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Author(s): Shalini Virani [1]; Akshay Bhatiwal [2]; Parveen Rewri (corresponding author) [2] Introduction Diabetic retinopathy (DR) is a leading cause of preventable blindness, with an estimated global prevalence of 22.27 [...], OBJECTIVES: Anti-vascular endothelial growth factor (VEGF) therapy restores retinal architecture and enhances vision in diabetic macular edema (DME). Bevacizumab is an off-label anti-VEGF drug that effectively treats DME. The safety and efficacy of bevacizumab biosimilars, which are more affordable than the original medication, still need to be established. This study aimed to assess the cost-effectiveness, efficacy, and safety of biosimilars for treating patients with naïve DME across various price ranges that are accessible in the Indian market. MATERIALS AND METHODS: Two biosimilars, BevaciRelTM (Reliance Life Sciences Pvt. Ltd.) and ZyBev (Cadila Healthcare Limited), were compared to their original, Avastin (Roche Products [India] Pvt. Ltd.), in a randomized, control study. Three end-notes were used to assess safety and efficacy: persistence, improvement, and adverse events. Cost-effective analysis was carried out using a decision-tree analysis model. RESULTS: This study included 69 (59) men and 54 (41) women with naïve DME. The cohort had an average log MAR visual acuity of 0.87 ± 0.22, and the central retinal thickness at baseline on OCT was 398.5 ± 37.61 μm. The visual acuity showed a similar improvement, and there was a decrease in central retinal thickness as observed on OCT across the groups. The incremental cost-effectiveness ratio was 10.8. CONCLUSIONS: The biosimilars of bevacizumab are safe and efficacious in treating DME in a cost-effective manner. Keywords: Anti-vascular endothelial growth factor, bevacizumab, biosimilars, cost-effectiveness, diabetic macular edema

Introduction Coronary artery disease (CAD) contributes to high mortality and disability-adjusted life-years worldwide (Hay et al. 2017). The burden of this disease is increasingly apparent worldwide, including in Indonesia, by [...], Diabetes mellitus (DM) increases risk of coronary artery disease (CAD). Endothelin-1 (ET-1) is a potential biomarker of endothelial dysfunction. This study aimed to evaluate ET-1 level in CAD patients and its relationship with DM. The cross-sectional design included subjects with angiographically proven CAD and controls among Indonesian. DM was defined by medical history and anti-diabetics use. Serum ET-1 level was measured in both subject groups. We recruited 305 subjects, 183 CAD patients and 122 controls. CAD subjects had higher percentage of males, DM, hypertension, dyslipidemia, smoking, family history of cardiovascular disease, and obesity. ET-1 level was significantly higher in CAD than in controls (2.44 [+ or -] 1.49 pg/mL vs. 1.76 [+ or -] 0.83 pg/mL; p < 0.001). Increased ET-1 level was significantly associated with DM and dyslipidemia. The highest ET-1 level was observed in CAD with DM, followed by CAD non-DM (2.79 [+ or -] 1.63 pg/mL vs. 2.29 [+ or -] 1.40 pg/mL; p = 0.023). Among controls, ET-1 level was the lowest in non-DM subjects. Female CAD had higher proportion of DM; however, ET-1 level was similar to male CAD with DM. In conclusion, an increased ET-1 level was significantly associated with DM in patients with CAD. Further research should investigate the potential role of ET-1 receptor antagonists in the secondary prevention of CAD with DM. Key words: coronary artery disease, endothelin-1, diabetes mellitus, cardiovascular risk factor, Indonesian population Le diabete sucre (DS) entraine un