Prevalence and Correlates of Macrovascular Complications at Type 2 Diabetes Diagnosis in a Tertiary Hospital in Yaoundé, Cameroon

Introduction: The presence of vascular complications at type 2 diabetes (T2D) diagnosis is a heavy burden for developing countries. We aimed to determine the prevalence and correlates of macrovascular complications at T2D diagnosis in Yaoundé, Cameroon. Materials and Methods: We conducted a cross-sectional study at the Essos Hospital Center in Yaoundé from January 2017 to June 2021. We recruited patients newly diagnosed with T2D who, simultaneously, with assessed macrovascular complications including stroke, myocardial infarction (MI) and arterial foot ulcer (AFU). Correlates were investigated using Chi square test and logistic regressions. The significance level was set at 5%. Results: In all, 286 newly diagnosed diabetic patients (51.7% being men) were included. The mean age was 52.6 ± 12.3 years. Prevalent cardiovascular risk factors at diabetes diagnosis were a dyslipidemia (63.6%), sedentary lifestyle (57.7%) and family history of type 2 diabetes (51.6%). The prevalence of macrovascular complications was 17.5% with 8.4% stroke, 5.6% myocardial infarction and 3.4% arterial foot ulcer. Hypertension was associated with all macrovascular complications (p Conclusion: Macrovascular complications are frequent at type 2 diabetes diagnosis and are represented by stroke and myocardial infarction in our study, highlighting the importance of cardiovascular risk evaluation and reduction in people with diabetes right from diagnosis.

Genetics of macrovascular complications in type 2 diabetes

Type 2 diabetes mellitus(T2DM)is a metabolic disorder that currently affects more than 400 million worldwide and is projected to cause 552 million cases by the year 2030.Long-term vascular complications,such as coronary artery disease,myocardial infarction,stroke,are the leading causes of morbidity and mortality among diabetic patients.The recent advances in genome-wide technologies have given a powerful impetus to the study of risk markers for multifactorial diseases.To date,the role of genetic and epigenetic factors in modulating susceptibility to T2DM and its vascular complications is being successfully studied that provides the accumulation of genomic knowledge.In the future,this will provide an opportunity to reveal the pathogenetic pathways in the development of the disease and allow to predict the macrovascular complications in T2DM patients.This review is focused on the evidence of the role of genetic variants and epigenetic changes in the development of macrovascular pathology in diabetic patients.

Clinical significance of serum miR-129-5p in patients with diabetes mellitus presenting macrovascular complications

BACKGROUND Diabetic macrovascular complications(DMCs)are the most common complications encountered during the course of diabetes mellitus(DM)with extremely high mortality rates.Therefore,there is an urgent need to identify specific and sensitive biomarkers for the early diagnosis of DMCs.AIM To investigate the expression and significance of serum miR-129-5p in patients with DM and macrovascular complications.METHODS Serum samples were collected from 36 healthy controls,58 patients with DM presenting no macrovascular complications,and 62 patients with DMCs.The expression of miR-129-5p was detected using quantitative real-time polymerase chain reaction.Pearson’s correlation assay was performed to analyze the correlation between serum miR-129-5p levels and clinical indicators.Receiver operator characteristic(ROC)analysis was conducted to analyze the diagnostic value of serum miR-129-5p in patients with DM or DMCs.RESULTS There was a 4.378-fold and 7.369-fold increase in serum miR-129-5p expression in the DM(5.346±0.405)and DMCs(8.998±0.631)groups,respectively(P<0.001),compared with the control group(1.221±0.090).In addition,the expression of serum miR-129-5p in patients with DMCs was higher than that in patients with DM,revealing a 1.683-fold increase(P<0.001).Additionally,serum miR-129-5p expression significantly correlated with smoking history,disease duration,and glycated hemoglobin(HbA1c)in patients with DMCs(P<0.001).The area under the ROC curve(AUC)of miR-129-5p as a serum marker was 0.964(95%confidence interval[CI]:0.930-0.997,P<0.001)in distinguishing between patients with DM and healthy controls,whereas the AUC of miR-129-5p as a serum marker was 0.979(95%CI:0.959-0.999,P<0.001)in distinguishing between patients with DMCs and healthy controls.CONCLUSION Elevated serum miR-129-5p expression levels correlate with the development of DMCs and can be utilized as a novel early diagnostic biomarker for DM combined with macrovascular complications.

Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities

Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly.The development of foot ulcer in a diabetic patient has been estimated to be 19%-34%through their lifetime.The pathophysiology of diabetic foot ulcer consist of neuropathy,trauma and,in many patients,additional peripheral arterial disease.In particular,diabetic neuropathy leads to foot deformity,callus formation,and insensitivity to trauma or pressure.The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification,surgical debridement,dressing to facilitate wound healing,offloading,vascular assessment(status and presence of a chance for interventional vascular correction),and infection and glycemic control.Although especially surgical procedures are sometimes inevitable,they are poor predictive factors for the prognosis of diabetic foot ulcer.Different novel treatment modalities such as nonsurgical debridement agents,oxygen therapies,and negative pressure wound therapy,topical drugs,cellular bioproducts,human growth factors,energy-based therapies,and systematic therapies have been available for patients with diabetic foot ulcer.However,it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials.This review aims at evaluating diabetic foot ulcer with regard to all aspects.We will also focus on conventional and novel adjunctive therapy in diabetic foot management.

Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea:A nationwide retrospective cohort

Objective The main aim of this study is to investigate whether acupuncture could be an effective complementary treatment for reducing the risk of macrovascular complications in diabetic patients currently taking antidiabetic medications using a nationwide population-based database.Methods We conducted a retrospective cohort study to assess the efficacy of acupuncture on cardiovascular complications in diabetic patients using data from patients between 40 and 79 years of age,newly diagnosed with diabetes between 2003 and 2006,found in the National Health Insurance Service-National Sample Cohort(NHIS-NSC)in Korea.From the data,we identified 21,232 diabetic patients who were taking antidiabetic medication between 2003 and 2006.The selected patients were divided into two groups-those who received acupuncture at least three times and those who received no acupuncture(non-acupuncture)in the year following their diagnosis of diabetes.After 1:1 propensity score matching(PSM),each group had 3350 patients,and the observation ceased at the occurrence of a major adverse cardiovascular event(MACE),which was defined as either myocardial infarction,stroke,or death due to cardiovascular cause.Results After PSM,the acupuncture group had a lower incidence of MACE(hazard ratio[HR]:0.87;95%confidence interval[CI]:0.81-0.94;P=0.0003)and all-cause mortality(HR:0.77;95%CI:0.70-0.84;P<0.0001)than the non-acupuncture group;the HRs for stroke-related mortality(HR:0.75;95%CI:0.56-1.00;P=0.0485),ischemic heart disease mortality(HR:0.53;95%CI:0.34-0.84;P=0.006)and circulatory system disease mortality(HR:0.67;95%CI:0.55-0.82;P<0.0001)were lower in the acupuncture group than in the non-acupuncture group in the secondary analysis.Conclusion Our results indicate that diabetic patients receiving acupuncture treatment might have a lower risk of MACE,all-cause mortality and cardiovascular mortality.This population-based retrospective study suggests beneficial effects of acupuncture in preventing macrovascular complications associated with diabetes.These findings call for further prospective cohort or experimental studies on acupuncture treatment for cardiovascular complications of diabetes.

