Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?

Prolonged exposure to simvastatin affects coenzyme Q9/10 status leading to impaired mitochondrial respiratory capacity and reduced viability of cultured cardiac cells

This study investigates the effects of prolonged simvastatin exposure on coenzyme Q9/10 (CoQ9/10) levels, an essential component of antioxidant defense, in cultured cardiac cells. Statins, commonly used to manage dyslipidemia and reduce cardiovascular risk, may impair mitochondrial function, but their impact on CoQ10 depletion and oxidative stress is not well understood. We examined the influence of simvastatin on mitochondrial oxidative capacity, reactive oxygen species (ROS) production, and CoQ9/10 status at concentrations of 0.3, 0.6, 1.25, 2.5, 5, 10, and 20 μM, over durations of 24, 48, and 72 h. Using an in vitro model of cultured H9c2 cardiomyoblasts, our results showed that short-term exposure (24 h) at lower concentrations (<5 μM) enhanced cytosolic and mitochondrial ROS levels without affecting mitochondrial function or CoQ9/10 status. However, prolonged exposure to higher concentrations (≥10 μM for >48 h) resulted in impaired mitochondrial oxidative capacity, indicated by increased proton leak and elevated ROS levels, which were followed by significantly reduced cell viability. These findings suggest that prolonged, high-dose simvastatin exposure may disrupt the oxidative balance of CoQ9/10, leading to myocardial injury. This research addresses a gap in understanding the long-term effects of statins on mitochondrial health and underscores the need for further studies to optimize statin therapy and minimize adverse effects on myocardial function.

Construction of a risk prediction model for hypertension in type 2 diabetes: Independent risk factors and nomogram

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder increasingly linked with hypertension, posing significant health risks. The need for a predictive model tailored for T2DM patients is evident, as current tools may not fully capture the unique risks in this population. This study hypothesizes that a nomogram incorporating specific risk factors will improve hypertension risk prediction in T2DM patients.

AIM

To develop and validate a nomogram prediction model for hypertension in T2DM patients.

METHODS

A retrospective observational study was conducted using data from 26850 T2DM patients from the Anhui Provincial Primary Medical and Health Information Management System (2022 to 2024). The study included patients aged 18 and above with available data on key variables. Exclusion criteria were type 1 diabetes, gestational diabetes, insufficient data, secondary hypertension, and abnormal liver and kidney function. The Least Absolute Shrinkage and Selection Operator regression and multivariate logistic regression were used to construct the nomogram, which was validated on separate datasets.

RESULTS

The developed nomogram for T2DM patients incorporated age, low-density lipoprotein, body mass index, diabetes duration, and urine protein levels as key predictive factors. In the training dataset, the model demonstrated a high discriminative power with an area under the receiver operating characteristic curve (AUC) of 0.823, indicating strong predictive accuracy. The validation dataset confirmed these findings with an AUC of 0.812. The calibration curve analysis showed excellent agreement between predicted and observed outcomes, with absolute errors of 0.017 for the training set and 0.031 for the validation set. The Hosmer-Lemeshow test yielded non-significant results for both sets (χ² = 7.066, P = 0.562 for training; χ² = 6.122, P = 0.709 for validation), suggesting good model fit.

CONCLUSION

The nomogram effectively predicts hypertension risk in T2DM patients, offering a valuable tool for personalized risk assessment and guiding targeted interventions. This model provides a significant advancement in the management of T2DM and hypertension comorbidity.

Advances in incretin therapies for targeting cardiovascular disease in diabetes

The global prevalence of obesity is skyrocketing at an alarming rate, with recent data estimating that one-in-eight people are now living with the disease. Obesity is a chronic metabolic disorder that shares underlying pathophysiology with other metabolically-linked diseases such as type 2 diabetes mellitus, cardiovascular disease and diabetic cardiomyopathy. There is a distinct correlation between type 2 diabetes status and the likelihood of heart failure. Of note, there is an apparent sexual dimorphism, with women disproportionately affected with respect to the degree of severity of the cardiac phenotype of diabetic cardiomyopathy that results from diabetes. The current pharmacotherapies available for the attenuation of hyperglycaemia in type 2 diabetes are not always effective, and have varying degrees of efficacy in the setting of heart failure. Insulin can worsen heart failure prognosis whereas metformin, sodium-glucose cotransporter 2 inhibitors (SGLT2i) and more recently, glucagon-like peptide-1 receptor agonists (GLP-1RAs), have demonstrated cardioprotection with their administration. This review will highlight the advancement of incretin therapies for individuals with diabetes and heart failure and explore newly-reported evidence of the clinical usefulness of GLP-1R agonists in this distinct phenotype of heart failure.

Impact of diabetes on short-term outcomes in patients undergoing coronary artery bypass grafting surgery in acute coronary syndrome

IntroductionDiabetes mellitus (DM) is associated with concomitant comorbidities, such as atherosclerosis and cardiovascular disease. Coronary artery bypass grafting (CABG) surgery is the optimal therapy in diabetic patients with triple vessel disease. DM is also known to be a relevant risk factor for higher morbidity and mortality in patients who underwent elective CABG procedures. Data regarding outcomes in diabetic patients in acute coronary syndrome (ACS) is heterogeneous. This study aimed to investigate the impact of DM on short-term outcomes in patients who underwent CABG surgery in ACS.MethodsA retrospective propensity score matched (PSM) analysis of 1370 patients who underwent bypass surgery for ACS between June 2011 and October 2019 was conducted. All patients were divided into two groups: non-diabetic group (n = 905) and diabetic group (n = 465). In-hospital mortality was the primary outcome. Secondary outcomes were perioperative myocardial infarction, new onset dialysis, reopening for bleeding and duration of intensive care unit (ICU) stay. A subgroup analysis of patients with insulin-dependent and non-insulin dependent DM was also performed.ResultsAfter performing PSM analysis, baseline characteristics and the preoperative risk profile were comparable between both groups. The proportion of patients who underwent total arterial revascularization (p = .048) with the use of both internal thoracic arteries (p < .001) was significantly higher in the non-diabetic group. The incidence of perioperative myocardial infarction (p = .048) and new onset dialysis (p = .008) was significantly higher in the diabetic group. In-hospital mortality was statistically (p = .907) comparable between the two groups.ConclusionDM was associated with a higher incidence of adverse outcomes, however with comparable in-hospital mortality in patients who underwent CABG procedure for ACS.

Relationship of the modified Glasgow Prognostic Score with peripheral artery disease severity and procedure success in patients who had undergone endovascular treatment

ObjectivesThe modified Glasgow Prognostic Score (mGPS) is one type of inflammation-based index; it includes data on elevated C-reactive protein and reduced albumin content. The predictive value of mGPS for outcomes is investigated in various diseases such as cancer, heart failure, myocardial infarction, acute pulmonary embolism, and inflammatory bowel diseases. This study aimed to evaluate the link between mGPS and the severity and complexity of peripheral arterial disease (PAD) as determined by the Transatlantic Intercommunal Consensus Document (TASC-II) classification and the prediction value of mGPS for procedural success in patients undergoing endovascular treatment (EVT).MethodsOur study included 203 consecutive patients receiving EVT for atherosclerotic obstruction of aortoiliac, femoro-popliteal, and below-knee arteries between January 2019 and February 2020. The lesion characteristics were determined according to categories in the TASC-II. Operational failure is the inability to position the guidewire through the occluded lesion following percutaneous intervention or achieve distal perfusion following EVT.ResultsIn our study, we observed 136 patients (%6) with TASC A-B lesions and 67 patients (%33) with TASC C-D lesions. EVT was performed on the femoro-popliteal artery in 59.4% of the patients, on the aortoiliac artery in 30.7%, and on the below-the-knee artery in 9.9%. mGPS was an independent predictor of severe PAD (OR: 17.943, 95% CI: 5.120-62.882; p < .001) and procedural success (odds ratio: 0.004; 95% CI: 0.001-0.099; p < .001). Additionally, we identified age and the presence of a TASC D lesion as independent predictors of interventional success (OR: 0.938, 95% CI: 0.819-0.979; p: .034; OR: 0.104, 95% CI: 0.107-0.643; p: .015, respectively).ConclusionWe determined that mGPS independently predicts PAD complexity and severity based on TASC-II classification; the EVT success rate is lower in patients with high mGPS.

Identifying and ranking non-traditional risk factors for cardiovascular disease prediction in people with type 2 diabetes

BACKGROUND

Cardiovascular disease (CVD) prediction models perform poorly in people with type 2 diabetes (T2DM). We aimed to identify potentially non-traditional CVD predictors for six facets of CVD (including coronary heart disease, ischemic stroke, heart failure, and atrial fibrillation) in people with T2DM.

METHODS

We analysed data on 600+ features from the UK Biobank, stratified by history of CVD and T2DM: 459,142 participants without diabetes or CVD, 14,610 with diabetes but without CVD, and 4432 with diabetes and CVD. A penalised generalized linear model with a binomial distribution was used to identify CVD-related features. Subsequently, a 20% hold-out set was used to replicate identified features and provide an importance based ranking.

RESULTS

Here we show that non-traditional risk factors are of particular importance in people with diabetes. Classical CVD risk factors (e.g. family history, high blood pressure) rank highly in people without diabetes. For individuals with T2DM but no CVD, top predictors include cystatin C, self-reported health satisfaction, biochemical measures of ill health. In people with diabetes and CVD, key predictors are self-reported ill health and blood cell counts. Unique diabetes-related risk factors include dietary patterns, mental health and biochemistry measures (e.g. oestradiol, rheumatoid factor). Adding these features improves risk stratification; per 1000 people with diabetes, 133 CVD and 165 HF cases receive a higher risk.

CONCLUSIONS

This study identifies numerous replicated non-traditional CVD risk factors for people with T2DM, providing insight to improve guideline recommended risk prediction models which currently overlook these features.

A systematic analysis and prediction of the disease burden of ischemic heart disease caused by hyperglycemia

OBJECTIVE

This study aims to analyze the disease burden of ischemic heart disease (IHD) caused by hyperglycemia and its changing trend, and to construct a visualization platform for disease burden and forecast trends on the Shiny platform.

