups. Conclusions:As demonstrated by the long-term follow-up result, IMRT combined with TACE and TKI could improve both the PFS and the OS of patients with HCC showing MVI after PSM.

Association between the Neutrophil-to-lymphocyte Ratio and New-onset Subclinical Macrovascular and Microvascular Diseases in the Chinese Population / 生物医学与环境科学（英文）

OBJECTIVE@#The association between neutrophil-to-lymphocyte ratio (NLR) with subclinical macrovascular and microvascular diseases has been less investigated. We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population.@*METHODS@#From a community cohort, we included 6,430 adults aged ≥ 40 years without subclinical macrovascular and microvascular diseases at baseline. We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and albuminuria.@*RESULTS@#During a mean follow-up of 4.3 years, 110 participants developed incident abnormal ABI, 746 participants developed incident elevated baPWV, and 503 participants developed incident albuminuria. Poisson regression analysis indicated that NLR was significantly associated with an increased risk of new-onset abnormal ABI, elevated baPWV, and albuminuria. Compared to overweight/obese participants, we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight. Furthermore, we found an interaction between the NLR and body mass index (BMI) on the risk of new-onset abnormal ABI ( P for interaction: 0.01).@*CONCLUSION@#NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population. Furthermore, in participants with normal weight, the association between NLR and subclinical vascular abnormalities was much stronger.

Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai Integration Model (SIM) / 医学前沿

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai, China. A total of 173 235 patients with type 2 diabetes in 2017 were included in the analysis. Profiles of risk factors and intermediate outcomes were determined. The patients had a mean age of 66.43 ± 8.12 (standard deviation (SD)) years and a mean diabetes duration of 7.95 ± 5.53 (SD) years. The percentage of patients who achieved the target level for HbA1c (< 7.0%) was 48.6%. Patients who achieved the target levels for blood pressure (BP) < 130/80 mmHg and low-density lipoprotein-cholesterol (LDL-c) < 2.6 mmol/L reached 17.5% and 34.0%, respectively. A total of 3.8% achieved all three target levels, and the value increased to 6.8% with an adaptation of the BP target level (< 140/90 mmHg) for those over 65 years. Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels: male, young age, short diabetes duration, low body mass index, macrovascular complications, no microvascular complications, prescribed with lipid-lowering medication, and no prescription of antihypertensive medication. In conclusion, nearly 50% and one-third of the patients with diabetes met the target levels for HbA1c and LDL-c, respectively, with a low percentage achieving the BP target level. The percentage of patients who achieved all three target levels needs significant improvement.

Hyper-reactive platelets and type 2 diabetes / 中南大学学报(医学版)

Type 2 diabetes mellitus is a progressive process. With the course of the disease progress, microvascular and macrovascular complications always happen. Thrombotic events caused by macrovascular complications, including coronary heart diseases and cerebrovascular diseases, are the main fatal factor for the patients with type 2 diabetes. Endothelial dysfunction, coagulative activation, impaired fibrinolysis, together with hyper-reactive platelets contribute to the diabetic prothrombotic state, which is strongly related to the macrovascular complications. In particular, the hyper-reactive platelets play a fundamental role among them. Type 2 diabetes is characterized by several metabolic dysfunctions such as hyperglycemia, insulin resistance and shortage, oxidative stress, systemic inflammation, obesity, and dyslipidemia. These metabolic dysfunctions work together to promote the formation of hyper-reactive platelets, which are distinctive in type 2 diabetes. The regular antiplatelet drugs, like aspirin, show limited inhibitory effect on them. Hence, studying the mechanism behind the hyper-reactive platelets could provide a brand-new view on the prevention of macrovascular complications and cardiovascular events in type 2 diabetes.

