Atherogenic Index of Plasma (AIP): The Most Accurate Indicator of Overweight and Obesity Among Lipid Indices in Type 2 Diabetes-Findings From a Cross-Sectional Study.

BACKGROUND: This study aimed to evaluate the relationships of conventional and calculated lipid indices with obesity or overweight in patients with type 2 diabetes (T2D). METHODS: In this cross-sectional study, all participants were categorised into three groups: normal weight (18 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). Conventional lipid indices, including triglyceride (TG), total cholesterol, LDL-C and HDL-C, were measured. Lipid indices, including the atherogenic index of plasma (AIP), non-HDL-C, TC/HDL-C, LDL-C/HDL-C, non-HLD-C/HDL-C (atherogenic index, AI) and lipoprotein combine index (LCI), were calculated. The associations of these lipid indices with obesity and overweight status were evaluated using univariate and multivariate multinomial logistic regression analyses. RESULTS: In this study, 2661 patients with T2D, including 651 patients with normal weight, 1144 with overweight, and 866 with obesity, were recruited. According to a multinomial logistic regression analysis after adjustment for multiple confounders, the odds ratio (OR) was greater for the AIP than for other conventional and calculated lipid indices in overweight and obese patients with T2D. The AIP had a significant relationship with overweight, with an OR of 4.79 (95% CI: 1.65-13.85), and it had a significant relationship with obesity, with an OR of 13.64 (95% CI: 3.96-47.04). According to the ROC curve, with a cut-off value of 0.68, AIP could predict obesity with 82% sensitivity and 55% specificity (AUC = 0.770, 95% CI: 0.729-0.812, p < 0.001). CONCLUSION: Compared with other conventional and calculated lipid markers, the AIP is most strongly associated with obesity and overweight in patients with T2D.

Waist-to-hip ratio as a contributor associated with higher atherosclerotic cardiovascular disease risk assessment in patients with diabetes: a cross-sectional study.

INTRODUCTION: This study aimed to identify the factors most strongly associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk score in patients with type 2 diabetes (T2D). METHODS: This cross-sectional study included 4698 patients with T2D over an 11-year period (2010-2021). Patients were categorized into four groups based on their 10-year ASCVD risk score (< 5%, 5-7.5%, 7.5-20%, and > 20%). Multinominal regression analysis was used to evaluate the association between various modifiable and non-modifiable risk factors and the ASCVD risk score. RESULTS: Of the patients, 35.9% had a 10-year ASCVD risk score below 5%, 12.6% had a score between 5% and 7.5%, 30.8% had a score between 7.5% and 20%, and 19.7% had a score above 20%. Higher ASCVD risk scores were significantly associated with elevated waist-to-hip ratio (WHR > 0.93), pulse pressure, uric acid, triglycerides, and decreased glomerular filtration rate (all p-values < 0.05). WHR demonstrated the strongest association with higher ASCVD risk scores (OR: 4.55, 95% CI: 2.94-7.03, p < 0.001) when comparing patients with ASCVD scores > 5% to those with scores < 5%. CONCLUSION: WHR was independently associated with higher ASCVD risk scores in patients with T2D. Incorporating WHR, along with traditional risk factors, could improve ASCVD risk assessments in this population.

Relationship between advanced glycation end-products and advanced oxidation protein products in patients with type 2 diabetes with and without albuminuria: A cross-sectional survey.

Background and Aims: Literature suggests that oxidative stress plays a crucial role in the progression of diabetes. Since poor glycemic control enhances the formation of advanced glycation end-products (AGEs) and advanced oxidation protein products (AOPP) in individuals with diabetes, exploring the association between glycation and oxidative states in diabetes could also shed light on potential consequences. This study evaluated the effects of albuminuria on AGEs and AOPP levels and measured their relationship in participants with type 2 diabetes (T2D) with or without albuminuria. Methods: A cross-sectional, matched case-control study was designed, including 38 T2D subjects with albuminuria and 38 matched T2D subjects with normoalbuminuria. Patients were matched by their body mass index (BMI), age, and duration of diabetes. The unadjusted and adjusted correlation between AGEs and AOPP in the studied groups were analyzed by multiple logistic regression. Using ggplot2, the ties between these two biochemical factors in cases and controls were plotted. Results: This study elucidated a significant association between AGEs and AOPP in participants with normoalbuminuria (r = 0.331, p-value < 0.05), which continued to be significant after controlling for BMI, age, systolic blood pressure (SBP), and diastolic blood pressure (DBP) (r = 0.355, p-value < 0.05). However, there was no significant association between AGEs and AOPP in those with albuminuria in the unadjusted model (r = 0.034, p-value = 0.841) or after controlling for BMI, age, SBP, and DBP (r = 0.076, p-value = 0.685). Conclusion: Oxidation and glycation molecular biomarkers were correlated in patients without albuminuria; however, this association was not observed in those with albuminuria.

