Local Diffusion Homogeneity Provides Supplementary Information in T2DM-Related WM Microstructural Abnormality Detection

Background: Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of type 2 diabetes mellitus (T2DM) with a prevalence ranging from 18.8% to 61.9% in India. For patients with T2DM, identifying those who are at risk of developing DPN is crucial for planning and implementing secondary preventive interventions, as well as for stepping up efforts to address risk factors. Very few studies have discovered a connection between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms and the onset and progression of DPN in T2DM. Objectives: The current study intends to investigate the relationship between ACE gene I/D polymorphism with T2DM and DPN subjects among the South Tamil Nadu regional population. Materials and Methods: Thirty T2DM patients with DPN, 30 T2DM patients without DPN, and 30 control (nondiabetic) subjects were enrolled in this study. DPN was diagnosed using clinical and neurophysiological evaluation. Blood samples were collected and subjected to relevant investigations including blood glucose, glycated hemoglobin, serum creatinine, and serum lipids. Polymerase chain reaction amplification was performed to genotype the DNA for ACE I/D polymorphism using specific primers. Results: The ACE genotypes were distributed as II, 17 (57%); DD, 3 (10%); and ID, 10 (33%) in control group; II, 7 (23%); DD, 11 (37%); and ID, 12 (40%) in T2DM without DPN group, II, 3 (10%); DD, 16 (53%); and ID, 11 (37%) in T2DM with DPN group. The frequency of DD genotype was significantly higher in T2DM (P = 0.03) and T2DM patients with DPN (P = 0.001) compared to controls. The DD genotype versus II genotype was found to be associated with an increased risk of DPN (odds ratio [OR] = 10.28; 95% confidence interval [CI] =2.55–41.37). The D allele was more frequent among T2DM patients with DPN (71.6%) followed by T2DM patients (56.6%) compared to controls (26.6%). The D allele (vs. the I allele) is associated with an increased risk of T2DM (OR = 3.59, 95% CI = 1.670–7.742) and DPN (OR = 6.95, 95% CI = 3.120–15.507). Conclusion: The D allele and DD genotype of the ACE gene may both be risk factors for T2DM; in fact, the D allele of this polymorphism may potentially be linked to the development of DPN in T2DM patients. This finding implies that it may be possible to prevent DPN by early detection by identifying defects in ACE I/D polymorphisms in the south Indian regional population.

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease caused by insulin resistance, impaired insulin secretion, and increased hepatic sugar production. T2DM is a type of DM with the most common occurrence. Gene mutation is a risk factor for T2DM. The most common mutations in T2DM are mutations in the tRNALeu A3243G DNA Mitochondria DNA gene. Objective: This study aimed to investigate the presence of mutations in the tRNALeu A3243G gene in T2DM patients in Bali. Materials and Methods: This study’s design was a cross-sectional study using 76 stored biological samples consisting of whole blood from T2DM patients in Bali. The technique used to identify this mutation is polymerase chain reaction and sequencing to detect base substitution from A to G at codon 3243. Results: From the results of the sequencing method of 76 samples, no mutations in the tRNALeu A3243G mitochondria DNA gene in T2DM patients in Bali. The absence of mutation may happen adieu to sample limitation and the location sources of the sample. Conclusions: This study did not detect any tRNALeu A3243G mitochondrial DNA mutation in 76 T2DM patients in Bali. Further research with larger sample sizes and diverse tissue sources is recommended.

