Seguridad y eficacia de la cirugía bariátrica en México: análisis detallado de 500 cirugías en un centro de alto volumen

Introduction and objectivesBariatric surgery is the best method for treating obesity and its comorbidities. Our aim was to provide a detailed analysis of the perioperative outcomes in Mexican patients that underwent surgery at a high-volume hospital center.Materials and methodsA retrospective study was conducted on all the patients that underwent bariatric surgery at a single hospital center within a time frame of 4 and one-half years. Demographics, the perioperative variables, complications (early and late), weight loss, failure, and type 2 diabetes mellitus remission were all analyzed.ResultsFive hundred patients were included in the study, 83.2% of whom were women. Mean patient age was 38.8 years and BMI was 44.1 kg/m². The most common comorbidities were high blood pressure, dyslipidemia, and diabetes. Laparoscopic gastric bypass surgery was performed in 85.8% of the patients, sleeve gastrectomy in 13%, and revision surgeries in 1%. There were 9.8% early complications and 12.2% late ones, with no deaths. Overall weight loss as the excess weight loss percentage at 12 and 24 months was 76.9 and 77.6%. The greatest weight loss at 12 months was seen in the patients that underwent laparoscopic gastric bypass. A total of 11.4% of the patients had treatment failure. In the patients with type 2 diabetes mellitus, 68.7% presented with complete disease remission and 9.3% with partial remission. There was improvement in 21.8% of the cases.ConclusionsIn our experience at a high-volume hospital center, bariatric surgery is safe and effective, based on the low number of adverse effects and consequent weight loss and type 2 diabetes mellitus control. Long-term studies with a larger number of patients are needed to determine the final impact of those procedures.     

What is the evidence for metabolic surgery for type 2 diabetes? A critical perspective

Bariatric surgery has emerged as a highly effective treatment not only for obesity, but also for type 2 diabetes (T2D). A meta-analysis has reported the complete resolution of T2D in 78.1% of cases of morbidly obese patients after bariatric surgery. Such extraordinary results obtained in diabetic patients with body mass index (BMI) scores > 35 kg/m² have led investigators to question whether similar results might be achieved in patients with BMIs < 35 kg/m². Preliminary studies suggest that metabolic surgery is safe and effective in patients with T2D and a BMI < 35 kg/m², whereas other studies report that metabolic surgery is less effective for promoting T2D remission in these patients. Thus, the results are discordant. Long-term studies would be useful for determining the safety, efficacy and cost-effectiveness of metabolic surgery for this population with T2D. In 2015, it is probably premature to say that metabolic surgery is an accepted treatment option for T2D patients with BMIs < 35 kg/m².     

Very-low-energy diet for type 2 diabetes: An underutilized therapy?

BackgroundCurrent approaches to the management of type 2 diabetes focus on the early initiation of novel pharmacologic therapies and bariatric surgery.ObjectiveThe purpose of this study was to revisit the use of intensive, outpatient, behavioral weight management programs for the management of type 2 diabetes.DesignProspective observational study of 66 patients with type 2 diabetes and BMI ≥ 32 kg/m² who enrolled in a program designed to produce 15% weight reduction over 12 weeks using total meal replacement and low- to moderate-intensity physical activity.ResultsPatients were 53 ± 7 years of age (mean ± SD) and 53% were men. After 12 weeks, BMI fell from 40.1 ± 6.6 to 35.1 ± 6.5 kg/m². HbA1c fell from 7.4% ± 1.3% to 6.5% ± 1.2% (57.4 ± 12.3 to 47.7 ± 12.9 mmol/mol) in patients with established diabetes: 76% of patients with established diabetes and 100% of patients with newly diagnosed diabetes achieved HbA1c < 7.0% (53.0 mmol/mol). Improvement in HbA1c over 12 weeks was associated with higher baseline HbA1c and greater reduction in BMI.ConclusionsAn intensive, outpatient, behavioral weight management program significantly improved HbA1c in patients with type 2 diabetes over 12 weeks. The use of such programs should be encouraged among obese patients with type 2 diabetes.     

