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Mutua Madrileña Medical Research Foundation, CIBERDEM Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Depto. de Fisiología, Depto. de Bioquímica y Biología Molecular, Fac. de Medicina, TRUE, pub

We aim to examine the incidences, clinical characteristics, and in-hospital outcomes of type 2 diabetes (T2DM) patients hospitalized with urinary tract infections (UTIs) in Spain and to identify the factors associated with in-hospital mortality (IHM). A retrospective observational study was carried out with a sample that included all adult patients who were hospitalized for UTIs between 2001 and 2018 and collected in the Spanish National Health System Hospital Discharge Database. We identified 850,276 patients with UTIs (25.49% with T2DM). The incidence of UTIs increased in patients with and without diabetes from 290.76 and 74.79 cases per 100,000 inhabitants in the period from year 2001 to year 2003 to 568.45 and 144.0 in the period from 2016 to 2018, respectively (p < 0.001). Adjusted incidence of UTIs was higher in T2DM patients (incidence rate ratio (IRR) 4.36; 95% CI 4.35-4.39). The multivariable analysis showed a significant reduction in the IHM over time for men and women with T2DM. In T2DM, patients' higher IHM was associated with older age, comorbidities, and Staphylococcus aureus isolation. Women with T2DM had a higher risk of dying than men. The risk of IHM with an episode of UTIs was independent of the presence of T2DM (odds ratio (OR) 0.97; 95% CI 0.91-1.01). We conclude that the incidence of UTIs was over four times higher in T2DM than nondiabetic patients and has increased over time., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: To evaluate trends in diabetes-related health behaviours and mortality from diabetes and other chronic diseases in the Spanish population before, during and after the 2008 economic crisis. Methods: Annual population measurements were obtained from national surveys and administrative registries for 2004-2016. Using segmented regression analysis, we calculated the annual percentage change (APC) in 2004-2007, 2008-2010, 2011-2013 and 2014-2016 in risk behaviours (smoking, alcohol consumption, obesity and meals away from home), in healthy behaviours (fruit and vegetable intake and physical activity) and in mortality rates from diabetes, cardiovascular disease and cancer. Results: In general, during the economic crisis (2008-2013), the Spanish population reduced risk behaviours and improved healthy behaviours as compared with the trend observed before and afterwards. Diabetes mortality decreased more during the crisis than before or afterwards. The APC in each time interval was -3.3, -3.7, -4.4 and -2.6 in all-age mortality and -2.9, -5.2, -6.7 and -1.3 in premature mortality (less than 75 years). Only in older people (≥75 years) diabetes mortality showed similar decline before and during the crisis. Mortality from cardiovascular disease also declined more during the crisis, except for all-age mortality and older people in the second part of the crisis, whereas the downward trend in cancer mortality was smaller during the crisis years. Conclusions: During the 6 years of the economic crisis in Spain, the favourable changes in health behaviours were accompanied by an important reduction in diabetes mortality in the population., Instituto de Salud Carlos III, Unión Europea, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

This paper will review the effect of aging on glucose metabolism and insulin resistance in pancreas and in peripheral tissues and how melatonin administration could affect these parameters. In SAMP8 mice insulin levels in plasma were found to be increased together with enhanced HOMA-IR values, whereas insulin content in pancreas showed a decrease with aging. Aging in SAMP8 mice was also associated with a significant increase in the relative expression of both protein and mRNA of different pro-inflammatory mediators. Furthermore, aging was associated with a decrease in the expression of Pdx-1, FoxO 1 and FoxO 3A and Sirt 1 in pancreas SAMP8 samples. Melatonin administration was able to reduce these age-related alterations, decreasing plasma insulin levels and increasing its pancreatic content in SAMP8 mice. HOMA-IR was decreased with melatonin treatment in all animals. Conversely, in SAMP8 mice, melatonin treatment decreased the expression of glucagon, GLUT2, somatostatin and insulin. Furthermore it was also able to increase the expression of Sirt 1, Pdx-1 and FoxO 3A. The present study has shown that aging is associated with significant alterations in the relative expression of pancreatic genes involved in both insulin secretion and glucose metabolism and that these are associated with an increase in inflammation and oxidative stress. Melatonin administration was able to reduce oxidative stress and inflammation and thus to improve pancreatic function in old mice. By doing so, insulin resistance is diminished and plasma insulin is reduced, enhancing insulin pancreatic content and reducing plasma glucose levels and HOMA index., Instituto de Salud Carlos III, Junta de Andalucía, Fondo de Investigaciones Sanitarias de la Seguridad Social, Depto. de Fisiología, Fac. de Medicina, TRUE, pub

