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Type II diabetes mellitus and hyperhomocysteinemia: a complex interaction.

ABSTRACT: BACKGROUND:Elevated homocysteine (Hc) levels have a well-established and clear causal relationship to epithelial damage leading to coronary artery disease. Furthermore, it is strongly associated with other metabolic syndrome variables, such as hypertension, which is correlated with type II diabetes mellitus (T2DM). Studies on T2DM in relation to Hc levels have shown both positive and negative associations. The aim of the present study is to examine the relationship between Hc levels and risk of T2DM in the Lebanese population. METHODS:We sought to identify whether Hc associates positively or negatively with diabetes in a case-control study, where 2755 subjects enrolled from patients who had been catheterized for coronary artery diagnosis and treatment. We further sought to identify whether the gene variant MTHFR 667C>T is associated with T2DM, and how Hc and MTHFR 667C>T also impact other correlates of T2DM, including the widely used diuretics in this study population. RESULTS:We found that Hc levels were significantly reduced among subjects with diabetes compared to those without diabetes when adjusted for all potential confounders (OR 0.640; 95% CI [0.44-0.92]; p = 0.0200). The associations between Hc levels and other variates contradicted the result: hypertension associates positively with high Hc levels, and with T2DM. The MTHFR 667C>T only associated significantly with high Hc levels. CONCLUSION:These results suggest population-specific variations among a range of mechanisms that modulate the association of Hc and T2DM, providing a probe for future studies.

SUBMITTER: Platt DE

PROVIDER: S-EPMC5359933 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Type II diabetes mellitus and hyperhomocysteinemia: a complex interaction.

Platt Daniel E DE Hariri Essa E Salameh Pascale P Merhi Mahmoud M Sabbah Nada N Helou Mariana M Mouzaya Francis F Nemer Rita R Al-Sarraj Yasser Y El-Shanti Hatem H Abchee Antoine B AB Zalloua Pierre A PA

Diabetology & metabolic syndrome 20170321

<h4>Background</h4>Elevated homocysteine (Hc) levels have a well-established and clear causal relationship to epithelial damage leading to coronary artery disease. Furthermore, it is strongly associated with other metabolic syndrome variables, such as hypertension, which is correlated with type II diabetes mellitus (T2DM). Studies on T2DM in relation to Hc levels have shown both positive and negative associations. The aim of the present study is to examine the relationship between Hc levels and ...[more]

PMID: 28331553

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Project description:Necrotising fasciitis is insidiously advancing soft tissue infection, characterized by widespread fascial necrosis. One of the most common conditions encountered in the clinical practice and which required clinical suspicion in patients who have less resistance to these infections. Especially in diabetic patients who are more prone for such infection due to low immunity and other reasons like early detection of these infections helps these patients to have a better recovery by aggressive surgical management and other measures required for the same. Literature has enough evidence on how serious this entity. Hence this study is designed in that aspect to help in early diagnosis and appropriate treatment. This study will help to determine the clinical presentation, the polymicrobial involved. The organisms most closely linked to necrotizing fasciitis are group A beta-hemolytic streptococci, although the disease may also be caused by other bacteria and their sensitivity patterns will help us to install appropriate antibiotics with the surgical management. And to compare our mortality rate with the other studies. A prospective descriptive study including all type II diabetic patients with necrotizing fasciitis over 3 years. Patients were evaluated in detail with respect to patient's history, examination, culture sensitivity and chart reviews and followed up using standard evaluation tools to measure the various outcomes. In 62 patients, the commonest clinical presentation was necrotic patch of skin and cellulites. The organisms cultured being beta hemolytic streptococci and E.Coli. The culture sensitivity pattern is to broad-spectrum antibiotics. The average stay in the hospital was about 13.74 days for the study group and the time delay in presentation is 6 days. Wagner's score is a useful tool for aiding the diagnosis. Patients without foot care had extensive lesions. And a mortality rate of 1.6 % in these patients. In an acutely swollen limb in a diabetic patient a high degree of suspicion of necrotizing fasciitis is required. A detailed foot care is warranted in these patients. An early extensive debridement is mandatory and key for a favorable outcome. And to start on broad- spectrum antibiotics is advisable. Wagner's scoring is helpful to predict the chances of a second surgery. With the above entities in mind the mortality rate of necrotizing fasciitis in type ii diabetes mellitus can be contained.

Project description:BackgroundThe proportion of patients with diabetic retinopathy (DR) has grown with increasing number of diabetes mellitus patients in the world. It is among the major causes of blindness worldwide. The main objective of this study was to identify contributing risk factors of DR among people with type II diabetes mellitus.MethodA sample of 191 people with type II diabetes mellitus was selected from the Black Lion Specialized Hospital diabetic unit from 1 March 2018 to 1 April 2018. A multivariate stochastic regression imputation technique was applied to impute the missing values. The response variable, DR is a categorical variable with two outcomes. Based on the relationship derived from the exploratory analysis, the odds of having DR were not necessarily linearly related to the continuous predictors for this sample of patients. Therefore, a semiparametric model was proposed to identify the risk factors of DR.ResultFrom the sample of 191 people with type II diabetes mellitus, 98 (51.3%) of them had DR. The results of semiparametric regression model revealed that being male, hypertension, insulin treatment, and frequency of clinical visits had a significant linear relationships with the odds of having DR. In addition, the log- odds of having DR has a significant nonlinear relation with the interaction of age by gender (for female patients), duration of diabetes, interaction of cholesterol level by gender (for female patients), haemoglobin A1c, and interaction of haemoglobin A1c by fasting blood glucose with degrees of freedom [Formula: see text], respectively. The interaction of age by gender and cholesterol level by gender appear non significant for male patients. The result from the interaction of haemoglobin A1c (HbA1c) by fasting blood glucose (FBG) showed that the risk of DR is high when the level of HbA1c and FBG were simultaneously high.ConclusionClinical variables related to people with type II diabetes mellitus were strong predictive factors of DR. Hence, health professionals should be cautious about the possible nonlinear effects of clinical variables, interaction of clinical variables, and interaction of clinical variables with sociodemographic variables on the log odds of having DR. Furthermore, to improve intervention strategies similar studies should be conducted across the country.

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Type II diabetes mellitus and hyperhomocysteinemia: a complex interaction.

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Type II diabetes mellitus and hyperhomocysteinemia: a complex interaction.

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