RISK OF CARDIOVASCULAR COMPLICATIONS OF ANTI-DIABETIC MEDICATION IN PROTEINURIC DIABETIC NEPHROPATHY PATIENTS
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Al Wakeel, J.; Hammad, D.; Mitwalli, A. H.; Al Suwaida, A.; Al Ghonaim, M. Author InformationDiabetic nephropathy is developed in 20‐40% of patients with diabetes mellitus, and patients with diabetic nephropathy require dialysis and renal transplantation. Traditional Chinese medicine has been widely used in treating patients with diabetic nephropathy in China. However, the detailed mechanisms of traditional Chinese medicine remain unclear. Yiqi Yangyin Huayu Tongluo formula (ZY formula) is a traditional Chinese medicinal formula. Here, we demonstrated kidney protective effect of ZY formula on the rats with diabetic nephropathy. The therapeutic effect of ZY formula on the diabetic nephropathy was almost the same as that of Irbesartan, which proved to have excellent curative effects on diabetic nephropathy. We also demonstrated the mechanism of ZY formula effect on the diabetic nephropathy. First, we validated that the activation of ROS‐JNK signaling pathway in diabetic rats could be reduced by ZY. Furthermore, collagen I expression could be downregulated by ZY formula treatment. Meanwhile, cell apoptosis in the kidney of diabetic rats could be alleviated by ZY formula.
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Oxidative stress is hypothesized to play a role in the development of diabetes with and without nephropathy. In addition, it has been suggested that some metabolic abormalities associated with diabetes may be due to cytokine overproduction. In the light of this knowledge, we aimed to measure MDA levels as a marker of oxidative stress and the IL-6 level in diabetes with and without different stages of nephropathy. Plasma MDA levels in the group of NIDDM patients with advanced nephropathy were significantly higher than in the group of NIDDM patients without nephropathy, which had significantly higher levels compared with the control group. Although IL-6 levels were elevated in diabetic groups with and without nephropathy in comparison with the control, no significant difference was found between patient groups. As a conclusion, oxidative stress may play an important role in diabetes with and without nephropathy, but the IL-6 level may not be useful in the evaluation of diabetic nephropathy.
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Hyperglycemia with or without blood glucose in diabetes range is an emerging finding not uncommonly encountered in patients with COVID-19. Increasingly, all evidence currently available hints that both new-onset hyperglycemia without diabetes and new-onset diabetes in COVID-19 is associated with a poorer outcome compared with normoglycemic individuals and people with pre-existing diabetes.
2019-20 coronavirus outbreak
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Objective: The current study aims to determine the frequency of diabetes mellitus in patients with COVID-19 infection. Methodology: Our cross-sectional study was conducted on 120 patients who presented with COVID-19 to Dr. Ziauddin Hospital, North Nazimabad, Karachi, from December 2021 to May 2022. The frequency of diabetes in these patients was determined. Results: In this study, the mean age of the patients recorded was 53.72±10.42 years. Frequency of diabetes was 37 (30.8%). Diabetes was significantly associated with hypertension, ischemic heart disease, and chronic kidney disease. Conclusion: The frequency of diabetes in COVID-19 patients in our study was 37 (30.8%). Diabetes was significantly more common in patients with comorbidities such as hypertension, ischemic heart disease, and chronic kidney disease. We recommend proper management of diabetic patients with COVID-19 infection as it can lead to a fatal manifestation of the disease.
Cross-sectional study
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Objective To study the metallothionein(MT-1)expression in diabetic nephropathy kidney of rats induced by streptozotosin(STZ).Methods Rats were induced diabetic nephropathy using STZ tail intravenous injection.The immunochemical and RT-PCR technique were used to study the MT-1 protein and mRNA expressions in the kidney tissues of normal and diabetic nephropathy rats.Results Weak MT-1 expression was detected in normal renal tissues while strong MT-1 staining was detected in renal tissues of diabetic nephropathy(P0.05).The MT-1 protein expression was increased with the development of diabetic nephropathy.The expression of MT-1,TNF-α,MIP-1,COX2,TGF-B,PAI-1,Col-3 mRNA increased in renal tissues of 16 weeks diabetic nephropathy rats.(P0.05).Conclusion Both MT-1 mRNA and protein expression were increased in STZ induced diabetic nephropathy rats indicated that MT-1 might be play an important role in pathophy siology process of diabetic nephropathy development.It might be relative to oxidize-injure and might be one of cellular defense reactions.
