Inflammatory Markers Associated With Diabetes Mellitus – Old and New Players

: Diabetes mellitus (DM) is a chronic and complex metabolic disorder, and also an important cause of cardiovascular (CV) diseases (CVDs). Subclinical inflammation, observed in patients with type 2 DM (T2DM), cannot be considered the sole or primary cause of T2DM in the absence of classical risk factors, but it represents an important mechanism that serves as a bridge between primary causes of T2DM and its manifestation. Progress has been made in the identification of effective strategies to prevent or delay the onset of T2DM. It is important to identify those at increased risk for DM by using specific biomarkers. Inflammatory markers correlate with insulin resistance (IR) and glycoregulation in patients with DM. Also, several inflammatory markers have been shown to be useful in assessing the risk of developing DM and its complications. However, the intertwining of pathophysiological processes and the not-quite-specificity of inflammatory markers for certain clinical entities limits their practical use. In this review we consider the advantages and disadvantages of various inflammatory biomarkers of DM that have been investigated to date as well as possible future directions. Key features of such biomarkers should be high specificity, non-invasiveness and cost-effectiveness.

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Euglycemic Diabetic Ketoacidosis Associated With Sodium–Glucose Cotransporter Type 2 Inhibitors in Patients With Type 2 Diabetes Mellitus Receiving Oral Therapy

Journal of Pharmacy Practice ◽

10.1177/0897190017748049 ◽

2017 ◽

Vol 32 (2) ◽

pp. 240-243 ◽

Cited By ~ 3

Author(s):

Ryan B. Dull ◽

Mikayla L. Spangler ◽

Emily L. Knezevich ◽

Britney M. Lau

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Case Reports ◽

Serious Adverse Events ◽

Type 2 Dm ◽

Sodium Glucose Cotransporter ◽

Increased Risk

Introduction and Objective: Postmarketing reports and warnings of serious adverse events such as diabetic ketoacidosis (DKA) have raised concern regarding the safety of sodium–glucose cotransporter 2 inhibitors (SGLT2i). This report describes 2 cases of symptomatic SGLT2i-associated euglycemic DKA (euDKA) leading to hospitalization in patients with type 2 diabetes mellitus (DM) previously well controlled on oral medications. Case Reports: Subject 1 is a 55-year-old female admitted with euDKA precipitated by infection and managed with intravenous insulin. This case was notable for a delayed diagnosis of euDKA and lack of clinical improvement despite withholding dapagliflozin. Subject 2 is a 62-year-old male admitted with euDKA precipitated by infection. His clinical condition improved rapidly and euDKA responded to withdrawal of empagliflozin alone. Discussion: Applying the Naranjo adverse medication reaction probability scale to each case (subject 1 score = 3 points; subject 2 score = 4 points) suggests these are possible adverse reactions to SGLT2i. Data from randomized controlled trials suggest DKA events in adults with type 2 DM receiving SGLT2i are rare and similar to placebo. However, data from a large cohort suggest these events occur more frequently and are associated with a 2-fold increased risk of DKA. Conclusion: This class of medications may be associated with a higher real-world risk of DKA in adults with type 2 DM than previously reported. Patients prescribed these medications should receive vigilant assessment for features of traditional DKA as well as euDKA.

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High Bodyweight Variability Increases Depression Risk in Patients With Type 2 Diabetes Mellitus: A Nationwide Cohort Study in Korea

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.765129 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ji Hyun An ◽

