Research progress of JAK/STAT signaling pathway in the intervention of diabetic microvascular complications / 中国临床药理学与治疗学

Diabetic microvascular complications are the main reason for the high mortality of diabetic patients. There is still a great shortage of existing therapeutic drugs, so there is an urgent need for more effective new drugs. Janus kinase/signal transducer and activator of transcription (JAK/STAT) is involved in the progression of diabetic microvascular complications, which can be improved by regulating this pathway. Therefore, this article reviews the progress of JAK/STAT in diabetic microvascular complications (diabetic kidney disease, diabetic retinopathy, diabetic peripheral neuropathy), and summarizes the potential drugs that intervene JAK/ stat to improve diabetic microvascular complications in recent years from three aspects of therapeutic drugs, preclinical drugs, and traditional Chinese medicine, in order to provide ideas for drug development and treatment of diabetic microvascular complications.

To screen for obstructive sleep apnea in patients with type 2 diabetes mellitus and its association with microvascular complications

Objectives: The objectives of this study were to find the association between obstructive sleep apnea (OSA) and microvascualr complications in patients with type 2 diabetes mellitus (T2DM). Material and Methods: This study was conducted at Bangalore Medical College. One hundred patients fulfilling the inclusion criteria were enrolled for the study. The study group included outpatients and inpatients with T2DM in Victoria Hospital and Bowring and Lady Curzon Hospital. The data were collected according to the pro forma in terms of history, clinical examination, and the necessary investigations (HbA1c and urine microalbumin- creatinine ratio). To screen for OSA, STOP-BANG questionnaire was used. To assess microvascular complications, patients were subjected to fundoscopy, urine microalbumin-creatinine ratio, and Toronto clinical neuropathy scoring system. Based on STOP-BANG score, patients were divided into three groups: Low risk (0–2), intermediate risk (3–4), and high risk (5–8) for OSA. Mean values for the duration of diabetes, HbA1c, urine microalbumin- creatinine ratio, and Toronto neuropathy score were compared in each group using ANOVA variance analysis. To find the association between OSA and diabetic retinopathy, Kruskal–Wallis test was used. Results: Based on STOP-BANG score, 16% of patients were in the low-risk group, 68% in the intermediate-risk group, and 16% in the high-risk group. There was a significant difference in Toronto neuropathy scores, urine microalbumin-creatinine ratio, and diabetic retinopathy between low-, intermediate-, and high-risk OSA groups indicating higher neuropathy scores, higher values of UMCR, and more advanced diabetic retinopathy among the high-risk group as compared to other two groups. The association between STOP-BANG scores and UMCR, Toronto neuropathy score, and diabetic retinopathy was statistically significant with P values of 0.002, 0.029, and 0.03, respectively. Conclusion: All diabetic patients should be screened for OSA which is simple and inexpensive. Those who fall in intermediate-risk and high-risk categories showed more advanced microvascular complications. They should be subjected to polysomnography and treated for OSA for better glycemic control and to delay the progression of microvascular complications

A systematic review of preclinical animal studies on fenofibrate's potential role in type 1 diabetic micro-vascular complications

Abstract Fenofibrate is a peroxisome-proliferator-activator α agonist and it is a widely used drug for hyperlipidemia since its approval in 2004. So, in this review we are focusing on the effect of fenofibric acid's mechanism to alleviate type 1 diabetic micro vascular complications like diabetic retinopathy, diabetic cardiomyopathy in animal models, since the drug is safe, efficacious and more economical when compared with the currently available treatment strategies for juvenile diabetic complications and also a profound observation is needed due to the rarity of research in these therapeutic areas. Important preclinical animal studies published from January 2001 to June 2020 were recognised from databases like PubMed and Cochrane central register of controlled trials. Reviewers screened the articles based on the selection criteria and risk of bias was determined using Systematic Review Centre for Laboratory animal Experimentation risk of bias tool for animal studies. Our literature search yielded a total of 5 studies and after pooling up the data from the 5 preclinical studies, we found that Fenofibrate have the efficacy to prevent type 1 diabetic complications, chiefly diabetic retinopathy and those mechanisms are dependent on peroxisome-proliferator-activator and fibroblast growth factor-21 pathways. Fenofibrate is a well safe and moreover, cost effective medication in preventing type 1 diabetic micro vascular complications especially diabetic retinopathy and also in maintaining the glucose homeostasis in apart from its anti-dyslipidemic effect.

