Caracterización de la enfermedad cerebrovascular isquémica en pacientes diabéticos del Hospital Universitario Clínico Quirúrgico General Calixto García

Fundamento: las enfermedades cerebrovasculares constituyen una de las principales causas de mortalidad en el mundo. En las Américas constituyen la tercera causa de muerte y su incidencia se ve aumentada en los pacientes diabéticos tipo 2. Objetivo: caracterizar los pacientes diabéticos tipo 2 con enfermedad cerebrovascular isquémica aguda. Método: se realizó un estudio descriptivo en pacientes diabéticos que ingresaron en el Hospital Calixto García con diagnóstico de enfermedad cerebrovascular isquémica aguda en el período comprendido entre enero y diciembre 2022. El universo estuvo constituido por la totalidad de pacientes diabéticos tipo 2 que ingresaron en la Institución y la población por 148 pacientes. Las variables analizadas fueron: sexo, color de piel y edad; tensión arterial e índice de masa corporal; colesterol, triacilgliceridos y glicemia; tipo enfermedad cerebrovascular y su gravedad y comorbilidades. Se utilizaron métodos de la estadística descriptiva como frecuencia absoluta y porciento. Los resultados se presentaron en tablas creadas a los efectos. Resultados: predominó el sexo masculino, el color de piel blanca y el grupo etáreo entre los 60 y 69 años con un 58,1 43,9 y 40,5 % respectivamente. Predominaron los pacientes hipertensos y con sobrepeso relacionados con la mayor gravedad de la enfermedad cerebrovascular, los pacientes hiperglicémicos con valores de colesterol y triacilgliceridos altos, en ellos fue más grave el evento isquémico cerebral. La hipertensión arterial y la cardiopatía isquémica prevalecieron en la población estudiada con un 81,8 y 52,7 respectivamente. Conclusiones: la enfermedad cerebrovascular fue más frecuente en el sexo masculino, color de piel blanca y pacientes de edad avanzada. La hipertensión arterial, el sobrepeso, la hiperglucemia así como los valores altos de colesterol y triglicéridos predominaron en la muestra y se relacionaron con la mayor gravedad del evento cerebrovascular isquémico.

Foundation: cerebrovascular diseases are one of the main causes of mortality in the world. In the Americas they constitute the third cause of death and their incidence is increased in type 2 diabetic patients. Objective: to characterize type 2 diabetic patients with acute ischemic cerebrovascular disease. Method: a descriptive study was carried out in diabetic patients who were admitted to the Calixto García Hospital with a diagnosis of acute ischemic cerebrovascular disease in the period between January and December 2022. The universe consisted of all type 2 diabetic patients who were admitted to the Institution and the population of 148 patients. The variables analyzed were: sex, skin color and age; blood pressure and body mass index; cholesterol, triacylglycerides and glycemia; type of cerebrovascular disease and its severity and comorbidities. Descriptive statistical methods such as absolute frequency and percentage were used. The results were presented in tables created for the purpose. Results: the male sex, the white skin color and the age group between 60 and 69 years predominated with 58.1, 43.9 and 40.5 % respectively. Hypertensive and overweight patients related to the greater severity of cerebrovascular disease, hyperglycemic patients with high cholesterol and triacylglyceride values ​​predominated, and in them the cerebral ischemic event was more severe. Arterial hypertension and ischemic heart disease prevailed in the studied population with 81.8 and 52.7 respectively. Conclusions: cerebrovascular disease was more frequent in males, white skin color and elderly patients. Arterial hypertension, overweight, hyperglycemia as well as high cholesterol and triglyceride values ​​predominated in the sample and were related to the greater severity of the ischemic cerebrovascular event.

