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@#BACKGROUND. The 84.4 percent of newly diagnosed patients with diabetes have obesity in Mongolia. Nowadays, prevalence of obesity has increased steadily in Mongolia. Diabetic patients with viral hepatitis has high risk of having liver cirrhosis. Therefore, screening of fatty liver and liver fibrosis in diabetic patients is more important. The main diagnosing method of fatty liver and liver fibrosis is liver biopsy and histology but so far, we are able to detect viral infection using viral marker and determine fibrosis stage of NAFLD in patients who has diabetes mellitus type 2. Using noninvasive method determining liver fibrosis involve many researches to reveal new biomarkers and technics to find out liver fibrosis. Japanese researchers has found The Wisteria floribunda agglutinin- positive human Mac-2-binding protein (WFA+-M2BP) was recently shown to be a liver fibrosis glycobiomarker with a unique fibrosis-related glycoalteration.This biomarker helps to determine liver fibrosis stage in fatty liver disease and viral hepatitis. There is no research to reveal viral infection, fatty liver and liver fibrosis in diabetic patients in Mongolia, so far. So it is necessary to study revealing viral infection, fatty liver disease and to determine stages of fibrosis using WFA+-M2BP to screen liver fibrosis in diabetic patients. OBJECTIVE. To identify viral infection, HCV/HBV in patients with diabetes and to compare liver function and diabetes control for diabetic patients with liver disease. METHODS. We collect data from 25thNovember, 2015 to October of 2016. We got permission of research from the patients by handwriting signature who diagnosed Diabetes mellitus in National University Hospital. Haemotology, biochemistry test, coagulogramm, immunology test are evaluated in 415 patients in clinical laboratory of National university hospital. By the objective, the diabetes patients with viral hepatitis will attend to second step of research. We used HISCL 5000 apparatus of Sysmex Japan to do immunology tests. Also we use SPSS 19.0 and EXCEL program. RESULT. There were 294 patients and by WHO classification of ages 20-29 aged patient (n=4), 30-39 aged(n=19), 40-49 aged(n=65), 50-59 aged(n=126), 60-70 aged(n=48), over 70 aged(n=14)or 53.24±9.43. 146 patients are male,148 patients are female.By BMI 29.9±1.14.By blood test, thrombocytes counted 256.6±11.7;in coagulogramm the prothrombin time was 111.7±31.4; in biochemistry test total bilirubin 16.46±10.6; AP 364.7±192.3;AST 35.7±45.7; ALT 42.8±45.5; GGT 86.53±123.4;albumin 42.06±23.95;total cholesterol 6.04±2.47;triglyceride 5.72±34.5;HbA1c 8.83±5.92; in immunology testsanti-HCV 29.37±18.87 (n=58); HBsAg 590.134±1013.7 (n=23); M2BP (COI) counted 2.24±2.19. CONCLUSION. There were 58 diabetic patients with C viral infection and 23 diabetic patients with B viral infection. By WFA+-M2BP glycobiomarker, we found that diabetic patients with viral hepatitis has more liver fibrosis.
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Today, there are 382 million people living with diabetes. A further 316 million with impaired glucose tolerance are at high risk from the disease – an alarming number that is set to reach 471 million by 2035. One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy (CAN) which encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics. The present report discusses the clinical manifestations (eg, resting tachycardia, orthostatic hypotension exercise intolerance, intra operative cardiovascular liability, silent myocardial infarction (MI), and increased risk of mortality) in the presence of CAN. The reported prevalence of CAN varies greatly depending on the criteria used to identify CAN and the population studied. CAN prevalence ranges from as low as 2.5% of the primary prevention cohort in the Diabetes Control and Complications Trial (DCCT) to as high as 90% of patients with long-standing type 1 diabetes who were potential candidates for a pancreas transplantation. Objective: The aim of this study was to evaluate the Cardiac Autonomic Neuropathy (CAN) among diabetic patients.This study included patients with T1 DM and 20 patients with T2 DM total (97 male, 86 female) diabetic patients. The CAN diagnosed by 6 clinical tests: Resting Heart Rate (RHR), Expiration : Inspiration (E:I) ratio, Heart rate response to standing (30:15 ratio), Orthostatic hypotension (OH) and Sustained Hand Grip (SHG) using Cardiac Autonomic Neuropathy System Analyzer CAN-504. CAN was indicated at least two of five tests are abnormal.Diabetic patients’ mean age was 48.74±12.74, diabetes duration 7.55±5.72, systolic blood pressure 136.25±22.76mm Hg, diastolic blood pressure 84.82±11.90 mmHg, cholesterol 5.04±1.04mmol/l, triglyceride 2.20±1.24mmol/l, LDL2.64±0.85mmol/l, HDL 1.12±0.41mmol/l, non-HDL 3.71±1.06, cholesterol/HDL ratio 4.70±1.29, HBA1c 10.08±2.39%. Result of RHR resting heart rate test was normal 92%, borderline 0.5% and abnormal 7.1%,Expiration:inspiration(E:I) ratio was normal 72.7%,borderline 13.7% and abnormal 14%, Heart rate response to standing (30:15ratio) was normal 47%,borderline 13.714% and abnormal 39.3%, Valsalva was normal 97.8%,borderline 2.2% and abnormal 0%, Orthostatic hypotension (OH) was normal 66%,borderline 29% abnormal 6% and Sustained hand grip(SHG) test was normal 4.9%,borderline 9%, and abnormal 87.8%.Number of abnormal cardiac autonomic neuropathy test results 2 (with cardiac autonomic neuropathy) was in 97(53%) among diabetic patients. Among diabetic patients cardiac autonomic neuropathy (CAN) was 53%.