Older age and duration of exposure to type 2 diabetes in selective screening of asymptomatic carotid artery stenosis for primary stroke prevention—A single institution experience

AimsTo evaluate the incidence and risk factors for carotid artery stenosis amongst asymptomatic type 2 diabetes from a single Malaysian tertiary institution.MethodsThis is a prospective cross-sectional study of asymptomatic type 2 diabetics selected from the outpatient ophthalmology and endocrine clinics for carotid duplex ultrasound scanning performed by a single radiologist. The duplex ultrasound criteria were based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) classification of carotid artery stenosis. Univariate and multivariate analysis was performed to identify possible risk factors of carotid artery stenosis.ResultsAmongst the 200 patients, the majority were males (56%) and Malay predominance (58.5%). There were 12/200 patients (6%) with mean age of 69.2 years identified to have carotid artery stenosis. Univariate analysis of patients with asymptomatic carotid artery stenosis identified older age of 69.2 years (p = 0.027) and duration of exposure to diabetes of 17.9 years (p = 0.024) as significant risk factors.ConclusionPatients with longer exposure of diabetes and older age were risk factors of carotid artery stenosis in asymptomatic type 2 diabetics. These patients should be considered for selective screening of carotid artery stenosis during primary care visit for early identification and closer surveillance for stroke prevention.     

One-year metabolic outcomes in patients with type 2 diabetes treated with exenatide in routine practice

AimThe study objective was to analyze, in everyday practice, the long-term metabolic effects of exenatide (for 9 and 12 months) in patients with type 2 diabetes not responding to treatments with metformin and sulphonylurea at maximum dosages.MethodsA total of 299 type 2 diabetics were recruited from 14 centres specializing in diabetes care across Belgium. Main study endpoints were changes in HbA_1c, weight and waist circumference, and tolerability and compliance. Two patient cohorts were analyzed for effectiveness, with data available at 9 (n = 90) and 12 (n = 94) months of follow-up.ResultsSignificant decreases in HbA_1c of −1.3% and −1.6% were observed in the 9- and 12-month cohorts, respectively (P < 0.001). The decrease in HbA_1c was greater in patients with higher baseline levels (P < 0.001), and the response was independent of baseline weight, body mass index (BMI), age, gender and diabetes duration. A progressive reduction of weight (4.9 kg) was also observed in the two cohorts at 9 and 12 months (P < 0.001), with greater weight loss in patients with higher baseline BMI (P = 0.046) and in female subjects (P = 0.025). Waist circumference also decreased from baseline to endpoints. A correlation was observed between reduction in HbA_1c and weight loss (P = 0.019). Side effects, mainly of gastrointestinal origin, were reported in 33% (93/284 patients in the safety cohort). The rate of hypoglycaemia was 3.5%. Treatment was discontinued in 27% of patients (n = 77) mainly due to drug inefficacy (53%, n = 41) or adverse events (26%, n = 20), or both (8%, n = 6).ConclusionExenatide leads to long-term improvement of glycaemic control as well as weight loss in a majority of patients not responding to combined oral drug therapy in real-world clinical practice. However, no baseline factors predictive of response could be identified. Exenatide can be considered an effective treatment option in such patients, including those with high baseline HbA_1c and long duration of diabetes.     