Objective: Prognosis in Type 1 diabetes mellitus (T1DM) patients is constantly improving and the role of other cardiovascular risk factors, e.g. hypertension is gradually increasing. The effective management of both conditions is important for the prevention of cardio-vascular diseases (CVD). Aim: to assess the blood pressure (BP) in patients with long-duration T1DM compared to controls and to evaluate arterial hypertension (AH) management in them. Design and method: A study of 124 patients of T1DM at a mean age 42.68 ± 10.4 years, 53% males, with a median duration of T1DM 24 years and mean HbA1c 8.42 ± 1.75% and 59 age- and sex matched controls. BP was measured twice with a calibrated sphygmomanometer and the mean of both measurements was used. AH was defined as BP> 140/90 mm Hg or history of AH or on antihypertensive treatment. Results: The mean systolic BP (SBP) in T1DM patients was significantly higher than in controls – 128.17 ± 18.87 vs 121.13 ± 1.26, p = 0.008, with no interaction with gender. Diastolic BP was not significantly higher – 80.28 ± 10.02 vs 77.98 ± 10.72, p = 0.16. AH was twice more prevalent in T1DM patients than in controls – 67 (54%) and 17 (27%), resp. (p = 0.001). It was due to already known hypertension - 51 (41%) vs 12 (20%), p = 0.001 while incident AH cases were equally found in T1DM and controls – 15 (25.4%) vs 4 (25%). Control of AH < 140/90 mmHg was achieved in only 35.8% of the patients with T1DM and in 37.5% of the controls, while BP< 130/80 mm Hg was even less frequent in both categories – 13.4% vs 12.5% (p = NS). Untreated were 24 (29%) of all hypertensive participants, combination treatment was prescribed in 32 (39%) and monotherapy – in 26 (32%). ACE-inhibitors were the preferred antihypertensive class, followed by beta-blockers, ARBs, diuretics, and CCBs. Conclusions: SBP is significantly higher in T1DM patients than in their healthy peers, irrespective of gender. The prevalence of AH is higher in diabetic patients with long duration even at still relatively younger age. The BP control is far from optimal in the studied population which requires more aggressive management to prevent CVD occurrence.

IDF21-0074 Role of methylglyoxal modified low density lipoprotein in type 2 diabetes mellitus and its role in periodontal disease

Introduction: Diabetic ketoacidosis (DKA) is traditionally associated with type 1 diabetes mellitus (T1DM) but is increasingly observed in type 2 diabetes mellitus (T2DM). Despite notable pathophysiological differences between these conditions, current DKA management follows standardized protocols regardless of diabetes classification. This “one-size-fits-all” approach raises concerns about potential treatment-related metabolic complications that are specific to distinct diabetes phenotypes.Objectives: To compare the rates of metabolic complications - specifically hypoglycemia and hypokalemia - during the initial management of DKA between T1DM and T2DM patients and identify associated factors. Secondary outcomes included evaluating the length of hospital stay (LOS), complication rates, and in-hospital mortality, and identifying predictors of hypoglycemia and hypokalemia during DKA treatment.Methods: A retrospective cohort study of DKA admissions at Penang General Hospital, Malaysia, was conducted between 2019 and 2023. Data on DKA admissions, metabolic complications, and hospitalization outcomes were extracted and analysed.Results: We reviewed the case records of 215 DKA admissions: 100 (46.5%) T1DM, 115 (53.5%) T2DM. The prevalence of hypoglycemia was significantly higher in patients with T1DM compared to T2DM (33/100, 33.0% vs 18/115, 15.7%, p=0.003). Conversely, the prevalence of hypokalemia did not differ significantly between the groups (55/100, 55.0% vs 62/115, 53.9%, p=0.873). Multivariate analysis identified T1DM and low body weight as independent predictors of hypoglycemia. Independent predictors for hypokalemia included low pH, low initial serum potassium, shorter diabetes duration, and absence of nephropathy. Patients with T1DM had a lower observed mortality rate (0/100, 0.0% vs 4/115, 3.5%) and fewer 30-day readmissions (4/100, 4.0% vs 10/115, 8.7%) compared to T1DM, but not statistically significant. T1DM patients required more intensive care, whereas T2DM patients experienced significantly longer hospital stays and higher rates of nosocomial infection.Conclusion: Significant differences exist in both metabolic safety profiles and clinical trajectories when managing T1DM and T2DM patients with DKA. While T1DM patients are prone to hypoglycemia, T2DM patients carry a higher burden of comorbidities leading to prolonged hospitalization and infection risks. Tailoring DKA management strategies specifically to diabetes type may reduce treatment-related complications and improve overall clinical outcomes.

