Metabolic Syndrome in Type 2 Diabetes Mellitus Patients: Prevalence, Risk Factors, and Associated Microvascular Complications

Heart failure and microvascular dysfunction: an in-depth review of mechanisms, diagnostic strategies, and innovative therapies

Microvascular dysfunction (MVD) is increasingly recognized as a critical contributor to the pathogenesis of heart failure (HF), particularly in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Coronary microvascular dysfunction (CMD) significantly impacts HFpEF by reducing coronary flow reserve and myocardial perfusion reserve, leading to adverse outcomes such as myocardial ischemia, diastolic dysfunction, and increased risk of major cardiovascular events, including atrial fibrillation. In HFrEF, microvascular impairment is linked to heightened oxidative stress, reduced nitric oxide production, and activation of the renin-angiotensin-aldosterone system, further driving disease progression and contributing to poor prognosis. Advancements in diagnostic techniques, such as positron emission tomography, cardiac magnetic resonance imaging, and biomarker analysis, improve our ability to assess CMD in heart failure patients, enabling earlier diagnosis and risk stratification. Emerging therapies, including sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors, and endothelial-targeted interventions, enhance microvascular function and improve patient outcomes. The role of personalized medicine is becoming increasingly important, as individualized therapeutic approaches tailored to patient-specific microvascular abnormalities are essential for optimizing treatment effectiveness. This review underscores the pivotal role of MVD in HF. It highlights the urgent need for innovative therapeutic strategies and diagnostic tools to address this complex condition and improve clinical outcomes for HF patients.

Prevalence and determinants of metabolic syndrome among type2 diabetic patients using different diagnosis criteria in ethiopia: systematic review and meta-analysis

BACKGROUND

Metabolic syndrome has become a major public health problem worldwide and is attributable to the spread of different non-communicable diseases such as type 2 diabetes mellitus, coronary artery diseases, stroke, and permanent or temporary disabilities. It is not a single disease entity but encompasses different risk factors. However, there were inconsistencies among previously conducted primary studies, hence this systematic review and meta-analysis aimed to determine the pooled prevalence and determinants of metabolic syndrome among type2 diabetes patients in Ethiopia.

METHOD

First-hand studies about the metabolic syndrome among adult type 2 diabetic patients in Ethiopia were searched through known and international databases (PubMed, Scopus, Web of Science, and Cochran Library) and search engines (Google and Google Scholar). Data was extracted using a standard data extraction checklist developed according to Joanna Briggs Institute (JBI). The I2 statistics are used to identify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A random effect model was used to estimate the pooled prevalence of the metabolic syndrome among non-insulin-dependent patients in Ethiopia. The STATA version 11 software employed for statistical analysis was conducted using STATA version 11 software.

RESULT

The overall pooled prevalence of metabolic syndrome among type2 diabetic patients in was 54.56% [95%CI (43.73, 65.38), I2 = 97.0%, P = 0.001] using NCEP-ATP III, 48.32% [95%CI (42.1, 54.44), I2 = 97.0%, P = 0.001] IDF diagnosis criteria, 47.0[95%CI(27.01-66.99)], I2 = 97.5%, p = 0.001 using WHO and 59.37%(95%CI(47.21-71.52), I2 = 91.2%, p = 0.001 using harmonized diagnosis criteria respectively. This meta-analysis identified several significant predictors of metabolic syndrome among type 2 diabetes patients in Ethiopia. The odds of having metabolic syndrome was reduced for females (Adjusted Odds Ratio [AOR] = 0.55, 95% CI: 0.35-0.87) compared to males. However, the odds of metabolic syndrome increased with alcohol intake (AOR = 1.44, 95% CI: 1.03-2.01), the odds of living in urban areas(AOR = 2.12, 95% CI: 1.55-2.88), and the odds of having a diabetes duration of six or more years since diagnosis (AOR = 2.94, 95% CI: 1.17-7.41) were significant predictors.

CONCLUSION

The pooled prevalence was considerably high among type 2 diabetic patients in Ethiopia. The pooled prevalence of metabolic syndrome varies as per the diagnosis criteria used with the highest observed in harmonized diagnosis criteria. Being female, being rural residency, alcohol intake, and duration of diabetes since diagnosis were significant predictors of metabolic syndrome among type 2 diabetic patients in Ethiopia.

