Dyslipidemia associated with poor glycemic control in type 2 diabetes mellitus and the protective effect of metformin supplementation

Type 2 diabetes mellitus risk assessment among Alrass city employees, Qassim, Saudi Arabia

Background

Diabetes mellitus (DM) is a serious chronic disease that can affect all parts of human body and associated with short-term and long-term complications such as retinopathy, nephropathy, and neuropathy. Age, obesity, family history, and hypertension are considered to be the most common risk factors for the incidence of DM. This study aimed to assess the risk of type 2 diabetes among governmental employee in Alrass city in Qassim, Saudi Arabia.

Material and Methods

A cross-sectional survey was done using health professional-administrated questionnaire. Two groups of data collectors were formed and trained to fill out the questionnaire, each group was consist of 1 family medicine doctor and 4 nurses. Data were entered and analyzed using SPSS v. 26.

Results

A total of 527 subjects participated in our study with a response rate of 100%. Of them, more than half (55%) were females. Approximately all of our participants were Saudi 92% regarding age, more than three quarters (79.5%) were aged less than 45 years, 15.6% were ranged from 45 to 50 years, and 4.9% were from 55 to 64 years. We reported no significant correlation between gender and nationality regarding the risk of DM.

Conclusion

Saudi females who aged less than 45 years and obese participants had a risk for developing DM.

Prevalence of Glycemic Control and Factors Associated With Poor Glycemic Control: A Systematic Review and Meta-analysis

The primary method for preventing health and health-related problems in diabetic people is glycemic control. Numerous studies have documented the importance of glycemic control and the factors that influence it. However, the results are dispersed. This study sought to identify the prevalence of poor glycemic control and associated factors in Ethiopia. Findings will be crucial to reduce the burden of poor glycemic control. Comprehensive search was performed from databases: PubMed, Global Health, CINAHL, IRIS, and FSTA. Gray literature sources were also explored. This document was prepared based on the PRISMA flowchart. The protocol is registered in PROSPERO (ID: CRD42022296583). STATA software was used for data analyses and I2 test with Cochrane Q statistics, and forest plot were used to verify heterogeneity. When the I2 value was higher than 50% and the p-value was 0.05, heterogeneity was deemed significant. To confirm publication bias, a funnel plot with an Egger's regression test was performed. The factors related to poor glycemic control were reported using pooled odds ratios (POR) and a 95% confidence interval. In this study, 46 papers totaling 15 457 people were used to calculate the pooled estimates. It was determined that 32.6% (95% CI: 28.3, 36.9) and 61.92% (95% CI: 57.92, 65.92) of the subjects, respectively, had good and poor glycemic control. Being male protected against poor glycemic control, while poor diet adherence, lack of exercise, poor adherence to anti-diabetic medications, and smoking increased the likelihood of poor glycemic control. Lack of formal education, no family history of diabetes, lack of glucometer for blood glucose monitoring, comorbidity, being overweight and prolonged length of stay with diabetes all contributed to poor glycemic control. Ethiopia had a fairly high rate of poor glycemic control. The main determinants are lifestyle factors. Therefore, it is important to focus on behavioral interventions.

Prevalence of dyslipidemia and the relationship between HbA1C and lipid profile in Moroccan patients with T2DM: a cross-sectional study

Introduction

the increased prevalence of dyslipidemia in patients with type 2 diabetes mellitus (T2DM) results from uncontrolled hyperglycemia and consistently contributes to an elevated risk of cardiovascular complications. This study sought to estimate the prevalence of dyslipidemia and to investigate the relationship between glycated hemoglobin (HbA1C) and serum lipid levels in Moroccan patients with T2DM.

Methods

a total of 505 patients with T2DM were included in this cross-sectional study, 77.4% with chronic complications and 22.6% without. The collected data were examined using statistical package for the social sciences (SPSS) version 20.0 software and appropriate statistical methods.

Results

the data analysis showed that the mean and SD of age were 57.27±10.74 years. Among 505 patients with T2DM, the prevalence of hypercholesterolemia, hypertriglyceridemia, increased low-density lipoprotein cholesterol (LDL-C), and decreased HDL-C was 41.4%, 35.9%, 27.1%, and 17%, respectively. In addition, the data analysis showed that levels of total cholesterol (TC) (p≤0.001), triglycerides (p≤0.001), Low-density lipoprotein cholesterol (LDL-C) (p≤0.001), TC/HDL-C ratio (p=0.006), and LDL-C/HDL-C ratio (p=0.006) were significantly higher in T2DM patients with complications as compared to those without complications. The patients with HbA1C > 7.0% had significantly higher values of fasting blood glucose (FBG) (p≤0.001), total cholesterol (p≤0.001), triglycerides (p≤0.001), and TC/HDL-C ratio (p=0.025) as compared to the patients with HbA1C ≤ 7.0%. The HbA1C demonstrated a significant negative correlation with age (r=-0.139), and positive correlation with FBG (r=0.673), total cholesterol (r=0.189) and triglycerides (r=0.243).

Conclusion

our results showed that HbA1C is the most important biomarker of long-term glycemic control and can also be a good indicator of the lipid profile.

The prevalence of diabetes and associated risk factors among adult population in a Turkish population (Trabzon city)

OBJECTIVE

The objectives of this study were to determine the prevalence of diagnosed and undiagnosed diabetes mellitus (DM) and prediabetes, and to evaluate the associated risk factors in a sample of adult Turkish population.

METHODS

A total of 4000 eligible study subjects, aged 20 years or older, chosen by multistage sampling on a field were considered. Of those 3721 subjects (2139 women and 1582 men) participated in the study.

RESULTS

The prevalence of prediabetes and DM were found to be as 6.4% and 10.4% (3.6% being newly diagnosed by this study), respectively. In multivariate logistic regression analysis, advanced age (OR:26.7, p < 0.0005 in the group 70 years and over), marriage (OR:2.05, p = 0.047), housewives (OR:1.34, p = 0.003), family history of diabetes (OR:2.84, p < 0.0005), overweight (OR:1.61, p = 0.026), obesity (OR:2.25, p < 0.0005), hypertension (OR:1.42, p = 0.007) and dyslipidemia (OR:1.38, p = 0.028) were independent risk factors for being diabetic.

CONCLUSIONS

DM is an important health problem in the adult population of Trabzon city. Newly diagnosed diabetic patients who were unaware of their status are at high risk. To control DM and associated risk factors, effective public health education and taking urgent steps are needed.

Ethyl acetate fraction of Fagara zanthoxyloides root-bark possess antidiabetic property against alloxan-induced diabetes and its complications in Wistar rat model

ETHNOPHARMACOLOGICAL RELEVANCE

Fagara zanthoxyloides Lam., an African traditional medicinal plant, is used for treatment of malaria and diabetes.

AIM

To investigate the antidiabetic property of ethyl acetate fraction of F. zanthoxyloides root-bark (EAFFZRB) on alloxan-induced diabetic rats.

MATERIALS AND METHODS

Extraction, isolation, preliminary phytochemical analysis, and acute toxicity study of ethanol extract and fractions of F. zanthoxyloides root-bark were achieved using standard methods. Phyto-constituents in EAFFZRB were identified using HPLC technique. Forty-eight male Wistar rats (140-185 g) were randomized into 6 groups (n = 8). Groups 1 and 2 served as normal and negative controls, respectively. Diabetes was induced in test groups (2-6) using 150 mg/kg body weight (b.w) Alloxan monohydrate. Rats in groups 4-6 received of 200, 400 and 600 mg/kg b.w. EAFFZRB orally, respectively, for 21 days. Group 3 rats received 5 mg/kg b.w Glibenclamide. The effect of EAFFZRB on alterations in hematological, biochemical, and histological indices of study rats were assessed.

RESULTS

Extraction of 3500 g ethanol extract yielded 15.71 g EAFFZRB. HPLC fingerprint of EAFFZRB indicated presence of luteolin, rutin, quercetin, apigenin, cinnamic acid and catechin. Diabetes triggered significant (p < 0.05) alterations in b.w., hematological, biochemical and histological indices of test rats relative to normal control. Treatment with EAFFZRB (LD₅₀ = 3807.9 mg/kg b.w.) resulted in remarkable improvements in altered b.w. changes, hematological, biochemical and histological parameters of diabetic rats.

CONCLUSION

The study demonstrated the antidiabetic potential of EAFFZRB, providing scientific basis for traditional use of the plant in treatment of diabetes and its complications.

Molecular Study of Lactobacilli Species in Patients with Type 2 Diabetes Mellitus

Background:

Diabetes mellitus type 2 (T2DM) is a metabolic disorder of multiple etiologies due to disturbances in carbohydrate, protein, and fat metabolism. Egypt is among the top 10 countries with a high prevalence of T2DM (15.56% of adults). There are studies that show a link between the diversity of the gut microbiota and the development of T2DM. There are species of Lactobacilli that inhabit the gut that might differ in patients with T2DM compared to healthy subjects.