(1) Background: The relationship between type 2 diabetes (T2DM) and pulmonary embolism (PE) has not been well stablished so far. We aim to analyze incidence, clinical conditions and in-hospital mortality (IHM) according to the presence of T2DM among patients hospitalized for suffering from PE. The factors associated with IHM were identified. (2) Methods: Patients aged ≥40 years hospitalized for PE from 2016 to 2018 included in the Spanish National Health System Hospital Discharge Database were analyzed. Dependent variables included incidence, IHM and length of hospital stay. Independent variables were age, sex, diagnosed comorbidities, thrombolytic therapy and inferior vena cava filter placement. Poisson and logistic regression models were constructed for multivariable analysis. (3) Results: Of the 47,190 hospitalizations for PE recorded, 16.52% had T2DM. Adjusted incidence of PE was higher among T2DM women (IRR 1.83; 95% CI: 1.58-1.96) and men (IRR 1.22; 95% CI: 1.18-1.27) than among non-diabetic subjects. Crude IHM in T2DM patients with PE was similar in both sexes but higher than in non-diabetic patients. Among T2DM patients with PE, risk factors for IHM included older age, comorbidity, atrial fibrillation and massive PE. Obesity was associated with lower IHM. Suffering T2DM was a risk of IHM (OR 1.15; 95% CI 1.05-1.26) after PE. (4) Conclusions: The incidence of PE is higher in T2DM men and women than in non-diabetic patients. T2DM was a risk factor for IHM after PE., Unión Europea, Instituto de Salud Carlos III, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: Among patients presenting with pulmonary embolism (PE), those with diabetes are at increased risk to die than those without diabetes. The reasons have not been identified. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to compare the mortality rate and the causes of death during anticoagulation in patients with PE according to the presence or absence of diabetes. Methods: A matched retrospective cohort study from consecutively enrolled patients in RIETE, from 179 hospitals in 24 countries. For each patient with diabetes we selected two patients with no diabetes matched by age, sex and year of diagnosis of the PE. Results: As of September 2017, there were 2010 PE patients with diabetes and two age-and-gender matched controls. Mean age was 74 ± 11 years, 46% were men. Patients with diabetes were more likely to have co-morbidities, to be using antiplatelets and to have more severe PE. During anticoagulation (median, 219 days), patients with diabetes had a higher mortality (hazard ratio [HR]: 1.45; 95% confidence intervals [CI]: 1.25-1.67) and a higher rate of arterial ischemic events (HR: 2.89; 95%CI: 1.71-4.94) than those without diabetes. On multivariable analysis, diabetes was not associated with an increased risk for death (HR: 1.26; 95%CI: 0.97-1.63). We also failed to find differences according to the use of antiplatelet drugs concomitantly. Conclusions: In our cohort of patients with PE, diabetes was not an independent predictor for death. The influence of arterial events or antiplatelet drugs (if any) was low., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Healthy lifestyle interventions and drug therapies are proven to have a positive preventative influence on normal glucose regulation in prediabetes. However, little is known on the specific role that these factors play on reversion to normal glycemia according to type of prediabetes. We used data from the Observational prospective cohort study, The Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes from 2012 to 2015. A total of 1184 individuals aged 30-74 years old were included and classified based on the ADA in three mutually exclusive groups using either fasting plasma glucose (FPG) levels (from 100 to 125 mg/dl, FPG group), HbA1c (5.7-6.4%, HbA1c group) or both impaired parameters. Information on lifestyle factors and biochemical parameters were collected at baseline. Reversion to normal glucose regulation was calculated at third year of follow-up. Relationship of lifestyle factor and type of prediabetes with reversion were estimated using odds ratios (ORs) with 95% confidence intervals (95% CIs) adjusting by different groups of confounders. Proportion of reversion rates were 31% for FPG group, 31% for HbA1c group and 7.9% for both altered parameters group, respectively. Optimal life style factors such as BMI < 25 kg/m2[OR (95% CI): 1.90 (1.20-3.01)], high adherence to Mediterranean diet 1.78 (1.21-2.63) and absence of abdominal obesity 1.70 (1.19-2.43) were the strongest predictors for reversion to normal glucose. However, those did not modify the ORs of reversion to normal glucose. Taking as reference those with both impaired parameters, subjects with FPG impairment (FPG group) had an OR of 4.87 (3.10-7.65) and 3.72 (2.39-5.78) for HbA1c group. These estimates remained almost the same after further adjustment for biochemical parameters and lifestyle factors (4.55(2.84-7.28) and 3.09 (1.92-4.97), respectively). Optimal lifestyle factors showed to be a positive predictor for reversion to normal glucose regulation however, the diffe, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007 Madrid, Spain, Background: To assess changes in the prevalence of dementia among patients hospitalized with type 2 diabetes (T2DM), to analyze the effects of dementia on in-hospital mortality (IHM) in this population, to evaluate sex differences, and to determine the impact of the COVID-19 pandemic on these parameters. (2) Methods: We used a nationwide discharge database to select all patients with T2DM aged 60 years or over admitted to Spanish hospitals from 2011 to 2020. We identified those with all-cause dementia, Alzheimer’s disease (AD), and vascular dementia (VaD). The effect of sex, age, comorbidity, and COVID-19 on the prevalence of dementia subtypes and on IHM was assessed using multivariable logistic regression. (3) Results: We identified 5,250,810 hospitalizations with T2DM. Allcause dementia was detected in 8.31%, AD in 3.00%, and VaD in 1.55%. The prevalence of all subtypes of dementia increased significantly over time. After multivariable adjustment, higher values were observed in women for all-cause dementia (OR 1.34; 95% CI 1.33–1.35), AD (OR 1.6; 95% CI 1.58–1.62), and VaD (OR 1.12; 95% CI 1.11–1.14). However, female sex was a protective factor for IHM in patients with all-cause dementia (OR 0.90; 95% CI 0.89–0.91), AD (OR 0.89; 95% CI 0.86–0.91), and VaD (OR 0.95; 95% CI 0.91–0.99). IHM among patients with dementia remained stable over time, until 2020, when it increased significantly. Higher age, greater comorbidity, and COVID-19 were associated with IHM in all dementia subtypes. (4) Conclusions: The prevalence of dementia (all-cause, AD, and VaD) in men and women with T2DM increased over time; however, the IHM remained stable until 2020, when it increased significantly, probably because of the COVID-19 pandemic. The prevalence of dementia is higher in women than in men, although female sex is a protective factor for IHM., Universidad Complutense de Madrid: Departamento de Salud Pública y Materno-Infantil, Universidad Rey Juan Carlos, Hospital General Universitario Gregorio Marañón, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

We aimed to assess the effect of the COVID-19 pandemic in Spain on people with diabetes undergoing cardiac procedures, such as coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), open surgical valve replacement (OSVR), and transcatheter valve implantation (TCVI). We compared the year 2019 with the year 2020. We conducted an observational study using data from the Spanish National Hospital Discharge Database from 1 January 2019 to 31 December 2020. In 2020, a total of 21,067 cardiac procedures were performed on people with diabetes compared with 24,675 in the previous year. The use of CABG, PCI, OSVR and TCVI decreased from 2019 to 2020 by 13.9%, 14.8%, 21.4% and 2.9%, respectively. In 2020, patients had a significantly higher mean Charlson Comorbidity Index than in 2019 for all the cardiac procedures analyzed. In-hospital mortality (IHM) was higher (p > 0.05) for all the procedures in the year 2020. Over the entire period, female sex was a significant risk factor for IHM among those who underwent CABG, PCI and OSVR (OR 1.94, 95%CI 1.41–2.66; OR 1.19, 95%CI 1.05–1.35; and OR 1.79, 95%CI 1.38–2.32, respectively). The sensitivity analysis including two more years, 2017 and 2018, confirmed that female patients and comorbidity were risk factors for IHM in patients with diabetes regardless of whether it was during the pandemic era or before. We conclude that the frequency of cardiac procedures among people with diabetes declined in 2020. IHM did not change significantly in the COVID-19 era., Unión Europea, Instituto de Salud Carlos III, Comunidad de Madrid, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

We aim to assess the time trend from 2014 to 2020 in the prevalence of physical activity (PA), identify gender differences and sociodemographic and health-related factors associated with PA among people with diabetes, and compare PA between people with and without diabetes. (2) Methods: We conducted a cross-sectional and a case–control study using as data source the European Health Interview Surveys for Spain (EHISS) conducted in years 2014 and 2020. The presence of diabetes and PA were self-reported. Covariates included socio-demographic characteristics, health-related variables, and lifestyles. To compare people with and without diabetes, we matched individuals by age and sex. (3) Results: The number of participants aged ≥18 years with self-reported diabetes were 1852 and 1889 in the EHISS2014 and EHISS2020, respectively. The proportion of people with diabetes that had a medium or high frequency of PA improved from 48.3% in 2014 to 52.6% in 2020 (p = 0.009), with 68.5% in 2014 and 77.7% in 2020 being engaged in two or more days of PA (p < 0.001). Males with diabetes reported more PA than females with diabetes in both surveys. After matching by age and gender, participants with diabetes showed significantly lower engagement in PA than those without diabetes. Among adults with diabetes, multivariable logistic regression showed confirmation that PA improved significantly from 2014 to 2020 and that male sex, higher educational level, and better self-rated health were variables associated to more PA. However, self-reported comorbidities, smoking, or BMI > 30 were associated to less PA. (4) Conclusions: The time trend of PA among Spanish adults with diabetes is favorable but insufficient. The prevalence of PA in this diabetes population is low and does not reach the levels of the general population. Gender differences were found with significantly more PA among males with diabetes. Our result could help to improve the design and implementation of public health strategie, Comunidad de Madrid, Instituto de Salud Carlos III: Fondo de Investigaciones Sanitarias, Fondo Europeo de Desarrollo Regional, Universidad Complutense de Madrid: Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007 Madrid, Spain, Background: To assess changes in the prevalence of dementia among patients hospitalized with type 2 diabetes (T2DM), to analyze the effects of dementia on in-hospital mortality (IHM) in this population, to evaluate sex differences, and to determine the impact of the COVID-19 pandemic on these parameters. (2) Methods: We used a nationwide discharge database to select all patients with T2DM aged 60 years or over admitted to Spanish hospitals from 2011 to 2020. We identified those with all-cause dementia, Alzheimer’s disease (AD), and vascular dementia (VaD). The effect of sex, age, comorbidity, and COVID-19 on the prevalence of dementia subtypes and on IHM was assessed using multivariable logistic regression. (3) Results: We identified 5,250,810 hospitalizations with T2DM. Allcause dementia was detected in 8.31%, AD in 3.00%, and VaD in 1.55%. The prevalence of all subtypes of dementia increased significantly over time. After multivariable adjustment, higher values were observed in women for all-cause dementia (OR 1.34; 95% CI 1.33–1.35), AD (OR 1.6; 95% CI 1.58–1.62), and VaD (OR 1.12; 95% CI 1.11–1.14). However, female sex was a protective factor for IHM in patients with all-cause dementia (OR 0.90; 95% CI 0.89–0.91), AD (OR 0.89; 95% CI 0.86–0.91), and VaD (OR 0.95; 95% CI 0.91–0.99). IHM among patients with dementia remained stable over time, until 2020, when it increased significantly. Higher age, greater comorbidity, and COVID-19 were associated with IHM in all dementia subtypes. (4) Conclusions: The prevalence of dementia (all-cause, AD, and VaD) in men and women with T2DM increased over time; however, the IHM remained stable until 2020, when it increased significantly, probably because of the COVID-19 pandemic. The prevalence of dementia is higher in women than in men, although female sex is a protective factor for IHM., Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