Mechanism of Didangtang in Inhibiting Aortic NLRP3 Inflammasome Cascade of Mice with Diabetic Macrovascular Disease / 中国实验方剂学杂志

Objective:To explore the progression of diabetic macrovascular disease and the effects of Didangtang at different doses on it. Method:Four-week-old male apolipoprotein-E knockout （ApoE^-/-） mice with diabetic macrovascular disease induced by exposure to high-fat diet combined with streptozotocin （STZ） were randomly divided into the model， simvastatin， as well as high-， medium-， and low-dose Didangtang groups. The age-matched ApoE^-/- mice of the same batch only fed with a high-fat diet were classified into the ApoE^-/- （model control） group， and C57BL/6 mice with the same genetic background receiving a regular diet into the normal group. The sampling was conducted at the 8th and 20th weeks of the experiment for observing the pathological characteristics of the aorta and the proportion of plaque area in mice of each group at different time points， followed by the comparison of blood glucose， blood lipid， and oxidized low-density lipoprotein （ox-LDL） levels. The aortic NOD-like receptor protein 3 （NLRP3） and cysteinyl aspartate-specific proteinase-1 （Caspase-1） protein expression was detected by Western blot assay， and the serum interleukin-1<italic>β</italic> （IL-1<italic>β</italic>）， interleukin-18 （IL-18）， interleukin-1<italic>α</italic> （IL-1<italic>α</italic>）， and tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） levels by enzyme-linked immunosorbent assay （ELISA）. Result:The comparison with the normal group revealed that the proportions of plaque area in the ApoE^-/- group and the model group were increased （<italic>P</italic><0.01）， while the proportion of plaque area in each administration group was significantly reduced in contrast to that of the model group （<italic>P</italic><0.05）. The aortic NLRP3 and Caspase-1 protein expression levels as well as the serum IL-1<italic>β</italic>， IL-18， IL-1<italic>α</italic>， and TNF-<italic>α </italic>levels in the ApoE^-/- group and the model group were significantly higher than those in the normal group （<italic>P</italic><0.01）. Compared with the model group， each administration group exhibited a significant reduction in aortic NLRP3 and Caspase-1 protein expression and serum IL-1<italic>β</italic>， IL-18， IL-1<italic>α</italic>， and TNF-<italic>α</italic> levels （<italic>P</italic><0.05）， with the strongest inhibitory effect detected in the medium-dose Didangtang group （<italic>P</italic><0.05）. Conclusion:Didangtang directly alleviates diabetic macrovascular disease possibly by down-regulating NLRP3 and Caspase-1 protein expression and easing the inflammatory cascade.

Transarterial chemoembolization combined with apatinib versus transarterial chemoembolization alone for hepatocellular carcinoma with macroscopic vascular invasion: A propensity score matching analysis

Context: Macroscopic vascular invasion in hepatocellular carcinoma (HCC) remains challenging to treat. Aims: The aim of this study was to compare the efficacy of transarterial chemoembolization (TACE)–apatinib therapy with TACE treatment alone in HCC patients with macrovascular invasion, using propensity score matching (PSM). Settings and Design: Matched paired comparison between the TACE–apatinib and TACE alone group using 1:2 PSM was utilized. Subjects and Methods: Between 2013 and 2019, 378 patients receiving TACE–apatinib or TACE alone were included based on specific selection criteria. Statistical Analysis Used: Multivariate Cox regression models were used to determine the independent prognostic factors for overall survival (OS). Results: Of the patients included, 40 (12.5%) received TACE–apatinib treatment and 280 (87.5%) received TACE alone. Tumor sizes of patients in the TACE–apatinib group were more frequently classified as small (<5 cm) compared to those in the TACE alone group (P = 0.021; mean: 8.6 cm vs. 10.2 cm). After 1:2 PSM, 40 pairs of HCC patients with well-matched covariates were selected from the two treatment groups. Patients in the TACE–apatinib group had higher OS rates than patients in the TACE alone group (P = 0.018). The median OS times were 18.2 and 8.5 months in the TACE–apatinib and TACE alone groups, respectively. The OS hazard ratio for the choice of TACE–apatinib treatment compared to TACE treatment alone was 0.50 (95% confidence interval: 0.28–0.90; P = 0.021). Conclusions: TACE combined with apatinib may result in superior OS compared to TACE therapy alone for HCC patients with macrovascular invasion