High prevalence of comorbidities in older adult patients with type 2 diabetes: a cross-sectional survey.

BACKGROUND: Diabetes is a global health problem, and its incidence and complications increase with the duration of the disease and over time. This increase in complications in older patients can lead to disability and a lower quality of life. This study aimed to investigate the rate of diabetes control and complications in older adults. METHOD: This was a cross-section of an ongoing cohort of patients with type 2 diabetes mellitus (T2DM) aged 65 years and older. The clinical and laboratory characteristics of older adult patients with T2DM in good and intermediate health conditions were collected between 2010 and 2022. RESULTS: A total of 2,770 older adult patients with T2DM were enrolled, including 1,530(55.3%) female and 1,240 (44.7%) male participants. Metabolic syndrome, hypertension, and coronary artery disease were the most common comorbidities, affecting 1,889 (71.4%), 1,495 (54.4%), and 786 (29.2%) patients, respectively. Albuminuria was present in 626 (22.6%) patients, while retinopathy was detected in 408 (14.7%) patients, including 6% with proliferative retinopathy. Most patients were treated with oral antidiabetic agents (88.9%), with metformin being the most prescribed medication (85.6%). Statins were prescribed to 71.8% of the patients. The most prescribed antihypertensive medications were angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, prescribed to 54% and 15% of patients, respectively. The hemoglobin A1c (HbA1c) goal (HbA1c < 7.5%) was achieved in 1,350 (56.4%) patients, and the low-density lipoprotein cholesterol (LDL-C) goal (LDL < 100) was achieved in 1,165 (45.6%) patients. Blood pressure control (BP < 140/90) was achieved in 1,755 (65.4%) patients. All three goals were achieved in 278 (10.3%) patients. There were no significant differences in clinical laboratory results and the patients' characteristics based on gender. CONCLUSION: The rate of progression of complications in older adult patients is higher than the effectiveness of the treatment, indicating the need for increased social support for this age group.

Vitamin D in Type 2 Diabetes and Its Correlation With Heat Shock Protein 70, Ferric Reducing Ability of Plasma, Advanced Oxidation Protein Products and Advanced Glycation End Products.

AIM: To investigate the association between vitamin D3 level and oxidative stress biomarkers such as Heat Shock Protein 70 (HSP70), ferric reducing ability of plasma (FRAP), advanced oxidation protein products (AOPP) and advanced glycation end products (AGEs) in patients with Type 2 diabetes. METHOD: In this cross-sectional study, 54 patients including 32 females and 22 males with a mean age of 54.92 ± 11.37 years with T2D attending the diabetes clinic from 2021 to 2022 were included. According to the average level of vitamin D in this population (14.91), they were divided into two groups with vitamin D ≤15 ng/mL and vitamin D >15 ng/mL. Multivariate regression analysis was conducted to evaluate the relationship between vitamin D and AOPP, HSP and FRAP parameters. The correlation between vitamin D and other variables was evaluated via the Pearson correlation test. RESULT: Vitamin D level had a positive relation with FRAP (ß = 0.32, p = 0.017) and HSP (ß = 0.39, p = 0.003), but had a negative relation with AOPP (ß = -0.30, p = 0.02). The level of 2hPP also had a negative relation with the level of vitamin D (ß = -0.33, p = 0.03). There was not any relationship between the level of vitamin D and AGEs or other variables. After adjusting for multiple confounders for the multivariate regression model, HSP remained significant. CONCLUSION: This research indicates the relationship between vitamin D levels and oxidative stress biomarkers in patients with Type 2 diabetes.