Quality of Life of Type 2 Diabetic Patients attending a Tertiary Hospital in South-South Nigeria

Background: Type 2 Diabetes mellitus affects the quality of life of individuals and their ability to function. It affects the physical, social and mental well-being of patients with immediate and delayed complications.This study determined the quality of life of type 2 diabetic patients attending a tertiary hospital in south-south Nigeria.Methods:This was a descriptive cross-sectional study conducted among type 2 diabetic patients attending the medical outpatient clinic of the University of Port Harcourt Teaching Hospital between September and November 2019. Purposive sampling technique was used to select a total of 347 participants for the study following ethical approval. WHOQOL-BREF questionnaire was used to measure the QoL of the participants. Data were analyzed using SPSS version 23.0. Descriptive data were presented in frequency distribution tables while summary statistics were done using mean and standard deviation for continuous variables and in proportions for categorical variables. Results:Results revealed that majority of the type 2 diabetic patients were females (53.3%) and between the ages of 51-60 years. 27.2% of them had poor overall QoL with the score of <45% while 65.7% had fair overall QoL with a score of 45-65 %. 7.1% had good overall QoL with a score of ≥65%. Conclusion:Majority of the type 2 diabetic patients had fair QoL while the least had good QoL. There is urgent need for increased health awareness and education of diabetic patients regarding diabetic care.

Clinical Characteristics of Lower-Limb Ischemia in Japanese Patients with Type 2 Diabetes and Usefulness of the Great Toe Blood Flow as a Predictive Indicator of Leg Arterial Obstruction.

Nurses are required to make quantitative, evidence-based observations when implementing diabetic foot care. This study aimed to clarify the characteristics of lower-limb ischemia in patients with type 2 diabetes using subjective and objective symptoms and physiological indicators and whether the physiological characteristics are established as predictive indicators of arterial obstruction. Fifty Japanese patients with type 2 diabetes (100 limbs) were classified into three groups using the ankle-brachial index (ABI). Patients with an ABI of ≤0.69 had subjective and objective symptoms of blood flow disturbance, such as pain at rest, cold sensation, pale skin, and imperceptibility to the dorsalis pedis artery. Blood flow in the first toe was the lowest. Binary logistic regression analysis established hallux perfusion as a predictive model for lower-limb arterial occlusion (odds ratio = 0.979, 95% confidence interval 0.900-0.999). Thus, when nurses perform diabetic foot care, it is necessary to evaluate not only subjective and objective symptoms, but also blood flow at the microcirculatory level of the great toe.

Dietary practice and associated factors among type 2 diabetic patients having followed up at the University of Gondar Comprehensive specialized hospital, northwest Ethiopia, 2019.

BACKGROUND: Diabetes is a chronic, metabolic disorder characterized by elevated level of blood glucose. In order to delay and prevent diabetes related complications, healthy meal planning and leading active life are very crucial. However, appropriate feeding practice among type 2 diabetic patients is low in many developing countries including Ethiopia. Therefore, the aim of this study was to assess dietary practice and associated factors among type 2 diabetic patients. METHODS: Institution based cross sectional study was conducted from July to December 2019. A total of 422 type 2 diabetic patients who had follow up at the diabetes clinic of the University of Gondar Comprehensive Specialized hospital were include in the study. Logistic regression was used to see the strength of the association between dependent and independent variables. In the logistic regression, both bivariable and multivariable logistic regression analysis were computed to identify factors associated with dietary practice. RESULTS: The overall prevalence of good dietary practice among type 2 diabetic patients was 46.7 % [95 % CI: 41.7, 51.4]. In the multivariable logistic regression analysis attending secondary and above education [AOR = 4.08, 95 % CI: 1.76, 9.46], high wealth status [AOR = 5.34, 95 % CI: 2.72, 10.50], presence of family support [AOR = 2.54, 95 % CI: 1.40, 4.63], and absence of difficulty of choosing food [AOR = 2.27, 95 % CI: 1.47, 3.53] were significantly associated with good dietary practice. CONCLUSIONS: Less than half of the patients with type 2 diabetes had good dietary practice. Dietary practice was good among high economic status, presence of family support, high educational level and no difficulty of choosing food. Therefore, strengthening income generating activities, improving literacy rate of nations, developing family engagement and food choosing strategies by the health care providers, policy makers and the Government are very crucial to improve good dietary practice among type 2 diabetic patients.

Association between Statin Use and Sensorineural Hearing Loss in Type 2 Diabetic Patients: A Hospital-Based Study.

