Paraoxonase 1 gene (Gln¹⁹²-Arg) polymorphism and the risk of coronary artery disease in type 2 diabetes mellitus

Background: Paraoxonase 1 (PON1) is reported to have an antioxidant and cardioprotective properties. Recently, an association of glutamine (Gln) or (type A)/arginine (Arg) or (type B) polymorphism at position 192 of PON1 gene has been suggested with coronary artery disease (CAD) among patients with diabetes mellitus (DM). However, conflicting results have also been reported. Objectives: To investigate the relationship between PON1 gene (Gln192-Arg) poly-morphism and the presence, extent and severity of CAD in type 2 DM. Methods: The study comprised 180 patients recruited from those undergoing coronary angiography for suspected CAD, who were divided according to the presence or absence of CAD and DM into 4 groups;Group I (n = 40 patients) nondiabetic subjects without CAD, Group II (n = 45 patients) diabetic patients without CAD, Group III (n = 47 patients) non diabetic patients with CAD and Group IV (n = 48 patients) diabetic patients with CAD. PON1 (Gln192-Arg) genotype was assessed using polymerase chain reaction (PCR) followed by AlwI digestion. Results: The frequency of Gln allele (Type A) was significantly higher in group I and group II compared to group III and group IV (62.5%, 60% vs 38.3%, 31.25% respectively, p 100 mg/dL [OR 4.31, CI (1.25 - 12.5), P < 0.001], high density lipoprotein (HDL) cholesterol <40 mg/dL [OR 5.11, CI (1.79 - 16.33), P < 0.001] and PON1 192 Arg allele [OR 4.62, CI (1.67 - 13.57), P < 0.001] were significantly independent predictors of CAD. Conclusion: Arg allele of PON1 192 gene polymorphism is an independent risk factor for CAD and it is associated not only with the presence of CAD but also with its extent and severity and its impact is clearly more pronounced in diabetic patients.

Association between Hepato-Biliary Status and HbA1C in Type 2 Diabetes Mellitus with Coronary Artery Disease (CAD)

Bilirubin has both antioxidant activity and cardioprotective potential. Decreased levels are associated with predicting CAD. Recent studies showed that bilirubin has inverse correlation with glycemic status. So in this we evaluated the role of Hepatobiliary function as a marker of predictor CAD in patient with T2DM. Total 100 subjects included 50 T2DM patients with CAD and 50 T2DM without CAD. All the subject venous blood was collected after overnight fasting for biochemical analysis. After the statistical analysis, the results showed significant difference between two groups as follows total bilirubin (0.32 ± 0.15;0.90 ± 032;p = 0.000), direct bilirubin, indirect bilirubibn, Total Protein, Albumin, ALT, AST, HbA1c. Our finding implies that decreased serum bilirubin increases the risk of CAD in patients with T2DM and it shows inverse correlation between HbA1c and bilirubin.

Can Ophthalmoscope Predict Silent Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus?

Background & Aim: Diabetic retinopathy (DR) and Coronary Artery Disease (CAD) share similar pathophysiological background of vascular damage. So we aimed to study the relationship between DR and silent CAD in patients with type 2 diabetes mellitus (T2DM). Subject & Methods: A cross sectional study was performed on 40 patients with T2DM from diabetic outpatient clinic in Ain Shams University Hospitals, Cairo, Egypt from June 2012 to December 2012. All patients were subjected to data collection, laboratory analysis and imaging studies. Patients with known CAD, abnormal resting or stress ECG, abnormal ejection fraction or segmental wall motion abnormalities, smoking history, hypertension, or abnormal lipid profile were excluded. Results: Mean age is 62.35 ± 1.38 years, 75% (n = 30) were females, 75% (n = 30) had DR, and 77.50% (n = 31) had positive Tc99 scan. There is a significant positive association between Tc99 scan and DR (p value = 0.029) as 86.7% of patients with DR had positive Tc99 scan. Resting and stress perfusion TC99 scan were significantly worse (91.77% vs 100%;86.48% vs 96.27%, p value = 0.008, 0.005 respectively) and microalbuminuria were significantly higher (207 ± 29.65 vs 36 ± 10.66 mg/dl, p value =< 0.001) in patients with DR. By binary logistic regression, DR was an independent predictor for CAD (OR was 16.377, 95% CI was 1.017 - 263.586, p value = 0.049) after adjustment of SBP and albuminuria. Conclusion: DR is an independent predictor of asymptomatic CAD even with normal stress ECG and echocardiography. Routine screening for CAD using Tc99 scan is recommended in patients with DR even if asymptomatic. More multi-centric prospective studies are needed to elucidate the effect of the degree of DR on CAD risk.