Increased high-density lipoprotein cholesterol in patients with type 2 diabetes and its correlates: a cross-sectional, matched case-control survey.

BACKGROUND: So far, high-density lipoprotein cholesterol (HDL-C) levels and mortality were shown to have a U-shaped relationship. Additionally, high HDL-C levels increase the risk of developing a variety of diseases. However, a paucity of data exists regarding the characteristics of people with high HDL-C levels. The aim of this study was to assess the demographics and characteristics of patients with high HDL-C levels and compare their features with normal and low HDL-C groups. METHODS: As a cross-sectional, matched case-control study, a total of 510 patients with type 2 diabetes (T2D) were enrolled in the study and categorized into three matched groups according to their HDL-C concentrations. The studied groups were matched by their age and gender. Restricted cubic spline (RCS) curves were designed to evaluate the relationship between height, blood pressure, triglyceride, and vitamin D concentrations with the probability of having high HDL-C levels. Furthermore, violin plots were conducted to illustrate the distribution of continuous variables within each group. RESULTS: This study showed that having high HDL-C (more than 70 mg/dL) compared to having low HDL-C (less than 40 mg/dL in men and 50 mg/dL in women) was significantly associated with height (OR 0.918, 95% CI 0.866-0.974), systolic blood pressure (SBP) (0.941, 0.910-0.972), vitamin D (0.970, 0.941-0.999), and triglyceride (0.992, 0.987-0.998) serum concentrations. Further analysis investigated that having high HDL-C levels compared to desired HDL-C levels (40 ≤ HDL-C levels < 70 in men and 50 ≤ HDL-C levels < 70 in women) was inversely associated with having SPB values greater than 130 mmHg. Besides, sufficient vitamin D levels (above 20 ng/ml) could 0.349 times decrease the odds of having high HDL-C versus normal HDL-C levels. CONCLUSION: Sufficient vitamin D levels, SPB values higher than 130 mmHg, as well as increased triglyceride levels, were inversely associated with having high HDL levels. However, higher height values were associated with a decreased likelihood of having high HDL.

Nonalcoholic Fatty Liver Disease as a Potential Risk Factor for Cardiovascular Disease in Patients with Type 2 Diabetes: A Prospective Cohort Study.

Methods and Results: In this prospective cohort study, 1197 patients with type 2 diabetes (T2D) were divided into two groups (360 patients with NAFLD and 847 without NAFLD) and were followed for a median of 5 years for the incidence of CVD. Cox regression analysis was used to assess the association between NAFLD, liver enzyme level, aspartate aminotransferase to platelet ratio index (APRI), and the incidence risk of CVD and its subgroups (i.e., myocardial infarction, chronic heart disease, coronary artery bypass grafting, and percutaneous coronary intervention). There was a significant positive association between CVD incidence and NAFLD (HR = 1.488, 95% CI = 1.041-2.124, p value = 0.029). Although patients with NAFLD had higher levels of ALT and AST levels (p value = <0.001), there was no significant association between liver enzymes and the incidence risk of CVD when adjusted for different variables. Furthermore, NAFLD was associated with NAFLD APRI Q (2), APRI Q (3), and APRIQ (4) (1.365 (1.046-1.781), 1.623 (1.234-2.135), and 3.373 (2.509-4.536)), respectively. Conclusion: NAFLD increased the incidence risk of CVD in T2D. However, there was no association between liver enzymes (ALT, AST, ALK-P, and GGT) and a higher incidence risk of CVD in T2D when adjusted for confounding variables.

ApoA1/HDL-C ratio as a predictor for coronary artery disease in patients with type 2 diabetes: a matched case-control study.