Objective:

The aim of the present research is to study the presence of Lactobacilli species in gut microbiota by multiplex PCR in patients with T2DM compared to healthy controls as a preliminary approach to open the way for future treatment with the help of probiotics or diet modulation.

Methods:

A retrograde case-control study was conducted on 79 patients with T2DM and 100 healthy controls cross-matched with age and sex. All patients were subjected to full clinical examination and laboratory tests, including identification of stool Lactobacillus species by multiplex polymerase chain reaction (PCR).

Results:

Certain species of L. acidophilus, and L. rhamnosus were found to be significantly increased in patients with T2DM (67.1%, 50.6% respectively) compared to control subjects (35%, P=0.001, OR 3.8, 95% CI:2.1-7.1, 25%, P=0.001, OR 3.1, 95% CI:1.64-5.8 respectively). Other species as determined by multiplex PCR, namely, L. gasseri, (70%, P=0.001, OR 0.16, 95% CI: 0.1-0.3), L. reuteri (74%, P=0.001, OR 0.28, 95% CI: 0.5-0.53), and L. plantarum (69%, P=0.003, OR 0.4, 95% CI: 0.073-0.22) were significantly higher in prevalence in control compared to patients with T2DM.

Conclusion:

The present study highlights the significant prevalence of certain species of Lactobacilli in gut as determined by multiplex PCR, namely L. gasseri, L. reuteri and L. plantarum in controls compared to patients with T2DM. These species may have a role in the reduction of certain risk factors associated with the development of T2DM. Moreover, certain species of L. acidophilus, L. delbrueckii and L. rhamnosus were significantly increased in prevalence in patients with T2DM. The findings of this preliminary study need further verification by a larger longitudinal study.

Type 2 Diabetes Mellitus with Early Dry Skin Disorder: A Comparison Study Between Primary and Tertiary Care in Indonesia

BACKGROUND

The prevalence of Type 2 Diabetes Mellitus (T2DM) in Indonesia has continued to increase over the years. Management of T2DM is challenging across clinical settings, including primary and tertiary care. Uncontrolled T2DM puts patients at risk of the development of T2DM complications, especially early-stage dry skin that is neglected by most of the patients. This study aimed to investigate the comparison between the T2DM management profile and dry skin clinical profile of T2DM patients in primary care and tertiary care settings.

METHODS

The study was conducted as a cross-sectional epidemiological study by comparing T2DM patient profiles in primary and tertiary care. The data collected included sociodemographic, clinical, and laboratory data that were correlated with T2DM and early dry skin related-T2DM. This study included early dry skin within the SRRC score of 3-11 and excluded infection, ulcer, and severe erythema.

RESULTS

The patients in primary and tertiary care presented poorly controlled T2DM with median HbA1c levels of 7.8% and 7.6%. The patients in primary care also presented with high triglyceride, 179 mg/dl. Furthermore, several significant differences were found in the duration of T2DM, duration of dry skin, and DM treatment (OAD and insulin).

CONCLUSION

Significant differences in the duration of T2DM, duration of dry skin, and DM treatment (OAD and insulin) might be affected by the parameter of T2DM glycemic control (Blood pressure (BP), body mass index (BMI), HbA1c, random blood glucose (RBG), and triglyceride).

Prevalence of Dyslipidemia in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study

Introduction: Diabetes mellitus (DM), a chronic metabolic noncommunicable disease (NCD), has assumed epidemic proportions worldwide. Type 2 diabetes (T2D) is defined as chronic high blood glucose levels due to the deficiency of insulin or resistance to it. Dyslipidemia is one of the major causes of cardiovascular diseases in patients with T2D. It is characterized by elevated plasma triglyceride (TG), low high-density lipoprotein (HDL) cholesterol, and high low-density lipoprotein (LDL) cholesterol, which is mostly present in patients with DM.

Methods: We conducted a retrospective cross-sectional study at the King Faisal University (KFU) Health Center in the eastern region of Saudi Arabia. The data of patients from October 2014 to February 2021 were collected. We collected the patients’ data from the KFU Health Center after obtaining approval from the KFU polyclinic administration. Prior ethical approval was taken from the Institutional Review Board of Ethics and Research Committee in the College of Medicine, KFU (approval number, 2020-10-62). We collected patients’ data, including their gender, age, nationality, and blood analysis (lipids profile - TGs, HDL, LDL, and hemoglobin A1c [HbA1c] levels).

Result: This study included 191 patients with T2D, 137 (71.7%) were from Saudi Arabia, and 54 (28.3%) were from other countries. Patients’ age ranged from 21 to 100 years, with a mean age of 56.2 ± 11.8 years. There were 107 (56%) females. Cholesterol levels ranged from 102 to 300 mg/dl with a mean value of 187.3 mg/dl.

Conclusion: In the current study, we assessed the association between HbA1c levels and lipid profiles in patients with T2D at the KFU Health Center in the eastern region of the Kingdom of Saudi Arabia. Our results on the adjusted relationship of HbA1c with lipid profile through regression model have demonstrated that HDL alone had significant adjusted relation with HbA1c if other factors are kept constant. We suggest focusing on TC and HDL levels in T2D health management in future studies.

Correlation of 25-Hydroxyvitamin D and Serum Lipid Levels Among Patients With Type 2 Diabetes

Introduction Type 2 diabetes mellitus (T2DM) is a well-known health care problem. The is a growing interest in the role of vitamin D in metabolism including glucose and lipid metabolism. This study aims to investigate the possible association between 25-hydroxyvitamin D levels and serum lipid levels among patients with T2DM. Method A cross-sectional study was done at the King Faisal University Health Care Center in the Eastern Region of Saudi Arabia. Ethical approval was obtained from the Ethics and Research Committee at the College of Medicine, King Faisal University. We obtained the clinical and laboratory data of patients with T2DM by searching the electronic files of patients attending the center during the period between 2014 and 2021. Data collected included age, gender, nationality, vitamin D levels, HbA1c, and lipid levels. The chi-square and independent sample t-tests were applied when appropriate, for comparisons between groups to determine significance. A P-value of less than 0.05 was considered statistically significant. Result The study included 191 diabetic patients, 137 (71.7%) from Saudi Arabia, and 54 (28.3%) from other countries. Patient ages ranged from 21 to 100 years with a mean age of 56.2 ± 11.8 years. Cholesterol levels were observed to be high among 61 (32.3%) patients. Considering vitamin D, the average level among male patients was 26.526 ng/ml compared to 26 ng/ml% among females (P = 0.742).  Conclusion Further long-term and more comprehensive randomized controlled trials are needed to make a firmer conclusion and stronger evidence on this beneficial role of vitamin D treatment on T2DM.

Prevalence and Risk Factors of Dyslipidemia among Type 2 Diabetes Patients at a Referral Hospital, North Eastern Ethiopia

Background

The prevalence of diabetes and its associated complications rising in Ethiopia ranged from 2.0%-6.5%, the primary cause of morbidity and mortality with consequential economic impact. This study aimed to assess the prevalence and risk factors of dyslipidemia among diabetes follow-up patients.

Methods

Institution-based cross-sectional study was conducted at Debre Berhan Referral Hospital from January to March 2020 in 347 Adult type 2 diabetes follow-up patients using a convenient sampling technique. Data were collected by interviews and entered using Epi-data 4.2 and analyzed using SPSS version 25. Factors having a p-value < 0.25 in the bi-variable logistic regression model were entered into a multivariable logistic regression model. Statistical Significance was declared at a p-value ≤ of 0.05.

Results

The prevalence of dyslipidemia among type 2 diabetes patients in this study was 59 %. Significantly associated variables were being female [AOR 2.6 (95% CI 1.2-3.2), P = 0.011], smoking history [AOR 4.1 (95% CI 2-6.8), P = 0.001], Being overweight [AOR 3.5 (95% CI 1.6-7.8), P = 0.002], Being obese [AOR 4.8 (95% CI 1.7-13), P = 0.002].

Conclusion

Prevalence of dyslipidemia was high among diabetic patients, which accounts for 59%. Being female, smoking history, being overweight, and being obese were determinants of dyslipidemia. Patients with poor glycemic control need additional lipid-lowering therapies to prevent secondary Atherosclerotic vascular complications.

Urinary Malondialdehyde as a Biomarker of Type 2 Diabetes Mellitus Treatment in the Primary Care Unit of a Tertiary Care Hospital

INTRODUCTION/OBJECTIVES

The examination of Urinary Malondialdehyde (UMDA) as a biomarker in the involvement of inflammatory response and oxidative stress, as a mechanism underlying the development of diabetes; in addition to complications in followed-up patients at a primary healthcare unit. The level of UMDA and its related factors in T2DM patients, between good and poor glycemic control was investigated.

METHODS

This analytical cross-sectional study was conducted at the primary care unit, of Songklanagarind Hospital; from May 2020 to August 2020. The voluntary patients were divided into 2 groups, by using a percentage of HbA1c ≤7% as a good control T2DM group, and higher than 7% as a poor control T2DM group. The comparison statistics and logistic regression analysis were performed by using R Program.