Kyung-do Han ◽

Jin-Hyung Jung ◽

Juhwan Yoo ◽

Maurizio Fava ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Body Weight ◽

Obese Patients ◽

Type 2 Dm ◽

Increased Risk ◽

Quartile Group ◽

New Onset

Objectives: Although obesity is associated with increased risk for depression in patients with type 2 diabetes mellitus (DM), the relationship between body weight variability (BWV) and depression remains poorly studied. This study was to investigate the incidence of depression in patients with type 2 DM according to their BWV.Methods: Intraindividual variation in body weight were measured in the nationwide, population-based retrospective cohort of 540,293 patients with type 2 DM from the Korean national health insurance system between 2009 and 2010. The diagnoses of new-onset depression occurring until the end of 2017 were ascertained. Risk of new-onset depression was examined using multivariate-adjusted Cox proportional hazards regression analysis by BWV quartile.Results: 93,149 (17.2%) patients developed new-onset depression for the follow up. BWV was significantly associated with an increased risk of depression after adjusting for confounding factors. The highest BWV quartile group had a hazard ratio (HR) of 1.17 (95% CI 1.15–1.19) compared to the lowest BWV quartile group as a reference. Obese patients in the highest BWV quartile group showed 12% increased risk of depression (HR 1.12, 95% CI 1.09–1.15) while non-obese patients in the highest BWV quartile group showed 20% increased risk of depression (HR: 1.20, 95% CI: 1.17–1.23) compared to their respective lowest BWV quartile groups.Conclusion: A higher BWV was significantly associated with an increased risk of depression in patients with type 2 DM. Thus, BWV may serve as an indicator for early detection of depression in type 2 DM patients.

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Lipid profile and markers of vascular inflammation in patients with stable angina in the presence and absence of type 2 diabetes mellitus

Diabetes Mellitus ◽

10.14341/7959 ◽

2017 ◽

Vol 20 (3) ◽

pp. 194-200 ◽

Cited By ~ 1

Author(s):

Tatiana I. Petelina ◽

Natalia A. Musikhina ◽

Liudmila I. Gapom ◽

Irina V. Емеneva ◽

Elena A. Gorbatenko

Keyword(s):

Diabetes Mellitus ◽

Lipid Profile ◽

Stable Angina ◽

Inflammatory Markers ◽

Vascular Inflammation ◽

Increased Risk ◽

Presence And Absence ◽

Group 2 ◽

Group 1

Background. The mechanisms underlying the close relationship between diabetes mellitus (DM) and coronary artery disease (CAD) have not been fully understood. The pathophysiological processes of vascular inflammation that accelerate and enhance the development of atherosclerotic vascular lesions and their complications warrant further study. Aims. To compare lipid profiles and inflammatory markers in patients with CAD and stable angina in the presence and absence of type 2 DM. Materials and methods. A total of 169 patients were examined: Group 1 included 123 patients with CAD but without DM; Group 2 consisted of 46 patients with CAD and DM. The biochemical parameters were estimated before coronary angiography. Results. The lipid profile in both groups of patients revealed elevated levels of atherogenic markers (TС, LDL, VLDLP and TG). Patients in Group 2 had significantly increased levels of vascular inflammatory markers (hs-CRP, homocysteine, IL-1), TNF-, MMP-9 and endothelin-1 compared to those in Group 1. Conclusions. Our results indicate that the vascular inflammatory response was more pronounced in patients with CAD and DM and that they have an increased risk of developing adverse vascular complications.

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Abstract 3636: Ekg Left Ventricular Hypertrophy And Cardiovascular Events In Patients With Type 1 And Type 2 Diabetes Mellitus

Circulation ◽

10.1161/circ.116.suppl_16.ii_825-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Massimo Salvetti ◽

Maria Lorenza Muiesan ◽

Barbara Stanga ◽

Antonio Cimino ◽

Umberto Valentini ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Total Cholesterol ◽

