To evaluate the atherosclerotic cardiovascular diseases (ASCVD) risk factors in type 2 diabetes patients from the primary diabetes clinics for further comprehensive intervention in China.A cross-sectional study was conducted in 5 primary diabetes chain hospitals in Beijing, Lanzhou, Harbin, Chengdu, and Taiyuan in continuous patients with type 2 diabetes from March 2016 to December 2019. The data collected at the first visit were analyzed, and proportions of patients reached the targets (glycosylated hemoglobin [HbA1c] < 7%, blood pressure < 130/80 mm Hg, and low-density lipoprotein cholesterol [LDL-C] < 2.6mmol/l) were calculated. The clinical characteristics and the associated factors with achievement in HbA1c, blood pressure, and LDL-C targets were analyzed.A total of 20,412 participants, including 11,353 men (55.6%), with an average age of (59.4 ± 10.4) years were enrolled. Nearly 95% diabetes had one or more ASCVD risk factors other than hyperglycemia. The control rates of HbA1c, blood pressure, and LDL-C were 26.5%, 27.8%, and 42.6%, respectively. Only 4.1% patients achieved all 3 targets. Nearly 95% patients had one or more ASCVD risk factors other than hyperglyciemia. Diabetes duration, family history, and overweight/obesity were associated with the number of aggregated ASCVD risk factors. The patients with older age, no overweight/obesity, not smoking, less ASCVD risk factors, and having special diabetes care insurance (Chengdu) were associated with a higher control rates.To deal with poor control status, global management of ASCVD risk factors, weight loss, and smoking cessation must be emphasized in the primary diabetes care settings. Special diabetes care insurance should be advocated.Current ClinicalTrial.gov protocol ID NCT03707379. Date of Registration: October 16, 2018. https://clinicaltrials.gov.
BACKGROUND Hospital hyperglycemia is common and associated with potential adverse outcomes. A Hospital-wide Mobile Phone Alert (HMA) system was built to achieve real time glucose monitoring with warnings for glucose excursions. This study investigated the status of glucose control and evaluated the impact of HMA system on inpatient glycemia management. METHODS Inpatients with hyperglycemia hospitalized between 1 January, 2017 and 31 December, 2018 were identified excluding those < 18 years of age. The HMA system was activated on 1 October, 2017. It sent real time cellphone warning messages to the patient’s designated team physician whenever glucose levels > 10 mmol/L or < 3 mmol/L were detected. A serum glucose > 7.8 mmol/L was defined as hospital hyperglycemia (HH), and > 10 mmol/L was defined as significant HH (SHH). Glucose excursions before and after the HMA system was instituted were compared. RESULTS The incidence of HH, SHH and hypoglycemia was 26.1%, 12.8% and 2.5%, respectively. With the HMA system, the monthly glucose related consultation rate for all inpatients increased 65.9%. The rate of HH glucose amount/ total glucose amount improved with the HMA system, being lower than pre HMA system activation for the surgical wards (15.8 ± 4.7% vs 21.1 ± 6.1%,p<0.05). CONCLUSIONS In this study, one third of inpatients were noted to experience hyperglycemia. Real time cellphone warning messages to the patient’s designated team physician can improve consultation utilization for blood glucose excursions. The alert system was found to reduce the incidence of hyperglycemia on surgical wards.