Chronic complications of type 2 diabetes and associated factors: a cross-sectional study at the Moulay Hassan Hospital in Kenitra, Morocco

Introduction

all around the world, type 2 diabetes is considered a metabolic disease that generates complications that can be very serious, even fatal, over time, especially if not properly managed. Clinical and biological parameters in blood glucose levels will be assessed in this study (N=300 patients). We assess the prevalence of complications caused by diabetes including diabetic retinopathy, nephropathy, neuropathy, and cardiovascular diseases. Type 2 diabetes is an incurred disease, but it can be managed. Self-therapeutic education is therefore imperative and highly recommended.

Methods

this study was carried out at the Moulay Hassan Hospital in Kenitra (Morocco) using a self-administered questionnaire targeting chronic complications caused by diabetes. Descriptive statistical analysis was followed to determine frequencies and percentages for complications and we carried out univariable and multivariable regression analysis to determine factors associated with complications.

Results

the study highlights clinical and bioclinical features. Mean age of patients (58.51±13.11 year with standard deviation: 13,113), hypertension (45.7%), glycemia (1.85±0.64 g/l), HbA1c (8.09±1.7%), BMI (26.44±3.4 kg/m2) and chronic complications (41.7%) including retinopathy (16%), nephropathy (4%), neuropathy (3.3%), cardiovascular diseases (16.7%) and amnesia (2%). There was mainly a statistical difference between complications and HTA: (AOR=2.43 (1.52-3.89) (CI=95%) (p=0.000), chronic complications and smoking: (AOR=0.16) (0.04-0.61) (CI=95%) (p=0.007), complications and physical activity: (AOR=3,34) (1.34-7.24) (CI=95%) (p=0.014) and complications and lipid profile: (AOR=4.95) (2.79-8.77) (CI=95%) (p=0.001).

Conclusion

therapeutic education of type 2 patients with diabetes remains highly recommended, as it improves compliance with non-pharmacological treatment, especially hygienic-dietary measures, and physical activity, and limits the early onset of complications associated with diabetes.

In-Hospital Mortality Among Elderly Patients Hospitalized for Femur Fracture with and Without Diabetes Mellitus: A Multicenter Case-Control Study

Purpose: The aim of the present study was to explore whether diabetes mellitus (DM) is associated with in-hospital mortality in patients admitted for femur fractures. Methods: Our multicenter case-control study included patients aged ≥65 with a primary diagnosis of femur fracture with and without DM treated in 36 German hospitals between January 2019 and December 2023. Patients with DM were matched to patients without DM (1:3) using propensity scores based on age and sex. Multivariable logistic regression analyses were conducted to assess the associations between DM and in-hospital mortality. Results: A total of 3220 patients with diabetes and 9660 patients without diabetes were included (mean age: 83 years). The overall in-hospital mortality rate was higher in DM patients (6.4%) than in those without DM (5.4%). However, the association between DM and in-hospital mortality was not significant after adjustment for other co-diagnoses. In particular, atrial fibrillation, heart failure, and CKD attenuated the effect of DM on in-hospital mortality. Conclusions: Our data show that DM is not significantly associated with in-hospital mortality in femur fracture patients. However, the presence of other comorbidities may influence mortality outcomes, highlighting the need for early intervention and targeted treatment to improve patient outcomes.

Metabolic syndrome and pharmacotherapy outcomes in patients with type 2 diabetes mellitus

Background

Metabolic syndrome is a group of metabolic abnormalities that increase predisposition to several diseases including ischemic heart disease and diabetes mellitus. The study aimed to investigate metabolic syndrome among patients with type-2 diabetes mellitus (DM), and its impact on pharmacotherapy outcomes.

Methods

An observational cross-sectional study was performed on 910 patients with type-2 DM between June and December 2023. Fasting blood sugar, triglycerides, high-density lipoproteins (HDL), blood pressure, and abdominal obesity were measured. Metabolic syndrome was identified according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Pharmacotherapy outcomes were assessed according to American Association of Clinical Endocrinologists and American Diabetes Association guidelines using the ability to achieve adequate glycemic control and normal levels of blood pressure and fasting plasma lipoproteins.