MATERIALS AND METHODS

Using data from the 2021 Global Burden of Disease Study, we analyzed deaths and disability-adjusted life years (DALYs) due to IHD triggered by hyperglycemia, with detailed analysis by region, gender, and age. The age-period-cohort model was used to assess the impact of age, cohort, and period on age-standardized disease rates across different Socio-Demographic Index (SDI) regions, and decomposition analysis was employed to disentangle the contributions of population, aging, and epidemiological changes.

RESULTS

In 2021, approximately 14-15% of IHD's DALYs and deaths were attributed to high fasting plasma glucose (HFPG), with a nonsignificant decrease in the annual average percentage change of DALYs. In middle, low-middle, and low SDI regions, the age-standardized mortality rates caused by HFPG are increasing, particularly among males. In high-middle and high SDI regions, the effects of aging and epidemiological changes surpass population growth, whereas in low SDI regions, population growth is the main factor. By 2050, the global Age-Standardized Mortality Rate of IHD attributed to HFPG is projected to reach 16.96. More data can be accessed by visiting the disease burden visualization platform.

CONCLUSION

Global HFPG-induced IHD health presents significant imbalances. In low SDI regions with larger populations and more unbalanced healthcare distribution, there is a need to strengthen the construction of medical levels.

Managing cardiovascular risk factors with telemedicine in primary care: A systematic review and meta-analysis of patients with arterial hypertension and type 2 diabetes

ObjectivesTo review the effect of telemedicine interventions on cardiovascular risk factors control in people with arterial hypertension (AH), type 2 diabetes (T2D), or both in primary care.MethodsWe conducted a systematic review in February 2024 using PubMed/MEDLINE, Cochrane Library, and EMBASE databases. We included randomised controlled trials from 2010 onwards, lasting ≥3 months, comparing telemedicine to standard care for managing cardiovascular risk factors in adults with AH, T2D, or both.ResultsAmong 1803 records, 54 were included. Telemonitoring with teleconsultations showed the best outcomes. For AH, systolic blood pressure decreased by -5.63 mmHg (95% CI -9.13 to -2.13) at 6 months and -5.59 mmHg (95% CI -10.03 to -1.14) at 12 months compared to standard care. For T2D, HbA1c decreased by -0.45% (95% CI -0.90 to 0.00) at 6 months and -0.18% (95% CI -0.41 to 0.05) at 12 months compared to standard care. Blood glucose self-monitoring was as effective as telemonitoring for T2D at 6 months. The effect on diastolic blood pressure, low-density lipoprotein, triglycerides, and body mass index was non-significant.DiscussionTelemedicine offers short-term benefits but lacks long-term effectiveness. Optimal outcomes require a combined telemedicine approach, health education co-intervention, ≥12-month follow-up, and careful patient selection.

Psychosocial and behavioral risk patterns and risk of cardiovascular complications in people with type 2 diabetes

INTRODUCTION

Psychosocial and behavioral risk factors often co-occur in patients with type 2 diabetes (T2D). The clustering of these risk factors and their role in predisposing patients to cardiovascular complications is not well understood. This study aims to identify patient subgroups with distinct psychological and behavioral risk patterns and evaluate the long-term risk of cardiovascular complications associated with these risk patterns.

METHODS

A total of 24,467 patients with T2D were identified from the UK Biobank (mean age 59 years, 86.7 %white), used Latent Class Analysis (LCA) to distinguish risk patterns among observed psychosocial (social isolation, loneliness, high neuroticism, anxiety, and depression) and behavioral (smoking, alcohol consumption, sleep duration, diet quality, and physical inactivity) risk factors. the Cox proportional hazards model was applied to assess the association of the identified risk patterns and risk of coronary heart disease (CHD), stroke, and a composite CVD (CHD or stroke) accounting for age, age at T2D diagnosis, race, gender, Townsend Deprivation Index, anti-diabetes medications, lipid-lowering medications, and anti-hypertensive medications.

RESULTS

Three distinct latent classes were identified: a low-risk group (n = 8,227, 33.62 %), a high psychosocial risk group (n = 15,965, 65.25 %), and a high behavioral risk group (n = 275, 1.12 %). Over a median follow-up of 12 years, the fully adjusted model showed that the high psychosocial risk group had a significantly increased risk of CHD (HR = 1.16; 95 % CI 1.08, 1.24) and composite CVD (HR = 1.13; 95 % CI 1.06, 1.20).

CONCLUSION

The psychosocial risk pattern is significantly associated with the risk of CHD and CVD among patients with T2D. These findings emphasize the importance of integrating psychosocial support into tailored care strategies to mitigate cardiovascular risks in T2D patients.

Mitochondrial DNA variants in the pathogenesis and metabolic alterations of diabetes mellitus

Mitochondrial DNA (mtDNA) variants considerably affect diabetes mellitus by disturbing mitochondrial function, energy metabolism, oxidative stress response, and even insulin secretion. The m.3243 A > G variants is associated with maternally inherited diabetes and deafness (MIDD), where early onset diabetes and hearing loss are prominent features. Other types of mtDNA variants involve genes ND4 and tRNA Ala genes that increase susceptibility to type 2 diabetes. Understanding these variants will provide a basis for developing targeted therapy to improve mitochondrial function and metabolic health. This article reviews the impact of mtDNA variants in diabetes, specifically with regards to the m.3243 A > G variant effects on mitochondrial function and insulin secretion and other mtDNA variants that contribute to diabetes susceptibility, particularly ND4 and tRNA Ala gene variants. Data from extant literature were synthesised to obtain an understanding of how mtDNA variants affect diabetes pathogenesis. The main defect for MIDD is the m.3243 A > G variant, which comprises enhanced susceptibility to metabolic syndrome and type 2 diabetes, followed by mitochondrial dysfunction, insulin resistance, and beta-cell dysfunction. Other mtDNA variants have also been reported to enhance diabetes susceptibility through mitochondrial dysfunction and insulin resistance. Increased production of reactive oxygen species (ROS) resulting from mitochondrial malfunction adds to metabolic and tissue damage. This happens in tissues crucial to glucose homeostasis, and it represents an important contribution of mitochondrial dysfunction to metabolic disturbances in diabetes. These mechanisms would underlie the rationale for developing targeted therapies to preserve mitochondrial function and, hence improve the metabolic health of diabetic patients.

Design and Development of Xanthone Hybrid for Potent Anti-Inflammatory Effects: Synthesis and Evaluation

Inflammatory responses, while essential for host defence, can precipitate chronic pathologies when sustained. The polyphenolic entity xanthone is distinguished by its capacity to modulate inflammation, notably via the inhibition of the COX-2 enzyme and associated inflammatory pathways. Additionally, heterocyclic frameworks such as pyrazole, triazole, and imidazole are recognised for their anti-inflammatory attributes. This investigation was conducted to engineer and synthesise a series of novel hybrid-xanthone molecules with enhanced anti-inflammatory capabilities. Utilising computational docking strategies, these hybrid-xanthone variants were virtually screened against the COX-2 enzyme structure (PDB ID:1CX2), and the 10 leading candidates were identified based on their binding affinities. These selected entities were synthesised through an optimised three-stage synthetic route. Subsequent in vitro assessments were performed using the Egg albumin denaturation assay at incremental concentrations. Complementary in vivo experiments involved the Carrageenan-induced paw edema protocol in Wistar rats, administered at 200 mg/kg to evaluate the anti-inflammatory response over a period of 6 h. The best percentage inhibition was shown by compound A127(3-(5'(1,2,4-Triazole)-pentyloxy)-1,6,8-trihydroxy xanthone), A11(3-(1'-(1,2,4-Triazole)-methyloxy)-1,6,8-trihydroxy xanthone) and A119(3-(1'-(1,2,4-Triazole)-methyloxy)-1,6,8-trihydroxy xanthone) as 60 ± 0.31, 58.57 ± 0.023, and 57.14 ± 0.21 respectively. Spectroscopic characterisation of the compounds was achieved through UV, IR, NMR, and Mass spectrometry techniques. The investigation revealed that out of the synthesised cohort, nine compounds exhibited favourable in silico profiles, and half of these manifested substantial anti-inflammatory efficacy in both in vitro and in vivo models, outperforming the reference standard. These hybrid-xanthone molecules demonstrated precise COX-2 inhibition and maintained an acceptable safety margin in vivo, underscoring their therapeutic promise as anti-inflammatory agents.

Antidiabetic Potential of Bananas (Musa spp.): A Systematic Review of Bioactive Compounds and Antihyperglycemic Activities

PURPOSE OF REVIEW

Bananas (Musa spp.), a staple fruit crop in Southeast Asia, are widely recognised for their nutritional value and potential medicinal properties, including the management of diabetes. To address the diabetes pandemic, various studies have explored the efficacy of many natural foods in reducing blood glucose, preventing complications that arise from the chronic illness. However, a comprehensive overview of bioactive compounds and their antidiabetic effects across different banana species in recent years is lacking. This review provides a comprehensive overview of bioactive compounds in various parts of the bananas that have demonstrated antihyperglycemic activities. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a thorough literature search using ScienceDirect, Scopus, and PubMed databases, resulting in the inclusion of 27 relevant articles.

RECENT FINDINGS

Emerging evidence suggests that different parts of the banana plant contain various bioactive compounds with antihyperglycemic activities, offering promising benefits for diabetes management. The findings reveal that the antihyperglycemic effects of bananas can be attributed to specific bioactive compounds, such as phenols, saponins, alkaloids, sterols, and flavonoids, through mechanisms like inhibition of α-glucosidase, β-glucosidase, α-amylase and sucrase enzymes, glucose uptake assay, and inhibition of formation of advanced glycation end-products. Liver glycogen content and fasting blood glucose in rat models, along with HbA1c measurements in human subjects, were also assessed to evaluate invivo antidiabetic activity, which has yielded positive outcomes. The results support the potential medicinal and pharmaceutical benefits of bananas in clinical diabetes management and suggest that incorporating banana-derived compounds could enhance the cost-effectiveness of antidiabetic treatments.

