Study of the gut microbiome in Egyptian patients with type 1 diabetes mellitus.

Introduction: Type 1 diabetes mellitus (T1DM) is an autoimmune disease. The gut microbiota has been proposed as a key actor in the pathogenesis of T1DM. Aim: To identify the gut microbiome that are likely to be related to T1DM. This may have an impact on the future understanding of the pathogenesis of T1DM and possible approaches to prevent and treat it. Material and methods: The study included 40 T1DM patients and a cross-matching control group of 20 healthy subjects of matched age and sex; stool specimens were taken from each group. Quantitative SYBR Green Real-Time PCR technique targeting 16S rRNA was done for the identification and quantitation of Bacteroides, Prevotella, Ruminococcus, Lactobacillus johnsonii, Lactobacillus reuteri, and Veillonella. Results: T1DM patients showed significantly higher Bacteroides (p < 0.001) and Lactobacillus johnsonii (p = 0.003), but lower Veillonella (p = 0.013) than the control group. However, there was no statistical difference between T1DM and control cases as regards Prevotella (p = 0.204), Ruminococcus (p = 0.598), Lactobacilli (p = 0.901), and Lactobacillus reuteri (p = 0.332). Conclusions: Egyptian patients showed dysbiosis of the gut microbiome that can be related to the pathogenesis of T1DM. This hopefully points to the potential therapeutic benefits of manipulating the composition of the gut microbiome in the management of, or even protection from, T1DM.

Prevalence of type 2 diabetes mellitus in a sample of the adult population of Alexandria, Egypt.

AIMS: To determine the prevalence of type 2 diabetes mellitus in a sample of the adult population of Alexandria, Egypt, and to delineate the epidemiologic profile of the disease in this community. METHODS: This cross-sectional study was conducted on a representative sample of the population. Participants provided demographic data, their medical history, and blood samples for measurement of plasma glucose (fasting and after oral glucose load) and underwent a detailed physical examination. RESULTS: Of 10,640 eligible subjects, 9657 (90.8%) aged 18-90 years agreed to participate (3795 men, 5862 women). We found an age-adjusted prevalence of diabetes of 16.8% (men, 12.7%; women 19.1%); of prediabetes, 14.6% (men, 13.5%; women, 15.2%), and of newly diagnosed diabetes, 5.5% (men, 3.3%; women, 6.6%). Diabetes was most common in people older than 50 years; prediabetes was most common in 30-39-year-old men and in women younger than 20. In logistic regression analysis, factors independently associated with prediabetes were a history of dyslipidaemia, urban residence, and widowhood. Independent associated factors for diabetes were a high waist-to-hip ratio, family history of diabetes, being divorced, history of dyslipidaemia, peripheral arterial disease or hypertension, low education level, and being not working. CONCLUSIONS: We found a high prevalence of diabetes and prediabetes in Alexandria, particularly in the middle-aged population. Given globally increasing life expectancies, the number of individuals with diabetes could become particularly challenging to the Egyptian healthcare system. Comprehensive national preventive measures are urgently needed.

Serum chemerin and high-sensitivity C reactive protein as markers of subclinical atherosclerosis in Egyptian patients with type 2 diabetes.

CONTEXT: Chemerin is one of the adipokines that regulate fat metabolism. High-sensitivity C-reactive protein (hs-CRP) may be considered as a cardiovascular risk predictor. Measuring intima-media thickness of the CCA (C-IMT) is a well-evidenced tool for the detection of early stages of atherosclerosis. We aimed here to study both serum chemerin and hs-CRP as markers of subclinical atherosclerosis in Egyptian patients with type 2 diabetes, who are angiographically free of coronary artery disease (CAD). SUBJECTS AND METHODS: This cross-sectional study was conducted on 180 subjects divided into two groups: Group A included 90 type 2 diabetic patients without CAD and group B including 90 nondiabetic control subjects. All study subjects were having normal coronary angiography. Serum chemerin, homeostasis model assessment for insulin resistance (HOMA-IR), glycated haemoglobin (HbA1c), lipid profile, hs-CRP as well as C-IMT were assessed in all study subjects. RESULTS: There was a statistically significant difference between the 2 groups regarding serum chemerin level, HOMA-IR, hs-CRP and C-IMT; being higher in the diabetic patients than in the control group (p = 0.006, 0.024, 0.040 and <0.001, respectively). There was positive correlation between serum chemerin level and waist-to-hip ratio (WHR), HOMA-IR, hs-CRP and C-IMT. Carotid intima-media thickness was positively correlated with patients' WHR, blood pressure, HbA1c, diabetes duration as well as hs-CRP, and negatively correlated with ankle-brachial index (ABI). Linear regression analysis showed that HbA1c, serum chemerin and hs-CRP were independently affecting C-IMT. Serum hs-CRP was positively correlated with HbA1c and HOMA-IR (p = 0.006 and 0.032, respectively), and negatively correlated with HDL-cholesterol level (p = 0.018). CONCLUSION: Both serum chemerin and hs-CRP could be considered as markers of subclinical atherosclerosis, and hence, may be utilized for the early detection of macrovascular disease, in Egyptian patients with type 2 diabetes.