Results

In total, 87.5% of type-2 DM patients had metabolic syndrome; the prevalence increased with age and was higher among females. Metabolic syndrome showed the following distribution of risk factors: insulin resistance (100%), low HDL (95.3%), elevated blood pressure (83%), triglycerides dyslipidemia (80.1%), and abdominal obesity (62.5%). Majority of the patients had either 5 or 4 risk factors of metabolic syndrome. The most common comorbidities were dyslipidemia (97.7%) and hypertension (83%). Treatment outcomes were insufficient where adequate glycemic control was only achieved in 12% of type-2 DM patients, and proper management of comorbid dyslipidemia and hypertension was achieved in 29% and 40.9% of patients, respectively. Adequate blood pressure control was less achieved in patients with metabolic syndrome (34.4%) than those without metabolic syndrome (77.2%). Similarly, dyslipidemia was less controlled in patients with metabolic syndrome (26.9%) than in those without metabolic syndrome (47.3%).

Conclusion

Pharmacotherapy outcomes were inadequate for most patients with type-2 diabetes mellitus. Adopting early preventive and therapeutic interventions for metabolic syndrome is advised to improve treatment outcomes of the comorbid dyslipidemia and hypertension.

Prevalence of Metabolic Syndrome and Its Risk Factors Influence on Microvascular Complications in Patients With Type 1 and Type 2 Diabetes Mellitus

BACKGROUND

Diabetes mellitus (DM) long-term macrovascular and microvascular complications pose significant health risks and increase mortality. In DM patients, metabolic syndrome (MetSy) either precedes or coexists with the condition. Central obesity, poor glycemic control, hypertension, elevated triglycerides (TG), and low high-density lipoproteins (HDL-C) are the components of MetSy. The purpose of this study is to investigate related diabetic microvascular complications in type 1 DM (T1DM) by comparing them with type 2 DM (T2DM), determine potential risk factors, and estimate prevalence based on the diagnosis of MetSy.

METHODOLOGY

This study included 160 T1DM and 160 T2DM patients, totaling 320 DM patients. It was carried out from April 20, 2022, to September 31, 2023, at the Sheikh Zayed Hospital, Rahim Yar Khan, in the Outdoor Diabetic Clinic and Medicine Department. A unique questionnaire was utilized to gather socio-demographic, general, clinical, and laboratory data for the MetSy criteria set forth by the International Diabetes Federation (IDF). The blood pressure, BMI, and waist circumference (WC) were measured, while venous fasting blood was used to assess biochemical markers such as HDL-C, TG, and fasting blood sugar. The microvascular diabetes complications were identified using abdominal ultrasound, fundus ophthalmoscopy, and routine laboratory tests. We quantified and analyzed these variables individually for T1DM and T2DM patients with or without MetSy and compared them in the presence or absence of diabetes microvascular complications.

RESULTS

MetSy prevalence was 25.62% (41, n=160) for T1DM and 60.62% (97, n=160) for T2DM, totaling 43.12%. Among T1DM patients with MetSy, the majority were married males, aged 36-49 years, with a BMI of 26.69±2.20 kg/m2 and a WC of 85.12±4.23, and 67.5% (108) patients had diabetes microvascular complications. Comparatively, in T2DM with MetSy, the majority were married females aged 50-59 years with a BMI of 29.79 ± 4.65 kg/m² and a large WC of 93.43±4.49, and 75% (123) patients had diabetes microvascular complications. Overall, this study noted significant p-values for hypertension, elevated TG, low HDL-c, high WC, obesity, female gender in T2DM, and above 36 years of age in both groups with MetSy. Diabetic retinopathy (DR) at 32.4% (p<0.001) was the most prevalent T1DM microvascular complication, followed by nephropathy (30.6%), neuropathy (DN) at 28.1%, and gastroparesis (DG) at 22.3%. Whereas in T2DM, the prevalence of DN was 36.3% (p<0.001), followed by DKD (29.3%), DG (28.9%), and DR (24.9%).

CONCLUSION

Nearly a quarter of T1DM patients had MetSy, with increasing percentages of overweight and obese patients who are more likely to have DR, DKD, or DN. MetSy affects two-thirds of T2DM patients, with married obese females aged 50-59 being more susceptible than males, who are more likely to suffer DN, DKD, or DG. Risk factors that contribute to the MetSy burden in T1DM and T2DM include hypertension, poor glycemic management, low HDL-C, high TG, and a higher BMI or WC. Increasing age, female gender in T2DM, longer diabetes duration, and co-morbid hypertension were independent predictors of microvascular complications. DR, DN, DKD, and gastroparesis are the most prevalent diabetic microvascular sequelae. The clinical management of diabetic patients with healthy lifestyle adaptations, good glycemic control, antihypertensives, and statins will contribute greatly to MetSy prevention.