risque accru de coronaropathie. L&apos;endotheline 1 (ET-1) est un biomarqueur potentiel du dysfonctionnement endothelial. Cette etude croisee visait a evaluer les taux d&apos;ET-1 chez les patients atteints de coronaropathie et le lien avec le DS. L&apos;etude comprenait des sujets indonesiens avec coronaropathie confirmee par angiographie et des temoins de la meme origine. Le DS etait caracterise par les antecedents medicaux et l&apos;utilisation de medicaments antidiabetiques. Nous avons mesure les taux d&apos;ET-1 dans les deux groupes de sujets. Nous avons inscrit a l&apos;etude 305 sujets, dont 183 patients atteints de coronaropathie et 122 temoins. Le groupe de sujets atteints de coronaropathie comprenait un pourcentage plus eleve d&apos;hommes, de DS, d&apos;hypertension, de dyslipidemie, de tabagisme, d&apos;antecedents familiaux de maladies cardiovasculaires et d&apos;obesite. Les taux d&apos;ET-1 etaient nettement plus eleves chez les patients atteints de coronaropathie que chez les temoins (2,44 [+ or -] 1,49 pg/ml p/r a 1,76 [+ or -] 0,83 pg/ml, p < 0,001). L&apos;augmentation des taux d&apos;ET-1 etait associee de facon appreciable au DS et a la dyslipidemie. Nous avons observe les taux d&apos;ET-1 les plus eleves chez les patients atteints a la fois de coronaropathie et de DS, suivis de la coronaropathie sans DS (2,79 [+ or -] 1,63 pg/ml p/r a 2,29 [+ or -] 1,40 pg/ml, p = 0,023). Chez les temoins, nous avons observe les taux d&apos;ET-1 les moins eleves chez les patients qui n&apos;etaient pas atteints de DS. Chez les femmes atteintes de coronaropathie, le DS etait plus frequent, mais les taux d&apos;ET-1 etaient similaires a chez les hommes atteints a la fois de coronaropathie et de DS. En conclusion, nous avons observe des taux d&apos;ET-1 nettement plus eleves chez les patients atteints a la fois de coronaropathie et de DS. Plus de recherches devraient porter sur le role eventuel des antagonistes des recepteurs de l&apos;ET-1 dans la prevention secondaire de la coronaropathie avec DS. Mots-cles : coronaropathie, endotheline 1, diabete sucre, facteurs de risque cardiovasculaire, population indonesienne

Introduction Progression to organ failure is marked by fibrosis and loss of architecture in solid organs, such as the kidney. In almost all progressive chronic kidney diseases (CKDs), the features [...], Diabetic kidney disease (DKD) can lead to end-stage kidney disease (ESKD) and mortality; however, few mechanistic biomarkers are available for high-risk patients, especially those without macroalbuminuria. Urine from participants with diabetes from the Chronic Renal Insufficiency Cohort (CRIC) study, the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D), and the American Indian Study determined whether urine adenine/creatinine ratio (UAdCR) could be a mechanistic biomarker for ESKD. ESKD and mortality were associated with the highest UAdCR tertile in the CRIC study and SMART2D. ESKD was associated with the highest UAdCR tertile in patients without macroalbuminuria in the CRIC study, SMART2D, and the American Indian study. Empagliflozin lowered UAdCR in nonmacroalbuminuric participants. Spatial metabolomics localized adenine to kidney pathology, and single-cell transcriptomics identified ribonucleoprotein biogenesis as a top pathway in proximal tubules of patients without macroalbuminuria, implicating mTOR. Adenine stimulated matrix in tubular cells via mTOR and stimulated mTOR in mouse kidneys. A specific inhibitor of adenine production was found to reduce kidney hypertrophy and kidney injury in diabetic mice. We propose that endogenous adenine may be a causative factor in DKD.

