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Mondal S, DasGupta R, Lodh M, Gorai R, Choudhury B, Hazra AK, Ganguly A. Predictors of new-onset diabetic ketoacidosis in patients with moderate to severe COVID-19 receiving parenteral glucocorticoids: A prospective single-centre study among Indian type 2 diabetes patients. Diabetes Metab Syndr 2021; 15:795-801. [PMID: 33839639 PMCID: PMC8004476 DOI: 10.1016/j.dsx.2021.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM COVID-19 infection predisposes to diabetic ketoacidosis(DKA); whether glucocorticoids enhances this risk is unknown.We aimed to study the occurrence of DKA after initiating glucocorticoids in patients with type 2 diabetes mellitus(T2DM) and moderate-to-severe COVID-19, and identify predictors for it. METHODS Patients with T2DM and moderate or severe COVID-19 infection were prospectively observed for development of new-onset DKA for one week following initiation of parenteral dexamethasone. Clinical and biochemical parameters were compared between those who developed DKA (Group A) and those who didnot (Group B). Logistic regression was done to identify independent risk-factors predicting DKA; ROC-curve analysis to determine cut-offs for the parameters in predicting DKA. RESULTS Amongst 302 patients screened, n = 196 were finally included, of whom 13.2% (n = 26,Group A) developed DKA. Patients in Group A were younger, had lower BMI, increased severity of COVID-19 infection, higher HbA1c%, CRP, IL-6, D-dimer and procalcitonin at admission (pall < 0.02). Further, admission BMI (OR: 0.43, CI: 0.27-0.69), HbA1c % (OR: 1.68, CI: 1.16-2.43) and serum IL-6 (OR: 1.02, CI: 1.01-1.03) emerged as independent predictors for DKA. Out of these, IL-6 levels had the highest AUROC (0.93, CI: 0.89-0.98) with a cut-off of 50.95 pg/ml yielding a sensitivity of 88% and specificity of 85.2% in predicting DKA. CONCLUSION There is significant incidence of new-onset DKA following parenteral glucocorticoids in T2DM patients with COVID-19, especially in those with BMI <25.56 kg/m2, HbA1c% >8.35% and IL-6 levels >50.95 pg/ml at admission.
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Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology and Metabolism, HealthWorld Hospitals, Durgapur, India.
| | - Riddhi DasGupta
- Department of Endocrinology and Metabolism, HealthWorld Hospitals, Durgapur, India.
| | | | - Ramprasad Gorai
- Department of Critical Care Medicine, HealthWorld Hospitals, Durgapur, India.
| | - Brojen Choudhury
- Department of Critical Care Medicine, HealthWorld Hospitals, Durgapur, India.
| | - Arindam Kumar Hazra
- Department of Critical Care Medicine, HealthWorld Hospitals, Durgapur, India.
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Tao L, Huang X, Xu M, Qin Z, Zhang F, Hua F, Jiang X, Wang Y. Value of circulating miRNA-21 in the diagnosis of subclinical diabetic cardiomyopathy. Mol Cell Endocrinol 2020; 518:110944. [PMID: 32717421 DOI: 10.1016/j.mce.2020.110944] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/05/2020] [Accepted: 07/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetic cardiomyopathy (DCM) is a type of cardiac dysfunction that affects approximately 12% of diabetic patients, ultimately leading to heart failure or even death. However, there is currently no efficient or specific biomarker for DCM diagnosis. METHODS A total of 266 subjects with type II diabetes (T2DM) were enrolled in this study and were divided into the T2DM with cardiac dysfunction (DCM) group and T2DM without cardiac dysfunction (non-DCM) group. The diagnostic efficacy of miR-21 was determined and compared with that of serum hemoglobin A1c% (HbA1c%). Db/db mice and H9c2 cells stimulated with high glucose (HG)/high fatty acid (PA) were used as in vivo and in vitro models of DCM, respectively. RESULTS Through echocardiography and gated-myocardial perfusion imaging (gated-MPI), 49 patients were selected to be enrolled in the DCM group, with 49 matched controls in the non-DCM group. The circulating miR-21 levels were significantly decreased in the DCM group compared to the non-DCM group (P < 0.001). The diagnostic efficiency of miR-21 (area under the curve AUC = 0.899) was higher than that of other parameters, including HbA1c%. Moreover, when miR-21 was combined with the duration of diabetes, HbA1c%, and lipid profiles, the AUC was the highest (AUC = 0.939) and had the highest diagnostic efficiency. Furthermore, overexpression of miR-21 improved the impaired mitochondrial biogenesis and decreased the cardiomyocyte apoptosis induced by HG/PA, while inhibition of miR-21 exerted the opposite effects. CONCLUSIONS Our findings identify circulating miR-21 as a novel biomarker in the diagnosis of DCM and provide an underlying mechanism for miRNA-based therapy for the treatment of DCM. TRIAL REGISTRATION The study was approved by the Ethics Committee of the Third Affiliated Hospital of Soochow University and has been registered in the Chinese Clinical Trial Registry (ChiCTR1900027080).