Statins have emerged as protective agents against sensorineural hearing loss (SNHL) associated with dyslipidemia, but the effects of statins on SNHL are not consistent. The purpose of this study was to investigate the association between statin use and the risk of SNHL using a hospital cohort. This nested case-control study included type 2 diabetic patients over the age of 18 years without a history of hearing loss. Of these, 1379 patients newly diagnosed with SNHL or tinnitus were classified as cases, and 5512 patients matched to the cases based on age, sex, and index year were classified as controls. Chi-squared tests were used to compare categorical variables between the two groups. Odds ratios (ORs) and adjusted odds ratios (AOR) were calculated from univariate and multivariable unconditional logistic regression analyses, respectively. There was a significant difference in the prevalence of statin use between the cases and controls (53.7% vs. 61.2%, respectively; p < 0.001). The use of statins in type 2 diabetic patients significantly reduced the risk of SNHL or tinnitus by 24.8% (95% CI 14.2-34.1%, p < 0.001) after controlling for confounders. Similar results were found for the association between statin use and SNHL (AOR = 0.706; 95% CI 0.616-0.811, p < 0.001). The protective effects of statins against SNHL were consistent regardless of age and sex. The use of statins for type 2 diabetic patients was significantly associated with a reduced risk of SNHL, regardless of age and sex. Further studies are needed, especially large cohort studies, to evaluate the long-term protective effects of statins.

Blood lead, nutrient intake, and renal function among type 2 diabetic patients.

Lead (Pb) exposure has been reported to have nephrotoxicity. However, such an effect has not been well investigated in type 2 diabetes (T2D) patients, especially when taking into account the nutrition status of the patients. Therefore, we explore the association between blood lead levels (BLLs), dietary intake of nutrients, and impaired renal function among patients with T2D. We measured BLLs and biochemical parameters of renal injury in 780 patients. Dietary nutrients intake was assessed by a food frequency questionnaire in 420 of 780 participants. We found high BLLs were significantly associated with certain parameters of renal injury, and dietary intake of specific nutrients (mainly micronutrients) was associated with reduced BLLs at high percentile distribution of concentration. BLLs were also found to have moderation effects on the association between specific dietary nutrients and specific renal function parameters.

Adipocyte precursor cells from first degree relatives of type 2 diabetic patients feature changes in hsa-mir-23a-5p, -193a-5p, and -193b-5p and insulin-like growth factor 2 expression.

First-degree relatives (FDRs) of type 2 diabetics (T2D) feature dysfunction of subcutaneous adipose tissue (SAT) long before T2D onset. miRNAs have a role in adipocyte precursor cells (APC) differentiation and in adipocyte identity. Thus, impaired miRNA expression may contribute to SAT dysfunction in FDRs. In the present work, we have explored changes in miRNA expression associated with T2D family history which may affect gene expression in SAT APCs from FDRs. Small RNA-seq was performed in APCs from healthy FDRs and matched controls and omics data were validated by qPCR. Integrative analyses of APC miRNome and transcriptome from FDRs revealed down-regulated hsa-miR-23a-5p, -193a-5p and -193b-5p accompanied by up-regulated Insulin-like Growth Factor 2 (IGF2) gene which proved to be their direct target. The expression changes in these marks were associated with SAT adipocyte hypertrophy in FDRs. APCs from FDRs further demonstrated reduced capability to differentiate into adipocytes. Treatment with IGF2 protein decreased APC adipogenesis, while over-expression of hsa-miR-23a-5p, -193a-5p and -193b-5p enhanced adipogenesis by IGF2 targeting. Indeed, IGF2 increased the Wnt Family Member 10B gene expression in APCs. Down-regulation of the three miRNAs and IGF2 up-regulation was also observed in Peripheral Blood Leukocytes (PBLs) from FDRs. In conclusion, APCs from FDRs feature a specific miRNA/gene profile, which associates with SAT adipocyte hypertrophy and appears to contribute to impaired adipogenesis. PBL detection of this profile may help in identifying adipocyte hypertrophy in individuals at high risk of T2D.

