Leptin concentration and oxidative stress in diabetic ketoacidosis

TIME COURSE OF RED BLOOD CELL DEFORMABILITY DURING DIABETIC KETOACIDOSIS

ABSTRACT

Background : Diabetic ketoacidosis (DKA) is a life-threatening emergency. Microvascular hyporeactivity has been reported in these patients and is completely reversible when acidosis is corrected with aggressive treatment. The shape of the red blood cell (RBC), a sensor of local hypoxia and a component of the microcirculation, is altered in diabetic patients, but no data are available concerning RBC deformability in DKA during treatment. Methods : In this prospective observational study, we included all adult patients admitted with DKA to a 32-bed medico-surgical intensive care unit (ICU) over a 6-month period. We excluded patients with infection. We measured RBC deformability in the DKA patients and compared results with those from patients with type 1 diabetes and from a group of healthy volunteers (HV). RBC deformability was assessed using ektacytometry. In the DKA patients, it was assessed at ICU admission, 8 and 24 h after admission, and prior to ICU discharge (48-72 h). The RBC elongation index (EI) was determined based on the laser diffraction pattern changes. A higher EI indicates greater RBC deformability. Results : A total of 46 diabetic patients (15 DKA and 31 type 1 diabetes patients) and 20 HV were included. RBC deformability was more altered at ICU admission in DKA patients, with significantly lower EI values than in the other groups, and these alterations persisted during the ICU stay despite treatment. There were no correlations between these alterations and the quantity of fluids or insulin received. Conclusions : In contrast to the reversible microvascular hyporeactivity observed in DKA, RBC deformability was already altered at ICU admission in patients with DKA and remained altered despite treatment. These alterations may contribute to the blood flow abnormalities observed in these patients.

Mitochondrial proteins as therapeutic targets in diabetic ketoacidosis: evidence from Mendelian randomization analysis

Introduction

Diabetic ketoacidosis (DKA) is a severe and potentially fatal acute complication in diabetic patients, commonly occurring in type 1 diabetes (T1D) but also seen in type 2 diabetes (T2D). The pathogenesis of DKA involves complex physiological processes that are not fully understood, especially the role of mitochondria. Mitochondria, known as the powerhouse of cells, plays a crucial role in oxidative phosphorylation and ATP production, which is vital in various metabolic diseases, including diabetes. However, the exact causal relationship between mitochondrial dysfunction and DKA remains unclear.

Methods

This study employed Mendelian randomization (MR) analysis and protein-protein interaction (PPI) networks to systematically explore the causal relationships between mitochondrial DNA copy number (mtDNA-CN) and specific mitochondrial proteins with DKA. We used bidirectional MR analysis and genome-wide association study (GWAS) data from openGWAS database to investigate the causal effects of mtDNA-CN and 64 mitochondrial-related proteins on DKA and its subtypes (T1DKA, T2DKA, unspecified-DKA).

Results

The study revealed that increased mtDNA-CN significantly reduces the risk of DKA, whereas the effect of DKA on mtDNA-CN was not significant. Mitochondrial-related proteins such as MRPL32, MRPL33, COX5B, DNAJC19, and NDUFB8 showed a negative causal relationship with DKA, indicating their potential protective roles. Conversely, ATP5F1B and COX4I2 have a positive causal relationship with DKA, indicating that excessive ATP production in diabetic patients may be detrimental to health and increase the risk of severe complications such as DKA.

Discussion

The results emphasize the necessity of protecting mitochondrial function in order to reduce the risk of DKA. The study offers novel perspectives on the molecular pathways involved in DKA, emphasizing the critical functions of mt-DNA and distinct proteins. These evidences not only enhance our comprehension of the implications of mitochondrial dysfunction in diabetes-related complications but also identify potential therapeutic targets for individualized treatment approaches, thereby making a substantial contribution to clinical care and public health initiatives.

Superoxide dismutase and glutathione peroxidase content in children with type 1 diabetes mellitus

Type 1 diabetes mellitus (T1D) is one of the most frequently diagnosed chronic diseases of childhood. Oxidative stress (OS) is considered as one of the possible mechanisms of its development and complications. The aim of the study was to analyze the content of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GP) in children and adolescents with adequately controlled T1D.Material and methods. A total of 58 children were examined, including 34 children with type 1 diabetes (study group) and 24 conditionally healthy children (control group). The content of glycated hemoglobin, blood plasma glucose per day, post-prandial glucose, total protein, creatinine and urea were determined by conventional methods, as well as the level of SOD and GP in the blood serum by ELISA.Results and discussion. A significant decrease in the content of both enzymes was found in type 1 DM patients compared to conditionally healthy children. In patients with the chronic form of the disease, SOD and GP level was significantly lower than in patients with incident T1D. An inverse correlation was revealed between the antioxidant enzymes level on the one hand and age, duration of the disease, and the number of episodes with a poor glucose history on the other hand. The decrease in SOD and GP concentration was associated with an increase in glycated hemoglobin and plasma glucose level over a 24-hour period in patients with chronic type SD 1. The decrease in SOD concentrations was associated with an increase in glycated hemoglobin in patients with T1D chronic type. The discovered abnormalities indicate that decreased antioxidant enzyme level represent a manifestation of OS in patients with adequately controlled type 1 DM.Conclusions. Content of antioxidant enzymes in children with T1D provides an important criterion for the assessment of OS manifestations in this disease.