The evolving progress of mitochondrial oxidative stress in the pathological mechanisms of diabetic microvascular complications / 中华内分泌代谢杂志

Diabetes complications are the primary cause of disability and mortality in diabetic patients. As the center of cell energy metabolism, mitochondria dysfunction is closely related to the occurrence and development of various microvascular complications. This review focuses on common complications, including diabetic ulcers, diabetic nephropathy and diabetic retinopathy, and on the research progress of mitochondrial function and oxidative stress involving pathological mechanisms of diabetic microvascular complications. We also conclude and update the theoretical basis for targeting mitochondrial oxidative stress in the treatment of these diseases.

Ferritin levels in children and adolescents with type 1 diabetes mellitus: relationship with microvascular complications and glycemic control

ABSTRACT Objective: Evaluate ferritin levels in children and adolescents with type 1 diabetes mellitus and its relation to diabetic microvascular complications, and metabolic control. Subjects and methods: This study included 180 children and adolescents with type 1 diabetes mellitus (T1DM) with a mean age of 14.9 ± 3.1 years and 180 apparently normal children matched for age and sex (control group). All children were evaluated with full history taking, thorough clinical examination, laboratory assessment of high-sensitivity C-reactive protein and hemoglobin A1c (HbA1c), and evaluation of the presence of microvascular complications. Serum ferritin levels were measured using electrochemiluminescence immunoassay. The patients were divided into two groups according to the presence or absence of microvascular complications. Results: Serum ferritin levels were significantly higher in patients with T1DM in both groups compared with healthy controls (p < 0.001). Additionally, patients with microvascular complications had higher serum ferritin concentrations than those without microvascular complications (p < 0.001). Patients with microalbuminuria showed higher ferritin levels compared with patients without microalbuminuria (p < 0.05). Stepwise regression analysis revealed that levels of HbA1c and urinary albumin excretion were independently related to ferritin levels (p < 0.001 for both). On receiver operating characteristic (ROC) curve analysis, a ferritin cutoff value of 163.6 ng/mL differentiated patients with microvascular complications from those without microvascular complications with a sensitivity of 92.1% and specificity of 93.4%. Conclusion: Serum ferritin levels are elevated in T1DM, particularly in patients with microvascular complications.

Prevalence and correlates of microvascular complications among patients with diabetes mellitus: a cross sectional study

Background: Diabetes mellitus is a metabolic disorder of multiple etiology, characterized by chronic hyperglycemia and associated with various microvascular, macrovascular and nonvascular complications leading to increasing morbidity and mortality. Microvascular complications are daibetes specific and their relation with associated comorbidities studied worldwide. To estimate the prevalence of microvascular complications in diabetic patients and to find their relation with various comorbid conditions.Methods: A total of hundred diagnosed patients of diabetes mellitus with age ranging from 18 to 75 years were enrolled in the study. Patients were assessed for the presence of microvascular complications and associated comorbidities. The effect of various comorbidities on frequency of microvascular complications was also determined. Data collected was statistically analyzed.Results: In this study, the mean age of the study group was 55.77±11.75 years. Mean age of onset of the disease was 48.89±11.50 years. Mean duration of the disease in the study group was 6.86±5.02 years. Diabetic retinopathy, neuropathy and nephropathy was found in 76%, 63% and 69% patients, respectively. Among patients with hypertension, 91.7%, 83.3%, and 81.7% cases were found to have retinopathy, neuropathy and nephropathy, respectively. The corresponding figures for those with comorbid IHD were 91.1%, 83.9% and 76.8% respectively whereas among patients with coexisting metabolic syndrome, 92.5%, 80.6%, and 79.1% were found to have retinopathy, neuropathy, and nephropathy, respectively.Conclusions: The most frequent microvascular complication reported by this study was diabetic retinopathy. comorbid conditions like hypertension, ischemic heart disease, and metabolic syndrome were associated with higher prevalence of microvascular complications in diabetic patients.