RESULTS

A total of 71 patients voluntarily participated in this study, and consisted of: 38 patients with poor glycemic control and 33 patients with good glycemic control. There were no significant differences between the patients; with the exception of smoking habits. The average levels of UMDA of the good control group (2.43 ± 0.91 μg/mL) were slightly lower than the poor control group (2.60 ± 0.96 μg/mL): P-value >.05. Patients who had underlying diseases, smoking, or drinking habits displayed significantly different levels of UMDA. Being a non-smoking patients, and having a higher level of HDL-C with significant protective factors, while having increased level of FBS and triglyceride were pointedly negative factors of oxidative stress status.

CONCLUSION

Patients who had good control of T2DM produced better health outcomes than the poor control group. UMDA, FBS, HDL-C, and triglyceride levels could be applied as follow-up criteria in T2DM patients within a primary healthcare setting.

Sociodemographic and clinical predictors of refractory type 2 diabetes patients: Findings from a case-control study

OBJECTIVES

To identify the sociodemographic and clinical predictors of uncontrolled diabetic patients, to identify high-risk and people with impaired glycemic control, to establish more effective strategies for reducing morbidity and mortality.

METHODS

This case-control study of 8209 enrolled patients were included from the diabetes registry by Chronic Illness Center (CIC), Family and Community Medicin, Prince Sultan Military Medical City, Riyadh Saudi Arabia between February 2019 and February 2020. Cases are defined as patients with type II refractory diabetes having persistent HbA1c >9, not reach adequate glycemic control despite intensified therapy under specialist care (CIC) for at least 6 months. Controls were defined as patients with Hba1c ≤9. Multivariable regression analysis was used to identify predictors for patients with the persistent outcome of HbA1c >9%.

RESULTS

Overall, a total of 1152 cases and 4555 controls were included. Patients with refractory diabetes were younger (mean: 58.5, standard deviation [SD]: 11.7) and females (63.4%). Duration of diabetes (13.3, SD: 7.4, p<0.001) and the mean value of low-density lipoprotein (LDL) (2.7, SD: 0.91, p<0.001) were significantly higher in the refractory group. The findings from the final model revealed that with every unit increase in age (odds ratio [OR]: 0.97, [95% confidence interval [CI]: 0.96-0.98]) and body mass index the odds of having refractory diabetes significantly reduced by 0.97 times (OR: 0.97, [95% CI: 0.95-0.99]). While with every unit increase in the duration of diabetes (OR: 1.03, [95% CI: 1.01-1.05]), systolic blood pressure (OR: 1.01, [95% CI: 1.00-1.02]) and LDL (OR: 1.42, [95% CI: 1.23-.62]) the odds of having refractory diabetes significantly increased by 1.03 and 1.42 times respectively compared to controls when adjusted for gender, albumin creatinine, diastolic blood pressure.

CONCLUSION

The findings from this study helped classify the predictors of refractory patients with diabetes. Understanding refractory patients' predictors may help to develop new therapeutic strategies to boost their glycemic status safely.

Diosmetin attenuates metabolic syndrome and left ventricular alterations via the suppression of angiotensin II/AT receptor/gp91phox/p-NF-κB protein expression in high-fat diet fed rats

Diosmetin, a monomethoxyflavone, is isolated from citrus fruits. The objective of this research was to test the biological role of diosmetin on parameters of metabolic syndrome (MS) and left ventricular (LV) alterations in rats fed with a high-fat (HF) diet. MS was induced by feeding male Sprague-Dawley rats with a HF diet plus 15% fructose in drinking water for 16 weeks. MS rats were given diosmetin (20 or 40 mg per kg per day) or metformin (100 mg per kg per day) for the final four weeks. Diosmetin attenuated signs of MS including, hypertension, hyperglycemia, insulin resistance, and dyslipidemia in rats that received the HF diet (p < 0.05). A decreased stroke volume, ejection fraction, fractional shortening, LV hypertrophy and fibrosis present in the MS group were alleviated by diosmetin treatment (p < 0.05). Diosmetin also suppressed angiotensin-converting enzyme activity, plasma angiotensin II (Ang II) levels and angiotensin II type 1 (AT1) receptor protein expression in MS rats. Increases in superoxide (O2˙-) formation, plasma malondialdehyde, plasma nitrate and nitrite and gp91phox expression induced by a HF diet were ameliorated in the diosmetin treated group. Inflammation indicated by an increased phospho nuclear factor kappa B (p-NF-κB) protein expression and cardiac TNF-α concentration was reduced in MS rats receiving diosmetin (p < 0.05). Metformin also attenuated MS, cardiac abnormalities relevant to decreasing the renin-angiotensin system stimulation, reactive oxygen species and inflammation in MS rats (p < 0.05). Diosmetin alleviated MS and LV dysfunction and remodeling in HF diet-induced MS rats. These results could be associated with the suppression of the Ang II/AT1 receptor/gp91phox/p-NF-κB protein pathway.

Atorvastatin Attenuates Vascular Remodeling in Mice with Metabolic Syndrome

Fundamento

A síndrome metabólica é caracterizada por um conjunto de comorbidades. Durante a síndrome, observam-se alterações estruturais no sistema cardiovascular, especialmente o remodelamento vascular. Uma das causas predisponentes para essas alterações é a inflamação crônica oriunda de mudanças na estrutura e composição do tecido adiposo perivascular. Atorvastatina é eficaz no tratamento das dislipidemias. No entanto, seus efeitos pleiotrópicos não são totalmente compreendidos. Supõe-se que, durante a síndrome metabólica, ocorre remodelamento vascular e que o tratamento com atorvastatina pode ser capaz de atenuar tal condição.

Objetivos

Avaliar os efeitos do tratamento com atorvastatina sobre o remodelamento vascular em modelo experimental de síndrome metabólica.

Métodos

Camundongos Swiss receberam dieta controle ou dieta hiperglicídica por 18 semanas. Após 14 semanas de dieta, os camundongos foram tratados com veículo ou atorvastatina (20mg/kg) durante 4 semanas. Foram avaliados o perfil nutricional e metabólico por testes bioquímicos; análise estrutural da artéria aorta por histologia e dosagem de citocinas por ensaio imunoenzimático. O nível de significância aceitável para os resultados foi p <0,05.

Resultados

A dieta hiperglicídica promoveu o desenvolvimento de síndrome metabólica. Tal fato culminou no remodelamento hipertrófico do músculo liso vascular e tecido adiposo perivascular. Além disso, houve aumentos das citocinas TNF-α e IL-6 circulantes e no tecido adiposo perivascular. O tratamento com atorvastatina reduziu significativamente os danos metabólicos, o remodelamento vascular e os níveis de citocinas.

Conclusão

Atorvastatina ameniza danos metabólicos associados à síndrome metabólica induzida por dieta hiperglicídica, além de atenuar o remodelamento vascular, sendo esses efeitos associados à redução de citocinas pró-inflamatórias.

Prevalence of dyslipidemia and associated risk factors among newly diagnosed Type-2 Diabetes Mellitus (T2DM) patients in Kushtia, Bangladesh

Dyslipidemia is considered a significant modifiable risk factor for type-2 diabetes mellitus (T2DM) and has become one of the emerging health problems throughout the world. In Bangladesh, data on dyslipidemia among newly diagnosed T2DM patients are comparatively inadequate. This study aimed to evaluate the prevalence of dyslipidemia and its associated risk factors in newly diagnosed T2DM patients. This cross-sectional study was conducted by a well-structured questionnaire from 132 newly diagnosed type-2 diabetic patients attending the Mujibur Rahman Memorial Diabetic Hospital in Kushtia, Bangladesh. Data regarding socio-demographic, anthropometric, fasting blood glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were collected from all the respondents. The association between dyslipidemia and its associated factors was analyzed using the multivariate logit regression model. The findings suggest that the prevalence rate of dyslipidemia was 75.7% in female and 72.6% in male T2DM patients. The odds of having dyslipidemia were 1.74 (95% Cl: 1.58-1.87) times significantly higher in female (p<0.001). The other factors associated with dyslipidemia encompassed age between 30-39 years (OR: 2.32, 95% CI: 1.97-2.69), obesity (OR: 2.63, 95% CI: 2.27-2.90), waist circumferences of male ≥90 and female ≥80 (OR: 1.65, 95% CI: 1.59-1.89), hypertensive patients (OR: 1.51, 95% CI: 1.45-1.74), physically inactive (OR: 3.25, 95% CI: 1.84-4.68), and current smoker or tobacco user (OR: 1.93, 95% CI: 1.85-2.13). This study concluded that the high prevalence of dyslipidemia was found among newly diagnosed type-2 diabetes patients and associated with gender, age, BMI, waist circumference, poor physical activity, and smoking, or tobacco use. This result will support increase awareness of dyslipidemia and its associated risk factors among type-2 diabetes patients.

Association Between CDKAL1, HHEX, CDKN2A/2B and IGF2BP2 Gene Polymorphisms and Susceptibility to Type 2 Diabetes in Uttarakhand, India

INTRODUCTION

Current study aimed to find the association of genes polymorphism of CDKAL1, HHEX, CDKN2A/2B, and IGF2BP2 with type 2 diabetes (T2DM) in the population of Uttarakhand.

