Romanian Journal of Diabetes Nutrition and Metabolic Diseases

Diabetes mellitus as a risk factor for severity and mortality in acute pancreatitis

Ján Csomor — 2024-09-30

Diabetes mellitus is a lifestyle disease that is one of the most common co-morbidities among patients and can have a substantial impact on the course and case fatality rate of acute disease, including acute pancreatitis. Our primary aim in this study was to analyze the impact of diabetes mellitus type 2 on the severity of acute pancreatitis (AP) and on the hospital mortality of patients with AP. Our secondary aims were 1) to assess the impact of various types of chronic diabetes therapy on the morbidity and lethality of AP and 2) to assess the impacts of decompensation on admission in known diabetics and of acute stress hyperglycemia in non-diabetics on the morbidity and lethality of AP—prospective evaluation of observational data in 248 patients. The hospital mortality rate in patients with diabetes was 5 times higher (17.5% compared to 3.4%, p=0.0004), nd the incidence of persistent organ failure was 6 times higher (40% compared to 6.7%, p<0.0001). Patients without diabetes who had acute stress hyperglycemia >8 mmol/l on admission had a greater incidence of severe AP than those with normal glycemia levels (15.8% compared to 3.3%, p=0.0014). Diabetes mellitus type 2 is connected with a higher incidence of local complications, organ failure and overall hospital mortality rate in patients hospitalized with AP. In non-diabetic patients, acute stress hyperglycemia at the time of admission has a comparable negative impact on the course of AP.

The lipid profile depends on the endothelial NO synthase gene promoter T786C-polymorphism in patients with arterial hypertension

Roman Hnizdyukh — 2024-09-30

According to the research data from recent years, genetic factors play an important role in the development and course of arterial hypertension (AHT). The study of the T786C polymorphism of the endothelial NO-synthase (NOS3) gene promoter in the case of arterial hypertension is a promising direction for determining the relationship between heredity, arterial hypertension, and dyslipidemia. A number of 86 AHT patients participated in the experiment, while the control group consisted of 30 practically healthy people. Indicators of lipid metabolism in the blood serum were determined. The T786C promoter of the endothelial NO-synthase (NOS3) gene was analyzed using the PCR method with electrophoretic detection of the results. The level of HDL, as an antiatherogenic factor, in the group of NOS3 gene “CC” genotype carriers was significantly lower by 45.8% than the HDL level of the “TT” genotype carriers, 0.58±0.06 vs. 1.07±0.03 mmol/L, respectively. A decrease in the HDL at the expense of an increase in the LDL and VLDL in AHT patients contributes to the formation of a secondary type IV dyslipidemia. “CC” genotype eNOS gene patients had a more pronounced disturbance of the lipid profile compared to patients with the “TT” and “TC” genotypes. Therefore, the “CC” genotype of the eNOS3 gene promoter may predict the development of dyslipidemia in patients with arterial hypertension and additional cardiovascular risk factors for the development of hypertension in patients.

Assessing the influence of home-based capillary blood glucose monitoring on healthcare utilization and glycemic management in diabetes

Rute Aparecida Casas Garcia — 2024-09-30

This study aimed to examine the relationship between home capillary blood glucose self-monitoring (CBGSM) with glycemic management and the number of consultations and capillary glucose strips consumed—a random sample of 422 patients with diabetes mellitus from a CBGSM program in Ribeirão Preto, Brazil. We have collected data on the number of consultations with physicians, nurses, and the multi-professional team, the use of glucose strips and bottles of insulin and sociodemographic data. Patients with poor glycemic management showed a lower crude frequency of nurse consultations (4.9±4.8, p=0.011). A strong negative correlation was found between the consumption of glucose strips and the value of HbA1c (r=-0.758; p=0.0029). Another strong correlation observed was between the consumption of regular human insulin and the frequency of medical consultations (r=-0.815; p=0.0014). Our findings suggest that patients in CBGSM with higher use of capillary glucose strips were associated with good glycemic management.