MiRNAs as biomarkers of nutritional therapy to achieve T2DM remission in patients with coronary heart disease: from the CORDIOPREV study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is currently a major global public health problem. Although disease remission is possible, few biomarkers have been identified which can help us select the diet that best promotes remission. Our aim was to study the potential of miRNAs as a tool to apply the Mediterranean diet or the low-fat diet in order to achieve T2DM remission in patients with coronary heart disease.

METHODS

From the CORDIOPREV study (n = 1002), a prospective, randomized, single-blind, controlled dietary intervention trial, all patients newly diagnosed with T2DM (n = 190) at baseline were included in the present study. Of these, after adhering to a low fat or Mediterranean diet for 60 months, 73 patients showed T2DM remission (Responders) and 110 continued with the disease (Non-responders). Plasma levels of 56 miRNAs were determined by RT-PCR. Generalized linear model, ROC curves and COX regression analyses were performed.

RESULTS

We observed that patients with low baseline plasma levels of miR-let7b-3p showed a high probability of T2DM remission after the consumption of a low-fat diet. In addition, patients with high levels of miR-141-5p, miR-182, and miR-192 at baseline showed a high probability of T2DM remission after following the Mediterranean diet. Scores built using miRNAs and clinical variables showed that high levels of a low-fat diet score and a high Mediterranean diet score were associated with a high probability of T2DM remission.

CONCLUSION

MiRNAs could be used as a tool for selecting the most efficient nutritional therapy (mediterranean or low-fat diet) to achieve T2DM remission in patients with coronary heart disease.

Effect of dietary glycemic index on insulin resistance in adults without diabetes mellitus: a systematic review and meta-analysis

Low glycemic index (LoGI) diets are associated with decreased insulin resistance and are an effective strategy for patients with diabetes mellitus to control postprandial glucose levels. However, whether these effects on insulin resistance and glucose levels are also observable in those without diabetes mellitus is poorly understood. The present study examined the influence of LoGI diets compared with that of high glycemic index (HiGI) diets on insulin resistance in adults without diabetes mellitus. This meta-analysis included six randomized controlled trials involving 192 participants with a mean age of 52.5 years. A homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated for each trial, and differences in HOMA-IR before and after each dietary intervention were calculated independently. The primary outcome was variations in insulin resistance, which was assessed by proxy as the difference between HOMA-IR scores at the beginning and end of the trials. The results suggested that LoGI diets decrease HOMA-IR scores to a greater extent than HiGI diets (estimate: 0.31; 95% confidence interval [CI], 0.01-0.61; p < 0.001) in individuals without diabetes mellitus. This association remained significant (estimate: 0.16; 95% CI, 0.01-0.31) after excluding one study with a short follow-up time (7 days). In conclusion, LoGI diets lower HOMA-IR scores to a greater extent than HiGI diets in adults without diabetes mellitus.

Systematic review registration

(https://www.crd.york.ac.uk/PROSPERO/).

Modifiable factors and 10-year and lifetime cardiovascular disease risk in adults with new-onset hypertension: insights from the Kailuan cohort

BACKGROUND

Preventing cardiovascular disease (CVD) in adults with hypertension is essential, but it remains uncertain whether optimizing modifiable factors can eliminate the excess CVD risk associated with new-onset hypertension.

METHODS

In this prospective cohort study, 29,597 adults with new-onset hypertension and no prior CVD (from 2006-2016 surveys) were each matched by age and sex to a normotensive control. Eight modifiable factors were assessed using the American Heart Association's Life's Essential 8 algorithm. We followed participants for incident CVD until December 2020, estimating 10-year and lifetime (age 25-95) CVD risks using the Fine-Gray competing risks model.

RESULTS

Over a median follow-up of 9.81 years, adults with new-onset hypertension had higher 10-year (8.97% vs. 6.31%) and lifetime CVD risks (45.55% vs. 34.98%) compared to normotensive controls. After adjusting for age, sex, and other unmodifiable factors, each additional favorable factor was associated with a stepwise reduction in CVD risk (P-trend < 0.05). Hypertensive participants with four or more favorable factors had a 17% lower 10-year CVD risk (HR 0.83; 95% CI 0.72-0.97) and a similar lifetime CVD risk (HR 0.90; 95% CI 0.78-1.05) compared to normotensive controls. Notably, the protective effect was weaker among those with early-onset (before age 45) hypertension than those with later-onset (age ≥ 60) hypertension (P-interaction < 0.05).

CONCLUSIONS

In adults with new-onset hypertension, maintaining four or more modifiable factors at favorable levels was associated with a CVD risk comparable to that of normotensive individuals. However, young hypertensive adults may require more aggressive interventions to mitigate CVD risk.

Machine learning-driven Raman spectroscopy: A novel approach to lipid profiling in diabetic kidney disease

Diabetes mellitus is a chronic metabolic disease that increasingly affects people every year. It is known that with its progression and poor management, metabolic changes can lead to organ dysfunctions, including kidneys. The study aimed to combine Raman spectroscopy and biochemical lipid profiling, complemented by machine learning (ML) techniques to evaluate chemical composition changes in kidneys induced by Type 2 Diabetes mellitus (T2DM). Raman spectroscopy identified significant differences in lipid content and specific molecular vibrations, with the 1777 cm-1 band emerging as a potential spectroscopic marker for diabetic kidney damage. The integration of ML algorithms improved the analysis, providing high accuracy, selectivity, and specificity in detecting these changes. Moreover, lipids metabolic profiling revealed distinct variations in the concentration of 11 phosphatydylocholines and 9 acyl-alkylphosphatidylcholines glycerophospholipids. Importantly, the correlation between Raman data and lipids metabolic profiling differed for control and T2DM groups. This study underscores the combined power of Raman spectroscopy and ML in offering a low-cost, fast, precise, and comprehensive approach to diagnosing and monitoring diabetic nephropathy, paving the way for improved clinical interventions. However, taking into account small number of data related to ethical committee approvals, the study should be verified on a larger number of cases.

Unveiling diabetes onset: Optimized XGBoost with Bayesian optimization for enhanced prediction

Diabetes, a chronic condition affecting millions worldwide, necessitates early intervention to prevent severe complications. While accurately predicting diabetes onset or progression remains challenging due to complex and imbalanced datasets, recent advancements in machine learning offer potential solutions. Traditional prediction models, often limited by default parameters, have been superseded by more sophisticated approaches. Leveraging Bayesian optimization to fine-tune XGBoost, researchers can harness the power of complex data analysis to improve predictive accuracy. By identifying key factors influencing diabetes risk, personalized prevention strategies can be developed, ultimately enhancing patient outcomes. Successful implementation requires meticulous data management, stringent ethical considerations, and seamless integration into healthcare systems. This study focused on optimizing the hyperparameters of an XGBoost ensemble machine learning model using Bayesian optimization. Compared to grid search XGBoost (accuracy: 97.24%, F1-score: 95.72%, MCC: 81.02%), the XGBoost with Bayesian optimization achieved slightly improved performance (accuracy: 97.26%, F1-score: 95.72%, MCC:81.18%). Although the improvements observed in this study are modest, the optimized XGBoost model with Bayesian optimization represents a promising step towards revolutionizing diabetes prevention and treatment. This approach holds significant potential to improve outcomes for individuals at risk of developing diabetes.

PCSK9 Expression in Vascular Smooth Muscle Cells: Role of Insulin Resistance and High Glucose

Beyond the regulation of cholesterol metabolism, a number of extrahepatic functions of proprotein convertase subtilisin/kexin type 9 (PCSK9) have been increasingly identified. The main purpose of this study was to verify whether PCSK9 expression in vascular smooth muscle cells (VSMC) is influenced by insulin resistance and high glucose (HG). In cultured rat aortic VSMC from lean insulin-sensitive Zucker rats (LZRs) and obese insulin-resistant Zucker rats (OZRs), a classical animal model of insulin resistance, we evaluated PCSK9 expression with or without the monoclonal antibodies against PCSK9 Alirocumab and Evolocumab or the synthetic PCSK9-binding peptide PEP 2-8. Effects and molecular mechanisms underlying altered PCSK9 expression were evaluated by proliferation and migration assay, reactive oxygen species (ROS) production, and involvement of PKC, NADPH-oxidase, MAPK/ERK-1/2 pathway activation. As a result, we found that, in comparison with LZR, VSMC from OZR showed basal PCSK9 overexpression mitigated by Alirocumab, Evolocumab, PEP 2-8, and the inhibitors of PKC, NADPH-oxidase, and MAPK. The finding of PCSK9 upregulation in VSMC from OZR paralleled with increased ROS production, proliferation, and migration. HG increased PCSK9 expression in VSMC from LZR, but not in OZR, via oxidative stress and with effects reduced by PCSK9 inhibitors. These findings suggest that a dysregulation of PCSK9 in VSMC could be involved in vascular damage in metabolic disorders, such as obesity and diabetes.