We aimed to assess the effect of the COVID-19 pandemic in Spain on people with diabetes undergoing cardiac procedures, such as coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), open surgical valve replacement (OSVR), and transcatheter valve implantation (TCVI). We compared the year 2019 with the year 2020. We conducted an observational study using data from the Spanish National Hospital Discharge Database from 1 January 2019 to 31 December 2020. In 2020, a total of 21,067 cardiac procedures were performed on people with diabetes compared with 24,675 in the previous year. The use of CABG, PCI, OSVR and TCVI decreased from 2019 to 2020 by 13.9%, 14.8%, 21.4% and 2.9%, respectively. In 2020, patients had a significantly higher mean Charlson Comorbidity Index than in 2019 for all the cardiac procedures analyzed. In-hospital mortality (IHM) was higher (p > 0.05) for all the procedures in the year 2020. Over the entire period, female sex was a significant risk factor for IHM among those who underwent CABG, PCI and OSVR (OR 1.94, 95%CI 1.41–2.66; OR 1.19, 95%CI 1.05–1.35; and OR 1.79, 95%CI 1.38–2.32, respectively). The sensitivity analysis including two more years, 2017 and 2018, confirmed that female patients and comorbidity were risk factors for IHM in patients with diabetes regardless of whether it was during the pandemic era or before. We conclude that the frequency of cardiac procedures among people with diabetes declined in 2020. IHM did not change significantly in the COVID-19 era., Unión Europea, Instituto de Salud Carlos III, Comunidad de Madrid, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

We aim to assess the time trend from 2014 to 2020 in the prevalence of physical activity (PA), identify gender differences and sociodemographic and health-related factors associated with PA among people with diabetes, and compare PA between people with and without diabetes. (2) Methods: We conducted a cross-sectional and a case–control study using as data source the European Health Interview Surveys for Spain (EHISS) conducted in years 2014 and 2020. The presence of diabetes and PA were self-reported. Covariates included socio-demographic characteristics, health-related variables, and lifestyles. To compare people with and without diabetes, we matched individuals by age and sex. (3) Results: The number of participants aged ≥18 years with self-reported diabetes were 1852 and 1889 in the EHISS2014 and EHISS2020, respectively. The proportion of people with diabetes that had a medium or high frequency of PA improved from 48.3% in 2014 to 52.6% in 2020 (p = 0.009), with 68.5% in 2014 and 77.7% in 2020 being engaged in two or more days of PA (p < 0.001). Males with diabetes reported more PA than females with diabetes in both surveys. After matching by age and gender, participants with diabetes showed significantly lower engagement in PA than those without diabetes. Among adults with diabetes, multivariable logistic regression showed confirmation that PA improved significantly from 2014 to 2020 and that male sex, higher educational level, and better self-rated health were variables associated to more PA. However, self-reported comorbidities, smoking, or BMI > 30 were associated to less PA. (4) Conclusions: The time trend of PA among Spanish adults with diabetes is favorable but insufficient. The prevalence of PA in this diabetes population is low and does not reach the levels of the general population. Gender differences were found with significantly more PA among males with diabetes. Our result could help to improve the design and implementation of public health strategie, Comunidad de Madrid-España, FIS (Fondo de Investigaciones Sanitarias—Health Research Fund, Instituto de Salud Carlos III), Fondo Europeo de Desarrollo Regional (FEDER, “Una manera de hacer Europa”), Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: Recent reports suggest a decrease in the prevalence of depression among people with diabetes and important sex-differences in the association between these conditions, however data from Spain is sparse. We aim to assess trends in the prevalence of depression and in-hospital outcomes among patients with type 2 diabetes (T2DM) hospitalized (2011–2020) identifying sex-differences. (2) Methods: Using the Spanish national hospital discharge database we analysed the prevalence of depression globally, by sex, and according to the conditions included in the Charlson comorbidity index (CCI). We tested factors associated with the presence of depression and with in-hospital mortality (IHM). Time trends in the prevalence of depression and variables independently associated with IHM were analyzed using multivariable logistic regression. (3) Results: From 2011 to 2020, we identified 5,971,917 hospitalizations of patients with T2DM (5.7% involved depression). The prevalence of depression decreased significantly between 2011 and 2020. The adjusted prevalence of depression was 3.32-fold higher in women than in men (OR 3.32; 95%CI 3.3–3.35). The highest prevalence of depression among men and women with T2DM was found among those who also had a diagnosis of obesity, liver disease, and COPD. Older age, higher CCI, pneumonia, and having been hospitalized in 2020 increased the risk of IHM in patients with T2DM and depression. Obesity was a protective factor for IHM in both sexes, with no differences detected for IHM between men and women. Among patients hospitalized with T2DM, concomitant depression was associated with lower IHM than among patients without depression (depression paradox). (4) Conclusions: The prevalence of depression decreased over time in both sexes. The prevalence of depression was over three-fold higher in women. Female sex and depression were not associated with higher IHM. Based on our results we recommend that clinicians screen regularly for depress, Unión Europea, Comunidad de Madrid, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Fondos FEDER Convenio V-PRICIT de la Comunidad de Madrid y la Universidad Complutense de Madrid (“Programa de Excelencia para el Profesorado Universitario” INV.AY.20.2021.1E126)., Background: We performed a study to assess sex-differences in incidence (2016-2020), clinical characteristics, use of therapeutic procedures, and in-hospital outcomes in patients with infective endocarditis (IE) according to T2DM status. Methods: Ours was a retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of hospitalizations for IE in men and women aged ≥ 40 years with and without T2DM. Propensity score matching (PSM) and multivariable logistic regression were used to compare subgroups according to sex and the presence of T2DM. Results: From 2016 to 2020, IE was coded in 9,958 patients (66.79% men). T2DM was diagnosed in 2,668 (26.79%). The incidence of IE increased significantly from 15.29 cases per 100,000 persons with T2DM in 2016 to 17.69 in 2020 (p < 0.001). However, this increment was significant only among men with T2DM (19.47 cases per 100,000 in 2016 vs. 22.84 in 2020; p = 0.003). The age-adjusted incidence of IE was significantly higher in people with T2DM (both sexes) than in those without T2DM (IRR, 2.86; 95% CI, 2.74-2.99). The incidence of IE was higher in men with T2DM than in women with T2DM (adjusted IRR, 1.85; 95% CI, 1.54-3.31). After PSM, in-hospital mortality (IHM) was higher among T2DM women than matched T2DM men (22.65% vs. 18.0%; p = 0.018). The presence of T2DM was not associated with IHM in men or women. Conclusions: T2DM is associated with a higher incidence of hospitalization for IE. Findings for T2DM patients who had experienced IE differed by sex, with higher incidence rates and lower IHM in men than in women. T2DM was not associated to IHM in IE in men or in women., European Commission, Instituto de Salud Carlos III (España), Universidad Complutense de Madrid, Depto. de Salud Pública y Materno - Infantil, Depto. de Medicina, Fac. de Medicina, TRUE, pub