Oral lichen planus among patients suffering from diabetes mellitus and type C hepatitis

Carmen Larisa Nicolae — 2024-09-30

The main goal of this observational retrospective study is to discover the common clinical features of the oral lichen planus among patients suffering from both, diabetes mellitus and type C hepatitis. Several 551 observation sheets of patients suffering from oral lichen planus were analyzed. We created 4 subgroups of patients with oral lesions of lichen planus: with no diabetes and hepatitis (1), with diabetes or hepatitis only (2 and 3), and with both diseases (4). Information about patients’ data, medical history, smoking status, oral lichen planus clinical forms and symptoms, and how it started were collected. The main finding of our study was that patients who have diabetes had a worse clinical evolution of the oral lesions of lichen planus (p<0.05). The results showed the need for closer supervision when oral lichen planus and general conditions coexist. Screening for diabetes or type C hepatitis in patients with oral lichen planus is also useful.

Diagnostic accuracy of different anthropometric indicators for detecting lipid profile alterations in the Peruvian population

Jamee Guerra Valencia — 2024-09-30

Dyslipidemias are prevalent cardiovascular risk factors in Latin America. This study aimed to assess the diagnostic accuracy of anthropometric indicators in detecting lipid profile alterations in Peruvian individuals. A diagnostic test study with secondary analysis of the PERU MIGRANT study was conducted using index tests based on waist circumference and skinfold thickness. Outcomes included hypercholesterolemia, low HDL-c, elevated triglycerides, and high total cholesterol to HDL-c ratio (TC/HDL-c). Receiver operating characteristic curves and area under the curve (AUC) were assessed with optimal cutoff points determined by the Youden index, stratified by sex. A number of 972 participants were included. Waist circumference showed the highest AUC for hypercholesterolemia (0.65 in women, 0.67 in men). The waist-to-height ratio showed the highest AUC for elevated triglycerides (AUC: 0.66). For low HDL-c, waist-to-hip ratio in women (AUC: 0.62) and waist-to-height ratio in men (AUC: 0.65) performed best. Waist-to-height ratio demonstrated AUCs ≥0.70 for elevated TC/HDL-c ratio in both sexes, with waist circumference having an AUC of 0.71 in men. Waist-based tests demonstrated moderate to high diagnostic capabilities for lipid alterations, particularly for elevated TC/HDL-c ratio. Further research is needed to confirm these findings.

Frequency of retinopathy in prediabetic patients: A retrospective one-center study

Eryilmaz Müzeyyen — 2024-09-30

Prediabetes is a condition in which glucose levels are high but do not reach the diagnostic limits of diabetes. The development of diabetes in prediabetic patients has been reported as 70% in some studies. Description of prediabetes is very important, as early diagnosis can prevent conversion to diabetes and diabetes complications. A number of observational studies have shown that prediabetes is associated with the risk of microvascular disease. In this study, it was aimed to identify prediabetic patients who started retinopathy. Our study is a retrospective study and was designed according to the 2022 guideline of the Turkish Endocrine and Metabolism Society (TEMS). It included 244 patients in the study. The presence of retinopathy was detected by performing a fundus examination of patients diagnosed with prediabetes. Of the 244 patients included in the study, 195 were female, 49 were male; mean age was 51.95±10.47 years, mean Body Mass Index (BMI) was 31.03±5.15 kg/m2 and mean HbA1c was 6.03%±0.17. Diabetic retinopathy was detected in 33 of 244 (13.5%) cases. The most common comorbidity detected in patients with diabetic retinopathy was hyperlipidemia. The frequency of hyperlipidemia was 54.55%, and the frequency of retinopathy-positive cases with hyperlipidemia was 35.55%, which was statistically significant (p=0.037). There was no significant difference in the coexistence of nephropathy and retinopathy. The rate of retinopathy detected in prediabetic patients was consistent with the literature (13.5%, p<0.05). When the study is designed prospectively, we can get fluent answers to our questions by determining the type and stage of retinopathy. If prediabetes is taken seriously in terms of both its transformation into diabetes and co-existing diseases, the expenses to be made in this regard will also be prevented.

