Incidence of microvascular complications of type 2 diabetes: A 12 year longitudinal study from Karachi-Pakistan

Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico

BACKGROUND

The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2D). Therefore, we compared metabolic control and macro/microvascular complications of patients with T2D before and throughout the three-year SARS-CoV-2 pandemic.

RESEARCH DESIGN AND METHODS

A retrospective observational cohort of subjects with T2D studied from 2018 to 2022 in Northern Mexico was treated by a dynamic multidisciplinary team. Levels of Glycated hemoglobin (HbA1c), fasting serum glucose (FG), LDL-Cholesterol (LDL-C), blood pressure (BP), albuminuria, triglycerides, Body Mass Index (BMI), and FIB-4 score, micro and macrovascular complications were evaluated.

RESULTS

A total of 999 patients were studied, 51.7% males with a mean (SD) age of 60.1 (12.7) years. Adequate glycemic control based on HbA1c increased by 15.2% and 42.3% in FSG (p < 0.001) between the beginning 2018 and the end of 2022. LDL-C control decreased by 5.1% between 2018 and 2022 (p < 0.001). Systolic BP control decreased by 2.6% (p < 0.001), whereas diastolic BP control increased by 1.8% (p = 0.01) between 2018 and 2022. Albuminuria control increased by 8.5% (p = 0.002). When comparing the Area Under the Curve (AUC) of metabolic parameters between patients who developed SARS-CoV-2 vs. those who did not, AUC was statistically higher in those who developed SARS-CoV-2 (p < 0.05). Diabetic neuropathy was the most prevalent microvascular complication (n = 35; 3.6%); ischemic heart disease was the most frequent macrovascular complication (n = 11;1.1%).

CONCLUSIONS

A multidisciplinary dynamic team that adapts to the pandemic SARS-CoV-2 maintains and increases metabolic control in subjects with type 2 diabetes in Mexico. This represents a low percentage of chronic complications. The AUC of metabolic parameters of subjects with SARS-CoV-2 infection is higher, reflecting more variability in metabolic control.

Association of triglyceride glucose index and triglyceride HDL ratio with glucose levels, microvascular and macrovascular complications in Diabetes Mellitus Type-2

Objective

To find out the role of triglyceride glucose index (TGI) and triglyceride HDL ratio (THR) as predictors of insulin resistance and control of glucose status in type two diabetes mellitus (T2DM).

Method

This cross-sectional study was conducted in Dr. Akbar Niazi Teaching Hospital, January-April 2022. A total of 56 individuals, both males and females aged 30-75 years having T2DM with fasting blood glucose ≥ 110 mg/dl and HbA1c ≥ 5.7% were included. Biochemical markers were estimated by applying standard methods. Independent sample t-test, Fisher exact test, and linear regression were applied.

Results

TGI and triglyceride HDL ratio were significantly raised (p=0.01) in patients with poor glycemic control as compared to controlled glucose levels (17.8 ± 4.7vs7.3 ± 1.75) and (3.84 ± 1.3vs2.12 ± 0.64) respectively. These two indices have a significant association (p=0.01) with HbA1c (r=0.963, r=0.757), fasting blood glucose (r=0.964, r=0.748), and HOMA-IR (r=0.955, r=0.718) respectively. Moreover, TGI and THR were found to have a more significant association with the development of cardiovascular disease (CVD) (r=0.717, r=0.555) and a significant but weak association with nephropathy (r=0.385, r=0.302) respectively. Regression analysis revealed that both TGI and THR have significant predictive ability for HbA1c, fasting blood glucose, HOMA-IR and CVD (delta R2=0.738vs 0.408, 0.740vs0.395, 0.725vs0.362, 0.354vs0.170) respectively, after controlling all confounding variables.

Conclusions

TGI and THR have a strong association and predictive capability to identify insulin resistance and detect the development and progression of T2DM. Moreover, TGI can be more precisely used for prediction analysis as compared to THR.

Prevalence of microvascular complications among patients with type 2 diabetes mellitus who visited diabetes clinics in Saudi Arabia

OBJECTIVES

To determine the microvascular complications prevalence in patients with type 2 diabetes mellitus (DM) in the eastern province of the Kingdom of Saudi Arabia.

METHODS

The participants in this retrospective, cross-sectional study included patients with type 2 DM who visited the diabetes clinics of primary health care centers of 2 National Guard Hospitals, Eastern Province, Saudi Arabia.

