AbstractDiabetes mellitus with atherosclerosis (AS) adds to the social burden. This study aimed to investigate whether advanced glycation end product (AGE) levels were correlated with inflammation and carotid AS (CAS) in type 2 diabetes mellitus (T2DM) patients. A total of 50 elderly T2DM patients and 50 age-matched senior healthy subjects were recruited in this study. T2DM patients were classified into two groups based on the intima–media thickness (IMT) of the carotid artery from color Doppler ultrasonography. Patients with IMT > 1 mm were classified into the T2DM + CAS group (n = 28), and patients with IMT < 1 mm were assigned as the T2DM + non-atherosclerosis (NAS) group (n = 22). The plasma levels of AGEs, receptor for AGE (RAGE), tumor necrosis factor alpha (TNF-α), and interferon gamma (IFN-γ) of all subjects were measured by enzyme-linked immunosorbent assay. The T-lymphocyte subsets were analyzed by a flow detector. T2DM + CAS patients showed significantly higher concentrations of AGEs, RAGE, TNF-α, and IFN-γ in the peripheral blood. The highest levels of CD4+ T cells were observed in the T2DM + CAS group. The AGE level was positively correlated with the concentrations of RAGE, TNF-α, IFN-γ, and CD4+. In summary, the results showed that the levels of AGEs may be correlated with the inflammatory status in T2DM patients with CAS.

Purpose: In addition to hyperglycemia and hyperlipidemia, obesity and hypertension are important cardiovascular risk factors for coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM). This study aims to explore the interaction of these risk factors. Patients and Methods: Data of hospitalized patients with T2DM from 2013 to 2018 were collected. A multivariate logistic regression model was established. Patients with normal weight and blood pressure were recruited as controls. The interaction on the risk of CHD was evaluated by relative excess risk due to interaction (RERI). Results: Among the 30,693 patients with T2DM, 7202 (23.5%) had CHD. In the low weight group, the prevalence of CHD in patients with hypertension was nearly four times higher than that in patients without hypertension (42.7% vs 11.3%, P < 0.01). The OR value of hypertension alone on CHD increased from 1.29 (95% CI 1.06-1.56) in the body mass index (BMI) 30.0-34.9 kg/m 2 group to 1.35 (95% CI 1.11-1.62) in the BMI ≤ 18.5 kg/m 2 group. Additive interaction was observed between hypertension and BMI in CHD risk, especially in the low weight group (RERI:2.2, 95% CI 0.9-3.5). BMI and CHD risk showed a smile curve relationship. The attributive proportion in the low weight group was higher than that in the severe obesity group, that is, 0.52 (95% CI 0.35-0.69) vs 0.18 (95% CI −0.59 to 0.95). Conclusion: Maintaining normal weight and avoiding low weight are particularly important for patients with co-occurring diabetes and hypertension to prevent the risk of CHD.

Purpose We aim to determine the role of free triiodothyronine (FT3), the main active ingredient of thyroid hormones (THs), in type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI). Patients and Methods A total of 255 T2DM patients without diagnosed thyroid diseases were recruited and divided into MCI group and healthy cognition group. Neuropsychological functions were observed by multidimensional cognitive function scales in including MoCA, Digit Span Test (DST), Verbal Fluency Test (VFT), Clock drawing test (CDT), Trail Making Test (TMT) A and B, Instantaneously Recalled Auditory Verbal Learning Test (AVLT-IR), Delayed Recalled Auditory Verbal Learning Test (AVLT-DR) and Logical Memory Test (LMT). Correlation and logistic regression analyses were performed to explore the association between FT3 and diabetic cognitive dysfunction. Results Compared with 147 normal cognition patients, 108 MCI patients exhibited lower FT3 and higher HOMA-IR. FT3 level was not only positively correlated with MoCA scores, but DST, VFT and LMT, while negatively associated with TMTB. Furthermore, there is a negative association between FT3 and HOMA-IR. Logistic regression showed that decreased FT3 is a risk factor of MCI in T2DM patients. Although FT3 is not the risk factor of MCI after homeostasis model assessment of insulin resistance (HOMA-IR) was entered as an independent variable, lower FT3 is associated with VFT and LMT adjusted by age, education, BMI, DM duration, HBP duration, smoking, HbA1c and HOMA-IR. Conclusion Lower FT3 levels may involve in MCI, especially for executive function and scene memory in T2DM patients without diagnosed thyroid diseases.

Background: Coronary heart disease (CHD) is the most common cause of death in patients with type 2 diabetes (T2DM). We aim to estimate the prevalence of CHD and cardiovascular risk factors in Chinese diabetic inpatients.Methods: A total of 66536 diabetic inpatients from 2013 to 2018 were investigated, demographic and clinical data were gathered from 30693 patients with T2DM. The age-standardized prevalence of CHD was calculated on the basis of data from Chinese population census in 2010. Multiple imputation was used to impute missing values and logistic regression analysis was used to analyze the risk factors.Results: The crude prevalence of CHD was estimated to be 23.5% and a standardized prevalence was 13.9% (16.0% in men and 11.9% in women). More than half of diabetic patients with CHD have 4 or above of the 5 traditional risk factors, which is much higher than 38.96% of diabetic patients (p<0.01). Multivariate regression analysis showed that diabetes duration, hypertension, smoking, underweight, overweight, obesity, hypoglycemia were significantly associated with a higher risk of CHD (all p<0.05). The odds ratio of CHD in patients having 3, 4, or 5 CHD risk factors were 2.35 (95%CI 1.81- 3.04), 2.96 (95%CI 2.28- 3.85), and 5.29 (95%CI 4.04- 6.93), compared with diabetes patients without any other risk factors.Conclusions: The prevalence of CHD was rather high in Chinese T2DM inpatients, aggregation of CHD risk factors was more seriously, hierarchical CHD prevention strategies based on risk factors are needed for them.

Aim Type 2 diabetes may impair cardiac structure and function at very early stage, other factors, for example, obesity and hypertension, can induce aforementioned abnormalities individually. This study aimed to explore precise prevention and treatment of diabetic cardiomyopathy (DCM) by using cluster analysis of echocardiographic variables. Methods and results A total of 66 536 inpatients with diabetes from 2013 to 2018 were investigated, and 7112 patients were available for analysis after nadir. The cluster analysis was performed on echocardiographic variables to assess the clinical profiles and risk factors of clusters. Two clusters were identified. Cluster 1 with 3576 patients (50.3%, including 62.5% female) had hypertension in 62.4%, while the lower rate of obesity (13.7%). Ultrasound findings showed that 79.9% of them had left ventricular diastolic dysfunction (LVDD), the most characteristic change in the early stages of DCM. Systolic blood pressure (SBP), uric acid and antithrombin III were independent risk factors for LVDD (P < 0.0001); 64.0% of the 3536 patients in the second group were male, with a high prevalence of obesity (30.1%) and a higher prevalence of hypertension (79.5%), In particular, decreased systolic function and a high rate of LV hypertrophy (46.8%) represented the progressive phase of DCM (P < 0.0001). SBP, diastolic blood pressure, BMI and creatinine were independent correlates of LV mass index (P < 0.05). Conclusion The cluster analysis of echocardiographic variables may improve the identification of groups of patients with similar risks and different disease courses and will facilitate the achievement of targeted early prevention and treatment of DCM.

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