Odds Ratio ◽

Cardiovascular Events ◽

Prognostic Significance ◽

Type 2 Dm ◽

Increased Risk

Background: A large number of studies have demonstrated that LVH detected with standard electrocardiography is an independent predictor of future cardiovascular complications in various subsets of patients. Despite the fact that ECG represents the first cardiovascular test performed in diabetics, few data are available on the prognostic significance of EKG LVH in these patients. Aim of this study was to evaluate the relationship between EKG LVH and the risk of future cardiovascular events in a wide group of patients with diabetes mellitus (DM). Methods A total of 1131 prospectively identified patients with type 1 (n=613, age 36 ± 13 years, 40 % women, BP 127 ± 16/79 ± 8 mmHg, total cholesterol 196 ± 43 mg/dl, HbA1C 7.81 ± 1.67%) and with type 2 DM (n=618, age 53 ± 11 years, 34 % women, BP 137 ± 18/82 ± 8 mmHg, total cholesterol 208 ± 41 mg/dl, HbA1C 7.97 ± 1.72%) were studied. At baseline all subjects underwent baseline clinical examination with blood pressure measurement according to current guidelines, standard laboratory examinations and a 12 leads electrocardiogram. LVH was defined as the presence of a “Sokolow-Lyon” voltage >38 mm and/or a “Cornell voltage QRS duration product” >2440 mm* msec. Treatment was not standardized. Results LVH prevalence was 8.3 % in type 2 DM and 6.4 % in type 1 DM. Patients were followed for 63 ± 27 months (range 1–126). A first non fatal cardiovascular event occurred in 62 patients. Kaplan-Meyer analysis revealed a higher risk of cardiovascular events in patients with LVH both with type 1 and type 2 DM (Log Rank Mantel Cox p<0.01). In Cox analysis, controlling for age, gender, BMI, history of cardiovascular disease, systolic blood pressure, heart rate, total plasma cholesterol, HbA1c, albuminuria and antihypertensive treatment, the presence of LVH was associated with an increased risk of cardiovascular events in all patients (odds ratio 2.96, 95% CI 1.39 to 6.32, p<0.01) and separately in DM type 1 (odds ratio 5.71, 95% CI 1.29 to 25.17, p=0.02) and in type 2 DM (odds ratio 2.92, 95% CI 1.02 to 8.35, p=0.05). Conclusions: Our data demonstrate that in patients with DM the detection of LVH by EKG is associated to an increased risk of cardiovascular events, independently of other risk factors and represent the first demonstration of the prognostic significance of EKG-LVH in patients with type 1 diabetes

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Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease

Cardiovascular Diabetology ◽

10.1186/s12933-019-0943-9 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Mee Kyoung Kim ◽

Kyungdo Han ◽

Han Na Joung ◽

Ki-Hyun Baek ◽

Ki-Ho Song ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Type 2 Diabetes Mellitus ◽

Cox Regression ◽

Reference Group ◽

Density Lipoprotein ◽

Type 2 Dm ◽

Increased Risk

Abstract Background The aim of the present study was to identify a threshold for the cholesterol level at which the risk of cardiovascular disease (CVD) begins to increase in people with type 2 diabetes mellitus (DM). Methods Using the Korean National Health Insurance Service database, 2,077,135 people aged ≥ 40 years with type 2 DM who underwent regular health checks between 2009 and 2012 were included. Subjects with previous CVD were excluded. Cox regression analyses were performed to estimate the risk of CVD for each low-density lipoprotein cholesterol (LDL-C) group using the < 70 mg/dL as the reference group. Results There were 78,560 cases of stroke (3.91%), and 50,791 myocardial infarction (MI, 2.53%) during a median follow-up of 7.1 years. Among participants not taking statins, LDL-C levels of 130–159 mg/dL and ≥ 160 mg/dL were significantly associated with the risk of MI: the hazard ratios (HRs) (95% confidence interval) were 1.19 (1.14–1.25) and 1.53 (1.46–1.62), respectively. Among participants taking statins, all categories of LDL-C level ≥ 70 mg/dL were significantly associated with increased risk of stroke and MI. Conclusions We identified an increased risk of CVD in people with an LDL-C level ≥ 130 mg/dL among individuals with type 2 DM not taking statins. The risk of CVD was significantly higher in those taking statins with an LDL-C level ≥ 70 mg/dL.

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Hormonal Contraception and Diabetes

Clinical Medicine Insights Women s Health ◽

10.4137/cmwh.s9934 ◽

2012 ◽

Vol 5 ◽

pp. CMWH.S9934

Author(s):

L.F. Pallardo ◽

A Cano ◽

I Cristobal ◽

M.A. Blanco ◽

M Lozano ◽

...

Keyword(s):

Diabetes Mellitus ◽

Preconception Care ◽

Microvascular Complications ◽

Hormonal Contraception ◽

Hormonal Contraceptive ◽

Contraceptive Methods ◽

Type 2 Dm ◽

Increased Risk

Women with gestational diabetes mellitus are at increased risk for developing diabetes mellitus (DM), mainly type 2 DM, as well as metabolic syndrome. The presence of subsequent pregnancies increases the risk. In addition, pregnancy in patients with type 1 and type 2 DM also elevates the risk of morbidity and mortality for both mothers and offspring. Thus, all women with pre-existing type 1 or type 2 DM should receive preconception care to optimize glycemic control (HbA1c ≤ 6%). In those cases with macrovascular or microvascular complications, family planning is even more important in order to avoid the risk of aggravation of such complications associated with a new pregnancy. The present review analyzes the metabolic and cardiovascular repercussions of hormone contraception in non-diabetic women as well as in type 1 and type 2 DM patients with and without macrovascular and microvascular complications. Finally, the recommendations pertaining to hormonal contraceptive methods for women with diabetes are summarized.

