Risk of type 2 diabetes in patients with insomnia: A population‐based historical cohort study

Background

We investigated the risk of type 2 diabetes mellitus (T2DM) in patients with and without insomnia.

Methods

In this historical cohort study, we performed a secondary analysis of data from 2001 to 2010, which was obtained from Taiwan's National Health Insurance Database. We developed a Cox proportional hazard regression model to estimate the effects of insomnia on T2DM risk. Kaplan‐Meier survival analysis was applied to compare the differences in the cumulative incidence of T2DM between the groups with and without insomnia.

Results

During the follow‐up period, the T2DM incidence rate of patients with insomnia was significantly higher than that of patients without insomnia (34.7 vs 24.3 per 1000 person‐years). Overall, patients with insomnia had a higher risk of T2DM than did patients without insomnia (adjusted hazard ratio, 1.16; 95% confidence interval [CI], 1.10‐1.19). Among patients aged younger than 40 years, those with insomnia had a higher risk of T2DM than did the comparison cohort (adjusted hazard ratio, 1.31; 95% CI, 1.14‐1.55). Compared with patients without insomnia, the risk tended to increase with the duration of follow‐up in patients with insomnia; when the insomnia duration was <4 years, 4 to 8 years, and >8 years, the risk of T2DM increased by 1.14, 1.38, and 1.51 times (95% CI, 1.03‐1.17, 1.15‐1.49, and 1.20‐1.86), respectively. Patients with insomnia had a higher risk of T2DM, and this risk was particularly pronounced among the younger (≤40 years) population.

Conclusion

Chronic insomnia could be an important risk factor for T2DM.     

Diabetes mellitus not an unfavorable factor on the prognosis of hepatitis C virus‐related hepatocellular carcinoma

Aim

Diabetes mellitus (DM) is a potential risk factor for hepatocarcinogenesis, especially in patients with hepatitis C virus (HCV) infection. We aimed to elucidate whether DM influences the surgical outcomes of patients with hepatocellular carcinoma (HCC).

Methods

Our patients were routinely controlled to keep urinary glucose excretion to less than 3.0 g/day before surgery, and the serum glucose level under 200 mg/dL after surgery. The surgical outcomes and postoperative complications of 112 patients with HCV‐related HCC with DM (DM group) were compared to those of 112 propensity‐matched patients without DM (non‐DM group).

Results

After a median follow‐up of 3.2 years (range, 0.2–11.3 years), the median overall (5.2 years; 95% confidence interval, 3.8–6.5 years) and recurrence‐free survival (2.2 years; 1.7–2.9 years) in the DM group were not significantly different from those (6.3 years; 5.4–7.1 years, P = 0.337; and 2.2 years; 1.7–3.6 years, P = 0.613) in the non‐DM group. The independent factors related to overall survival were the background liver (hazard ratio, 2.06; 95% confidence interval, 1.27–3.39, P = 0.014) and tumor differentiation grade (2.07; 1.14–4.05, P = 0.015). Thirty‐two patients (28.5%) in the DM group and 32 patients (28.5%) in the non‐DM group had morbidities after operation, with no significant difference between the groups (P = 1.000). Furthermore, postoperative control status of DM did not affect the prognostic outcome.

Conclusion

Diabetes mellitus does not affect the surgical outcomes of patients with HCV‐related HCC, and it is not an unfavorable factor when selecting candidates for liver resection of HCC.     

Insulin resistance increases the risk of incident type 2 diabetes mellitus in patients with non‐alcoholic fatty liver disease

Aim

Type 2 diabetes mellitus (T2DM) is a major complication of patients with non‐alcoholic fatty liver disease (NAFLD). The aim of this retrospective study is to determine the risk factors for development of T2DM in patients with biopsy‐proven NAFLD.

Methods

One hundred and sixty two consecutive patients with biopsy‐proven NAFLD who received a 75‐g oral glucose tolerance test were enrolled as the total cohort. Among them, we analyzed 89 patients without T2DM diagnosed by oral glucose tolerance test to estimate the cumulative rate for development of T2DM as the follow‐up cohort.