Parámetros clínicos, bioquímicos y metabólicos predictores de complicaciones micro y macrovasculares en diabéticos tipo 2 / Clinical, biochemical and metabolic parameters predictive of micro and macrovascular complications in type 2 diabetics / Parâmetros clínicos, bioquímicos e metabólicos preditivos de complicações micro e macrovasculares em diabéticos tipo 2

RESUMEN Introducción: la diabetes mellitus (DM) es una enfermedad endocrino - metabólica, vascular, crónica, producida por una interacción variable de factores genéticos y ambientales. Actualmente la DM2 es considerada por algunos autores como pandémica, sin la existencia de signos de reducción de las tasas de incidencia. Objetivo: identificar los parámetros clínicos, bioquímicos y metabólicos predictores de complicaciones micro y macrovasculares en personas con diabetes mellitus tipo 2. Método: se realizó un estudio analítico de tipo casos y controles con pacientes ingresados en el Centro de Atención al Diabético de Bayamo (CAD), Granma, desde el año 2010 al 2017, 81 con alguna complicación microvascular, 40 con alguna complicación macrovascular y 162 sin ninguna complicación. Resultados: en el análisis univariado se observó que el tiempo de evolución de la enfermedad y la HTA descontrolada fueron los factores de riesgo para el desarrollo de una complicación microvascular, mientras que a estas se le unieron el tabaquismo y le hipercolesterolemia como factores de riesgo para el desarrollo de complicaciones macrovasculares. Las variables que mostraron una relación independiente con el riesgo de desarrollar alguna complicación microvascular fueron el tiempo de evolución de la enfermedad y la HTA descontrolada, mientras que para el desarrollo de complicaciones macrovasculares fueron el tiempo de evolución de la enfermedad y el tabaquismo. Conclusiones: el tiempo de evolución de la diabetes y la HTA descontrolada y el tiempo de evolución de la enfermedad y el tabaquismo se asocian de forma independiente con la aparición de complicaciones microvasculares y macrovasculates respectivamente.

ABSTRACT Introduction: diabetes mellitus (DM) is an endocrine-metabolic, vascular, chronic disease, produced by a variable interaction of genetic and environmental factors. Currently DM2 is considered by some authors as pandemic, without the existence of signs of reduction of incidence rates. Objective: to identify clinical, biochemical and metabolic parameters predictors of micro and macrovascular complications in people with type 2 diabetes mellitus. Method: an analytical case and control study was conducted with patients admitted to the Bayamo Diabetic Care Center (CAD), Granma, from 2010 to 2017, 81 with some microvascular complications, 40 with some macrovascular complications and 162 without any complications. Results: the univariate analysis found that disease progression time and uncontrolled HTA were the risk factors for the development of a microvascular complication, while these were joined by smoking and hypercholesterolemia as risk factors for the development of macrovascular complications. The variables that showed an independent relationship with the risk of developing some microvascular complications were the time of disease evolution and uncontrolled HTA, while for the development of macrovascular complications were the time of disease evolution and smoking. Conclusions: the time of evolution of diabetes and uncontrolled HTA and the time of disease and smoking evolution are independently associated with the emergence of microvascular and macrovasculate complications respectively.

RESUMO Introdução: diabetes mellitus (DM) é uma doença endócrina-metabólica, vascular, crônica, produzida por uma interação variável de fatores genéticos e ambientais. Atualmente o DM2 é considerado por alguns autores como pandemia, sem a existência de sinais de redução das taxas de incidência. Objetivo: identificar preditores de parâmetros clínicos, bioquímicos e metabólicos de complicações micro e macrovasculares em pessoas com diabetes mellitus tipo 2. Método: estudo analítico de caso e controle foi realizado com pacientes internados no Centro de Atendimento Diabético Bayamo (CAD), Granma, de 2010 a 2017, 81 com algumas complicações microvasculares, 40 com algumas complicações macrovasculares e 162 sem complicações. Resultados: a análise univariada constatou que o tempo de progressão da doença e o HTA descontrolado foram os fatores de risco para o desenvolvimento de uma complicação microvascular, enquanto estes foram acompanhados pelo tabagismo e hipercolesterolemia como fatores de risco para o desenvolvimento de complicações macrovasculares. As variáveis que apresentaram relação independente com o risco de desenvolver algumas complicações microvasculares foram o tempo de evolução da doença e HTA descontrolada, enquanto para o desenvolvimento de complicações macrovasculares foi o tempo de evolução da doença e tabagismo. Conclusões: o tempo de evolução do diabetes e do HTA descontrolado e o tempo de evolução da doença e do tabagismo estão independentemente associados ao surgimento de complicações microvasculares e macrovasculadas, respectivamente.