1. Introduction According to the International Diabetes Federation, approximately 12%-32% of patients with diabetes have suffered from diabetic cardiomyopathy (DCM), a major cause of mortality, and these patients have a [...], Beta-caryophyllene (BCP), a cannabinoid 2 ([CB.sub.2]) receptor agonist has recently been found to have cardioprotective activity as an anti-inflammatory and antioxidant molecule. L-arginine (LA), a nitric oxide (NO) donor, is a potential regulator of cardiovascular function. Considering the role of [CB.sub.2] receptor activation and NO regulation in cardiovascular diseases, the combination of BCP with LA may be a possible treatment of diabetic cardiomyopathy (DCM). Hence, we investigated the efficacy of the novel combination of BCP with LA on cardiovascular inflammation and oxidative stress in diabetic rats. DCM was induced by streptozotocin (55 mg/kg) in Sprague-Dawley rats intraperitoneally. BCP, LA, and BCP with LA were administered to diabetic rats for 4 weeks. After completion of the study, hemodynamic parameters, biochemical parameters, and inflammatory cytokine levels were analyzed. Also, oxidative stress parameters, nuclear factor kappa beta (NF-[kappa][beta]) expression, and histopathology in cardiac tissues were estimated. The combination of BCP (200 mg/kg) with LA (200 mg/kg) significantly normalized the hemodynamic parameters and decreased the glucose, cardiac markers, interleukin-6, and tumor necrosis factor-alpha levels. Treatment of BCP and LA showed a significant decrease in oxidative stress and down-regulated the cardiac expression of NF- [kappa][beta]. Thus, the combination of BCP with LA improves cardiac functions by attenuating inflammation through NF- [kappa][beta] inhibition in DCM. Key words: beta-caryophyllene, L-arginine, diabetic cardiomyopathy, NF-[kappa][beta] inhibition, streptozotocin. Recemment, on a montre que le beta caryophyllene (BCP), un agoniste des recepteurs cannabinoides de type 2 ([CB.sub.2]), dispose d&apos;une activite cardioprotectrice comme molecule anti-inflammatoire et anti-oxydante. La L- arginine (LA), un donneur d&apos;oxyde nitrique (NO), est un agent de regulation potentiel du fonctionnement cardiovasculaire. Etant donne le role de l&apos;activation des recepteurs [CB.sub.2] et de la regulation du NO dans les maladies cardiovasculaires, l&apos;association de BCP avec de la LA pourrait constituer un traitement eventuel contre la cardiomyopathie diabetique (CMD). Par consequent, nous avons etudie l&apos;efficacite de la nouvelle association du BCP avec la LA sur l&apos;inflammation et le stress oxydatif cardiovasculaires chez des rats diabetiques. Nous avons provoque la CMD a l&apos;aide de streptozotocine (55 mg/kg) administree par voie intraperitoneale chez des rats SD. Nous avons administre le BCP, la LA et le BCP avec la LA pendant 4 semaines chez des rats diabetiques. Une fois l&apos;etude terminee, nous avons analyse les parametres hemodynamiques et biochimiques, de meme que les taux de cytokines inflammatoires. Nous avons aussi estime les parametres du stress oxydatif, l&apos;expression du NF-[kappa][beta] et l&apos;histopathologie des tissus cardiaques. L&apos;association du BCP (200 mg/kg) avec la LA (200 mg/kg) entrainait une stabilisation des parametres hemodynamiques et la diminution des taux de glucose, de marqueurs cardiaques, d&apos;IL-6 et de TNF-[alpha] de facon notable. L&apos;administration de BCP et de LA a entraine une diminution marquee du stress oxydatif, avec une regulation a la baisse de l&apos;expression du NF-[kappa][beta] dans le coeur. Par consequent, l&apos;association du BCP avec la LA permet d&apos;ameliorer certains aspects du fonctionnement du coeur en attenuant l&apos;inflammation par l&apos;intermediaire de l&apos;inhibition du NF-[kappa][beta] dans la CMD. Mots-cles: beta caryophyllene, L-arginine, cardiomyopathie diabetique, inhibition du NF-[kappa][beta], streptozotocine.