Results

Of 162 patients, the glucose tolerance pattern were DM in 45 patients (27.8%), impaired glucose tolerance in 68 (42.0%), and normal glucose tolerance in 49 (30.2%). Patients with NAFL tended to be more likely to have normal glucose tolerance than those with non‐alcoholic steatohepatitis (NASH). The serum levels of pre‐ and post‐load insulin were significantly higher in the NASH group. Of 89 patients without T2DM, 13 patients newly developed T2DM during a follow‐up period of 5.2 years. The cumulative rate of T2DM incidence was 8.8% at the end of the 5th year and 23.4% at the end of the 10th year. Multivariate analysis identified homeostasis model of assessment – insulin resistance (≥3.85, hazard ratio 40.1, P = 0.033) as an independent risk factor for development of T2DM.

Conclusions

Patients with NASH have an underlying potential of glucose intolerance. In NAFLD patients, insulin resistance is the most important risk factor for the incidence of T2DM. Appropriate therapy against insulin resistance could be needed for patients with NAFLD to prevent development of T2DM.     

Beta cell stress in a 4‐year follow‐up of patients with type 2 diabetes: A longitudinal analysis of the BetaDecline Study

Background

Type 2 diabetes mellitus (T2DM) is associated with a progressive deterioration in beta cell function and loss of glycaemic control. Clinical predictors of beta cell failure are needed to guide appropriate therapy.

Methods

A prospective evaluation of a large set of potential predictors of beta cell stress, measured as change in the proinsulin/insulin (PI/I) ratio, was conducted in a cohort of 235 outpatients with T2DM on stable treatment with oral hypoglycaemic agents or diet followed up for ~4 years (median value 3.9 years; interquartile range 3.8‐4.1 years).

Results

Overall, metabolic control deteriorated over time, with a significant increase in glycated haemoglobin (HbA1c; P < .0001), proinsulin (P < .0001), and PI/I ratio (P = .001), without significant changes in the homeostatic model assessment of insulin resistance. Multivariate regression analysis showed that for each 1% (10.9 mmol/mol) increase from baseline in HbA1c, the risk of beta cell stress increased by 3.8 times; for each 1% (10.9 mmol/mol) incremental increase in HbA1c during the study, risk of beta cell stress increased by 2.25 times that at baseline. By contrast, baseline anthropometric and clinical variables, lipid profile, inflammatory markers (PCR, IL‐6), non‐esterified fatty acids, and current therapies did not independently influence PI/I ratio variation during follow‐up.

Conclusions

In this cohort of patients with T2DM, beta cell function progressively deteriorated despite current therapies. Among a large set of clinical and biochemical predictors, only baseline HbA1c levels and their deterioration overtime were associated with higher beta cell stress over time.     

Outcomes of hyperglycemia in patients with and without diabetes hospitalized for infectious diseases

Objective

To examine the prognostic implications of diabetes mellitus (DM) and the importance of glycemic control during hospitalization for infectious diseases.

Methods

Historical prospectively collected data of patients hospitalized between 2011 and 2013. Infection‐related hospitalizations were classified according to site of infection. Median follow‐up was 4.5 years. Outcome measures included in‐hospital and end‐of‐follow‐up mortality.

Results

The cohort included 8051 patients (50% female, mean age ± SD, 68 ± 20 years) with a primary diagnosis of an infectious disease. Of these, 2363 patients (29%) had type 2 DM. The most common infectious sites included respiratory tract (n = 3285), genitourinary tract (n = 1804), skin and soft tissue (n = 934) and gastrointestinal tract (n = 571). There was no difference in admission rates of patients with and without DM according to the site of infection, except for skin and soft tissue infection which were more common among patients with DM (16% vs 10%). In‐hospital mortality risk was greater in patients with DM (aOR = 1.3, 95% CI = 1.1‐1.7). In the entire cohort, adjusted mortality risk (aHR, 95% CI) at the end‐of‐follow‐up was greater among patients with DM (1.2, 1.1‐1.4), with increased mortality risk following hospitalization for respiratory (1.1, 1.0‐1.4) and skin and soft tissue infections (1.7, 1.3‐2.3). In‐hospital and end‐of‐follow‐up mortality risk were highest among patients with and without DM with median glucose >180 mg/dL during hospitalization.