(1) Background: To assess the time trend in the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine or frequent headache (MFH) among people with diabetes in Spain from 2014 to 2020, this study identified sex differences and compared the prevalence of these pain sites between people with diabetes and age–sex-matched non-diabetic subjects. (2) Methods: The study design included a cross-sectional and a case–control study. The data were obtained from the European Health Interview Surveys for Spain conducted in 2014 and 2020. The presence of diabetes, CNP, CLBP, and MFH was self-reported. Study covariates included sociodemographic characteristics, comorbidities, lifestyles, and pain-related variables. (3) Results: Among people with diabetes, the prevalence of CNP, CLBP, and MFH did not improve from 2014 to 2020. Women with diabetes had a significantly higher prevalence of all the pain sites analyzed than men with diabetes. After matching by sex and age, the prevalence of CNP (26.0% vs. 21.1%; p < 0.001), CLBP (31.2% vs. 25.0%; p < 0.001), and MFH (7.7% vs. 6.5%; p = 0.028) was higher for people with diabetes than for those without diabetes. Self-reported mental disease was independently associated with reporting the three pain sites analyzed in people with diabetes. (4) Conclusions: The prevalence of CNP, CLBP, and MFH has remained stable over time. Remarkable sex differences were found, with a higher prevalence among women than men with diabetes. Diabetes was associated with reporting in all the pain sites analyzed. Self-reported mental disease was associated with reporting CNP, CLBP, and MFH., Unión Europea, Comunidad de Madrid, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: During the COVID-19 pandemic, different non-validated tests were proposed to simplify the diagnosis of gestational diabetes (GDM). Aim: To analyse the effects of replacing the two-step approach for Early-GDM and GDM diagnosis, with a fasting plasma glucose test. Material and Methods: This is a cohort study consisting of 3200 pregnant women: 400 with Early-GDM, 800 with GDM and 2000 with Non-GDM diagnosed using the two-step approach. Using fasting plasma glucose for Early-GDM and GDM diagnosis, according to the recommendations of Spain, Australia, Italy and the UK during the pandemic, the rates of missed and new Early-GDM and GDM were calculated and perinatal outcomes were analysed. Results: Using fasting plasma glucose in the first trimester >100 mg/dL for Early-GDM diagnosis, the rates of post-COVID missed and new Early-GDM were 79.5% and 3.2%, respectively. Using fasting plasma glucose at 24–28 weeks <84 or >92, 95 or 100 mg/dL for GDM diagnosis, the rates of missed GDM were 50.4%, 78%, 82.6% and 92.4%, respectively, and 8.6%, 5.6% and 2.3% women with Non-GDM were diagnosed with new GDM. Conclusion: Fasting plasma glucose is not a good test for the diagnosis of GDM either in the first trimester or at 24–28 weeks., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license., Colorectal cancer (CRC) and diabetes are two of the most prevalent chronic diseases worldwide with dysregulated receptor tyrosine kinase signaling and strong co-occurrence correlation. Plasma autoantibodies represent a promising early diagnostic marker for both diseases before symptoms appear. We explore here the value of autoantibodies against receptor-type tyrosineprotein phosphatase-like N PTPRN (full-length or selected domains) as diagnostic markers using a cohort of type 2 diabetic (T2D), CRC, healthy individuals or patients with both diseases. We show that PTPRN autoantibody levels in plasma discriminated between T2D patients with and without CRC. Consistently, high PTPRN expression correlated with decreased survival of CRC patients. Mechanistically, PTPRN depletion significantly reduced invasiveness of CRC cells in vitro and liver homing and metastasis in vivo by means of a dysregulation of the epithelial-mesenchymal transition and a decrease of the insulin receptor signaling pathway. Therefore, PTPRN autoantibodies may represent a particularly helpful marker for the stratification of T2D patients at high risk of developing CRC. Consistent with the critical role played by tyrosine kinases in diabetes and tumor biology, we provide evidences that tyrosine phosphatases such as PTPRN may hold potential as therapeutic targets in CRC patients., Ministerio de Economía y Competitividad (MINECO)/FEDER, Instituto de Salud Carlos III (ISCIII)/FEDER, Ministerio de Educación, Unidad Docente de Bioquímica y Biología Molecular, Fac. de Óptica y Optometría, TRUE, pub

(1) Background: Recent reports suggest a decrease in the prevalence of depression among people with diabetes and important sex-differences in the association between these conditions, however data from Spain is sparse. We aim to assess trends in the prevalence of depression and in-hospital outcomes among patients with type 2 diabetes (T2DM) hospitalized (2011–2020) identifying sex-differences. (2) Methods: Using the Spanish national hospital discharge database we analysed the prevalence of depression globally, by sex, and according to the conditions included in the Charlson comorbidity index (CCI). We tested factors associated with the presence of depression and with in-hospital mortality (IHM). Time trends in the prevalence of depression and variables independently associated with IHM were analyzed using multivariable logistic regression. (3) Results: From 2011 to 2020, we identified 5,971,917 hospitalizations of patients with T2DM (5.7% involved depression). The prevalence of depression decreased significantly between 2011 and 2020. The adjusted prevalence of depression was 3.32-fold higher in women than in men (OR 3.32; 95%CI 3.3–3.35). The highest prevalence of depression among men and women with T2DM was found among those who also had a diagnosis of obesity, liver disease, and COPD. Older age, higher CCI, pneumonia, and having been hospitalized in 2020 increased the risk of IHM in patients with T2DM and depression. Obesity was a protective factor for IHM in both sexes, with no differences detected for IHM between men and women. Among patients hospitalized with T2DM, concomitant depression was associated with lower IHM than among patients without depression (depression paradox). (4) Conclusions: The prevalence of depression decreased over time in both sexes. The prevalence of depression was over three-fold higher in women. Female sex and depression were not associated with higher IHM. Based on our results we recommend that clinicians screen regularly for depress, Unión Europea, Comunidad de Madrid, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