RESULTS

This study included 935 patients with type 2 diabetes (54.1% women versus 45.9% men). Oral hypoglycemic medication was the most common treatment (90.3%). Overall, 55.1% of patients visited the ophthalmology clinic for retinopathy screening. The last glycated hemoglobin A1c result (mean: 8.04%) was higher than the second-to-last result (mean: 8.03%), or the third-to-last result (mean: 7.99%). The prevalence of microvascular complications of DM was 55.1%. Independent significant factors linked with a higher risk of microvascular issues of DM were higher age, visits to an ophthalmology clinic, and the use of injection therapy. The most typical complications that our patients experienced was nephropathy (80.2%), followed by retinopathy (32.7%), and neuropathy (8.4%).

CONCLUSION

Microvascular complications were extremely common in type 2 DM patients in our region. Being older, regularly visiting an ophthalmologist, and using injection therapy were predictive factors correlated with a higher chance of experiencing these complications.

Development and validation of a risk prediction model for early diabetic peripheral neuropathy based on a systematic review and meta-analysis

Background

Early identification and intervention of diabetic peripheral neuropathy is beneficial to improve clinical outcome.

Objective

To establish a risk prediction model for diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM).

Methods

The derivation cohort was from a meta-analysis. Risk factors and the corresponding risk ratio (RR) were extracted. Only risk factors with statistical significance were included in the model and were scored by their weightings. An external cohort were used to validate this model. The outcome was the occurrence of DPN.

Results

A total of 95,604 patients with T2DM from 18 cohorts were included. Age, smoking, body mass index, duration of diabetes, hemoglobin A1c, low HDL-c, high triglyceride, hypertension, diabetic retinopathy, diabetic kidney disease, and cardiovascular disease were enrolled in the final model. The highest score was 52.0. The median follow-up of validation cohort was 4.29 years. The optimal cut-off point was 17.0, with a sensitivity of 0.846 and a specificity of 0.668, respectively. According to the total scores, patients from the validation cohort were divided into low-, moderate-, high- and very high-risk groups. The risk of developing DPN was significantly increased in moderate- (RR 3.3, 95% CI 1.5-7.2, P = 0.020), high- (RR 15.5, 95% CI 7.6-31.6, P < 0.001), and very high-risk groups (RR 45.0, 95% CI 20.5-98.8, P < 0.001) compared with the low-risk group.

Conclusion

A risk prediction model for DPN including 11 common clinical indicators were established. It is a simple and reliable tool for early prevention and intervention of DPN in patients with T2DM.

Time to diabetic neuropathy and its predictors among adult type 2 diabetes mellitus patients in Amhara regional state Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022: A retrospective follow up study

BACKGROUND

Diabetic neuropathy is the primary cause of foot ulcers and amputations in both industrialized and poor countries. In spite of this, most epidemiological research on diabetic neuropathy in Ethiopia have only made an effort to estimate prevalence, and the information underlying the condition's beginning is not well-established. Therefore, determining the time to diabetic neuropathy and its variables among adult patients with type 2 diabetes mellitus at the Compressive Specialized Hospitals of the Amhara region was the aim of this study.

METHODS

An institutional-based retrospective follow-up study was undertaken among 669 newly recruited adult patients with type 2 diabetes mellitus who were diagnosed between the first of March 2007 and the last day of February 2012. Patients with diabetic neuropathy at the time of the diagnosis for type 2 diabetes mellitus (T2DM), patients without a medical chart, patients with an unknown date of DM diagnosis, and patients with an unknown date of diabetic neuropathy diagnosis were excluded from the study. All newly diagnosed type 2 diabetes mellitus (T2DM) patients aged 18 years and older who were enrolled from 1st March 2007 to 28th February 2012 in selected hospitals were included in this study. Cox proportional hazard model was fitted to determine predictors of time to diabetic neuropathy, and the Kaplan Meier survival curve was used to assess the cumulative survival time. Variables with a p-value < 0.05 were considered to be statistically significance at 95% confidence interval.