Conclusions

In patients hospitalized for infectious diseases, DM is associated with increased long‐term mortality risk, specifically following hospitalization for respiratory and skin and soft tissue infections. Poor glycemic control during hospitalization is associated with increased long‐term mortality.     

Cohort study to determine the waist circumference cutoffs for predicting type 2 diabetes mellitus in rural China

Background

Limited information is available on the cutoffs of waist circumference (WC) for predicting type 2 diabetes mellitus (T2DM). We aimed to define the optimal WC cutoffs for predicting T2DM among rural Chinese people.

Methods

A cohort of 11 968 participants (732 new‐onset T2DM) from a rural area in China with age 18 to 87 years was established at baseline during July to August of 2007 and 2008 and followed up during July to August of 2013 and 2014. Scatterplot, X‐tile plot, and receiver operating characteristic (ROC) curve analyses were used to determine WC cutoffs for predicting T2DM.

Results

The WC cutoffs for males and females were 84 and 86 cm (scatterplot), 83 and 88 cm (X‐tile plot), and 87 and 88 cm (ROC curve). According to the highest risk score, the optimal WC cutoffs were 87 cm for males and 88 cm for females. With the optimal WC cutoffs, the sensitivity, specificity, positive likelihood ratio, area under the ROC curve, and population‐attributable risk proportions were 67.9%, 67.0%, 2.06%, 0.70%, and 46%, respectively, for males and 52.5%, 75.0%, 2.10%, 0.69%, and 34%, respectively, for females; the corresponding adjusted hazard ratio for WC predicting T2DM was 3.66 (95% confidence interval 2.80‐4.78) for males and 2.55 (2.08‐3.12) for females.

Conclusions

The optimal WC cutoffs for predicting T2DM were similar between males and females. As well, the criteria of WC for central obesity are no longer practical for predicting T2DM.     

Impact of muscle volume and muscle function decline in patients undergoing surgical resection for hepatocellular carcinoma

Background and Aim

This study investigated the prognostic impact of muscle volume loss (MVL) and muscle function decline in patients undergoing resection for hepatocellular carcinoma (HCC).

Methods

This study enrolled 171 naïve HCC patients treated with resection from 2007 to 2015, after excluding those lacking spirometry or computed tomography findings, who had received non‐curative treatments, or with restrictive or obstructive lung disorders. The median peak expiratory flow rate (%PEF) was set as the cut‐off value for muscle function decline, and MVL was diagnosed using a previously reported value. Clinical backgrounds and prognosis were retrospectively evaluated.

Results

Overall survival rate was lower in the MVL (n = 35) as compared with the non‐MVL (n = 136) group (1/3/5‐year overall survival rate = 88.2%/81.6%/55.6% vs 91.0%/81.5%/74.8%, respectively; P = 0.0083), while there were no differences regarding hepatic function or tumor burden between the groups. Child‐Pugh class B (hazard ratio [HR] 3.510, 95% confidence interval [CI]: 1.558–7.926, P = 0.0025), beyond Milan criteria (HR 1.866, 95%CI: 1.024–3.403, P = 0.042), and presence of MVL (HR 1.896, 95%CI: 1.052–3.416, P = 0.033) were significant prognostic factors. The decreased %PEF group (n = 84) showed a higher rate of postoperative delirium than the others (n = 87) (27.4% vs 11.5%, P = 0.0088). The cut‐off values for %PEF and age for postoperative delirium were 63.3% (area under receiver operating characteristic [AUROC] 0.697) and 73 years old (AUROC 0.734), respectively. Delirium was observed in 50.0% (14/28) of patients with both factors, 23.8% (15/63) of those with 1 factor, and 5.0% (4/80) of those without either factor.

