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Liu X, Zeng X, Mahe J, Guo K, He P, Yang Q, Zhang Z, Li Z, Wang D, Zhang Z, Wang L, Jing L. The Effect of Nattokinase-Monascus Supplements on Dyslipidemia: A Four-Month Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Nutrients 2023; 15:4239. [PMID: 37836525 PMCID: PMC10574353 DOI: 10.3390/nu15194239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Dyslipidemia, a condition implying high cardiovascular risks, has been widely studied on its potential nutrition interventions, including functional foods. This study aims to examine the effect of nattokinase monascus supplements (NMSs) on cardiovascular biomarkers and carotid intima-media thickness (CIMT) in patients with dyslipidemia. A total of 113 eligible subjects were randomly assigned to receive either NMSs or a placebo (55 and 58, respectively). After a 120-day intervention, there were significant mean absolute changes in total cholesterol (TC), low-density cholesterol (LDL-C), non-high-density cholesterol (non-HDL-C), and low-density cholesterol to high-density cholesterol ratio (LDL-C to HDL-C ratio), with values of -0.52 (95% CI: -0.51 to -0.54) mmol/L, -0.43 (95% CI: -0.45 to -0.41) mmol/L, -0.52 (95% CI: -0.52 to -0.52) mmol/L, and -0.29 (95% CI: -0.30 to -0.28) mmol/L, respectively, between the two groups. However, no significant differences were found in triglycerides (TGs), high-density cholesterol (HDL-C), and CIMT. Furthermore, the results for lipids and CIMT remained essentially unchanged after adjusting for various confounding factors using the analysis of covariance model. There were no significant differences in coagulation, liver function, renal function, or other indicators. No intervention-related adverse events, such as mouth ulcers, drooling, and stomach pain, were reported. The study results demonstrate that NMSs can ameliorate lipid levels (TC, LDL-C, non-HDL-C, and the LDL-C to HDL-C ratio) without the occurrence of adverse events. However, it did not significantly affect serum TG, HDL-C, and CIMT.
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Affiliation(s)
- Xiaoming Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China; (X.L.); (X.Z.); (J.M.); (K.G.); (P.H.); (Q.Y.); (Z.Z.)
| | - Xuejiao Zeng
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China; (X.L.); (X.Z.); (J.M.); (K.G.); (P.H.); (Q.Y.); (Z.Z.)
| | - Jinli Mahe
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China; (X.L.); (X.Z.); (J.M.); (K.G.); (P.H.); (Q.Y.); (Z.Z.)
| | - Kai Guo
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China; (X.L.); (X.Z.); (J.M.); (K.G.); (P.H.); (Q.Y.); (Z.Z.)
| | - Panpan He
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China; (X.L.); (X.Z.); (J.M.); (K.G.); (P.H.); (Q.Y.); (Z.Z.)
| | - Qianwen Yang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China; (X.L.); (X.Z.); (J.M.); (K.G.); (P.H.); (Q.Y.); (Z.Z.)
| | - Zhiwei Zhang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China; (X.L.); (X.Z.); (J.M.); (K.G.); (P.H.); (Q.Y.); (Z.Z.)
| | - Zhongxia Li
- BYHEALTH Institute of Nutrition & Health, No.3 Kehui 3rd Street, No.99 Kexue Avenue Central, Huangpu District, Guangzhou 510663, China; (Z.L.); (D.W.)
| | - Di Wang
- BYHEALTH Institute of Nutrition & Health, No.3 Kehui 3rd Street, No.99 Kexue Avenue Central, Huangpu District, Guangzhou 510663, China; (Z.L.); (D.W.)
| | - Zheqing Zhang
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China;
| | - Lei Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Lipeng Jing
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China; (X.L.); (X.Z.); (J.M.); (K.G.); (P.H.); (Q.Y.); (Z.Z.)