Update on the Efficacy and Safety of Sodium-Glucose Co-Transporter 2 Inhibitors in Patients with Chronic Diseases: A Systematic Review and Meta-Analysis

Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have emerged as vital medications for the management of type 2 diabetes mellitus (T2DM). Numerous studies have highlighted the cardioprotective and renal protective benefits of SGLT2 inhibitors. Consequently, it is essential to assess their efficacy and safety in patients with chronic diseases. Method: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the effects of SGLT2 inhibitors on major cardiovascular and safety outcomes in patients with T2DM, heart failure (HF), and chronic kidney disease (CKD). We searched the PubMed, Cochrane, and Embase databases for trials published between 30 September 2021 and 17 May 2023. The primary outcomes of interest included nonfatal myocardial infarction (MI), hospitalization for heart failure (HHF), cardiovascular death, and nonfatal stroke. The safety outcomes assessed were hypoglycemia, urinary tract infections (UTIs), and acute kidney injury (AKI). Result: We identified 13 RCTs involving 90,413 participants. In patients with T2DM, SGLT2 inhibitors significantly reduced the risk of nonfatal MI by 12% (hazard ratio [HR] = 0.88, 95% confidence interval [CI]: 0.78-0.98), HHF by 33% (HR = 0.67, 95% CI: 0.62-0.74), and cardiac death by 15% (HR = 0.95, 95% CI: 0.80-1.13). However, they did not significantly reduce the risk of nonfatal stroke (HR = 0.85, 95% CI: 0.75-0.95). In patients with HF, SGLT2 inhibitors reduced the risk of HHF by 28% (HR = 0.72, 95% CI: 0.66-0.77) and cardiac death by 12% (HR = 0.88, 95% CI: 0.80-0.96). For patients with CKD, SGLT2 inhibitors reduced the risk of HHF by 35% (HR = 0.65, 95% CI: 0.55-0.76) and cardiac death by 16% (HR = 0.84, 95% CI: 0.73-0.96). Regarding safety outcomes, SGLT2 inhibitors did not significantly increase the risk of hypoglycemia in patients with T2DM, HF, or CKD, nor did they increase the risk of urinary tract infections (UTIs) in patients with HF or CKD, or the risk of acute kidney injury (AKI) in patients with HF. However, they did increase the risk of UTIs by 8% (risk ratio [RR] = 1.08, 95% CI: 1.01-1.16) in patients with T2DM and reduced the risk of AKI by 22% (RR = 0.78, 95% CI: 0.67-0.89) and 19% (RR = 0.81, 95% CI: 0.69-0.97) in patients with T2DM and CKD, respectively. Conclusions: SGLT2 inhibitors have demonstrated a significant improvement in cardiovascular outcomes for patients with T2DM, HF, and CKD while also maintaining a favorable safety profile. These findings advocate for the broader application of SGLT2 inhibitors in the management of chronic diseases, particularly in reducing the incidence of nonfatal MI, HHF, and cardiac death. Further research is essential to optimize their use across diverse patient populations and stages of disease.

Lymphocyte Subset Imbalance in Cardiometabolic Diseases: Are T Cells the Missing Link?

Cardiometabolic and cardiovascular diseases (CVDs) remain the leading cause of death worldwide, with well-established risk factors such as smoking, obesity, and diabetes contributing to plaque formation and chronic inflammation. However, emerging evidence suggests that the immune system plays a more significant role in the development and progression of CVD than previously thought. Specifically, the finely tuned regulation of lymphocyte subsets governs post-injury inflammation and tissue damage resolution and orchestrates the functions and activation of endothelial cells, cardiomyocytes, and fibroblasts in CVD-associated lesions (e.g., atherosclerotic plaques). A deeper understanding of the immune system's involvement in CVD development and progression will provide new insights into disease biology and uncover novel therapeutic targets aimed at re-establishing immune homeostasis. In this review, we summarize the current state of knowledge on the distribution and involvement of lymphocyte subsets in CVD, including atherosclerosis, diabetes, hypertension, myocardial infarction, and stroke.

Frameshift variation in the HMG-CoA reductase gene and unresponsiveness to cholesterol-lowering drugs in type 2 diabetes mellitus patients

Dyslipidemia, an imbalance in blood lipid levels, is a frequent complication of type 2 diabetes mellitus (DM2) and heightens the risk of cardiovascular diseases (CVDs). Statins, which inhibit 3-hydroxy-3-methylglutaryl-CoA reductase, are potent competitive inhibitors that reduce plasma cholesterol levels. However, individual responses to statins can vary markedly, possibly due to genetic variations in the 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) gene. This study aimed to investigate the pharmacogenetic relationship between the HMGCR gene and hypercholesterolemia in type 2 diabetes mellitus patients who respond differently to atorvastatin, as well as in healthy individuals. Ninety participants were involved, including sixty with type 2 diabetes mellitus and hypercholesterolemia, and thirty healthy individuals. They were randomly assigned to three groups: responsive (received atorvastatin 40 mg), non-responsive (also received atorvastatin 40 mg), and control. Both responsive and non-responsive groups underwent fasting. Biochemical tests were conducted, followed by genetic analysis to identify mutations in the HMGCR gene. The effects of statins in each group were assessed using analysis of variance (ANOVA) and post hoc Tukey's Honestly Significant Difference (HSD) analysis. Atorvastatin 40 mg was administered to assess its efficacy in reducing cholesterol levels in patients with hypercholesterolemia and type 2 diabetes mellitus. The control group exhibited similar cholesterol levels to the responsive group (cholesterol < 200 mg/dl). However, both control and responsive groups significantly differed from the non-responsive group, which had markedly elevated cholesterol levels (> 240 mg/dl). Genetic analysis revealed a cytosine nucleotide insertion in the catalytic domain of the HMGCR gene in only two non-responsive participants to atorvastatin 40 mg therapy. These two patients showed non-responsiveness to atorvastatin 40 mg due to a genetic mutation in the HMGCR gene. This mutation altered the amino acid sequence in the flap domain, replacing isoleucine with a stop codon. As a result, translation was prematurely terminated, leading to the production of truncated proteins.

The Multifaceted Role of the Polyphenol Curcumin: A Focus on Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by chronic hyperglycemia, which often co-exists with other metabolic impairments. This condition can damage various tissues and organs, resulting in the development of severe complications, both microvascular, such as retinopathy, nephropathy, and neuropathy, and macrovascular, responsible for an increased risk of cardiovascular diseases. Curcumin is the main bioactive molecule found in the rhizomes of turmeric. Many studies have reported curcumin to exhibit antioxidant, anti-inflammatory, anti-infectious, and anti-cancer properties; thus, there is an increasing interest in exploiting these properties in order to prevent the rise or the progression of T2DM, as well as its possible associated conditions. In this review, we have presented the current state-ofart regarding the clinical trials that have involved curcumin administration and analyzed the possible mechanisms by which curcumin might exert the beneficial effects observed in literature.

Diabetic Cardiomyopathy: An Update on Emerging Pathological Mechanisms

Diabetic Cardiomyopathy (DCM) is a notable consequence of diabetes mellitus, distinguished by cardiac dysfunction that occurs separately from coronary artery disease or hypertension. A recent study has revealed an intricate interaction of pathogenic processes that contribute to DCM. Important aspects involve the dysregulation of glucose metabolism, resulting in heightened oxidative stress and impaired mitochondrial function. In addition, persistent high blood sugar levels stimulate inflammatory pathways, which contribute to the development of heart fibrosis and remodelling. Additionally, changes in the way calcium is managed and the presence of insulin resistance are crucial factors in the formation and advancement of DCM. This may be due to the involvement of many molecular mechanistic pathways such as NLRP3, NF-κB, PKC, and MAPK with their downstream associated signaling pathways. Gaining a comprehensive understanding of these newly identified pathogenic pathways is crucial in order to design precise therapy approaches that can enhance the results for individuals suffering from diabetes. In addition, this review offers an in-depth review of not just pathogenic pathways and molecular mechanistic pathways but also diagnostic methods, treatment options, and clinical trials.

Triglyceride-glucose index (TyG) as a novel biomarker in the era of cardiometabolic medicine

In the period of increasing prevalence of metabolic disorders such as obesity and diabetes, healthcare professionals are facing significant challenges. Therefore, an accurate global assessment of insulin resistance is of utmost importance. Current medical research is focused on identifying an easily accessible and reproducible gold-standard surrogate marker for insulin resistance. Ideally, such a marker would enable healthcare providers to predict the risk of type 2 diabetes and cardiovascular diseases. The triglyceride-glucose index (TyG) is a promising marker for preventive cardiology and cardiometabolic medicine. This narrative review article aims to provide a comprehensive evaluation of the credibility of TyG as a surrogate marker of insulin resistance among patients at different stages across the cardiometabolic continuum. This assessment fully complies with evidence-based medicine and offers valuable insight into the clinical utility of TyG.

Phantom Spouse; Adaptive Strategies of the Older Adult in the Face of the Death of a Spouse: Content Analysis

The death of a spouse in the older adult is a devastating loss. Given that older adults employ unique strategies for adapting to bereavement, this study was conducted to aim explaining the adaptation strategies of the older adult in the face of death of a spouse. The experiences of 21 participants were collected through semi-structured interviews and analyzed using the conventional content analysis approach of Lundman and Granheim's (2004), which led to the creation "Phantom Spouse" as the main category with four categories: "1-speaking to the deceased, 2- Establishing and maintaining the privacy of the deceased, 3- Being committed to the deceased, 4- Inducing the feeling of the presence of the deceased" and explained fourteen sub-categories. The concept of the phantom spouse represents a novel strategy for maintaining a symbolic and emotional connection with the deceased which leads to facilitating the adaptation process of the older adult to the bereavement of their spouse.

Additive interaction of family medical history of cardiovascular diseases with hypertension and diabetes on the diagnosis of cardiovascular diseases among older adults in India

Introduction

The present study aimed to examine the additive interaction of family medical history of cardiovascular disease (CVD) and self-reported hypertension and diabetes on the diagnosis of CVD among older adults aged 45 years and above in India. A family medical history of CVD in individuals with hypertension and diabetes could identify a subpopulation with a higher risk of CVD.

Methods

The study used the data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The total sample size for the study was 58,734 older adults aged 45 years and above. An additive model was applied to determine the additive interaction effect of the family medical history of CVD with hypertension and diabetes on the diagnosis of CVD by calculating three different measures of additive interaction: the relative excess risk due to interaction (RERI), attribution proportion due to interaction (AP), and synergy index (S).

Results

The prevalence of CVD was higher among hypertensive individuals with a family medical history of CVD (18.6%) than individuals without the coexistence of family medical history of CVD and hypertension (4.7%), and hypertensive individuals without family medical history of CVD (11.3%). On the other hand, the prevalence of CVD was higher among individuals with diabetes and family history of CVD (20.5%) than individuals without the coexistence of family history of CVD and diabetes (5.0%). Individuals with parental and sibling medical history had two times higher odds of having chronic heart diseases and strokes, respectively than those without parental and sibling history. In the adjusted model, RERI, AP, and S for CVD were 2.30 (95% CI: 0.87-3.74), 35% (0.35; 95% CI: 0.20-0.51), and 1.71 (95% CI: 1.27-2.28) respectively, demonstrating significant positive interaction between family medical history and hypertension on the diagnosis of cardiovascular diseases.