Discovering hidden patterns:Association rules for cardiovascular diseases in type 2 diabetes mellitus

BACKGROUND It is increasingly common to find patients affected by a combination of type 2 diabetes mellitus(T2DM)and coronary artery disease(CAD),and studies are able to correlate their relationships with available biological and clinical evidence.The aim of the current study was to apply association rule mining(ARM)to discover whether there are consistent patterns of clinical features relevant to these diseases.ARM leverages clinical and laboratory data to the meaningful patterns for diabetic CAD by harnessing the power help of data-driven algorithms to optimise the decision-making in patient care.AIM To reinforce the evidence of the T2DM-CAD interplay and demonstrate the ability of ARM to provide new insights into multivariate pattern discovery.METHODS This cross-sectional study was conducted at the Department of Biochemistry in a specialized tertiary care centre in Delhi,involving a total of 300 consented subjects categorized into three groups:CAD with diabetes,CAD without diabetes,and healthy controls,with 100 subjects in each group.The participants were enrolled from the Cardiology IPD&OPD for the sample collection.The study employed ARM technique to extract the meaningful patterns and relationships from the clinical data with its original value.RESULTS The clinical dataset comprised 35 attributes from enrolled subjects.The analysis produced rules with a maximum branching factor of 4 and a rule length of 5,necessitating a 1%probability increase for enhancement.Prominent patterns emerged,highlighting strong links between health indicators and diabetes likelihood,particularly elevated HbA1C and random blood sugar levels.The ARM technique identified individuals with a random blood sugar level>175 and HbA1C>6.6 are likely in the“CAD-with-diabetes”group,offering valuable insights into health indicators and influencing factors on disease outcomes.CONCLUSION The application of this method holds promise for healthcare practitioners to offer valuable insights for enhancing patient treatment targeting specific subtypes of CAD with diabetes.Implying artificial intelligence techniques with medical data,we have shown the potential for personalized healthcare and the development of user-friendly applications aimed at improving cardiovascular health outcomes for this high-risk population to optimise the decision-making in patient care.

Bidirectional relationship between type 2 diabetes mellitus and coronary artery disease:Prospective cohort study and genetic analyses

Background:While type 2 diabetes mellitus(T2DM)is considered a putative causal risk factor for coronary artery disease(CAD),the intrinsic link underlying T2DM and CAD is not fully understood.We aimed to highlight the importance of integrated care targeting both diseases by investigating the phenotypic and genetic relationships between T2DM and CAD.Methods:We evaluated phenotypic associations using data from the United Kingdom Biobank(N=472,050).We investigated genetic relationships by leveraging genomic data conducted in European ancestry for T2DM,with and without adjustment for body mass index(BMI)(T2DM:N_(case)/N_(control)=74,124/824,006;T2DM adjusted for BMI[T2DM_(adj)BMI]:N_(case)/N_(control)=50,409/523,897)and for CAD(N_(case)/N_(control)=181,522/984,168).We performed additional analyses using genomic data conducted in multiancestry individuals for T2DM(N_(case)/N_(control)=180,834/1,159,055).Results:Observational analysis suggested a bidirectional relationship between T2DM and CAD(T2DM→CAD:hazard ratio[HR]=2.12,95%confidence interval[CI]:2.01–2.24;CAD→T2DM:HR=1.72,95%CI:1.63–1.81).A positive overall genetic correlation between T2DM and CAD was observed(r_(g)=0.39,P=1.43×10^(-75)),which was largely independent of BMI(T2DM_(adj)BMI–CAD:r_(g)=0.31,P=1.20×10^(–36)).This was corroborated by six local signals,among which 9p21.3 showed the strongest genetic correlation.Cross-trait meta-analysis replicated 101 previously reported loci and discovered six novel pleiotropic loci.Mendelian randomization analysis supported a bidirectional causal relationship(T2DM→CAD:odds ratio[OR]=1.13,95%CI:1.11-1.16;CAD→T2DM:OR=1.12,95%CI:1.07-1.18),which was confirmed in multiancestry individuals(T2DM→CAD:OR=1.13,95%CI:1.10-1.16;CAD→T2DM:OR=1.08,95%CI:1.04-1.13).This bidirectional relationship was significantly mediated by systolic blood pressure and intake of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors,with mediation proportions of 54.1%(95%CI:24.9-83.4%)and 90.4%(95%CI:29.3-151.5%),respectively.Conclusion:Our observational and genetic analyses demonstrated an intrinsic bidirectional relationship between T2DM and CAD and clarified the biological mechanisms underlying this relationship.