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Affiliation(s)
- Lichan Tao
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China
| | - Xiaoli Huang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China
| | - Min Xu
- Department of Echocardiography, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China
| | - Zihan Qin
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China
| | - Fei Hua
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China.
| | - Xiaohong Jiang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China.
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China.
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Umesha L, Shivaprasad SM, Rajiv EN, Kumar MMS, Leelavathy V, Sreedhara CG, Niranjan MR. Acute Pyelonephritis: A Single-center Experience. Indian J Nephrol 2018; 28:454-461. [PMID: 30647500 PMCID: PMC6309380 DOI: 10.4103/ijn.ijn_219_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Mean age was 53.85 ± 9.78 years. Male to females ratio was 1.93:1. Among the risk factors recognized for complicated pyelonephritis (PN), diabetes mellitus (DM) (54.4%) was the most common factor followed by renal calculi (14.4%), benign prostatic hyperplasia (6.7%), immunocompromised state (3.3%), stricture urethra and meatal stenosis (3.3%), and neurogenic bladder (2%). Urinary culture was negative in 153 (51.7%) and positive in 143 patient (48.3%). Most common organism isolated was Escherichia coli (29.7%), followed by Klebsiella pneumoniae (5.4%), pseudomonas (5.4%), Enterococcus (4.4%), and Proteus in 10 (3.4%). Serum creatinine of more than 1.5 mg/dl at admission was seen in 96.3% patients; 40% of them had underlying chronic kidney disease with DM being the most common. Multiorgan dysfunction either at admission or during the course in hospital stay was seen in 31.8% patients. Twelve (2%) had emphysematous PN. Six patients had Class II, 4 had Class III, 1 with Class I, and another with Class IV. A total of 18 deaths were noted (6.1%). Hemoglobin <10 g/dl, serum creatinine at admission >1.5 mg/dl, HbA1c% >10%, and immunosuppression had statistically significant association with the development of multiorgan dysfunction on univariate analysis, but on multivariate analysis, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance. Even with attributable risk of mortality, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance on multivariate analysis. HbA1c% adds to the predictive parameters to recognize at-risk patients to intensify the treatment and avoid complications.