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Kirac CO, Sirikci V, Findikli HA. The impact of insulin induced lipohypertrophy on carotid intima-media thickness in patients with type 2 diabetes mellitus. Medicine (Baltimore) 2023; 102:e34696. [PMID: 37773793 PMCID: PMC10545240 DOI: 10.1097/md.0000000000034696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/20/2023] [Indexed: 10/01/2023] Open
Abstract
Lipohypertrophy (LH) is a major localized complication of insulin therapy. We aimed to investigate the association between insulin-induced LH and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus (DM). A total of 75 patients with DM treated with insulin were included in this study. The insulin injection sites of the patients were evaluated by inspection and palpation and then radiologically with ultrasound. The CIMT of the patients was evaluated using ultrasonography. According to the guideline recommendation, the CIMT cutoff value was taken as 0.9 mm, and the patients were categorized into 2 groups according to the CIMT value and evaluated statistically. The presence of LH (CI: 1.379-30.000; OR = 6.432; P < .05), age (CI: 1.036-1.149; OR = 1091; P < .05), BMI (CI: 1.003-1.262; OR = 1.125; P < .05) and duration of DM (CI: 1.001-1.300; OR = 1.141; P < .05) were independent risk factors for high-CIMT in patients with DM. The most interesting result of this study was that the presence of LH was an independent risk factor for increased CIMT. According to this result, we think that LH may increase the risk of cardiovascular disease as well as being a complication that disrupts the blood glucose regulation of patients with DM and increases the cost of treatment.
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Affiliation(s)
- Cem Onur Kirac
- Necip Fazil City Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism, Kahramanmaras, Turkey
| | - Vehbi Sirikci
- Necip Fazil City Hospital, Department of Internal Medicine, Kahramanmaras, Turkey
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Adusu‐Donkor L, Ofori EK, Kotey FCN, Dogodzi FK, Dziedzorm W, Buabeng A, Bernard SK, Amponsah SK, Asare‐Anane H. Blood C-peptide concentration as a proxy marker of cardiovascular disease: An observational cross-sectional study. Health Sci Rep 2023; 6:e1535. [PMID: 37662537 PMCID: PMC10472907 DOI: 10.1002/hsr2.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background and Aims Cardiovascular diseases (CVDs) are among the leading causes of disability and early death in sub-Saharan Africa. Most of the current blood tests for CVD diagnosis involve performing about three test profiles; often at additional cost to patients. C-peptide, a cleavage product of proinsulin, is a promising marker that has the potential to serve as a proxy marker for diagnosing CVDs in resource-poor settings. Methodology The study was an observational cross-sectional one and involved 127 consenting persons diagnosed with CVD and 127 individuals without CVD. The socio-demographic and clinical characteristics of participants were obtained. Blood levels of C-peptide, fasting plasma glucose (FPG), total creatinine kinase (CK), creatine kinase myocardial bound (CKMB), lactate dehydrogenase (LDH), propeptide of brain natriuretic peptide (PBNP), Troponin T, lipids, and biomarkers of kidney and liver function were analyzed using ELISA and an automated analyzer. Insulin resistance was computed using the modified homeostatic model assessment (HOMA-IR). Results The CVD Group had significantly higher levels of C-peptide, CK, CKMB, troponin T, PBNP, FPG, HOMA-IR, and several selected kidney, liver, and lipid parameters compared to the non-CVD Group (p < 0.05 for all). Troponin T recorded a positive correlation (r = 0.34, p < 0.001) with C-peptide among the CVD Group. The sensitivity and specificity of C-peptide in identifying CVD were 96.1% and 91.3% respectively (area under the curve = 0.938, p < 0.001). Conclusion C-peptide levels were higher in the CVD Group and appeared to be a valuable (high sensitivity and specificity) biomarker in detecting CVD.
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Affiliation(s)
- Laurinda Adusu‐Donkor
- Department of Chemical PathologyU.G.M.S, University of GhanaAccraGhana
- Department of Chemical Pathology37 Military HospitalAccraGhana
| | | | - Fleischer C. N. Kotey
- Department of Medical MicrobiologyU.G.M.S, University of GhanaAccraGhana
- FleRhoLife Research ConsultAccraGhana
| | | | | | - Alfred Buabeng
- Department of Chemical PathologyU.G.M.S, University of GhanaAccraGhana
| | | | - Seth K. Amponsah
- Department of Medical PharmacologyU.G.M.S, University of GhanaAccraGhana
| | - Henry Asare‐Anane
- Department of Chemical PathologyU.G.M.S, University of GhanaAccraGhana
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Jahromi MK, Ahmadirad H, Jamshidi S, Farhadnejad H, Mokhtari E, Shahrokhtabar T, Tavakkoli S, Teymoori F, Mirmiran P. The association of serum C-peptide with the risk of cardiovascular events: a meta-analysis and systematic review. Diabetol Metab Syndr 2023; 15:168. [PMID: 37568168 PMCID: PMC10416519 DOI: 10.1186/s13098-023-01142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND C-peptide is considered a peptide with active function in the body, which can affect people's health. However, the results of previous studies on the possible association of C-peptide with the risk of cardiometabolic disorders have not been fully understood. This systematic review and meta-analysis aimed to investigate the association between serum C-peptide level and the risk of cardiovascular disease (CVD) events. METHODS The various important databases, including PubMed, Scopus, and Web of Science, were searched comprehensively to November 2022 to identify the relevant studies. The HR(95% CI) or OR(95% CI) for observational studies were extracted and converted into log HR or log OR and their standard deviation(SD) was computed. A random-effects model with an inverse variance weighting method was conducted, to calculate the pooled effect size. RESULTS Sixteen observational studies, including one case-control study, eight cohort studies, and seven cross-sectional studies were included in the current meta-analysis. The sample size ranged from 90 to 7030, with an age range from 12 to 85 years. During the follow-up time (ranging from 5 to 17 years), 4852 CVD events occurred. Based on cohort and case-control studies, the pooled results showed no significant association between serum C-peptide with CVD events risk (RR = 1.02;95%CI:0.91-1.15, I2 = 34.7%; P-heterogeneity = 0.140). For cross-sectional studies, the pooled results indicated a positive association between serum C-peptide and the odds of CVD outcomes (OR = 1.35;95%CI:1.04-1.76, I2 = 83.6%; P-heterogeneity < 0.001). CONCLUSIONS The pooled results of the current study suggested that C-peptide level was not related to the risk of CVD events in cohort studies, however, the meta-analysis of cross-sectional studies showed a significant association between C-peptide and an increased risk of CVD events.