RESULTS

The restricted mean survival time of this study was 179.45 (95% CI: 173.77-185.14) months. The overall incidence rate of diabetic neuropathy was 2.14 cases per 100 persons-years. Being aged > 60 years [AHR = 2.93(95% CI: 1.29-6.66)], having diabetic retinopathy [AHR = 2.76(95% CI: 1.84-4.16)], having anemia [AHR = 3.62 (95% CI: 2.46-5.33)], having hypertension [AHR = 3.22(95% CI: 2.10-4.93)], and baseline fasting blood sugar > 200 mg/dl [AHR = 2.56(95% CI: 1.68-3.92)] were the predictors of diabetic neuropathy.

CONCLUSION

The risk of occurrence of diabetic neuropathy among type two diabetes mellitus patients was high in the early period. Age > 60 years, diabetic retinopathy, anemia, baseline fasting blood sugar level > 200 mg/dl, and hypertension were the main predictors of incidence of diabetic neuropathy. Therefore, early detection and appropriate interventions are important for patients with old age, diabetic retinopathy, anemia, hypertension, and FBS > 200mg/dl.

The association of cell adhesion molecules and selectins (VCAM-1, ICAM-1, E-selectin, L-selectin, and P-selectin) with microvascular complications in patients with type 2 diabetes: A follow-up study

OBJECTIVE

Chronic hyperglycemia induces pathogenic changes in the vascular endothelium and leads to the development of microvascular complications in patients with type 2 diabetes mellitus. Early identification of markers of diabetes complications may help to minimize the risk of the development and progression of microvascular complications.

METHODS

This follow-up study was conducted in type 2 diabetic cohort aged between 30-70 years. Out of 160 eligible participants, 70 of them completed follow-up. Levels of cell adhesion molecules and selectins (VCAM-1, ICAM-1, E-selectin, L-selectin and P-selectin) at baseline and follow-up were measured using Randox Evidence biochip analyzer (UK). Development of microvascular complications (diabetic neuropathy, retinopathy and nephropathy) was evaluated.

RESULTS

During the follow-up (2 years, median), 31 (44.3%) developed diabetic neuropathy, 10 (14.3%) developed diabetic retinopathy and, 27 (38.6%) developed diabetic nephropathy. A significant difference in levels of cell adhesion molecules and selectins were found in type 2 diabetic patients with and without microvascular complications. Multiple logistic regression analysis reveals that baseline level of VCAM-1 is significantly associated with microvascular complications; diabetic neuropathy(p=0.028), retinopathy (p=0.007) and nephropathy(p=<0.001). Additionally, levels of P-selectin (p=0.05) and L-selectin (p=0.008) is associated with diabetic nephropathy while retinopathy associated with L-selectin (p=0.005) only.

CONCLUSION

Cell adhesion molecules and selectins are indicators of microvascular complication among patients with type 2 diabetes (T2D). Association of these markers with the development of microvascular complications may provide additive information for developing strategies for diabetes management and prediction of microvascular complications.

Risk Factors of Microvascular Complications Among Type 2 Diabetic Patients Using Cox Proportional Hazards Models: A Cohort Study in Tabuk Saudi Arabia

Purpose

The burden of type 2 diabetes (T2D) is high in Saudi Arabia, but data related to its complications are limited. This study aimed to determine the incidence of microvascular complications caused by T2D and evaluate the impact of the associated risk factors.

Patients and Methods

This retrospective cohort study was conducted at two military hospitals in Tabuk, Saudi Arabia. Data on the socio-demographics, glycaemic profile, blood lipid indices, duration of T2D, and associated microvascular complications were collected from electronic health records and medical files. Descriptive statistics and Cox proportional hazards models were used for data analysis.

Results

This study included 1563 T2D patients. The incidence of microvascular complications was 34.3% (95% confidence interval [CI], 32.0-36.6). Retinopathy was the most common complication (incidence=20.0%; 95% CI, 18.0-22.0%), while nephropathy was the least common complication (incidence=12.2%; 95% CI, 10.6-13.8%). Advanced age (≥65 years) showed the highest risk of retinopathy (Hazard ratios [HR], 2.86; 95% CI, 2.56-3.21), neuropathy (HR, 2.70; 95% CI, 2.40-3.05), and nephropathy (HR, 2.37; 95% CI, 2.12-2.64) compared with their counterparts. After adjusting for potential confounders, the study found that the significant risk factors for microvascular complications were longer duration (≥10 years) of T2D (HR, 5.3; 95% CI, 5.1-5.6), uncontrolled hypertension (HR, 3.9; 95% CI, 3.3-4.2), poor glycaemic control (HR, 4.6; 95% CI, 4.3-5.1), obesity (HR, 2.3; 95% CI, 2.2-2.6), and dyslipidaemia (HR, 1.6; 95% CI, 1.2-2.0).