Introduction Diabetic cardiomyopathy (DCM) is a cardiac dysfunction that affects about 12% of people with diabetes, leading to significant heart failure and death (Lorenzo-Almoros et al. 2017). It has been [...], Cardiac fibrosis is one of the major pathological characteristics of diabetic cardiomyopathy (DCM). MicroRNAs (miRNAs, miRs) have been identified as key regulators in the progression of cardiac fibrosis. This study aimed to investigate the role of miR-30a-5p in DCM and the underlying mechanism. The rat model of diabetes mellitus (DM) was established by streptozotocin injection, and the rat primary cardiac fibroblasts (CFs) were isolated from cardiac tissue and then treated with high glucose (HG). MTT assay was performed to assess the viability of CFs. Dual-luciferase reporter gene assay was conducted to verify the interaction between miR-30a-5p and Smad2. The expression of miR- 30a-5p was downregulated in the myocardial tissues of DM rats and HG-stimulated CFs. Overexpression of miR-30a-5p reduced Smad2 levels and inhibited collagen formation in HG-stimulated CFs and DM rats, as well as decreased the proliferation of CFs induced by HG. Smad2 was a target of miR-30a-5p and its expression was inhibited by miR-30a-5p. Furthermore, the simultaneous overexpression of Smad2 and miR-30a-5p reversed the effect of miR-30a-5p overexpression alone in CFs. Our results indicated that miR-30a-5p reduced Smad2 expression and also induced a decrease in proliferation and collagen formation in DCM. Key words: diabetic cardiomyopathy, cardiac fibrosis, high glucose, miR-30a-5p, Smad2. La fibrose cardiaque est l&apos;une des principales caracteristiques pathologiques de la cardiomyopathie diabetique (CMD). On a etabli que les microARN (miARN) sont des regulateurs cles dans l&apos;evolution de la fibrose cardiaque. Cette etude portait sur le role du miR-30a-5p dans la CMD et le mode d&apos;action sous-jacent. Nous avons realise le modele de diabete sucre (DS) chez le rat par l&apos;injection de streptozotocine, et nous avons isole des fibroblastes cardiaques (FC) de rat a partir de tissu cardiaque, puis administre des quantites de glucose elevees (HG). Nous avons evalue la vitalite des FC a l&apos;aide de l&apos;epreuve MTT. Nous avons mene l&apos;epreuve de gene rapporteur par la double luciferase afin de verifier la presence d&apos;une interaction entre le miR30a-5p et Smad2. Les resultats ont montre que l&apos;expression du miR-30a-5p etait regulee a la baisse dans le tissu myocardique de rats atteints de DS et dans des FC stimules par l&apos;HG. La subexpression du miR-30a-5p entrainait une diminution des taux de Smad2 avec une inhibition de la formation de collagene dans les FC stimules par l&apos;HG et chez les rats atteints de DS, de meme qu&apos;une diminution de la proliferation des FC induite par l&apos;HG. Smad2 constituait une cible du miR- 30a-5p et son expression etait inhibee par le miR-30a-5p. En outre, la surexpression simultanee de Smad2 et du miR-30a-5p entrainait une inversion de l&apos;effet de la subexpression du miR-30a-5p seul dans les FC. Nos resultats ont montre que le miR-30a-5p permettait de faire diminuer l&apos;expression de Smad2, de meme que la proliferation des cellules et la formation de collagene dans la CMD. [Traduit par la Redaction] Mots-cles: cardiomyopathie diabetique, fibrose cardiaque, hyperglycemie, miR- 30a-5p, Smad2.