Conclusion

Muscle volume loss is an independent prognostic factor in HCC patients treated with surgical resection, while advanced age and decreased muscle function might indicate high risk for postoperative delirium.     

Elevated serum interferon‐α activity in juvenile dermatomyositis: Associations with disease activity at diagnosis and after thirty‐six months of therapy

Objective

Interferon‐α (IFNα) has been implicated in the pathogenesis of juvenile dermatomyositis (DM). The aim of this study was to examine serum IFNα activity in a cohort of children with juvenile DM to determine relationships between IFNα and indicators of disease activity and severity.

Methods

Thirty‐nine children with definite/probable juvenile DM were included in the study. Serum samples were obtained at the time of diagnosis from 18 untreated patients with juvenile DM. Second samples from 11 of these patients were obtained at 24 months, while they were receiving treatment, and third samples were obtained from 7 of these patients at 36 months. The remaining 21 children were studied 36 months after their initial diagnosis. Serum IFNα activity was measured using a functional reporter cell assay.

Results

Patients with juvenile DM had higher serum IFNα activity than both pediatric and adult healthy control subjects. In untreated patients, serum IFNα activity was positively correlated with serum muscle enzyme levels (P < 0.05 for creatine kinase, aspartate aminotransferase, and aldolase) and inversely correlated with the duration of untreated disease (P = 0.017). The tumor necrosis factor α −308A allele was associated with higher serum IFNα levels only in untreated patients (P = 0.030). At 36 months, serum IFNα levels were inversely correlated with muscle enzyme levels in those patients still requiring therapy and with the skin Disease Activity Score in those patients who had completed therapy (P = 0.002).

Conclusion

Serum IFNα activity was associated with higher serum levels of muscle‐derived enzymes and a shorter duration of untreated disease in patients with newly diagnosed juvenile DM and was inversely correlated with measures of chronic disease activity at 36 months postdiagnosis. These data suggest that IFNα could play a role in disease initiation in juvenile DM.

     

[HDL‐C/apoA‐I]: A multivessel cardiometabolic risk marker in women with T2DM

Aims

Although women have higher high‐density lipoprotein cholesterol (HDL‐C) than have men, their HDL particles are also prone to become small, dense, and dysfunctional in case of type 2 diabetes mellitus (T2DM). To assess the vascular risk related to HDLs of different sizes/densities without direct measurement, we adjusted HDL‐C to its main apolipoprotein (apoA‐I) as [HDL‐C/apoA‐I]. This ratio estimates HDL sizes and provides indices as to their number, cholesterol load, and density.

Methods

We stratified 280 Caucasian T2DM women according to [HDL‐C/apoA‐I] quartiles (Q) to determine how they are segregated according to cardiometabolic risk, β‐cell function, glycaemic control, and vascular complications. Five parameters were derived from combined determination of HDL‐C and apoA‐I: HDL size, HDL number, cholesterol load per particle (pP), apoA‐I pP, and HDL density.

Results

An adverse cardiometabolic profile characterized QI and QII patients whose HDLs were denser and depleted in apoA‐I, whereas QIII patients had HDLs with characteristics closer to those of controls. QIV patients had HDLs of supernormal size/composition and a more favourable phenotype in terms of fat distribution; insulin sensitivity (64% vs 41%), metabolic syndrome, and β‐cell function (32% vs 23%); exogenous insulin (44 vs 89 U·d^?1); and glycaemic control (glycated haemoglobin, 56 vs 61 mmol·mol^?1), associated with lower prevalence of microvascular/macrovascular complications: all‐cause microangiopathy 47% vs 61%; retinopathy 22% vs 34%; all‐cause macroangiopathy 19% vs 31%; and coronary artery disease 6% vs 24% (P < .05).

Conclusion

[HDL‐C/apoA‐I] can stratify T2DM women according to metabolic phenotype, macrovascular and coronary damage, β‐cell function, microangiopathic risk, and retinopathy. This ratio is a versatile and readily available marker of cardiometabolic status and vascular complications in T2DM women.     