Conclusion

Given the high burden of microvascular complications in military healthcare facilities in Tabuk, Saudi Arabia, a context-specific accessible public health program focusing on the promotion of a healthy lifestyle, physical activity, and consumption of a healthy diet, as well as the early diagnosis and management of diabetes, needs to be developed and implemented.

Joint modeling of time to diabetic retinopathy and change in fasting blood sugar among type 2 diabetic patients, Northwest Ethiopia

This study aimed to assess changes in fasting blood sugar (FBS) levels, time to diabetic retinopathy (DR) and its predictors among type 2 diabetes patients in Ethiopia. An institution-based retrospective follow-up study was conducted at the University of Gondar Comprehensive Specialized Hospital. The linear mixed effect model and Cox proportional hazard models were fitted separately, and later, the two models were fitted jointly using R software. Variables with a p value < 0.05 were considered significant predictors in the adjusted analysis. The incidence rate of DR was 2 per 100-person year of observation with a median follow-up time of 90.8 months (IQR 63.4). The current value and rate of change in FBS level were significant predictors of time to DR (AHR = 1.35; 95% CI 1.12-1.63) and (AHR = 1.70; 95% CI 1.21-2.39), respectively. Hypertension (AHR = 2.49; 95% CI 1.32-4.66), taking > 1 antidiabetic oral agent (AHR = 4.90; 95% CI 1.07-20.0) and more than 10 years duration (AHR = 0.17, 95% CI 0.06-0.46) were predictors of time to DR. This study revealed that the current value of FBS and the rate of FBS change were significantly associated with the time to DR.

Microvascular complications and its predictors among type 2 diabetes mellitus patients at Dessie town hospitals, Ethiopia

BACKGROUND

Diabetes mellitus is a serious metabolic disorder which becomes common in middle and low incomes countries since few decades. Microvascular complications include retinopathy, neuropathy and nephropathy all of which can lead to disability, dependency, accelerate their morbidity, and mortality. In Ethiopia, there is paucity data regarding this topic. Hence, this study aimed to assess prevalence of microvascular complications and its predictors among type 2 diabetes mellitus patients.

METHODS

Cross-sectional study was conducted from February to March 2020 at Dessie town hospitals. We used simple random sampling to recruit study participants and pre-tested interviewer administered questionnaire to collect the data. Data was entered into Epi-Data 3.1 and exported to SPSS-23 for analysis. Binary logistic regression was done to select potential variables to be adjusted at p ≤ 0.25. After running multivariable regression, variables with a p-value ≤ 0.05 were declared as statistically significant.

RESULTS

Three hundred and thirty-five type 2 DM patients participated in the study, of which 54.6% were males. One hundred and twenty-seven [37.9% (95% CI 32.5%-43.3%)] of diabetes mellitus had at least one microvascular complications. These were retinopathy 24.8%, nephropathy 16.1%, and neuropathy 8.1%. Age 60-87 years (AOR = 2.76, 95% CI 1.02-7.46), duration of diabetes > 5 years (AOR = 4.09, 95% CI 2.40-6.96), mellitus and co-morbid hypertension (AOR = 3.52, 95% CI 2.09-5.95), were statistically significant.

CONCLUSIONS

In this study, diabetic microvascular complications are prevalent. Increasing the age of participants, longer duration of diabetes mellitus and co-morbid hypertension were independent predictors. Health workers should give emphasis for diabetes mellitus through early screening and health education, abrupt medication for aged patients with long duration of diabetes mellitus, and hypertension, and also early detection and management of microvascular complication.

Diabetic kidney disease in type 2 diabetes: a review of pathogenic mechanisms, patient-related factors and therapeutic options

The global prevalence of diabetic kidney disease is rapidly accelerating due to an increasing number of people living with type 2 diabetes. It has become a significant global problem, increasing human and financial pressures on already overburdened healthcare systems. Interest in diabetic kidney disease has increased over the last decade and progress has been made in determining the pathogenic mechanisms and patient-related factors involved in the development and pathogenesis of this disease. A greater understanding of these factors will catalyse the development of novel treatments and influence current practice. This review summarises the latest evidence for the factors involved in the development and progression of diabetic kidney disease, which will inform better management strategies targeting such factors to improve therapeutic outcomes in patients living with diabetes.

