Association between visit-to-visit variability of glycemic indices and lipid profile and the incidence of coronary heart disease in adults with type 2 diabetes.

Coronary heart disease (CHD) is one of the major causes of mortality and morbidity in patients with type 2 diabetes mellitus. In this study, we aimed to assess the association between visit-to-visit variability of fasting blood sugar (FBS), HbA1c, blood sugar 2 h post-prandial (BS2hpp), lipid indices, creatinine, systolic and diastolic blood pressure (SBP, DBP) and incident CHD in patients with type 2 diabetes during a median follow-up of ten years. The current case-cohort study consisted of 1500 individuals with type 2 diabetes, followed up for the occurrence of CHD from 2002 to 2019. The patients had at least four annual follow-ups during which glycemic and lipid profile were measured. Co-efficient of variance (CV) for each parameter was calculated by 10-21 measurements. Cox regression analysis was performed to assess the association between CV of glycemic indices, lipid profile, blood pressure, creatinine, weight and incident CHD during the follow-up period. Hazard ratios (HR) were adjusted for the confounding variables. Glycemic indices variability (i.e., CV-HbA1c, CV-FBS, and CV-BS2hpp), were significantly higher in the group with incident CHD (P=0.034, P=0.042, and P=0.044, respectively). Hazard ratios were 1.42 (95 % CI=1.13-2.09) for CV-HbA1c, 1.37 (95 % CI=1.02-2.10) for CV-FBS, and 1.16 (95 % CI=1.01-1.63) for CV-BS2hpp (P=0.012, P=0.046, P=0.038, respectively). Creatinine was significantly higher in the group with incident CHD (P=0.036) and it was significantly associated with higher incidence of CHD (HR=1.14, 95 % CI=1.02-2.17, P=0.048). Visit to visit variability of glycemic indices of the patients with type 2 diabetes is associated with incident CHD independent of their baseline and mean values.

IgG4-related hypophysitis.

Hypophysitis is a rare pituitary inflammatory disorder classified in different ways. Immunoglobulin G4-related disease (IgG4-RD), also a rare disease is a systemic fibro-inflammatory condition characterized by infiltration of tissue with IgG4-positive plasma cells; however prevalence of both of them probably is underestimated. In this paper, we present an Iranian patient with biopsy-proven IgG4-related hypophysitis and then review the clinical characteristics, laboratory, imaging, pathologic findings and therapeutic management as well as prognosis of 115 published cases of hypophysitis secondary to IgG4-related disease.

Advanced glycation end-products and advanced oxidation protein products levels are correlates of duration of type 2 diabetes.

AIMS: Diabetes is associated with the excess formation of advanced glycation end-products (AGEs) and advanced oxidation protein products (AOPP), and low levels of ferric reducing ability of plasma (FRAP). However, the trend of oxidative and antioxidant markers levels according to diabetes duration is unclear. MAIN METHODS: In a case-control study, 240 patients with diabetes and 100 healthy controls were enrolled. Patients were divided into four groups according to the duration of diabetes, including newly diagnosed, 1-5, 5-10, and 10-15 years. Serum AGEs, AOPP, and FRAP levels were compared among groups. KEY FINDINGS: AGEs and AOPP were higher and FRAP was lower in patients with diabetes compared to healthy controls. Serum levels of AGEs increased progressively with increasing in diabetes duration. AGEs levels were 68.97 ± 7.28% in newly-diagnosed, 73.43 ± 12.96% in 1-5 years and 80.44 ± 13.84% in 10-15 years of diabetes duration (pairwise p-values <0.05). In linear regression analysis the correlation among AGEs, AOPP, FRAP, and diabetes duration remained significant after adjustment for age, BMI, HDL, HbA1c, waist circumference, microvascular complications, and coronary artery diseases. ROC analysis showed AGEs could predict the duration of diabetes when patients with 10-15 years duration of diabetes were compared to patients with 1-5 years duration of diabetes (AUC = 0.676, p-value = 0.003). SIGNIFICANCE: Diabetes promotes AGEs, and AOPP production, independent of glycemic control and patients age. Serum levels of AGEs increase progressively with increasing duration of diabetes. AGEs may be helpful in estimating chronicity of diabetes.