INTRODUCTION: This study investigated the possible relationship between the Apo lipoprotein A1 /high-density lipoprotein cholesterol (ApoA1/HDL-C) ratio and coronary artery disease (CAD) in patients with type 2 diabetes (T2D). METHODS: This was a matched case-control study of 482 patients with T2D in two groups of CAD and (n = 241) non-CAD (n = 241). The patients were classified into four quartiles according to the ApoA1/HDL-C ratio, and multivariate logistic regression analysis was performed to assess the relationship between ApoA1/HDL-C and CAD. ROC analysis was also conducted. RESULTS: This study showed that the ApoA1/HDL-C ratio has an independent association with CAD in individuals with T2D. The CAD group exhibited a significantly higher ApoA1/HDL-C ratio than those without CAD (p-value = 0.004). Moreover, the risk of CAD increased significantly across the ApoA1/HDL-C ratio quartiles, with the highest odds in the fourth quartile. The second quartile showed an odds ratio (OR) of 2.03 (p-value = 0.048) compared to the first. Moving to the third quartile, the OR increased to 2.23 (p-value = 0.023). The highest OR was noted in the fourth, reaching 3.41 (p-value = 0.001). Employing a cut-off value of 2.66 and an area under the curve (AUC) of 0.885, the ApoA1/HDL-C ratio predicts CAD among patients with T2D with a sensitivity of 75% and a specificity of 91% (p-value < 0.001). CONCLUSION: The current study revealed an independent association between ApoA1/HDL-C ratio and CAD in patients with T2D. This ratio can be a promising tool for predicting CAD during the follow-up of patients with T2D, aiding in identifying those at higher risk for CAD.

Impact of Gender on Chronic Complications in Participants With Type 2 Diabetes: Evidence From a Cross-Sectional Study.

INTRODUCTION: This study aimed to assess and compare the prevalence of diabetes complications between men and women with Type 2 diabetes (T2D), as well as how gender relates to these complications. METHODS: In this cross-sectional study, complications of diabetes, including coronary artery disease (CAD), retinopathy, neuropathy and diabetic kidney disease (DKD), were evaluated in 1867 participants with T2D. Additionally, baseline characteristics of the individuals, including anthropometric measurements, metabolic parameters and the use of dyslipidaemia drugs and antihyperglycaemic agents, were assessed. Gender differences in complications were examined using the chi-squared test. Multivariate logistic regression was employed to investigate the relationship between gender and T2D complications, with and without adjusting for the characteristics of the studied population. RESULTS: In the studied population, 62.1% had at least one complication, and complications were 33.5% for DKD, 29.6% for CAD, 22.9% for neuropathy and 19.1% for retinopathy. The prevalence of CAD and neuropathy was higher in men. However, DKD and retinopathy were more prevalent among women. Odds ratios of experiencing any complication, CAD and retinopathy in men compared with women were 1.57 (95% CI: 1.27-2.03), 2.27 (95% CI: 1.72-2.99) and 0.72 (95% CI: 0.52-0.98), respectively, after adjusting for demographic factors, anthropometric measures, metabolic parameters and the consumption of dyslipidaemia drugs and antihyperglycaemic agents. CONCLUSION: The prevalence of diabetes complications was significantly higher in men with diabetes, highlighting the need for better treatment adherence. CAD was associated with the male gender, whereas retinopathy was associated with the female gender. Men and women with diabetes should be monitored closely for CAD and retinopathy, respectively, regardless of their age, diabetes duration, anthropometric measures, laboratory findings and medications.

Effects and safety of resveratrol supplementation in older adults: A comprehensive systematic review.

Resveratrol (RSV) has garnered significant attention in recent years due to its potential benefits against chronic diseases. However, its effects and safety in older adults have not been comprehensively studied. This study aimed to determine the effects and safety of RSV supplementation in older adults. MEDLINE/PubMed, Scopus, and Web of Science databases were comprehensively searched for eligible studies. Studies were enrolled if they were randomized clinical trials and had incorporated RSV supplementation for older adults. Two independent authors conducted the literature search, and eligibility was determined according to the PICOS framework. Study details, intervention specifics, and relevant outcomes were collected during the data collection. The Cochrane RoB-2 tool was used to evaluate the risk of bias. This review included 10 studies. The combination of RSV and exercise improved exercise adaptation and muscle function in healthy older adults and physical performance and mobility measures in individuals with functional limitations. RSV showed potential neuroprotective effects in patients with Alzheimer's disease. In overweight individuals, RSV demonstrated a positive impact on cognitive function, but it increased some biomarkers of cardiovascular disease risk at high doses. In older adults with diabetes and those with peripheral artery disease (PAD), RSV was not more effective than placebo. No study reported significant adverse events following RSV treatment. RSV can improve various health parameters in age-related health conditions. However, the optimal dosage, long-term effects, and potential interactions with medications still need to be investigated through well-designed RCTs.