Correlation Between Extracutaneous Microvascular Complications and Diabetic Foot Ulcers in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Diabetes is a metabolic disease that is taking an epidemic proportion around the world. The occurrence of microvascular complications and diabetic foot ulcer is associated with an increased mortality and morbidity incidence, which is the most serious complication of this disease, which significantly reduce the quality of patient life.

OBJECTIVE

The aim of the study was to determine the correlation of extracutaneous microvascular complications with diabetic foot ulcer in patients with type 2 diabetes.

METHOD

The study was prospective, and included 160 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska in the period from January 2016 until December 2019. The respondents were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was established based on a target HbA1c value of 7%.

RESULTS

Of the 160 patients in the study, 53.8% were men and 46.2% were women. The average age of the patients was 70.11%±10.05 years. Extracutaneous microvascular complications were present in 85 patients (53.1%); of which 30.2% had well-regulated glycemia (HbA1c≤7.0%), while 61.5% (p<0.001) had unregulated glycemia (HbA1c≥7.0). Polyneuropathy was present in 23.3% of patients with HbA1c≤7.0%, while 41.0% of patients had HbA1c≥7.0% (p<0.043). Nephropathy with HbA1c≤7.0% was present in 36.8% of cases compared to patients with HbA1c≥7.0 in whom the prevalence was 36.8% (p<0.004). Out of total, 25.6% had retinopathy with HbA1c≤7.0%, while in 41.9% of patients with HbA1c≥7.0% (p <0.067). Diabetic ulcer foot was present in 13 patients with HbA1c≥7 (11.1%) compared to patients with HbA1c≤7.0% where there was no occurrence of this complication 0.0% (p<0.021). At the same time, 5.6% of patients had a diabetic foot ulcer with polyneuropathy (p=0.010), 4.4% had neuropathy (p=0.058) and 5.6% had retinopathy (p=0.014).

CONCLUSION

The high incidence of extracutaneous microvascular complications and diabetic foot ulcer in patients with type 2 diabetes requires a multidisciplinary approach of medical professionals that includes prevention of risk factors and good regulation of glycemia.

Influence of single nucleotide polymorphism of LAT1 on therapeutic response to gabapentinoids in Pakistani patients with neuropathic pain

Gabapentinoids are substrate of L-type amino acid transporter 1 (LAT1) for distribution across the blood-brain barrier. The present study aimed to evaluate the effect of LAT1 rs4240803 genetic polymorphism on the clinical efficacy and tolerability of gabapentinoids in Pakistani patients with neuropathic pain. Three-hundred and ninety-two patients were recruited, genotyped for SNP rs4240803, and followed up for eight weeks to evaluate the clinical response to gabapentinoids in terms of pain relief, inadequate response, and the emergence of adverse events. LAT1 rs4240803 GG, GA, and AA genotype frequency were 33.42%, 47.96% and 18.62%, respectively. Out of 392 patients, 323 responded to the treatment and 17.6% discontinued either due to insufficient response or intolerable adverse events (AEs). GA genotype was more frequent in non-responder group (P ˂ 0.001). Maximum pain responders (≥50%) in combination with the lowest incidence of AEs were observed in the GG group, whereas partial responders belonged to GA genotype and with the highest frequency of somnolence (83.6%) and dizziness (69.9%). Overall, 72.5% patients with GA genotype experienced AEs (P ˂ 0.001). In conclusion, clinical outcomes of gabapentinoids are influenced by LAT1 rs4240803 polymorphism and population pharmacogenetics should be considered to evaluate the maximum potential of gabapentinoids in the management of neuropathic pain.

Foveal avascular zone analysis by optical coherence tomography angiography in patients with type 1 and 2 diabetes and without clinical signs of diabetic retinopathy

PURPOSE

To analyze the early macular microvascular alterations in patients with type 1 and 2 diabetes mellitus (DM) without diabetic retinopathy (DR), using optical coherence tomography angiography (OCT-A), and compare these with nondiabetic patients.

METHODS

This prospective study involved 93 patients with type 1 diabetes (DM1), 104 patients with type 2 diabetes (DM2) without signs of DR, and 71 healthy subjects for the control group. The foveal avascular zone (FAZ) area and the vessel density (VD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were evaluated.