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Type 2 diabetes is known to be associated with elevated cardiovascular mortality and central pathological mechanism in is the process of atherosclerosis, which leads to narrowing of arterial walls throughout the body. Cardio-Ankle Vascular Index (CAVI) was developed as an index of arterial stiffness independently of early atherosclerosis. The aim of the study is to evaluate the correlation of arterial stiffness and atherosclerotic riskfactors patients with Type 2 DM. We used hospital-based onetime cross-sectional study for 52 type 2 DM patients aged 27-55 (mean age 46.7 ± 7.2) who were involved. Materials are collected by questionnaire, physicalexamination, blood analyzes and arterial stiffness is measured by VaSera VS-1000 device. Our result showed that CAVI was statistically significant on age (r=0.65 p=0.001), duration of disease (r=0.32 p=0.021), , systolic pressure (r = 0.54 p = 0.001), diastolic pressure (r = 0.54 p=0.001), red blood cell (r=0.31, p=0.02) , hematocrit (r=0.32, p=0.02) respectively. CAVI, Bodymass index and visceral fat were significantly higher in patients with hypertension than patients with normotensive.This result suggests that age, hypertension and hematocrits improve arterial stiffness in type 2diabetic patients. So it’s necessary to reduce the obesity and control the hypertension in type 2 diabetic patients to prevent from cardiovascular disease.
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AIMAim of this study was to evaluate Predicted 4 and 10-years risk of major CVD of DMpatients.METHODSCross-sectional study included 80 (40 male and 40 female) DM patients with meanage 66.32 ±7.94 years old. Predicted 4-year risk of major CVD was calculated by usingADVANCE Risk Engine of the George Institute for Global Health, Australia. Ten parameters(age at diagnosed diabetes, duration of diabetes, sex, atrial fibrillation, retinopathy,HbA1C, pulse pressure, treated hypertension, albuminuria and Non HDL-cholesterol)were used for risk calculation. Predicted 10-year risk of major CVD was calculated byusing WHO/ISH risk prediction chartrs Parameters (age, sex, systolic blood pressure, totalcholesterol, smoking) were used for risk calculation.RESULTSOur study relieved that average of diagnosis diabetes was 54.98±9.37 years oldand mean diabetes duration was 11.35±7.46 years. DM patient with atrial fibrillation,retinopathy and treated hypertension were 0(0%), 20(16%) and 77.5(62%). Mean HbA1C,microalbuminuria and Non HDL cholesterol were 7.74±1.5%, 49.99±94.02 mg/l and3.61±1.08 mmol/l. DM patients with 20% Predicted 4-year riskof major CVD were 64( 80%), 12 (15%) and 4(5.0%). Age (p30% Predicted 10-year risk of major CVDwere 44 (55%), 20 (25%), 6 (7.5.0%) and 10 (12.5%). Age (p=0.008), total cholesterol(p=0.001), systolic blood pressure (p=0.001) and treated hypertension (p=0.023) wererisks for Predicted 10-year risk of major CVD.CONCLUSIONSAmong the diabetic patients 80% have a low, 15% have a moderate and 5.0%have a high Predicted 4-year risk of major CVD. Age (p<0.042), age at diagnoseddiabetes (p=0.013), , duration of diabetes (p=0.045), total cholesterol (p<0.027)Microalbuminuria (p<0.001) and retinopathy (p=0.028) were risks for Predicted 4-yearrisk of major CVD. Among the diabetic patients 55% have a low, 25% have a moderate,7.5% have a high and 12.5% have a very high Predicted 10-year risk of major CVD. Age(p=0.008), total cholesterol (p=0.00, systolic blood pressure (p=0.001) and treatedhypertension (p=0.023) were risks for Predicted 10-year risk of major CVD.