Associations of major dietary patterns with cardiometabolic risk factors among Iranian patients with type 1 diabetes.

Objective: To examine the associations between dietary patterns and cardiometabolic risk factors among type 1 diabetic (T1D) patients. Methods: This cross-sectional study was conducted on 229 Iranian T1D patients. Data on dietary intakes were collected using a 168-item food frequency questionnaire. To identify major dietary patterns, we merged data on the 168 food items to obtain 23 food groups. Then, we constructed major dietary patterns using factor analysis with varimax rotation. We used binary logistic regression to assess the association between dietary patterns and cardiometabolic risk factors, in which potential confounders were adjusted. Results: Four dietary patterns were identified: Western, unhealthy, traditional, and semi-healthy patterns. After adjusting for confounders including demographic variables, physical activity, energy intake, and medical history, participants in the highest tertile of the Western dietary pattern had 2.53 (95 % CI: 1.03-6.22) and 3.37 (95 % CI: 1.18-9.63) times more odds of elevated HbA1c and low estimated glucose disposal rate (eGDR), respectively, compared with those in the lowest tertile. Such the positive association was also seen for elevated fasting blood glucose (FBG). Moreover, individuals in the top tertile of unhealthy diet had more odds of elevated LDL-c and abdominal obesity than those in the lowest tertile. Regarding the semi-healthy diet, higher adherence was associated with 51 % lower odds of elevated FBG (OR: 0.49, 95 % CI: 0.24-0.99). For other outcomes, no significant association was found. Conclusion: We found that T1D patients may take benefit from adherence to a semi-healthy diet with a low amount of unhealthy and Western-related foods.

Correlates of normal and decreased HDL cholesterol levels in type 2 diabetes: a cohort-based cross-sectional study.

BACKGROUND: The literature describes an inverse association between the values of triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C). This survey was designed to exhibit the features of people with type 2 diabetes (T2D) who display this inverse association and identify potential contributing factors to having normal HDL-C values. METHODS: A total of 6127 persons with T2D were assigned to the present survey. Demographic features and clinical status data were compared between subjects with a substantial inverse association of TG and HDL-C and those without. Logistic regressions were performed to ascertain the role of different factors related to normal HDL-C. Moreover, the restricted cubic spline (RCS) functions were conducted to scrutinize the underlying relationships between the studied variables and low HDL-C levels. RESULTS: Patients with high TG (150 ≤ TG < 400) compared to patients with normal TG (TG < 150) were less likely to have normal HDL-C. Younger age, narrow hip, lower levels of blood pressure, two-hour postprandial glucose (2hPP), fasting blood sugar (FBS), hemoglobinA1C (HbA1C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and non-HDL-C, higher atherogenic index of plasma (AIP), and TG/HDL-C ratio correlate with an inverse connection between the values of HDL-C and TG (all P < 0.05). Age greater than 65 years (odds ratio (OR) 1.260, 95% confidence intervals (CI) 1.124-1.413) had a positive association, whereas female sex (OR 0.467, CI 0.416-0.523) , 25 kg/m2 < body mass index (BMI) (OR 0.786, CI 0.691-0.894), and higher serum creatinine levels (OR 0.481, CI 0.372-0.621) had an inverse association with having normal HDL-C. CONCLUSIONS: Patients with an inverse connection between TG and HDL-C values had considerably different anthropometric features, lipid profiles, and glucose indices compared to those without this relationship. Furthermore, patients who aged less than 65 years, had female gender, BMI more than 25 kg/m2, and higher serum creatinine levels were less likely to exhibit normal HDL-C levels.

Serum lipoprotein(a) and reclassification of coronary heart disease risk; application of prediction in a cross-sectional analysis of an ongoing Iranian cohort.

