1645-P: Polygenic Risk Score for Prediction of Complications in Men and Women with Type 2 Diabetes
Johanne TremblayRedha AttaouaMounsif HalouiRamzan TahirCarole LongCandan HızelJohn ChalmersStephen HarrapMark WoodwardPavel Hamet
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Introduction: We assessed the performance of our newly developed polygenic risk score (PRS) to predict microvascular and macrovascular complications of type 2 diabetes (T2D) in men and women. The PRS is composed of 600 common genomic variants associated to diabetes, cardiovascular and renal diseases and their key risk factors selected from summary statistics of meta-analyses of published genome-wide association studies performed in over 1.2 million of individuals. The performance of the polygenic model was assessed by c-statistics in 4098 genotyped participants of European descent of the ADVANCE trial (46.4% women) followed during a period of five years. Methods: The logistic regression model that included the PRS adjusted for the principal component (PC1) of genetically determined ancestry, age at diagnosis and T2D duration, and treatment assignment, did not include any clinical or outcome data. Results: The discrimination between cases (having a specific complication) from controls (free of this complication) at entry in ADVANCE had AUCs for microvascular complications of 0.63 (0.60-0.65) in men and 0.66 (0.63-0.69) in women, sex differences p = 0.07. AUCs for macrovascular complications were 0.56 (0.54-0.58) in men and 0.57 (0.54-0.61) in women; p = 0.41. The AUCs for prediction of incident cases, defined as having an outcome during the ADVANCE trial (free of outcome at baseline) compared to controls that did not have a specific outcome at any time during the study, were for microvascular events 0.66 (0.63-0.70) in men and 0.71 (0.66-0.77) in women; p = 0.15. AUCs for macrovascular events were 0.65 (0.62-0.68) and 0.72 (0.68-0.76) respectively, p = 0.01. AUC for prediction of cardiovascular death occurring during the trial was 0.71 (0.67-0.75) in men and 0.77 (0.72-0.82) in women; p = 0.04. Conclusion: Our polygenic model demonstrated an overall better performance in women than in men and a better prediction capacity in individuals free of previous events in both sexes. Disclosure J. Tremblay: Research Support; Self; Servier. Stock/Shareholder; Self; OPTITHERA. R. Attaoua: None. M. Haloui: None. R. Tahir: None. C. Long: None. C. Hizel: None. J. Chalmers: None. S. Harrap: None. M. Woodward: Consultant; Self; Amgen, Kyowa Hakko Kirin Co., Ltd. P. Hamet: Research Support; Self; Servier. Stock/Shareholder; Self; OPTITHERA. Funding Genome Quebec; Canadian Institutes of Health Research; MEIE; CQDM; Opti Thera; Servier, Canada Research Chair in Predictive GenomicsDiabetes and hyperglycemia are risk factors for critical COVID-19 outcomes; however, the impact of pre-diabetes and previously unidentified cases of diabetes remains undefined. Here, we profiled hospitalized patients with undiagnosed type 2 diabetes and pre-diabetes to evaluate its impact on adverse COVID-19 outcomes. We also explored the role of de novo and intrahospital hyperglycemia in mediating critical COVID-19 outcomes.
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The results of treatment of 103 patients with tuberculosis and non-specific diseases of the lungs with concomitant diabetes mellitus were analysed. The main principles of preoperative preparation and postoperative management of the patients are presented. The incidence of operative complications was 10.7%, postoperative--17.5%, mortality--2.9%. The clinical effect was achieved in 97.1% of patients. Reactivation of tuberculosis after operation was noted in 7.8% of patients.
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The purpose is to use statistical methods to analysis some female data, trying to figure out what physiological factors will affect the occurrence of diabetes on female and how. Method: using dataset from “AKSHAY DATTATRAY KHARE” in Kaggle, which comes from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in original. In particular, all patients here are females of Pima Indian descent who are at least 21 years old. Use binary logit regression model to analysis. Result: Pregnancies, skin thickness, insulin and blood pressure, as long as age can’t be taken into account (p>0.05). The remaining three elements, which is glucose (OR=1.039), BMI(OR=1.073), diabetes pedigree function (OR=3.130), are all risk factors. The overall correct rate is 78.3%. The conclusion is using binary logit regression model can analysis factors related diabetes well. The logistic regression model among the influencing factors of diabetes shows that glucose, BMI, and diabetes pedigree function are likely to cause diabetes, and diabetes pedigree function has a greater impact on the psychological function of patients.