This study is a part of the research funded by the: FIS (Fondo de Investigaciones Sanitarias—Health Research Fund, Instituto de Salud Carlos III) and co-financed by the European Union through the Fondo Europeo de Desarrollo Regional (FEDER, “Una manera de hacer Europa”): grant no. PI20/00118. Additionally, by: Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970)., Background: In this work, we aim to describe influenza vaccine uptake among the diabetic population in Spain to assess the time trend from 2011 to 2020 and identify predictors of vaccine uptake among diabetes patients. (2) Methods: We conducted a descriptive cross-sectional study using the European Health Interview Survey for Spain (2014 and 2020) and the Spanish National Health Surveys (2011 and 2017). The independent variables analysed included socio-demographic characteristics, health-related variables and lifestyle variables. We matched each participant with diabetes with a non-diabetic participant based on age, sex, place of residence and year of survey. (3) Results: The overall coverage among diabetic adults was 52.1% compared to 40.6% for matched participants without diabetes (p < 0.01). The vaccine uptake among adults with diabetes was 52.6% in 2011, 54.38% in 2014 and 53.4% in 2017. The adjusted OR of having been vaccinated in 2020, with respect to 2011, was not significant at 0.87 (95% CI: 0.72–1.06). Factors such as being male, higher age, being affected by respiratory disease or cancer and being physically active were identified as positive predictors for influenza vaccination uptake, while smoking was a negative predictor. (4) Conclusions: The influenza vaccine uptake is below desirable levels among the adult diabetic population in Spain and has not improved from 2011 to 2020. More efforts should be made to increase influenza vaccine uptake in this high-risk group, especially for women, those aged 18–64 years, without other high-risk conditions and smokers., Unión Europea, Instituto de Salud Carlos III, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Spanish Ministry of Education, Culture and Sports (FPU15/02759). Adrián Macho-González received a predoctoral fellowship, Depto. de Farmacología, Farmacognosia y Botánica, Fac. de Farmacia, TRUE, pub

This study is a part of the research funded by the FIS (Fondo de Investigaciones Sanitarias—Health Research Fund, Instituto de Salud Carlos III) and co-financed by the European Union through the Fondo Europeo de Desarrollo Regional (FEDER, “Una manera de hacer Europa”): grant no. PI20/00118., Background: To analyze the incidence, clinical characteristics, use of procedures, and in-hospital outcomes in patients who developed pneumonia during their hospital admission according to sex and to the presence of type 2 diabetes mellitus (T2DM). (2) Methods: Retrospective cohort study using data from the Spanish National Hospital Discharge Database. Hospital-acquired pneumonia (HAP) was classed as non-ventilator HAP and ventilator-associated pneumonia (VAP). Separate analyses were performed for men and women with and without T2DM. Population subgroups were compared using propensity score matching. (3) Results: HAP was identified in 38,814 patients (24.07% with T2DM). The adjusted incidence of HAP was higher in patients with T2DM (both sexes) (IRR 1.28; 95% CI 1.25–1.31). The incidence of HAP was higher in men with T2DM than in women with T2DM (adjusted-IR 1.47; 95% CI 1.41–1.53). The incidence of HAP among T2DM patients increased over time. In-hospital mortality (IHM) was around 28% irrespective of T2DM status and sex. After adjusting for confounders and sex, VAP was associated to higher IHM among patients with T2DM (OR 2.09; 95% CI 1.7–2.57). (4) Conclusions: T2DM is associated with a higher risk of HAP, whose incidence increased over time. Men with T2DM have an almost 50% higher risk of HAP than women with T2DM. The probability of dying in the hospital was not associated with sex or T2DM., Unión Europea, Instituto de Salud Carlos III, Depto. de Salud Pública y Materno - Infantil, Fac. de Enfermería, Fisioterapia y Podología, Fac. de Medicina, TRUE, pub

Funding was provided by the A.P. Møller Foundation; Riisfort Foundation; Toyota Foundation; Independent Research Fund Denmark (DFF–5053-00195 to J.F.); Steno Diabetes Center Aarhus, which is partially funded by an unrestricted donation from the Novo Nordisk Foundation (NNF17OC0027242 to N.J. and NNF16OC0021496 to T.H.P.); Lundbeck Foundation (R190-2014-3904 to T.H.P.); Roche per la Ricerca 2019 to L.M.; and NIH/NIAMS (R01AR076247-01 to P.L.P.)., Type 2 diabetes mellitus (T2DM) is associated with impaired skeletal muscle function and degeneration of the skeletal muscles. However, the mechanisms underlying the degeneration are not well described in human skeletal muscle. Here we show that skeletal muscle of T2DM patients exhibit degenerative remodeling of the extracellular matrix that is associated with a selective increase of a subpopulation of fibro-adipogenic progenitors (FAPs) marked by expression of THY1 (CD90)—the FAPCD90+. We identify platelet-derived growth factor (PDGF) as a key FAP regulator, as it promotes proliferation and collagen production at the expense of adipogenesis. FAPsCD90+ display a PDGF-mimetic phenotype, with high proliferative activity, clonogenicity, and production of extracellular matrix. FAPCD90+ proliferation was reduced by in vitro treatment with metformin. Furthermore, metformin treatment reduced FAP content in T2DM patients. These data identify a PDGF-driven conversion of a subpopulation of FAPs as a key event in the fibrosis development in T2DM muscle., A.P. Møller Foundation, Riisfort Foundation, Toyota Foundation, Independent Research Fund Denmark, Novo Nordisk Foundation, Lundbeck Foundation, National Institutes of Health, Depto. de Genética, Fisiología y Microbiología, Fac. de Ciencias Biológicas, TRUE, pub

Healthy lifestyle interventions and drug therapies are proven to have a positive preventative influence on normal glucose regulation in prediabetes. However, little is known on the specific role that these factors play on reversion to normal glycemia according to type of prediabetes. We used data from the Observational prospective cohort study, The Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes from 2012 to 2015. A total of 1184 individuals aged 30-74 years old were included and classified based on the ADA in three mutually exclusive groups using either fasting plasma glucose (FPG) levels (from 100 to 125 mg/dl, FPG group), HbA1c (5.7-6.4%, HbA1c group) or both impaired parameters. Information on lifestyle factors and biochemical parameters were collected at baseline. Reversion to normal glucose regulation was calculated at third year of follow-up. Relationship of lifestyle factor and type of prediabetes with reversion were estimated using odds ratios (ORs) with 95% confidence intervals (95% CIs) adjusting by different groups of confounders. Proportion of reversion rates were 31% for FPG group, 31% for HbA1c group and 7.9% for both altered parameters group, respectively. Optimal life style factors such as BMI < 25 kg/m2[OR (95% CI): 1.90 (1.20-3.01)], high adherence to Mediterranean diet 1.78 (1.21-2.63) and absence of abdominal obesity 1.70 (1.19-2.43) were the strongest predictors for reversion to normal glucose. However, those did not modify the ORs of reversion to normal glucose. Taking as reference those with both impaired parameters, subjects with FPG impairment (FPG group) had an OR of 4.87 (3.10-7.65) and 3.72 (2.39-5.78) for HbA1c group. These estimates remained almost the same after further adjustment for biochemical parameters and lifestyle factors (4.55(2.84-7.28) and 3.09 (1.92-4.97), respectively). Optimal lifestyle factors showed to be a positive predictor for reversion to normal glucose regulation however, the diffe, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