Glucokinase regulatory protein rs780094 polymorphism is associated with type 2 diabetes mellitus, dyslipidemia, non-alcoholic fatty liver disease, and nephropathy

In this editorial,we comment on the article by Liu et al published in the recent issue of the World Journal of Diabetes(Relationship between GCKR gene rs780094 polymorphism and type 2 diabetes with albuminuria).Type 2 diabetes mellitus(T2DM)is a chronic disorder characterized by dysregulated glucose homeostasis.The persistent elevated blood glucose level in T2DM significantly increases the risk of developing severe complications,including cardiovascular disease,re-tinopathy,neuropathy,and nephropathy.T2DM arises from a complex interplay between genetic,epigenetic,and environmental factors.Global genomic studies have identified numerous genetic variations associated with an increased risk of T2DM.Specifically,variations within the glucokinase regulatory protein(GCKR)gene have been linked to heightened susceptibility to T2DM and its associated complications.The clinical trial by Liu et al further elucidates the role of the GCKR rs780094 polymorphism in T2DM and nephropathy development.Their findings demonstrate that individuals carrying the CT or TT genotype at the GCKR rs780094 locus are at a higher risk of developing T2DM with albuminuria compared to those with the CC genotype.These findings highlight the importance of genetic testing and risk assessment in T2DM to develop effective preventive strategies and personalized treatment plans.

Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease

BACKGROUND Peripheral vascular disease(PVD)is a common complication of type 2 diabetes mellitus(T2DM).Patients with T2DM have twice the risk of PVD as nondiabetic patients.AIM To evaluate left ventricular(LV)systolic function by layer-specific global longitudinal strain(GLS)and peak strain dispersion(PSD)in T2DM patients with and without PVD.METHODS Sixty-five T2DM patients without PVD,57 T2DM patients with PVD and 63 normal controls were enrolled in the study.Layer-specific GLS[GLS of the epimyocardium(GLSepi),GLS of the middle myocardium(GLSmid)and GLS of the endocardium(GLSendo)]and PSD were calculated.Receiver operating characteristic(ROC)analysis was performed to calculate the sensitivity and specificity of LV systolic dysfunction in T2DM patients with PVD.We calculated Pearson’s correlation coefficients between biochemical data,echocardiographic characteristics,and layer-specific GLS and PSD.RESULTS There were significant differences in GLSepi,GLSmid and GLSendo between normal controls,T2DM patients without PVD and T2DM patients with PVD(P<0.001).Trend tests revealed a ranking of normal controls>T2DM patients without PVD>T2DM patients with PVD in the absolute value of GLS(P<0.001).PSD differed significantly between the three groups,and the trend ranking was as follows:normal controls<T2DM patients without PVD<T2DM patients with PVD(P<0.001).ROC analysis revealed that the combination of layer-specific GLS and PSD had high diagnostic efficiency for detecting LV systolic dysfunction in T2DM patients with PVD.Lowdensity lipoprotein cholesterol was positively correlated with GLSepi,GLSmid and PSD(P<0.05),while LV ejection fraction was negatively correlated with GLSepi,GLSmid and GLSendo in T2DM patients with PVD(P<0.01).CONCLUSION PVD may aggravate the deterioration of LV systolic dysfunction in T2DM patients.Layer-specific GLS and PSD can be used to detect LV systolic dysfunction accurately and conveniently in T2DM patients with or without PVD.

