Factors associated with no apparent coronary artery disease in patients with type 2 diabetes mellitus for more than 10 years of duration: a case control study

Prevalence of normal coronary arteries by coronary computed tomography angiography (CCTA) in patients with type 2 diabetes mellitus from Semaglutide Treatment on Coronary Plaque Progression (STOP) trial

INTRODUCTION

Coronary artery disease (CAD) is leading cause of morbidity and mortality among type 2 diabetics (T2DM).

METHODS

140 T2DM will be enrolled in randomized, double blind, placebo controlled Semaglutide Treatment On Coronary Plaque Progression (STOP) trial to determine effect of weekly subcutaneous semaglutide on coronary plaque progression. All participants will undergo Coronary Artery Calcium (CAC) Scoring and Coronary Computed Tomography Angiography (CCTA) at our center. A Fisher test, ANOVA and Kruskal Wallis were used.

RESULTS

As of May 2020, 87 patients (81%) randomized (mean age 56.4 ± 8.4 yrs. and 62% male) with documented CAD by CCTA. Approximately 20% of screened study population were screen failed due to normal coronaries (n= 14) or HbA1C<7 (n=7). Of interest, 14 persons with diabetes with normal coronaries (no calcification) were significantly more likely to be females (21% vs 62%), have higher glomerular filtration rate (106.5 ± 19.4 vs 89.9 ± 22.6 mL/min/1.73m²; p= 0.006), and younger (53.4 ± 9.0 vs 56.4 ± 8.4 yrs.; p=0.02) than those who were randomized.

CONCLUSION

Among T2DM, there is a significant portion who have normal coronary arteries and may have a better prognosis. Excluding these participants from cardiovascular studies may improve power and decrease sample size.

Screening and Risk Assessment of Coronary Artery Disease in Patients With Type 2 Diabetes: An Updated Review

Current literature indicates that there is a strong correlation between coronary artery disease (CAD) and type 2 diabetes. The arteriosclerotic progression occurs earlier and in a greater extent in the diabetic than in the non-diabetic population. In diabetic subjects, the detection of arterial disease does not always precede the development of an acute arterial incident. Herein, we reviewed studies published within the last 5 years in order to reveal the risk factors for coronary artery disease in patients with type 2 diabetes. In addition, we aimed to discuss how to diagnose in an early stage or even screen the presence of coronary artery disease in asymptomatic diabetic patients. Possible blood markers as predictors of CAD, which are mostly related to the lipidemic profile of subjects, are included in this review. Less invasive imaging methods than conventional coronary angiography, included in the article, are gradually used more in the diagnosis of CAD and show high effectiveness. Data from 23 articles with 22,350 patients having type 2 diabetes were summarized and presented descriptively.

Clinical and anatomical myocardium features according to invasive and non-invasive examination methods in patients with coronary artery disease in combination with diabetes mellitus

Aim.To study the clinical and anatomical myocardium features according to invasive and non-invasive examination methods in men and women with coronary artery disease (CAD) in combination with diabetes mellitus (DM).

Material and methods.A single-step clinical study included 77 men and 68 women with angina of the II-III functional classes, observed in the Republican clinical hospital in Nazran. Depending on the presence of type 2 DM and gender, patients were divided into 4 groups: Group I — men with CAD+DM (n=34), Group II — women with CAD+DM (n=36), Group III — men with CAD without DM (n=43), group IV — women with CAD without DM (n=32). All patients underwent electrocardiography (ECG), echocardiography (EchoCG) and coronary angiography.