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Influence of ferritin levels and inflammatory markers on HbA1c in the Type 2 Diabetes mellitus patients

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.1003 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 2

Author(s):

Nazan Erenoglu Son

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Blood Glucose ◽

Serum Ferritin ◽

Inflammatory Markers ◽

Outpatient Clinics ◽

Type 2 Dm ◽

Hba1c Levels

Objective: Diabetes Mellitus (DM) is a significant public health issue worldwide due to the associated comorbidities. Recent studies have demonstrated a strong relationship between blood glucose levels and serum ferritin levels in patients with type 2 DM. The aim of the study was to investigate the association between Ferritin Levels and Inflammatory Markers on HbA1c in the Type 2 Diabetes Mellitus Patients. Methods: This single-center, cross-sectional, controlled study included patients who were admitted to the Endocrine and Metabolic Disorders outpatient clinics of the Private Kütahya Hospital in the province of Kutahya in the Western Turkey. The study included a total of 172 patients, 84 of whom had type 2 DM and 88 without diabetes and constituted the control group. A total of 190 patients with DM were admitted to the Adult Endocrine and Metabolic Diseases Outpatient Clinics of the hospital between July 1, 2018 and September 1, 2018, and among these, the study was conducted on 172 volunteer patients who met the study inclusion criteria and who did not have any missing data. The HbA1c levels, serum ferritin, hemoglobin (Hb), insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), C-Reactive Protein (CRP), lipid profiles, and uric acid levels were compared between the groups. Results: The serum ferritin levels of the patients with type 2 DM significantly increased with increasing HbA1c levels (p<0.01). A strong positive correlation was found between serum ferritin levels and HbA1c and fasting blood glucose (FBG) levels (p<0.01). Conclusions: Our study results show a significant relationship between HbA1c levels and serum ferritin and CRP levels, suggesting that serum ferritin and CRP levels can be used as a routine screening tool for the early diagnosis of DM. However, further large-scale, prospective studies are needed to confirm these findings. doi: https://doi.org/10.12669/pjms.35.4.1003 How to cite this:Son NE. Influence of ferritin levels and inflammatory markers on HbA1c in the Type 2 Diabetes mellitus patients. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.1003 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Predictive Value of Small Dense Low-density Lipoprotein Cholesterol and Remnant-like Particle Cholesterol for Cardiovascular Events in Chinese Elder Diabetes Mellitus Patients

10.21203/rs.3.rs-59530/v1 ◽

2020 ◽

Author(s):

Li Xu ◽

Feifei Lu ◽

Jingfen Lu ◽

Yan Xu ◽

Nuoer Chen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Predictive Value ◽

Cardiovascular Events ◽

Cox Regression ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Cox Regression Analysis ◽

Type 2 Dm ◽

Increased Risk

Abstract BackgroundAs a subcomponent of lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C) have been suggested to be a better predictor of cardiovascular diseases(CVD). This research was to evaluate the predictive of the sdLDL-C in cardiovascular events (CVs) in Chinese elder type 2 diabetes mellitus(DM) patients.MethodsSerum sdLDL-C measured by homogeneous method was compared in 386 consecutive type 2 DM patients between December 2014 and December 2016. Finally, 92 type 2 DM patients had CVs during the 48-month follow-up period. Receiver operating characteristic (ROC) curves were used for assess the predictive value of baseline parameters to major CVs.ResultsNinety-two CVs occurred during the study period.The ROC curve manifested that sdLDL-C in the study population had a matchable discriminatory power (AUC for sdLDL-C was 0.7366, P = 0.003). In addition, kaplan-Meier event-free survival curves displayed a obvious increase of CVs risk for sdLDL-C ≧ 26 mg/dL (log-rank = 9.10,P = 0.003). This phenomenon had analogousresultsin patients who received statins at baseline (log rank = 7.336༌P = 0.007).The study discovered that the increase in HbA1c, glucose, LDL-C, sdLDL-C, non-HDL-C and ApoB and the decrease in ApoA1 were obviously interrelated with heightened CVs risk through Cox regression analysis. Multivariate analysis demonstrated that the increase of sdLDL-C and HbA1c was obviously correlated with CVs. The results of the study indicated that sdLDL-C (per 10 mg/dL) was a increased risk for CVs in the multivariate model (HR 1.281, 95% CI 1.225–16.032; P < 0.01).ConclusionThe consequences demonstrated that sdLDL-C was more effective than RLP-C in predicting the future CVs of Chinese elder type 2 DM patients

