Evaluation of IScore validity in a Greek cohort of patients with type 2 diabetes

BACKGROUND: Diabetes constitutes a risk factor for stroke that also aggravates stroke prognosis. Several prognostic models have been developed for the evaluation of neurologic status, severity, short-term functional outcome and mortality of stroke patients. IScore is a novel tool recently developed in order to predict mortality rates within 30 days and 1 year after ischemic stroke and diabetes is not included in the scoring scale of IScore. The aim of the present study was to evaluate and compare IScore validity in ischemic stroke patients with and without diabetes. METHODS: This prospective study included 312 consecutive Caucasian patients with type 2 diabetes and 222 Caucasian patients without diabetes admitted for ischemic stroke in a tertiary Greek hospital. Thirty-day and 1-year IScores were individually calculated for each patient and actual mortality was monitored at the same time intervals. IScore’s predictive ability and calibration was evaluated and compared for ischemic stroke patients with and without diabetes. The performance of IScore for predicting 30 and 1-year mortality between patients with and without diabetes was assessed by determining the calibration and discrimination of the score. The area under the receiver operating characteristic curve was used to evaluate the discriminative ability of IScore for patients with and without diabetes, whereas the calibration of IScore was assessed by the Hosmer–Lemeshow goodness-of fit statistic. RESULTS: Baseline population characteristics and mortality rates did not differ significantly for both cohorts. IScore values were significantly higher for patients with diabetes at 30 days and 1 year after ischemic stroke and patients with diabetes presented more frequently with lacunar strokes. Based on ROC curves analysis IScore’s predictive ability for 30 day mortality was excellent, without statistically significant difference, for both cohorts. Predictive ability for 1 year mortality was also excellent for both groups with significantly better ability for patients with diabetes especially at high score values. Calibration of the model was good for both groups of patients. CONCLUSIONS: IScore accurately predicts mortality in acute ischemic stroke Caucasian patients with and without diabetes with higher efficacy in predicting 1 year mortality in patients with diabetes especially with high scores

Toll/Interleukin-1 receptor member ST2 exhibits higher soluble levels in type 2 diabetes, especially when accompanied with left ventricular diastolic dysfunction

<p>Abstract</p> <p>Background</p> <p>Soluble ST2, a member of the of the Toll/IL-1 superfamily, is a novel biomarker with exceptional predictive value in heart failure and myocardial infarction- related mortality as well as in acute dyspneic states. Soluble ST2 is considered a decoy receptor of IL 33 that blocks the protective effects of the cytokine in atherosclerosis and cardiac remodeling. In the present study we investigated the differences in the levels of soluble ST2, BNP and hs-CRP between healthy controls and patients with type 2 diabetes with and without left ventricular diastolic dysfunction. A secondary aim was to investigate correlations between sST2 and other biomarkers of type 2 diabetes, such as HbA1c.</p> <p>Methods</p> <p>158 volunteers were recruited and underwent a complete Doppler-echocardiographic evaluation of both systolic & diastolic cardiac function. All subjects with ejection fraction < 50% were excluded. The study population was divided in 4 groups as follows: A: 42 healthy controls, B: 18 subjects without diabetes with LVDD, C: 48 patients with type 2 diabetes without LVDD & D: 50 patients with type 2 diabetes & LVDD. ELISA technique was performed to measure sST2 levels. Statistical analysis was performed with Kruskal-Wallis & Mann-Whitney test (continuous variables), chi squared & Fischer exact test (discrete variables), Spearman coefficient (univariate analysis) and step-wise backward method (multivariate analysis).</p> <p>Results</p> <p>Patients with type 2 diabetes with (p < 0.001) or without LVDD (p = 0.007) had higher serum ST2 levels compared to healthy controls, state found also for hs-CRP levels but not for the corresponding BNP levels (p = 0.213 & p = 0.207 respectively). Patients with type 2 diabetes & LVDD had higher serum ST2 in relation to diabetic patients without LVDD (p = 0.001). In multivariate analysis HbA1c positively and independently correlated with sST2 levels in both groups of patients with type 2 diabetes.</p> <p>Conclusions</p> <p>Patients with type 2 diabetes exhibit higher sST2 levels compared to healthy controls. The presence of LVDD in patients with type 2 diabetes is associated with even higher sST2 levels. A significant correlation between glycemic control and sST2 levels was also revealed.</p

Latest data on obesity

Obesity is a chronic and morbid disease which has reached epidemic dimensions nowadays, becoming the springboard for the emergence of other unfavorable metabolic diseases such as type 2 diabetes mellitus. In 2014 overweight and obese people in the world were estimated at 2.022 billion while prediction for 2025 is to reach 2.693 billion. Regarding the statistical data from Greece, we should note that overweight and obese individuals are estimated at 5.266 million for 2014. Obesity is a systemic disease with significant impact on human health, such as increased incidence of type 2 diabetes, osteoarthritis ( knee, hip), cancers (mostly breast and endometrium for women and colon and kidney for men), cognitive disorders (dementia, Alzheimer's), mood disorders (anxiety, depression, emotional eating disorders), sleep apnea syndrome, cardiovascular disease (myocardial infarction, stroke) and increased incidence of all-cause mortality, reducing in this patern the overall life expectancy. The underlying pathophysiological disorders of obesity are complex and mostly not understood well. The main disorder is the disturbance of the human energy balance when intake calories are more than the calories consumed, thus an excess of energy is generated daily, which is stored by the body in the form of triglycerides in adipose tissue of the body. On the other hand, weight loss is very important since even moderate weight loss significantly reduces the comorbidities of obesity. For the treatment of obesity, we have dietary interventions (hypocaloric diets, very low calorie diets, special diets), exercise interventions, pharmacological interventions (Orlistat, Liraglutide, Naltrexone / Boupropion, Phentermine / Topiramate, Lorcaserin) and bariatric surgery (gastric banding, gastric Roux-en-Y by pass, sleeve gastrectomy). Despite all these, obesity remains an unsolved problem of our time with unmet needs that need combined global awareness from both the scientific community and the state