Effects of moderate-intensity exercise training on plasma biomarkers of inflammation and endothelial dysfunction in older patients with type 2 diabetes

Background and aimsSome plasma biomarkers of inflammation and endothelial dysfunction have been recently recognized as important cardiovascular risk factors. Currently, there is little information about the effects of aerobic exercise training on these biomarkers in older adults with type 2 diabetes. We have therefore assessed the effects of a twice-weekly moderate, aerobic exercise programme, without a concomitant weight loss diet, on plasma inflammatory and endothelial dysfunction biomarkers in older type 2 diabetic patients.Methods and resultsA group of 16 sedentary, overweight, non-smoking, older patients with type 2 diabetes volunteered to participate in a 6-month, supervised, progressive, aerobic training study, two times per week. Plasma levels of hs-C-reactive protein (hs-CRP), soluble tumour necrosis factor (TNF)-α receptors, P-selectin and intercellular adhesion molecule-1 (ICAM-1) were measured before and after physical training. While hs-CRP and soluble TNF-α receptors remained essentially unaffected by physical training, plasma concentrations of P-selectin (P < 0.001) and ICAM-1 (P < 0.01) markedly decreased; physical training also increased HDL cholesterol by 12% (P < 0.05) and decreased uric acid levels by ∼33% (P = 0.021). Body weight, waist circumference, blood pressure, haemoglobin A1c, plasma triglyceride and LDL cholesterol concentrations did not change. Interestingly, the exercise-induced changes in ICAM-1 and P-selectin levels remained significant after adjustment for the percent variations of body weight, waist circumference, haemoglobin A1c, HDL cholesterol and uric acid concentrations.ConclusionsA twice-weekly, 6-month, progressive aerobic-training programme, without a concomitant weight loss diet, is associated with significant decreases in circulating P-selectin and ICAM-1 levels and with a less atherogenic lipid profile in overweight, non-smoking, older type 2 diabetic individuals.     

High prevalence of undiagnosed diabetes and high risk for diabetes using HbA1c criteria in middle-aged patients undergoing cataract surgery

AimThis study assessed the prevalence of undiagnosed diabetes and a high risk for diabetes using glycated haemoglobin (HbA_1c) values in middle-aged patients undergoing cataract surgery.MethodsThe study comprised 137 consecutive patients, aged 40 to 65 years, with no known diabetes undergoing cataract surgery at a French national eye centre. Fasting glucose, obesity parameters, and vascular and ocular cataract risk factors were recorded. HbA_1c was measured on the day of cataract surgery. Prevalence of undiagnosed diabetes (HbA_1c ≥ 6.5%) and a high risk of diabetes (≥ 6.0% but < 6.5%) in the study population was compared with recently published estimates from general French, Dutch and US populations.ResultsIn the study population, undiagnosed diabetes was found in 12 patients (9%; 95% CI: 4–14%) and a high risk for diabetes in 47 (34%; 95% CI: 26–42%). These prevalences were four to 11 times higher than the corresponding population-based estimates, whereas obesity parameters recorded in the general populations and in our study population were similar according to HbA_1c subcategories. Of the 125 patients with HbA_1c less than 6.5%, values were higher in patients without ocular cataract risk factors (n = 73; 58%) than in those with cataract risk factors (n = 52; 42%) at 5.92 ± 0.30% and 5.57 ± 0.29%, respectively (P < 0.001), thereby suggesting a significant role for blood glucose levels in cataractogenesis.ConclusionMiddle-aged patients undergoing cataract surgery showed a high prevalence of diabetes and a high risk for diabetes not recognized before surgery, suggesting that this patient population should be targeted for diabetes screening and prevention.     

Body weight, plasma insulin, and coronary events with gemfibrozil in the Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT)