The Proportion of Type 2 Diabetic Patients Achieving Treatment Goals and the Survey of Patients' Attitude Towards Insulin In tiation ini Patient s with Inadequate Glycaemic Control with Oral Anti-diabetic Drugs.

BACKGROUND: Type 2 diabetic patients often require insulin therapy for better glycaemic control. However, many of these patients do not receive insulin or do not receive it in a timely manner. OBJECTIVE: The study was planned to assess the proportion of type 2 diabetic patients attaining treatment goals as per the ADA 2018 guidelines. In addition, patient's perception of insulin therapy was assessed and compared between insulin naïve and insulin-initiated type 2 diabetic patients. METHODS: The study was conducted in type 2 diabetic patients. Data on their demographics, medical history, duration of diabetes, history of diabetes related complications, the current anti-diabetic medication received, and the most recent glycaemic parameters were all noted. Patient's perception of insulin initiation was recorded through a structured interview. RESULTS: A total of 129 patients were included in the study. Around 76.7% patients achieved HbA1c target (<7%). The duration of the disease is much higher in patients who did not meet the HBA1c target. A good number of patients felt that insulin injection would be physically painful (56.5%). The majority of the patients also felt that insulin would make their life less flexible (64.8%). Many patients have the opinion that insulin is required for life long (73.2%). More number of patients on insulin agreed with the statement 'Leads to good short-term outcomes as well as long-term benefits' compared to insulin naïve patients. CONCLUSION: The results highlight that the proportion of patients achieving the recommended glycaemic target is not satisfactory. Many patients who are inadequately controlled with oral anti-diabetic drugs were reluctant to initiate insulin.

Does reviewing fasting plasma glucose results patterns before glycosylated hemoglobin testing in type-2 diabetic patients lead to better testing decision?

AIMS: Glycosylated hemoglobin (HbA1c) test for blood glucose control in type-2 diabetic patients is recommended at least once annually under the guidelines of the Thai National Health Security Office (NHSO) benefits coverage. With limited resources and capability for HbA1c testing in most primary-care providers, this study explored patterns of fasting plasma glucose (FPG) tests for proper timing of HbA1c test would increase value of the money spent. METHODS: A retrospective review of laboratory findings of 4906 type-2 diabetic outpatients in two university hospitals in Thailand was conducted. Percentages of discordant results between the indexed FPG and HbA1c tests were compared between the patient groups with different FPG patterns before HbA1c testing and the control group of randomly selected cases. RESULTS: Having HbA1c tested after two and three consecutively normal FPG tests (OO and OOO patterns) were found to have significantly less discordance than the control group (-9.6% and -15.7%). HbA1c testing after two abnormal and one normal consecutive FPG tests (XXO pattern) gained the discordant results by 24.8%. CONCLUSIONS: Some FPG patterns were more predictive of HbA1c findings than focusing on one-time FPG results. Reviewing and recognizing certain patterns of FPGs prior to taking HbA1c tests can lead to better HbA1c testing decision than randomly prescribing the tests.

The perceived barriers to insulin therapy among type 2 diabetic patients.

BACKGROUND: Problems may arise with insulin treatment, due to patients' perspective towards it leading to refusal. OBJECTIVES: To evaluate diabetic patients' refusal towards insulin therapy, and to assess patients' perception and perceived barriers towards insulin. METHODS: A cross-sectionalstudy, where type 2 diabetics participated in the study during a period, February through March 2017. They were interviewed in person by a questionnaire including three sections; socio-demography, medical history and a health belief model, comprising barriers to use insulin. Five points Likert scale was used to measure patients' perception and barriers towards insulin therapy. RESULTS: One fourth (24.4%) of the diabetic patients refused insulin. Among the controlled group, 34.4% refused insulin, while 21% refused insulin among the uncontrolled group. The study showed different barriers towards insulin therapy, including fear of injection, pain, insulin injection needs help from others, fear of hypoglycaemia and embarrassment. CONCLUSION: Diabetics showed a negative attitude towards insulin therapy due to social and psychological factors. The results necessitate the development of a strategy to address problems related with a reluctance to initiate insulin and put a strategy to implement education and better interaction with diabetic team to the stigma from phobia from insulin use.