The relationship between haemoglobin level and type 1 diabetic nephropathy in Han patients in Anhui,China

Background/Aim

Recent studies have shown that low haemoglobin (Hb) levels promote the progression of chronic kidney disease. This study assessed the relationship between Hb level and type 1 diabetic nephropathy (DN) in Han patients in Anhui, China.

Methods

There was a total of 236 patients diagnosed with type 1 diabetes mellitus (T1DM) seen between January 2014 and December 2016 in our centre. Haemoglobin levels in patients with DN were compared with those without DN. The relationship between Hb level and the urinary albumin–creatinine ratio (ACR) was examined by Spearman's correlational analysis and multiple stepwise regression analysis. The binary logistic multivariate regression analysis was performed to analyse the correlated factors for type 1 DN, calculate the odds ratio (OR) and 95% confidence interval (CI). The predicting value of Hb level for DN was evaluated by area under receiver operation characteristic curve (AUROC) for discrimination and Hosmer–Lemeshow goodness‐of‐fit test for calibration.

Results

The average Hb levels in the DN group (116.1 ± 20.8 g/L) were significantly lower than the non‐DN group (131.9 ± 14.4 g/L), P < 0.001. Hb levels were independently correlated with the urinary ACR in multiple stepwise regression analysis. The logistic multivariate regression analysis showed that the Hb level (OR: 0.936, 95% CI: 0.910–0.963, P < 0.001) was inversely correlated with DN in patients with T1DM. In sub‐analysis, low Hb level (Hb < 120 g/L in female, Hb < 130 g/L in male) was still negatively associated with DN in patients with T1DM. The AUROC was 0.721 (95% CI: 0.655–0.787) in assessing the discrimination of the Hb level for DN. The value of P was 0.593 in Hosmer‐Lemeshow goodness‐of‐fit test.

Conclusions

In patients with T1DM, the Hb level is inversely correlated with urinary ACR and DN.     

Changing psychosocial determinants of physical activity and diet in women with a history of gestational diabetes mellitus

Background

To investigate how a behavioural lifestyle intervention influences psychosocial determinants of physical activity and dietary behaviours in a population at risk of type 2 diabetes (T2DM).

Methods

Fifty‐nine women with a body mass index of ≥25 kg/m² and a history of gestational diabetes mellitus (GDM) participated in a randomized controlled study. The intervention group (n = 29) received 2 face‐to‐face and 5 telephone lifestyle‐counselling sessions with a health professional. The control group (n = 30) received care as usual. At baseline and 6 months, psychosocial determinants related to physical activity and diet were measured with a self‐administrated questionnaire. Linear regression analyses were applied to test for intervention effects.

Results

The intervention was effective in improving social support (β = 3.5, P < 0.001; β = 2.1, P = 0.02), modifying self‐efficacy (β = ‐2.2, P = 0.02; β = ‐4.3, P < 0.001), and reducing barriers (β = ‐3.5, P = 0.01; β = ‐3.8, P = 0.01) for, respectively, physical activity and diet from baseline to 6‐month follow‐up in the intervention group compared with the control group. The intervention reduced the following barriers to a physically active lifestyle: lack of energy and lack of motivation. Physical activity barriers like lack of time and lack of childcare were unchanged. The intervention reduced the following barriers to a healthy diet: lack of time, costs, having unhealthy snacks at home, and having cravings for sweets.

Conclusion

This lifestyle intervention influenced psychosocial determinants relevant for overweight women with a history of gestational diabetes mellitus (GDM) in prevention of T2DM.     

Effects of glucagon-like peptide-1 receptor agonists on major coronary events in patients with type 2 diabetes

Aims

To perform a meta-analysis to assess the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on major coronary events, including myocardial infarction (MI), unstable angina and coronary revascularization, in patients with type 2 diabetes mellitus (T2DM).

Materials and methods

We systematically searched the PubMed, CENTRAL, EMBASE and clinicaltrial.gov databases to seek eligible studies with a cardiovascular endpoint comparing GLP-1RAs with a placebo in T2DM patients. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated for the outcomes.