A study of microvascular and macrovascular complications in prediabetes

Background: Prediabetes, a state defined by the presence of either impaired fasting glucose or impaired glucose tolerance is a condition in which blood glucose or haemoglobin A1c (HbA1c) levels are higher than normal but not high enough to be classified as diabetes.Methods: The present study was conducted for a period of one year with effect from November 2014 to October 2015 and patients were recruited for study from OPD and wards of Department of General Medicine, ASCOMS Hospital, Sidhra. 50 Patients/subjects were selected as per specified inclusion criteria Method of collection of data is based on detailed history, clinical examination and routine investigations.Results: In this study, out of 50 subjects, 8 case who were in the range of impaired glucose tolerance initially at the time of start of study gradually progressed to frank diabetes i.e. 15% over a study period of 1 year.Conclusions: In this study, 50 Patients of impaired glucose tolerance or prediabetes were included in the study. Among 50 subjects, 80% were male and 20% were females. Majority were 30-60 yrs of age, average weight was 65±5 kg, and average height was 150±10cm. In risk factors, 20% of the subjects suffered from hypertension, 40% from lipid derangement, 30% suffered from obesity, 50% suffered from central obesity, 56% are smokers, and 60% have family history of diabetes. 10 subjects out of 50 i.e. 20% suffered from cardiovascular complications, no subject presented with peripheral neuropathy.

Discussion on Regulating AGEs to Improve Diabetic Macrovascular Disease Based on Fu-xie Theory / 中国实验方剂学杂志

The long-term existence of hyperglycemia leads to the occurrence of metabolic memory effect， which is an important reason for the formation of diabetic macrovascular disease， so the early control of metabolic memory is the key to the prevention and treatment of diabetes and its complications. The excessive formation of advanced glycation end products （AGEs） is not only an important factor to cause metabolic memory， but also the core mechanism for diabetic macrovascular disease. It is believed in traditional Chinese medicine（TCM） that Fu-xie （incubative pathogen） is the key pathogenesis of the formation of diabetic vascular diseases， and it is necessary to adopt the principle of removing pathogenic factors and opening collaterals as early as possible to prevent and cure the disease. During the Spring and Autumn Period and the Warring States Period， the theory of Fu-xie was germinated， and got mature in the Ming and Qing dynasties after the continuous development. The so-called Fu-xie means that the pathogens are of a potential nature but not cause diseases immediately. The theory of Fu-xie first appeared in Huangdi Neijing， with an original meaning of epidemic febrile disease occurring after incubation， and then its meaning continues to expand， now referring to all potential pathogenic factors that would not immediately cause diseases. As the cause and pathogenesis of many diseases， the theory of Fu-xie is widely used in clinical practice to guide the treatment of diseases. In the body， the accumulation of AEGs can induce the subsequent cascade effect in the body， and finally promote the formation and development of diabetic macrovascular diseases. This is very similar to the process of inducing metabolic disorder and disease in TCM due to the accumulation of phlegm and silt. Therefore， under the guidance of Fu-xie theory， the mechanism of AEGs in blocking metabolic memory and preventing and treating diabetic macrovascular disease was analyzed in this paper. On the one hand， it will provide a scientific basis for the exploration of Fu-xie theory affecting the disease course of diabetic macrovascular disease by regulating the generation of AEGs. On the other hand， it can also provide the material change basis for the development of Fu-xie theory in the occurrence and development of diabetic macroangiopathy.