Association between hypothyroidism and metabolic syndrome in a tertiary care hospital

Jothsna Aravindan — 2024-09-30

Thyroid disorders are among the most common endocrine conditions, presenting a wide range of biochemical and clinical features with varying degrees of severity. Metabolic syndrome (MetS) consists of a group of abnormalities, including abdominal obesity, insulin resistance, hypertension, hypertriglyceridemia, and reduced high-density lipoprotein cholesterol. Hypothyroidism is linked to hypertension, impaired carbohydrate metabolism, and dyslipidemia, all of which are components of MetS. Both hypothyroidism and MetS frequently occur in clinical practice, and their overlap increases the risk of cardiovascular disease, contributing to higher mortality rates. This study aimed to investigate the association between hypothyroidism and MetS by evaluating the relationships between TSH, FT4, and specific components of MetS. Conducted as a hospital-based case-control study at Chettinad Hospital and Research Institute in Chennai, the study included 50 cases of hypothyroid patients and 50 controls of healthy euthyroid individuals. The presence of MetS was assessed in both groups, with findings revealing that 82% of hypothyroid patients had MetS, compared to 16% of the euthyroid population. In the hypothyroid group, waist circumference (WC) and HDL were significantly associated with TSH (p=0.018 and p=0.029, respectively). Among euthyroid individuals, positive correlations were observed between WC and TSH (p=0.031) and between triglycerides and TSH (p=0.020). Independent sample t-tests revealed statistically significant differences in WC (p=0.004) and fasting blood sugar (FBS) (p<0.001). Additionally, body mass index (BMI) showed a significant difference (p<0.001).

Prevalence and risk factors for hypoglycemia in acutely ill children seen at the emergency pediatric unit of the Federal Teaching Hospital Katsina, Northern Nigeria

Ibrahim Nuraddeen — 2024-09-30

Hypoglycemia is a common metabolic problem seen in children presenting with acute illnesses. It may be part of the presentation and portends the illness’s severity, contributing to morbidity and mortality. This study aimed to evaluate the prevalence and risk factors for hypoglycemia in children seen at the Emergency Paediatric Unit of the Federal Teaching Hospital Katsina. The study was descriptive and cross-sectional and was conducted in the Emergency Paediatric Unit (EPU) of the Federal Teaching Hospital Katsina. Of the One hundred and forty-six children screened for hypoglycemia, 6.2% had (plasma glucose less than 3 mmol/l). Patients whose last feed was taken 12 hours or more were more likely to have hypoglycemia at presentation (OR 51; CI=7.5–358). There were more deaths among hypoglycemic subjects compared to those without hypoglycemia. Children have a limited capacity for gluconeogenesis and are thus at higher risk of morbidities and mortalities related to hypoglycemia. Hypoglycemia should, therefore, be sought in all patients presenting with acute pediatric emergencies, particularly in those with a history of prolonged fasting.

Insulin resistance in nonobese, euglycemic and normotensive first-degree relatives of individuals with obesity