A Retrospective Analysis of Glucagon-Like Peptide 1 Receptor Agonists in Treating Type 2 Diabetes Mellitus Complicated by Nonalcoholic Fatty Liver Disease

Background: The objective of this study was to compare and analyze the variations in clinical indices before and after treatment of type 2 mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD) that were treated with glucagon-like peptide 1 receptor agonists (GLP-1RAs). Methods: The electronic medical record system was utilized to search for a total of 16 patients with type 2 diabetes complicated by NAFLD who were hospitalized at the First Affiliated Hospital of Yangtze University from October 2022 to April 2023 and treated with GLP-1RA for the first time. The clinical indices were compared before and after 12 weeks of treatment with GLP-1RA. Results: The liver-spleen CT ratio (L/S), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in all patients treated with GLP-1RA after 12 weeks were significantly different (P 0.05). The patients were categorized into two groups based on the types of GLP-1RAs. The changes in L/S, TC, TG, and LDL-C in the long-acting group after treatment were statistically significant (P Conclusions: GLP-1RAs can improve liver function, regulate lipid metabolism, and reduce the severity of fatty liver in patients with T2DM complicated by NAFLD, which demonstrates the importance of clinical applications.

Association of plasma vitamin A level with type 2 diabetes mellitus:a community aging population-based cross-sectional study

Recent studies indicated that vitamin A(VA)might be involved in the pathology of type 2 diabetes mellitus(T2DM).This cross-sectional study was conducted to explore the association between circulating VA level and T2DM.A total of 1818 subjects aged 50 years old and above were recruited from the community.Binomial logistic regression and restricted cubic spline(RCS)were applied to analyze the association of plasma VA level with the risk of T2DM.Serum VA and lipid-adjusted VA levels of T2DM patients were significantly higher than that of non-T2DM subjects(P<0.05).The ratios of plasma VA/total cholesterol(TC),VA/high-density lipoprotein cholesterol(HDL-c)and VA/low-density lipoprotein cholesterol(LDL-c)were positively associated with the risk of T2DM in the aging population(P<0.05).Compared with the Q1 level,subjects with Q2 to Q3 levels of plasma VA/triglyceride(TG)have decreased risk of T2DM(odds ratio(OR)Q2=0.68,P_(Q2)=0.021;ORQ3=0.59,P_(Q3)<0.01).Our results indicated that the imbalance of circulating lipids and VA might affect the relationship between VA and T2DM.The middle and aging subjects with higher ratios of plasma VA/TC,VA/HDL-c,and VA/LDL-c displayed increased risk for T2DM,but the moderate ratio of VA/TG might protect against risk of T2DM.

Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus:A real-world experience

BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and urinary infection-20(8.8%)&17(7.5%)with dapagliflozin;9(5.6%)&5(3.13%)with canagliflozin;and 4(5%)&4(5%)with empagliflozin.Diabetic ketoacidosis was observed in 4(1.8%)with dapagliflozin and 1(0.63%)with canagliflozin.CONCLUSION Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c,body weight,and better than those reported in RCTs,with low side effect profiles.A review of large-scale real-world data is needed to inform better clinical practice decision making.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes:A retrospective cohort study

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Association of bone turnover biomarkers with severe intracranial and extracranial artery stenosis in type 2 diabetes mellitus patients

BACKGROUND Intracranial and extracranial artery stenosis is associated with cerebral infarction.Vascular calcification and atherosclerosis are the main causes of stenosis and major risk factors for cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus(T2DM).Bone turnover biomarkers(BTMs)are associated with vascular calcification,atherosclerosis,glucose,and lipid metabolism.AIM To investigate the association of circulating BTM levels with severe intracranial and extracranial artery stenosis in patients with T2DM.METHODS For this cross-sectional study including 257 T2DM patients,levels of the BTMs serum osteocalcin(OC),C-terminal cross-linked telopeptide of type I collagen(CTX),and procollagen type I N-peptide were measured by electrical chemiluminescent immunoassay,and artery stenosis was assessed by color Doppler and transcranial Doppler.Patients were grouped according to the existence and location(intracranial vs.extracranial)of artery stenosis.Correlations between BTM levels,previous stroke,stenosis location,and glucose and lipid metabolism were analyzed.RESULTS T2DM patients with severe artery stenosis had a higher frequency of previous stroke and levels of all three tested BTMs(all P<0.05)than patients without.Some differences in OC and CTX levels were observed according to the location of artery stenosis.Significant associations were also observed between BTM levels and some glucose and lipid homeostasis parameters.On multivariate logistic regression analysis,all BTMs were significant predictors of artery stenosis in T2DM patients with and without adjustment for confounding factors(all P<0.001),and receiver operating characteristic curve analysis demonstrated the ability of BTM levels to predict artery stenosis in T2DM patients.CONCLUSION BTM levels were found to be independent risk factors for severe intracranial and extracranial artery stenosis and were differentially associated with glucose and lipid metabolism in patients with T2DM.Therefore,BTMs may be promising biomarkers and potential therapeutic targets for artery stenosis.