Results

Nine studies, with a total of 64 236 patients, were included. GLP-1RA treatment reduced fatal and nonfatal MI by 8% (OR 0.92, 95% CI 0.86–0.99; P = 0.02, I² = 39%). The reduction reached 15% in human-based GLP-1RA-treated patients. Similarly, once-weekly GLP-1RA treatment reduced the risk of MI by 13%. In contrast, GLP-1RA treatment did not reduce the risk of hospitalization for unstable angina (OR 1.11, 95% CI 0.97–1.28; P = 0.13, I² = 21%). GLP-1RAs exhibited a tendency to lower the risk of coronary revascularization (OR 0.95, 95% CI 0.89–1.02; P = 0.15, I² = 22%), but without statistical significance. Human-based GLP-1RAs decreased the risk by 11%.

Conclusions

In high-risk patients with T2DM, GLP-1RAs were associated with a decrease in MI, especially the human-based and once-weekly GLP-1RAs. No benefit was seen for hospitalization for unstable angina or coronary revascularization. Further research is urgently needed to ascertain improvements in coronary events.     

Clinical significance of serum interleukin‐8 and soluble tumor necrosis factor‐like weak inducer of apoptosis levels in patients with diabetic nephropathy

Aims/Introduction

Recent studies suggest that chronic inflammatory responses are important in the development of diabetic nephropathy (DN). Various inflammatory and angiogenesis molecules affect the pathogenesis and progression of DN. Inflammation damages the microcirculation and causes kidney damage. In the present study, we studied changes in interleukin‐8 (IL‐8) and soluble tumor necrosis factor‐like weak inducer of apoptosis (sTWEAK) levels in patients with DN, and investigated the clinical significance of these two inflammatory factors.

Materials and Methods

Participants were categorized into healthy controls (n = 30) and patients with type 2 diabetes mellitus (n = 124). The type 2 diabetes mellitus group was further subdivided into the normoalbuminuria (n = 34), microalbuminuria (MAU; n = 46,) and proteinuria (MaAU; n = 44,) groups. Patients with DN were included in the MAU and MaAU groups. Total cholesterol, triglyceride, low‐density lipoprotein cholesterol, glycosylated hemoglobin, fasting blood glucose, 2‐h postprandial blood glucose, blood urea nitrogen, serum creatinine, 24‐h urine microalbumin, IL‐8 and sTWEAK levels were measured. Logistic regression was used to analyze the factors associated with proteinuria.

Results

In the healthy controls, normoalbuminuria, MAU and MaAU groups, we found that IL‐8 levels increased, whereas sTWEAK levels decreased (P < 0.05). IL‐8 might be an independent risk factor and serum sTWEAK a protective factor for MAU and MaAU. Serum levels of sTWEAK, IL‐8 and microalbumin were significantly correlated in the MAU and MaAU groups.

Conclusions

Serum IL‐8 and sTWEAK levels might be markers that can be used for an early diagnosis of DN.     

The risk of mortality among people with type 2 diabetes in Latin America: A systematic review and meta‐analysis of population‐based cohort studies

Type 2 diabetes mellitus (T2DM) is associated with a high mortality risk, although the magnitude of this association remains unknown in Latin America (LA). We aimed to assess the strength of the association between T2DM and all‐cause and cause‐specific mortality in population‐based cohort studies in LA. Systematic review and meta‐analysis: inclusion criteria were (1) men and women 18 years old and above with T2DM; (2) study outcomes all‐cause and/or cause‐specific mortality; and (3) using people without T2DM as comparison group. Five databases (Scopus, Medline, Embase, Global Health, and LILACS) were searched. Risk of bias was evaluated with the ROBINS‐I criteria. Initially, there were 979 identified studies, of which 17 were selected for qualitative synthesis; 14 were included in the meta‐analysis (N = 416 821). Self‐reported T2DM showed a pooled relative risk (RR) of 2.49 for all‐causes mortality (I‐squared [I²] = 85.7%, p < 0.001; 95% confidence interval [CI], 1.96‐3.15). T2DM based on a composite definition was associated with a 2.26‐fold higher all‐cause mortality (I² = 93.9%, p < 0.001; 95% CI, 1.36‐3.74). The pooled risk estimates were similar between men and women, although higher at younger ages. The pooled RR for cardiovascular mortality was 2.76 (I² = 59.2%; p < 0.061; 95% CI, 1.99‐3.82) and for renal mortality 15.85 (I² = 0.00%; p < 0.645; 95% CI, 9.82‐25.57). Using available population‐based cohort studies, this work has identified and estimated the strength of the association between T2DM and mortality in LA. The higher mortality risk compared with high‐income countries deserves close attention from health policies makers and clinicians to improve diabetes care and control hence preventing complications and delaying death.     