Nishanth Dev — 2024-09-30

Insulin resistance (IR) is reportedly high in individuals with obesity and relatives of patients with diabetes. However, there is a paucity of data on its prevalence in first-degree relatives of obese individuals. The study aimed to determine whether nonobese, normotensive and euglycemic first-degree relatives of obese individuals differ in IR from controls. This cross-sectional study compared 35 first-degree, nonobese, normotensive, euglycemic relatives of obese individuals with 35 age, gender, and body mass index (BMI) matched first-degree relatives of normotensive, euglycemic, nonobese individuals. More than 1/3rd of subjects in the study group had IR as compared to the control group [34% (95% CI: 21–51) vs. 14% (6–9); p=0.05]. It highlights an important trend of higher IR in first-degree relatives of the at-risk populations. Hyperinsulinemia was also higher in the study group (37% vs. 17%). Impaired fasting glucose (IFG) and serum insulin levels were higher in the group with IR [47% vs. 9.4%; p=0.001 (IFG) and 184 vs. 114 (serum insulin); p<0.0001). We observed a high proportion of healthy relatives of individuals with obesity to have IR. There is a need to closely monitor these apparently healthy individuals for the development of diabetes mellitus. Our findings are exploratory and provide novel information that needs further confirmation.

Quantitative morphological assessment of the structural changes in the arterial bed of the cardiac ventricles in diabetes mellitus and post-resection pulmonary hypertension

Serhii Konovalenko — 2024-09-30

Cardiovascular disease and diabetes mellitus have been recognized as global challenges of the 21st century. The study aimed to evaluate the structural changes in the arterial bed of the heart chambers in diabetes mellitus and pulmonary hypertension. The myocardium of 54 rats divided into 4 groups was studied morphologically. The outer diameter of small-caliber arteries of the right ventricle in diabetes mellitus statistically significantly (p<0.05) increased by 3.0%; in post-resection pulmonary hypertension – by 4.1% (p<0.05); in combined lesions, this morphometric index increased by 18.7% (p<0.001). In the presence of diabetes mellitus in the right ventricle, the internal diameter of small arteries decreased statistically significantly (p<0.01) by 8.6%, in the case of post-resection pulmonary hypertension – by 23.2% (p<0.001), and in the combination of pathology – by 57.4% (p<0.001). In small-caliber arteries of the right ventricle, the thickness of the media increased by 11.0% in diabetes mellitus, adventitia by 37.1%, in post-resection pulmonary hypertension by 28.8% and 65.5%, respectively, and in the combination of these two pathologies by 89.0% and 251.7%, respectively. In diabetes mellitus and post-resection pulmonary hypertension, hemodynamic and structural changes occur in the arterial bed of the heart, which significantly disrupts the blood supply to the myocardium, worsens its trophic supply, and plays an important role in the photomorphogenesis of its diseases.

Prevalence and correlation of metabolic syndrome with chronic kidney disease in middle-aged adults

Shankar Ganesh Muthusamy — 2024-09-30

Previous surveys suggest that obesity, hypertension, and diabetes mellitus may be positively related to the development of chronic kidney disease (CKD), though this association might be influenced by metabolic syndrome. CKD has become a global health problem among aging populations, yet epidemiological information on middle-aged patients with metabolic syndrome remains scarce. This hospital-based cross-sectional study aimed to identify and validate novel biomarkers that predict CKD progression in middle-aged individuals with metabolic syndrome. The study included 317 participants aged 40–59 years, all of whom underwent standardized personal interviews, structured questionnaires, anthropometric measurements, and laboratory blood tests. Metabolic syndrome was defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria. The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault formula to predict CKD stages based on NKF-KDOQI guidelines. Our study revealed that metabolic syndrome was prevalent in more than half of the participants (54.2%) and increased with the worsening of CKD stages. Significant metabolic factors associated with CKD included waist circumference, fasting blood sugar, and triglycerides. Moreover, longer durations of diabetes mellitus and hypertension, particularly when combined, heightened the risk of CKD. Our findings indicate that metabolic syndrome is a major contributor to CKD, emphasizing the need for early detection and management of metabolic factors to prevent kidney damage in middle-aged populations.