DPP4 Inhibitors in the Management of Hospitalized Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

INTRODUCTION: We studied the effects of dipeptidyl peptidase 4 (DPP4) inhibitors on glycemic control in non-critically ill patients admitted to hospital. METHODS: We searched MEDLINE and EMBASE for published studies in English up to July 2019. We included randomized clinical trials (RCTs) that compared DPP4 inhibitors plus insulin supplementation versus basal-bolus insulin regimen in the management of hyperglycemia non-critically ill patients with type 2 diabetes admitted to hospital. Mean difference (MD), relative risk (RR), and 95% confidence intervals (CI) were generated to interpret the data. RESULTS: Of 401 papers, four RCTs including 648 participants met inclusion criteria. There was no significant difference in mean daily blood glucose level between the two groups (MD 4.63; 95% CI = - 1.57, 10.83; p = 0.14) (I2 = 14%, p = 0.32). Total insulin dose per day was lower in patients receiving DPP4 inhibitors (MD - 14.27; CI = - 22.47, - 6.07; p = 0.001) (I2 = 92%, p = 0.001). Also, the number of insulin injection was significantly lower in patients receiving DPP4 inhibitors (MD - 0.79; CI = - 1.01, - 0.57; p = 0.001) (I2 = 0%, p = 0.68). The rate of hypoglycemia was not significantly different between the two groups (RR 0.60, CI = 0.34, 1.074; p = 0.08) (I2 = 37.3%, p = 0.18). Treatment failure was not significantly different between the two groups (RR 0.87, CI = 0.64, 4.8; p = 0.38) (I2 = 49%, p = 0.11). CONCLUSION: The results indicate that using DPP4 inhibitors plus basal or supplemental insulin in hospitalized patients is non-inferior to a standard basal-bolus insulin regimen and leads to a lower amount of insulin use and a lower rate of insulin injection. Limitations of this study were heterogeneity of baseline characteristics of included patients, small sample size, short duration, and non-uniformly defined outcome assessment parameters in the included studies.

Lifestyle Interventions to Promote Healthy Nutrition and Physical Activity in Middle-Age (40-60 Years) Adults: A Randomized Controlled Trial in the North of Iran.

BACKGROUND: This study was conducted to evaluate the effectiveness of short-term structured interventions on healthy lifestyle behaviors, dietary intake, anthropometric measures, blood pressure, fasting blood glucose, and serum lipid profile of middle-aged adults. STUDY DESIGN: Randomized controlled trial study. METHODS: Overall, 300 individuals out of apparently healthy (non-patient) adults aged 40-60 yr living in Amirkola, Babol the north of Iran were enrolled in 2016-2017. The Persian translation of the Health Promoting Lifestyle Profile II (HPLP-II) and two days 24-h food recall questionnaires were used for data collection. Eligible participants were allocated randomly in three groups (high-intensive, low-intensive and the control). The follow-up examination has been conducted after 16 wk of intervention. RESULTS: The three study groups had no significant difference in age (P=0.888), sex (P=0.395), BMI (P=0.969), healthy lifestyle score (P=0.675) and total daily energy intake (P=0.612). After intervention, the mean scores of all the six subdomains of HPLP-II questionnaire had significant improvement (P<0.001). Mean weight loss was 1.5, 1.0 and 0.3 kg, in high-intensive, low-intensive and control groups, respectively. BMI although reduced, was still in the overweight range in two sexes. Mean of neck, arm, waist and buttock size, diastolic blood pressure, serum triglyceride, total cholesterol, and HDL levels have been changed to a better condition in comparison with the baseline values (P<0.001). Dietary intake had good changes in total daily energy (P<0.001), daily intake of carbohydrate, protein, and fat (P<0.001), and proportion of energy from carbohydrate (P=0.007) and fat (P=0.022) after the intervention. CONCLUSION: Our intervention program could have positive impact on healthy lifestyle behaviors, dietary intake and weight in addition to some other anthropometric variables and serum lipid profile of middle-aged adults.