The predictive role of soluble ST2 in type 2 diabetes patients with early stage left ventricular diastolic dysfunction

Soluble ST2, a member of the Toll/IL-1 superfamily, is considered as a decoy receptor for IL-33 which inhibits the protective effect of this cytokine in atherosclerosis and myocardial remodeling. We investigated the differences in the levels of soluble ST2 and other biomarkers between healthy controls and patients with type 2 diabetes mellitus (DM2) with and without left ventricular diastolic dysfunction (LVDD). Secondly, we investigated the predictive value of soluble ST2 in the new onset LVDD in DM2 patients.We recruited 158 volunteers, who after extensive echocardiographic control were divided into 4 groups: Group A: 42 healthy controls, group B: 18 subjects without DM2 with LVDD, Group C: 48 patients with type 2 diabetes without LVDD and Group D: 50 patients DM2 and LVDD. Patients were followed up after 6, 12, 24 months. Soluble ST2 was measured by ELISA.Patients with type 2 diabetes with LVDD (p <0.001) or without LVDD (p = 0.007) showed higher levels of soluble ST2 compared to individuals without DM2. This relationship was found also for hs-CRP but not for the BNP. In the multivariate analysis HbA1c emerged that is positively and independently associated with the baseline values ​​of ST2. At the prospective part of the study, 54.16% of patients in group C demonstrated new onset LVDD. The logistic regression highlighted fasting triglycerides and hs-CRP as those biomarkers that can predict the installation new LVDD in DM2 patients within 24 months. Soluble ST2 had no such predictive power.Patients with type 2 diabetes have higher levels of ST2 compared to individuals without type 2 diabetes. The presence LVDD on DM2 is associated with even higher levels of ST2. Fasting triglycerides and hs-CRP can predict the installment of new LVDD in DM2 patients within 24 months, while soluble ST2 has no such power.Ο διαλυτός ST2, ένα μέλος της Toll/IL-1 υπεροικογένειας, θεωρείται ως δεσμευτικός υποδοχέας της IL-33 αναστέλλοντας την προστατευτική δράση αυτής της κυτταροκίνης στην αθηρωμάτωση και αναδιαμόρφωση του μυοκαρδίου. Ερευνήσαμε τις διαφορές στα επίπεδα του διαλυτού ST2 και άλλων κλασικών βιοδεικτών μεταξύ υγιών μαρτύρων και ασθενών με σακχαρώδη διαβήτη τύπου 2 (ΣΔτ2) με και χωρίς διαστολική δυσλειτουργία αριστερής κοιλίας (ΔΔΑΚ). Δευτερευόντως, διερευνήσαμε την προβλεπτική ικανότητα του διαλυτού ST2 στην εγκατάσταση ΔΔΑΚ σε ασθενείς με ΣΔτ2.Συμπεριλάβαμε 158 εθελοντές, οι οποίοι μετά από εκτενή υπερηχογραφικό καρδιολογικό έλεγχο χωρίστηκαν σε 4 ομάδες: Ομάδα Α: 42 υγιείς μάρτυρες, Ομάδα Β: 18 άτομα χωρίς ΣΔτ2 με ΔΔΑΚ, Ομάδα Γ: 48 άτομα με ΣΔτ2 χωρίς ΔΔΑΚ και Ομάδα Δ: 50 άτομα με ΣΔτ2 και ΔΔΑΚ. Οι ασθενείς επανεξετάστηκαν μετα από 6, 12, 24 μήνες. O διαλυτός ST2 μετρήθηκε με ELISA.Οι ασθενείς με ΣΔτ2 με ΔΔΑΚ (p<0.001) ή χωρίς ΔΔΑΚ (p=0.007) εμφάνισαν υψηλότερα επίπεδα διαλυτού ST2 σε σχέση με τα άτομα χωρίς ΣΔτ2. Η σχέση αυτή βρέθηκε και για την hs-CRP ενώ δεν επιβεβαιώθηκε για το BNP. Στην πολυπαραγοντική ανάλυση η HbA1c αναδείχθηκε ότι σχετίζεται θετικά και ανεξάρτητα με τις τιμές του ST2. Στην προοπτική μελέτη, το 54.16% των ατόμων της ομάδας Γ εμφάνισαν νέα ΔΔΑΚ. Η λογιστική παλινδρόμηση ανέδειξε τα τριγλυκερίδια νηστείας και την hs-CRP ως τους βιοδείκτες εκείνους που μπορούν να προβλέψουν την εγκατάσταση ΔΔΑΚ σε ΣΔτ2 ασθενείς εντός 24μήνου. Ο διαλυτός ST2 δεν είχε τέτοια προβλεπτική ικανότητα.Οι ασθενείς με ΣΔτ2 εμφανίζουν υψηλότερα επίπεδα ST2 σε σχέση με άτομα χωρίς ΣΔτ2. Η παρουσία ΔΔΑΚ επί ΣΔτ2 συνδέεται με ακόμη υψηλότερα επίπεδα ST2. Τα τριγλυκερίδια νηστείας και η hs-CRP μπορούν να προβλέψουν την εμφάνιση νέας ΔΔΑΚ σε ΣΔτ2 ασθενείς εντός 24μήνου, ενώ ο διαλυτός ST2 δεν έχει τέτοια δυνατότητα