Peculiarities of behavioral response in rats of different sexes with metabolic syndrome under the conditions of carbacetam administration

Olga Pryzhbylo — 2024-09-30

Metabolic syndrome has become prevalent worldwide. It is a multi-component, progressing condition closely associated with nervous system pathology. Clinical signs of metabolic syndrome are not often clear, which makes diagnostics more difficult and promotes the development of severe, sometimes irreversible consequences. At the same time, GABA is known to play a considerable role in memorization processes and the mechanisms of memory formation. Thus, early diagnostics and timely treatment improve the prognosis of the disease. Therefore, our work aimed to study the peculiarities of behavioral response and memorization processes of female and male rats with metabolic syndrome under the conditions of carbapenem administration as a modulator of GABA receptors. The experiments were conducted on laboratory nonlinear white male and female rats weighing 0.220–0.250 kg. Metabolic syndrome was simulated by keeping the rats on a high-fat diet and giving them free access to fructose solution (100 g/L). Carbacetam was administered intraperitoneally at 5 mg/kg for 14 days. Conclusions. According to the results of “open field” and “CPAR” tests, both males and females with metabolic syndrome decrease their motor, locomotor, learning and emotional activity. Administration of GABA-receptor modulator motor activity promoted increases and inconsiderable changes in the emotional behavior of rats by the number of washings that occur. The results indicate the experimental rats’ behavior modulation due to carbacetam administration. At the same time, effective retention of conditioned passive avoidance reflex to electric painful stimulation in rats receiving carbacetam indicates improved cognitive ability.

Comparison of the effect of passive static stretching exercise of upper and lower extremity on blood glucose levels, functional capacity and lipid profile in patients with type 2 diabetes mellitus

Manisha Tanwar — 2024-09-30

Skeletal muscle is non-uniform tissue; in healthy individuals, slow twitch fibers have higher GLUT-4 density compared to fast twitch, and the reverse mechanism occurs in type 2 diabetes mellitus. Stretching exercises of various muscle groups help integrate GLUT-4, which increases metabolic activity and lowers blood glucose levels in patients with type 2 diabetes. Computer generated randomization of 25 participants each into 4 groups, namely Brisk walking (group l), upper limb passive static stretching (group 2), lower limb passive static stretching (group 3) and combined passive static stretching of upper and lower limb (group 4). Stretching exercises were given 4 days/week to corresponding muscle groups for 8 weeks. HbA1C, postprandial blood glucose level (PPBGL), lipid profile and 6-minute walk test were recorded at baseline, after 4 weeks and after 8 weeks of intervention. After 8 weeks of training, HbA1c and postprandial blood glucose levels reduced significantly in upper limb passive static stretching (p<0.05) compared to lower limb passive static stretching and control group (p>0.05). However, there was an insignificant improvement in lipid profile and 6-minute walk test within and between groups 1, 2, 3 and 4. The decrease in HbA1c and PPBGL levels following 8 weeks of stretching indicates that upper limb stretching had a higher impact on glucose clearance than lower limb stretching in type 2 diabetes.

Histomorphological changes in brown adipose tissue and energy metabolism in rats of different ages with induced visceral obesity

Roman Yanko — 2024-09-30

The question of the mechanisms of interrelationship between age-related changes in the morpho-functional state of brown adipose tissue (BAT) with the state of energy metabolism and their role in the pathogenesis of visceral obesity (VO) remains open. The aim of this work was to compare histomorphological changes in BAT of rats of different ages with VO. The study was conducted in male Wistar rats aged 6 and 21 months. VO was modeled in the animals by 12 weeks of exposure to a high-calorie diet. Histological preparations were made from the interscapular bodies of the BAT. Blood serum concentrations of lipids and cholesterol were determined. Total oxygen consumption and rectal temperature were measured in rats. VO leads to morphological changes in the BAT, indicating its hypofunction. The increase in BAT weight is due to the hypertrophy of adipocytes and their transformation into white adipose tissue. With VO, total oxygen consumption and rectal temperature increase, they were indicating the presence of a certain degree of disruption of oxidation and phosphorylation processes. The intensity of BAT histomorphological disturbances and energy metabolism is more pronounced in young rats and depends on the degree of obesity.