Introduction Prenatal exposures to environmental chemicals are ubiquitous in the United States (1,2) and studies have demonstrated they can have lifelong consequences for maternal and child health outcomes, such as [...], BACKGROUND: Nontargeted analysis (NTA) methods identify novel exposures; however, few chemicals have been quantified and interrogated with pregnancy complications. OBJECTIVES: We characterized levels of nine exogenous and endogenous chemicals in maternal and cord blood identified, selected, and confirmed in prior NTA steps, including linear and branched isomers perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), monoethylhexyl phthalate, 4-nitrophenol, tetraethylene glycol, tridecanedioic acid, octadecanedioic acid, and deoxycholic acid. We evaluated relationships between maternal and cord levels and between gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy in a diverse pregnancy cohort in San Francisco. METHODS: We collected matched maternal and cord serum samples at delivery from 302 pregnant study participants from the Chemicals in Our Bodies cohort in San Francisco. Chemicals were identified via NTA and quantified using targeted approaches. We calculated distributions and Spearman correlation coefficients testing the relationship of chemicals within and between the maternal and cord blood matrices. We used adjusted logistic regression to calculate the odds of GDM and hypertensive disorders of pregnancy associated with an interquartile range increase in maternal chemical exposures. RESULTS: We detected linear PFOS, PFHxS, octadecanedioic acid, and deoxycholic acid in at least 97% of maternal samples. Correlations ranged between -0.1 and 0.9. We observed strong correlations between cord and maternal levels of PFHxS, linear PFOS, and branched PFOS (coefficient = 0.9, 0.8, and 0.8, respectively). An interquartile range increase in linear and branched PFOS, tridecanedioic acid, octadecanedioic acid, and deoxycholic acid was associated with increased odds ratio (OR) of GDM [OR = 1.33 (95% CI: 0.89, 2.01), 1.24 (95% CI: 0.86, 1.80), 1.26 (95% CI: 0.93, 1.73), 1.24 (95% CI: 0.86, 1.80), and 1.23 (95% CI: 0.87, 1.75), respectively]. Tridecanedioic acid was positively associated with hypertensive disorders of pregnancy [OR= 1.28 (95% CI: 0.90, 1.86)]. DISCUSSION: We identified both exogenous and endogenous chemicals seldom quantified in pregnant study participants that were also related to pregnancy complications and demonstrated the utility of NTA to identify chemical exposures of concern. https://doi.org/ 10.1289/EHP11546

Introduction Cardiovascular pathologies often complicate diabetes mellitus (DM) (Braunwald 2019). Specifically, DM increases risk of ventricular arrhythmias and sudden cardiac death in patients with coronary artery disease as well as [...], Diabetes mellitus (DM) is associated with increased risk of sudden cardiac death, but its role in arrhythmogenesis is not clear. We evaluated contributions of DM duration and hyperglycemia level to development of proarrhythmic electrophysiological changes in the experimental ischemia/reperfusion model. Ventricular epicardial 64-lead mapping and arrhythmia susceptibility burst-pacing testing were performed in 43 healthy and 55 diabetic (alloxan model) anesthetized rabbits undergoing 15 min left anterior descending coronary artery occlusion, followed by 15 min reperfusion. During ischemia, arrhythmia inducibility did not differ between the groups, but the number of reperfusion ventricular tachycardias and (or) fibrillations (VT/VFs) were higher in the DM group (14 out of 55) as compared with control (3 out of 43, p = 0.017). In the diabetic animals, both DM duration and glucose concentration were associated with reperfusion VT/VF development in univariate logistic regression analysis (odds ratio (OR) 1.058, 95% confidence interval (CI) 1.025-1.092, p < 0.001; and OR 1.119, 95% CI 1.045-1.198, p = 0.001, respectively). Only the DM duration, however, remained an independent predictor of reperfusion VT/VF in multivariate logistic regression analysis (OR 1.060, 95% CI 1.006-1.117, p = 0.029). Among mapping parameters, DM duration was associated with the prolongation of total ventricular activation duration (regression coefficient 0.152, 95% CI 0.049- 0.255, p = 0.005) and activation-repolarization intervals (ARIs) (regression coefficient 0.900, 95% CI 0.315-1.484, p = 0.003). The prolonged ARI was the