Effects of phlorizin on vascular complications in diabetes db/db mice

Background Diabetic macrovascular complications are important causes of cardiovascular and cerebrovascular diseases and also one of the major causes of morbidity and mortality in patients with type 2 diabetes mellitus （T2DM）. Phlorizin has been reported to be effective in reducing the blood glucose level in diabetic mellitus, while little is known about its effects on vascular complications. This study aimed to observe the effects of phlorizin on the aorta of diabetes db/db mice and explore its mechanism. Methods Diabetic db/db mice （n=16） and age-matched db/m mice （n=8） were divided into three groups： normal control group （CC group, db/m mice, n=8）, untreated diabetic group （DM group, db/db mice, n=8） and diabetic group treated by phlorizin （DMT group, db/db mice, n=8）. Phlorizin （20 mg/kg body weight） was given in normal saline solution intragastrically for 10 weeks. Animals were weighed weekly. At the 10th weekend, all mice were fasted overnight and then sacrificed. Fasting blood was collected, and the aortas were dissected. The blood samples were analyzed for fasting blood glucose （FBG）, serum advanced glycation end products （AGEs）, malondialdehyde （MDA） and superoxide dismutase （SOD） activity, the aortic ultrastructure was studied. Results The weight and serum concentration of FBG, AGEs, and MDA in the DM group were higher than that in the CC group （P 〈0.01 ）, and they were significantly lower in the DMT group （P 〈0.05）. Serum SOD activity was lower than that in the CC group （P 〈0.01）, and it is significantly higher in the DMT group （P 〈0.05）. The severity of aorta damage in the DMT group was less than that in the DM group. Conclusions Phlorizin protected the db/db mice from diabetic macrovascular complications, attributed to the decreasing of blood glucose and AGEs level, and its antioxidant potential. This study may provide a new natural medicine for treating diabetic macrovascular complications.

Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes: a systematic review and meta-analysis

Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes.However,the role of HbAlc variability is unclear in clinical practice.This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro-and macro-vascular complications and death in people with type 2 diabetes.Methods:We searched PubMed,EMBASE(via OVID),and Cochrane Central Register(CENTRAL,via OVID)for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation(SD),coefficient of variation(CV),and HbAlc variability score(HVS).Results:In people with type 2 diabetes,the highest quantile of all three HbAlc variability metrics(HbAlc-standard deviation[HbAlc-SD],HbAlc-coefficient of variance[HbAlc-CV],and HVS)is associated with increased risks of all-cause mortality,cardiovascular events,progression to chronic kidney disease,amputation,and peripheral neuropathy.For example,the hazard ratio of HbAlc-SD on all-cause mortality was 1.89 with 95%confidence interval(95%CI)1.46–2.45(HbAlc-CV 1.47,95%CI 1.26-1.72;HVS 1.67,95%CI 1.34–2.09).Conclusions:High HbAlc variability leads to micro-and macro-vascular complications of type 2 diabetes and related death.People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.

Effectiveness of quality of care for patients with type 2 diabetes in China:findings from the Shanghai Integration Model(SIM)

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai,China.A total of 173235 patients with type 2 diabetes in 2017 were included in the analysis.Profiles of risk factors and intermediate outcomes were determined.The patients had a mean age of 66.43±8.12(standard deviation(SD))years and a mean diabetes duration of 7.95±5.53(SD)years.The percentage of patients who achieved the target level for HbA_(1c)(<7.0%)was 48.6%.Patients who achieved the target levels for blood pressure(BP)<130/80 mmHg and low-density lipoprotein-cholesterol(LDL-c)<2.6 mmol/L reached 17.5%and 34.0%,respectively.A total of 3.8%achieved all three target levels,and the value increased to 6.8%with an adaptation of the BP target level(<140/90 mmHg)for those over 65 years.Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels:male,young age,short diabetes duration,low body mass index,macrovascular complications,no microvascular complications,prescribed with lipid-lowering medication,and no prescription of antihypertensive medication.In conclusion,nearly 50%and one-third of the patients with diabetes met the target levels for HbA_(1c)and LDL-c,respectively,with a low percentage achieving the BP target level.The percentage of patients who achieved all three target levels needs significant improvement.