RESEARCH DESIGN AND METHODS

Overall 469 persons comprising 369 recently diagnosed T2DM cases and 100 healthy control were enrolled in the present study. The polymorphisms were analyzed through the PCR-RFLP technique.

RESULTS

For the rs10440833 variant (CDKAL1), CC genotype's frequency was significantly high among T2DM subjects than controls and increase the T2DM risk (OR: 4.46, 95% CI: 2.22-8.99, p <0.0001). The c allele was significantly found to increase the T2DM risk (OR: 2.20, 95% CI: 1.54-3.14, p <0.001). In the rs1111875 variant (HHEX), the difference of genotype frequencies among T2DM cases and control was statistically non-significant (p-0.138). We did not observe significant differences in allelic frequencies among T2DM cases and control (p-0.444). In the case of rs10811661 variant (CDKN2A/2B), frequency of both TC (OR: 3.16, 95% CI: 1.84-5.42, p <0.0001) and TT (OR: 5.84, 95% CI: 1.75-19.45, p -0.004) genotype were significantly higher in T2DM cases in comparison with control and significantly associated with higher T2DM risk. Compared to the C allele, a significant increase in T2DM risk was documented with the T allele (OR: 2.47, 95% CI: 1.55-3.92, p <0.001). For rs4402960 variant (IGF2BP2), TT genotype contributed to increased T2DM risk (OR: 4.25, 95% CI: 2.02-8.93, p -0.0001). T allele's frequency was significantly high in T2DM cases in comparison with healthy control. Except WHR, HDL-C, exercise, household chores, standing work more than 3 hours, and family history, significant differences were found between T2DM cases and healthy individuals in all other parameters.

CONCLUSION

Our study concluded a significant association of CDKAL1, CDKN2A/2B, and IGF2BP2 polymorphism with T2DM in the Uttarakhand population. For HHEX, the genotype and allelic frequencies difference between T2DM cases and control were statistically non-significant. However, a significant association of HHEX gene polymorphism with T2DM was observed only under the dominant model.

Factors associated with glycemic control among South African adult residents of Mkhondo municipality living with diabetes mellitus

This study examines the rate and the influencing factors of glycemic control among adult residents living with DM in Mkhondo Municipality of South Africa.In this cross-sectional study, 157 individuals attending care for DM were recruited. Glycemic control status was categorized as poor if glycated hemoglobin (HbA1c) > 7% and very poor if HbA1c ≥ 9%. Multivariate regression analysis was used to identify the significant determinants of poor and very poor glycemic control.The majority of the study participants were females (84.71%) and above 45 years old (88.55%). The overall prevalence of poor glycemic control was 77.71% (n = 122), while very poor glycemic control occurred in 50.6% (n = 80) of the study cohort. In the multivariate logistic regression model analysis, African traditional [AOR = 0.15; 95% confidence interval (95% CI) 0.04-0.57], fast food consumption (AOR = 5.89; 95% CI 2.09-16.81), elevated total cholesterol (TC) [odds ratio (OR) = 2.33; 95% CI 1.50-5.17], elevated low-density lipoprotein cholesterol (LDL-C) (AOR = 5.28; 95% CI 1.89-14.69), and triglyceride (TG) (AOR = 4.39; 95% CI 1.48-13.00) were the independent and significant determinants of poor glycemic control. Age (AOR = 0.46; 95% CI 0.23-0.92) was the only independent and significant determinant of very poor glycemic control.We found a high rate of poor glycemic control (77.71%) possibly attributed to religious affiliation, fast food consumption, and dyslipidemia. On the contrary, about half of the study sample had very poor glycemic control (HbA1c ≥9%), which was predominant among younger cohort with diabetes mellitus. Interventions aimed at improving glycemic control in this population must also target religious practice, dietary patterns and dyslipidemia as well as tailored-approach for young people.

Glycemic control in Kuwaiti diabetes patients treated with glucose-lowering medication

BACKGROUND

Diabetes is prevalent in Kuwait. We aimed to assess the level of glycemic control in Kuwaiti adults with diabetes.

METHODS

The World Health Organization's STEPS non-communicable disease risk factor survey was conducted in Kuwait in 2014. Participants' demographics, medical history, physical measurements and blood biochemistry were assessed. A total of 2561 Kuwaiti men and women aged 18-69 years completed all three survey steps. Glycemic control in 278 individuals with diabetes who were on glucose-lowering medication was determined using the US National Institutes of Health guidelines of fasting plasma glucose (FPG) ≤7.2mmol/l and the American Diabetes Association guidelines of glycated hemoglobin (HbA1c) <7% (53mmol/mol).

RESULTS

Adequate glycemic control in people with drug-treated diabetes was 34.5% when determined by HbA1c, 37.8% when determined by FPG level, and 24.5% when both criteria were met. Mean body-mass index and fasting serum triglycerides were significantly higher and serum high-density lipoprotein-cholesterol significantly lower in individuals with an inadequate glycemic control than in those with adequate control. Women with diabetes were almost twice as likely to have inadequate HbA1c levels as men with diabetes (OR, 1.9, [95% CI, 1.03, 3.5]).

CONCLUSIONS

Glycemic control in Kuwaiti adults with treated diabetes is low. A systemic, multi-disciplinary public health approach is needed to improve diabetes education and adherence to treatment.

Relationship between Lipid Profiles and Glycemic Control Among Patients with Type 2 Diabetes in Qingdao, China

Glycosylated hemoglobin (HbA1c) was the best indicator of glycemic control, which did not show the dynamic relationship between glycemic control and lipid profiles. In order to guide the health management of Type 2 diabetes (T2D), we assessed the levels of lipid profiles and fasting plasma glucose (FPG) and displayed the relationship between FPG control and lipid profiles. We conducted a cross-sectional study that included 5822 participants. Descriptive statistics were conducted according to gender and glycemic status respectively. Comparisons for the control of lipid profiles were conducted according to glycemic control. Four logistic regression models were generated to analyze the relationship between lipid profiles and glycemic control according to different confounding factors. The metabolic control percentage of FPG, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) was 27.50%, 73.10%, 28.10%, 64.20% and 44.80% respectively. In the fourth model with the most confounding factors, the odds ratios (ORs) and 95% confidence intervals (CIs) of TG, TC, LDL-C and HDL-C were 0.989 (0.935, 1.046), 0.862 (0.823, 0.903), 0.987 (0.920, 1.060) and 2.173 (1.761, 2.683). TC and HDL-C were statistically significant, and TG and LDL-C were not statistically significant with adjustment for different confounding factors. In conclusion, FPG was significantly associated with HDL and TC and was not associated with LDL and TG. Our findings suggested that TC and HDL should be focused on in the process of T2D health management.

Association between Adiponectin Gene Polymorphism and Environmental Risk Factors of Type 2 Diabetes Mellitus among the Chinese Population in Hohhot

Objective

The aim of this study was to investigate the association between adiponectin gene polymorphisms rs10937273, rs1501299, rs182052, rs2241767, and rs266729 and environmental risk factors of type 2 diabetes mellitus (T2DM) in Hohhot. The study explored different models of gene-environment interactions, aimed at providing approaches for the prevention and control of T2DM in combination with the characteristics of the local population.

Methods

A case-control study was conducted including 406 Chinese participants, comprising 203 cases and 203 controls from various hospitals. Adiponectin (ADIPOQ) gene polymorphisms rs10937273, rs1501299, rs182052, rs2241767, and rs266729 were detected using an improved multiple ligation detection reaction technique. Generalized multifactor dimensionality reduction (GMDR) and logistic regression were conducted to analyze the associations between adiponectin gene polymorphisms and T2DM, as well as the interactions between adiponectin gene polymorphisms and environmental factors.

Results

ADIPOQ gene polymorphisms rs10937273, rs1501299, rs182052, rs2241767, and rs266729 were associated with type 2 diabetes. Based on the haplotype of the five adiponectin gene single-nucleotide polymorphism (SNP) loci, we found that G-G-A-A-C was a susceptible haplotype of T2DM (P < 0.05). Interaction analyses demonstrated associations between rs1501299 and central obesity (consistency = 80%, P = 0.011) and between rs266729 and rs182052 and central obesity (consistency = 70%, P = 0.011).

Conclusions

Our findings indicate that there is an interaction between the ADIPOQ gene and central obesity, which provides new insights into the prevention and treatment of T2DM.

Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period

BACKGROUND

This study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period.

METHODS

A total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3-12 months.

RESULTS

Patients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c <7%) was achieved by 13.8% of patients. Multivariate analysis revealed <55 years of age, female gender, >3 years duration of diabetes, HbA1c >10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI <25 kg/m² and presence of hypertension were associated with a decreased risk of poor glycemic control.

CONCLUSION

Using data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.

Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study

OBJECTIVE AND BACKGROUND

In 2015 approximately 5.0 million people were estimated to have died from diabetes. Poor glycemic control is the most determinant of diabetes-related complication and death. The percentage of patients whose blood glucose level are not well controlled remains high yet. The aim of this study is to identify the determinants of poor glycemic control at the diabetes clinic of the Jimma University Medical Center from April 01 to June 30/2017.