BackgroundThe Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) showed that gemfibrozil significantly reduced major coronary events in men with known coronary heart disease (CHD). To better understand why therapy was especially effective with obesity, diabetes, and hyperinsulinemia, changes in body weight and plasma insulin were determined after 1 year of gemfibrozil or placebo therapy and related to changes in lipids and CHD events.ResultsWith gemfibrozil significantly more subjects lost weight (51.7% versus 38.6%, P < 0.0001) and significantly fewer subjects gained weight (42.5% versus 54.0%, P < 0.0001) than with placebo. Both a greater loss and smaller gain in weight with gemfibrozil were age-related and significant in subjects ≥66 years (median age), but not in younger subjects. Weight change was paralleled by changes in insulin. With gemfibrozil, CHD events were significantly reduced with weight loss (hazard ratio [HR], 0.61; 95% CI, 0.44–0.84; P = 0.002) and, particularly, with diabetes or hyperinsulinemia (HR, 0.53; 95% CI, 0.34–0.83; P = 0.006). In contrast, CHD events were not significantly reduced without weight loss (HR, 0.83; 95% CI, 0.62–1.12; P = 0.22).ConclusionsIn VA-HIT, gemfibrozil resulted in weight loss associated with reductions in insulin. With weight loss gemfibrozil produced a significant reduction in CHD events that did not occur in the absence of weight loss.     

Insulin detemir improves glycaemic control with less hypoglycaemia and no weight gain: 52-week data from the PREDICTIVE? study in a cohort of French patients with type 1 or type 2 diabetes

AimPREDICTIVE™ (an ongoing multinational observational study) provides an opportunity to explore the impact of insulin detemir use in routine clinical practice. Here, we report on long-term (52-week) data from a French cohort of patients (n = 1772), comprising 643 with type 1 diabetes and 1129 with type 2 diabetes.MethodsPatients were prescribed insulin detemir at their physician's discretion and assessed at various visits (baseline, 12 weeks, 26 weeks and 52 weeks). The primary endpoint was the frequency of serious adverse drug reactions, including major hypoglycaemia. Secondary endpoints included minor and nocturnal hypoglycaemia, glycaemic control (HbA_1c, fasting blood glucose and variability of fasting blood glucose) and weight change.ResultsThe incidence of serious adverse drug reactions was low throughout the study, seen in 10 patients with type 1 diabetes (14 events, 1.6%) and seven with type 2 diabetes (seven events, 0.6%). In both type 1 and type 2 diabetes cohorts, the overall minor and nocturnal hypoglycaemic events were reduced from baseline (P < 0.001), with no clinically significant changes in weight from baseline to endpoint. After 52 weeks of treatment with insulin detemir, glycaemic control improved, with reductions in: HbA_1c, by −0.6% and −0.8% in type 1 and type 2 diabetes patients, respectively; fasting blood glucose, by −1.4 mmol/L and −1.9 mmol/L respectively; and FBG variability, by −0.8 mmol/L and −0.3 mmol/L, respectively (P < 0.0001 for all).ConclusionPatients treated with insulin detemir in a clinical healthcare setting improved their glycaemic control with no increases in hypoglycaemia, adverse events or weight compared with baseline.     

Evaluation of risk factors for cardiovascular diseases among Saudi diabetic patients attending primary health care service

BackgroundCardiovascular disease is currently the primary cause of morbidity and mortality in patients with diabetes. For each risk factor present, the risk of cardiovascular death is about three times greater in people with diabetes than people without diabetes.ObjectivesTo determine the risk factors for cardiovascular disease among patients with type 2 diabetes. To stratify the patients into risk categories to develop coronary arteries disease (CAD) based on the British Joint Societies risk chart. To assess the awareness and implementation of the risk assessment charts by primary care physiciansSubject and methodsCross sectional study was designed. Sixty six (66 patients) diabetic patients were selected randomly by simple selection, from them 29 were males and 37 were females. Patients’ medical records were reviewed. The following parameters were detected; blood pressure, lipid profile, weight, height, smoking and degree of glycemic control.A questionnaire was designed and distributed to randomly selected physicians working in primary health care assessed their awareness and implementation of risk assessment charts was done.ResultsUncontrolled diabetes was found to be the common risk factor followed by uncontrolled lipid profile, obesity, uncontrolled systolic blood pressure and smoking. Seven percent (7%) of male group felled in highest risk group in comparison with 1% in female group (P < 0.05), while 31% in male group felled in mild risk group in comparison with 90% in female group (P < 0.05). Sixty two percent (62%) in male group felled in high risk group in comparison with 9% in female group (P < 0.05). Criteria for ranking in risk class differed between male and female group. Forty one physicians were contacted and received the questionnaire. Twenty nine (70.7%) physicians were responded to the questionnaire. Twenty two (22) informed that they were aware about risk assessment score systems. Fourteen (14) physicians informed that they were aware about the BJSs charts but only two informed that they had used it to assess their patients.ConclusionClustering of multi risk factors is a serious event which may raise the risk category of diabetic patients. For each risk category the risk factors may differed between male and female patients. More studies are recommended to study distribution of risk factors between male and female diabetic patients. Attention should be directed toward raising the awareness about the risk assessment scoring system and encouraging physicians to use it.     