Influencing factors of macrovascular complications in type 2 diabetes mellitus / 第二军医大学学报

The incidence of type 2 diabetes in China is increasing annually, and its chronic complications are very common. Macrovascular complications are the main cause of death in patients with type 2 diabetes mellitus. The pathogenesis of diabetic macrovascular complications is different from that of traditional cardiovascular diseases. It has been found that macrovascular complications of type 2 diabetes are not only related to traditional cardiovascular disease risk factors (age, gender, hypertension, smoking, body mass index, diabetes duration, serum lipid, and glycosylated hemoglobin), but also diabetic microvascular complications, some specific molecular proteins and individual genetic background. This article reviews the clinical factors, molecular proteins and genetic background that affect the incidence of macrovascular complications in type 2 diabetes.

A Study to Evaluate the Effect of Saroglitazar in Type 2 Diabetes

Introduction: Type 2 diabetes mellitus is a commoncondition characterized by high blood sugar level. This riskgets inflated by lipid abnormalities additionally. Diabeticshave high risk of developing dyslipidemia (AtherogenicDiabetic Dyslipidemia-ADD) which is characterized by hightriglycerides and/or low HDL-C and/or small dense LDL-C.Study aimed to assess difference in mean Fasting plasmaglucose (FPG), Post prandial plasma glucose (PPPG), Lipidparameters [ triglycerides (TG), total cholesterol (TC), verylow density lipoprotein (VLDL), low density lipoprotein(LDL), high density lipoprotein (HDL) and non-HDL] beforeand after adding saroglitazar in patients of type 2 diabetes.Material and Methods: A total of 36 cases with DiabetesMellitus Type 2 aged between 18 and 65 years with their BMI>25kg/m2, HbA1c between 7 and 9% and total cholesterollevels >150mg/dl were enrolled. Their baseline glycemicand lipid parameters were measured and they were givenSaroglitazar 4mg every day for 3 months and their parameterswere checked again at the end of 3 months.Results: It was found that the mean Fasting plasma glucose(FPG), Post prandial plasma glucose (PPPG), Lipid parametersdecreased after 3 months of Saroglitazar therapy and thisdecrease was found to be statistically significant (P<0.001).Conclusion: Thus, addition of Saroglitazar to the drugregimen of the patients with Diabetic Dyslipidemia can bringabout significant improvement in the glycemic and lipidparameters with the added advantage of insignificant adverseeffects, thus proving beyond doubt the efficacy and safety ofthis drug in the treatment of Diabetic Dyslipidemia.

A study of clinical profile and complications in patients with type 2 diabetes mellitus in a tertiary care centre

Background: Diabetes is the most common non-communicable disease known today. This study was conducted to assess the clinical profile and complications in patients with type 2 diabetes mellitus.Methods: A prospective study was carried out between April 2017 to April 2018 in patients attending a tertiary care hospital in Chennai. Patients with type 2 diabetes of age 25-80 years, minimum of 5 years duration were enrolled.Results: Out of 66 patients, 23(34.8%) were males whereas 43 (65.2%) were females. Mean age in this study population was 55.36 years with a standard deviation of 11.362. In present study, the mean fasting blood sugar level was 196.12±77.180, mean postprandial blood sugar level was 303.26±115.385 and the mean HbA1C levels was 10.95±2.369. 77.3% were on oral hypoglycaemic agents, 13.6% on insulin and 9.1% on combined therapy with oral hypoglycemic agents and insulin. The complications associated with diabetes found in present study were microvascular complications which include peripheral neuropathy 41(62.1%), retinopathy 31(46.96%), nephropathy 28 (42.42%). Peripheral neuropathy was found to be most commonly associated. Macrovascular complications include cardiovascular disease in 12.12% (n=8) and cerebrovascular disease in 4.54% (n=3). Autonomic neuropathy was found in 69.69% (n=46).Conclusions: The complications of DM are commonly seen in patients with poor glycaemic control. Among microvascular complications, peripheral neuropathy was most commonly seen. Autonomic neuropathy usually goes unnoticed and asymptomatic in most of the individuals. Increasing levels of HbA1c was found to be significantly correlated with neuropathy.

A Study Of Pulmonary Function Tests In Type 2 Diabetes Mellitus Patients Of Sub-Himalayan Plain Area Of Darjeeling District.