METHODS

Facility-based case-control study design was conducted on patients with type 2 diabetes mellitus on follow-up at the diabetes clinic of Jimma University medical center. The consecutive sampling technique was employed and data were collected from April to June 2017. The data were entered using Epidata manager version 4.0.2 and exported to SPSS Version 21 for analysis. Logistic regression analysis was performed and variables with the p-value of less than 0.05 were considered as statistically significant determinants of poor glycemic control.

RESULT

The study was conducted on 410 patients, of which 228 males and 182 females. The determinants of poor glycemic control were comorbidities [Adjusted odd ratio(AOR) = 2.56, 95%CI = 1.10-5.96], lack of self-monitoring blood glucose [AOR = 3.44,95%CI = 1.33-8.94], total cholesterol level of 200 mg/dl or more [AOR = 3.62, 95%CI = 1.46-8.97], diabetes duration of greater than 7 years [AOR = 3.08, 95%CI = 1.33-7.16], physical activity of three or less than three days [AOR = 4.79, 95%CI = 1.70-13.53], waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female [AOR = 3.52, 95%CI = 1.23-10.11], being on metformin plus insulin [AOR = 9.22, 95%CI = 2.90-29.35] and being on insulin [AOR = 4.48, 95%CI = 1.52-13.16].

CONCLUSION

Lack of Self-monitoring blood glucose, presence of comorbidities, duration of diabetes mellitus, physical activity of three or less than three days, total cholesterol of 200 mg/dl or more, waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female, and types of antidiabetic medication were the independent predictors of poor glycemic control. Effort should be made towards reducing these factors by the concerned body.

Molecular and biochemical monitoring of the possible herb-drug interaction between Momordica charantia extract and glibenclamide in diabetic rats

Momordica charantia is used in folk medicine to manage diabetes mellitus. In this study, we investigated the possible herb-drug interaction between M. charantia fruit extract (MCFE) and glibenclamide (GLB) in streptozotocin-diabetic rats. Rats were divided into 7 groups. The 1st group received 3% Tween 80. The 2nd–5th groups were diabetic rats received vehicle, GLB (5 mg/kg), MCFE (250 and 500 mg/kg), respectively. The 6th–7th groups administered GLB plus MCFE (250 and 500 mg/kg), respectively. After 8 weeks, fasting blood glucose (FBG), insulin and glycosylated hemoglobin (HbA1c) levels were assessed. Histopathological and immunohistochemical examinations of the pancreases were done. Quantitative RT-PCR was used to analyze hepatic mRNA expression of insulin receptor (INR), glucose transporter 2 (Slc2a2) and peroxisome proliferator-activated receptor α (PPAR-α) genes. All medicaments greatly reduced FBG in diabetic rats when compared with diabetic control group. GLB plus MCFE combination was better than GLB alone in improving levels of insulin and HbA1c. All medicaments restored insulin content of pancreatic β-cells and reduced glucagon and somatostatin of alpha and delta endocrine cells. Moreover, GLB plus MCFE-500 was the most efficient in restoring INR, Slc2a2 and PPAR-α mRNA expression to their normal levels. In conclusion, MCFE in combination with GLB gives greater glycemic improvement than GLB monotherapy.

Prevalence, treatment, and control of dyslipidemia in diabetic participants of two brazilian cohorts: a place far from heaven

OBJECTIVE

Diabetes is one of the leading causes of cardiovascular mortality. Over the last years, mortality has decreased significantly, more in individuals with diabetes than in healthy ones. That is mostly due to the control of other cardiovascular risk factors. The objective of our study was to analyze the dyslipidemia control in two diabetes cohorts.

METHODS

Patients from two distinct cohorts were studied, 173 patients from the BHS (Brasília Heart Study) and 222 patients from the BDS (Brazilian Diabetes Study). The data on dyslipidemia control were studied in both different populations. All patients had diabetes.

RESULTS

There are significant differences concerning comorbidities between the LDL-C and BDS groups. The average glycated hemoglobin is of 8.2 in the LDL-C > 100 group in comparison with 7.7 and 7.5 in the 70-100 and < 70 groups, respectively (p = 0.024). There is a higher percentage of hypertensive patients with LDL between 70-100 (63.9%), when comparing the < 70 and > 100 groups (54.3% and 54.9%, respectively; p = 0.005). Diastolic pressure is higher in the group with LDL > 100, with an average of 87 mmHg, in comparison with 82.6 mmHg and 81.9 mmHg in the 70-100 and < 70 groups, respectively (p = 0.019). The group with LDL > 100 has the greatest percentage of smokers (8.7%) in comparison with the groups with LDL between 70-100 and < 70 (5.6% and 4.3%, respectively; p = 0.015). There is also a difference in the previous incidence of coronaropathy. In the group with LDL < 70, 28.3% of patients had already experienced a previous infarction, compared with 11.1% and 10.6% in the 70-100 and > 100 groups, respectively (p < 0.001).

CONCLUSIONS

The data in our study have shown that the dyslipidemia control in diabetic patients is inadequate and there is a tendency of direct association between lack of blood glucose control and lack of dyslipidemia control, in addition to the association with other cardiovascular risk factors, such as diastolic hypertension and smoking. This worsened control might be related to the plateau in the descending curve of mortality, and investments in this regard can improve the cardiovascular health in diabetic patients.

SPHK1 Is a Novel Target of Metformin in Ovarian Cancer

The role of phospholipid signaling in ovarian cancer is poorly understood. Sphingosine-1-phosphate (S1P) is a bioactive metabolite of sphingosine that has been associated with tumor progression through enhanced cell proliferation and motility. Similarly, sphingosine kinases (SPHK), which catalyze the formation of S1P and thus regulate the sphingolipid rheostat, have been reported to promote tumor growth in a variety of cancers. The findings reported here show that exogenous S1P or overexpression of SPHK1 increased proliferation, migration, invasion, and stem-like phenotypes in ovarian cancer cell lines. Likewise, overexpression of SPHK1 markedly enhanced tumor growth in a xenograft model of ovarian cancer, which was associated with elevation of key markers of proliferation and stemness. The diabetes drug, metformin, has been shown to have anticancer effects. Here, we found that ovarian cancer patients taking metformin had significantly reduced serum S1P levels, a finding that was recapitulated when ovarian cancer cells were treated with metformin and analyzed by lipidomics. These findings suggested that in cancer the sphingolipid rheostat may be a novel metabolic target of metformin. In support of this, metformin blocked hypoxia-induced SPHK1, which was associated with inhibited nuclear translocation and transcriptional activity of hypoxia-inducible factors (HIF1α and HIF2α). Further, ovarian cancer cells with high SPHK1 were found to be highly sensitive to the cytotoxic effects of metformin, whereas ovarian cancer cells with low SPHK1 were resistant. Together, the findings reported here show that hypoxia-induced SPHK1 expression and downstream S1P signaling promote ovarian cancer progression and that tumors with high expression of SPHK1 or S1P levels might have increased sensitivity to the cytotoxic effects of metformin. IMPLICATIONS: Metformin targets sphingolipid metabolism through inhibiting SPHK1, thereby impeding ovarian cancer cell migration, proliferation, and self-renewal.

Hypoglycemic Agents and Changes in Oxidative Stress Indices, Electrolytes, and Cardiovascular Risk Factors in Type 2 Diabetes

<b><i>Background:</i></b> Metabolic complications of type 2 diabetes (T2DM), including dyslipidemia, electrolyte imbalance, and oxidative stress, have been shown to be modulated by hypoglycemic agents. <b><i>Objective:</i></b> The lipid profile, electrolytes, and oxidative stress indices were evaluated in T2DM. <b><i>Methods:</i></b> Fifty T2DM patients on metformin (<i>n</i> = 23), insulin (<i>n</i> = 17), and insulin/metformin (<i>n</i> = 10) and 40 controls were studied. Fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), total antioxidant capacity (TAC), total plasma peroxide (TPP), and total calcium (Ca) values were determined colorimetrically, sodium (Na⁺) and potassium (K⁺) levels were determined by flame photometry, chloride (Cl^–) and bicarbonate (HCO₃^–) levels were determined by titration, and low-density lipoprotein cholesterol (LDL-C) levels, the atherogenic index of plasma (AIP), and the oxidative stress index (OSI) were determined by calculation. Data were analyzed using <i>t</i> test, analysis of variance, and Pearson’s correlation at <i>p</i> &#x3c; 0.05. <b><i>Results:</i></b> T2DM patients had higher lipid peroxidation (TPP and OSI), atherogenic lipids (higher LDL-C and AIP and lower HDL-C), and lower antioxidants compared to controls (<i>p</i> &#x3c; 0.05). T2DM patients with poor glycemic control had higher lipid peroxidation (higher TPP) and atherogenic lipids (TG and AIP) compared to those with good control (<i>p</i> &#x3c; 0.05). Patients with T2DM for &#x3e;5 years had higher protein glycosylation (higher HBA1c) and TC compared to those with T2DM for &#x3c;5 years (<i>p</i> &#x3c; 0.05). The class of hypoglycemic agent has no effect on the levels of all of the biochemical indices studied (<i>p</i> &#x3e; 0.05). HDL-C correlated negatively with TG (<i>r</i> = –0.347, <i>p</i> = 0.013), LDL-C (<i>r</i> = –0.322, <i>p</i> = 0.018), and AIP (<i>r</i> = –0.714, <i>p</i> = 0.000) in T2DM. <b><i>Conclusion:</i></b> Chronic T2DM and poor glycemic control are associated with reduced antioxidants, lipid peroxidation, and atherogenic dyslipidemia. Different hypoglycemic agents exert no differential effects on the metabolic indices of T2DM studied.