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.

Serum magnesium levels in newly diagnosed type 2 diabetes mellitus and its relation with microvascular complications of diabetes

Background: Prevalence of hypomagnesaemia is significantly higher in diabetic patients with microvascular complications compared to diabetics with no microvascular complications. The aim of this study is to measure levels of serum magnesium in patients with newly diagnosed type 2 diabetes mellitus and study its association with the presenting microvascular complications.Methods: This was hospital based, one year cross-sectional study carried out in Department of Medicine, IGMC Shimla in patients with newly diagnosed type 2 diabetes mellitus. Total 53 patients were enrolled in this study who presented in medicine OPD or admitted in medicine ward.Results: Serum Magnesium value of the patients ranged from 1.20-3.0 mg/dl with mean value of 1.9±0.3 mg/dl. Fourteen patients (26.4%) had hypomagnesaemia. A total of 34 (64.2%) patients presented with complications of diabetes in which proteinuria was present in 34 (64.2%), retinopathy in 4 (7.5%) and neuropathy in 1 (1.9%). Fourteen (41.2%) patients with hypomagnesaemia presented with complications of diabetes (p value=0.003). 34 (64.2%) patients presented with proteinuria out of which 14 (41.2%) patients had hypomagnesaemia while 20 (58.8%) had normomagnesaemia (p=0.03). One (1.9%) patient had neuropathy and hypomagnesaemia was also present in this patient (p=0.6). Four patients (7.5%) presented with retinopathy out of which 3 (5.7%) had hypomagnesaemia while 1 (1.9%) had normomagnesaemia.Conclusions: Hypomagnesaemia is associated with microvascular complications of diabetes. Also there is statistically significant relationship between proteinuria and hypomagnesaemia in patients with newly diagnosed type 2 diabetes mellitus.

Renal cortical stiffness is markedly increased in pre-diabetes mellitus and associated with albuminuria

INTRODUCTION@#We aimed to investigate changes in renal cortical stiffness (CS) in Type 2 diabetes mellitus (DM) and pre-DM patients compared to subjects with normal glucose metabolism (NGM), as well as the usefulness of renal CS to determine the presence of nephropathy.@*METHODS@#This study included 125 individuals with NGM, pre-DM and Type 2 DM. Routine laboratory data was obtained, and micro- and macrovascular involvement were investigated. Urinary albumin-creatinine ratio (UACR) was measured for urinary albuminuria detection. In addition to routine renal ultrasonography, CS was measured using renal elastography.@*RESULTS@#Among the included patients, 42, 40 and 43 patients had NGM, pre-DM and Type 2 DM, respectively, with prevalence of nephropathy of 5%, 15% and 33%, respectively. Carotid and aortic intima-media thickness (IMT), renal width, and CS were found to be higher in the pre-DM and Type 2 DM groups than the NGM group. Aortic IMT, renal width and UACR levels were independently associated with CS. Patients with nephropathy were found to have a higher CS value than those without nephropathy (8.72 ± 1.67 kPa vs. 10.60 ± 1.74 kPa, p = 0.001). In receiver operating characteristic curve analysis, when the cut-off value for CS was taken as 9.2 kPa, renal CS predicted the possibility of nephropathy with 78.9% sensitivity and 71.4% specificity.@*CONCLUSION@#CS values are significantly higher in patients with impaired glucose metabolism. We recommend CS measurement as part of routine screening of nephropathy in patients with pre-DM and newly diagnosed Type 2 DM.