BACKGROUND: Diabetes mellitus is one of the most common endocrine and metabolic disorders. It is fifth in ranking as a leading cause of death worldwide and is responsible for almost 3 million deaths annually. Chronic hyperglycemia and related metabolic derangements are mainly associated with secondary damage in multiple organ systems, especially kidneys, eyes, nerves and blood vessels. Pulmonary functions in diabetes mellitus have been studied frequently in many countries other than India, while in our country, there are few studies concerning these abnormalities and their relationship with the disease. OBJECTIVES:To determine and compare the lung function test between type 2 diabetic patients with normoglycemic control group. MATERIALS AND METHODS: This is a prospective observational cross sectional study. This study was carried out in North Bengal Medical College and Hospital in Department of Physiology and Department of Medicine. A total number of 215 subjects were included in this study . Among them, 106 subjects who suffered from type 2 diabetes mellitus for >5 year duration were included in Group A (study group) and 109 normoglycemic subjects were included in Group B – (control group). The spirometer parameters (FVC, FEV1, PEFR, FEV1/FVC) of participants of both groups were evaluated and compared. RESULTS: We have found that all of the spirometric parameters, except FEV1/FVC ratio were significantly lower in the type 2 diabetes mellitus patients than the control group. FEV1/FVC ratio was lower in study group than control group, but the reduction in study group was not statistically significant (Pvalue >0.05). CONCLUSION: The present study is revealing that, type 2 diabetes mellitus, being a systemic disease, also affects lungs and causes restrictive type of ventilatory changes on long duration hyperglycemia.

Mechanism of Danzhi Jiangtang Capsules in treatment of diabetic macrovascular disease in GK rats based on correlation between microRNAs and inflammatory factors / 中国中药杂志

This study was aimed to investigate the mechanism of Danzhi Jiangtang Capsules( DJC) in the treatment of diabetic macrovascular disease in Goto-Kakizaki( GK) rats. The diabetic macrovascular disease rat model was induced by feeding high-fat and high-sugar combined with endothelial nitric oxide synthase( NOS) inhibitor N-nitro-L-arginine methyl ester( L-NAME)( 0. 1 g·L-1·d-1). According to the random array table,the model rats were randomly divided into the model group,DJC groups( 1 260,630,320 mg·kg-1),atorvastatin group( 105 mg·kg-1) and metformin group( 10 mg·kg-1),with 12 rats in each group. The rats received gavage administration for 8 weeks. Twelve Wistar rats were selected as the normal control group. The changes of body weight,water intake,blood glucose,plasma total cholesterol( TC),triglyceride( TG),high density lipoprotein( HDL-C),low density lipoprotein( LDL-C),interleukin( IL-1β),IL-6,tumor necrosis factor( TNF-α),nitric oxide( NO),endothelin( ET-1) were observed in these rats. Aortic tissue was taken and the pathological changes were observed by HE staining. RT-PCR was used to detect the mRNA levels of IL-1β,IL-6,and TNF-α in rat aorta. RT-PCR of the stem loop was used to detect the levels of miRNA-126,miRNA-155,miRNA-146 a,and miRNA-21 in rat plasma and aortic tissue. The canonical correlation between miRNAs and inflammatory factors was then analyzed. The results showed that DJC increased the rat body weight,lowered water intake,reduced the random blood glucose,reversed the rat aorta tissue damage,reduced serum TC,TG,LDL-C,ET-1,IL-1β,IL-6,TNF-α,as well as miRNA-155,miRNA-146 a and miRNA-21 levels in serum,elevated plasma HDL-C,NO content,reduced the aorta mRNA of IL-1β,IL-6,TNF-α,and the miRNA-155,miRNA-146 a and miRNA-21,elevated miRNA-126 expression in aorta. Aortic miRNA-126,miRNA-155,miRNA-146 a and miRNA-21 expression levels were typically correlated with the expression of inflammatory factors,among which miRNA-126 was negatively correlated,miRNA-155,miRNA-146 a and miRNA-21 were positively correlated with the factors. These results suggested that DJC had therapeutic effects on diabetic macrovascular diseases,and the mechanism of action may be related to the regulation of miRNA-126,miRNA-155,miRNA-146 a and miRNA-21 levels,as well as the reduction of inflammatory factors and vascular inflammatory response.