Long‐term muscular outcome and predisposing and prognostic factors in juvenile dermatomyositis: A case–control study

Objective

To compare muscle strength, physical health, and HLA–DRB1 allele carriage frequencies in patients with longstanding juvenile dermatomyositis (DM) with that of controls, and to determine the presence of and risk factors for muscle weakness and magnetic resonance imaging (MRI)–detected muscle damage in juvenile DM patients.

Methods

Fifty‐nine patients with juvenile DM examined a median of 16.8 years (range 2.0–38.1 years) after disease onset were compared with 59 age‐ and sex‐matched controls. Muscle strength/endurance was measured by manual muscle testing (MMT) and the Childhood Myositis Assessment Scale (CMAS); health status was measured by the Short Form 36. HLA–DRB1 alleles were determined by sequencing in patients and 898 healthy controls. In patients, disease activity/damage was measured by the Disease Activity Score (DAS), Myositis Damage Index (MDI), Health Assessment Questionnaire/Childhood Health Assessment Questionnaire, and MRI scans of the thigh muscles. Early disease characteristics were obtained by chart review.

Results

Patients had lower muscle strength/endurance (P < 0.001 for both) and physical health (P = 0.014) and increased HLA–DRB1*0301 (P = 0.01) and DRB1*1401 (P = 0.003) compared with controls. In patients, persistent muscle weakness was found in 42% with MMT (score <78) and in 31% with the CMAS (score <48), whereas MRI‐detected muscle damage was found in 52%. Muscle weakness and MRI‐detected muscle damage were predicted by MDI muscle damage and a high DAS 1 year postdiagnosis.

Conclusion

A median of 16.8 years after disease onset, juvenile DM patients were weaker than the controls; muscle weakness/reduced endurance was found in 31–42% of patients and MRI‐detected muscular damage was found in 52% of patients. The outcomes were predicted by high disease activity and muscle damage present 1 year postdiagnosis.     

Diabetes primary prevention program: New insights from data analysis of recruitment period

Background

Primary Prevention of Diabetes Program in Buenos Aires Province evaluates the effectiveness of adopting healthy lifestyle to prevent type 2 diabetes (T2D) in people at high risk of developing it. We aimed to present preliminary data analysis of FINDRISC and laboratory measurements taken during recruitment of people for the Primary Prevention of Diabetes Program in Buenos Aires Province in the cities of La Plata, Berisso, and Ensenada, Argentina.

Methods

People were recruited through population approach (house‐to‐house survey by FINDRISC in randomized areas) and opportunistic approach (FINDRISC completed by participants during consultations for nonrelated prediabetes/diabetes symptoms in public and private primary care centres of cities involved). In people with FINDRISC score ≥ 13 points, we evaluated blood concentrations of HbA_1c, creatinine, lipids, and an oral glucose tolerance test (OGTT).

Results

Approximately 3415 individuals completed the FINDRISC populational survey and 344 the opportunistic survey; 43% of the 2 groups scored over 13 points; 2.8 and 75.4% of them, respectively, took the prescribed OGTT. Approximately 53.7% of the OGTT showed normal values and 5.2% unknown T2D. The remaining cases showed 69.5% impaired fasting glucose, 13.6% impaired glucose tolerance, and 16.9% both impairments. HbA_1c values showed significant differences compared with normal glucose tolerance (4.96 ± 0.43%), prediabetes (5.28 ± 0.51%), and T2D (5.60 ± 0.51%). Participants with prediabetes and T2D showed a predominant increase in low‐density lipoprotein‐cholesterol values. In prediabetes, >50% showed insulin resistance.