Conclusions

The present study revealed that in the additive model, the interaction effects of family medical history and hypertension were significantly positive on cardiovascular diseases even after adjustment with potential confounding factors. Therefore, it is crucial to consider the presence of family medical history of CVD among individuals with hypertension and diabetes measured in research and clinical practice.

Diabetes Mellitus and Cardiovascular Disease: Exploring Epidemiology, Pathophysiology, and Treatment Strategies

Diabetes mellitus (DM) affects 537 million people as of 2021, and is projected to rise to 783 million by 2045. This positions DM as the ninth leading cause of death globally. Among DM patients, cardiovascular disease (CVD) is the primary cause of morbidity and mortality. Notably, the prevalence rates of CVD is alarmingly high among diabetic individuals, particularly in North America and the Caribbean (46.0%), and Southeast Asia (42.5%). The predominant form of CVD among diabetic patients is coronary artery disease (CAD), accounting for 29.4% of cases. The pathophysiology of DM is complex, involving insulin resistance, β-cell dysfunction, and associated cardiovascular complications including diabetic cardiomyopathy (DCM) and cardiovascular autonomic neuropathy (CAN). These conditions exacerbate CVD risks underscoring the importance of managing key risk factors including hypertension, dyslipidemia, obesity, and genetic predisposition. Understanding the genetic networks and molecular processes that link diabetes and cardiovascular disease can lead to new diagnostics and therapeutic interventions. Imeglimin, a novel mitochondrial bioenergetic enhancer, represents a promising medication for diabetes with the potential to address both insulin resistance and secretion difficulties. Effective diabetes management through oral hypoglycemic agents (OHAs) can protect the cardiovascular system. Additionally, certain antihypertensive medications can significantly reduce the risk of diabetes-related CVD. Additionally, lifestyle changes, including diet and exercise are vital in managing diabesity and reducing CVD risks. These interventions, along with emerging therapeutic agents and ongoing clinical trials, offer hope for improved patient outcomes and long-term DM remission. This study highlights the urgent need for management strategies to address the overlapping epidemics of DM and CVD. By elucidating the underlying mechanisms and risk factors, this study aims to guide future perspectives and enhance understanding of the pathogenesis of CVD complications in patients with DM, thereby guiding more effective treatment strategies.

Low circulating levels of neuregulin 4 as a potential biomarker associated with the severity and prognosis of obesity-related metabolic diseases: a systematic review

BACKGROUND

Neuregulin 4 (Nrg4) is a brown adipose tissue-derived adipokine that greatly affects systemic metabolism and improves metabolic derangements. Although abnormal circulating levels of Nrg4 are common in obesity, it remains elusive whether low or elevated levels of this batokine are associated with the onset of metabolic diseases.

AIM

To assess Nrg4 levels and its role as a feasible biomarker to predict the severity of obesity, gestational diabetes mellitus (GDM), type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), and cardiovascular diseases (CVD).

METHODS

A search for relevant studies was performed systematically using prominent search engines, including PubMed, Google Scholar, and Embase, by following PRISMA guidelines.

RESULTS

Ample clinical evidence reported low serum/plasma levels of Nrg4 in obesity and these were inversely proportional to the indices of metabolic syndrome, including body mass index, waist circumference, triglycerides, fasting plasma glucose, and homoeostatic model assessment for insulin resistance as well as high-sensitivity C-reactive protein. Low circulating Nrg4 levels may aid in the prediction of morbid obesity, and subsequent GDM, T2DM, NAFLD, and CVD.

CONCLUSION

Current clinical evidence emphasizes that the circulating levels of Nrg4 are decreased in morbid obesity, and it also highlights that Nrg4 May serve as a potential prognostic biomarker for obesity-related metabolic diseases.

Multifaceted Role of Apolipoprotein C3 in Cardiovascular Disease Risk and Metabolic Disorder in Diabetes

Apolipoprotein C3 (APOC3) plays a critical role in regulating triglyceride levels and serves as a key predictor of cardiovascular disease (CVD) risk, particularly in patients with diabetes. While APOC3 is known to inhibit lipoprotein lipase, recent findings reveal its broader influence across lipoprotein metabolism, where it modulates the structure and function of various lipoproteins. Therefore, this review examines the complex metabolic cycle of APOC3, emphasizing the impact of APOC3-containing lipoproteins on human metabolism, particularly in patients with diabetes. Notably, APOC3 affects triglyceride-rich lipoproteins and causes structural changes in high-, very low-, intermediate-, and low-density lipoproteins, thereby increasing CVD risk. Evidence suggests that elevated APOC3 levels-above the proposed safe range of 10-15 mg/dL-correlate with clinically significant CVD outcomes. Recognizing APOC3 as a promising biomarker for CVD, this review underscores the urgent need for high-throughput, clinically feasible methods to further investigate its role in lipoprotein physiology in both animal models and human studies. Additionally, we analyze the relationship between APOC3-related genes and lipoproteins, reinforcing the value of large-population studies to understand the impact of APOC3 on metabolic diseases. Ultimately, this review supports the development of therapeutic strategies targeting APOC3 reduction as a preventive approach for diabetes-related CVD.

Chronic complications of type 2 diabetes and associated factors: a cross-sectional study at the Moulay Hassan Hospital in Kenitra, Morocco

Introduction

all around the world, type 2 diabetes is considered a metabolic disease that generates complications that can be very serious, even fatal, over time, especially if not properly managed. Clinical and biological parameters in blood glucose levels will be assessed in this study (N=300 patients). We assess the prevalence of complications caused by diabetes including diabetic retinopathy, nephropathy, neuropathy, and cardiovascular diseases. Type 2 diabetes is an incurred disease, but it can be managed. Self-therapeutic education is therefore imperative and highly recommended.

Methods

this study was carried out at the Moulay Hassan Hospital in Kenitra (Morocco) using a self-administered questionnaire targeting chronic complications caused by diabetes. Descriptive statistical analysis was followed to determine frequencies and percentages for complications and we carried out univariable and multivariable regression analysis to determine factors associated with complications.

Results

the study highlights clinical and bioclinical features. Mean age of patients (58.51±13.11 year with standard deviation: 13,113), hypertension (45.7%), glycemia (1.85±0.64 g/l), HbA1c (8.09±1.7%), BMI (26.44±3.4 kg/m2) and chronic complications (41.7%) including retinopathy (16%), nephropathy (4%), neuropathy (3.3%), cardiovascular diseases (16.7%) and amnesia (2%). There was mainly a statistical difference between complications and HTA: (AOR=2.43 (1.52-3.89) (CI=95%) (p=0.000), chronic complications and smoking: (AOR=0.16) (0.04-0.61) (CI=95%) (p=0.007), complications and physical activity: (AOR=3,34) (1.34-7.24) (CI=95%) (p=0.014) and complications and lipid profile: (AOR=4.95) (2.79-8.77) (CI=95%) (p=0.001).

Conclusion

therapeutic education of type 2 patients with diabetes remains highly recommended, as it improves compliance with non-pharmacological treatment, especially hygienic-dietary measures, and physical activity, and limits the early onset of complications associated with diabetes.

Lp(a) and high-sensitivity C-reactive protein are predictive biomarkers for coronary heart disease in Chinese patients with type 2 diabetes mellitus

Objective

Type 2 diabetes (T2DM) is a significant risk factor for coronary heart disease (CHD). This study aimed to assess the variations in biomarkers associated with CHD in T2DM patients across different age groups in the Han Chinese population.

Methods

A strict selection process was employed, involving three groups: a control group (n = 300) with no medical history, a new-onset T2DM group (n = 300), and a new-onset T2DM + CHD group (n = 300). Participants in each group were further categorized based on age: Group 1 (<60 years), Group 2 (60-75 years), and Group 3 (>75 years). Fasting glucose, hemoglobin A1c (HbA1c), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), ApoB/ApoA1 ratio, lipoprotein(a) [Lp(a)], high-sensitivity C-reactive protein (hsCRP), and homocysteine (HCY) levels were analyzed in all groups.

Results

Both T2DM and T2DM + CHD groups exhibited elevated levels of TG, TC, LDL-C, ApoB, ApoB/ApoA1, Lp(a), hsCRP, and HCY, alongside decreased levels of HDL-C and ApoA1 in comparison to the control group. Notably, when comparing the T2DM to the T2DM + CHD groups, significant increases were noted in ApoB, Lp(a), and hsCRP levels in the T2DM + CHD group, whereas other biomarkers did not show significant differences. Across all age groups, the patterns remained consistent, with the T2DM and T2DM + CHD groups showing elevated levels of TG, TC, LDL-C, ApoB, ApoB/ApoA1, Lp(a), hsCRP, and HCY, and decreased levels of HDL-C and ApoA1 compared to their respective age-matched control groups. Furthermore, within each age category, significant increases in ApoB, Lp(a), and hsCRP were specifically observed with advancing age in the T2DM + CHD group, with Lp(a) and hsCRP levels showing particularly notable elevations, underscoring their potential as significant indicators of CHD risk in the T2DM population.

Conclusion

Lp(a) and hsCRP may serve as valuable risk biomarkers for the development of CHD in T2DM patients. Understanding the variations in these biomarkers across different age groups can assist in risk assessment and the development of personalized management strategies for CHD in T2DM patients.

Effectiveness of a digital health and financial incentive intervention to promote physical activity in patients with type 2 diabetes: study protocol for a randomised controlled trial with a nested qualitative study-ACTIVATE trial

BACKGROUND

The prevention of type 2 diabetes (T2DM) is recognised as a health care priority in the UK. In people living with T2DM, lifestyle changes (e.g. increasing physical activity) have been shown to slow disease progression and protect from the development of associated comorbidities. The use of digital health technologies provides a strategy to increase physical activity in patients with chronic disease. Furthermore, behaviour economics suggests that financial incentives may be a useful strategy for increasing the maintenance and effectiveness of behaviour change intervention, including physical activity intervention using digital health technologies. The Milton Keynes Activity Rewards Programme (MKARP) is a 24-month intervention which combines the use of a mobile health app, smartwatch (Fitbit or Apple watch) and financial incentives to encourage people living with T2DM to increase physical activity to improve health. Therefore, this randomised controlled trial aims to examine the long-term acceptability, health effects and cost-effectiveness of the MKARP on HbA1c in patients living with T2DM versus a waitlist usual care comparator.