Clinical sensitivity and specificity of serum total bilirubin - A study on thyroid status in clinically euthyroid non-obese, overweight, and obese type 2 diabetics

OBJECTIVE

The objective of this study was to evaluate the sensitivity and specificity of total bilirubin (serum) in determining thyroid status in clinically euthyroid non-obese, overweight, and obese type 2 diabetics.

SUBJECTS AND METHODS

Three anthropometry specific groups of clinically euthyroid type 2 diabetics were enabled, following enrolment: 153 non-obese (body mass index [BMI] = 18.5-24.99), 291 overweight (BMI = 25-29.99), and 126 obese type 2 diabetes mellitus (BMI ≥30). Total bilirubin (serum), glycemic status, insulin resistance (IR), and thyroid hormones, besides routine biochemistry, were estimated, as per International Federation of Clinical Chemistry approved procedures.

RESULTS

Receiver operating characteristic curves for non-obese, overweight, and obese were plotted to assess the role of total bilirubin (serum) in determining thyroid status in clinically euthyroid type 2 diabetics. In overweight, the area under curve (AUC) for FT3 and postprandial sugar showed 0.621 and 0.531 with cutoff values of 2.02 pg/ml and 147.5 mg/dl, respectively, whereas for aspartate aminotransferase/alanine aminotransferase (De Ritis ratio), the AUC was 0.583. As regards, obese diabetics and the AUC for insulin and homeostatic model assessment IR were 0.657 and 0.709, respectively, with cutoff values of 16.06 mIU/L and 7.274, respectively, and for postprandial sugar 0.727, in the same group (obese) with cutoff value of 208.5 mg/dl.

CONCLUSION

Total bilirubin could predict thyroid status and IR in anthropometry specific clinically euthyroid type 2 diabetics.

Haematological parameters and lipid profile abnormalities among patients with Type-2 diabetes mellitus in Ghana

Background

Diabetes mellitus is a non-infectious disease that has a high prevalence worldwide. Altered level of many haematological parameters have been observed in patients with diabetes. The levels of lipids are also affected in diabetes by many factors since carbohydrate metabolism affect lipid metabolism. So far, very little work has been done linking haematological parameters and lipid profile in diabetics. The purpose of this study was therefore to evaluate the haematological parameters and lipid profiles of patients with type-2 diabetes and to correlate the results.

Method

Three hundred and four (304) patients with type-2 diabetes with an age range of 28 to 70 years (171 males and 133 females) were recruited. About 5 ml of venous blood samples were collected from each participant after an overnight fast. A part of the blood samples was used to determine the lipid profile parameters and the other parts for the haematological parameters. The Statistical Package for Social Science (SPSS) version 21.0 and Microsoft office excel (2010) for windows were used for the statistical analysis of the data. Pearson’s correlation were performed between haematological and lipid parameters. Significance was set at p < 0.05.

Results

The means and standard deviation of all the lipid parameters except TC showed significant difference in both males and females. There was also proportional increment in LDL-C (in males), LDL-C and Triglycerides (in females) as the age of participants increased and the ratio of TC/HDL was higher in males. There was also significant difference in all of the haematological parameters between the male and female populations. Further, a strong, significant positive correlation between RBC and lymphocytes and lipid parameters was observed. However, the correlation between platelets, haematocrit and haemoglobin and the lipid parameters was negatively significant.

Conclusion

From the results obtained, it can be concluded that there is significant difference in lipid parameters between male and female diabetic patients. Levels of LDL-C and Triglycerides increased as the age of participants increased and the male population showed increased risk for coronary disease. Almost all of the haematological parameters examined differed significantly between the sexes. There was also, both strong positive and negative correlations between the haematological parameters and the lipid profiles.

Magnitude of glycemic control and its associated factors among patients with type 2 diabetes at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Back ground

Diabetes is increasing at an alarming rate throughout the world and about 80% of diabetic cases live in low and middle income countries. Glycemic control is the most important predictor for diabetic related complications and deaths. Identifying factors associated with glycemic control help health care providers and patients to work in the areas that reduce risks of diabetic related complications and deaths.

Objectives

The aim of this study is to assess the magnitude and factors associated with glycemic control among type 2 diabetic patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Methods

Hospital-based cross sectional study was conducted on 412 type 2 diabetic patients who were attending in diabetic clinics at Tikur Anbessa Specialized Hospital. Data were collected through structured interview questionnaire, and data abstraction format to collect information from each patient’s medical records from March to April, 2015. Data were entered and analyzed using SPSS version 20 statistical software. Both descriptive and inferential statistics were used to determine magnitude of glycemic control and factors associated with poor glycemic control.

Result

Median age of participants was 52 years old (IQR = 40–60 years old). From the study participants,51.7% were females. Median duration of living with diabetes since diagnosis was 10 years (IQR: 5–16 years). About 80% of the respondents had uncontrolled fasting blood glucose level. The factors which are significantly associated with poor glycemic control were longer duration of diabetes (AOR = 2.72 95%CI:1.16–6.32), and being on insulin therapy (AOR = 3.01 95% CI: 1.5–5.9).

Conclusion

A high proportion of patients had poor glycemic control. Longer duration of the disease, and being on drug regimen of insulin were associated with poor glycemic control. Appropriate attention should be given to patients with longer duration of disease and those who are on insulin therapy.

Association between unfavorable lipid profile and glycemic control in patients with type 2 diabetes mellitus

Background:

Recent studies hypothesize that dyslipidemia can predict glycated hemoglobin (HbA1c) and could be important contributing factor to the pathogenesis of type 2 diabetes mellitus (DM2). Therefore, we aimed to evaluate the influence of lipid parameters on long-term glycemic control in DM2.

Materials and Methods:

A total of 275 sedentary DM2 (mean [±standard deviation] age 60.6 [±10.0] years) who volunteered to participate in this cross-sectional study were enrolled. Anthropometric (body weight, body hight, and waist circumference), biochemical parameters (fasting glucose, HbA1c, lipid parameters, creatinine), as well as blood pressure were obtained.

Results:

Total cholesterol (odds ratio [OR] =1.30, 95% confidence interval [CI] [1.02–1.66], P = 0.032), triglycerides (OR = 1.34, 95% CI (1.07–1.67), P = 0.010), and low density lipoprotein cholesterol (OR = 1.42, 95% CI [1.10–1.83], P = 0.006) were the independent predictors of higher HBA1c, and as they increased by 1 mmol/L each, probabilities of higher HBA1c increased by 30%, 34%, and 42%, respectively. Low level of high-density lipoprotein cholesterol (HDL-c) was found to be the independent predictor of higher HBA1c (OR = 0.44, 95% CI [0.20–0.67], P = 0.039), and increase in HDL-c by 1 mmol/L, reduced the probability of higher HBA1c by 56%.

Conclusion:

Unfavorable lipid profile can predict HbA1c level in DM2 patients. Early diagnosis of dyslipidemia, as well as its monitoring and maintaining good lipids control can be used as a preventive measure for optimal long-term glycemic control.

Correlation between Serum Lipid Profile with Anthropometric and Clinical Variables in Patients with Type 2 Diabetes Mellitus

BACKGROUND

The problem of dyslipidemia is high in patients with diabetes mellitus. There is ample evidence that abnormalities in lipid metabolism are important risk factors for increased incidence of diabetes associated complications. The most important risk indicators for these complications are lipid profile abnormalities. Therefore, the aim of this study was to assess the correlation between serum lipid profile with anthropometric and clinical variables among type 2 diabetes mellitus patients.

METHODS

A comparative cross sectional study was conducted at University of Gondar Hospital from February to April in 2015. A total of 296 participants (148 case and 148 healthy controls) were selected using systematic random sampling technique. Socio-demographic characteristics and clinical data were collected using pretested structured questionnaire incorporating the WHO Stepwise approach. Fasting venous blood sample was collected for blood sugar; lipid profile investigations and the blood levels were determined by Bio Systems A25 Chemistry Analyzer (Costa Brava, Spain). Independent sample t-test and Man Whitney U test were used to compare means. P-value < 0.05 was considered statistically significant.