Awareness of diabetes risks is associated with healthy lifestyle behavior in diabetes free American adults: evidence from a nationally representative sample

PurposeThe purpose of this study was to examine whether diabetes free healthy non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and Mexican-Americans (MA) who are told of their diabetes risk were more likely to adopt healthy lifestyle behavior defined as current weight control, physical activity and reduced fat/calories intake than those who were not told that they were at increased risk.MethodsA nationally representative data (n = 5073) from the 2007–2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Odds ratio from multiple logistic regression analysis was used to determine whether diabetes free NHW, NHB, and MA who are told of their increased diabetes risk were more likely than those who are not told of their diabetes risk to adopt healthy lifestyle behavior.ResultsBeing told of increased diabetes risk was associated with increased adoption of healthy lifestyle behaviors as indicated by odds ratio of 2.38 (95% CI = 1.34–4.05) in NHW, 2.46 (95% CI = 1.20–5.05) in NHB and 2.27 (95% CI = 1.32–3.89) in MA who have no diabetes, after adjusting for age, sex, race/ethnicity, hypertension, education, household income and total cholesterol.ConclusionsAwareness of increased risk for diabetes is associated with implementing healthy lifestyle behaviors in diabetes free healthy American adults. Population-based programs designed to assess and communicate diabetes risk may be helpful in preventing or delaying the onset of type 2 diabetes. Programs designed along racial/ethnic line may be needed to reduce racial/ethnic differences in rates of type 2 diabetes.     

U-shaped association of sleep duration with metabolic syndrome and insulin resistance in patients with type 2 diabetes: The Fukuoka Diabetes Registry

ObjectiveSleep duration is suggested to be associated with adverse health outcomes. However, few studies are available on the impact of sleep duration on metabolic syndrome in patients with diabetes, who were at high risk for cardiovascular diseases (CVD). The objective of the present study was to examine the associations of sleep duration with metabolic syndrome and insulin resistance, a major pathophysiologic feature of metabolic syndrome, in patients with type 2 diabetes.Materials/MethodsA total of 4402 Japanese patients with type 2 diabetes aged ≥ 20 years were divided into 5 groups according to self-reported sleep duration: less than 5.5 h, 5.5–6.4 h, 6.5–7.4 h, 7.5–8.4 h, and more than 8.5 h. The associations of sleep duration with metabolic syndrome and other cardiovascular risk factors were examined cross-sectionally.ResultsThe proportions of patients who had metabolic syndrome increased significantly in both patients with shorter and longer sleep duration compared with those with 6.5–7.4 h of sleep (P for quadratic trend < 0.001). This U-shaped association remained significant after adjustment for potential confounders, including total energy intake, current smoking, current drinking and depressive symptoms. Each component of metabolic syndrome also showed similar trends. Furthermore, sleep duration had a quadratic association with homeostasis model assessment of insulin resistance and high sensitivity C-reactive protein.ConclusionsSleep duration was shown to have a U-shaped relationship with metabolic syndrome and insulin resistance, independent of potential confounders, and therefore may be an important modifiable risk factor for CVD prevention in patients with type 2 diabetes.     