Introduction and Aim:Atherosclerotic cardiovascular disease (ASCVD)and Framingham score (FRS) are two important scores used for the prediction of coronary events in an individual.Both of these scores do not account for certain known predisposing factors such as BMI, duration of diabetes, LDL cholesterol and glycemic index levels among type 2 diabetes mellitus (T2DM) subjects. So, this study aims to assess whether addition of any of these important risk factors might help in improving these scoring systems in T2DM patients.
 Methodology: Our study is a cross-sectional study which included 320 T2DM patients without CAD and 120 T2DM patients with CAD. Duration of T2DM, BMI, glycated hemoglobin and fasting lipid profile values of the T2DM patients were recorded from the Laboratory information system.
 Results: IBM Statistical Package for the Social Sciences (SPSS) 16 version was used for statistical analysis. T2DM patients with CAD had more years of duration of T2DM than the patients without CAD and a significant association was found (p=.045*). A strong significant positive correlation was observed between FRS score and duration of T2DM in diabetic patients with CAD (r=.331, p=<.0001*).
 Conclusion:Our observations imply that inclusion of important parameter such as duration of T2DM might improve in better calculation of these risk scores in T2DM patients. Future studies are needed to assess the performance of existing risk scores by including important parameter such as duration of diabetes which might help in improving these scoring systems in T2DM patients.

Type 2 diabetes mellitus (T2DM) in children and adolescents is becoming an increasingly important public health concern throughout the world. This study aimed to estimate the frequency of T2DM among diabetic young people in El-Minia Governorate, Egypt, and to detect its risk factors. A total of 210 diabetic patients under 18 years old in Minia Governorate were included in the study and underwent a thorough history-taking, a physical examination and laboratory investigations. T2DM was present in 28 patients (13.3%); it was significantly present in 18 females (64.3%) and 20 (71.4%) of them had a positive family history of DM. T2DM patients had significantly higher BMI and waist circumference centiles for age and sex than those with T1DM. Also, haemoglobin A1c %, serum C-peptide and cholesterol levels were significantly higher in T2DM than T1DM patients. Finally, there were weak significant positive correlations between C-peptide level and both BMI and waist circumference. T2DM is no longer a disease of adults but can also occur in children and adolescents. The results suggested that obesity, female gender and a positive family history of DM are risk factors for T2DM. Also, patients with T2DM had poorer glycaemic control and hypercholesterolemia than those with other types of diabetes.

AimTo explore the relationship between inflammatory biomarkers and cognitive dysfunction in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).MethodsT1DM patients (n=32), T2DM patients (n=90) and age-matched controls (n=36 and 81, respectively) were included. The 72-hour dynamic blood glucose test and cognitive function, including visuoconstructive function, executive function, learning and memory, attention, language expression ability, and orientation, were analyzed. The head, body and tail grey matter of the hippocampus were analyzed by magnetic resonance spectroscopy. In addition, serum HMGB1, IL-1β, IL-6, and TNF-α concentrations were examined.ResultsHbA1C, MAGE and MODD were higher in T1DM patients than in T2DM patients (p<0.05). MoCA scores and IL-1β and IL-6 levels in patients with T2DM were higher than T1DM patients. NAA/Cr and Cho/Cr of the hippocampus were higher in patients with T1DM than in those with T2DM. Levels of inflammatory factors in T1DM and T2DM patients were higher than in nondiabetic subjects (p<0.05). Regression analysis showed that cognition was associated with MAGE, MODD, NAA/Cr of the left hippocampus and HMGB1 in T1DM patients, after adjustment for age, sex, BMI and other co-variables. In T2DM patients, cognitive impairment was associated with MAGE, NAA/Cr of the left hippocampus, HMGB1 and IL-6, after adjustment for co-variables such as sex, age and BMI.ConclusionT2DM patients have more cognitive impairment than T1DM patients. Changes in brain function connections and metabolites may be the structural basis of the differences in cognitive functional impairment. Inflammation is related to cognitive impairment in diabetes patients, especially in T2DM patients.