BACKGROUND At the initial presentation of autoimmune adrenal insufficiency, most patients present with hormonal deficiencies from all three layers of adrenal cortex. However, isolated aldosterone deficiency causing a true partial adrenal insufficiency in the setting of autoimmune adrenalitis remains underrecognized. CASE REPORT A 67-year old female patient with a known history of diabetes mellitus type 1 since the age of 13 and morphea, presented with progressively worsening symptoms of confusion and hallucinations, fatigue, and loss of appetite over the past 5 years. During this time, she has had frequent and recurrent episodes of mild intermittent hyponatremia with hyperkalemia requiring intravenous fluids and ingested salt tablets, especially when she felt more symptomatic. On her initial evaluation here, she presented with hyponatremia (125 mmol/l, n: 135-145 mmol/l), low osmolality (264 mOsm/kg, n: 275-295 mOsm/kg), and normal potassium level (3.6 mmol/l, n: 3.6-5.2 mmol/l). Further investigations drawn at the same time revealed a low aldosterone (<4 ng/dL), normal renin (5.3 ng/mL/hr, ref 2.9-10.8), normal serum cortisol level (and normal response to Cortrosyn stimulation), though all in the setting of positive antibodies against 21-hydroxylase. Pan-imaging revealed no evidence of malignancy that can be causing ectopic SIADH production. Additional testing showed presence of auto antibodies contributing to pernicious anemia and thyroid disease. Treatment was started with fludrocortisone 0.1 mg tablet daily and she was advised to take the salt tablets only if she has any symptoms. The patient’s symptoms have resolved 8 months since this diagnosis, with normalized sodium and potassium levels. CONCLUSION Autoimmune primary adrenal insufficiency usually affects all three layers of the adrenal cortex, where patients present with deficiencies in cortisol and aldosterone. Isolated hypoaldosteronism has rarely been reported, however because it can cause life-threatening hyponatremia, it is an important entity to recognize. It is important to work up in such patients as they may be in the initial stages of autoimmune Addison’s disease and can progress to developing cortisol deficiency, though the time course to this progression is not well known.
Background: Maturity onset diabetes in young 3 (MODY 3) is caused by mutation of the hepatic nuclear factor 1 alpha (HNF-1A) gene. Craniofacial macrosomia (CFM) is associated with an abnormal development of craniofacial structures during the embryonic period. Maternal diabetes and genetic predisposition have been associated with CFM1. There are rare reports about an association of MODY 3 and CFM. Clinical case: An 11-year-old male patient presented with right side CFM (mild mandibular hypoplasia, internal auditory canal absence, severe pinna hypoplasia, abnormal orbital size and location, O3.M0.E3.N0.S02) noted at 8 months of age. Preoperative examination revealed A1c at 10.9%. After short term intensive insulin therapy, he had standard bread meal test: fasting glucose 8.11 mmol/L, insulin 13.9 mIU/L (3-25), C-peptide 1.25 ng/ml (0.81-3.85); 1 hour glucose 10.05 mmol/L, insulin 27 mIU/L, C-peptide 2.42 ng/ml; 2 hour glucose 8.17 mmol/L, insulin 16.09 mIU/L, C-peptide 2.11 ng/ml. GADA, IAA and ICA were negative. The mother was diagnosed diabetes at age 27years, when the patient was 8-month-old, and received insulin therapy. The mother was blind by age 35years due to diabetic retinopathy and died of DKA at 38-years-old. The patient’s 16-year-old brother had left side CFM (O2.M1.E2.N0.S0) and his OGTT was normal. The father was diagnosed with impaired glucose tolerance. The family had whole genome sequencing by Sanger technique, and resequenced the mutation with side primers. The CGA to CAA mutation was present at the 686 loci of exon 3 of HNF1A gene in the patient and mother. The HNF1A exon 3 mutation of CGA to CAA resulted in the change of arginine to glutamine which by the HGMA database is recognized as a reported MODY3 gene mutation. There was a mutation of G to A in the 4 loci of exon 1 of the insulin coding region in chromosome 11 in both the patient and elder brother. Neither elder brother nor father had the CGA mutation of HNF1A. Conclusion: There has not been a previous report of a relationship between HNF1A and CFM. In this case, the elder brother had CFM without a HNF1A mutation which does not support a connection between CFM and HNF1A. The two brothers both had CFM and insulin coding gene mutations which would represent a new association not previously described. Further testing is needed to confirm a relationship between the two. Reference: 1. Chen Q, Zhao Y, Shen G, Dai J. Etiology and Pathogenesis of Hemifacial Microsomia. J Dent Res 2018; 97(12): 1297-305. 2. Gougoutas AJ, Singh DJ, Low DW, Bartlett SP. Hemifacial microsomia: clinical features and pictographic representations of the OMENS classification system. Plast Reconstr Surg 2007; 120(7): 112e-20e.