INTRODUCTION: Recent studies have introduced elevated lipoprotein(a) (Lp(a)) as a risk factor for coronary heart disease (CHD). This study investigated whether the addition of Lp(a) as a novel biomarker to the Framingham Risk Score (FRS) model improves CHD risk prediction. METHODS: The study included 1101 Iranian subjects (443 non-diabetic and 658 diabetic patients) who were followed for 10 years (2003-2013). Lp(a) levels and CHD events were recorded for each participant. RESULTS: The Net Reclassification Index (NRI) after adding Lp(a) to the FRS model was 19.57% and the discrimination slope was improved (0.160 vs. 0.173). The Akaike Information Criterion (AIC), a measure of model complexity, decreased significantly after adding Lp(a) to the FRS model (691.9 vs. 685.4, P value: 0.007). CONCLUSIONS: The study concluded that adding Lp(a) to the FRS model improves CHD risk prediction in an Iranian population without making the model too complex. This could help clinicians to better identify individuals who are at risk of developing CHD and to implement appropriate preventive measures.

The lack of association between different LDL-C levels and oxidized LDL in patients with type 2 diabetes.

Background: High concentrations of low-density lipoprotein cholesterol (LDL-C) have been a known risk factor for cardiovascular diseases. Also, the role of oxidized LDL (ox-LDL) in forming atherosclerosis plaque has been proven. However, it has not yet been proven that atherogenic LDL-C by-products like ox-LDL will decrease by keeping the LDL levels at the desired level. This study aimed to examine the relationship between LDL-C and ox-LDL in different LDL-C values in patients with type 2 diabetes (T2D). Methods: In this cross-sectional study, 347 patients with T2D who received statins were enrolled. LDL-C values were defined into four groups as LDL-C < 55 mg/dL, 55 mg/dL ≤ to <70 mg/dL, 70 mg/dL ≤ to <100 mg/dL and LDL-C ≥ 100 mg/dL. Total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and ox-LDL were studied in the four defined groups. Results: Ox-LDL levels were not different among the four groups (p = 0.30). In addition, LDL-C and ox-LDL levels had no significant correlation (r = 0.480, p = 0.376). Additionally, based on this study analysis, ox-LDL levels were significantly correlated with TG levels (r = 0.119, p < 0.05) and TG/HDL ratio (r = 0.390, p < 0.01). Conclusions: It is concluded that ox-LDL levels were not associated with different LDL-C level categories from <55 mg/dL to >100 mg/dL in patients with T2D. However, the revealed association of ox-LDL with TG level and TG/HDL ratio may be considered in the clinic.

Bilateral inferior petrosal sinus sampling: validity, diagnostic accuracy in lateralization of pituitary microadenoma, and treatment in eleven patients with Cushing's syndrome - a single-center retrospective cohort study.

BACKGROUND: This single-center retrospective cohort study aimed to describe the findings and validity of Bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of patients with ACTH-dependent Cushing's syndrome (CS). METHODS: Eleven patients underwent BIPSS due to equivocal biochemical tests and imaging results. Blood samples were taken from the right inferior petrosal sinus (IPS), left IPS, and a peripheral vein before and after stimulation with desmopressin (DDAVP). ACTH and prolactin levels were measured. The diagnosis was based on the ACTH ratio between the IPS and the peripheral vein. Also, lateralization of pituitary adenoma in patients with Cushing's disease (CD) was predicted. No significant complications were observed with BIPSS. RESULTS: Based on the pathology report, eight patients had CD, and three had ectopic ACTH syndrome (EAS). Unstimulated BIPSS resulted in a sensitivity of 87.5%, specificity of 100%, PPV of 100%, NPV of 75%, and accuracy of 91%. Stimulated BIPSS resulted in a sensitivity of 100%, specificity of 100%, PPV of 100%, NPV of 100%, and accuracy of 100%. However, pituitary magnetic resonance imaging (MRI) had a lower diagnostic accuracy (sensitivity:62.5%, specificity:33%, PPV:71%, NPV:25%, accuracy:54%). BIPSS accurately demonstrated pituitary adenoma lateralization in 75% of patients with CD. CONCLUSIONS: This study suggests that BIPSS may be a reliable and low-complication technique in evaluating patients with ACTH-dependent CS who had inconclusive imaging and biochemical test results. The diagnostic accuracy is improved by DDAVP stimulation. Pituitary adenoma lateralization can be predicted with the aid of BIPSS.

Vitamin C supplementation lowers advanced glycation end products (AGEs) and malondialdehyde (MDA) in patients with type 2 diabetes: A randomized, double-blind, placebo-controlled clinical trial.