Diabetic nephropathy (DN) is a major cause of type 2 diabetes mellitus (T2DM) mortality. Innate immunity has been shown to be closely associated with the occurrence and progression of T2DM-associated complications. In this study, we investigated the expression of Toll-like receptor 4 (TLR4) and CD14(+)CD16(+) monocytes in patients with T2DM and DN patients with uremia and TLR4 response to lipopolysaccharide (LPS), and to further explore the potential effects of inflammatory immune response in T2DM and DN uremia. Thirty DN patients with uremia, 28 T2DM patients, and 20 healthy volunteers were enrolled for the determination of CD14(+)CD16(+) fluorescence intensity and TLR4 expression on monocytes by using peripheral blood flow cytometry. Serum C-reactive protein (CRP) level was determined by using the immunoturbidimetry. Peripheral blood mononuclear cells (PBMCs) were isolated and stimulated with LPS for 24 h. monocytes were collected to detect NF-κB p65 and phosphorylated STAT5(p-STAT5) expressions by using Western blotting. Supernatants were sampled for the determination of interleukin-6 (IL-6) concentration by using ELISA. Compared to normal control, T2DM patients and DN uremic patients had a significantly higher CD14(+)CD16(+) fluorescence intensity, TLR4 expression, serum IL-6 and CRP level, whilst these biomarkers were more upregulated in DN uremic patients than in T2DM patients. Following the exposure to LPS, PBMCs showed a significant upregulation in NF-κB-p65 and p-STAT5 expression and a remarked increase in Supernatants IL-6 level, in a positive correlation with disease severity. Our results suggest that the disturbance in proinflammatory CD14(+)CD16(+) monocytes occurs in T2DM and DN uremic patients. Such immunological dysfunction may be related to the activation of TLR4/NF-κB and STAT5 signaling pathways underlying the immune abnormalities of CD14(+)CD16(+) monocytes.

Type 2 diabetes mellitus (T2DM) is a long-term metabolic disorder. It is characterized by hyperglycemia, insulin resistance (IR), and relative impairment in insulin secretion. IR plays a major role in the pathogenesis of T2DM. Many previous studies have investigated the relationship between estrogen, androgen, and obesity, but few focused on the relationship between sex hormones, abnormal lipid metabolism, and IR. The goal for the present study was to identify the association of IR with sex hormone, abnormal lipid metabolism in type 2 diabetes, and impaired glucose tolerance (IGT) patients.In total 13,400 participants were analyzed based on the results of the glucose tolerance test. Using a cross-sectional study, we showed the relationship between IR and the level of sex hormones among 3 different glucose tolerance states: normal control people, IGT, and T2DM patients. We also analyzed the relationship between IR and abnormal lipid metabolism.Significantly, luteinizing, progesterone, estradiol, prolactin, and follicle-stimulating hormone levels decreased in T2DM and IGT patients compared with those in normal control people. The association between IR and lipid metabolism disorders in T2DM and IGT patients was also observed.Our clinical findings may offer new insights into understanding the mechanism of metabolic disorders and in new therapeutic methods for the treatment of the prevalence of type 2 diabetes.