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Type 2 diabetes may be a more heterogeneous disease than previously thought. Better understanding of pathophysiological subphenotypes could lead to more individualized diabetes treatment. We examined the characteristics of different phenotypes among 5813 Danish patients with new clinically diagnosed type 2 diabetes.We first identified all patients with rare subtypes of diabetes, latent autoimmune diabetes of adults (LADA), secondary diabetes, or glucocorticoid-associated diabetes. We then used the homeostatic assessment model to subphenotype all remaining patients into insulinopenic (high insulin sensitivity and low beta cell function), classical (low insulin sensitivity and low beta cell function), or hyperinsulinemic (low insulin sensitivity and high beta cell function) type 2 diabetes.Among 5813 patients diagnosed with incident type 2 diabetes in the community clinical setting, 0.4% had rare subtypes of diabetes, 2.8% had LADA, 0.7% had secondary diabetes, 2.4% had glucocorticoid-associated diabetes, and 93.7% had WHO-defined type 2 diabetes. In the latter group, 9.7% had insulinopenic, 63.1% had classical, and 27.2% had hyperinsulinemic type 2 diabetes. Classical patients were obese (median waist 105 cm), and 20.5% had cardiovascular disease (CVD) at diagnosis, while insulinopenic patients were fairly lean (waist 92 cm) and 17.5% had CVD (P = 0.14 vs classical diabetes). Hyperinsulinemic patients were severely obese (waist 112 cm), and 25.5% had CVD (P < 0.0001 vs classical diabetes).Patients clinically diagnosed with type 2 diabetes are a heterogeneous group. In the future, targeted treatment based on pathophysiological characteristics rather than the current "one size fits all" approach may improve patient prognosis.
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Objective To investigate the risk factors on postoperative complications of patients in department of ENT. Methods Clinical datas of 376 patients in department of ENT were retrospectively analyzed in the hospital from October 2008 to December 2010. 52 patients had postoperative complications. The single factor analysis and Logistic regression analysis were used for risk factors on postoperative complications of patients in department of ENT. Results By single factor analysis and Logistic regression analysis, infection site (P = 0.000, HR = 14.283, 95.0%CI: 9.365-21.038), operation time (P = 0.000, HR = 13.716, 95.0%CI: 7.147-20.275), the hospitalization time (P = 0.002, HR = 15.208, 95.0%CI: 8.918-24.237), antibiotic use (P = 0.000, HR = 14.054, 95.0%CI: 8.163-21.739), hypertension (P = 0.000, HR = 13.976, 95.0%CI: 7.926-22.385) were risk factors on postoperative complications of patients in department of ENT. Conclusion Control of the major risk factors of postoperative infection and bleeding of patients in department of ENT can significantly improve the prognosis.
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Abstract Background Diabetes is related with both AF occurence and increased thromboembolic risk. There is scarce data about the outcomes of AF catheter ablation in patients with diabetes. Purpose We aimed to evaluate outcomes of AF catheter ablation in patients with diabetes. Methods All patients underwent AF cryoablation between January 2013 and January 2018 were included . Results A total of 493 patients were enrolled. Mean age was 59.6 ± 11.8 years and 253 (51.3 %) patients were female. Median follow up time was 28 (6-59) months. Recurrence occured in 61 (12.4%) patients. Diabetes was present in 78 (16%) cases. Mean HbA1c value of the diabetic patients was 6.79 ± 1.02 %. 50 (64.1 %) patients was under treatment with only oral antidiabetics while others were using insulin. Diabetic group was older (p < 0.001) and hypertension prevalance was significantly higher in diabetics(p < 0.001). Complication and recurrence rates were similar between the two groups (Table-1). Subgroup analysis revealed that there was not significant difference by AF recurrence between not only patients treated with OAD alone and treated with insulin but also patients with HbA1c value <7 and HbA1c value ≥7 (p = 0.064). Conclusion Recurrence and complication rates were similar between diabetic and non-diabetic patients. Despite neuropathy is a well known manifestation of diabetes; phrenic nerve damage rate is similar in diabetic patients with non-diabetic counterparts. Table-1 Diabetic group (n = 78) Non-diabetic group (n = 415) p value Age, (years) 64.38 ±10.12 58.91 ±11.84 <0.001* Gender, female (%) 45 (57 %) 207 (49.8 %) 0.267 Follow up, (months) 29.5 (6-59) 28 (6-58) 0.987 Hypertension, n (%) 57 (73%) 191 (46 %) <0.001 StrokeTIA, n(%) 4 (5.1 %) 8 (1.9 %) 0.104 Coronary artery disease, n (%) 39 (50 %) 176 (42.4 %) 0.242 AF type, Paroxysmal, (%) 65.7 % 71% 0.367 LV EF, % 59.81 ± 8.44 61.82 ± 6.89 0.027* LV end diastolic diameter, cm 4.90 ± 0.49 4.82 ± 0.46 0.160 LA diameter, cm 3.88 ± 0.51 3.81± 0.58 0.361 Recurrence 8 (10.2 %) 53 (12.7 %) 0.708 Phrenic nerve damage, n (%) 0 (0 %) 17 (4.1 %) 0.088 Inguinal hematoma, n (%) 7 (8.9%) 44 (10.6 %) 0.647 Pseudoaneurysm, n(%) 1 ( 1.2%) 3 ( 0.7 %) 0.502 Comparison of diabetic and non-diabetic patients