Complications of Diabetes Mellitus: Prevention in Type 2 Diabetes Mellitus

@#Type 2 Diabetes Mellitus is a complex disorder which has many associated comorbidities besides hyperglycaemia. Micro and macrovascular complications develop as a result of poor risk factor control and contribute to the disability, reduced quality of life and reduced life expectancy associated with the disease. Intensive glucose control and, more importantly, comprehensive care involving treatment of all modifiable cardiovascular risk factors over a sustained period decreases the risk of morbidity and mortality especially in people newly diagnosed with Type 2 Diabetes Mellitus. The need to recognise subgroups of people with diabetes with increased risks of complications and the importance of individualised treatment are also discussed. Early intensive treatment and control of risk factors provides the opportunity for greatest accrual of benefit over the longer term.

Effect of sex hormone levels on macrovascular complications in community-dwelling male patients with diabetes mellitus in Shanghai / 中华内分泌代谢杂志

Objective We aimed to investigate whether sex hormone levels including total testosterone, estradiol, estradiol/total testosterone, and dehydroepiandrosterone ( DHEA ) were associated with macrovascular complications among Shanghai community-dwelling diabetic men. Methods Relying on the Environmental Pollutant Exposure and Metabolic Diseases in Shanghai (METAL) study (ChiCTR1800017573, www.chictr.org.cn), 2147 male diabetic participants were recruited from 10 communities. Carotid plaques and common carotid artery ( CCA) diameters were detected by carotid ultrasound. Cardiovascular disease ( CVD) was defined as a self-reported diagnosis of CVD, including coronary heart disease, myocardial infarction, or stroke. Results ( 1) The prevalence of CVD in this study was 36. 0％, and patients with CVD had higher rates of hypertension and dyslipidemia than those without CVD. ( 2) After controlling for multiple factors, serum DHEA levels were negatively correlated with the prevalence of CVD while estradiol levels were positively correlated with both the prevalences of CVD and carotid plaque, estradiol/total testosterone ratio was also positively correlated with the prevalence of CVD. ( 3) In subgroup with unilateral/bilateral CCA plaque, and after controlling for multiple factors, total serum testosterone was negatively associated with the mean CCA diameter. Conclusion The incidence of macrovascular complications was lower in male diabetic patients with higher serum total testosterone and DHEA levels and lower estradiol levels, suggesting that sex hormone levels may be a window for the diagnosis and treatment of diabetic macrovascular complications.

A Prospective Study on Prevalence of Foot ulcers in diabetic patients visiting Surgery Department in a Tertiary Care Teaching Hospital

Background: Diabetes Mellitus (DM) is one of the most widespread non communicable diseases across the world. Two types of complications are encountered usually with DM: microvascular and macrovascular. Diabetic neuropathy is one of the most commonly occurring microvascular complications, of which the most common type is distal symmetrical neuropathy or polyneuropathy. Patients who present with diabetic foot ulceration are heterogeneous. Methods: A checklist was prepared to enter the data already recorded in the case record. This checklist was pilot-tested by recording data from positive case records before analyzing the checklist. A Research Assistant was involved in collection of data from the Medical Records. Results: In  the present  study, 26 patients with DM only and 40 patients with DM foot ulcers were included. With regard to gender distribution, among cases and controls, males were more compared to females. Among cases 28.7% and among controls 75% were males. Age distribution showed more than 75% of the cases and controls were in the age group of 30–60 years. In some of the cases and control subjects, the lipid profile values were not available and hence the comparison of lipid profile was done with available data. The mean values of lipid profile was high among cases compared to controls but was not statistically significant except HDL (p < 0.05). The mean HDL value for diabetic patients with foot ulcers was 37.3± 8.25 whereas that for the non-foot ulcer patients is 31.3± 7.85. Conclusion: Middle-aged male diabetics are most likely to have foot complications. It can be drawn from this study that socio-demographic factors like age, gender along with factors like glycemic control and dyslipidemia are associated with foot ulcers in diabetic patients. It is binding on the health care provider to control these have risk factors to prevent development of complications in diabetic patients with foot ulcers and improve the quality of life.