RESULTS

The SCP and DCP FAZ areas were significantly larger in the DM1 group in comparison with the controls (p = .001), while no significant differences were observed between the DM2 group and the healthy control group (p = .12). Additionally, no significant differences in FAZ area were found between the DM1 and DM2 groups (p = .26). The VD was significantly reduced in DM1 and DM2 groups compared to controls. A direct correlation was found between the duration of diabetes and SCP FAZ area (r = 0.44; R² = 0.19; p = .0001). Statistically significant differences in the FAZ area at SCP and DCP were observed when comparing patients with a diabetes duration > 10 years and < 10 years in the DM2 group (p = .0001, respectively) and only in the FAZ area at the DCP in the DM1 group (p = .0001).

CONCLUSION

Diabetic patients without DR demonstrate early microvascular alteration in the macular area on OCT-A, which is more pronounced in type I DM, and correlates with the duration of the disease.

Relationship between diabetic retinopathy and diabetic nephropathy; A longitudinal follow-up study from a tertiary care unit of Karachi, Pakistan

OBJECTIVE

To determine the development and progression of diabetic retinopathy in subjects with diabetic nephropathy.

METHODOLOGY

This retrospective longitudinal follow up study was conducted in outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes unit of Karachi Pakistan, from January 2005 to December 2016. Type 2 diabetic subjects with newly diagnosed diabetic nephropathy (DN) and sex-age matched controls were identified from the electronic database of the institute, Health Management System (HMS). Subjects with type 1 diabetes, gestational diabetes and subjects with diabetic retinopathy (DR) at the baseline of both DN and non-DN group were excluded from the study. Statistical analyses were conducted by using SPSS version 20.

RESULT

Out of 3056 type 2 diabetic subjects, 2389 were with DN and 667 were without DN. The incidence of retinopathy was found to be 21.7 per 1000 person years. The incidence rate ratio (IRR) of 2.57 (1.92-3.43) showed that retinopathy was significantly higher in subjects with DN as compared to subjects without DN. Kaplan-Meier survival plot confirmed that subjects with DN had a worse diabetic retinopathy-free survival than subjects without DN.

CONCLUSION

Diabetic nephropathy is an independent risk factor for the development and progression of diabetic retinopathy.

The Association of Obesity and Microvascular Complications with Glycemic Control in Patients with Type 2 Diabetes Mellitus

INTRODUCTION

According Type 2 diabetes mellitus is a chronic metabolic disease with a high prevalence characterized by elevated blood glycemic values and with progressive development of micro and macrovascular complications. Glycemia control is a very important factor in the process of "delaying" the onset of complications by glycated hemoglobin (HbA1c) analysis.

AIM

The aim of the study is to determine the association of obesity, microvascular complications with glycemic control in patients with type 2 diabetes.

METHODS

The study was prospective, involving 105 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska from January 2016 to January 2018. The patients were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was evaluated based on a target HbA1c value of 7%.

RESULTS

Out of the 105 patients in the study, 45.8% were male, 54.2% female. The mean age of the patients was 68.3%±10.7 years. The mean HbA1c level was 8.32±1.57%. Of the total number of patients, in 25.7% the HbA1c levels were ≤7.0%, while in 74.3% the HbA1c were ≥7.0% (p<0.001). There were 57.1% of obese patients, of whom 37.0% had HbA1c ≤7.0%, and 64.1% had HbA1c ≥7.0% (p<0.014). Depending on the duration of diabetes, the study found that ≥7.0% HbA1c was more present in patients with an diabetes duration over 20 years (24.4%) compared with those who had had the diabetes for less than 20 years (3.8%) (p<0.037). Microvascular complications were present in 58 patients (55.2%), of which 33.3% had normal HbA1c values, while unregulated glycemia had 62.8% (p<0.008). Retinopathy was present in 40.9%, polyneuropathy 37.1% and nephropathy 32.4% from which the unregulated glycemia (HbA1c ≥7.0%) was present in 39.7% of patients compared to normal glycemic values in 11.1 % of respondents (p<0.006). In 88 patients, certain diseases were present: hypertension in 76.2% of patients, cardiovascular disease 58.0% and hyperlipidemia 35.2%.

CONCLUSION

Glycemia control in obese patients with type 2 diabetes mellitus is important especially for the prevention of serious microvascular complications that significantly affect the quality of life of patients.