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Background Diabetic dermopathy is the most common cutaneous marker of diabetes mellitus. The relationship of diabetic dermopathy to internal complications of diabetes mellitus, such as nephropathy, retinopathy, and neuropathy, is still unknown. Methods The possible role of diabetic dermopathy as a clinical sign of internal complications in diabetes mellitus was investigated. One hundred and seventy‐three patients with diabetes mellitus, of whom 125 (72%) had insulin‐dependent diabetes mellitus and 48 (28%) had non‐insulin‐dependent diabetes mellitus, were studied. Results Diabetic dermopathy was present in 69 (40%) of patients, statistically more significant in patients 50 years of age and older. The mean diabetic duration was significantly higher in patients with diabetic dermopathy than in those without. The associations of diabetic dermopathy with retinopathy, nephropathy, and neuropathy were each statistically significant, and the increased frequency of diabetic dermopathy correlated with an increased number of these three complications in each patient. Conclusions Some of the factors that affect the development of internal complications in diabetes mellitus may play a role in the development of diabetic dermopathy, and diabetic dermopathy may serve as a clinical sign of an increased likelihood of these internal complications in diabetic patients.
Diabetic Neuropathy
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Risk factors for arteriosclerosis, such as age, duration of diabetes, sex, and plasma lipoprotein levels, were correlated with the presence of arteriosclerosis obliterans (ASO) as determined by noninvasive methods in 485 of 506 subjects studied with diabetes mellitus. The diabetic subjects were separated into two major groups for analysis: insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). The NIDDM group was subdivided into those treated by diet (NIDDM-D), sulfonylureas (NIDDM-S), and insulin (NIDDM-I). Overall, lipoprotein levels in the diabetics were higher than in an age- and sex-adjusted nondiabetic group. Cholesterol levels were elevated in all females and HDL cholesterol levels were depressed in diet- and sulfonylurea-treated females. VLDL levels were most elevated in diet-treated subjects followed by sulfonylurea-treated subjects; VLDL levels in insulin-treated subjects were not elevated. The prevalence of ASO is related to different factors in each group. In IDDM and NIDDM-I subjects, VLDL triglyceride, LDL cholesterol, and duration of diabetes or age are important risk indicators. By contrast, in NIDDM-S subjects, age alone is the significant risk indicator, and in NIDDM-D subjects, inverse HDL cholesterol correlated with ASO. While males have a higher prevalence of ASO than females, the difference is not statistically significant in any group. Other possible factors, such as hypertension, smoking, and obesity, were not considered in this initial analysis.
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Basal and maximal Ca2+ ATPase activity was studied in erythrocytes of 29 healthy controls, 15 patients with insulin-dependent diabetes mellitus (IDDM) and 22 patients with non-insulin-dependent diabetes mellitus (NIDDM). Basal and maximal Ca2+ ATPase activity was significantly decreased in insulin-dependent diabetes mellitus (8.4±0.5 and 22.5±1.1 pmol/106 RBC/min) and non-insulin-dependent diabetes mellitus (7.3±1.0 and 18.6±1.8 pmol/106 RBC/min) compared to healthy controls (9.3±1.0 and 24.6±1.1 pmol/106 RBC/min). Maximal Ca2+ ATPase activity showed a significant correlation to systolic blood pressure in both insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus. There was no significant correlation of maximal Ca2+ ATPase activity to fasting serum glucose concentration and to HbA1 levels. Maximal Ca2+ ATPase activity was significantly correlated to creatinine clearance in non-insulin-dependent diabetes mellitus, but not in insulin-dependent diabetes mellitus. It is concluded that a decreased cellular Ca2+ ATPase activity may predispose to the development of hypertension in diabetes mellitus.
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