METHODS

A two-arm, single-centre, randomised controlled trial aiming to recruit 1018 participants with follow-up at 12 and 24 months. The primary outcome is the change in HbA1c at 12 months. Secondary outcomes included changes in markers of metabolic, cardiovascular, anthropometric, and psychological health along with cost-effectiveness. Recruitment will be via annual diabetes review in general practices, retinal screening services and social media. Participants aged 18 or over, with a diagnosis of type 2 diabetes and a valid HbA1c measurement in the last 2 months are invited to take part in the trial. Participants will be individually randomised (1:1 ratio) to receive either the Milton Keynes Activity Rewards Programme or usual care. The intervention will last for 24 months with assessment for outcomes at baseline, 12 and 24 months.

DISCUSSION

This study will provide new evidence of the long-term effectiveness of an activity rewards scheme focused on increasing physical activity conducted within routine care in patients living with type 2 diabetes in Milton Keynes, UK. It will also investigate the cost-effectiveness of the intervention.

TRIAL REGISTRATION

ISRCTN 14925701. Registered on 30 October 2023.

Inhibitory properties of quinopimaric acid derivatives towards cholinesterases

A series of new diterpene quinopimaric acid derivatives modified at the hydroxyl group with different pharmacophore fragments has been synthesised and their (along with previously obtained compounds) inhibitory properties towards cholinesterases were studied. Thereby an indole-3-acetyl derivative 7 and a propargyl substituted compound 28 were shown to be excellent and acetylcholinesterase-selective inhibitors. Both compounds inhibited the enzyme as a mixed type inhibitor, and Ki values of 0.41 and 0.44 µM and Ki' values of 0.98 and 2.26 µM were determined. The binding interactions between all active compounds and ligands protein were confirmed through molecular docking study.

Circulating CD31+ Angiogenic T cells are reduced in prediabetes and increase with exercise training

AIMS

To investigate circulating angiogenic cells in adults with prediabetes and the effect of a structured exercise program.

METHODS

A cohort of adults with overweight/obesity and either normal glucose (NG) or prediabetes were randomised to receive exercise (Exercise) (as twice weekly supervised combined high intensity aerobic exercise and progressive resistance training, and once weekly home-based aerobic exercise) or an unsupervised stretching intervention (Control) for 12 weeks. Circulating angiogenic T cells, muscle strength, and cardiovascular disease risk factors, including blood lipids, arterial stiffness, central haemodynamic responses, and cardiorespiratory fitness (VO2peak) in those with prediabetes (n = 35, 16 Control, 19 Exercise) and NG (n = 37, 17 Control, 20 Exercise) were analysed at baseline and after the 12-week intervention.

RESULTS

At baseline, compared with NG those with prediabetes demonstrated reduced VO2peak, angiogenic CD31+CD8+ T cells and VEGFR2+CD4+ T cells, and increased systolic blood pressure. CD31+ T cells were negatively correlated with cardiovascular disease (CVD) risk. Compared with Control, exercise training increased muscle strength, VO2peak, and CD31+CD4+ and CD31+CD8+ T cells in NG and prediabetes.

CONCLUSIONS

Circulating angiogenic CD31+ T cells are decreased in people with prediabetes and are enhanced with exercise training. Exercise increases CD31+ T cells, and through this mechanism it is proposed that it may reduce CVD risk.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry number: ACTRN12617000552381.

Metabolic Syndrome in Non-diabetic Stroke Patients

Introduction Metabolic syndrome (MetS) encompasses a range of diverse conditions, such as hypertension, hyperglycemia, central obesity, dyslipidemia, and diabetes. MetS in non-diabetic elderly patients with acute ischemic stroke can worsen vascular damage and lead to worse outcomes, highlighting the significance of early detection. Objective The objective of this paper was to determine the frequency of MetS in non-diabetic elderly patients with acute ischemic stroke visiting a tertiary care hospital. Material and methods This study was carried out in the medical department of Dr. Ziauddin Hospital in Karachi, Pakistan for a duration of six months from June 20, 2023, to December 19, 2023, following the adoption of the synopsis. All patients meeting the specified criteria and attending Dr. Ziauddin Hospital in Karachi were enrolled in the research. Informed consent was obtained after a thorough description of the methods, possible dangers, and advantages of the study. Each patient underwent the metabolic assessment according to the International Diabetes Federation (IDF) criteria. Data collected was recorded in the provided proforma and electronically utilized for research endeavors. The analysis was conducted utilizing SPSS version 26.0 (IBM Corp., Armonk, NY). Descriptive statistics were computed, and the chi-square/Fisher's exact test was utilized for stratified analysis, with a p-value < 0.05 deemed significant. Result The study included patients aged between 65 and 90 years, with a median age of 74. Among the total population assessed, 133 individuals were male (76.4%) and 41 were female (23.6%). MetS was identified in 116 patients, representing 66.7% of the study population. Conclusion It is to be concluded that MetS was highly prevalent in non-diabetic elderly patients with acute ischemic stroke. This highlights a significant relationship between MetS and the occurrence of cerebrovascular accidents in this demographic. Further exploration and potential interventions targeting MetS in this population could be beneficial for improving health outcomes.

Integrative analysis of gene expression, protein abundance, and metabolomic profiling elucidates complex relationships in chronic hyperglycemia-induced changes in human aortic smooth muscle cells

Type 2 diabetes mellitus (T2DM) is a major public health concern with significant cardiovascular complications (CVD). Despite extensive epidemiological data, the molecular mechanisms relating hyperglycemia to CVD remain incompletely understood. We here investigated the impact of chronic hyperglycemia on human aortic smooth muscle cells (HASMCs) cultured under varying glucose conditions in vitro, mimicking normal (5 mmol/L), pre-diabetic (10 mmol/L), and diabetic (20 mmol/L) conditions, respectively. Normal HASMC cultures served as baseline controls, and patient-derived T2DM-SMCs served as disease controls. Results showed significant increases in cellular proliferation, area, perimeter, and F-actin expression with increasing glucose concentration (p < 0.01), albeit not exceeding the levels in T2DM cells. Atomic force microscopy analysis revealed significant decreases in Young's moduli, membrane tether forces, membrane tension, and surface adhesion in SMCs at higher glucose levels (p < 0.001), with T2DM-SMCs being the lowest among all the cases (p < 0.001). T2DM-SMCs exhibited elevated levels of selected pro-inflammatory markers (e.g., ILs-6, 8, 23; MCP-1; M-CSF; MMPs-1, 2, 3) compared to glucose-treated SMCs (p < 0.01). Conversely, growth factors (e.g., VEGF-A, PDGF-AA, TGF-β1) were higher in SMCs exposed to high glucose levels but lower in T2DM-SMCs (p < 0.01). Pathway enrichment analysis showed significant increases in the expression of inflammatory cytokine-associated pathways, especially involving IL-10, IL-4 and IL-13 signaling in genes that are up-regulated by elevated glucose levels. Differentially regulated gene analysis showed that compared to SMCs receiving normal glucose, 513 genes were upregulated and 590 genes were downregulated in T2DM-SMCs; fewer genes were differentially expressed in SMCs receiving higher glucose levels. Finally, the altered levels in genes involved in ECM organization, elastic fiber synthesis and formation, laminin interactions, and ECM proteoglycans were identified. Growing literature suggests that phenotypic switching in SMCs lead to arterial wall remodeling (e.g., change in stiffness, calcific deposits formation), with direct implications in the onset of CVD complications. Our results suggest that chronic hyperglycemia is one such factor that leads to morphological, biomechanical, and functional alterations in vascular SMCs, potentially contributing to the pathogenesis of T2DM-associated arterial remodeling. The observed differences in gene expression patterns between in vitro hyperglycemic models and patient-derived T2DM-SMCs highlight the complexity of T2DM pathophysiology and underline the need for further studies.

Plasma lipids and glycaemic indices in australians following plant-based diets versus a meat-eating diet

BACKGROUND

Vegan and vegetarian dietary patterns are known to beneficially modulate risk factors for cardiovascular disease; however, the current literature does not differentiate between various plant-based diets. This study aimed to examine the association between various plant-based diets and plasma lipids and glycaemic indices compared to a regular meat-eating diet.

METHODS

A cross-sectional study of Australian adults (n = 230) aged 30-75yrs habitually consuming the following were recruited: vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian, or regular meat-eater. Multivariable regression analysis was used to adjust for covariates.

RESULTS

Compared to regular meat-eaters, vegans had significantly lower total cholesterol (-0.77mmol/L,95% CI -1.15, -0.39, P < 0.001), low-density lipoprotein cholesterol (LDL-C, -0.71mmol/L, 95% CI -1.05, -0.38, P < 0.001), non-high-density lipoprotein cholesterol (non-HDL-C, -0.75mmol/L, 95% CI -1.11, -0.39, P < 0.001), total cholesterol/HDL-C-ratio (-0.49mmol/L, 95% CI -0.87, -0.11, P = 0.012), fasting blood glucose (FBG, -0.29mmol/L, 95% CI -0.53, -0.06, P = 0.014), haemoglobin A1C (-1.85mmol/mol, 95% CI -3.00, -0.71, P = 0.002) and insulin (-1.76mU/L, 95% CI -3.26, -0.26, P = 0.021) concentrations. Semi-vegetarians had significantly lower LDL-C (-0.41mmol/L, 95% CI -0.74, -0.08, P = 0.041) and non-HDL-C (-0.40mmol/L, 95% CI -0.76, -0.05, P = 0.026) and lacto-ovo vegetarians had significantly lower FBG (-0.34mmol/L, 95% CI -0.56, -0.11, P = 0.003) compared to regular meat-eaters. There were no differences in HDL-C and triglycerides between plant-based and regular-meat diets.