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Affiliation(s)
- Mitra Kazemi Jahromi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran
| | - Hamid Ahmadirad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Jamshidi
- Imam Ali Hospital, Shiraz University of Medical Sciences, Kazerun, Iran
| | - Hossein Farhadnejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Mokhtari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahere Shahrokhtabar
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Tavakkoli
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Teymoori
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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You H, Hou X, Zhang H, Li X, Feng X, Qian X, Shi N, Guo R, Wang X, Sun H, Feng W, Li G, Zheng Z, Chen Y. Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: a retrospective study. Diabetol Metab Syndr 2023; 15:20. [PMID: 36788548 PMCID: PMC9930270 DOI: 10.1186/s13098-023-00984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The optimal glycemic control level in diabetic patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (On-Pump) remains unclear. Therefore, this study aimed to investigate the effect of different blood glucose control levels and glucose fluctuations on in-hospital adverse outcomes in diabetic patients undergoing on-pump CABG. METHOD A total of 3918 patients with diabetes undergoing CABG were reviewed in this study. A total of 1638 patients were eligible for inclusion and were categorized into strict, moderate and liberal glucose control groups based on post-operative mean blood glucose control levels of < 7.8 mmol/L, from 7.8 to 9.9 mmol/L and ≥ 10.0 mmoL/L, respectively. The primary endpoint was defined as a composite endpoint including in-hospital all-cause mortality and major cardiovascular complications. The secondary endpoint was defined as major cardiovascular complications including acute myocardial infarction, strokes and acute kidney injuries. To determine the associations between blood glucose fluctuations and adverse outcomes, patients with different glycemic control levels were further divided into subgroups according to whether the largest amplitude of glycemic excursion (LAGE) was ≥ 4.4 mmol/L or not. RESULTS A total of 126 (7.7%) patients had a composite endpoint. Compared with moderate control, strict glucose control was associated with an increased risk of the primary endpoint (adjusted OR = 2.22, 95% CI 1.18-4.15, p = 0.01) and the secondary endpoint (adjusted OR = 1.95, 95% CI 1.01-3.77, p = 0.049). Furthermore, LAGE ≥ 4.4 mmol/L was significantly associated with the primary endpoint (adjusted OR = 1.67, 95% CI 1.12-2.50, p = 0.01) and the secondary endpoint (adjusted OR = 1.75, 95% CI 1.17-2.62, p = 0.01),respectively. Patients with LAGE ≥ 4.4 mmol/L had significantly higher rates of the composite endpoint and major vascular complications in both the strict-control (the primary endpoint, 66.7% vs 12.4%, p = 0.034, the secondary endpoint, 66.7% vs 10.3%, p = 0.03) and moderate-control groups (the primary endpoint, 10.2% vs 6.0%, p = 0.03, the secondary endpoint, 10.2% vs 5.8%, p = 0.02). CONCLUSIONS After On-Pump CABG patients with diabetes, strict glucose control (< 7.8 mmol/L) and relatively large glucose fluctuations (LAGE ≥ 4.4 mmol/L) were independently associated with in-hospital adverse outcomes.