Clinical Characteristics and Coronary Angiographic Findings in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus

Objectives To study clini- cal and coronary angiographic findings in patients with both coronary heart diseases (CHD) and type 2 diabe- tes mellitus (T2DM). Methods 215 patients with CHD confirmed by coronary angiography were involved in this study. The patients were divided into two groups: 74 CHD patients with T2DM (mean age 64.7 ± 8.2 years, male/female 47/27), and 141 CHD pa- tients without T2DM ( mean age 66. 2 ±9. 2 years, male/female 100/41 ). The clinical features and the data from selective coronary angiographies were com- pared between type 2 diabetic and non - diabetic CHD patients. Results Compared to non - diabetic CHD patients, the patients with both CHD and T2DM suf- fered more from acute myocardial infarction, silent is- chemia and severe arrhythmias ( P < 0. 01, P < 0. 05 ) , and had higher serum triglycerides and apo - lipoprotein B, along with increased serum uric acid (P < 0. 01, P < 0.05), increased left ventricular end diastolic diameter ( P < 0. 01 ) , and decreased left ventricular ejection fraction ( P < 0. 001 ). Compared to non - diabetic CHD patients, the patients with both CHD and T2DM suffered more from triple vessel disease (P < 0. 01) , severe coronary artery stenosis, complete occlusions and diffuse lesions ( P < 0. 001). Conclusions Se- vere clinical manifestation, left ventricular dysfunction, diffuse or complicated lesions of coronary arteries weremore common in patients with both CHD and T2DM, it suggests that the type 2 diabetic CHD patients have poor prognosis.

Genetic variability in adapter proteins with APPL1/2 is associated with the risk of coronary artery disease in type 2 diabetes mellitus in Chinese Han population

Background Adaptor proteins containing PH domain, PTB domain, and leucine zipper motif 1 and 2 （APPL1/2） play a key role in cell proliferation in many tissues. APPL1 or APPL2 as an adaptor for adiponectin receptors mediates the signaling pathway of adiponectin which acts as an anti-atherosclerotic adipokine. This study aimed to investigate whether genetic variations in the APPL 1/2 genes affect the risk of coronary artery disease （CAD） in Chinese patients with type 2 diabetes mellitus （T2DM）. Methods Seven haplotype-tagging single nucleotide polymorphisms （tag-SNPs） were selected from CHB HapMap database （Phase II） and total 203 CAD-positive cases and 106 CAD-negative controls with T2DM were genotyped for the 7 tag-SNPs by polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） assay. Results The minor allele G of rs4640525 at APPL1 locus was protective from CAD in patients with T2DM, with the carriers of genotype CC at higher risk of CAD compared with non-carriers （OR=2.830, 95% Cl 1.285-6.230, P=0.010; OR＇=4.992, 95% C1=1.758-14.173, P＇0.003, after adjustment for the other known CAD risk factors）; the homozygotes of AA at rs11112412 in APPL2 gene had higher risk of CAD compared with those of GG （adjusted OFt=5.697, 95% Cl 1.006-32.257, P=0.049）. Conclusion Genetic variation（s） in APPL 1/2 may be associated with CAD risk in T2DM in Chinese population.