An assessment of counseling quality provided by community pharmacies to type 2 diabetic adult patients for oral therapy: a simulated patient study from Pakistan.

This study was conducted to assess quality of counseling provided to type 2 diabetic patients. For this cross-sectional study, a simulated patient method was applied in 562 selected community pharmacies of Punjab, Pakistan. A scenario for the metformin oral therapy was developed that illustrates direct counseling for adult diabetic patients. Counseling and communication skills were also assessed. Descriptive statistics and chi-square tests were used for analysis. Only 29.4% of simulated patients received medication counseling directly; 47.6% received it on request. About 32.8% of clients were referred to a physician without counseling. The most frequently provided information was dietary instruction (94.8%) and dose of therapy (84.5%). Only one quarter (25.3%) of simulated patients were asked about disease duration and similar rate (25.0%) was found for discussions of special warnings. The side effects, drug storage, drug-drug interactions and duration of therapy were ignored. Minimal information was provided about other medication during therapy (0.2%) and effect of medicine withdrawal (2.7%). About 59.5% simulated patients were instructed for compliance to medication. Counseling to type 2 diabetic patients in Pakistani community pharmacies is not very satisfactory. Pharmacies' staff have little focus on counseling. Professional training of staff could improve counseling and communication skills.

Effect of mobile learning (application) on self-care behaviors and blood glucose of type 2 diabetic patients.

PURPOSE: More than 70% of the health expenditure is related to chronic diseases. Therefore, an efficient managerial program can markedly reduce medical and administrative costs and benefit both patients and service providers. The use of mobile technologies can be very helpful in this regard. This study was conducted to determine the effect of mobile learning (application) on self-care behaviors and blood glucose control of type 2 diabetic patients attending the Diabetes Clinic of Imam Khomeini Hospital Complex. METHODS: This interventional, quasi-experimental study was conducted on 51 diabetic patients. The patients were randomly assigned to case and control groups, and a specifically designed application was used in the case group for three months. Self-care behavior, FBS, and HbA1C were assessed in both groups before and three months after the intervention, and the results were analyzed after the intervention. The Summary of Diabetes Self-Care Activities (SDSCA) measure and medical records was used for data collection. Descriptive and inferential statics (paired t test, ANCOVA analysis) were used for data analysis. RESULTS: The Mean ± SD of the self-care posttest score, FBS, and HbA1C was 76.95 ± 7.94 vs. 43.4 ± 9.74 (P = 0.001), 143.58 ± 23.39 vs. 171.81 ± 36.98 (P = 0.001), and 6.84 ± 0.63 vs. 8.10 ± 0.10 (P = 0,001), in the case and control group respectively, indicating a difference in all cases. CONCLUSIONS: The results indicated the positive effect of the mobile application on self-care behavior, FBS, and HbA1C.

The Gene Polymorphisms (-308G/A) and the Tumor Necrosis Factor-alpha Levels in Type 2 Diabetic Patients with and Without Tuberculosis Infection.

BACKGROUND: The gene polymorphism (-308G/A) and tumor necrosis factor-alpha (TNF-α) levels influence development of disease in type 2 diabetic patients and tuberculosis patients. AIM: In this study, we analyze the association between the TNF-α polymorphisms (-308G/A) and the levels of TNF-α in type 2 diabetic patients with and without tuberculosis infection. METHODS: This study was an analytic observational with cross sectional approach consisting 40 type 2 diabetic patients with tuberculosis infection, 40 type 2 diabetic patients without tuberculosis infection and 40 healthy control (HC) subjects. The TNF-α gene polymorphism (-308G/A) was analyzed with polymerase chain reaction-restriction fragment lengths polymorphisms (PCR-RFLP) method. The TNF-α levels were measured using an enzyme-linked immunosorbent assay. The association between gene polymorphism (-308G/A) in study groups was analyzed by Fisher's exact test, tumor necrosis factor-alpha (TNF-α) levels in study groups was carried out using the Kruskal-Wallis test. Hardy-Weinberg Equilibrium also determined genotype deviation and allele frequencies. RESULTS: The GG and GA+AA genotypes frequency in both of patient groups and HC subjects were not differ significantly (95% and 5% vs 95% and 5% vs 92.5% and 7.5%; p > 0.05). The TNF-α levels (pg/ml) of type 2 diabetic without tuberculosis infection were higher than those of type 2 diabetic with tuberculosis infection and HC subjects (7.42 ± 0.78 vs 2.23 ± 0.51 vs 2.57 ± 0.63; p < 0.01). The TNF-α levels in the GA+AA genotypes were higher than the GG wild-type genotype (p > 0.05). There was no significant deviation of genotype frequency and allele from Hardy-Weinberg Equilibrium. CONCLUSION: The gene polymorphism (-308G/A) had no association with type 2 diabetic patients with and without tuberculosis infection and the gene polymorphism (-308G/A) was not influence the TNF-α levels but there was a significant differentiation of TNF-α levels between the groups.