A retrospective cohort study of clinical characteristics and outcomes of type 2 diabetic patients with kidney disease

Background

Type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD) poses a serious health threat and becomes a new challenge. T2DM patients with CKD fall into three categories, diabetic nephropathy (DN), non-diabetic kidney disease (NDKD), and diabetic nephropathy plus non-diabetic kidney disease (DN + NDKD), according to kidney biopsy. The purpose of our study was to compare the clinical characteristics and kidney outcomes of DN, NDKD, and DN + NDKD patients.

Methods

Data on clinical characteristics, pathological findings, and prognosis were collected from June 2016 to July 2022 in patients with previously diagnosed T2DM and confirmed DN and or NDKD by kidney biopsy at Tongji Hospital in Wuhan, China. The endpoint was defined as kidney transplantation, dialysis, or a twofold increase in serum creatinine.

Results

In our 6-year retrospective cohort research, a total of 268 diabetic patients were admitted and categorized into three groups by kidney biopsy. The 268 patients were assigned to DN (n = 74), NDKD (n = 109), and DN + NDKD (n = 85) groups. The most frequent NDKD was membranous nephropathy (MN) (n = 45,41.28%). Hypertensive nephropathy was the most common subtype in the DN+NDKD group (n = 34,40%). A total of 34 patients (12.7%) reached the endpoint. The difference between the Kaplan-Meier survival curves of the DN, NDKD, and DN + NDKD groups was significant (p < 0.05). Multifactorial analysis showed that increased SBP [HR (95% CI): 1.018(1.002-1.035), p = 0.025], lower Hb [HR(95% CI): 0.979(0.961-0.997), p = 0.023], higher glycosylated hemoglobin [HR(95% CI): 1.338(1.080-1.658), p = 0.008] and reduced serum ALB [HR(95% CI): 0.952(0.910-0.996), p = 0.032] were risk factors for outcomes in the T2DM patients with CKD.

Conclusions

This research based on a Chinese cohort demonstrated that the risk of endpoint events differed among DN, NDKD, and DN+NDKD patients. In T2DM patients with CKD, DN patients displayed worse kidney prognosis than those with NDKD or DN + NDKD. Increased SBP, higher glycosylated hemoglobin, lower Hb, and decreased serum ALB may be correlated with adverse kidney outcomes in T2DM patients.

Various apolipoprotein E genotypes relate to responsiveness to flaxseed lignan complex in older persons with type 2 diabetes mellitus

Objective. The objective of the study was to determine if there would be statistically significant differences or trends among apolipoprotein E genotypes in the responsiveness of members of a cluster of seven measures in older persons with type 2 diabetes mellitus (T2DM) consuming flaxseed lignan complex (FLC). The cluster of seven are abdominal obesity, hypertension, platelet hyperaggregability, hyperglycemia, dyslipidemia (decreased plasma levels of high-density lipoprotein cholesterol (HDLc), and increased plasma levels of triglycerides), increased low-density lipoprotein (LDL) oxidation and increased inflammation. All cluster members exacerbate T2DM. Methods. Sixteen patients with well-controlled T2DM participated in this double-blind randomized, placebo-controlled crossover study consisting of four visits. Apolipoprotein E genotyping was done at visit one. The cluster of seven, diet, exercise, smoking and medication use were assessed at each visit. Results. The 3/4 genotype showed a stronger downward trend in systolic blood pressure compared to the 3/3 genotype with no trend or significant difference in the 2/4 genotype. There was a downward trend in diastolic blood pressure in genotype 3/3 compared genotype 2/4, which showed no significant difference or trend. Only genotype 3/4 showed a significant drop in diastolic pressure compared to genotypes 2/4 and 3/3. HDLc only showed a downward trend in 3/4 relative to genotypes 2/4 and 3/3. LDL apolipoprotein B oxidation (LDL-Box) only showed an upward trend in 3/3 compared to genotypes 2/4 and 3/4. There were no other significant differences or trends by genotype in the cluster of seven. Conclusions. It appears that those with the 2/4 genotype may not benefit from FLC, those with 3/3 and 3/4 genotypes may benefit only in terms of systolic and diastolic pressures, those with the apo E 3/4 genotype should perhaps avoid FLC to manage HDLc, and those with the 3/3 genotype should perhaps avoid FLC to manage LDL apolipoprotein B oxidation.