This study evaluated how daily vitamin C administration impacts systemic oxidative stress and inflammation and its safety in T2D patients. This randomized, double-blinded, placebo-controlled, parallel-arm clinical trial included 70 patients with T2D. They were allocated to receive either 500 mg/day of vitamin C or a matching placebo for 8 weeks. Of the 70 subjects assigned to the trial, 57 were included in the statistical analysis (vitamin C: n = 32, placebo: n = 25). Inflammatory and oxidative markers, including advanced glycation end products (AGEs), malondialdehyde (MDA), advanced oxidation protein products (AOPP), oxidized low-density lipoprotein (ox-LDL), highly sensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and ferric reducing ability of plasma (FRAP) were measured at baseline and the end of the trial. In addition, vitamin C tolerance was evaluated. A nutritionist visited all participants for a standard diabetic regimen. Following vitamin C supplementation, the serum levels of MDA (p-value < .001) and AGEs (p-value = .002) demonstrated a significant decrease after controlling for multiple confounders, including age, blood pressure, waist circumference, HbA1C, TG, and LDL-C, while no significant changes were observed for AOPP (p-value = .234) and ox-LDL (p-value = .480). The FRAP showed an increasing trend as an antioxidant marker but was not statistically significant (p-value = .312). The hs-CRP and TNF-α had no significant changes (p-value: .899 and .454, respectively). Also, no major adverse events were observed. Vitamin C supplementation may be beneficial in reducing AGEs and MDA in patients with T2D.

Individualized Glycemic Control in Type 2 Diabetic Patients in Iran: A Multi-Center Data Analysis.

Background: Clinical guidelines and expert committees have recently suggested that the hemoglobin A1C (HbA1c) should be individualized based on various criteria. Data regarding the achievement of individualized glycemic targets in type 2 diabetes mellitus (T2DM) patients is scant in Iran. We intended to provide information found on real-world outcomes from the perspective of an individualized recommendation. Methods: A cross-sectional analysis was conducted in 15 diabetes centers in Iran between 2013-2017. Two steps cluster sampling selection was used to recruit 1591 patients with T2DM. Considering Ismail-Beigi's individualized strategy, the study population was categorized into five treatment intensities of HbA1c: most intensive (≤6.5%), intensive (6.5-7.0%), less intensive (~7.0%), not intensive (7.0-8.0%), and moderated (~8.0%). The percentage of patients who met their group individualized glycemic targets was estimated as the degree of achievement of each treatment intensity. Results: The cumulative incidence rate of early microvascular, advanced microvascular, and macrovascular complications was 53%, 25%, and 34%, respectively. Besides, [78% 77.6-79%] of patients did not achieve individualized glycemic targets. Conclusion: The outcome showed poor individualized glycemic control and a high incidence of diabetes complications. Considering individualized HbA1c targets for Iranian patients with T2DM is an urgent need.

Decreasing trend of blood lipid profile in type 2 diabetes: Not a promising change in HDL-C, a serial cross-sectional study.

BACKGROUND: The prevalence of dyslipidemia in patients with type 2 diabetes (T2D) has been reported to be relatively high. The current study aimed to investigate the trend of serum lipid levels and the prevalence of dyslipidemia in patients with T2D. METHODS: Data were extracted from a cohort of patients with T2D who had regular follow-ups every year for three years. TG, TC, LDL-C, HDL-C, and non-HDL-C were analyzed. The atherogenic index of plasma (AIP) was calculated using log (TG/HDL-C). RESULTS: A total of 747 patients with T2D were included in this study, consisting of 469 (62.8%) women and 278 (37.2%) men. There was a significant downward trend in mean TG, TC, LDL-C, non-HDL-C, and AIP levels. The trend of mean HDL-C levels showed no significant change. The prevalence of high TG, high TC, high LDL-C, and high non-HDL-C significantly decreased from the first to the last visit. There was no significant change in the trend of prevalence of low HDL-C. The prevalence of high AIP significantly decreased in women and showed no significant changes in men. CONCLUSIONS: A decreasing trend was observed in the mean levels and prevalence of TG, TC, LDL-C, non-HDL-C, and AIP. HDL-C did not change significantly. The success rate in achieving a complete normal lipid profile during follow-up years was not promising and continues to be challenging.