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Affiliation(s)
- L Umesha
- Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - S M Shivaprasad
- Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - E N Rajiv
- Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - M M Satish Kumar
- Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - V Leelavathy
- Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - C G Sreedhara
- Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - M R Niranjan
- Department of Nephrology, Institute of Nephro Urology, Victoria Hospital Campus, Bengaluru, Karnataka, India
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Kullisaar T, Zilmer K, Salum T, Rehema A, Zilmer M. The use of probiotic L. fermentum ME-3 containing Reg'Activ Cholesterol supplement for 4 weeks has a positive influence on blood lipoprotein profiles and inflammatory cytokines: an open-label preliminary study. Nutr J 2016; 15:93. [PMID: 27793203 PMCID: PMC5084312 DOI: 10.1186/s12937-016-0213-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 10/19/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cardiovascular diseases continue to be a challenge and burden to heath. The incidence of type 2 diabetes is increasing. Modifying the (common) risk factors of them is the key of longterm success. The aim of the study was to establish if the special composition of innovative food supplement Reg'Activ Cholesterol (RAC) has a positive influence to the human body cardiovascular-inflammatory and diabetic parameters. METHODS Forty-five clinically asymptomatic participants consumed an RAC containing an antioxidative and antiatherogenic probiotic Lactobacillus fermentum ME-3 (LFME-3) for 4 weeks. The parameters measured were total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, oxLDL, hsCRP, IL-6 and glycosylated haemoglobin (HbA1c%). RESULTS The cardiovascular and diabetes risk profile of the participants improved significantly after 4 weeks of the intervention. The reduction of total cholesterol (from 6.5 ± 1.0 to 5.7 ± 0.9 mmol/l, p = 9.90806E-11) was on the account of LDL cholesterol as the HDL cholesterol level rose from 1.60 ± 0.31to 1.67 ± 0.34mml/l, p = 0.01. HbA1c% was reduced from 5.85 ± 0.28 to 5.66 ± 0.25 p = 4.64E-05 and oxLDL decreased from 84 ± 20 to 71 ± 15 U/l, p = 4.66292E-08. CONCLUSIONS The consumption of RAC in clinically asymptomatic volunteers with borderline-high values of risk factors for cardiovascular disease (BMI, HbA1c%, LDL cholesterol) for 4 weeks had a positive effect on blood lipoprotein, oxidative stress and inflammatory profile. There are no human trials published before with RAC. TRIAL REGISTRATION The trial described here isa n open label pilot study within the framework of a larger special clinical trial ( ISRCTN55339917 ) [Accessed 20 Feb 2016].
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Affiliation(s)
- Tiiu Kullisaar
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Genomics and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411 Estonia
| | - Kersti Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Genomics and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411 Estonia
| | - Tiit Salum
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Genomics and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411 Estonia
| | - Aune Rehema
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Genomics and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411 Estonia
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Genomics and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, 50411 Estonia
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Al-Mukhtar SB, Fadhil NN, Hanna BE. General and gender characteristics of type 2 diabetes mellitus among the younger and older age groups. Oman Med J 2012; 27:375-82. [PMID: 23074547 DOI: 10.5001/omj.2012.94] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/21/2012] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To study the characteristics of cardiovascular risk factors in regard to age (before and after 60) and gender. Many reports refer to the higher prevalence of cardiovascular risk factors among the younger type 2 diabetics in comparison with the older population. METHODS The study included 462 randomly recruited type 2 diabetic subjects (above and below 60 years) attending Al-Zahrawi Private Hospital in Mosul City-Iraq, during the period from June to August 2011. They were analyzed in regard to age, duration of diabetes, smoking, socioeconomic status, anthropometric indices, blood pressure, fasting plasma glucose, glycated hemoglobin A1c and serum lipids. Data were analyzed using chi-square and unpaired Z test. RESULTS Duration of diabetes, diastolic blood pressure, glycated hemoglobin A1c, fasting plasma glucose, serum lipids, number of hypercholesterolemic patients, number of patients having unfavorable total cholesterol/HDL ratio (≥5) and positive family history of coronary heart disease were all significantly higher in the younger diabetics. In addition, younger diabetic females were distinguished by a larger number of hypertensive patients, higher level of systolic blood pressure, higher means of body mass index, total cholesterol and LDL, and larger number of patients having low HDL-C (<1 mmol/L). The younger diabetic males were distinct by a larger number of smokers, number of smoked cigarettes/day, and longer duration of smoking. All parameters ranged between p<0.05 and p<0.005. CONCLUSION Cardiovascular risk factors were significantly higher among younger type 2 diabetics (<60 years), particularly females.
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