QT-interval dispersion in type 2 diabetic and non-diabetic patients with post-myocardial infarction

Background and aimsQT-interval dispersion (QTD), which reflects spatial ventricular repolarization inhomogeneity, has been reported to increase and to have a prognostic value in patients with either myocardial infarction or diabetes. Our aim was to compare increases in QTD in type 2 diabetic and non-diabetic patients following post-myocardial infarction (post-MI). We also compared QTD in type 2 diabetic patients with post-MI treated with insulin, sulfonylurea, or diet alone.Methods and resultsWe determined the rate corrected QT-interval (QTc) dispersion (QTcD) in 178 consecutive post-MI patients, including 48 type 2 diabetic and 130 non-diabetic patients. The QTcD, measured with software (QTD-1), was defined as the difference in the minimum and maximum QTc in any of the 12 standard electrocardiographic leads. There were no significant differences in age, gender, left ventricular end-diastolic diameter, ejection fraction, or minimum QTc between type 2 diabetic and non-diabetic patients with post-MI. Compared with post-MI patients without diabetes, those with type 2 diabetes had higher maximum QTc (481 ± 37 vs. 459 ± 43 ms, P < 0.05) and QTcD (67 ± 18 vs. 58 ± 16 ms, P < 0.05). Among type 2 diabetic patients with post-MI treated with insulin, sulfonylurea, or diet alone, the QTcD (81 ± 18 vs. 64 ± 16 vs. 62 ± 17 ms, P < 0.05, respectively) was significantly greater and the R-R interval was shorter in the insulin therapy group.ConclusionsType 2 diabetes is associated with an additional increase in the QTD in post-MI patients. This additional increase in spatial repolarization inhomogeneity might be implicated in the increased mortality risk in post-MI patients with type 2 diabetes. These findings were thought to be more striking in the insulin therapy group.     

Incident type 2 diabetes is associated with HDL,but not with its anti-oxidant constituent - paraoxonase-1: The prospective cohort PREVEND study

ObjectiveHigh-density lipoprotein cholesterol (HDL-C) is an established risk marker for cardiovascular disease and consistently associated with type 2 diabetes risk. Serum paraoxonase-1 (PON-1) - an anti-oxidant constituent of HDL - is inversely associated with cardiovascular disease risk, but its relationship with incident type 2 diabetes is uncertain. We aimed to investigate the prospective association between PON-1 and type 2 diabetes risk.MethodsPON-1 was measured as its arylesterase activity at baseline in the Prevention of Renal and Vascular End-stage Disease (PREVEND) prospective study of 5947 predominantly Caucasian participants aged 28–75 years with no pre-existing diabetes, that recorded 500 type 2 diabetes cases during a median follow-up of 11.2 years.ResultsSerum PON-1 was positively correlated with HDL-C (r = 0.17; P < 0.001). In analyses adjusted for conventional diabetes risk factors, the hazard ratio (95% CI) for type 2 diabetes per 1 standard deviation increase in PON-1 was 1.07 (0.98 to 1.18; P = 0.13), which remained non-significant (1.02 (0.93 to 1.12) P = 0.65) after additional adjustment for potential confounders. The association was unchanged on further adjustment for HDL-C (1.05 (0.96 to 1.15; P = 0.29). However, in subsidiary analyses in the same set of participants, serum HDL-C concentration was inversely and independently associated with risk of type 2 diabetes.ConclusionsIncident type 2 diabetes is associated with HDL cholesterol but not with its anti-oxidant constituent - PON-1 - in a large cohort of apparently healthy men and women. The current data question the importance of PON-1 activity for the development of diabetes.     

