The Association of Postprandial Triglyceride Variability with Renal Dysfunction and Microalbuminuria in Patients with Type 2 Diabetic Mellitus: A Retrospective and Observational Study

Objective. We examined whether or not day-to-day variations in lipid profiles, especially triglyceride (TG) variability, were associated with the exacerbation of diabetic kidney disease. Methods. We conducted a retrospective and observational study. First, 527 patients with type 2 diabetes mellitus (DM) who had had their estimated glomerular filtration rate (eGFR) checked every 6 months since 2012 for over 5 years were registered. Variability in postprandial TG was determined using the standard deviation (SD), SD adjusted (Adj-SD) for the number of measurements, and maximum minus minimum difference (MMD) during the first three years of follow-up. The endpoint was a ≥40% decline from baseline in the eGFR, initiation of dialysis or death. Next, 181 patients who had no micro- or macroalbuminuria in February 2013 were selected from among the 527 patients for an analysis. The endpoint was the incidence of microalbuminuria, initiation of dialysis, or death. Results. Among the 527 participants, 110 reached a ≥40% decline from baseline in the eGFR or death. The renal survival was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0073 , 0.0059, and 0.0195, respectively). A lower SD, lower Adj-SD, and lower MMD were significantly associated with the renal survival in the adjusted model (hazard ratio, 1.62, 1.66, 1.59; 95% confidence intervals, 1.05-2.53, 1.08-2.58, 1.04-2.47, respectively). Next, among 181 participants, 108 developed microalbuminuria or death. The nonincidence of microalbuminuria was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0241 , 0.0352, and 0.0474, respectively). Conclusions. Postprandial TG variability is a novel risk factor for eGFR decline and the incidence of microalbuminuria in patients with type 2 DM.

Relationship among Family Support, Mental Resilience and Di-abetic Distress in Patients with Type 2 Diabetic Mellitus during COVID-19

Background: To promote the treatment effects and self-management behaviors of the patients with type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic, this study empirically investigated the relationship among family support (FMS), mental resilience (MR) and diabetic distress (DD) in patients with T2DM. Method: Overall, 256 patients with T2DM from the Department of Endocrinology, Jinhua People’s Hospital, ZheJiang, China were selected and measured for their perceptions of FMS, MR and DD from 2019-2020. Based on the measurements, the difference and correlation matrix under different background variables were studied by one-way variance and correlation analysis. A structural equation was used to analyze the causal path among the measurements. Results: Patients that differ in marital status, annual family income, medical insurance level, number of complications, and with/without insulin injection therapy were significantly different in their perception of FMS, MR and DD. FMS and MR had a significant negative correlation with DD. FMS used MR as an intermediary variable that affected DD. Conclusion: Diabetes education, improved medical insurance levels, and targeted psychological consultation for patients could effectively improve their MR and alleviate DD.

Renoprotective effects of sodium glucose cotransporter 2 inhibitors in type 2 diabetes patients with decompensated heart failure

Background Sodium-glucose cotransporter 2 inhibitor (SGLT2i) reduces the risk of the composite renal endpoint and weakens the progressive decline in renal function in patients with chronic heart failure (HF). However, a detailed mechanism of SGLT2i on renal function and outcome remains uninvestigated. Methods We prospectively included 40 type 2 diabetic mellitus (T2DM) patients (median 68 years old, 29 male) who were hospitalized for decompensated HF and received SGLT2i during the index hospitalization. Of them, 24 patients had increases in estimated glomerular filtration rate (eGFR) at 12-month follow-up and 16 had decreases in eGFR. We investigated the baseline factors associating with the improvement in renal function. Results Lower plasma B-type natriuretic peptide (BNP) level and the use of renin-angiotensin system inhibitor (RASI) were independently associated with increases in eGFR during the follow-up period (p < 0.05 for both). Patients with both low plasma BNP levels and uses of RASI achieved significant increases in eGFR irrespective of the baseline HbA1c levels. Conclusions Lower plasma BNP level and the use of RASI at baseline were the key factors contributing to the renoprotective effects of SGLT2i among patients with decompensated HF and T2DM.