Establishment of models to predict factors influencing periodontitis in patients with type 2 diabetes mellitus

BACKGROUND Type 2 diabetes mellitus(T2DM)is associated with periodontitis.Currently,there are few studies proposing predictive models for periodontitis in patients with T2DM.AIM To determine the factors influencing periodontitis in patients with T2DM by constructing logistic regression and random forest models.METHODS In this a retrospective study,300 patients with T2DM who were hospitalized at the First People’s Hospital of Wenling from January 2022 to June 2022 were selected for inclusion,and their data were collected from hospital records.We used logistic regression to analyze factors associated with periodontitis in patients with T2DM,and random forest and logistic regression prediction models were established.The prediction efficiency of the models was compared using the area under the receiver operating characteristic curve(AUC).RESULTS Of 300 patients with T2DM,224 had periodontitis,with an incidence of 74.67%.Logistic regression analysis showed that age[odds ratio(OR)=1.047,95%confidence interval(CI):1.017-1.078],teeth brushing frequency(OR=4.303,95%CI:2.154-8.599),education level(OR=0.528,95%CI:0.348-0.800),glycosylated hemoglobin(HbA1c)(OR=2.545,95%CI:1.770-3.661),total cholesterol(TC)(OR=2.872,95%CI:1.725-4.781),and triglyceride(TG)(OR=3.306,95%CI:1.019-10.723)influenced the occurrence of periodontitis(P<0.05).The random forest model showed that the most influential variable was HbA1c followed by age,TC,TG, education level, brushing frequency, and sex. Comparison of the prediction effects of the two models showedthat in the training dataset, the AUC of the random forest model was higher than that of the logistic regressionmodel (AUC = 1.000 vs AUC = 0.851;P < 0.05). In the validation dataset, there was no significant difference in AUCbetween the random forest and logistic regression models (AUC = 0.946 vs AUC = 0.915;P > 0.05).CONCLUSION Both random forest and logistic regression models have good predictive value and can accurately predict the riskof periodontitis in patients with T2DM.

Mechanisms of Huanglian Jiedu Decoction in treating coronary heart disease and type 2 diabetes mellitus based on network pharmacology

Objective:To explore the common mechanism of Huanglian Jiedu Decoction in treating coronary heart disease and type 2 diabetes by network pharmacology.Methods:All chemical components and targets of the four drugs in Huanglian Jiedu Decoction were retrieved through TCMSP,and the genes were standardized through Uniprot database.Acquire disease targets related to coronary heart disease and diabetes in OMIM and GeneCards databases.The network diagram of"drug-component-target-disease"is constructed by using the software of cytopscape 3.7.2,the PPI network diagram of protein interaction is constructed by using STRING database,and the network diagram of"drug-disease"core target is constructed by using the software of cytopscape 3.7.2.DAVID's online database platform was used to analyze GO biological process and KEGG pathway enrichment of common targets of Huanglian Jiedu Decoction in treating coronary heart disease and type 2 diabetes.Results:103 active ingredients of Huanglian Jiedu Decoction were retrieved,including 140 acting targets,5342 coronary heart disease targets,114 diabetes targets,and 14 common intersection targets of drugs and diseases,involving AR,PPARG,TNF,IL6,CCL2,VEGFA,PON1,etc.The GO biological process analysis results in 98 biological processes,10 cell components and 10 molecular functions.Among them are positive regulation of gene expression,positive regulation of nitric oxide biosynthesis process,Extracellular space,cytokine activity,steroid hormone receptor activity and other biological processes;The enrichment analysis of KEGG pathway yielded 20 signal pathways(P≤0.05).It mainly involves Malaria,cancer in cancer,HIF-1 signaling pathway,TNF signaling pathway,NOD-like receptor signaling pathway,PI3K-Akt signaling pathway,etc.Conclusion:Huanglian Jiedu Decoction"treats different diseases at the same time"coronary heart disease and type 2 diabetes have the characteristics of multiple components,multiple targets and multiple pathways,which provide theoretical basis for Huanglian Jiedu Decoction to treat coronary heart disease and type 2 diabetes in clinic,but the key targets and pathways of Huanglian Jiedu Decoction to treat diseases still need further experimental verification.