Conclusions

People with prediabetes/T2D had dyslipidemia associated with insulin resistance, which promotes the development of T2D and cardiovascular disease. Thus, it merits its appropriate treatment.     

Decreased handgrip strength in patients with type 2 diabetes: A cross-sectional study in a tertiary care hospital in north India

Background and aimsType 2 diabetes mellitus (T2DM) has been associated with low muscle mass and strength. India has second highest number of diabetes cases worldwide. Till date, muscle mass and strength of Asian Indians with T2DM are not well studied. Aim of the study was to compare the skeletal muscle mass and muscle strength between individuals with and without T2DM.MethodsThis cross-sectional study, included subjects with T2DM, age 18–70 years and age and sex-matched individuals without diabetes (controls). Body composition was assessed using Inbody 570 body composition analyser. Hand grip strength (HGS) was measured using JAMAR’s Hydraulic Hand Dynamometer.ResultsTotal of 194 subjects (95 T2DM and 99 controls) were studied. Mean HGS (kg) was significantly lower both in men and women with diabetes compared with controls (32.4 ± 7.9 vs 37.9 ± 8.1, p = 0.001 in men and 20.6 ± 6.4 vs 23.1 ± 4.06, p = 0.02 in women). Significantly higher percentage of men and women with diabetes had sarcopenia compared with controls (44.4% vs 15.1% in men and 51% vs 20% in women). In multivariate logistic regression analysis, diabetes was an independent risk factor for low HGS in both men (OR = 6.6) and women (OR = 3.4) after adjusting for age, smoking, alcohol consumption, obesity, physical activity and dietary protein intake.ConclusionHGS was significantly lower in subjects with T2DM compared with subjects without diabetes. Diabetes was an independent risk factor for low HGS.     

The effect of type 2 diabetes mellitus on multiple obstructive coronary artery disease

Background

Although type 2 diabetes mellitus (T2DM) individuals easily develop three-vessel disease (3VD) coronary artery disease (CAD), there is very little information available about their left ventricle (LV) functions. The purpose of this study is to evaluate the LV function using two-dimensional speckle tracking echocardiography (2-D STE) in T2DM patients with 3VD.

Methods

One hundred and three consecutive patients with confirmed 3VD CAD were enrolled and divided into two groups, while 53 patients with DM and 50 patients without. The control group was composed of 30 age- and sex-matched healthy individuals. All patients underwent 2-D STE and standard echocardiograms. The durations of DM and the level of HbA1c were also recorded.

Result

Between the 3VD-DM and 3VD-non-DM groups, normal echocardiography did not reveal any appreciable differences. However, patients with 3VD-DM had significantly lower global longitudinal strain (GLS) than those with 3VD-non-DM (15.87 ± 2.51 vs.17.56 ± 2.72, p < .05) by 2-D STE strain measurement. Besides, patients whose duration of DM excess 5 years showed significant lower GLS than those with less than 5 years duration (14.25 ± 2.31 vs. 16.65 ± 1.96, p = .007). However, there was no difference in GLS between the 3VD-DM patients with HbA1c ≥ 7% and HbA1c < 7%.

Conclusions

Compared to patients with 3VD alone, those with 3VD-DM have a lower cardiac function. In 3VD-DM patients, the duration of DM is a significant factor that contributes to cardiac function deterioration, whereas, the glucose control state has limited influence.     

Inverse association between plasma homocysteine concentrations and type 2 diabetes mellitus among a middle-aged and elderly Chinese population

Background and aims

Plasma homocysteine concentrations have been reported to be associated with type 2 diabetes mellitus (T2DM) with controversial findings. The aim of the present study was to investigate the association between plasma homocysteine concentrations and T2DM.