Results.Hypertrophy of the left ventricle on ECG was most often diagnosed in men with CAD+DM (38%). Similar, but less pronounced tendency is observed in men without DM (23%). Among women, these parameters were <20%. Left ventricular hypertrophy on EchoCG was determined two times more than the ECG results. Defect of local contractility and myocardial hypokinesis according to EchoCG data was found in both men and women with DM — 29% and 22%, respectively. Among patients without DM, these parameters were 40% less. In general, the frequency of cicatricial ECG changes in all groups had a similar trend. According to coronary angiography, anterior interventricular stenosis was the most frequent vascular lesion. Among men with CAD+DM, it was noted in 62% of cases, in men without DM — in 30%. Among women with CAD+DM, anterior interventricular branch stenosis is detected in 28% of cases, without ~20%. Stenosis of the circumflex branch is detected in no more than 20% of cases in men and women with CAD+DM, and in the groups without DM — in 10%. Stenosis of the right coronary artery is detected in every fourth patient, regardless of the glycemic status. The majority of patients (60%) have constriction of the coronary vessels, the absolute number of such constrictions in the groups of men with CAD and with or without DM was ~70 cases. Among women, this figure was less than 50 cases. Constriction of one or more coronary arteries >80% more often occurred among men with CAD without DM, among men and women with CAD+DM, the absolute number of such constrictions was 21-25 cases. The greatest number of stenoses ≥2 coronary arteries was observed in men with CAD+DM (~30 cases), in the group of men with CAD without DM constriction >2 vessels are found in ~20 cases. Among women, stenosis ≥2 vessels are detected twice as less as compared with men. At the same time, in the group of women with CAD+DM, the frequency of multiple stenoses was 15% higher than those of women with CAD without DM.

Conclusion.Thus, using non-invasive and invasive examination methods in CAD patients, a number of complementary changes in the myocardium and coronary arteries were found. The presence of DM worsens these changes, both among men and women.

Hydrogel optical fibers for continuous glucose monitoring

Continuous glucose monitoring facilitates the stringent control of blood glucose concentration in diabetic and intensive care patients. Optical fibers have emerged as an attractive platform; however, their practical applications are hindered due to lack of biocompatible fiber materials, complex and non-practical readout approaches, slow response, and time-consuming fabrication processes. Here, we demonstrate the quantification of glucose by smartphone-integrated fiber optics that overcomes existing technical limitations. Simultaneously, a glucose-responsive hydrogel was imprinted with an asymmetric microlens array and was attached to a multimode silica fiber's tip during photopolymerization, and subsequent interrogated for glucose sensing under physiological conditions. A smartphone and an optical power meter were employed to record the output signals. The functionalized fiber showed a high sensitivity (2.6 μW mM^-1), rapid response, and a high glucose selectivity in the physiological glucose range. In addition, the fiber attained the glucose complexation equilibrium within 15 min. The lactate interference was also examined and it was found minimal ∼0.1% in the physiological range. A biocompatible hydrogel made of polyethylene glycol diacrylate was utilized to fabricate a flexible hydrogel fiber to replace the silica fiber, and the fiber's tip was functionalized with the glucose-sensitive hydrogel during the ultraviolet light curing process. The biocompatible fiber was quickly fabricated by the molding, the readout approach was facile and practical, and the response to glucose was comparable to the functionalized silica fiber. The fabricated optical fiber sensors may have applications in wearable and implantable point-of-care and intensive-care continuous monitoring systems.

Changes in proteinuria and the risk of myocardial infarction in people with diabetes or pre-diabetes: a prospective cohort study

Background

The relationship between changes in proteinuria and myocardial infarction (MI) remains unclear in people with diabetes or pre-diabetes. We aimed to evaluate the predictive value and independent role of changes in proteinuria over a 2-year period in the incidence of MI in people with diabetes or pre-diabetes.

Methods

Based on the baseline and 2-year dipstick screening results from the Kailuan prospective cohort study, participants were divided into four categories: no proteinuria, remittent proteinuria, incident proteinuria, and persistent proteinuria. Four multivariable Cox proportional hazard models were built to adjust for the effects of different confounding covariates.

Results

Among the 17,625 participants in this study, there were a total of 238 incidents of MI during a median follow-up of 6.69 years. After adjusting for demography factors and laboratory indices, the association between persistent proteinuria and MI incidence was maintained (hazard ratio [HR] 2.50, 95% confidence interval [CI] 1.48–4.22). Every decrease of proteinuria from 2006 to 2008 was observed to be responsible for a 21% decline of MI incidence (HR 0.79, 95% CI 0.68–0.90). The interaction between changes in proteinuria and diabetes was confirmed with no effect on MI (P = 0.3371).