Objective To investigate the relationship between apolipoprotein E (APOE) gene polymorphism and cerebral infraction (CI) in Chinese type 2 diabetes mellitus (T2DM) patients. Methods This study included 245 samples of T2DM patients without cerebral infraction (CON group) (Male/Female, 128/117) and 270 samples of T2DM patients with cerebral infraction (CI group)(Male/Female, 145/125) from the department of endocrinology and neurology utilizing real-time fluorescence quantitative PCR technique. The t test and χ2 test were used to compare the differences between the two groups. Results Patients with a history of hypertension in the CI group (84.12%) were significantly higher than those in the CON group (70.42%) (χ2=15.91, P<0.05).The systolic blood pressure (142.78±20.52)mmHg of the CI group was significantly higher than that of the CON group (133.89±18.58)mmHg (t=-5.16, P<0.05).Compared with CON group, the frequency of genotypes of e2/e3 and e3/e4 in CI group was significantly higher, while the frequency of e3/e3 genotype was significantly lower (χ2=11.48, P<0.05); the allele frequency of APOE e4 was higher while e3 was lower in CI group than that in CON group (χ2=7.00, P<0.05). Logistic regression analysis showed that hypertension history (OR=1.95, P<0.05), high systolic blood pressure (OR=1.02, P<0.05), APOE genotypes of e2/e3 (OR=2.08, P<0.05) and e3/e4 (OR=1.85, P<0.05) were independent risk factors for cerebral infarction in T2DM patients. Conclusion The polymorphism of APOE gene may be related to cerebral infraction in Chinese T2DM patients. Key words: Diabetes mellitus, type 2; Diabetic angiopathies; Brain infarction; Apolipoprotein E4; Polymorphism, genetic

Background:Dietary quality indices are practical as an instrument to investigate the extent of adhering to a special diet to prevent cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Considering the lack of any systematic review with regards to this issue, our aim was to examine observational studies to test the relationship between dietary quality indices and CVD risk factors in T2DM.Methods:Systematic search was performed in Web of knowledge, PubMed, Cochrane, Science direct, Google Scholar and Scopus databases from January 1990 to July 2020. The studies exploring the relationship between dietary quality indices (diet quality score (DQS), dietary diversity score (DDS), healthy diet indicator (HDI), healthy eating index (HEI), diet quality index (DQI), Mediterranean diet score (MDS)) and lipid profile, anthropometric indices, glucose profile as well as blood pressure were eligible to be included in this review. Overall, mean changes, odd ratio (RR), correlation coefficients, and beta coefficient of outcomes were extracted, with the quality assessment of studies performed applying The Newcastle-Ottawa scale.Results:From among 1627 papers, 10 articles were included: Eight cross-sectional and two prospective (cohort) studies. The association between HEI as well as MDS and CVD risk factors was more evident in the included studies. Fasting blood sugar, hemoglobin A1c, body mass index, and waist circumference revealed the greatest inverse significant relationship with dietary quality indices in adults with T2DM.Conclusion:Overall, the findings of this study suggest that the level of CVD risk factors in T2DM decreases significantly with increase in the score of dietary quality indices. Further studies in future are required to confirm these findings.

In China, the prevalence of type 2 diabetes mellitus (T2DM) among diabetic patients is estimated to be between 90%-95%. Additionally, China is among the 22 countries burdened by a high number of tuberculosis cases, with approximately 4.5 million individuals affected by active tuberculosis. Notably, T2DM poses a significant risk factor for the development of tuberculosis, as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis (T2DM-PTB), which has risen from 19.3% to 24.1%. It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature. To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis (T2DM-PTB), as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM. T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group, Simple DM patients presenting to our hospital in the same period were the control group, Controls and case groups were matched 1:2 according to the principle of the same sex, age difference ( ± 3) years and disease duration difference ( ± 5) years, patients were investigated for general demographic characteristics, diabetes-related characteristics, body immune status, lifestyle and behavioral habits, univariate and multivariate analysis of the data using conditional logistic regression, calculate the odds ratio (OR) values and 95%CI of OR values. A total of 315 study subjects were included in this study, including 105 subjects in the observation group and 210 subjects in the control group. Comparison of the results of both anthropometric and biochemical measures showed that the constitution index, systolic blood pressure, diastolic blood pressure and lymphocyte count were significantly lower in the case group, while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group. The results of univariate analysis showed that poor glucose control, hypoproteinemia, lymphopenia, TB contact history, high infection, smoking and alcohol consumption were positively associated with PTB in T2DM patients; married, history of hypertension, treatment of oral hypoglycemic drugs plus insulin, overweight, obesity and regular exercise were negatively associated with PTB in T2DM patients. Results of multivariate stepwise regression analysis found lymphopenia (OR = 17.75, 95%CI: 3.40-92.74), smoking (OR = 12.25, 95%CI: 2.53-59.37), history of TB contact (OR = 6.56, 95%CI: 1.23-35.03) and poor glycemic control (OR = 3.37, 95%CI: 1.11-10.25) was associated with an increased risk of developing PTB in patients with T2DM, While being overweight (OR = 0.23, 95%CI: 0.08-0.72) and obesity (OR = 0.11, 95%CI: 0.02-0.72) was associated with a reduced risk of developing PTB in patients with T2DM. T2DM-PTB patients are prone to worse glycemic control, higher infection frequency, and a higher proportion of people smoking, drinking alcohol, and lack of exercise. Lymphopenia, smoking, history of TB exposure, poor glycemic control were independent risk factors for T2DM-PTB, and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