This study is a part of the research funded by the FIS (Fondo de Investigaciones Sanitarias—Health Research Fund, Instituto de Salud Carlos III) and co-financed by the European Union through the Fondo Europeo de Desarrollo Regional (FEDER, “Una manera de hacer Europa”): grant no. PI20/00118., Background: To analyze the incidence, clinical characteristics, use of procedures, and in-hospital outcomes in patients who developed pneumonia during their hospital admission according to sex and to the presence of type 2 diabetes mellitus (T2DM). (2) Methods: Retrospective cohort study using data from the Spanish National Hospital Discharge Database. Hospital-acquired pneumonia (HAP) was classed as non-ventilator HAP and ventilator-associated pneumonia (VAP). Separate analyses were performed for men and women with and without T2DM. Population subgroups were compared using propensity score matching. (3) Results: HAP was identified in 38,814 patients (24.07% with T2DM). The adjusted incidence of HAP was higher in patients with T2DM (both sexes) (IRR 1.28; 95% CI 1.25–1.31). The incidence of HAP was higher in men with T2DM than in women with T2DM (adjusted-IR 1.47; 95% CI 1.41–1.53). The incidence of HAP among T2DM patients increased over time. In-hospital mortality (IHM) was around 28% irrespective of T2DM status and sex. After adjusting for confounders and sex, VAP was associated to higher IHM among patients with T2DM (OR 2.09; 95% CI 1.7–2.57). (4) Conclusions: T2DM is associated with a higher risk of HAP, whose incidence increased over time. Men with T2DM have an almost 50% higher risk of HAP than women with T2DM. The probability of dying in the hospital was not associated with sex or T2DM., Unión Europea, Instituto de Salud Carlos III, Depto. de Salud Pública y Materno - Infantil, Fac. de Enfermería, Fisioterapia y Podología, Fac. de Medicina, TRUE, pub

This study is a part of the research funded by the: FIS (Fondo de Investigaciones Sanitarias—Health Research Fund, Instituto de Salud Carlos III) and co-financed by the European Union through the Fondo Europeo de Desarrollo Regional (FEDER, “Una manera de hacer Europa”): grant no. PI20/00118. Additionally, by: Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970)., Background: In this work, we aim to describe influenza vaccine uptake among the diabetic population in Spain to assess the time trend from 2011 to 2020 and identify predictors of vaccine uptake among diabetes patients. (2) Methods: We conducted a descriptive cross-sectional study using the European Health Interview Survey for Spain (2014 and 2020) and the Spanish National Health Surveys (2011 and 2017). The independent variables analysed included socio-demographic characteristics, health-related variables and lifestyle variables. We matched each participant with diabetes with a non-diabetic participant based on age, sex, place of residence and year of survey. (3) Results: The overall coverage among diabetic adults was 52.1% compared to 40.6% for matched participants without diabetes (p < 0.01). The vaccine uptake among adults with diabetes was 52.6% in 2011, 54.38% in 2014 and 53.4% in 2017. The adjusted OR of having been vaccinated in 2020, with respect to 2011, was not significant at 0.87 (95% CI: 0.72–1.06). Factors such as being male, higher age, being affected by respiratory disease or cancer and being physically active were identified as positive predictors for influenza vaccination uptake, while smoking was a negative predictor. (4) Conclusions: The influenza vaccine uptake is below desirable levels among the adult diabetic population in Spain and has not improved from 2011 to 2020. More efforts should be made to increase influenza vaccine uptake in this high-risk group, especially for women, those aged 18–64 years, without other high-risk conditions and smokers., Unión Europea, Instituto de Salud Carlos III, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Introduction. One of the unsolved problems in coronary and vascular surgery there is a choice of tactics of surgical treatment at the combined atherosclerotic damage of coronary and carotid arteries. Surgical procedures with the use of artificial circulation can lead to high frequency of postoperative complications in comparison with operation on a beating heart. The aim. To improve the results of treatment of patients with combined damage of the brachiocephalic and coronary arteries. Materials and methods. 56 patients with type 2 diabetes mellitus with combined damage of the brachiocephalic and coronary arteries were treated from 2015 to 2020. All patients performed coronary artery bypass grafting on a beating heart in combination with carotid endarterectomy. Results and discussion. No deaths were observed in the postoperative period. In 50 (89,2 %) patients the postoperative period passed without complications. After 5 years of monitoring during clinical and non-invasive methods of examination of coronary circulation disorders were not detected. Conclusions. Our clinical experience showed promising short- and medium-term results. The chosen surgical tactics allowed to effectively avoid the problem of atherosclerotic damage of the coronary and cerebral arteries.

The purpose of the workisto investigate the relationship between body composition parameters and uric acid metabolism and lipid spectrum in obese type 2 diabetic male compared with non-obese patients. Materials and methods. In 34 patients with type 2 diabetes, aged 45 to 75 years, with unsatisfactory glycemic control (HbA1c from 7.1 to 12.6 %), mainly with abdominal obesity, anthropometric parameters, characteristics of body composition (percentage of total and abdominal fat, segmental distribution of adipose and muscle tissue, by bioimpedance method), level of HbA1c, C-peptide, concentration of uric acid (UA), 24 h UA excretion, and serum lipid fractions were measured. Patients were divided into 2 groups depending on the degree of obesity: group 1—15 men with overweight without obesity (BMI 25.0—29.9 kg/m2); group2—19 obese men (BMI ≥ 30.0 kg/m2). The groups did not differ in age and disease duration. Results and discussion. Normouricemia was observed in almost all examined patients, without a significant difference in uricemia levels between two groups. In 42 % of obese patients, elevated UA excretion was significantly higher than in the non-obese group, which may reflect increased UA production during the day and increased urate elimination, which leads to normal uricemia. Comparison of body composition between groups with different phenotypes showed that obese patients had significantly higher percentages of total fat and visceral fat than non-obese individuals. Adipose tissue in both groups was evenly distributed between body segments. In obese patients, there was a significant increase in muscle mass, especially in the lower extremities, with some dehydration, as indicated by a decrease in the % water content. Conclusions. It has been shown that both variants of metabolic phenotypes in patients with type 2 diabetes (with and without obesity), under conditions of central fat accumulation and normouricemia, in many cases were accompanied by hyperexcretion of UA

Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients.The objective: was to determine sex and age differences in the structural and functional state of the vessels of the carotid and vertebro-basilar basins in patients with stage I–III cerebral atherosclerosis (CA) and type 2 diabetes mellitus.Materials and methods. A comprehensive clinical and instrumental study involved 229 patients with stageI–IIICA and type 2 diabetes mellitus. The patients were divided into 2 groups: I – the general group of patients who had an ischemic atherothrombotic stroke in the middle cerebral artery basin – CA III; II – with CA I–II stages. All patients underwent conventional clinical, laboratory and instrumental studies (Doppler ultrasound of the vessels of the head and neck – study of cerebral blood flow in the extra- and intracranial sections of the main arteries of the head and neck using the Aplio XG device (Toshiba).Results. In patients of group I, there were no age or sex differences in the linear systolic blood flow velocity (LSBFV) of the vessels of the carotid and vertebro-basilar basins. In group II patients over 60 years of age, the LSBFV in both internal carotid arteries was statistically significantly higher than in middle-aged patients, while the LSBFV in the left vertebral, posterior cerebral arteries and the basilar artery was statistically significantly higher in middle-aged patients than in the elderly. In our opinion, these differences can be explained by statistically significant differences in fasting blood glucose levels. It is important to note that statistically significant sex differences were found only for LSBFV in both

Mango fruits and mango leaf extracts (Mangifera indica) are a medicinal plant used to treat diabetes and its complications. The tender leaves of the mango tree contain tannins called anthocyanidins, which help treat early diabetes. The leaves contain the compound 3 betataraxerol and ethyl acetate extract, which interacts with insulin, activating GLUT4 and stimulating glycogen synthesis. Mango leaves have powerful antioxidant properties because they contain a large amount of flavonoids, phenols, zeaxanthin and beta-carotene. Animal studies have shown that mangiferin can counteract the free radical associated with cancer, diabetes, and other diseases.