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GoalAim of this study was to evaluate the effectiveness of weight loss intervention in overweight and obesepatients with newly diagnosed type 2 diabetes mellitus (T2D).Materials and Methods92 overweight and obese subjects (42 men and 50 women), aged 32-56 years, with recently diagnosedtype 2 diabetes were enrolled to the prospective cohort study. A 6-month counselingbased interventionwas conducted between December 2011 and June 2012. Participants were Mongolian and receivededucation sessions on healthy lifestyle guidelines including nutrition and physical activity in smallgroups. Before and after intervention, body weight (kg), body fat (%), waist and hip circumferences(cm), blood pressure (mm Hg), fasting blood glucose (mmol/l), HbA1C (%), total cholesterol (mmol/L)and triglyceride (mmol/L) were measured.Results80 out of 92 (86.9%) overweight and obese patients with T2D (BMI 31.57±4.2) completed weightloss intervention. Results of this study before and after the intervention showed mean body weight84.41±13.08 vs 80.11±12.42, p<0.0001; BMI 31.57±4.2 vs 29.87±3.72, p<0.0001; waist circumference104.18±10.51 vs 99.78±8.52, p<0.0001); hip circumference 107.04±8.66 vs 105.38±7.79, p<0.01;WHR 0.96±0.07 vs 0.94±0.05, p<0.0005; body fat 36.19±5.64 vs 34.26±6.57, p<0.0005; systolic bloodpressure 133.03±22.5 vs 127.54±17.5, p<0.01; diastolic blood pressure 81.18±13.14 vs 77.61±11.03,p<0.05; fasting blood glucose 11.57±4.06 vs 7.99±2.64, p<0.0001; HbA1C 8.45±2.70 vs 5.95±1.70,p<0.0001; and total cholesterol 3.87±1.05 vs 3.15±0.96, p<0.0001were improved significantly, excepttriglyceride 2.11±0.82 vs 1.73±1.8, p=0.0519. Thus results of the study showed an average weight lossof 4.3 kg and a significant decrease in BMI, percent body fat, and waist and hip circumferences, waist tohip ratio at 6 month. Significant reduction found in levels of fasting glucose, HbA1c and total cholesterolin blood after intervention, however no significant change found in blood level of triglyceride. Systolicand diastolic blood pressures were reduced significantly.ConclusionWeight reduction of 5.1% of body weight in overweight and obese subjects with type 2 diabetes bythe lifestyle intervention for 6 months resulted in significant reductions in total, abdominal and trunkadiposity and reduced blood pressure and improved glycemic control and dislipidemia.
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Aim of this study was to evaluate the effectiveness of weight loss intervention in overweight and obese patients with newly diagnosed type 2 diabetes mellitus (T2D).92 overweight and obese subjects (42 men and 50 women), aged 32-56 years, with recently diagnosed type 2 diabetes were enrolled to the prospective cohort study. A 6-month counselingbased intervention was conducted between December 2011 and June 2012. Participants were Mongolian and received education sessions on healthy lifestyle guidelines including nutrition and physical activity in small groups. Before and after intervention, body weight (kg), body fat (%), waist and hip circumferences (cm), blood pressure (mm Hg), fasting blood glucose (mmol/l), HbA1C (%), total cholesterol (mmol/L) and triglyceride (mmol/L) were measured.80 out of 92 (86.9%) overweight and obese patients with T2D (BMI 31.57±4.2) completed weight loss intervention. Results of this study before and after the intervention showed mean body weight 84.41±13.08 vs 80.11±12.42, p<0.0001; BMI 31.57±4.2 vs 29.87±3.72, p<0.0001; waist circumference 104.18±10.51 vs 99.78±8.52, p<0.0001); hip circumference 107.04±8.66 vs 105.38±7.79, p<0.01; WHR 0.96±0.07 vs 0.94±0.05, p<0.0005; body fat 36.19±5.64 vs 34.26±6.57, p<0.0005; systolic blood pressure 133.03±22.5 vs 127.54±17.5, p<0.01; diastolic blood pressure 81.18±13.14 vs 77.61±11.03, p<0.05; fasting blood glucose 11.57±4.06 vs 7.99±2.64, p<0.0001; HbA1C 8.45±2.70 vs 5.95±1.70, p<0.0001; and total cholesterol 3.87±1.05 vs 3.15±0.96, p<0.0001 were improved significantly, except triglyceride 2.11±0.82 vs 1.73±1.8, p=0.0519. Thus results of the study showed an average weight loss of 4.3 kg and a significant decrease in BMI, percent body fat, and waist and hip circumferences, waist to hip ratio at 6 month. Significant reduction found in levels of fasting glucose, HbA1c and total cholesterol in blood after intervention, however no significant change found in blood level of triglyceride. Systolic and diastolic blood pressures were reduced significantly.Weight reduction of 5.1% of body weight in overweight and obese subjects with type 2 diabetes by the lifestyle intervention for 6 months resulted in significant reductions in total, abdominal and trunk adiposity and reduced blood pressure and improved glycemic control and dislipidemia.