Relationship Between Carotid Intima-Media Thickness and Osteoporosis in Type 2 Diabetic Patients: Cross-Sectional Study in the Third-Level Center.

Aim: Although atherosclerosis and osteoporosis (OP) are seen in elderly patients, it is still a matter of research whether there is an age-independent relationship between them. In our study, we planned to investigate the relationship between carotid intima-media thickness (CIMT), OP, and bone turnover parameters in patients with type 2 diabetes mellitus (DM2) of both sexes. Materials and Methods: A total of 69 patients and 40 healthy volunteers with chronic diseases such as DM2, hypertension, hyperlipidemia, and OP. Group 1 had 27 patients with DM2 and OP, group 2 had 42 patients with DM2 and no OP, and group 3 had 40 healthy volunteers without DM2 and OP. Results: In the control group, CIMT was measured lower than the patients with DM2 (0.8 + 0.1 and 1.1 + 0.3, P < 0.001, respectively). Femur T score and lumbar T score values of patients with DM2 were lower than the control group (-0.48 + 1.1 and 0.7 + 0.6, P < 0.001, and -1.3 + 1.5 and 0.6 + 0.5, P < 0.001, respectively). Bone turnover markers in DM2 compared to the control group (C-terminal telopeptide of type 1 collagen: 240.9 ± 211.1 and 606.5 ± 200.8, P < 0.001; bone-specific alkaline phosphatase: 47.9 ± 15.5 and 431.5 ± 140, P < 0.001; and osteocalcin: 13.2 ± 5.0 and 19.7 ± 9.2, P < 0.001, respectively) were lower. Patients with femoral region (TSF) T score and lumbar region (TSL) T score below -2.5 were found to have higher CIMT values than those without (1.2 ± 0.23 mm and 0.9 ± 0.23 mm, P = 0.006, and 1.1 ± 0.28 mm and 0.95 ± 0.21 mm, P = 0.003, respectively). In linear regression analysis, age (ß = 0.01, P < 0.001), OP (ß = 0.166, P = 0.001), and DDM2 (ß = 0.222, P = 0.04) were found to be effective on CIMT, while DM2 (ß) = -0.754, P < 0.001), CIMT (ß = -0.258, P = 0.021), body mass index (ß = 0.355, P = 0.028), and age (ß = -0.229, P = 0.029) were found to be independent factors on TSF. Conclusion: Bone turnover and bone mineral density are decreased in DM2 patients. In addition, subclinical atherosclerosis is more common in DM2 patients. Findings suggest that there is a relationship between subclinical atherosclerosis and OP due to metabolic factors other than age.

Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations.

The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.

The Effects of Diabetic Polyneuropathy and Autonomic Neuropathy on Bone Turnover.

Background: The effect of diabetic polyneuropathy (DPN) and autonomic neuropathy (AN) on bone turnover in type 2 diabetes mellitus (DM) is uncertain due to the lack of data. In this study, we tried to determine the effect of DPN and AN on bone metabolism. Materials and Methods: The study included patients with type 2 DM (aged 18-80 years) and age-matched healthy individuals who presented to the Departments of Metabolism and Diabetes, Geriatrics, and General Internal Medicine, Cerrahpasa Medical School, Istanbul University. The patients were examined to find out whether they had AN, and neuropathy scores were recorded by exploring peripheral neuropathy. Bone mineral density was measured by dual-energy X-ray (DXA). Demographic characteristics, the presence of microvascular complications, and biochemical data were obtained from patients' files. Serum cross-linked C-telopeptide (Ctx), osteocalcin, and bone-specific alkaline phosphatase (B-ALP) were analyzed. Results: The study comprised a total of 64 patients: 23 had type 2 DM and osteoporosis (OP) (duration of diabetes 10.1 ± 7 years; mean age 63 ± 9.1 years; female/male 18/5; Group 1), 41 had type 2 DM and non-OP (duration of diabetes 10.3 ± 7.6 years; mean age 58 ± 7.4 years; female/male 30/11; Group 2), and 26 healthy volunteers made up the control group (mean age 62 ± 11.9 years; female/male 14/12; Group 3). The bone turnover parameters were lower in type 2 DM individuals. The levels of osteocalcin (13.3 ± 5.2 ng/mL) and B-ALP (44.7 ± 10.9 IU/L) in patients with type 2 DM were lower than those of healthy subjects: osteocalcin (20.6 ± 10 ng/mL) and B-ALP (111 ± 31.4 IU/L; P = 0.001 and P = 0.000, respectively). Ctx levels (193.5 ± 49.3; 207.6 ± 40 ng/mL) were recorded to be similar (P = 0.2). AN was also noted as a risk factor for OP. For patients without AN, the likelihood of developing OP (odds ratio) was 0.7. The corresponding ratio for patients with AN was 9.3. Conclusions: Among the independent variables, the neuropathy score was determined to have an impact on bone turnover. AN was identified to be a significant risk factor for OP.

Expert Panel Recommendations for Use of Standardized Glucose Reporting System Based on Standardized Glucometrics Plus Visual Ambulatory Glucose Profile (AGP) Data in Clinical Practice.

This expert panel of diabetes specialists aimed to provide guidance to healthcare providers on the best practice in the use of innovative continuous glucose monitoring (CGM) techniques through a practical and implementable document that specifically addresses the rationale for and also analysis and interpretation of the new standardized glucose reporting system based on standardized CGM metrics and visual ambulatory glucose profile (AGP) data. This guidance document presents recommendations and a useful algorithm for the use of a standardized glucose reporting system in the routine diabetes care setting.

Does treatment with sodium-glucose co-transporter-2 inhibitors have an effect on sleep quality, quality of life, and anxiety levels in people with Type 2 diabetes mellitus?

Background/aim: To evaluate the impact of treatment with sodium-glucose co-transporter-2 (SGLT2) Inhibitors on quality of life (QoL), sleep quality (SQ), and anxiety levels in patients with Type 2 diabetes mellitus (T2DM). Materials and methods: Ninety-seven patients with type 2 diabetes admitted to tertiary care hospital diabetes clinic were included. Fifty patients were randomized to receive SGLT2 inhibitors in addition to baseline treatment (Group A), 47 subjects continued with their baseline treatment or were added other medications as needed (Group B). Thirty healthy controls (HC) were recruited (Group C). All groups were subjected to the Turkish version of Short Form-36 (SF-36), Pittsburgh Sleep Quality (PSQ), and Beck Anxiety Inventory (BAI) scales both at baseline and final visit. Results: Physical function, emotional role limitation, vitality, mental health, pain, general health perception scores of SF-36 were significantly improved in Group A, at the end of the follow-up period. There was no significant change in terms of PSQ, BAI scores, and hypoglycaemia documented in all groups. The intervention-related change in HbA1c level, body weight, and body mass index were significantly higher in Group A. Conclusion: The QoL was improved in people with diabetes who were taking SGLT2 inhibitors. This may be explained by weight loss observed in participants.