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Affiliation(s)
- Hongzhao You
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xiaopei Hou
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Heng Zhang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojue Li
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xinxing Feng
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xin Qian
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Na Shi
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Rong Guo
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xuan Wang
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Hansong Sun
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwei Li
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Zhe Zheng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yanyan Chen
- Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
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Yang W, Liu M, Tian Y, Zhang Q, Zhang J, Chen Q, Suo L, Chen Y. The increased prevalence of depression and anxiety in T2DM patients associated with blood glucose fluctuation and sleep quality. BMC Endocr Disord 2022; 22:232. [PMID: 36114534 PMCID: PMC9482159 DOI: 10.1186/s12902-022-01147-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current evidence demonstrates that blood glucose fluctuation can be associated with depression and anxiety. The association among blood glucose fluctuation, traditional risk factors and emotional disorders in T2DM should be studied and clarified. METHODS A total of 182 diabetic patients including 81 patients with depression or anxiety and 101 patients without emotional disorder were enrolled into this study. Data were obtained through medical history and questionnaire survey. Data were analyzed using appropriate statistical methods. RESULTS The comparison results of basic information between the two groups showed that the differences of the proportion of female were statistically significant (p = 0.002). There was no statistical difference in laboratory examination indexes between the two groups, however, standard deviation of blood glucose (SDBG) and postprandial glucose excursion (PPGE) of the comorbidity group were significantly higher than that of control group (p = 0.032 and p = 0.037). The results of questionnaire survey showed that there were statistically significant differences in sleep quality, PSQI and dietary habit between the two groups (p < 0.001, p < 0.001 and p < 0.001). Stratified analysis results according to gender showed that the percentage of cognitive disorder, anxiety and depression in female group was significantly higher than that in male group (p = 0.001, p < 0.001 and p < 0.001). Mini-mental state examination (MMSE), self-rating anxiety scale (SAS) and patient health questionnaire (PHQ-9) score in female group were also higher than male group (p = 0.001, p < 0.001 and p < 0.001). Logistic regression analysis results showed that SDBG and sleep quality were associated with emotional disorders in T2DM (p = 0.040 and p < 0.001) and the OR values of these factors were 7.588 (1.097-52.069) and 4.428 (2.649-7.401). CONCLUSIONS Blood glucose fluctuation and sleep quality are associated with the increased prevalence of depression and anxiety disorders in T2DM.
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Affiliation(s)
- Wei Yang
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Min Liu
- Department of Hospital Infection Control, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China.
| | - Yuan Tian
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Qianwei Zhang
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jiahua Zhang
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Qiaoyun Chen
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Lixia Suo
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yang Chen
- Department of Neurology, The 904Th Hospital of PLA, Medical School of Anhui Medical University, Wuxi, Jiangsu, China.
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Li W, Zhao J, Zhu LL, Peng YF. Serum vitamin B12 levels and glycemic fluctuation in patients with type 2 diabetes mellitus. Ther Adv Endocrinol Metab 2022; 13:20420188221102800. [PMID: 35677226 PMCID: PMC9168854 DOI: 10.1177/20420188221102800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/09/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose The aim of the study was to explore the correlation between serum vitamin B12 levels and glycemic fluctuation in patients with type 2 diabetes mellitus (T2DM). Methods This study included 202 T2DM patients in whom blood glucose levels were recorded using a continuous glucose monitoring system retrospectively. Glycemic fluctuation was determined using the average daily risk range (ADRR), a diabetes-specific measure of the risk for hyper- and hypoglycemia. Results Serum vitamin B12 levels were higher in T2DM patients with wider glycemic fluctuations than in those with minor glycemic fluctuations (p < 0.001). We observed a positive correlation between serum vitamin B12 levels and ADRR in both T2DM patients who received and did not receive metformin therapy (r = 0.388, p < 0.001 and r = 0.280, p = 0.004, respectively). Multiple linear regression analysis showed that serum vitamin B12 levels were independently correlated with ADRR in T2DM patients who received and did not receive metformin therapy (beta = 0.367, p < 0.001 and beta = 0.410, p < 0.001, respectively). Conclusions Serum vitamin B12 levels are correlated with glycemic fluctuation in patients with T2DM and may serve as an underlying useful biomarker of glycemic fluctuation in T2DM patients, treated with or without metformin therapy.