Conclusions

Persistent proteinuria is an independent risk factor for MI incidence in the pre-diabetic and diabetic population. These findings may help clinicians to interpret proteinuria changes in the outpatient setting and provide possible preventive approaches for people with pre-diabetes or diabetes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12933-017-0586-7) contains supplementary material, which is available to authorized users.

Evaluation of Association of Hyperuricaemia with Metabolic Syndrome and Insulin Resistance

INTRODUCTION

The prevalence of Metabolic Syndrome (MetS) ranges from <10% to as much as 84% depending on region and composition of the population studied. The MetS is a growing public health problem in the world.

AIM

To evaluate association of hyperuricaemia with components of MetS and insulin resistance.

MATERIALS AND METHODS

Sixty patients with MetS were conveniently recruited. MetS was defined as per Adult Treatment Panel III (ATP III) guidelines. For the purpose of analysis study participants were grouped into, group-I (controls - normal serum uric acid levels) and group-II (cases - hyperuricaemia). Hyperuricaemia was defined with cut-off >6.8mg/dl in both men and women. Associated work up for MetS and insulin resistance like fasting blood sugar, fasting lipid profile, fasting insulin, serum uric acid was done. Blood pressure and anthropometric measurements including weight, height and waist circumferences were measured and BMI was calculated. HOMA IR method was used to measure the degree of insulin resistance. Logistic regression analysis was used to evaluate association of hyperuricaemia with MetS and insulin resistance. Receiver Operating Curve (ROC) was plotted to find out optimum cut-off value for insulin resistance.

RESULTS

A significant increase in systolic blood pressure (p < 0.001) and triglyceride levels (p=0.027) were observed in hyperuricaemia subjects when compared to controls. After adjusting for potential confounders, Insulin resistance (HOMA IR >3.4) was independently associated with hyperuricaemia (OR=5.79, 95% CI=1.6- 20.69, p=0.007).

CONCLUSION

Insulin resistance beyond a threshold is independently associated with hyperuricaemia in subjects with MetS.

Insulin resistance, endothelial function, angiogenic factors and clinical outcome in non-diabetic patients with chest pain without myocardial perfusion defects

Background

Patients with angina-like symptoms without myocardial perfusion scintigram (MPS)-verified abnormality may still be at risk for cardiovascular events. We hypothesized that insulin resistance could play a role in this population even without diagnosed diabetes. We further explored physiological and blood biomarkers, as well as global gene expression patterns that could be closely related to impaired glucose homeostasis to deepen our mechanistic understanding.

Methods

A total of 365 non-diabetic patients with suspected myocardial ischemia referred to MPS were enrolled and followed up regarding event-free survival with a median time of 5.1 years. All patients underwent endothelial function assessment by reactive hyperemic index (RHI) using EndoPAT and extensive biomarker analysis. Whole blood global gene expression pathway analysis was performed in a subset of patients.

Results

Homeostasis model assessment of insulin resistance (HOMA-IR) added independent prognostic value in patients without myocardial perfusion defects. In a multivariable analysis, HOMA-IR was inversely associated with low RHI. Furthermore, elevated HOMA-IR was associated with decreased levels of vascular endothelial growth factor D, stem cell factor and endocan as well as to increased level of interleukin-6. Global gene expression pathway analysis of whole blood cells showed that high HOMA-IR and impaired endothelial function were associated with upregulated pro-inflammatory pathways and down-regulated eukaryotic initiation factor-2 pathway.

Conclusions

Insulin resistance measured by HOMA-IR is associated with endothelial dysfunction and confers independent prognostic information in non-diabetic patients with chest pain without myocardial perfusion defects. Increased systemic pro-inflammatory state and decreased levels of pro-angiogenic vascular growth factors may be important underlying molecular mechanisms.