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Plasma Atherogenic Index in Type 2 Diabetes Mellitus Patients

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v15i2.50837 ◽

2020 ◽

Vol 15 (2) ◽

pp. 204-205

Author(s):

Most. Sarmin Sultana ◽

Yasmin Akhter ◽

Mimi Parvin ◽

Lubna Naznin ◽

Md Mahbub Ul Alam ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Personal Data ◽

Armed Forces ◽

Atherogenic Index ◽

Cross Sectional ◽

Type 2 Dm ◽

Increased Risk

Introduction:Atherogenic index of plasma (AIP) is defined as log of TG to HDL-C ratio. People with high AIP have a higher risk for coronary heart disease (CHD) than those with low AIP. AIP is useful in predicting atherogenecity. Objectives: To determination of AIP among the study subjects and find out the prevalence of AIP among type 2 diabetes mellitus (DM) patients. Materials and Methods: This cross sectional study was conducted at Armed Forces Institute of Pathology (AFIP) from November 2014 to October 2015. The study included 300 type 2 DM patients belonging to the age group 30-60 years. Fasting plasma glucose (FPG), HDL-C, TG were estimated. The AIP was calculated as log (TG/HDL-C) using the Czech online calculatorof atherogenic risk. Personal data and history of co-existing medical conditions were collected by data collection sheet. Data were analyzed by SPSS version 18.0. Results: Among 300 study subjects the AIP were found in the range of “increased risk” in 298(99.3%) and “low risk” in 02(0.7%). In this study mean FPG was 9.81±3.08 mmol/L and mean AIP was 0.73 ± 0.23A and significant positive correlation between FPG and AIP (r = 0.123, p < 0.05) was observed. Conclusion: The study revealed that AIP is significantly higher in type 2 DM patients. So, patients with type 2 DM should be followed up with AIP regularly. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 204-205

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Correlation Between Onset of Diabetes Mellitus and Nitric Oxide Levels in Patient with Type 2 Diabetes Mellitus

Medical Laboratory Technology Journal ◽

10.31964/mltj.v4i1.175 ◽

2018 ◽

Vol 4 (1) ◽

pp. 8

Author(s):

Theosobia Grace Orno ◽

Mansyur Arif ◽

Irfan Idris

Keyword(s):

Nitric Oxide ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cross Sectional ◽

Type 2 Dm ◽

Increased Risk ◽

Significant Difference ◽

Onset Of Diabetes

Type 2 diabetes mellitus (DM) is associated with increased risk of endothelial dysfunction if it lasts a long time without control. This study aims to connect the Onset of Diabetes Mellitus (DM) with Nitric Oxide levels in patients of type 2 diabetes mellitus. The study used cross-sectional study method. The samples were 86 subjects, consisting of 38 subjects of Type 2 DM controlled and 48 subjects of Type 2 DM uncontrolled. The results of the Kruskal-Wallis statistical test showed no significant difference between the Onset of DM and Nitric Oxide levels in the categories of 4-6 years (19.4 ± 10.1), 7-9 years (17.3 ± 9.3) and 10-12 years (13.3 ± 8.5) (p=0.06). Furthermore, the Spearman correlation test revealed a negative correlation between the Onset of DM and Nitric Oxide level in patients with Type 2 DM with and without control (r =-0.217). The level of Nitric Oxide (NO) can consider as a predictor of long-term complication in patients with type 2 DM.

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