The article highlights the relevance of the high prevalence of chronic viral hepatitis C in the world and in Ukraine in particular as well as the associated clinical features of the extrahepatic manifestations. Type 2 diabetes mellitus is found in one-third of patients with chronic viral hepatitis C. Also, this study reveals problem points of gastric mucosal changes in type 2 diabetes mellitus which leads to atrophic gastritis and irondeficiency anemia. This presented clinical case demonstrates the clinical features of comorbid pathology as well as the princip­les of laboratory and instrumental diagnostics. The material presents the results of videoesophagogastro­duodenoscopy and pathohistological examination of gastric mucosa changes in type 2 diabetes which lead to chronic atrophic gastritis, and, as a consequence, iron deficiency anemia.Videocolonoscopy w/biopsy data was also highlighted. Differential diagnosis of diseases associated with sideropenic syndrome and pancreatic enzyme insufficiency by fecal tests - fecal calprotectin, fecal elastase 1 and analysis for intestinal parasites and protozoa, as well as by tests for a celiac disease, is carefully described. The basic laboratory signs of hepatitis C virus ribonucleic acid and indicators of sideropenic syndrome before and after the treatment were highlighted. The presented clinical case demonstrates the importance of timely thorough diagnosis of comorbid pathology in patients with type 2 diabetes mellitus and discusses the selection of personalized treatment regimens.

We aim to examine the incidences, clinical characteristics, and in-hospital outcomes of type 2 diabetes (T2DM) patients hospitalized with urinary tract infections (UTIs) in Spain and to identify the factors associated with in-hospital mortality (IHM). A retrospective observational study was carried out with a sample that included all adult patients who were hospitalized for UTIs between 2001 and 2018 and collected in the Spanish National Health System Hospital Discharge Database. We identified 850,276 patients with UTIs (25.49% with T2DM). The incidence of UTIs increased in patients with and without diabetes from 290.76 and 74.79 cases per 100,000 inhabitants in the period from year 2001 to year 2003 to 568.45 and 144.0 in the period from 2016 to 2018, respectively (p < 0.001). Adjusted incidence of UTIs was higher in T2DM patients (incidence rate ratio (IRR) 4.36; 95% CI 4.35-4.39). The multivariable analysis showed a significant reduction in the IHM over time for men and women with T2DM. In T2DM, patients' higher IHM was associated with older age, comorbidities, and Staphylococcus aureus isolation. Women with T2DM had a higher risk of dying than men. The risk of IHM with an episode of UTIs was independent of the presence of T2DM (odds ratio (OR) 0.97; 95% CI 0.91-1.01). We conclude that the incidence of UTIs was over four times higher in T2DM than nondiabetic patients and has increased over time., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: The relationship between type 2 diabetes (T2DM) and pulmonary embolism (PE) has not been well stablished so far. We aim to analyze incidence, clinical conditions and in-hospital mortality (IHM) according to the presence of T2DM among patients hospitalized for suffering from PE. The factors associated with IHM were identified. (2) Methods: Patients aged ≥40 years hospitalized for PE from 2016 to 2018 included in the Spanish National Health System Hospital Discharge Database were analyzed. Dependent variables included incidence, IHM and length of hospital stay. Independent variables were age, sex, diagnosed comorbidities, thrombolytic therapy and inferior vena cava filter placement. Poisson and logistic regression models were constructed for multivariable analysis. (3) Results: Of the 47,190 hospitalizations for PE recorded, 16.52% had T2DM. Adjusted incidence of PE was higher among T2DM women (IRR 1.83; 95% CI: 1.58-1.96) and men (IRR 1.22; 95% CI: 1.18-1.27) than among non-diabetic subjects. Crude IHM in T2DM patients with PE was similar in both sexes but higher than in non-diabetic patients. Among T2DM patients with PE, risk factors for IHM included older age, comorbidity, atrial fibrillation and massive PE. Obesity was associated with lower IHM. Suffering T2DM was a risk of IHM (OR 1.15; 95% CI 1.05-1.26) after PE. (4) Conclusions: The incidence of PE is higher in T2DM men and women than in non-diabetic patients. T2DM was a risk factor for IHM after PE., Unión Europea, Instituto de Salud Carlos III, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background. The widespread use of laparoscopy has greatly accelerated the development of bariatric/metabolic surgery. Mastering of the laparoscopic techniques in bariatric surgery is important considering the potential complications and their implications for the patient’s life. Laparoscopic sleeve gastrectomy is a common bariatric/metabolic procedure worldwide. This procedure seems relatively standard, but some steps of this procedure still depends on the choice of the surgeon. There are two main steps that are not standardized yet — the choice of the calibration bougie and the distance from the pylorus to the first staple. The objective of the study is to establish the anatomical landmarks of the beginning of staplerfiring, which are simple, constant, and which can be used to standardize laparoscopic gastric sleeve resection. Materials and methods. Thirty-six obese patients with type 2 diabetes mellitus undergo laparoscopic sleeve gastrectomy. Body measurements, such an age, gender, height, weight, body mass index, and carbohydrate metabolism parameters, such as glucose, glycated hemoglobin, insulin, C-peptide, HOMA index was analyzed. The distance from the gastric pylorus was measured intraoperatively using a silicone tape. Results and discussion. The study included 19 women and 17 men, with an average age of 50.3 ± 9.6 years (range 30—67 years). The average body mass index is 50.6 ± 10.9 kg/m2 (range 30.2—82.3 kg/m2). The average distance from the pylorus to the first branch of the gastroepiploic artery, which runs in the transverse direction to the axis of the antrum, was 41 ± 1.7 mm (range 38—44 mm). The average distance for women was 40.6 ± 1.6 mm, for men — 41.5 ± 1.6 mm. Conclusion. The first branch of the gastroepiploic artery which runs perpendicularly to the axis of the antrum can be used as constant anatomical landmark. It is located on average 41 mm proximal to the gastric pylorus. Using this landmark for the first stapler firing allows to offset the n

Background. Autoimmune monogenic diabetes (AMD) is a disease that causes a mutation in one gene that determines the development of a specific autoimmune reaction with the development of diabetes mellitus (DM) at an early age. In addition to DM, such patients have frequent severe infections, autoimmune hematological disorders (autoimmune cytopenia, lympho­proliferative diseases), gastroente­rological diseases (autoimmune enteropathy, diar­rhea, celiac disease, hepatosplenomegaly), endocrinopathies (autoimmune thyroid disease etc.), which causes the high and early mortality of patients in the absence of specific treatment. The aim. To conduct a genetic testing in children with DM type 1 and other severe autoimmune pathology and to assess the clinical course of the disease in the case of a genetically confirmed AMD. Matherials and methods. We selected patients (n = 11) for the AMD genetic testing who were diagnosed with DM type 1 at an early age (from 1 month to 12 years old), and who additionally had at least one more serious autoimmune disease. Genetic diagnostics was done using a tNGS of neonatal DM or AMD panels including AIRE, CTLA4, FOXP3, IL2RA, ITCH, JAK1, LRBA, SIRT1, STAT1, STAT3, STAT5B and TNFAIP3 genes. Results and discussion. The article presents three fatal clinical cases in children with DM, for whom genetic diagnostics confirmed the diagnosis of AMD. In the first child with a hemizygous mutation FOXP3 c.1040G> A, p.R347H type 1 DM was combined with severe respiratory failure, perhaps due to Guillain — Barré syndrome with respiratory muscle paralysis due to acute autoimmune polyradiculoneuropathy. The second child with AIRE p.Cys311fs/p.Arg257Ter had all the classic signs of APS-1. Patient 3 had classic signs of a mutation in the LRBA gene, namely DM type 1 and autoimmune enteropathy, but the lack of timely AMD genetic diagnosis did not allow to prescribe the appropriate treatment with specific monoclonal antibodies or hematopoietic stem cell transplant

