Risk related to pre–diabetes mellitus and diabetes mellitus in heart failure with reduced ejection fraction: insights from prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial

Background—The prevalence of pre–diabetes mellitus and its consequences in patients with heart failure and reduced ejection fraction are not known. We investigated these in the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. Methods and Results—We examined clinical outcomes in 8399 patients with heart failure and reduced ejection fraction according to history of diabetes mellitus and glycemic status (baseline hemoglobin A1c [HbA1c]: <6.0% [<42 mmol/mol], 6.0%–6.4% [42–47 mmol/mol; pre–diabetes mellitus], and ≥6.5% [≥48 mmol/mol; diabetes mellitus]), in Cox regression models adjusted for known predictors of poor outcome. Patients with a history of diabetes mellitus (n=2907 [35%]) had a higher risk of the primary composite outcome of heart failure hospitalization or cardiovascular mortality compared with those without a history of diabetes mellitus: adjusted hazard ratio, 1.38; 95% confidence interval, 1.25 to 1.52;P<0.001. HbA1c measurement showed that an additional 1106 (13% of total) patients had undiagnosed diabetes mellitus and 2103 (25%) had pre–diabetes mellitus. The hazard ratio for patients with undiagnosed diabetes mellitus (HbA1c, >6.5%) and known diabetes mellitus compared with those with HbA1c<6.0% was 1.39 (1.17–1.64); P<0.001 and 1.64 (1.43–1.87); P<0.001, respectively. Patients with pre–diabetes mellitus were also at higher risk (hazard ratio, 1.27 [1.10–1.47];P<0.001) compared with those with HbA1c<6.0%. The benefit of LCZ696 (sacubitril/valsartan) compared with enalapril was consistent across the range of HbA1c in the trial. Conclusions—In patients with heart failure and reduced ejection fraction, dysglycemia is common and pre–diabetes mellitus is associated with a higher risk of adverse cardiovascular outcomes (compared with patients with no diabetes mellitus and HbA1c <6.0%). LCZ696 was beneficial compared with enalapril, irrespective of glycemic status

Effect of vitamin D3 supplement in glycemic control of pediatrics with type 1 diabetes mellitus and vitamin D deficiency

Background: Glycemic control prevents microvascular complications in patients with type I diabetes mellitus such as retinopathy, nephropathy and neuropathy that influences quality of life. Some studies show the immunomodulatory effect of vitamin D in synthesis and secretion of insulin. Aims: In this study we evaluate glycemic changes after vitamin D3 supplement in children with type I diabetes mellitus and vitamin D deficiency. Materials and Methods: In children with type I diabetes mellitus, level of vitamin D and HbA1C was measured. Patients with type I diabetes mellitus who had vitamin D deficiency (25OHD 9.9. This supplement transfer patients toward better glycemic control for the entire group (p-value < 0.0001). Conclusion: Vitamin D3 supplement improves HbA1C in pediatrics with type I diabetes mellitus and vitamin D deficiency. © 2015, Journal of Clinical and Diagnostic Research. All Rights Reserved

RESPONS AKUT KADAR GULA DARAH AKIBAT LATIHAN “SENAM DIABETES MELLITUS VERSI JAKARTA” DAN SENAM DIABETES MELLITUS VERSI JOGJA PADA PENDERITA DIABETES MELLITUS

By the rapid development of science and technology, the development in the economic sector and uncontrolled healthy life patterns can cause serious diseases. Degenerative diseases have replaced chronic diseases. The prominent degenerative diseases these days are heart disease, hypertension, and diabetes mellitus. The diseases are caused by unhealthy life style, diet, and less physical activity. Minor diabetes mellitus can be controlled through diet and exercise programs, and if the programs do not work, the patients can consume anti-diabetes medicines. The patients who perform the exercise experience the decrease of the needs of insulin until 40%. This is an experimental research study using Randomized pre-test post-test Design. The populations involved in this study were patients of diabetes mellitus which were the members of diabetes mellitus exercise fitness program in dr. Sardjito Hospital, Yogyakarta. The samples were 12 participants which were divided into two groups. The tool used in this research was One Touch BASIC Plus Life Scan 2000 made in USA. The results of this study show that there were different decreases of blood sugar levels as the effect of treatment of Senam Diabetes Mellitus Versi Jakarta and Senam Diabetes Mellitus Versi Jakarta Dan Versi Jogja (Jakarta and Jogja Versions of Diabetes Mellitus Exercise). The stressors of Jakarta version of diabetes mellitus exercise could stimulate the decrease of sugar blood levels (pre-post) of 15mg/100ml in average, while the stressors of Jogja version of diabetes mellitus exercise could stimulate the decrease of sugar blood level (pre-post) of 20.83mg/100ml in average. Statistically, the results show that t count was 0.913 with the probability level of 0.403 (p>0.05). Thus, statistically the levels of sugar blood before and after performing Jakarta version of diabetes mellitus exercise were relatively similar. It implies that Jakarta version of diabetes mellitus exercise was not effective to decrease the acute levels of sugar blood. The results of t-test on the group of Jogja version of diabetes mellitus exercise show that t count was 2.016 with the probability level of 0.100 (p>0.05). It implies that the levels of sugar blood before and after performing Jogja version of diabetes mellitus exercise were relatively similar. Therefore, it was said that Jogja version of diabetes mellitus exercise could not effectively decrease the levels of sugar blood. Keywords: acute response, diabetes mellitus, sugar bloo

Renin-Angiotensin-Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA.