CONCLUSIONS

Plasma lipaemic and glycaemic measures as a collective were more favourable among vegans, whereas among lacto-ovo vegetarians and semi-vegetarians, only some measures were favourable.

TRIAL REGISTRATION

ACTRN12621000743864. Date 6/11/2021.

Plasma glucose, HbA1c, insulin and lipid profile in Sudanese type 2 diabetic patients with cardiovascular disease: a case control study

Background: Type 2 diabetes mellitus (T2DM) and its consequences are a serious global public health issue. By 2030, the number of people with type 2 diabetes is predicted to reach 439 million. The purpose of this study is to evaluate the plasma levels of glucose, HbA1c, insulin, and lipid profile in Sudanese T2DM patients. Methods: This case control study included 165 Sudanese patients with diabetic type 2 and a cardiovascular condition as cases and 165 diabetic type 2 volunteers without a cardiovascular disorder as controls. The concentrations of plasma glucose, HbA1c, and lipid profile were assessed using a Mindray BS-480 auto-chemistry analyzer, and insulin was analyzed using a Cobase 411 auto analyzer. The collected data were analyzed using statistical tools for social science computer programs (SPSS version 21). Results: According to the findings, (59.4%) of patients between the ages of (50-69). Females made up 50.9%. (38.2%) of patients had an illness duration of between (8-15 years). (41.8%) of individuals did not have hypertension. There was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin among diabetics with cardiovascular disease compared to diabetics without cardiovascular disease (p-value = 0.001, 0.000, 0.018, and 0.000). Females had significantly higher blood TC, LDL-C, HDL-C, and BMI than males (p-values = 0.000, 0,001, and 0.000, respectively). There were significant positive correlation between FBS, HBA1c, insulin and duration of disease (r=0.155, p, value=0.005) (r=0.160, p, value=0.004)(r=0.103, p. value=0.061)respectively, while there were significant negative correlation between TC, TG,LDL-C, HDL-C and duration of disease (r=-0.152, p, value= 0.006)(r=-0.023, p, value=0.678)(r=-0.113, p, value= 0.040)(r=-0.145, p, value=0.008)respectively. Conclusion: When comparing diabetics with cardiovascular disease to diabetics without cardiovascular disease, there was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin. FBS, HBA1c, insulin, and illness duration all had a strong positive connection.

Forecasting Trial Milestones: A Predictive Analysis for Early Termination of the SOUL Study

INTRODUCTION

Semaglutide, a glucagon-like peptide 1 receptor agonist (GLP1RA), is available in both parenteral and oral preparations. Studies of injectable preparations have convincingly demonstrated its beneficial effect on major adverse cardiac events (MACE). This predictive analysis was undertaken to forecast early termination of the SOUL trial (oral semaglutide) as well as the primary events.

METHODS

SOUL is a multicenter, double-blind, placebo-controlled randomized controlled trial (RCT) evaluating the reduction in MACE associated with oral semaglutide versus placebo in patients with type 2 diabetes (T2D) and cardiovascular (CV) disease. A sample of 9642 participants will be followed for 5 years and 5 months. A random-effects model meta-analysis, pooling hazard ratios from previous RCTs, was conducted using R software to inform the predictive model. The background CV event rates from the placebo arms of previous RCTs with semaglutide were matched with the pre-adjudicated assumptions of the SOUL trial to create the predictive model. The truncated trial duration, MACE, and its individual components in the intervention and placebo arms were estimated. The predicted difference between the two groups was estimated using the chi-squared test.

RESULTS

A pooled analysis of 10,013 patients revealed a significant reduction in the number of MACEs associated with semaglutide (HR 0.79, 95% CI 0.69-0.91). Predictive analysis indicated that 1225 events would be achieved by 3.78 years, suggesting premature termination.

CONCLUSION

The mathematical model based on the meta-analysis predicts that the SOUL study on oral semaglutide will be terminated early, with oral semaglutide showing benefits in terms of MACE compared to placebo. If the SOUL study corroborates the findings of this model, it may not only form the basis for the calculation of power but also define the duration of such studies, reducing costs and easing the process of designing cardiovascular outcome trials (CVOTs).

PROTOCOL REGISTRATION

INPLASY202460061.

Sex differences in the correlation between lipids related to cardiovascular risk factors and small dense LDL particles in patients with type 2 diabetes

Objective

Sex differences in lipid metabolism associated with prevalent small dense (S-) low-density lipoprotein (LDL) cholesterol particles are not elucidated. An LDL to apolipoprotein B (ApoB) ratio < 1.2 can estimate how prevalent S-LDL particles are and, thus, reflect cardiovascular risk. The aim of this study was to evaluate the sex distribution of LDL/ApoB ratio among patients with type 2 diabetes (DM) and to assess, in both sexes, the correlations between key lipid parameters and LDL/ApoB < 1.2.

Subjects and methods

The study included 190 Caucasian participants (mean age 51.8 ± 6.4 years) with DM (DM group) or without DM (control group) divided into subgroups according to sex. The participants were examined for levels of several lipid parameters, selected lipid-related oxidative stress markers, and estimated S-LDL prevalence.

Results

An LDL/ApoB < 1.2 (p < 0.05) was observed in 67% of male and female patients with DM. Although triglyceride levels did not differ between men and women, women had higher levels of total cholesterol (p < 0.05) and LDL cholesterol (p < 0.01) than men. Among women with LDL/ApoB < 1.2, strong correlations were observed between values of lipid hydroperoxides (LOOH) and atherogenic index of plasma (p < 0.005) and between levels of triglycerides and LOOH (p < 0.005) and ApoB (p < 0.0001).

Conclusions

The findings indicate that women with LDL/ApoB < 1.2 tend to have a higher cardiovascular risk than men. Additionally, LDL/ApoB < 1.2 can be a surrogate marker for estimating the S-LDL prevalence in individuals with potentially increased cardiovascular risk.

Comparative Effectiveness of Bariatric Metabolic Surgery Versus Glucagon-Like Peptide-1 Receptor Agonists on Cardiovascular Outcomes and Mortality: A Meta-Analysis

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, particularly in individuals with obesity and type 2 diabetes mellitus (T2DM). This meta-analysis aimed to compare the effectiveness of bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) on cardiovascular outcomes and mortality in patients with obesity. A comprehensive literature search was conducted in Medline, Embase, and Cochrane CENTRAL from inception to September 15, 2024. Four observational studies meeting the inclusion criteria were analyzed, comprising a total of 247,000 patients. The primary outcomes were major adverse cardiovascular events (MACE) and all-cause mortality. Random effects models were used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). The results showed that BMS was associated with a significantly lower risk of MACE compared to GLP-1RAs (RR: 0.71, 95% CI: 0.56-0.90, p = 0.004), indicating a 29% reduction in MACE risk. Additionally, BMS demonstrated a 25% reduction in all-cause mortality risk (RR: 0.75, 95% CI: 0.65-0.87, p < 0.0001). These findings suggest that BMS offers superior cardiovascular protection and improved survival outcomes compared to GLP-1RAs in obese patients. The observed benefits may be attributed to more significant reductions in body mass index (BMI) and improvements in metabolic parameters achieved through surgical intervention. However, the limitations of this study, including its observational nature and the limited number of included studies, underscore the need for further research, particularly randomized controlled trials (RCTs), to confirm these findings and guide clinical decision-making in obesity management.

Are there sociodemographic-specific associations of coping with heart disease and diabetes incidence?

OBJECTIVE

Psychological factors, including psychological distress and well-being, have been associated with cardiometabolic disease risk. Here, we examined whether a psychological process, namely how individuals cope with stressors, relates to such risk, which has been understudied.

METHOD

During 2004-2006, 2,142 participants without heart disease and diabetes from the Midlife in the U.S. study completed a validated coping inventory assessing six strategies (positive reinterpretation and growth, active coping, planning, focus on and venting of emotion, denial, and behavioral disengagement) and relevant covariates. As a proxy for coping flexibility, participants were also classified as having lower, moderate, or greater variability in their use of these strategies. Heart disease and diabetes were documented in 2013-2015. Logistic regressions modeled adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of developing heart disease and diabetes, separately, with coping exposures.

RESULTS

In sociodemographic-adjusted models, greater use of adaptive strategies predicted lower diabetes risk (e.g., positive reinterpretation and growth: AOR = 0.83; 95% CI [0.72, 0.96]); estimates were weaker for maladaptive strategies, and all strategies were unrelated to heart disease. All associations for coping variability were null. In secondary analyses, greater use of adaptive strategies predicted lower heart disease risk in more educated participants only (e.g., active coping: AOR = 0.71; 95% CI [0.55, 0.92]) and lower diabetes risk in females only (e.g., planning: AOR = 0.75; 95% CI [0.61, 0.91]). Results were maintained additionally adjusting for health, behavioral, and social factors.

CONCLUSIONS

Findings suggest sex and education differences in coping's association with heart disease and diabetes. Future studies should recognize adaptive strategies may be more potent for health among certain populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Healthy beverage index is associated with metabolic syndrome: insights from the Ravansar non-communicable disease (RaNCD) cohort study

BACKGROUND

Dietary patterns play a crucial role in the development and management of metabolic syndrome (MetS). The Healthy Beverage Index (HBI) is a novel tool that assesses the quality of beverage choices in the diet and provides insights into their potential impact on metabolic health. The aim of this study was to investigate the association between the HBI and the MetS.

METHODS

This cross-sectional study was conducted using data collected at baseline from the Ravansar Noncommunicable Disease Cohort Study. A total of 9,025 participants aged 35 to 65 years were included in the analysis. HBI was calculated using food items from the Food Frequency Questionnaire (FFQ). MetS status was defined according to established criteria, and logistic regression analysis was performed to assess the association between HBI scores and MetS, adjusting for potential confounding variables.

RESULTS

In our study, 41.13% of the population was found to have MetS, with a significant association between MetS and tertiles of HBI. Furthermore, the logistic regression model showed a significant inverse association between HBI scores and the odds of developing a MetS (OR = 0.90; 95% CI: 0.86, 0.94), even after adjusting for confounding factors, emphasizing the potential protective effect of higher HBI scores.