Association between physical activity and glycemic control among type 2 diabetic patients with a good compliance level / 中华疾病控制杂志

Objective To examine the relationship between physical activity and glycemic control among type 2 diabetic patients with a good compliance level in China. Methods A total of 1 272 patients diagnosed with type 2 diabetes with a good compliance level were recruited from five community health centers in Nanjing Chemical Industry Administrative Zone from 2014 to 2016. Logistic regression models were used to examine the relationship between physical activity and glycemic control. Results In this cross-sectional study, 1 272 type 2 diabetic patients (596 men and 676 women) were recruited. The participants’ mean (standard deviation, SD) age was (64.63±9.04) years old. Male participants who achieved sufficient physical activity had the odds ratio (OR) of 2.11 (95%CI:1.17-3.18, P=0.013) for a tight glycemic control compared to their counterparts who had sufficient physical activity, after controling for the potential confounders, no significant association between physical activity and glycemic control status existed in women. Conclusions Physical activity is positively associated with glycemic control among male type 2 diabetic patients who had a good compliance level in Nanjing. Specific physical activity interventions should be implemented to type 2 diabetic patients

Prevalence and clinical characteristics of dry eye disease in community-based type 2 diabetic patients: the Beixinjing eye study.

BACKGROUND: This study was performed to evaluate the prevalence and clinical characteristics of dry eye disease (DED) in community-based type 2 diabetic patients and to identify the associated factors related with DED. METHODS: A total of 1360 type 2 diabetic patients in the Beixinjing community were randomly selected. All participants were given a questionnaire that assessed basic information and subjective symptoms.DED was diagnosed using the revised Japanese DED diagnostic criteria. All subjects underwent a routine ophthalmic examination, corneal sensitivity test, tear film break-up time(BUT) test, Schirmer I test, fluorescein and lissamine green staining(FL) and fundus photography. Diabetic retinopathy (DR) was graded according to the International severity scale of diabetic retinopathy and diabetic macular edema. RESULTS: Of the 1360 subjects, 238 (17.5%) were diagnosed with DED. There was a significant association between the presence of DED and higher blood glucose (P < 0.001, OR1.240) as well as higher levels of glycosylated hemoglobin HbA1c (P < 0.001, OR1.108). Corneal sensitivity was negatively correlated with the prevalence of DED (P = 0.02, OR0.973). CONCLUSIONS: The prevalence of DED in this community-based study was 17.5%, which was lower than that observed in hospital-based studies. Diabetic patients with poor metabolic control were more likely to present with DED. A dry eye examination should be added to the routine screening of diabetes.

Effect of Anagliptin and Sitagliptin on Low-Density Lipoprotein Cholesterol in Type 2 Diabetic Patients with Dyslipidemia and Cardiovascular Risk: Rationale and Study Design of the REASON Trial.