Lipid profile, ox-LDL, and LCAT activity in patients with endometrial carcinoma and type 2 diabetes: The effect of concurrent disease based on a case-control study.

Background and Aim: The role of lecithin: cholesterol acyltransferase (LCAT) and oxidized low-density lipoprotein (ox-LDL) in endometrial cancer (EC) or EC with concurrent type 2 diabetes is still unclear. This study investigated the LCAT activity, ox-LDL, and lipid profile in EC patients with or without type 2 diabetes and compared them with healthy individuals and patients with type 2 diabetes alone. Methods: In this cross-sectional, case-control study, 93 female participants were recruited. The participants were divided into four groups, including EC with type 2 diabetes (n = 19), EC without type 2 diabetes (n = 17), type 2 diabetes (n = 31), and healthy controls (n = 26). Sociodemographic information, the LCAT activity, triglyceride (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and ox-LDL levels were collected. One-way analysis of variance and analysis of covariance, Student's t-test, Mann-Whitney U-test, and χ 2-test were used to compare demographic features and laboratory results among studied groups. Regression analyses were also performed to evaluate the interaction effect between EC and type 2 diabetes on serum LCAT activity. Results: The LCAT activity was significantly lower, and ox-LDL levels were significantly higher in all patient groups compared to the healthy controls (p < 0.001). EC patients had significantly lower LCAT activity and higher ox-LDL levels than type 2 diabetes and healthy groups (p < 0.05). Higher levels of TG and lower levels of HDL-C were observed in all patient groups compared to the healthy group (all p < 0.001). Patients with EC and concomitant type 2 diabetes had significantly lower serum LDL-C levels than healthy and type 2 diabetes groups (p < 0.05). Conclusions: The combination of EC and type 2 diabetes had a subadditive effect on LCAT activity and ox-LDL level. The lowest LCAT activity and the highest ox-LDL levels were observed in patients with EC and concurrent type 2 diabetes.

Efficacy and Safety of a Biosimilar Liraglutide (Melitide®) Versus the Reference Liraglutide (Victoza®) in People with Type 2 Diabetes Mellitus: A Randomized, Double-Blind, Noninferiority Clinical Trial.

INTRODUCTION: Liraglutide effectively controls blood glucose level and reduces body weight. The aim of this study was to compare the efficacy and safety of a biosimilar liraglutide (Melitide®; CinnaGen, Tehran, Iran) to the reference liraglutide (Victoza®; Novo Nordisk, Bagsvaerd, Denmark) in people with type 2 diabetes mellitus (T2DM). METHODS: In this phase 3 clinical noninferiority trial, adult patients with inadequately controlled T2DM and with hemoglobin A1C (HbA1C) levels of 7-10.5% on at least two oral glucose-lowering drugs with stable doses for at least 3 months were randomized to receive Melitide® (n = 150) or Victoza® (n = 150) 1.8 mg/day for 26 weeks. The primary outcome was assessment of the noninferiority of Melitide® to Victoza® in terms of change in HbA1C level with a prespecified margin of 0.4%. The secondary outcomes were the assessment of additional efficacy parameters (including the proportion of patients achieving HbA1C levels of < 7%), the incidence of adverse events, and immunogenicity. RESULTS: Of the 300 participants enrolled in this study, 235 were included in the per-protocol analysis (112 in the Melitide® group and 123 in the Victoza® group). The mean (standard deviation) changes in HbA1C were - 1.76% (1.22) in the Melitide® group and - 1.59% (1.31) in the Victoza® group. The upper limit of the 95% one-sided confidence interval (CI) of the mean difference between Melitide® and Victoza® in lowering HbA1C was lower than the predefined margin (mean difference - 0.18, 95% CI - 0.5 to 0.15). Similar findings were obtained with the intention-to-treat analysis. No statistically significant differences were observed between the two study arms regarding the proportion of patients achieving HbA1C < 7% (p = 0.210), other efficacy parameters (p > 0.05), and reported adverse events (p = 0.916). Furthermore, none of the patients developed anti-liraglutide antibodies. CONCLUSION: The biosimilar liraglutide (Melitide®) was noninferior in efficacy and comparable in safety when compared with the reference liraglutide. TRIAL REGISTRATION: NCT03421119.