Metallothionein
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Introduction: Diabetic nephropathy (DN) is one of the major microvascular complications of diabetes mellitus. Patients with diabetic nephropathy are at a higher risk of morbidity and mortality than those without nephropathy. In this case, early diagnosis and prevention of DM are crucial. SIRT1, which is among the seven members of sirtuins, is recognized as an important element in the pathogenesis of type 2 diabetes, therefore it has several actions in the diabetic nephropathy that will be further discussed in this study. This study will analyse the relationship between SIRT1 gene polymorphism and serum sirt1 in the pathogenesis of diabetic nephropathy. Aim of the study: evaluation of the association of Silent Information Regulator1 (SIRT1) gene polymorphism and serum SIRT1 protein with type 2 diabetic patients and their role in the pathogenesis of diabetic nephropathy. Subjects and Methods: This study was carried out on 120 subjects with matched age and sex. They were divided into 3 groups: (Group 1: 40 diabetic nephropathy patients, Group 2: 40 diabetic patients without diabetic nephropathy, Group 3: 40 healthy control subjects ) to discuss the association of sirt1 gene polymorphism and the pathogenesis of diabetic nephropathy. Results: The mean levels of the serum SIRT1 protein was significantly increasing in the diabetic nephropathy group than the diabetics without diabetic nephropathy and the controls, while it was not significant between the diabetics without DN and the control group. Conclusion: Basedon this study, SIRT1 gene polymorphism is a significant factor in the development and progression of DN.
Pathogenesis
Gene polymorphism
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Objective To understand the status of diabetes cognition among COPD patients complicated with diabetes mellitus. Method Totally, 240 COPD patients complicated with diabetes mellitus were investigated by self- designed questionnaire about their knowledge of diabetes mellitus. Results There were significant differences between different gender patients in hypoglycemia symptoms and treatment principles( P 0. 01),among different age patients in diabetes mellitus causes,clinical manifestation and complications,treatment( P 0. 01 or P 0. 05). There were significant differences between among different education background patients in correlation between long- term using glucocorticoid and diabetes and diabetes treatment( P 0. 01 or P 0. 05),among different COPD stages patients in correlation between long- term using glucocorticoid and diabetes,diabetes mellitus causes,hypoglycemia symptoms and treatment principles,diabetes treatment( P 0. 01 or P 0. 05). There were significant differences between different diabetes stages patients in diabetes mellitus causes,clinical manifestation and complications,hypoglycemia symptoms and treatment principles,diabetes treatment( P 0. 01 or P 0. 05). Conclusion The diabetes related health education for COPD patients should be specific according to their situations,in order to control the glucose,promote the prognosis and improve their self- control of glucose.
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Abstract Background Diabetic nephropathy is a common complication of diabetes, which can be prevented by early diagnosis and development. The aim of the present study was to evaluate the expression level of miR-192 and miR-377 in serum samples of diabetic subjects without nephropathy and diabetic nephropathy subjects to investigate these miRNAs as a biomarker for the diagnosis and prognosis of diabetic nephropathy. Methods and Results We reviewed 370 patients diagnosed with diabetes mellitus type 2 (T2D) (190 patients with diabetic nephropathy and 180 patients with diabetes without nephropathy), and 170 healthy control individuals without any history of T2D. Expression analysis of miR-192 and miR-377 was performed by Real-Time PCR. The expression level of miR-192 was significantly increased in the diabetic nephropathy and diabetic without nephropathy groups (p < 0.05 and p < 0.01). Also, the expression level of miR-377 was significantly increased in the diabetic group without nephropathy compared to the control group (P < 0.05), although miR-377 expression in the diabetic nephropathy samples was a significant decrease compared with the diabetic without nephropathy samples (P > 0.05). QRT-PCR results showed that the expressions of miR-192 and miR-377 were significantly lower and higher in the diabetic without nephropathy group than in micro-albuminuria and macro-albuminuria groups, respectively. Conclusions Overexpression of miR-192 and down-regulation of miR-377 were observed in diabetic nephropathy. Up-regulation of miR-192 can be used as a prognostic factor for diagnosing diabetic nephropathy.
Albuminuria
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Abstract We estimated effects of diabetes mellitus and metabolic control on long-term change in coronal caries and restorative status using 11-year-follow-up data from the population-based Study of Health in Pomerania. Data of 3731 participants with baseline and 5- and 11-year follow-up information were included. Diabetes was defined via self-reported physician´s diagnosis or intake of glucose-lowering drugs or hemoglobin A1c (HbA1c) ≥6.5% or fasting blood glucose levels ≥11.1 mmol/l. The diabetes status was defined as no diabetes (HbA1c < 6.5% or non-fasting blood glucose <11.1 mmol/l), subjects with known or undetected diabetes mellitus and HbA1c ≤ 7% (well-controlled diabetes), and subjects with known or undetected diabetes mellitus and HbA1c > 7% (poorly-controlled diabetes). The caries status was clinically assessed using the half-mouth method and the Decayed Missing Filled Surfaces (DMFS) index and its component scores were determined. Covariate-adjusted linear mixed models were evaluated. Rates in change in DMFS were significantly higher in subjects with poorly-controlled diabetes compared to subjects without diabetes. Subjects with poorly- and well-controlled diabetes had significantly higher rates in change in Missing Surfaces (MS) compared to subjects without diabetes. For the DFS, rates in change were significantly lower for subjects with well-controlled diabetes and higher for subjects with poorly-controlled diabetes as compared to subjects without diabetes. Concordantly, all rates in change increased proportional to HbA1c levels. Effects were even more pronounced in subjects with diabetes duration of ≥5 years. Subjects with poorly-controlled diabetes are at higher risk for caries progression compared to subjects without diabetes, especially in case of longer disease duration.
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