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Affiliation(s)
- Wei Li
- Department of Endocrinology, Suzhou Hospital of
Anhui Medical University, Suzhou, China
| | - Jing Zhao
- Department of Endocrinology, Suzhou Hospital of
Anhui Medical University, Suzhou, China
| | - Ling-Ling Zhu
- Department of Endocrinology, Suzhou Hospital of
Anhui Medical University, Suzhou, China
| | - You-Fan Peng
- Department of Respiratory and Critical Care
Medicine, Affiliated Hospital of Youjiang Medical University for
Nationalities, No. 18 Zhongshan Er Road, Baise, Guangxi 533000, China
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Effects of Serum C-Peptide Level on Blood Lipid and Cardiovascular and Cerebrovascular Injury in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6314435. [PMID: 35480084 PMCID: PMC9012635 DOI: 10.1155/2022/6314435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/07/2022] [Accepted: 03/17/2022] [Indexed: 12/15/2022]
Abstract
Objective This study aims to investigate the effects of serum C-peptide levels on blood lipid and cardiovascular and cerebrovascular injury in patients with type 2 diabetes mellitus (T2DM). Methods China National Knowledge Infrastructure (CNKI), WanFang Data, PubMed, Web of Science, and Embase databases were searched for relevant studies published from January 2010 to June 2021. All retrieved randomized controlled trials that evaluated the effect of serum C-peptide levels on blood lipids or cardiovascular and cerebrovascular injuries in T2DM patients were included in our study. Patients in the included studies were divided into normal C-peptide group (control group) and low C-peptide group (treatment group) according to fasting C-peptide levels. Meta-analysis was performed using Stata16.0. Results A total of 7 studies were included for the meta-analysis. Compared with the control group, the treatment group was associated with a higher incidence of coronary heart disease (OR = 4.89; 95% CI: 1.13, 21.24; P < 0.05) and cerebral infarction (OR = 3.24; 95% CI: 0.59, 17.66; P < 0.05). In addition, patients in the treatment group had significantly higher levels of total cholesterol (SMD = 0.01; 95% CI: -0.38, 0.39; P < 0.05), triglyceride (SMD = 0.62; 95% CI: 0.24, 1.00; P < 0.05), glycated hemoglobin (SMD = 0.25; 95% CI: -0.50, 1.00; P < 0.05), and low-density lipoprotein cholesterol (SMD = 0.23; 95% CI: -0.00, 0.46; P < 0.05). However, there was no significant difference in high-density lipoprotein cholesterol levels between the two groups (SMD = 0.30; 95% CI: -0.26, 0.86; P > 0.05). Conclusions Low serum C-peptide level significantly increases the incidence of coronary heart disease and cerebral infarction. Additionally, low serum C-peptide increases blood lipid level and promotes lipid deposition. Collectively, low serum C-peptide has a negative impact on the occurrence and development of T2DM and therefore serum C-peptide level needs to be adjusted timely.
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Zhao H, Zhang LD, Liu LF, Li CQ, Song WL, Pang YY, Zhang YL, Li D. Blood Levels of Glycated Hemoglobin, D-Dimer, and Fibrinogen in Diabetic Retinopathy. Diabetes Metab Syndr Obes 2021; 14:2483-2488. [PMID: 34103957 PMCID: PMC8180300 DOI: 10.2147/dmso.s309068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This study aimed to describe the levels of glycated hemoglobin (HbA1c), D-dimer (D-D), and fibrinogen (FIB) in different types of diabetic retinopathy (DR). METHODS A total of 61 patients with diabetes, who were treated in our department between November 2017 and May 2019, were selected. According to their non-mydriatic fundus photography and fundus angiography results, patients were divided into three groups, ie, the non-DR (NDR) group (n=23), the non-proliferative DR (NPDR) group (n=17), and the proliferative DR (PDR) group (n=21). A control group of 20 people who had tested negative for diabetes was also included. The levels of HbA1c, D-D, and FIB were measured and compared, respectively. RESULTS The mean values of HbA1c were 6.8% (5.2%, 7.7%), 7.4% (5.8%, 9.0%), and 8.5% (6.3%, 9.7%) in the NDR, NPDR, and PDR groups, respectively. The control group values were 4.9% (4.1%, 5.8%). These results indicated a significant statistical difference between groups. The mean values of D-D were 0.39 ± 0.21 mg/L, 1.06 ± 0.54 mg/L, and 1.39 ± 0.59 mg/L in the NDR, NPDR, and PDR groups, respectively. The control group result was 0.36 ± 0.17 mg/L. The values of the NPDR and PDR groups were significantly higher than those of the NDR and control groups, and the value of the PDR group was significantly higher than that of the NPDR group, indicating a significant difference between the groups (P < 0.001). The mean values of FIB were 3.07 ± 0.42 g/L, 4.38 ± 0.54 g/L, and 4.46 ± 1.09 g/L in the NDR, NPDR, and PDR groups, respectively. The control group result was 2.97 ± 0.67 g/L. The difference between the groups was statistically significant (P < 0.05). CONCLUSION Blood levels of HbA1c, D-D, and FIB in the PDR group were significantly higher than in the NPDR group.