Relationships of apolipoprotein E genotypes with a cluster of seven in persons with type 2 diabetes

OBJECTIVE.

The objective of the study was to determine if there would be statistically significant differences or trends among apolipoprotein E genotypes (2/2, 2/3, 2/4, 3/3, 3/4, and 4/4) for each member of the cluster of seven associated with type 2 diabetes (T2D). The cluster of seven includes abdominal obesity, hypertension, platelet hyperaggregability, hyperglycemia, dyslipidemia (decreased plasma levels of high-density lipoprotein cholesterol (HDL-C) and increased plasma levels of triglycerides)), increased low-density lipoprotein (LDL) oxidation, and increased inflammation.

METHODS.

Forty-six patients with well-controlled T2D participated in the study. Abdominal obesity (assessed by waist circumference), hypertension (measured by manual sphygmomanometry), platelet hyperaggregability (measured by bleeding time), hyperglycemia (by enzymatic kit and spectrophotometry), decreased plasma levels of HDL-C and increased plasma levels of triglycerides (by enzymatic kit and spectrophotometry), increased LDL oxidation (measured by LDL conjugated dienes using spectrophotometry) and increased inflammation measured by C-reactive protein (CRP) (by EIA kit) were determined.

RESULTS.

All genotypes, except 2/2 were found in the population studied. Abdominal obesity did not vary significantly across the five genotypes. However, glucose levels trended progressively higher going from 2/3 to 2/4 to 3/4 to 4/4. Systolic blood pressure was higher in 3/4 compared to 2/4 and trended higher in 3/4 compared to 3/3. Diastolic blood pressure trended higher in 3/3 vs 2/4 and significantly higher in 3/4 compared to 2/4. Triglycerides trended higher in 3/4 vs 3/3 while HDL-C came close to trending downward in 4/4 compared to 2/4. Bleeding time was unaffected by genotype. Plasma LDL conjugated dienes trended higher in 3/4 vs 2/4 and were significantly higher in 3/4 vs 3/3. CRP trended higher in 4/4 vs 2/3.

CONCLUSION.

We can conclude that those with at least one 4 allele in the presence of another allele being 2, 3 or 4 is potentially (in the case of trends) deleterious or is deleterious in terms of hyperglycemia, hypertension (systolic and diastolic blood pressure), dyslipidemia, LDL conjugated dienes and CRP levels.

Cerebral Haemodynamic Changes in Type 2 Diabetes Mellitus Following a Three-Month Yoga Intervention: A Randomized Controlled Trial

Background and purpose Cerebral haemodynamics and cognitive performance may be adversely affected in type 2 diabetes mellitus (T2DM). Previous studies reported reduced cerebral blood flow (CBF) and altered cerebrovascular reactivity (CVR) in T2DM. Yoga, an ancient holistic health approach, is known to be beneficial for T2DM. We hypothesized that yoga practice may alter CBF and the flow resistance in the middle cerebral artery (MCA) and improve cognition in T2DM. Our secondary objective was to explore the relationship between changes in cerebral haemodynamics and cognition in T2DM. Materials and methods Participants were randomly allotted into the yoga and control groups based on the eligibility criteria. One hour of yoga intervention specific to type 2 diabetes was provided to the yoga group for three months, while conventional treatment was provided to the control group. A transcranial Doppler was used to evaluate longitudinal changes in cerebral haemodynamics in MCA. A Corsi block tapping test was used to assess visio-spatial working memory. Results There were 75 participants recruited, of whom 38 participated in yoga and 37 participated in a control group. Both intention to treat and per protocol analysis showed significant results. At day 90, intention-to-treat analysis showed significant changes in CBF velocities (mean difference -10.85%, 95% CI (-13.26, -6.15), p<0.001), cerebral vasodilatory reserve (mean difference -0.23%, 95% CI (-0.43, -0.03), p=0.02) and cognition (mean difference -12.13%, 95% CI (-17.48, -6.78), p≤0.001). There was no between-group effect. Also, the correlation between the CBF and cognition did not show any significant results. Conclusion The three-month yoga intervention was associated with an improvement in cerebral hemodynamics. The study also revealed an improvement in visio-spatial working memory among patients with T2DM. The study did not show any correlation between the improvement in cerebral haemodynamics and working memory. We recommend larger and longer studies on yoga intervention for T2DM patients to evaluate whether such benefits are sustained and improve their quality of life.