BACKGROUND: Reduction of low-density lipoprotein cholesterol (LDL-C) is important for patients with a high risk for atherosclerotic events, such as patients with diabetes and other risk factors. Anagliptin was reported to reduce LDL-C for 12 weeks in phase III trials regardless of the use of statins, but it is uncertain whether this effect is common to other dipeptidylpeptidase-4 (DPP-4) inhibitors. METHODS: A multicenter, randomized, open-label, parallel-group trial was conducted to confirm the superiority of anagliptin to sitagliptin in terms of the primary endpoint of reduction of LDL-C for 52 weeks in patients with type 2 diabetes and atherosclerotic vascular lesions, as well as the non-inferiority of anagliptin to sitagliptin in terms of change in hemoglobin A1c (HbA1c). Patients are randomly assigned to receive anagliptin or sitagliptin at a ratio of 1:1, with those in the anagliptin group receiving anagliptin 100 mg orally twice per day and those in the sitagliptin group receiving sitagliptin 50 mg orally once per day. During the trial period, hypoglycemic agents and anti-dyslipidemia drugs should not be added and neither should their dosages be changed. A total sample size of 300 was estimated to provide a power of 0.8 with a two-sided alpha of 0.05 for LDL-C, considering a 30% dropout rate. Pre-specified factors for subgroup analyses are HbA1c, use of DPP-4 inhibitors, sex, body mass index, LDL-C, age, and the presence of treatment for existing ischemic heart disease. DISCUSSION: If anagliptin were to be shown to reduce LDL-C in patients with type 2 diabetes and atherosclerotic vascular lesions despite pre-existing statin treatment, more intensive cholesterol management would be appropriate. TRIAL REGISTRATION: Clinicaltrials.gov NCT02330406.

Relationship between serum irisin, glycemic indices, and renal function in type 2 diabetic patients.

Introduction: Irisin is a novel peptide that plays notable role in human and animal biology and physiology. It has been reported that irisin may improve insulin resistance and related disturbances. Objectives: The aim of this investigation was to assess the relationship between serum irisin, glycemic indices, and renal function in diabetic subjects. Patients and Methods: In this cross-sectional study, a total of 102 type 2 diabetes mellitus (T2DM) patients were recruited. Blood biochemical parameters, including fasting plasma sugar (FBS), glycosylated hemoglobin (HbA1C), serum uric acid (sUA), creatinine concentration and glomerular filtration rate (GFR) were measured. All statistical analysis was performed with SPSS 16.0. Results: There was a positive correlation between irisin and age (P=0.05, r=0.19) and a negative correlation between irisin and body mass index (BMI) (P=0.01, r=-0.25) was detected. There was a significant difference of serum irisin level between patients with normal and abnormal FBS too. Conclusion: In this study we found, irisin concentration was increased with age, decreased with BMI, and it was higher in subject with abnormal FBS. Thus further research is needed to provide inclusive understanding of irisin associated physiological effects and possible implications in clinical conditions.

Association of retinol-binding protein 4 with metabolic syndrome in first-degree relatives of type 2 diabetic patients.

BACKGROUND: Retinol-binding protein 4 (RBP4) is known to regulate lipid and glucose metabolism and insulin resistance. The influences of RBP4 on metabolic syndrome (MS) are still unclear. The purpose of this study is to evaluate the association between serum levels of RBP4 and MS components in first-degree relations of type 2 diabetic patients. MATERIALS AND METHODS: This cross-sectional study was performed within the framework of the diabetes prevention project in Isfahan. This study has been conducted during 2012-2013. Seventy-eight subjects participate, with an average age of 43.20 ± 5.29 years. Weight, height, waist and hip circumferences, blood pressure (BP) of participants, fasting plasma glucose, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, triglyceride (TG), and serum RBP4 were measured from fasting blood sample taken from each participant after an overnight fast (12-14 h). RESULTS: Systolic and diastolic BP were significantly higher in people in top median of RBP4 (11.8 ± 1.5 vs. 11.0 ± 1.2, P = 0.01 and 7.8 ± 1.0 vs. 7.3 ± 0.9, P = 0.03). Moreover, TG in people with high levels of RBP4 was higher compared with those with low levels of RBP4 (177.7 ± 97.6 vs. 138.7 ± 56.9, P = 0.02). People with low levels of RBP4 had significant greater hip circumferences (107.9 ± 7.5 vs. 104.3 ± 8.0, P = 0.04). There was no correlation between RBP4 and MS in crude model (odds ratio [OR]: 1.00, 0.95-1.05, P = 0.97). This null correlation remained after adjustment for body mass index, age, and physical activity (OR: 0.93, 0.91-1.07, P = 0.31). CONCLUSION: Although RBP4 levels were positively association with some risk factors of MS including hip circumference, TG, and systolic and diastolic BP, it does not seem to be a valuable marker for identification of the MS in the first relative degree of diabetic patients.