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Affiliation(s)
- Heng Zhao
- Endocrinology Laboratory, The First Central Hospital of Baoding, Baoding, Hebei Province, 071000, People’s Republic of China
| | - Li-Dan Zhang
- Department of Nuclear Medicine, The First Central Hospital of Baoding, Baoding, Hebei Province, 071000, People’s Republic of China
| | - Li-Fang Liu
- Endocrinology Laboratory, The First Central Hospital of Baoding, Baoding, Hebei Province, 071000, People’s Republic of China
| | - Chun-Qing Li
- Outpatient Department, The First Central Hospital of Baoding, Baoding, Hebei Province, 071000, People’s Republic of China
| | - Wei-Li Song
- Outpatient Department, The First Central Hospital of Baoding, Baoding, Hebei Province, 071000, People’s Republic of China
| | - Yong-Yang Pang
- Endocrinology Laboratory, The First Central Hospital of Baoding, Baoding, Hebei Province, 071000, People’s Republic of China
| | - Yun-Liang Zhang
- Endocrinology Laboratory, The First Central Hospital of Baoding, Baoding, Hebei Province, 071000, People’s Republic of China
| | - Dan Li
- Department of Ophthalmology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, 071000, People’s Republic of China
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Taya N, Katakami N, Mita T, Okada Y, Wakasugi S, Yoshii H, Shiraiwa T, Otsuka A, Umayahara Y, Ryomoto K, Hatazaki M, Yasuda T, Yamamoto T, Gosho M, Shimomura I, Watada H. Associations of continuous glucose monitoring-assessed glucose variability with intima-media thickness and ultrasonic tissue characteristics of the carotid arteries: a cross-sectional analysis in patients with type 2 diabetes. Cardiovasc Diabetol 2021; 20:95. [PMID: 33947398 PMCID: PMC8097791 DOI: 10.1186/s12933-021-01288-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The association between glucose variability and the progression of atherosclerosis is not completely understood. We aimed to evaluate the associations of glucose variability with the progression of atherosclerosis in the early stages. METHODS We conducted a cross-sectional analysis to investigate the associations of glucose variability, assessed by continuous glucose monitoring, with intima-media thickness (IMT) and gray-scale median (GSM) of the carotid arteries, which are different indicators for the progression of atherosclerosis. We used baseline data from a hospital-based multicenter prospective observational cohort study among Japanese patients with type 2 diabetes without a history of cardiovascular diseases aged between 30 and 80 years. Continuous glucose monitoring was performed by Freestyle Libre Pro, and glucose levels obtained every 15 min for a maximum of eight days were used to calculate the metrics of glucose variability. IMT and GSM were evaluated by ultrasonography, and the former indicates thickening of intima-media complex in the carotid artery wall, while the latter indicates tissue characteristics. RESULTS Among 600 study participants (age: 64.9 ± 9.2 (mean ± SD) years; 63.2%: men; HbA1c: 7.0 ± 0.8%), participants with a larger intra- and inter-day glucose variability had a lower GSM and most of these associations were statistically significant. No trend based on glucose variability was shown regarding IMT. Standard deviation of glucose (regression coefficient, β = - 5.822; 95% CI - 8.875 to - 2.768, P < 0.001), glucose coefficient of variation (β = - 0.418; - 0.685 to - 0.151, P = 0.002), mean amplitude of glycemic excursion (β = - 1.689; - 2.567 to - 0.811, P < 0.001), mean of daily differences (β = - 6.500; - 9.758 to - 3.241, P < 0.001), and interquartile range (β = - 4.289; - 6.964 to - 1.614, P = 0.002) had a statistically significant association with mean-GSM after adjustment for conventional cardiovascular risk factors, including HbA1c. No metrics of glucose variability had a statistically significant association with IMT. CONCLUSIONS Continuous glucose monitoring-assessed glucose variability was associated with the tissue characteristics of the carotid artery wall in type 2 diabetes patients without cardiovascular diseases.