RESULTS

Overall, T2DM patients had significantly higher total cholesterol ([205.4±50.9vs184.9±44.1]mg/dl), low density lipoprotein ([113.1±43.2vs100.1±36.4] mg/dl) and triacylglycerol ([189.22± 100.9 vs 115.13±59.2] mg/dl), and significant decline of high density lipoprotein cholesterol ([56.5±20.4vs62.1±13] mg/dl) as compared to healthy controls, respectively. Triacylglycerolemia was significantly associated with the risk of cardiovascular disease (AOR: 1.015; 95%CI: 1.010-1.021). Evident correlation was observed between anthropometric and clinical variables with lipid profile.

CONCLUSION

Higher serum levels of fasting blood sugar, total cholesterol, low density lipoprotein cholesterol, and triacylglycerol and lower levels of high density lipoprotein cholesterol are found in type 2 diabetes mellitus patients. Thus, DM patients are more prone to dyslipidemia which is an important risk factor for atherosclerosis and coronary heart disease.

Metformin treatment of antipsychotic-induced dyslipidemia: an analysis of two randomized, placebo-controlled trials

Dyslipidemia is one of the most common adverse effects in schizophrenia patients treated with antipsychotics. However, there are no established effective treatments. In this study, data were pooled from two randomized, placebo-controlled trials, which were originally designed to examine the efficacy of metformin in treating antipsychotic-induced weight gain and other metabolic abnormalities. In total, 201 schizophrenia patients with dyslipidemia after being treated with an antipsychotic were assigned to take 1000 mg day^-1 metformin (n=103) or placebo (n=98) for 24 weeks, with evaluation at baseline, week 12 and week 24. The primary outcome was the low-density lipoprotein cholesterol (LDL-C) levels. After metformin treatment, the mean difference in the LDL-C value between metformin treatment and placebo was from 0.16 mmol l^-1 at baseline to -0.86 mmol l^-1 at the end of week 24, decreased by 1.02 mmol l^-1 (P<0.0001); and 25.3% of patients in the metformin group had LDL-C ≥3.37 mmol l^-1, which is significantly <64.8% in the placebo group (P<0.001) at week 24. Compared with the placebo, metformin treatment also have a significant effect on reducing weight, body mass index, insulin, insulin resistance index, total cholesterol and triglyceride, and increasing high-density lipoprotein cholesterol. The treatment effects on weight and insulin resistance appeared at week 12 and further improved at week 24, but the effects on improving dyslipidemia only significantly occurred at the end of week 24. We found that metformin treatment was effective in improving antipsychotic-induced dyslipidemia and insulin resistance, and the effects improving antipsychotic-induced insulin resistance appeared earlier than the reducing dyslipidemia.

Vascular Disease in Young Indians (20-40 years): Role of Dyslipidemia

Dyslipidemia is an established risk factor for cardiovascular disease (CVD). Atherosclerosis begins early in life as suggested by "fatty streaks" observed in coronaries of healthy organ donors aged 20-29 years. Premature occurrence of coronary heart disease (CHD) in Indians, increases the risk for young individuals. Management of Dyslipidemia in the young Indian poses several challenges. In this article we provide in-depth review of prevalence, guidelines' perspective and expert comments on management of Dyslipidemia in the young (20-40 years) Indian.

Hba1c, Blood Pressure, and Lipid Control in People with Diabetes: Japan Epidemiology Collaboration on Occupational Health Study

Aims

The control of blood glucose levels, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of diabetes complications; however, data are scarce on control status of these factors among workers with diabetes. The present study aimed to estimate the prevalence of participants with diabetes who meet glycated hemoglobin (HbA1c), BP, and LDL-C recommendations, and to investigate correlates of poor glycemic control in a large working population in Japan.

Methods

The Japan Epidemiology Collaboration on Occupational Health (J-ECOH) Study is an ongoing cohort investigation, consisting mainly of employees in large manufacturing companies. We conducted a cross-sectional analysis of 3,070 employees with diabetes (2,854 men and 216 women) aged 20–69 years who attended periodic health examinations. BP was measured and recorded using different company protocols. Risk factor targets were defined using both American Diabetes Association (ADA) guidelines (HbA1c < 7.0%, BP < 140/90 mmHg, and LDL-C < 100 mg/dL) and Japan Diabetes Society (JDS) guidelines (HbA1c < 7.0%, BP < 130/80 mmHg, and LDL-C < 120 mg/dL). Logistic regression models were used to explore correlates of poor glycemic control (defined as HbA1c ≥ 8.0%).

Results

The percentages of participants who met ADA (and JDS) targets were 44.9% (44.9%) for HbA1c, 76.6% (36.3%) for BP, 27.1% (56.2%) for LDL-C, and 11.2% (10.8%) for simultaneous control of all three risk factors. Younger age, obesity, smoking, and uncontrolled dyslipidemia were associated with poor glycemic control. The adjusted odds ratio of poor glycemic control was 0.58 (95% confidence interval, 0.46–0.73) for participants with treated but uncontrolled hypertension, and 0.47 (0.33–0.66) for participants with treated and controlled hypertension, as compared with participants without hypertension. There was no significant difference in HbA1c levels between participants with treated but uncontrolled hypertension and those with treated and controlled hypertension.

Conclusion

Data from a large working population, predominantly composed of men, suggest that achievement of HbA1c, BP, and LDL-C targets was less than optimal, especially in younger participants. Uncontrolled dyslipidemia was associated with poor glycemic control. Participants not receiving antihypertensive treatment had higher HbA1c levels.

Hematological indices and their correlation with fasting blood glucose level and anthropometric measurements in type 2 diabetes mellitus patients in Gondar, Northwest Ethiopia

BACKGROUND

Diabetes mellitus is (DM) a global public health problem and a complex disease characterized by chronic hyperglycemia that leads to long-term macrovascular and microvascular complications. Recent studies have reported the role of hematological indices in contributing to the vascular injury in diabetic patients. Thus, the aim of this study was to determine hematological indices and their correlation with fasting blood glucose level and anthropometric measurement in type 2 DM patients in comparison with healthy controls.

METHODS

A comparative cross-sectional study was conducted at the chronic illness clinic of Gondar University Hospital from February to April 2015. A total of 296 participants (148 cases and 148 healthy controls) were selected using systematic random sampling technique. Data were collected using a pretested structured questionnaire. Fasting blood glucose levels and hematological indices were determined by using Bio Systems A25 and Sysmex-KX 21N analyzers, respectively. Independent sample t-test, Mann-Whitney U-test, and correlation statistics were used. A P-value <0.05 was considered as statistically significant.

RESULT

There was significant difference in red blood cell distribution width (47.3±2.6 fL vs 45.2±3 fL) between diabetic patients and controls. Total white blood cells in 10(3)/µL (6.59±1.42 vs 5.56±1.38), absolute lymphocyte count in 10(3)/µL (2.60±0.70 vs 2.04±0.63), and absolute neutrophil count in 10(3)/µL (3.57±1.46 vs 3.11±1.04) increased significantly in diabetic patients compared with controls, respectively. Among platelet indices, mean platelet volume (10.4±1.1 fL vs 9.9±1.1 fL) and platelet distribution width (14.5±2.1 fL vs 13.4 ±2.1 fL) were found to be significantly increased in the diabetic patients (P<0.05). Anthropometric measurements significantly correlated with white blood cell and platelet indices.

CONCLUSION

The study showed statistically significant difference in some hematological parameters of diabetic patients compared to controls. Thus, hematological indices could be useful indicators of vascular complication and glycemic control in type 2 DM patients.

Inflammatory stress induces lipid accumulation in multi-organs of db/db mice

Dyslipidemia and chronic inflammation play crucial roles in the progression of diabetes. This study aimed to investigate the effects of inflammatory stress on lipid accumulation in multi-organs in diabetes. Eight-week-old male db/db mice were randomly assigned to inflamed group with alternating day subcutaneous injection of 10% casein or control group with daily injection of distilled water. The lipid profile and plasma levels of inflammatory cytokines were determined using a clinical biochemical assay and enzyme-linked immunosorbent assay. The effects of inflammation on lipid accumulation in target organs were evaluated by hematoxylin-eosin staining, Oil Red O staining, Filipin staining, and a quantitative intracellular cholesterol assay. The protein expressions of low-density lipoprotein receptor (LDLr), sterol regulatory element binding protein-2 (SREBP-2), and SREBP-cleavage-activating protein (SCAP) in tissues were assessed by immunohistochemical staining and western blotting. Results showed that the serum levels of inflammatory cytokines were significantly elevated in casein-injected mice, suggesting that an inflamed diabetic model was established. Furthermore, the protein expressions of inflammatory cytokines in aortas, livers, kidneys, and intestines were significantly increased in inflamed group compared with control. Whereas the serum levels of lipid moieties in inflamed mice were not different compared with the control, inflammatory stress significantly increased lipid accumulation in aortas, livers, kidneys, and intestines, which coincided with increased protein expressions of LDLr, SREBP-2, and SCAP in these organs of inflamed mice. In conclusion, inflammation induces lipid accumulation in multi-organs of db/db mice from the circulation to peripheral tissues, potentially due to lipid redistribution mediated by the disruption of LDLr feedback regulation.