This review focuses on the analysis of existing literature data on the role of intestinal microbioceno­sis as an epigenetic factor in the formation of an organism’s phenotype, including such common dysmetabolic conditions as obesity, metabolic syndrome (MS), type 2 diabetes mellitus (DM). It has been established that microorganisms that reside in the intestinal tract play a crucial role in digestion, nutrition, immune regulation and metabolism, contributing to the maintenance of metabolic homeostasis and well-being. The results of clinical and epidemiological studies have highlighted the relationship between qualitative and quantitative changes in the microbiota (dysbiosis) and pathophysiological mechanisms of the development of obesity, dysglycemia and dyslipidemia, effects on glycemia and insulin resistance in humans. The mechanisms underlying the metabolic effects of the gut microbiota include action on the secretion of incretins, production of short-chain fatty acids, metabolism of bile acids, and regulation of adipose tissue. The review discusses the relationship features between the gut microbiota and enteroendocrine secretion, in particular the influence of microbial metabolites on the secretion of endogenous glucagon-like peptide-1, as well as the effect of GLP-1 receptor agonists on the composition and function of the gut microbiota. Modulation of the intestinal microbiota is probably one of the factors affecting the secretion of enteroendocrinepeptides, therefore, the gut microbiota may serve as a potential therapeutic target for the treatment of obesity, MS and type 2 DM.

Background. Metformin is the most widely used oral antihyperglycaemic drug, but it may lower B12 status, which could have important clinical implications. There are limited data about the effect of metformin use on serum vitamin B12 levels in type 2 diabetes mellitus (DM) patients. Aim. To study serum Vitamin B12 levels in patients with type 2 diabetes mellitus who were receiving metformin and compared them to those never treated with metformin. Materials and methods. A total of 60 patients with type 2 DM (group 1, n = 35, receiving metformin and group 2, n = 25, never treated with metformin) from the endocrinology clinic in Chernivtsi were studied. Serum vitamin B12 levels were measured in all patients. Results and discussion. The serum vitamin B12 levels were 239.6 ± 37.4 pg/ml in metformin group and 293.6 ± 42.3 pg/ml in the no metformin group (p = 0.37). When adjusted for duration of DM, metformin use was associated with a 57.2 ± 7.3 pg/ml (p = 0.03) lower serum vitamin B12 levels. Serum vitamin B12 levels were higher by 41.4 pg/ml in patients with DM of 1—5 years compared to those with recently diagnosed diabetes (p = 0.41). Serum vitamin B12 levels were higher by 119.4 pg/ml in patients with duration of DM > 5 years compared to those with recently diagnosed diabetes (p < 0.02). Similarly, serum vitamin B12 levels were 77.1 pg/ml higher in > 5 years DM duration group compared to 1—5 year duration of DM group (p = 0.03). Serum vitamin B12 levels for the entire cohort were higher by 11.8 ± 1.7 pg/ml (p < 0.01) for every 1 year increase in the DM duration. Conclusions. Metformin use was associated with a lower serum vitamin B12 levels when adjusted for duration of DM. Increasing duration of DM was associated with higher serum vitamin B12 levels.

The objective: to study the informativeness of the use of well-known comorbidity indices for assessing the status of patients with nonalcoholic fatty liver disease (NADH) and associated pathology, to substantiate the feasibility of developing and applying a new method for such patients.Materials and methods. 114 patients with NAFLD on type 2 diabetes mellitus background were been examed, the concomitant hypothyroidism were diagnosed in 47 of them (32 – subclinical, 15 – clinically expressed). The clinical severity of diseases was been evaluated using Charlson index, Caplan-Feinstein index, CIRS system, and a new Comorbidity Index (CI).Results. The benefits of Comorbidity Index (IVPKZ) are posibility of assessing the presence such diseases: non-alcoholic fatty liver disease, concomitant thyroid dysfunction, anemia and dyslipidemia. It makes possible to correct the patient’s management, taking into account the dominant concomitant diseases and cardiovascular risk.Conclusions. The index of the severity of the course of comorbid diseases can be used in practical medicine to assess the severity of the concomitant pathology in patients with diabetes mellitus.

The article discusses the relationship of glycemia control with the development of mid-vascular pathology. Proved a clear link glycemic control with a reduced risk of micro- and macrovascular complications of diabetes. At present, the ideology of early intervention is actively developing and is gaining more and more admirers. Effective competent self-monitoring of blood glucose is one of the fundamental factors in slowing down and preventing the development of cardiovascular complications of diabetes. The maintenance of a high quality of life of the patient is no less important than the achievement of target values of glycemia.

Background: To evaluate trends in diabetes-related health behaviours and mortality from diabetes and other chronic diseases in the Spanish population before, during and after the 2008 economic crisis. Methods: Annual population measurements were obtained from national surveys and administrative registries for 2004-2016. Using segmented regression analysis, we calculated the annual percentage change (APC) in 2004-2007, 2008-2010, 2011-2013 and 2014-2016 in risk behaviours (smoking, alcohol consumption, obesity and meals away from home), in healthy behaviours (fruit and vegetable intake and physical activity) and in mortality rates from diabetes, cardiovascular disease and cancer. Results: In general, during the economic crisis (2008-2013), the Spanish population reduced risk behaviours and improved healthy behaviours as compared with the trend observed before and afterwards. Diabetes mortality decreased more during the crisis than before or afterwards. The APC in each time interval was -3.3, -3.7, -4.4 and -2.6 in all-age mortality and -2.9, -5.2, -6.7 and -1.3 in premature mortality (less than 75 years). Only in older people (≥75 years) diabetes mortality showed similar decline before and during the crisis. Mortality from cardiovascular disease also declined more during the crisis, except for all-age mortality and older people in the second part of the crisis, whereas the downward trend in cancer mortality was smaller during the crisis years. Conclusions: During the 6 years of the economic crisis in Spain, the favourable changes in health behaviours were accompanied by an important reduction in diabetes mortality in the population., Instituto de Salud Carlos III, Unión Europea, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: Among patients presenting with pulmonary embolism (PE), those with diabetes are at increased risk to die than those without diabetes. The reasons have not been identified. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to compare the mortality rate and the causes of death during anticoagulation in patients with PE according to the presence or absence of diabetes. Methods: A matched retrospective cohort study from consecutively enrolled patients in RIETE, from 179 hospitals in 24 countries. For each patient with diabetes we selected two patients with no diabetes matched by age, sex and year of diagnosis of the PE. Results: As of September 2017, there were 2010 PE patients with diabetes and two age-and-gender matched controls. Mean age was 74 ± 11 years, 46% were men. Patients with diabetes were more likely to have co-morbidities, to be using antiplatelets and to have more severe PE. During anticoagulation (median, 219 days), patients with diabetes had a higher mortality (hazard ratio [HR]: 1.45; 95% confidence intervals [CI]: 1.25-1.67) and a higher rate of arterial ischemic events (HR: 2.89; 95%CI: 1.71-4.94) than those without diabetes. On multivariable analysis, diabetes was not associated with an increased risk for death (HR: 1.26; 95%CI: 0.97-1.63). We also failed to find differences according to the use of antiplatelet drugs concomitantly. Conclusions: In our cohort of patients with PE, diabetes was not an independent predictor for death. The influence of arterial events or antiplatelet drugs (if any) was low., Depto. de Medicina, Fac. de Medicina, TRUE, pub