Aim:To evaluate the atherosclerotic cardiovascular diseases (ASCVD) risk factors in type 2 diabetes (T2DM) patients from the primary diabetes clinics for further comprehensive intervention in China.Methods:A cross-sectional study was conducted in 5 primary diabetes chain hospitals in Beijing, Lanzhou, Harbin, Chengdu and Taiyuan in continuous patients with T2DM from March 2016 to December 2019. The data collected at the first visit were analyzed, and proportions of patients reached the targets (glycosylated hemoglobin (HbA1C) < 7%, blood pressure < 130 / 80mmHg, and low-density lipoprotein cholesterol (LDL-C) < 2.6mmol/l) were calculated. The differences among different hospitals, different treatment and numbers of aggregated ASCVD risk factors were compared.Results:A total of 20,431 participants, including 11,363 men (55.6%), with an average age of (59.4 ± 10.4) years were enrolled. Nearly 95% diabetes had one or more ASCVD risk factors other than hyperglycemia. The control rates of HbA1C, blood pressure, and LDL-C were 26.5%, 27.9%, and 42.6%, respectively. Only 4.1% patients achieved all 3 targets. Diabetes duration, family history and overweight/obesity were associated with the number of aggregated ASCVD risk factors. And the patients with short duration, no overweight/obesity, not smoking, less ASCVD risk factors and lived in Chengdu were associated with a higher control rates.Conclusions:In confront of poor control status, global management of ASCVD risk factors including weight loss and smoking stopping must be emphasized in the primary diabetes care settings.Highlights:The prevalence of ASCVD risk factors was high and control rates were low in the primary diabetes care hospitals in China.Overweight/obesity, smoking and resident area were associated with the aggregated ASCVD risk factors and worse control.Trial registration:Current ClinicalTrial.gov protocol ID NCT03707379. Date of Registration: October 16, 2018.https://clinicaltrials.gov
Objectives: The activation of immune cells plays a significant role in the progression of type 2 diabetes. This study aimed to investigate the potential role of Myeloid-derived suppressor cells (MDSCs) and T regulatory cells (Tregs) in type 2 diabetes. Methods: A total of 61 patients diagnosed with type 2 diabetes were recruited. Clinical characteristics were reviewed and peripheral blood samples were collected. Frequencies of MDSC subsets and T cell subsets and their mutual relationship, immunosuppressive mediators in the peripheral blood between patients with type 2 diabetes and healthy individuals were compared. Results: Frequencies of programmed cell death ligand-1 positive granulocytic MDSCs (PD-L1+G-MDSCs), programmed cell death ligand-2 positive monocytic MDSCs (PD-L2+M-MDSCs), PD-L2+G-MDSC and programmed cell death protein 1 positive Tregs (PD-1+Tregs) were decreased in patients with type 2 diabetes. Frequency of PD-1+Tregs was positively with PD-L2+M-MDSCs (r = 0.357, P = 0.009) and negatively related to HbA1c (r = -0.265, P = 0.042), fasting insulin level (r = -0.260, P = 0.047) and waist circumference (r = -0.373, P = 0.005). Conclusions: Decreased PD-L2+M-MDSCs and PD-1+Tregs may promote effector T cell activation, leading to chronic low-grade inflammation in type 2 diabetes. These findings highlight the contribution of MDSCs and Tregs to the immunopathogenesis of type 2 diabetes and suggest their potential as targets for new therapeutic approaches.
IntroductionDiabetic kidney disease (DKD) and diabetic retinopathy (DR) share similar pathophysiological mechanisms. However, signs of DKD may be present at diagnosis of diabetes without retinopathy. Risk factors for the development of DKD and DR may not be identical.MethodsThis study aimed to evaluate the concordance and discordance between DKD and DR by investigating the distribution of DKD and DR in patients with type 2 diabetes mellitus from 5 Chinese cities. A total of 26,809 patients were involved in this study. The clinical characteristics were compared among patients based on the presence of DKD and DR. Logistic regression models were used to analyze the independent risk factors of DKD and DR.ResultsThe prevalence of DKD and DR was 32.3% and 34.6%, respectively. Among eligible patients, 1,752 patients without DR had an increased urinary albumin-to-creatinine ratio (ACR) or reduced estimated glomerular filtration rate (eGFR), and 1,483 patients with DR had no DKD. The positive predictive value of DR for DKD was 47.4% and negative predictive value was 67.1%. Elder age, male gender, a longer duration of disease, higher values of waist circumference and HbA1c were associated with both DR and DKD. A lower educational level was associated with DR. Higher BP and TG would predict increased prevalence of DKD.ConclusionsDKD and DR shared many risk factors, but a significant discordance was present in patients with type 2 diabetes mellitus. DKD was more strongly associated with blood pressure and triglycerides than DR.
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