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Affiliation(s)
- Naohiro Taya
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Tomoya Mita
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yosuke Okada
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Satomi Wakasugi
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hidenori Yoshii
- Department of Medicine, Diabetology & Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20, Shinsuna, Koto-ku, Tokyo, Japan
| | | | - Akihito Otsuka
- Department of Internal Medicine, Kawasaki Hospital, 3-3-1, Higashiyamacho, Hyogo-ku, Kobe, Hyogo, Japan
| | - Yutaka Umayahara
- Department of Diabetes and Endocrinology, Osaka General Medical Center, 3-1-56, Bandaihigashi, Sumiyoshi-ku, Osaka-shi, Osaka, Japan
| | - Kayoko Ryomoto
- Center for Diabetes Mellitus, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Masahiro Hatazaki
- Department of Internal Medicine, Japan Community Health Care Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka-shi, Osaka, Japan
| | - Tetsuyuki Yasuda
- Department of Diabetes and Endocrinology, Osaka Police Hospital, 10-31, Kitayamacho, Tennoji-ku, Osaka-shi, Osaka, Japan
| | - Tsunehiko Yamamoto
- Diabetes and Endocrinology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hirotaka Watada
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Huang Y, Xu Y, Qiu J, Jiang C, Tan W, Tao X, Gu Q, Sun J. The impact of dusk phenomenon on total glucose exposure in Chinese people with type 2 diabetes. Medicine (Baltimore) 2021; 100:e25298. [PMID: 33787619 PMCID: PMC8021309 DOI: 10.1097/md.0000000000025298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 03/04/2021] [Indexed: 01/04/2023] Open
Abstract
This study was aimed at assessing the impact of the dusk phenomenon on the total glucose exposure in Chinese people with type 2 diabetes.A total of 380 type 2 diabetes who received a retrospective continuous glucose monitoring system (CGMs) for 72 hours were enrolled in our study, 32 of them failed in CGMs. The patients were first divided into 2 groups: dusk phenomenon (n = 95) and non dusk phenomenon group (n = 253). The magnitude of the dusk phenomenon (δDusk) was quantified by pre-dinner glucose minus post-lunch 2 hours glucose. A persistent δDusk ≥ 0 or a once only δDusk < 0 can be diagnosed with the dusk phenomenon. The participants were secondarily matched for the post-lunch 2 hours glucose to assess the impact of the dusk phenomenon on the overall glucose exposure. The impact of the dusk phenomenon was assessed on high-performance liquid chromatography assay (HbA1c) and 24-hour mean glucose.There were 95 of 348 (27.3%) participants with the dusk phenomenon in the overall population, and the median of δDusk level was -0.8 (-1.8, 0.2) mmol/L. The median of glucose differences between the 2 paired groups were 0.4 (-0.4, 1.0)% for HbA1c, 0.9 (0.2, 1.4) mmol/L for 24 hours mean glucose. The correlation analysis showed no relationship between the magnitude of dawn phenomenon and the dusk phenomenon (r = 0.052, P = .472).The incidence of dusk phenomenon is about 27.3% in people with type 2 diabetes. The impacts of dusk phenomenon on HbA1c and 24-hour mean glucose were about 0.4% and 0.9 mmol/L and the dusk phenomenon was not related with the dawn phenomenon.
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Yang L, Liu Z, Ling W, Wang L, Wang C, Ma J, Peng X, Chen J. Effect of Anthocyanins Supplementation on Serum IGFBP-4 Fragments and Glycemic Control in Patients with Fasting Hyperglycemia: A Randomized Controlled Trial. Diabetes Metab Syndr Obes 2020; 13:3395-3404. [PMID: 33061500 PMCID: PMC7532046 DOI: 10.2147/dmso.s266751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Insulin-like growth factor binding protein-4 (IGFBP-4) fragments have been shown to be associated with cardiometabolic diseases. Anthocyanins as a subgroup of natural polyphenols could have benefits on treating cardiometabolic diseases. The aim of this study was to examine the effects of purified anthocyanins on serum IGFBP-4 fragments and glycemic control in patients with fasting hyperglycemia. METHODS A set of 121 participants with elevated fasting glucose (≥5.6 mmol/L), who were originally randomly assigned to anthocyanins (320 mg/day) or placebo groups, were included in this study. Serum IGFBP-4 fragments, fasting and postload glucose, insulin, and C-peptide after a three-hour oral glucose tolerance test (OGTT) were measured at baseline and at the end of 12 weeks. RESULTS Compared with placebo, anthocyanins increased serum IGFBP-4 fragments (net change 8.33 ng/mL, 95% CI [1.2, 15.47], p=0.023) and decreased fasting glucose (-0.4 mmol/L [-0.71, -0.1], p=0.01), 2-hour C-peptide (-1.02 ng/mL [-1.99, -0.04], p=0.041) and the 3-hour area under the curve (AUC) of C-peptide (-2.19 [-4.11, -0.27], p=0.026). No other significant difference in parameters for glycemic control and insulin resistance was observed. CONCLUSION Anthocyanins supplementation for 12 weeks improved serum IGFBP-4 fragments and decreased fasting glucose and postload C-peptide in patients with fasting hyperglycemia. Further studies are needed to confirm our findings and clarify the potential mechanism. TRIAL REGISTRATION ClinicalTrials.gov, NCT02689765. Registered on 6 February 2016, https://clinicaltrials.gov/ct2/show/NCT02689765.