Diabetes Mellitus in Very Elderly Russian Patients with Coronary Artery Disease

Background: Conflicting data are available on prevalence and characteristics of diabetes mellitus in very elderly patients and centenarians;therefore, we evaluated features of this pathology in patients with coronary artery disease (CAD) over 75 years old. Material and Methods: 580 patients with CAD over 75 years old were enrolled in the study on the prevalence of diabetes mellitus. 190 patients with CAD and diabetes mellitus were included in the cross-sectional study of the diabetes mellitus characteristics in old age: 153 very elderly patients (mean age—85.7 ± 4.7 years)—in the main group, 37 patients < 70 years old—in the comparison group. Toassess the condition of patients, standard clinical and laboratory methods for coronary artery disease and diabetes mellitus were used. 24-hour plasma glucose profile and hemoglobin A1c (HbA1c) level were evaluated in all patients with diabetes mellitus. Results: Diabetes mellitus or impaired glucose tolerance was found in 22.2% of very elderly patients with CAD. Glucose levels in very elderly diabetic patients were lower at all time points than in patients < 70 years old. The largest differences were recorded for the blood glucose concentration at 6 a.m. (p = 0.00005). Glucosuria was registered in 29.7% of patients aged 51 - 69 years, while among elderly patients—in 11.1% (p = 0.004). The mean levels of HbA1c were 7.3% and 8.7%, respectively (p = 0.01). Correlation analysis revealed negative correlation between the age of patients and the glucose level (r = ?0.4, p = 0.00002—for 6 AM glucose). The mean body mass in-dex in very elderly patients was 30.8 ± 5.8 kg/m2, in patients < 70 years old—33.9 ± 6.5 kg/m2 (p = 0.03). Significant differences between the groups of very elderly and younger patients were registered in terms of triglycerides (1.65 and 3.57 mmol/L, respectively, p < 0.00001), HDL-cholesterol (1.16 and 0.87 mmol/L, respectively, p = 0.03) and ath-erogenic index (3.45 and 6.73, respectively, p = 0.002). Conclusion: The study results indicate that diabetes mellitus is often diagnosed in very elderly patients with CAD. In very elderly patients, lower values of blood glucose, hemoglobin A1c and glucosuria are recorded, compared with younger patients with diabetes mellitus.

Assessment of serum lipid metabolism index and cytokine levels in patients with type 2 diabetes mellitus complicated by coronary heart disease after telmisartan combined with lipid-lowering drug treatment

Objective:To study the effect of telmisartan combined with lipid-lowering drug therapy on serum lipid metabolism index and cytokine levels in patients with type 2 diabetes mellitus complicated by coronary heart disease.Methods:A total of106 patients with type 2 diabetes mellitus complicated by coronary heart disease who were treated in our hospital between September 2013 and October 2016 were collected and then divided into the control group (n=55) who received conventional treatment + lipid-lowering drug treatment and the observation group (n=51) who received conventional treatment + lipid-lowering drug + telmisartan treatment after the therapies were reviewed. Before and after treatment, serum levels of lipid metabolism indexes, inflammatory mediators and oxidative stress indexes were compared between two groups of patients.Results:Before treatment, the differences in serum levels of lipid metabolism indexes, inflammatory mediators and oxidative stress indexes were not statistically significant between two groups of patients. After treatment, serum TG and LDL-C levels in observation group were lower than those in control group while HDL-C level was higher than that in control group;serum inflammatory mediators IL-6, IL-8, HMGB1 and TNF-α levels were lower than those in control group;serum oxidative stress indexes MDA and ROS levels were lower than those in control group while GSH-Px level was higher than that in control group.Conclusion:Telmisartan combined with lipid-lowering drug therapy can effectively optimize the lipid metabolism and reduce the systemic inflammatory response and oxidative stress response in patients with type 2 diabetes mellitus complicated by coronary heart disease.

Screening for coronary artery disease in asymptomatic patients with type 2 diabetes mellitus

In China, the prevalence of type 2 diabetes mellitus is .increasing rapidly due to aging of the population,increased frequency of obesity, and suboptimal nutritional habits. Currently, the number of people with diabetes was estimated to be 20 million and will be projected to double by the year 2030. The age-adjusted prevalence of diabetes among patients with acute myocardial infarction has increased significantly over the past two decades, and diabetic patients without known coronary artery disease have similar rates of subsequent myocardial infarction compared with non-diabetic counterparts with a previous myocardial infarction.4 Diabetes is a strong risk factor for cardiovascular disorders,