MO649DIAGNOSTIC TESTS OF NOVEL URINARY BIOMARKERS TO IDENTIFY EARLY STAGES OF NEPHROPATHY IN NON HYPERTENSIVE TYPE 2 DIABETIC MELLITUS

Background and Aims Activation of RAS and tubulointerstitial damage might be seen in pre-albuminuria stage of diabetic nephropathy. Here, diagnostic tests of urinary Angiotensinogen, Cystatin C, Neutrophil gelatinase associated lipocalin and IL 18 have been studied in pre-microalbuminuria diabetic patients. Method Total 952 Diabetic screened for Nephropathy (e-GFR ≥120&ACR≥30), among them 120 cases were followed up for one year. At one year they were classified in to Hyperfiltration43, Normoalbuminuria29 and Microalbuminuria48 groups. Another 63 Diabetes without nephropathy were included as controls. Hypertension, on ACEI/ARB, e-GFR&lt;60ml/min/1.73m2 and all Macroalbuminuria conditions were excluded. All were subjected to urine protein, ACR, HbA1c,e-GFR, along with urinary bio markers(IL-18, Cystatin-C, NGAL and Angiotensinogen). Comparative analysis of all groups, Diagnostic tests, correlation and logistic regression were analysed. Results Urinary IL18/Cr, Cystatin /Cr. and Angiotensiogen /Cr. levels were higher in groups of hyper filtration (13.47, 12.11 & 8.43mg/g), Normoalbuminuria (9.24,11.74&9.15mg/g) and microalbuminuria(11.59,14.48&10.24mg/g) than controls(7.38,8.39&1.26mg/g) but not NGAL/Cr. in all groups. High levels were significant in all except Cystatin/Cr. & IL18/Cr. in normoalbuminuria group. The AUC, sensitivity and specificity of Angiotensinogen (0.9, 90% and 80%) ACR (0.69, 40% and 100%) and e-GFR (0.6,37 and 100%)respectively. AUC of other biomarkers viz, IL 18/cr. Cystatin/Cr and NGAL/Cr. were 0.65, 0.64 and 0.51 respectively. Angiotensinogen/Cr and IL18/Cr showed correlation with log albuminuria r-0.3 p 0.00 and r-0.28 p 0.00 respectively; NGAL with log e-GFR (r-0.28 p0.00).Multivariate logistic analysis showed Odds of contracting nephropathy is 7.5 times having higher values of Log Angio/Cr. Conclusion Urinary Angiotensinogen has higher diagnostic value than ACR and e-GFR followed by IL 18 and Cystatin to diagnose DN at the pre-albuminuric stages but not urinary NGAL.

Yunpi-Huoxue-Sanjie Formula Alleviates Diabetic Cardiomyopathy by Inducing Autophagy

Background: Yunpi-Huoxue-Sanjie (YP-SJ) formula is a Chinese herbal formula with unique advantages for the treatment of diabetic cardiovascular complications, such as diabetic cardiomyopathy (DCM). The aim of this study was to investigate the role of YP-SJ formula in regulating myocardial autophagy. To determine whether YP-SJ formula can be used as an adjuvant therapy for DCM, its therapeutic effects and mechanism in myocardial injury caused by type 2 diabetic mellitus (T2DM) rats were determined. Methods: A high-fat diet combined with low-dose streptozotocin (STZ) injection was used to induce DCM in rats. Biochemical reagents were used to analyze blood glucose levels, an enzyme-linked immunosorbent assay determined insulin levels, echocardiography assessed cardiac structure and function, histopathology was used to detect myocardial inflammation and fibrosis, myocardial autophagosomes were observed by transmission electron microscopy, and quantitative RT-PCR and Western blot analyses were used to detect the expression levels of autophagy-related proteins. Results: After treatment with YP-SJ formula, DCM rats’ metabolism was abnormal and myocardial inflammation, fibrosis, and cardiac dysfunction were significantly improved. In addition, compared with DCM, YP-SJ formula significantly increased the number of autophagosomes, the expression of forkhead box protein O1 (FoxO1) and autophagy related 12 (Atg12) ; the expression of phosphorylated FoxO1 and p62 was significantly decreased, and the level of myocardial autophagy was increased. Conclusions: YP-SJ formula can alleviate the myocardial damage caused by T2DM, and thus may serve as an alternative treatment for DCM.