Background Mechanistic studies suggest that aldosterone impairs glucose metabolism. We investigated the cross-sectional associations of aldosterone and plasma renin activity with fasting plasma glucose, insulin resistance ( IR ), β-cell function, and longitudinal association with incident diabetes mellitus among adults in MESA (the multiethnic study of atherosclerosis) prospective cohort study. Methods and Results Homeostatic model assessment of IR ( HOMA 2- IR ) and HOMA 2-β were used to estimate IR and β-cell function, respectively. Incident diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dL or anti-diabetic medication use at follow-up. Linear regression was used to examine cross-sectional associations of aldosterone with fasting plasma glucose, HOMA 2- IR and HOMA 2-β; Cox regression was used to estimate hazard ratios ( HR ) for incident diabetes mellitus with multivariable adjustment. There were 116 cases of incident diabetes mellitus over 10.5 years among 1570 adults (44% non-Hispanic white, 13% Chinese American, 19% Black, 24% Hispanic American, mean age 64±10 years, 51% female). A 100% increase in log-aldosterone was associated with a 2.6 mg/dL higher fasting plasma glucose, 15% higher HOMA 2- IR and 6% higher HOMA 2-β ( P&lt;0.01). A 1- SD increase in log-aldosterone was associated with a 44% higher risk of incident diabetes mellitus ( P&lt;0.01) with the greatest increase of 142% ( P&lt;0.01) observed in Chinese Americans ( P for interaction=0.09 versus other ethnicities). Similar cross-sectional findings for log-plasma renin activity existed, but log-plasma renin activity was not associated with incident diabetes mellitus after full adjustment. Conclusions Aldosterone is associated with glucose homeostasis and diabetes mellitus risk with graded associations among Chinese Americans and blacks, suggesting that pleiotropic effects of aldosterone may represent a modifiable mechanism in diabetes mellitus pathogenesis with potential racial/ethnic variation

The PPARγ2 P12A polymorphism is not associated with all-cause mortality in patients with type 2 diabetes mellitus

The high mortality risk of patients with type 2 diabetes mellitus may well be explained by the several comorbidities and/or complications. Also the intrinsic genetic component predisposing to diabetes might have a role in shaping the risk of diabetes-related mortality. Among type 2 diabetes mellitus SNPs, rs1801282 is of particular interest because (i) it is harbored by peroxisome proliferator-activated receptor-γ2 (PPARγ2), which is the target for thiazolidinediones which are used as antidiabetic drugs, decreasing all-cause mortality in type 2 diabetes mellitus, and (ii) it is associated with insulin resistance and related traits, risk factors for overall mortality in type 2 diabetes mellitus. We investigated the role of PPARγ2 P12A, according to a dominant model (PA + AA vs. PP individuals) on incident all-cause mortality in three cohorts of type 2 diabetes mellitus, comprising a total of 1672 patients (462 deaths) and then performed a meta-analysis of ours and all available published data. In the three cohorts pooled and analyzed together, no association between PPARγ2 P12A and all-cause mortality was observed (HR 1.02, 95 % CI 0.79–1.33). Similar results were observed after adjusting for age, sex, smoking habits, and BMI (HR 1.09, 95 % CI 0.83–1.43). In a meta-analysis of ours and all studies previously published (n = 3241 individuals; 666 events), no association was observed between PPARγ2 P12A and all-cause mortality (HR 1.07, 95 % CI 0.85–1.33). Results from our individual samples as well as from our meta-analysis suggest that the PPARγ2 P12A does not significantly affect all-cause mortality in patients with type 2 diabetes mellitus

Heart failure is common in diabetic cats : findings from a retrospective case-controlled study in first-opinionpractice

Diabetes mellitus is common in the cat and the prevalence of this condition appears to be increasing (Peterson 1998,Rand and Marshall 2004, Rand and others 2004). The prognosis for cats with diabetes mellitus in first opinion practice has received little attention in the literature; few data indicate why diabetic cats die. Death in people with diabetes is overwhelmingly because of cardiovascular disease (Grundy and others 1999, Almdal and others 2004, Bell 2004, Bertoni and others 2004, Nichols and others 2004). Experimental induction of diabetes mellitus in various laboratory mammals also causes cardiovascular disease and heart failure so that the prevalence of cardiac disease and failure in diabetic cats seemed worthy of examination. The purpose of this study was to examine the prognosis and cause of death for a cohort of consecutive cases of feline diabetes mellitus diagnosed in a first opinion veterinary practice, and to compare these with control cats matched for age, breed and sex

Facilitators and barriers of adaptation to diabetes: experiences of Iranian patients

Background: Diabetes mellitus is one of the most challenging and burdensome chronic diseases of the 21st century and More than 1% of the Iranian urban population older than 20 years develops Type 2 diabetes each year. Living with diabetes mellitus has been described as a dynamic personal transitional adaptation, based on restructuring of the illness perceived experience and management of the self. Adaptation to Type 2 Diabetes mellitus is an integral part of diabetes care.This study explored the experiences of facilitators and barriers adaptation to Type 2 Diabetes by Iranian patients.Methods: This study was conducted by using qualitative content analysis. Data were collected via in-depth, semi-structured and face to face interviews with 15 patients with type2 diabetes.Results: Three themes emerged from collected data, including a) individual context with Beliefs, personal background, and previous experience subthemes. b) supportive system with Family, Society and Health organizations subthemes and c) self-comparison with comparison with other diabetes and comparison with other diseases subthemes.Conclusions: Identifying and managing Facilitators and Barriers adaptation to Type 2 Diabetes mellitus are an integral part of diabetes care. This study provides a better understanding of the factors from perspective of patients and it can be utilized by health care providers to adapt their health care and education contents to better meet the needs of people with diabetes. © 2014 Karimi Moonaghi et al.; licensee BioMed Central Ltd