Metformin inhibits monocyte-to-macrophage differentiation via AMPK-mediated inhibition of STAT3 activation: potential role in atherosclerosis

Monocyte-to-macrophage differentiation is a critical event that accentuates atherosclerosis by promoting an inflammatory environment within the vessel wall. In this study, we investigated the molecular mechanisms responsible for monocyte-to-macrophage differentiation and, subsequently, the effect of metformin in regressing angiotensin II (Ang-II)-mediated atheromatous plaque formation in ApoE(-/-) mice. AMPK activity was dose and time dependently downregulated during phorbol myristate acetate (PMA)-induced monocyte-to-macrophage differentiation, which was accompanied by an upregulation of proinflammatory cytokine production. Of note, AMPK activators metformin and AICAR significantly attenuated PMA-induced monocyte-to-macrophage differentiation and proinflammatory cytokine production. However, inhibition of AMPK activity alone by compound C was ineffective in promoting monocyte-to-macrophage differentiation in the absence of PMA. On the other hand, inhibition of c-Jun N-terminal kinase activity inhibited PMA-induced inflammation but not differentiation, suggesting that inflammation and differentiation are independent events. In contrast, inhibition of STAT3 activity inhibited both inflammation and monocyte-to-macrophage differentiation. By decreasing STAT3 phosphorylation, metformin and AICAR through increased AMPK activation caused inhibition of monocyte-to-macrophage differentiation. Metformin attenuated Ang-II-induced atheromatous plaque formation and aortic aneurysm in ApoE(-/-) mice partly by reducing monocyte infiltration. We conclude that the AMPK-STAT3 axis plays a pivotal role in regulating monocyte-to-macrophage differentiation and that by decreasing STAT3 phosphorylation through increased AMPK activity, AMPK activators inhibit monocyte-to-macrophage differentiation.

Lipid abnormalities in patients with adrenal incidentalomas: role of subclinical hypercortisolism and impaired glucose metabolism

BACKGROUND

Subclinical hypercortisolism (SH) has been associated with metabolic complications such as type 2 diabetes mellitus, obesity and dyslipidemia. Scarce data are available regarding the lipid pattern abnormalities in SH, in relation to insulin resistance and impaired glucose metabolism (IGM). We aimed to evaluate the possible influence of SH on lipid pattern in relation to the presence/absence of impaired glucose metabolism.

METHODS

In 338 patients with adrenal incidentaloma, the presence of SH, hypertension, dyslipidemia and IGM was evaluated. According to the presence of SH and IGM the patients were divided into 4 groups (IGM+SH+, IGM+SH-, IGM-SH+, IGM-SH-). We recruited 98 subjects without IGM (IGM-) and 100 with IGM (IGM+) as control groups.

RESULTS

The prevalence of dyslipidemia was comparable among Group IGM+SH+, Group IGM+SH- and IGM+ controls (57.9, 58.4, 56%, P = NS). No difference in dyslipidemia prevalence among IGM- patients and IGM- controls was observed. The IGM+SH+ patients had a higher prevalence of dyslipidemia (57.9%) than IGM-SH+ ones (29.1%, P < 0.01). The IGM+SH- patients showed an increased prevalence of hypertension (76.6 vs 54.8%, P < 0.01) and dyslipidemia (58.4 vs 23.8%, P < 0.0001) as compared with IGM-SH- patients. Logistic regression analysis showed that only IGM was associated to dyslipidemia (OR 4.31, 95% CI 2.61-7.12, P = 0.0001) regardless of age, SH and gender.

CONCLUSIONS

In the absence of alterations of glucose metabolism the presence of a subtle cortisol excess has no effect on lipid pattern. IGM seems to influence the lipid metabolism regardless of the presence of SH.

Assessment of the common risk factors associated with type 2 diabetes mellitus in jeddah

Risk factor management is important in avoiding life-threatening complications and preventing new-onset diabetes. We performed a case-control study in 2013 at ten primary health care centers in Jeddah, Saudi Arabia to determine the common risk factors of diabetes mellitus type 2 (DM2) and the demographic background of adult Saudi patients with DM2. Known diabetic patients were recruited as cases, while nondiabetic attendants were selected as controls. A pretested designed questionnaire was used to collect data from 159 cases and 128 controls. Cases were more likely than controls to be men (P < 0.0001), less educated (P < 0.0001), natives of eastern Saudi Arabia (P < 0.0001), retired (P < 0.0001), lower-salaried (P < 0.0001), or married or divorced (P < 0.0001). By univariate analysis cases were likely to be current smokers (P < 0.0001), hypertensive (P < 0.0001), or overweight/obese (P < 0.0001). Cases were also more likely to have a history of DM in a first-degree relative (P = 0.020). By multivariate analysis, cases were more likely to be older than 40 years (P < 0.0001), less educated (P = 0.05), married or divorced (P = 0.04), jobless/housewives (P < 0.0001), or current smokers (P = 0.002). They were also more likely to have salaries <7000 Saudi riyals (P = 0.01). Overall, prediabetic and high risk groups should be identified and counseled early before the occurrence of diabetes.

Novel approaches to drug discovery for the treatment of type 2 diabetes

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is a chronic, complex and multifactorial metabolic disorder, which has become a serious global health problem. The side effects of known drugs and the deficiency of long-term safety data, in addition to the already determined adverse effects for the current preclinical drugs against T2DM, have largely called upon the urgent exploration of novel therapeutic and preventative strategies against this disease.

AREAS COVERED

The authors highlight the potential approaches for anti-T2DM drug discovery by focusing on: the restoration of pancreatic β-cell mass, the promotion of insulin secretion, the regulation of oxidative stress and endoplasmic reticulum (ER) stress and the modulation of autophagy.

EXPERT OPINION

T2DM is based on the gradual development of insulin resistance and β-cell dysfunction. Thus, the restoration of β-cell function is considered as one of the promising therapeutic strategies against T2DM. The stress factors, such as oxidative stress, ER stress and autophagy, play potent roles in the regulation of β-cell apoptosis, insulin secretion and sensitivity in the development of T2DM involving complicated cross-talks. Based on multiplex stress-involved regulatory networks, more and more novel potential targets have been discovered and the multi-targeted drug leads are expected to help develop more effective clinical agents for the treatment of T2DM.

Correlation of Plasma Lipid Profile with Salivary Oxidative Stress Markers in Type II Diabetes Mellitus Patients

INTRODUCTION

Diabetes is known to be associated with greater production of reactive oxygen species (ROS) like malondialdehyde (MDA) and decreased antioxidants like total thiols and its estimation in plasma is used in monitoring the redox status. The aim of this study was to analyse the association between plasma lipid profile parameters like HDL and LDL with salivary MDA and thiols in diabetic patients.

MATERIALS AND METHODS

Sixty subjects between the age group 35- 70 years who were diagnosed with type II diabetes mellitus based on fasting blood glucose and glycated haemoglobin levels who attended the dental OPD at Kasturba Medical College and Hospital, Manipal consented to participate in this study. Plasma glucose, HDL and LDL were estimated in Cobas autoanalyser by hexokinase method, homogenous enzymatic colorimetric assay and Friedwald's formula respectively. Assessment of glycated hemoglobin was by ion exchange chromatography, MDA by thiobarbituric acid as a substrate and thiols by Ellmann's manual method in plasma and saliva.

RESULTS

The association of plasma LDL with salivary MDA was found to be positive and significant and that with salivary thiols was negative and significant. Also, the association of plasma HDL with salivary MDA was found to be negative and significant and that with salivary thiols was positive and significant.

CONCLUSION

RESULTS indicate the potential of saliva as a tool to monitor prognosis of diabetes.

Level of A1C control and its predictors among Lebanese type 2 diabetic patients

AIM

Lebanon is among the top 10 countries with the highest prevalence of diabetes in the Middle East region with estimates reaching as high as 16.6% in adults aged 20-79 years. The objective of this study was to assess the level of A1C control among a cohort of type 2 diabetic patients and factors associated with uncontrolled A1C.

METHODS

We carried out a retrospective observational study among type 2 diabetes mellitus patients attending an outpatient endocrinologist's clinic between June 2008 and July 2012 in Beirut, Lebanon. Two groups were compared, based on their diabetic control (A1C < 7% and A1C ≥ 7%).

RESULTS

A total of 551 patients were included in this study, where 31.8% attained A1C control. Crude analyses showed that some factors were significantly associated with uncontrolled A1C, and these were long-standing diabetes, diabetes-related complications, uncontrolled blood pressure, lipid profile, as well as the use of metformin, sulfonylurea, or insulin. When multivariate analysis was carried out, the chances of having uncontrolled A1C were significantly higher among patients who developed neuropathy (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.11-3.90), had uncontrolled triglycerides (OR 1.98, 95% CI 1.33-2.94), used insulin (OR 4.52, 95% CI 2.32-8.83), and sulfonylureas (OR 2.88, 95% CI 1.88-4.40).

CONCLUSION

Uncontrolled diabetes is more likely to exist in patients with neuropathy, uncontrolled triglycerides and those using insulin or sulfonylurea. Further research is needed to confirm the findings.