The effect of inflammatory biomarkers on COVID-19 patients with diabetes and comorbidities

Bouchra Abi-Ayad — 2024-09-30

The Beta variant Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused a global health emergency, leading to pulmonary lesions and aggravation with preexisting cardiovascular diseases (CVD) and risk factors. A transversal retrospective study has been conducted at the infectious diseases ward of Tlemcen University Hospital Centre (CHU). The survey was conducted on 482 patients divided into 4 groups linked to preexisting cardiovascular diseases and diabetes. The data were collected from the medical records from March 2020–April 2022. The study revealed a high prevalence in patients with cardiovascular comorbidities (68%), including 37% with diabetes and 69% with hypertension. The clinical and biological evaluation of these patients found clearly worse results with a high mortality rate (34%). In the frame of the biological evaluation, we have noticed an unfavorable evolution for patients with cardiovascular disease history (+). The key parameter of the monitoring is oxygen saturation (SpO2), as the results indicated that persisting hypoxemia in hospitalized patients correlated significantly with C-reactive Protein (CRP) levels (p=0.04) and lymphocytes (p=0.009). Regarding inflammation, CRP levels were higher, exceeding 40 mg/L in subjects with a cardiovascular disease history (CDH+). Furthermore, the results: platelets (<100000/mm3 in patients with diabetes), fibrinogen (>6 g/L), and D-dimer (>1.5 µg/mL) confirmed high thrombotic risk in patients suffering from CVD regardless of diabetes. This study supports the hypothesis that cardiovascular comorbidities are contaminating and aggravating factors for the COVID-19 condition.

An exploratory investigation associated with type 2 diabetes mellitus and public awareness regarding diabetes and its complications

Naveena Ponnam — 2024-09-30

Living with type II diabetes mellitus (DM) involves various challenges, including acute metabolic complications such as diabetic ketoacidosis and hyperosmolar nonketotic coma, as well as chronic systemic complications like retinopathy, diabetic neuropathy, diabetic nephropathy, coronary heart disease, and cerebrovascular disorders. Psychosocial well-being is also impacted, with prevalent concerns like sexual dysfunction and hearing impairment. Our observational study aimed to assess the prevalence of diabetic complications and patient awareness. The study was conducted in Warangal, Telangana, India, from December 2021 to May 2022. We collected data from 300 type II diabetes mellitus patients using designed questionnaires and conducted a statistical analysis using GraphPad Prism 9.4.0, specifically employing a Chi-square test where a P-value less than 0.05 was deemed statistically significant. The study disclosed a higher prevalence of neuropathy (74%) and a heightened awareness of nephropathy’s complications compared to neuropathy within the overall population. Among participants, 56.00% were aware of diabetic complications, while 44.00% had no awareness. Rural areas had 63.63% of participants without awareness, while urban areas had 36.3%. Rural females exhibited poorer awareness compared to rural males. Overall, the study emphasizes the significance of managing DM complications, particularly diabetic neuropathy, and the need for enhancing patient education through effective communication between physicians/clinical pharmacists and patients.

Hand grip strength and diabetic foot ulcers: A mini-review

Nikolaos Karakousis — 2024-09-30

This narrative mini-review article aimed to discuss the emerging association between hand grip strength (HGS) and diabetic foot ulcers (DFUs). HGS is related to muscle strength and conditions such as sarcopenia. However, it can be utilized as a confirmative evaluation test of sarcopenia after initial screening tools such as the SARC-F questionnaire. Diabetes mellitus (DM) seems to be related to sarcopenia and skeletal muscle mass loss. In this narrative mini-review article, it was demonstrated that older type 2 diabetes mellitus (T2DM) subjects with DFUs had a higher rate of low HGS, while low HGS was significantly related to the occurrence of DFUs. Additionally, HGS might be a significant predictor not only of wound healing but also of the overall survival of DFU subjects and the likelihood of amputation. Nevertheless, further studies are needed to enable definitive conclusions and suggest potential practical implications.