Preadmission predictors of severe COVID-19 in patients with diabetes mellitus

ObjectiveTo explore predictors of severe COVID-19 disease in patients with diabetes hospitalized for COVID-19.MethodsThis is a retrospective observational study of adults with diabetes admitted for COVID-19. Bivariate tests and multivariable Cox regression were used to identify risk factors for severe COVID-19, defined as a composite endpoint of intensive care unit admission/intubation or in-hospital death.ResultsIn 1134 patients with diabetes admitted for COVID-19, more severe disease was associated with older age (HR 1.02, p < 0.001), male sex (HR 1.28, p = 0.017), Asian race (HR 1.34, p = 0.029 [reference: white]), and greater obesity (moderate obesity HR 1.59, p = 0.015; severe obesity HR 2.07, p = 0.002 [reference: normal body mass index]). Outpatient diabetes medications were not associated with outcomes.ConclusionsAge, male sex, Asian race, and obesity were associated with increased risk of severe COVID-19 disease in adults with type 2 diabetes hospitalized for COVID-19.SummaryIn patients with type 2 diabetes hospitalized for COVID-19 disease, we observed that age, male sex, Asian race, and obesity predicted severe COVID-19 outcomes of intensive care unit admission, intubation, or in-hospital death. The risk conferred by obesity increased with worsening obesity. Outpatient diabetes medications were not observed to be significant predictors of study outcomes.     

Smoking habits and the risk of type 2 diabetes: A case-control study

AimThe objective of the study was to assess the relationship between smoking and the risk of type 2 diabetes.Subject and methodsThis case-control study included 234 cases with newly confirmed diagnoses of type 2 diabetes and 468 controls who were free of the disease in 2001. Cases and controls were matched by gender and age (±5 years). A questionnaire was used to collect information on the possible risk factors of type 2 diabetes. Clinical measurements were taken in accordance with the recommendations of the WHO. Fasting plasma glucose and triglycerides were also measured, and the glucose tolerance test was performed in the controls. The odds ratios (OR) and 95% confidence intervals (CI) for type 2 diabetes were calculated using conditional logistic regression.ResultsThe diabetes cases had significantly less education, more first-degree relatives with a positive family history of diabetes and higher body mass index (BMI) scores compared with the controls. Also, after adjusting for possible confounders, an increased risk of type 2 diabetes was determined for current smokers (OR = 2.41; 95% CI 1.07–5.44) vs. non-smokers. In addition, there was an association between the disease and duration of smoking (OR = 2.47; 95% CI 1.03–5.93 for 40 years or more) vs. non-smokers, and those who had been smokers for 10 or more pack-years had twice the risk of diabetes (OR = 2.17; 95% CI 1.07–4.40) vs. non-smokers. There were no significant associations found between the risk of type 2 diabetes and number of cigarettes smoked per day or stopping smoking.ConclusionOur data confirms that smoking may be an independent risk factor for type 2 diabetes.     

Cardiovascular risk prediction model for Omanis with type 2 diabetes

Aim

To date, no cardiovascular risk assessment tool has been developed specifically for any Arabian population including Omanis. This study aims to develop a suitable cardiovascular risk prediction model in the form of a statistical equation, for Omanis with type 2 diabetes.

Vitamin D supplementation and glycemic control in type 2 diabetes patients: A systematic review and meta-analysis