Malabsorption, Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Type 2 Diabetic Patients: A Connection.

Type 2 diabetes mellitus consists of dysfunctions characterized by hyperglycemia and resulting from combination of resistance to insulin action and inadequate insulin secretion. Most of diabetic patients report significant gastrointestinal symptoms. Entire GI tract can be affected by diabetes from oral cavity to large bowel and anorectal region. Proteins, carbohydrates, fats, and most fluids are absorbed in small intestine. Malabsorption may occurs when proper absorption of nutrients does not take place due to bacterial overgrowth or altered gut motility. The present study was planned to measure various malabsorption parameters in type 2 diabetic patients. 175 patients and 175 age and sex matched healthy controls attending Endocrinology Clinic in PGI, Chandigarh were enrolled. Lactose intolerance was measured by using non-invasive lactose hydrogen breath test. Urinary d-xylose and fecal fat were estimated using standard methods. Orocecal transit time and small intestinal bacterial overgrowth were measured using non-invasive lactulose and glucose breath test respectively. Out of 175 diabetic patients enrolled, 87 were males while among 175 healthy subjects 88 were males. SIBO was observed in 14.8 % type 2 diabetic patients and in 2.8 % of controls. There was statistically significant increase (p < 0.002) in OCTT in type 2 diabetic patients compared with controls. OCTT was observed to be more delayed (p < 0.003) in patients who were found to have SIBO than in patients without SIBO. Lactose intolerance was observed in 60 % diabetic patients and 39.4 % in controls. Urinary d-xylose levels were also lower in case of diabetic patients but no significant difference was found in 72 h fecal fat excretion among diabetic patients and controls. Urinary d-xylose and lactose intolerance in SIBO positive type 2 diabetic patients was more severe as compared to SIBO negative diabetic patients. From this study we can conclude that delayed OCTT may have led to SIBO which may have instigated the process of malabsorption among type 2 diabetic patients.

The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis.

BACKGROUND: Diabetic mellitus and periodontal disease have bilateral associations. However, there is a dilemma on the effect of periodontal therapy on glycemic control and/or fasting plasma glucose level in type 2 diabetic patients with periodontitis. Therefore, this review aimed to assess the effectiveness of periodontal therapy versus no periodontal therapy on glycated hemoglobin (HbA1c) and fasting plasma glucose level in type 2 diabetic patients. METHODS: Article searching was done using four databases (MEDLINE, Cochrane library (CENTRAL), EMBASE and CINAHL) and a manual search (until December 2015). We included randomized controlled trials testing the effectiveness of periodontal therapy on glycated hemoglobin and fasting plasma glucose level in patients with type 2 Diabetes mellitus with periodontal disease. Studies published in English between 2005 and 2015 were included. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. RESULTS: After the article selection process, seven Randomized controlled trials involving 940 participants with a primary outcome of change in glycated hemoglobin and/or fasting plasma glucose and having a minimum of 3 months follow-up were included. There was a reduction of glycated hemoglobin 0.48(95 % CI: 0.18-0.78) after 3 months follow-up and 0.53 (95 % CI: 0.24-0.81) at the end of the intervention period. There was also a significant reduction of fasting plasma glucose level, 8.95 mg/dl (95 % CI: 4.30-13.61) in the intervention group after the end of the intervention. The pooled analysis showed that patients with adjunctive antibiotic therapy and mouth wash had effect size of 0.51(0.03, 1.00, p = 0.04) and it was 0.53 (95 % CI: 0.19, 0.87; p = 0.002) in patients without adjunctive therapy. The publication bias of the studies was 0.066 according to Egger's test. CONCLUSION: In this systematic review and meta-analysis, there is a significant reduction of Glycated hemoglobin and Fasting plasma glucose level on type 2 diabetic and periodontal patients with non-surgical periodontal therapy.