Patients with type 2 diabetes mellitus (T2DM) are prone to developing diabetic peripheral neuropathy (DPN) with an increased risk of injuries while walking, potentially leading to plantar ulcers. We aimed to assess the early gait changes in T2DM patients without clinical signs of DPN in comparison to age-matched healthy controls (HC). One hundred T2DM patients (78 women, mean age: 66.4 ± 11.5 years) and 50 age-matched HC (34 women, mean age 62.1 ± 7.9 years) were evaluated with the PODOSmart® gait analysis device. Anthropometric and biochemical data, as well as dietary habits were collected for all participants. T2DM patients also completed the Diabetes Distress (DS) self-report validated questionnaire. One patient was excluded from the study due to lack of recent biochemical data. Among the T2DM patients, 88.9% reported little or no DS and 11.1% moderate DS. The T2DM group had higher body mass index, waist circumference, systolic blood pressure, glycated hemoglobin A1c, sodium, white blood cell count, triglycerides and low-density lipoprotein cholesterol, but lower high-density lipoprotein cholesterol than HC (p < 0.05 for all comparisons). The MedDiet score was satisfactory in both groups (p > 0.05). Significant differences were found between the two study groups in gaitline heel off, propulsion speed, foot progression angle, time taligrade phase, stride length, walking speed, angle attack, oscillation speed, pronation-supination toe off and clearance. The T2DM patients without self-reported DS or clinical signs of DPN may exhibit significant differences in several gait parameters analyzed with PODOSmart®. Whether gait analysis can be used as an early diagnostic tool of T2DM complications should be further explored.

Aim: To evaluate serum renalase and salivary alpha amylase concentrations and their relationship with plasma catecholamine levels in patients with Metabolic Syndrome (MS), Type 2 Diabetes Mellitus (T2DM), and End-Stage Renal Disease (ESRD). Method: In cross-sectional study 163 patients were enrolled; 43 patients with MS, 93 withT2DM, 13 with ESRD, and 14 healthy subjects (control group). All patients had their ascription to the UMAA/UMF No. 75, in Morelia, Michoacan, Mexico. Glucose, creatinine, cholesterol, triglycerides, HDL, and renalase were measurement in serum, and Dopamine (DA), Epinephrine (E) and Norepinephrine (NE) in plasma. An aliquot of saliva was collected for alpha amylase determination. Results: High plasma concentrations of DA, E and NE (p&lt;0.0001) was founded in T2DM and ESRD patients. Renalase was lower in ESRD compared to MS and T2DM patients (p&lt;0.0001). High concentrations of alpha amylase were found in MS, T2DM, and ESRD patients in comparison with control group (p&lt;0.0001). Catecholamines correlated positively with alpha amylase and diabetes evolution. Conclusion: Sympathetic hyperactivity in MS, T2DM and ESRD patients was founded. Renalase could be proposed as biomarker of renal function and salivary alpha amylase as sympathetic hyperactivity. Additional studies are required to evaluate the pathophysiological mechanisms involved of SNS in CKD development.