Nomogram for the Risk of Diabetic Nephropathy or Diabetic Retinopathy Among Patients with Type 2 Diabetes Mellitus Based on Questionnaire and Biochemical Indicators: A Cross-Sectional Study

PURPOSE

This study aimed to develop a diabetic nephropathy (DN) or diabetic retinopathy (DR) incidence risk nomogram in China's population with type 2 diabetes mellitus (T2DM) based on a community-based sample.

METHODS

We carried out questionnaire evaluations, physical examinations and biochemical tests among 4219 T2DM patients in Shanghai. According to the incidence of DN and DR, 4219 patients in our study were divided into groups of T2DM patients with DN or DR, patients with both, and patients without any complications. We successively used least absolute shrinkage and selection operator regression analysis and logistic regression analysis to optimize the feature selection for DN and DR. To ensure the accuracy of the results, we carried out multivariable logistic regression analysis of the above significant risk factors on the sample data for both DN and DR. The selected features were included to establish a prediction model. The C-index, calibration plot, curve analysis and internal validation were used to validate the distinction, calibration, and clinical practicality of the model.

RESULTS

The predictors in the prediction model included disease course, body mass index (BMI), total triglycerides (TGs), systolic blood pressure (SBP), postprandial blood glucose (PBG), haemoglobin A1C (HbA1c) and blood urea nitrogen (BUN). The model displayed moderate predictive power with a C-index of 0.807 and an area under the receiver operating characteristic curve of 0.807. In internal verification, the C-index reached 0.804. The risk threshold was 16-75% according to the analysis of the decision curve, and the nomogram could be applied in clinical practice.

CONCLUSION

This DN or DR incidence risk nomogram incorporating disease course, BMI, TGs, SBP, PBG, HbA1c and BUN can be used to predict DN or DR incidence risk in T2DM patients. The research team has developed an online app based on a clinical prediction model incorporating risk factors for rapid and simple prediction.

Health literacy and exercise-focused interventions on clinical measurements in Chinese diabetes patients: A cluster randomized controlled trial

BACKGROUND

The diabetes patients in China have low health literacy and low levels of physical activities which may result in the poor glycemic control and other clinical outcomes. This study is designed to evaluate the effectiveness of health literacy and exercise-focused interventions on clinical outcomes among Chinese patients with type 2 diabetes (T2DM).

METHODS

In this cluster randomized controlled trial, 799 T2DM patients with the most recent A1c ≥ 7·5% (58 mmol/mol, or fasting glucose level ≥10 mmol/L) were recruited from 35 clinics in 8 communities in Shanghai, China, and randomized into one standard care (control) arm and three intervention arms receiving interventions focused on health literacy, exercise or both. A1c (primary outcome), blood pressure and lipids (secondary outcomes) were measured at baseline, 3-, 6-, 12-months of intervention period and 12-months after completion of the interventions. This trial is registered with the International Standard RCT Number Register, number ISRCTN76130594.

FINDINGS

The three intervention groups had more reductions in A1c than the control group, with 0·90% reduction in the health literacy, 0·83% in the exercise and 0·54% in the comprehensive group at 12-months (p<0·001) and these improvements remained even after a 1-year follow-up period post intervention. The risk of suboptimal A1c (≥7·0% or 53 mmol/mol) was also significantly lower in three intervention groups than control group at each follow-up visit, with adjusted risk ratios (RR) ranging from 0.06 to 0.16. However, the control group has greater reductions in low-density lipoprotein (LDL) than the health literacy group from baseline to 12-months (β=0·55, p<0·0001) and from baseline to 24-months (β=0·62, p<0·0001). A higher risk of abnormal LDL was also observed for the health literacy group at 12-months [adjusted risk ratio (RR): 2·22, 95%CI: 1·11-4·44] and 24-months [adjusted risk ratio (RR): 2·37, 95%CI: 1·16-4·87] compared to the control group. No significant benefits in systolic blood pressure (SBP), diastolic blood pressure (DBP) and low-density lipoprotein (HDL) were observed from the interventions compared to the usual care.

INTERPRETATION

The health literacy and exercise interventions result in significant improvements in A1c. However, no significant benefits in blood pressure and lipids control were observed. These effective interventions may have potential of scaling up in China and other countries to help diabetes patients manage their blood glucose levels.

FUNDING

This Study was supported by the China Medical Board (CMB) Open Competition Project (No.13-159) and the Social Science Fund of China National Ministry of Education (No.14YJAZH092).