IntroductionLow vitamin D status has been found to be associated with impaired glycemic control in patients who suffer from type 2 diabetes; however, whether vitamin D supplementation is associated with improved glycemic status remains controversial. The aim of this study was to summarize evidence from randomized controlled trials (RCTs) to assess the efficacy of vitamin D supplementation in reducing glycosylated haemoglobinA1c (HbA1c) and fasting blood glucose (FBG) levels.Materials/MethodsWe searched PubMed, Web of Science and the Cochrane Library for reports published up to March 2017. We selected parallel RCTs investigating the effect of vitamin D or vitamin D analogues on HbA1c or FBG levels in type 2 diabetes patients. Cohen's d was calculated to represent the standardized mean difference (SMD) for each study, and the SMDs with 95%confidence intervals (CIs) were pooled using a random effects model.ResultsTwenty-four studies were included that evaluated HbA1c levels and 18 studies were included that evaluated FBG levels. Meta-analyses showed that vitamin D supplementation was associated with reduced HbA1c levels (standardized mean difference (SMD) − 0.25 [− 0.45 to − 0.05]) but had no influence on FBG levels (SMD − 0.14 [− 0.31 to 0.03]). However, the subgroup analyses suggested that vitamin D supplementation was associated with reduced HbA1c levels (SMD − 0.39 [− 0.67 to − 0.10]) and FBG (SMD − 0.27 [− 0.46 to − 0.07]) among patients with 25-hydroxyvitamin D (25(OH) D) deficiency at baseline. Significantly reduced HbA1c levels were also observed in association with vitamin D supplementation in the subgroup including type 2 diabetes patients with a body mass index (BMI) < 30 kg m^− 2 (SMD − 0.30 [− 0.54 to − 0.07]).ConclusionsVitamin D supplementation could be effective at improving glycemic control in vitamin D deficient or non-obese type 2 diabetes patients.     

Polymorphism in microRNA-196a2 contributes to the risk of cardiovascular disease in type 2 diabetes patients

AimsTo investigate the effect of the microRNA-196a2 gene polymorphism (rs11614913) on risk of cardiovascular disease in type 2 diabetes patients.MethodsWe examined 920 patients with diabetes and 834 healthy controls. All subjects were genotyped for the miRNA-196a2 SNP by polymerase chain reaction (PCR) and restriction analysis.ResultsThe genotype distribution among controls and patients was in Hardy–Weinberg equilibrium (p = 0.227 and 0.308, respectively). The frequency of the T allele was lower in patients than in controls (p = 0.044). The odds ratio 0.66 (95% CI 0.54–0.79) suggests an association of the T allele with decreased risk of T2DM. For the main purpose of the study, T2DM patients were stratified into patients with CVD and those without it. The T allele and TT genotype were significantly more frequent in patients with CVD compared to those without CVD (p = 0.013, p < 0.001, respectively). The odds ratio for the T allele in the CVD + subgroup vs. CVD − was 1.76 (1.35–2.30), p < 0.0001, mostly due to the overrepresentation of TT homozygotes. The highest risk of development of CVD was observed in the additive model for TT homozygotes (OR 3.33, 95% CI 2.05–5.42, p < 0.0001).ConclusionOur findings suggest that miRNA-196a2 T/C polymorphism (rs11614913) is associated with an increased risk of CVD in type 2 diabetes patients. This provides further insights on pathogenesis of cardiovascular disease in type 2 diabetes patients.     

Ethnic differences in the relationship between birth weight and type 2 diabetes mellitus in postmenopausal women

AimThe objective of this study is to examine the relationship between self-reported birth weight and the adult occurrence of type 2 diabetes mellitus in a large multi-ethnic population of women.MethodsBaseline data from the Women's Health Initiative Observational Study [n = 75,993] was used to examine the association between participant birth weight category and prevalent type 2 diabetes mellitus. Models were adjusted for age, ethnicity, body mass index and other pertinent risk factors. Sub-analyses were performed stratifying by ethnicity.ResultsThere was a strong inverse association between birth weight and type 2 diabetes mellitus with a birth weight of <6 pounds (lbs) (OR: 1.16, 95% CI: 1.01, 1.33) significantly associated with an increased risk of type 2 diabetes mellitus and a birth weight of ≥10 lbs (OR: 0.72, 95% CI: 0.57, 0.92) associated with a decreased risk of type 2 diabetes mellitus compared to women who reported their birth weight between 7 and 8 lbs 15 ounces (oz). Stratifying by ethnicity, the inverse association between birth weight and type 2 diabetes mellitus was only apparent in White women, but not Black, Hispanic or Asian women.ConclusionLower birth weight was associated with increased T2D risk in American White and Black post-menopausal women.