Detection of microvascular complications of diabetes by EZSCAN method and their correlation with metabolic indices

Background: EZSCAN is a new, non-invasive technique to detect sudomotor dysfunction and thus neuropathy in diabetes patients at an early stage. It further predicts chances of development of other microvascular complications. In this study we evaluated EZSCAN for detection of microvascular complications in Type 2 diabetes patients and assessed their correlation with various metabolic parameters.Methods: 104 known diabetes patients, 56 males and 48 females, were studied. All cases underwent the EZSCAN test, Body mass index measurement, fasting and postprandial blood glucose, HbA1c tests. Diabetes related complications were thereafter correlated with various metabolic indices.Results: Strong correlation was found between HbA1c, body mass index (BMI), fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) with diabetes related microvascular complications assessed by EZSCAN, strongest being with FBG (r=0.755) and weakest with BMI(r=0.232).Conclusions: Microvascular complications of diabetes as detected by EZSCAN method correlate strongly with metbolic indices of the patient and thus EZSCAN can be used as a simple, non-invasive and quick method to detect microvascular complications of diabetes.

Glycemic Control and Long-term Complications in Pediatric Onset Type 1 Diabetes Mellitus: A Single-center Experience from Northern India

Objective: To study glycemic control, mortality and long-termcomplications in children with type 1 diabetes (T1D).Design: Cross-sectional study.Setting: Referral centre at a government teaching hospital.Participants: Patients with T1D with age ≤18 years at onset.Methods: We retrospectively collected demographic data fromcomputer records from 1991 to 2015. Prospective study foroutcomes was conducted between 2012 and 2016.Main outcome measures: Mortality rate, glycosylatedhemoglobin (HbA1c), and microvascular complication rate.Results: The proportion of T1D patients (n=512) <5 years of ageat onset was 18.6% between 1995 and 2004, and 24.2% in2005-2014 (P<0.001). Twenty eight patients had died out of 334whose living status was known (mortality 1.1 per 100 patient-years over 2549 patient-years follow up). Median (range)HbA1c (n=257) was 8.3% (5.1-15.0%). At least one episode ofsevere hypoglycemia (coma/seizure/inability to assist self) hadoccurred in 22.8% patients over two years. Hypertension waspresent in 11.7% patients. Microvascular complications screenin 164 eligible patients [median (range) age 20 (8-45) y andduration of diabetes 9.1 (5-30) y] showed diabetic nephropathy in3.0%, proliferative retinopathy in 3.6% and LDL cholesterol >100mg/dL in 34% patients.Conclusion: The mortality rate and prevalence of hypertensionwere high, given the short duration of diabetes of the patients.The proportion of patients with age ≤5 years at onset of diabeteshas increased at our center.

A study of thyroid dysfunction in known cases of diabetes mellitus type 2 and their clinical profile

Introduction: Thyroid dysfunction is a disorder of the thyroid gland which manifests either as hyper - or hypothyroidism and is reflected in the levels of thyroid stimulating hormone (TSH). Type 2 Diabetes Mellitus is the commonest endocrine disorder and leading cause of morbidity worldwide. These two most common endocrine disorders encountered in clinical practice have been shown to mutually influence each other, and association between both the conditions has long been reported. The present study was conducted to find out the prevalence of thyroid disorders in patients of type 2 diabetes mellitus. Materials and methods: 100 cases of type 2 diabetes mellitus were examined for thyroid dysfunction. A detailed history was taken regarding presenting symptoms, duration of type 2 diabetes mellitus and clinical course of disease. A family history was taken with special reference to type 2 diabetes mellitus and other comorbidities. BMI was calculated to diagnose obesity. A thorough clinical examination was done. Ophthalmic examination was done to diagnose retinopathy and cataract. Detailed blood investigations were done including serum TSH, free T3 and free T4. Results: Males were more affected with diabetes than females and occurrence of thyroid dysfunction was found more common in females with Type 2 DM in our study. Hypothyroidism was most common type of thyroid dysfunction with affected age group was 51-60 years. DM and thyroid dysfunction were more common in overweight patients. Thyroid dysfunction in type 2 DM was seen more commonly with higher levels of HBA1C. Dyslipidemia was more in patients of diabetes with thyroid dysfunction. Patients taking insulin had more incidence of hypothyroidism than patients on OHA. Diabetes related microvascular complications increase the risk for thyroid dysfunction. Krunal Talsaniya, Chitralekha Vora, Bhavikkumar Prajapati. A study of thyroid dysfunction in known cases of diabetes mellitus type 2 and their clinical profile. IAIM, 2019; 6(1): 103-108. Page 104 Conclusion: Thyroid dysfunction prevalence is very high in patients with diabetes. Patients with diabetes having microvascular complications are more affected with thyroid diseases. Dyslipidemia is also common in DM with thyroid diseases. So thyroid function test must be done on regular basis in each and every patient of DM 2.