CONCLUSION

Increased HBI scores were associated with lower risk of MetS, emphasizing the importance of choosing health-promoting beverages in controlling MetS. These findings support the association between dietary habits and metabolic health and provide practical guidance for individuals and public health initiatives aimed at improving metabolic outcomes.

The effects of resistance training on cardiovascular factors and anti-inflammation in diabetic rats

Diabetes induces a range of macrovascular and microvascular changes, which lead to significant clinical complications. Although many studies have tried to solve the diabetic problem using drugs, it remains unclear. In this study, we investigated whether resistance exercise affects cardiovascular factors and inflammatory markers in diabetes. The study subjected Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which have genetically induced diabetes mellitus, to a resistance exercise program for 12 weeks and assessed the levels of cardiovascular factors and inflammatory markers using western blotting analysis, ELISA, and immunohistochemistry. During the training period, OLETF + exercise (EX) group exhibited lower body weight and reduced glucose levels when compared with OLETF group. Western blotting analysis, ELISA, and immunohistochemistry revealed that the levels of PAI-1, VACM-1, ICAM-1, E-selectin, TGF-β, CRP, IL-6, and TNF-α were decreased in OLETF + EX group when compared with the OLETF group. Moreover, the anti-inflammatory markers, IL-4 and IL-10, were highly expressed after exercise. Therefore, these results indicate that exercise may influence the regulation of cardiovascular factors and inflammatory markers, as well as help patients with metabolic syndromes regulate inflammation and cardiovascular function.

Clinical profile, microbiology and outcomes in infective endocarditis treated with aortic valve replacement: a multicenter case-control study

BACKGROUND

Aortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease.

METHODS

Between January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models.

RESULTS

The mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36-5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43-2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78).

CONCLUSIONS

In this multicenter case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.

Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients in Africa: A systematic review and meta-analysis

Background

In sub-Saharan African nations, there's a documented shortfall in the utilization of statins, despite established clinical guidelines advocating their use for reducing cardiovascular risks and overall mortality among Type 2 diabetes patients aged 40-75 years old. Most clinical guidelines recommend prescribing statins to individuals with type 2 diabetes to reduce the chances of cardiovascular disease. There is currently a lack of extensive research on statin utilization specifically for primary prevention of cardiovascular disease in Africa. Thus, this study aimed to assess the prescription patterns of statins for preventing cardiovascular disease in type 2 diabetes patients.

Methods

The findings of the review were presented following the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-2020) checklist. We conducted searches on electronic databases including PubMed, EMBASE, Cochrane Library, Science Direct, African Journal Online, and Google Scholar. This systematic review and meta-analysis included articles that met specific inclusion criteria: observational studies such as cross-sectional, cohort, and case-control studies focusing on determinants, risk factors, or correlates associated with statin prescription within Africa. Only published articles up to June 2, 2024, published in English, and conducted in either community or healthcare facility settings were considered. Data import was initially conducted using Microsoft Excel, and statistical analysis was performed using STATA software. Cochran's Q test was employed to assess whether there was a significant variance in prevalence among the studies. Additionally, the I2 statistic was utilized to quantify the extent of heterogeneity. A funnel plot, a visual tool, was utilized to evaluate publication bias.

Results

The search strategy resulted in 7695 published original articles. The full texts of the 89 papers were assessed for eligibility and quality. Moreover, some articles were rejected due to inaccuracies in the outcome variable. Ultimately, only ten studies focusing on the prevalence of statin prescription were examined. The research suggests that the pooled prevalence of statin prescription among Type 2 diabetic individuals in Africa is found to be 48.82% (95% CI: 35.41-63.24). Age greater than 65 years (AOR = 3.56, 95% CI: 1.70-7.45; I2 = 54.7%), comorbidity (AOR = 1.13, 95% CI: 0.27-4.63, I2 = 96.4%), dyslipidemia (AOR = 3.15, 95% CI: 1.54-6.44, I2 = 61.7%), DM duration greater than ten years (AOR = 1.36, 95% CI: 0.81-2.28, I2 = 77.3%), and government insurance (AOR = 8.85, 95% CI: 2.72-28.76, I2 = 81.5%) were factors associated with statin prescription among type 2 diabetic patients.

Conclusions

In general, the extent of statin prescriptions for individuals with type 2 diabetes who are eligible for statin therapy was below the target outlined by clinical practice guidelines. Being over 65 years old, having comorbidities, experiencing dyslipidemia, having type 2 diabetes for more than ten years, and having government insurance were all identified as independent factors predicting the prescription of statins. This finding is concerning and underscores the urgent need to enhance adherence to clinical practice guidelines for the well-being of this vulnerable population at high risk.

Barriers and Strategies to Optimize the Use of Glucagon-Like Peptide 1 Receptor Agonists in People with Type 2 Diabetes and High Cardiovascular Risk or Established Cardiovascular Disease: A Delphi Consensus in Spain

INTRODUCTION

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for glycemic control, with many also demonstrating cardiovascular (CV) benefit, in people with type 2 diabetes (T2D). This study aimed to find a consensus on the barriers and strategies for the optimal use of GLP-1 RAs in people with T2D and high CV risk or established cardiovascular disease (CVD) in Spain.

METHODS

A two-round Delphi survey (53 questions) was conducted among members of four national scientific societies in Spain, including physicians experienced in the management of people with T2D. The degree of consensus was evaluated with a 7-point Likert scale, establishing consensus when ≥ 70% of the panelists agreed (6-7) or disagreed (1-2).

RESULTS

A total of 97 physicians participated in the first round (endocrinology: 34%, family and community medicine: 21%, internal medicine: 23%, and cardiology: 23%), and 96 in the second round. The main barriers identified were: therapeutic inertia and late use of GLP-1 RAs; lack of a comprehensive approach to CV risk; lack of knowledge on the usefulness of GLP-1 RAs in CVD prevention and treatment; and economic/administrative barriers. Strategies with a highest consensus included: the need to establish simple protocols that integrate awareness of CV risk monitoring; training professionals and patients; and the use of new technologies.

CONCLUSION

Physicians identified clinical, healthcare, and economic/administrative barriers that limit the use of GLP-1 RAs in people with T2D and high CV risk or established CVD in Spain, highlighting the importance of integrating these therapies according to clinical practice guidelines.

Vulvovaginal candidiasis and type 2 diabetes: A nationwide retrospective cohort study

AIMS

To examine whether vulvovaginal candidiasis (VVC) precedes type 2 diabetes and to quantify the possible time period between VVC and subsequent diabetes.

MATERIAL AND METHODS

We conducted a nationwide retrospective primary healthcare study including 1 838 929 women aged 35-65 years in Sweden (2007-2018). Cox regression models were used to examine associations between VVC and type 2 diabetes, while controlling for possible confounders. Propensity-score-weighted analysis was also conducted.

RESULTS

The incidence rate of diabetes per 1000 person-years was 3.06 (95% confidence interval [CI] 3.05-3.08) in women without preceding VVC and 4.05 (95% CI 3.86-4.24) in women with preceding VVC. The incidence rate was particularly high in women aged 55 years and older with VVC: 9.56 (95% CI 8.01-11.11). Women with VVC had a hazard ratio (HR) of 1.41 (95% CI 1.28-1.55) for diabetes compared to women without VVC in the multivariable-adjusted model. The corresponding HR was 1.63 (95% CI 1.53-1.74) in propensity-score-weighted analysis. Women with prior VVC also seemed to have a stronger risk of diabetes with older age, particularly after the age of 55 years. The mean (range) time between VVC and subsequent diabetes was 0.57 (0-2) years, depending on the age of the woman.

CONCLUSION

We found temporal associations between VVC and diabetes. The findings demonstrate that the presence of VVC may indicate a future diagnosis of diabetes, especially in women aged 55 years and older. This knowledge could be valuable for clinicians when treating women with VVC.

Glycemic Control and Cardiometabolic Risk in Black Zimbabweans with Type 2 Diabetes Mellitus

Purpose

Type 2 diabetes mellitus (T2DM) frequently presents with modified cardiometabolic risk profiles, indicative of an elevated susceptibility to cardiovascular disease (CVD). Cardiometabolic risk factors such as obesity, hyperglycemia, hypertension, insulin resistance and dyslipidemia are known contributors to increased CVD hazard in individuals with T2DM. This study evaluated the glycemic control-based cardiometabolic risk profiles of black Zimbabweans with T2DM.

Patients and Methods

A cross-sectional study of 116 T2DM patients recruited from diabetic clinics at Parirenyatwa and Sally Mugabe Hospitals, Harare, Zimbabwe, was conducted. Blood samples were collected for glycated hemoglobin (HbA1c) and lipid profile assessment. The Framingham risk scores (FRS) based on body mass index (BMI) and lipid profile were used to determine CVD risk. Parametric variables were analyzed using one-way analysis of variance (ANOVA) with post hoc Bonferroni correction, while non-parametric variables were compared using the Kruskal-Wallis test with post hoc Dunn test for multiple comparisons.

Results

The overall frequency of dyslipidemia was 83.6% (n=97) and hypoalphalipoproteinemia was the most prevalent dyslipidemia (79.3%). Median HDLC levels were significantly lower in participants with poor glycemic control (1.12 mmol/L) compared to those with good glycemic control group (1.37 mmol/L) (p=0.011). Despite lack of significant variations in Framingham Risk Scores, there was a trend towards lower FRS-BMI in the good control group (29.8%) compared to the inadequate control (35.4%) and poor control (32.7%) groups (p=0.078).

Conclusion

Duration since DM diagnosis was observed to be an important risk factor for poor glycemic control being significantly shorter in those with good glycemic control compared to those with inadequate and poor control. Overall, there was no significant difference in HbA1c status by age but individuals with poor glycemic control were significantly older than those with good control. The most prevalent dyslipidemia among the study participants was hypoalphalipoproteinemia which is reportedly associated with genetic predisposition, warranting further investigations.