The Red Blood Cell Distribution Width-Albumin Ratio Was a Potential Prognostic Biomarker for Diabetic Ketoacidosis

Background

The red blood cell distribution width (RDW)–albumin ratio (RA) is a new biomarker, which is d-efined as RDW divided by albumin. This study aimed at determining the prognostic values of RA for diabetic ketoacidosis (DKA).

Methods

Data were obtained from Medical Information Mart for Intensive Care Database III V1.4 (MIMIC-III) and the RA calculated. Multivariate Cox regression analysis was performed to determine the correlation between RA and 90-day mortality or 365-day mortality. To further investigate the association with RA and mortality, the patients were divided into two groups. The second outcome was the association between the incidence of DKA-related infections and RA.

Results

For DKA patients in the ICU, RA was significantly correlated with 90-day mortality (HR: 2.1, 95% CI: 1.5, 3.0, p < 0.001) and 365-day mortality (HR: 1.9, 95% CI: 1.5, 2.5, p < 0.001). A high RA was independently correlated with increased 90-day mortality (HR: 7.8, 95% CI: 1.8, 34.0, p for trend <0.001) and 365-day mortality (HR: 5.2, 95% CI: 2.4, 11.3, p for trend <0.001). Moreover, RA was found to be an independent predictor for sepsis and septic shock in patients with DKA (HR: 2.9, 95% CI: 2.0, 4.1, p < 0.001). After adjusting for confounders, the statistical outcome was the same.

Conclusion

A high RA is significantly correlated with increased all-cause mortality of DKA as well as an increased incidence of DKA-related infections. RA is a potential prognostic marker for DKA.

Parathyroid Hormone and 25-Hydroxyvitamin D Do Not Mediate the Association between Dietary Calcium, Protein and Vitamin D Intake and Adiposity and Lipid Profile in Patients with Type 2 Diabetes: a Structural Equation Modeling Approach

This study aimed to utilize structural equation modeling (SEM) techniques to determine the effects of dietary calcium, protein and vitamin D on adiposity and lipidemia and to assess mediatory effects of parathyroid hormone (PTH) and 25-hydroxyvitamin D (25(OH)D) in patients with type 2 diabetes. In this cross-sectional study, a total of 150 diabetic patients (93 females and 57 males) were randomly selected. Anthropometric measures, biochemical analyses, and fat mass percent were recorded. Nutritional data were collected. SEM was performed. Based on the primary hypothesis, adiposity and lipidemia were fitted in a model. The direct effects of dietary calcium (λ = -0.165, p value = 0.002) and PTH (λ = -0.143, p value = 0.011) were significantly associated with lipidemia. There were no significant effects for dietary protein on PTH (λ = -0.270, p value = 0.057), 25(OH)D (λ = -0.071, p value = 0.613), lipidemia (λ = -0.044; p value = 0.638) or adiposity (λ = -0.009, p value = 0.949) as well as for dietary vitamin D on PTH (λ = -0.119, p value = 0.194), 25(OH)D (λ = 0.023, p value = 0.806), lipidemia (λ = 0.034, p value = 0.587) or adiposity (λ = -0.221, p value = 0.118). The correlation between calcium intake and lipidemia, and adiposity are not mediated by 25(OH)D and PTH. There were the direct effects of dietary calcium on adiposity in patients with type 2 diabetes. The model can be tested in future longitudinal and intervention studies to identify the predictors of obesity.

Evaluation of Thiol/Disulfide Homeostasis in Pediatric Patients with Diabetic Ketoacidosis

AIMS AND OBJECTIVE

This study aimed to investigate the value of Thiol/Disulfide homeostasis in pediatric diabetic ketoacidosis patients suffering from type 1 diabetes mellitus.

MATERIALS AND METHODS

This study featured children who were diagnosed with diabetic ketoacidosis and who were consecutively admitted to pediatric intensive care within one year of their diagnosis. Thiol/disulfide homeostasis was evaluated in 45 pediatric patients suffering from DKA, as well as 45 healthy controls of parallel gender and age. Thiol/disulfide homeostasis parameters were measured using a novel automated measurement method and the correlation between demographic data and parameters was measured.

RESULTS

Pediatric patients were found to have low native thiols, total thiols and disulfide levels with type 1 diabetes after DKA (331.82±106.40, 362.71±113.31, 17.02±5.33 μmol/L, respectively) as compared to the control group (445.08±24.41, 481.21± 28.47, 18.06±5.12 μmol/L, respectively).

CONCLUSION

Thiol/disulfide homeostasis was distorted in pediatric patients with DKA. Furthermore, it was found that they are not likely to return to normal, immediately after treatment.