The Utility of the Mini-Addenbrooke's Cognitive Examination as a Screen for Cognitive Impairment in Elderly Patients with Chronic Kidney Disease and Diabetes.

BACKGROUND/AIMS: We tested the utility of the Mini-Addenbrooke's Cognitive Examination (M-ACE) in a cohort of older adults with chronic kidney disease (CKD) and diabetes. METHOD: The M-ACE was administered to 112 CKD and diabetes patients attending a nephrology clinic. Cognitive impairment was based upon patient, informant, and case review, neuropsychological assessment, and application of criteria for mild cognitive impairment (MCI) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition for dementia. The M-ACE was also compared to the Mini-Mental State Examination (MMSE). RESULTS: Upon assessment, 52 patients had normal cognitive function, 33 had MCI, and 27 had dementia. The area under the receiver operating curve for the M-ACE was 0.96 (95% CI 0.95-1.00). The sensitivity and specificity for a dementia diagnosis were 0.96 and 0.84 at the cut point <25 and 0.70 and 1.00 at the cut point <21. Mean M-ACE scores differed significantly between normal, demented, and MCI groups (p < 0.001), and compared to the MMSE, the M-ACE did not suffer from ceiling effects. CONCLUSION: The M-ACE is an easily administered test with good sensitivity and specificity to capture and assist in the diagnosis of MCI or dementia in patients with CKD and diabetes.

Optimal waist circumference cutoff points for the determination of abdominal obesity and detection of cardiovascular risk factors among adult Egyptian population.

OBJECTIVE: To determine the best anthropometric measurement of obesity, and its optimal cutoff, that best predicts the presence of cardiovascular risk factors among adult Egyptian population. METHODS: This is a cross-sectional study including a representative randomly chosen sample of the adult Egyptian population from all Alexandria Districts (the second largest governorate in Egypt) based on the multistage random technique. It included 3209 subjects (1567 men, 1642 women) aged 18-80 years from urban and rural areas. The response rate was 80.2%. History, blood pressure, and anthropometric measurements were taken. Laboratory investigations included fasting lipid profile, fasting plasma glucose, and serum uric acid. Different criteria of metabolic syndrome were used and compared. Receiver operator characteristic curve and Youden index were used to determine predictability and cutoffs. RESULTS: Waist circumference (WC) is the best to predict at least two other components of the metabolic syndrome as defined by the International Diabetes Federation (IDF). The optimal WC cutoffs were 100.5 and 96.25 cm for Egyptian men and women, respectively. The Joint Interim Statement definition (JIS) of metabolic syndrome was the best to predict cardiovascular disease in both genders and diabetes mellitus in women. The prevalence of metabolic syndrome and abdominal obesity was 42.5%, 61%, respectively (ATPIII definition); 43.8%, 61% (American Heart Association definition); 44.3%, 76.4% (IDF definition); 33.8%, 51.7% (IDF definition with Egyptian cutoffs); and 41.5%, 51.7% (JIS with Egyptian cutoffs). CONCLUSION: WC cutoffs in Egyptians differ from those currently recommended. Prevalence of metabolic syndrome and abdominal obesity is high in Egypt, despite being lower on using the Egyptian cutoffs.

Resveratrol promotes foot ulcer size reduction in type 2 diabetes patients.

Objective. The effect of a proprietary formulation of trans-resveratrol (t-RSV) on manifestations of diabetic foot syndrome (DFS) was studied in type 2 diabetic patients with newly diagnosed diabetic foot ulcers. Method. Placebo-controlled, examiner-blinded, parallel-group randomized controlled pilot clinical trial (ACTRN Clinical Trial Registry number 12610000629033) involving 24 patients with DFS (15 males and 9 females, average age of 56.4 ± 9.1 years) divided into the placebo and RSV-treatment groups was performed. 50 mg of t-RSV or placebo capsules was given to each patient twice a day over a 60-day time period. Results. Reduction in the parameters reflecting diabetic ulcer size was more profound in the RSV group as compared to placebo. RSV-treated patients also had a marginally improved performance in the foot pressure test. A statistically significant decline in the plasma fibrinogen level, but not CRP, was also found in the RSV-treated patients. Some improvement in the plasma lipid profile and fasting glucose levels were not related to RSV-treatment, since they have been seen on both the RSV and placebo groups, revealing the effectiveness of medical supervision and education in the newly diagnosed patients with DFS. Conclusion. t-RSV supplementation promotes reduction of the foot ulcer size and reduces plasma fibrinogen level in type 2 diabetic patients.