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Affiliation(s)
- Liping Yang
- Center for Chronic Disease Control, Nanshan, Shenzhen, People’s Republic of China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zhaomin Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wenhua Ling
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Li Wang
- Center for Chronic Disease Control, Nanshan, Shenzhen, People’s Republic of China
| | - Changyi Wang
- Center for Chronic Disease Control, Nanshan, Shenzhen, People’s Republic of China
| | - Jianping Ma
- Center for Chronic Disease Control, Nanshan, Shenzhen, People’s Republic of China
| | - Xiaolin Peng
- Center for Chronic Disease Control, Nanshan, Shenzhen, People’s Republic of China
| | - Jianying Chen
- Internal Medicine Department, BaiYun Hospital, GuangZhou, GuangDong Province, People’s Republic of China
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Zhou YY, Qiu HM, Yang Y, Han YY. Analysis of risk factors for carotid intima-media thickness in patients with type 2 diabetes mellitus in Western China assessed by logistic regression combined with a decision tree model. Diabetol Metab Syndr 2020; 12:8. [PMID: 32015760 PMCID: PMC6988356 DOI: 10.1186/s13098-020-0517-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/10/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with type 2 diabetes (T2DM). Carotid intima-media thickness (CIMT) is considered a preclinical stage of atherosclerosis. Therefore, it is necessary to identify the related risk factors for CIMT to facilitate the early prevention of CVD. Previous studies have shown that visceral fat area (VFA) is a risk factor for T2DM and CVD. However, few studies have focused on the effects of VFA on CIMT associated with T2DM. Moreover, considering that the body fat distribution shows regional and racial heterogeneity, the purpose of this study was to investigate the predictive value of VFA and other risk factors for CIMT associated with T2DM in Western China. METHODS In a cross-sectional study, a total of 1372 patients with T2DM were divided into the CIMT (-) group (n = 965) and the CIMT (+) group (n = 407) based on CIMT values. In addition to the univariate analyses, logistic regression analysis and a decision tree model were simultaneously performed to establish a correlation factor model for CIMT. RESULTS Univariate analyses showed that sex, smoking status, age, heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), height, weight, body mass index (BMI), waist circumference, hip circumference, waist-hip ratio, VFA, subcutaneous fat area, and the levels of 2-h C-peptide, serum creatinine, urea nitrogen and uric acid were significantly different between the two groups (all p < 0.05). Smoking, increased VFA, female sex and increased BMI were risk factors in the logistic regression analyses (OR = 5.759, OR = 1.364, OR = 2.239, OR = 1.186, respectively). In the decision tree model, smoking was the root node, followed by sex, waist circumference, VFA and chronic kidney disease (CKD) in order of importance. CONCLUSIONS In addition to smoking, sex and BMI, VFA has a significant effect on CIMT associated with T2DM in the Chinese Han population in Western China. In addition, the decision tree model could help clinicians make more effective decisions, with its simplicity and intuitiveness, making it worth promoting in future medical research.Trial registration ChiCTR, ChiCTR1900027739. Registered 24 November 2019-Retrospectively registered, http://www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Yuan-Yuan Zhou
- Department of Endocrinology and Metabolism, Fourth Affiliated Hospital of Kunming Medical University, The Second People’s Hospital of Yunnan Province, Kunming, 650021 China
- Department of Endocrinology and Metabolism, Sixth Affiliated Hospital of Kunming Medical University, The People’s Hospital of Yuxi City, Yuxi, 653100 China
| | - Hong-Mei Qiu
- Department of Endocrinology and Metabolism, Sixth Affiliated Hospital of Kunming Medical University, The People’s Hospital of Yuxi City, Yuxi, 653100 China
| | - Ying Yang
- Department of Endocrinology and Metabolism, Fourth Affiliated Hospital of Kunming Medical University, The Second People’s Hospital of Yunnan Province, Kunming, 650021 China
| | - Yuan-Yuan Han
- Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650021 China
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