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.

Fibrinogen levels in type II diabetes mellitus patients with microvascular complications

Background: Diabetes increases the morbidity and mortality due to its propensity to develop micro and macrovascular complications. Recently the role of haemostatic factors, particularly fibrinogen, in atherosclerosis and its complications has invited considerable attention. The present study was conducted to study plasma fibrinogen levels in type II diabetes mellitus patients with microvascular complications.Methods: One hundred patients aged 18years to 60years with type 2 diabetes mellitus with microvascular complications were included in the study. HBA1c, plasma fibrinogen, urine routine examination, fundoscopy, monofilament testing, FBS, PPBS were done. Descriptive statistics was used to analyse data.Results: Out of 100 diabetes patients with microvascular complication studies, 88 patients were found to have hyperfibrinogenaemia. Out of 100 patients 67 patients had HbA1c of more than 8%, and all of them had elevated fibrinogen levels (p <0.0001). The prevalence of hyperfibrinogenemia was higher in patients with diabetic retinopathy (90%), when compared to those without diabetic retinopathy (83.33%) although it was statistically not significant (p=0.266).Conclusions: Hyperfibrinogenemia among type 2 diabetes mellitus patients with microvascular complications was high. Glycaemic control has a significant impact on the fibrinogen levels. Longer the duration of diabetes, there was a higher prevalence of hyperfibrinogenemia.

Comparative Study Of Pulmonary Function Tests With Microvascular Complications, Retinopathy And Nephropathy In Type 2 Diabetes Mellitus And Correlation With Duration Of Diabetes

Background:Themajorintype2diabetesThough lung has been widely acknowledged to be a target organ in diabetes mellitus, its se-verity of involvement and correlation with other microvascular complications has not been studied. Aim:To study pulmonary function tests in type 2 diabetes mellitus and evaluate association of PFTs with microvascular complica-tions, retinopathy and nephropathy and further assess the relationship of retinopathy, nephropathy and lungs with duration of diabetes. Methods:A cross sectional study was carried out in 100 male type 2 diabetic patients attend-ing diabetic clinic in tertiary hospital. 100 non-diabetic subjects were selected as control from general population. PFTs tests were performed. Results were interpreted by one way ANOVA test. Association of PFT parameters FVC, FEV1, FEV1%in type 2 diabetic patients with nephropathy and retinopathy was analysed by Pearson’s correlation co-efficient. The patient population was subdivided according to the duration of diabetes into 2 groups; less than 10 years of illness and more than 10 years. Relationship of retinopathy, nephropathy and pulmonary function tests with duration of diabetes was assessed by one-way ANOVA test. Results:There was a significant decrease in PFT parame-ters as compared to non-diabetic controls. The PFTs in type 2 diabetic subjects with nephropathy showed decline in FVC, FEV1,FEV1%, however association of these parameters with Glomerular filtration rate (GFR) and microalbuminu-ria was not significant. Also, a similar decline of PFT parameters was observed with increasing grade of retinopathy, though not significant. There was a significant positive correlation of retinopathy with microalbuminuria and GFR (nephropathy) in type 2 diabetic subjects. Also, there was significant association of microalbuminuria, GFR and reti-nopathy with increase in duration of diabetes. On the contrary the decline in FVC, FEV1, FEV1%with duration of diabe-tes was not statistically significant. Conclusion:Type 2 diabetic patients with poor glycaemic control and longer du-ration of diabetes history had significant correlation with microvascular complications, nephropathy and retinopathy as compared to pulmonary complications (PFT parameters). It is highly suggestive that diabetic patients with reti-nopathy must be screened for nephropathy.

Serum Magnesium Levels in Type II Diabetes Mellitus and Its Association with the Microvascular Complications

Background: Hypomagnesemia has been associated with type 2 diabetic mellitus and is known to be a risk factor for microvascular complications. This study aimed to evaluate serum magnesium levels in patients with type 2 DM and correlate them with microvascular complications. Materials & Methods: A hospital based cross-sectional study was conducted on150 patients with type 2 diabetes mellitus were admitted in the Mahatma Gandhi Hospital, Bhilwara, Rajasthan, India. Serum magnesium levels were assessed in all the diabetic patients and they were also tested for presence of microvascular complications. Results: In the present study majority of the patients (71.33%) were males and male to female ratio was 2.48:1. The commonest age group was > 60 years (50%) and the mean age was 60.38 ± 10.81 years. The duration of diabetes in 45.33% of the patients was between 6 to 10 years and mean duration was 7.43 ± 4.11 years. Hypomagnesemia was associated with microvascular complications including diabetic retinopathy, diabetic nephropathy and diabetic neuropathy (p<0.050). Also, association was found between serum magnesium levels glycaemic control and duration of diabetes (p<0.050). Conclusion: Hypomagnesemia is widely prevalent in patients with type 2 diabetes mellitus and a major risk factor for the development microvascular complications that is, diabetic retinopathy, nephropathy and neuropathy.   Key words: Hypomagnesemia, Diabetic nephropathy, Diabetic neuropathy, Diabetic retinopathy, Microvascular complications, Type 2 diabetes mellitus

Association of nocturnal serum cortisol level with diabetic microvascular complications in overweight/obese type 2 diabetic patients / 中华内分泌代谢杂志

Objective To explore the association of nocturnal serum cortisol levels with diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus. Methods Serum cortisol levels of 316 overweight or obese type 2 diabetic patients were tested at midnight by the method of chemiluminescence. Diabetic microvascular complications were compared among various groups according to nocturnal serum cortisol levels. All the patients with nocturnal serum cortisol level > 50 nmol/L were asked to undergo overnight low-dose dexamethasone suppression test to rule out the possibility of subclincal Cushing's syndrome. The incidences of diabetic nephropathy ( DN ) , diabetic retinopathy ( DR ) , and diabetic peripheral neuropathy ( DPN ) were examined in all the patients. Results (1)The incidence of DN was gradually increased from 13.3％to 27.7％and 44.2％in patients with low, medium, and high cortisol level groups, showing a statistical difference among 3 groups ( P<0.05) . The incidences of DR in medium and high cortisol level groups were higher than that in low cortisol level group (40.6％and 47.7％vs 22.7％, both P<0.01). The incidence of DPN in high cortisol level group was higher as compared with low cortisol level group (60.5％ vs 38.7％, P<0.01). (2) Nocturnal serum cortisol level in patients with diabetic microvascular complications was higher than that in patients without complications [ (136.87 ± 105.78 vs 97.55 ± 93.48) nmol/L, P<0.01]. Nocturnal serum cortisol level in patients with multiple diabetic microvascular complications was higher than that in patients with single diabetic microvascular complication [ (151.66±114.54vs117.69±90.26)nmol/L,P<0.05].(3)Singlefactorlogisticregressionanalysisshowedthat higher nocturnal serum cortisol level was a risk factor for diabetic microvascular complications in addition to female, age, longer diabetic duration, higher fasting plasma glucose ( FPG ) . Multivariate logistic regression analysis showed that higher nocturnal serum cortisol level was still a risk factor for diabetic microvascular complications after adjusted by diabetic duration, FPG, HbA1C, and the use of insulin (P=0.013). Conclusion Nocturnal serum cortisol level seems to be a risk factor for diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus.

Stationary Treatment Compared with Individualized Chinese Medicine for Type 2 Diabetes Patients with Microvascular Complications: Study Protocol for a Randomized Controlled Trial / 中国结合医学杂志

BACKGROUND@#Microvascular complications in type 2 diabetes (T2DM), including diabatic retinopathy (DR), diabetic kidney disease (DKD), diabetic peripheral neuropathy (DPN) are the leading causes of visual loss, end-stage renal disease or amputation, while the current therapies are still unsatisfactory. Chinese medicine (CM) has been widely used for treating diabetic mellitus. However, most of the previous studies focused on the single complication. The role of CM treatment in T2DM patients with 2 or multiple microvascular complications is not clear.@*OBJECTIVE@#To appraise the curative effect of CM in T2DM patients with 2 or multiple microvascular complications, and to compare the effects of stationary treatment and individualized treatment in T2DM patients with microvascular complications.@*METHODS@#This trial will be an 8-center, randomized, controlled study with 8 parallel groups. A total of 432 patients will be randomized to 8 groups: DR study group (32 cases) and a corresponding control group (32 cases), DR+DKD study group (64 cases) and a corresponding control group (64 cases), DR+DPN study group (64 cases) and a corresponding control group (64 cases), DR+DKD+DPN study group (56 cases) and a corresponding control group (56 cases). The control group will receive stationary treatment, and the study group will receive individualized treatment based on CM syndrome differentiation in addition to stationary treatment. The study duration will be 50 weeks, comprising a 2-week run-in period, 24 weeks of intervention, and 24 weeks of follow-up. The outcomes will assess efficacy of treatment, improvement in CM symptoms, safety assessments, adherence to the treatment, and adverse events.@*CONCLUSION@#This study will provide evidence of evidence-based medicine for CM treatment in two or multiple microvascular complications caused by T2DM. (Registration No. ChiCTR-IPR-15007072).

Fisiopatología de la nefropatía diabética: una revisión de la literatura / Pathophysiology of diabetic nephropathy: a literature review

La enfermedad renal crónica es una complicación frecuente en la diabetes mellitus. Su importancia radica en la alta prevalencia y la proyección a futuro que ésta tiene. Se asocia a altos gastos en salud y además a deterioro cardiovascular global. La fisiopatología del desarrollo de esta enfermedad está siendo estudiada y se sabe que en ella participan una serie de vías moleculares complejas que determinan una enfermedad microvascular. En esta revisión se intenta abordar las vías conocidas en el desarrollo de nefropatía diabética, con el fin de comprender mejor posibles blancos terapéuticos que se podrían desarrollar.

Chronic kidney disease is a common complication of diabetes. Its importance lies in its high prevalence and future projection. It is associated with high health costs and global cardiovascular deterioration as well. The development of this disease pathophysiology is being studied and it is known that a series of complex molecular pathways determining a microvascular disease are involved. This review addresses the known pathways in the development of diabetic nephropathy aiming to improve the understanding of potential therapeutic targets that could be developed in the future.

Changes and clinical significance of serum CA199 in patients with type 2 diabetes mellitus / 中国糖尿病杂志

Objective To investigate the relationship between CA199 and clinical indicators and its related factors in patients with type 2 diabetes mellitus(T2DM). Methods A total of 1224 hospitalized T2DM patients were enrolled retrospectively from the Endocrinology and metabolism department of our hospital. All the patients were divided into two groups according to CA199 level:negative group (CA199<37 U/ml) and positive group(CA199≥37 U/ml). Clinical and biochemical data were compared between the two groups. Results The level of FPG,HbA1c,UACR,and the prevalence of diabetic microvascular complications were significantly higher in CA199 positive group than in negative group[(13.12±4.58)vs(10.22±4.01)mmol/L,(10.84±2.58)% vs (8.78±2.22)%,(38.25±3.15) vs (29.09±1.02)mg/g,P<0.05]. Serum albumin level was lower in CA199 positive group than in negative group[(38.59±5.33) vs (40.13±5.63)g/L,P<0.05]. Pearson correlation analysis showed that CA199 was associated with FPG,HbA1c,and serum albumin(r=0.251,0.260,-0.082,P<0.05 or P<0.01). Multiple logistic regression analysis further found that FPG and HbA1c were the independent risk factors for CA199(β=0.793,0.975,P<0.05). Conclusion The elevated CA199 in T2DM patients correlated with poor glucose control and development of diabetic microvascular complications.