only mapping characteristic predicting reperfusion VT/VF development (OR 1.028, 95% CI 1.009-1.048, p = 0.004). The DM durationdependent prolongation of ventricular repolarization presents a link between DM development and reperfusion VT/VF inducibility. Key words: diabetes, arrhythmias, activation-recovery interval, reperfusion, repolarization. Le diabete sucre (DS) est associe a un risque accru de mort subite cardiaque, mais son role dans l&apos;arythmogenese demeure a clarifier. Nous avons evalue les contributions de la duree du DS et du degre d&apos;hyperglycemie sur Revolution de changements electrophysiologiques proarythmiques dans le modele experimental d&apos;ischemie-reperfusion. A l&apos;aide de la cartographie de l&apos;epicarde ventriculaire a 64 derivations, nous avons procede a l&apos;etude de stimuli en salves sur la susceptibilite aux arythmies chez 43 lapins anesthesies (modele d&apos;alloxane) en bonne sante et 55 atteints de DS, tous soumis a une occlusion de l&apos;artere interventriculaire anterieure pendant 15 minutes, suivie d&apos;une reperfusion de 15 minutes. Au cours de l&apos;ischemie, l&apos;inductibilite des arythmies n&apos;etait pas differente entre les deux groupes, mais le nombre d&apos;arythmies de reperfusion de type tachycardie ventriculaire et/ou fibrillation ventriculaire (TV-FV) etait plus eleve dans le groupe DS (14 sur 55) que chez les temoins (3 sur 43; p = 0,017). Chez les animaux atteints de diabete, la duree du DS comme la glycemie etaient associees avec l&apos;apparition de TV-FV de reperfusion selon une analyse de regression logistique univariee (rapport de cotes [RC] de 1,058; IC a 95 % de 1,025 a 1,092; p < 0,001; et RC de 1,119; IC a 95 % de 1,045 a 1,198; p = 0,001; respectivement). Cependant, selon une analyse de regression logistique multivariee, seule la duree du DS demeurait un facteur de prediction independant pour les TV-FV de reperfusion (RC de 1,060; IC a 95 % de 1,006 a 1,117; p = 0,029). Parmi les parametres de la cartographie, la duree du DS etait associee avec une prolongation de la duree totale de l&apos;activation ventriculaire (coefficient de regression de 0,152; IC a 95 % de 0,049 a 0,255; p = 0,005) et de la duree des intervalles entre l&apos;activation et la repolarisation (IAR; coefficient de regression de 0,900; IC a 95 % de 0,315 a 1,484; p = 0,003). La prolongation des IAR etait l&apos;unique caracteristique cartographique constituant un facteur de prediction pour l&apos;apparition de TV-FV de reperfusion (RC de 1,028; IC a 95 % de 1,009 a 1,048; p = 0,004). Nous en sommes arrives a la conclusion que la prolongation de la repolarisation des ventricules dependante de la DS represente un lien entre Revolution du DS et l&apos;inductibilite de TV-FV de reperfusion. [Traduit par la Redaction] Mots-cles: diabete, arythmies, intervalle entre l&apos;activation et la recuperation, reperfusion, repolarisation.

INTRODUCTION Diabetes mellitus is a disease of epidemic proportions, currently affecting 451 million individuals worldwide. (1) The most devastating consequence of diabetes mellitus is the development of chronic complications, such [...], PURPOSE Although diabetes care guidelines recommend paying attention to oral health, the effect on daily practice has been limited, and patients with diabetes have yet to benefit. We investigated whether implementation of an oral care protocol for general practitioners (GPs [family physicians]) can improve patient-centered outcomes for patients with type 2 diabetes. METHODS Twenty-four GP offices were randomly assigned to the experimental or control group (12 offices each). In the experimental group, GPs and nurse practitioners implemented an oral care protocol. No extra attention was given to oral health in the control group. The primary outcome parameter was oral health-related quality of life (QoL) assessed with the 14-item Oral Health Impact Profile at baseline and 1 year later. Other outcomes were self-reported oral health complaints and general health-related QoL (36-item Short Form Health Survey). RESULTS Of 764 patients with type 2 diabetes, 543 (71.1%) completed the 1-year follow-up. More patients reported improved oral health-related QoL in the experimental group (35.2%) compared to the control group (25.9%) (P = .046; [P.sub.adj] = .049). In a secondary post hoc analysis including GP offices with [greater than or equal to] 60% patient follow-up (n = 18), improvement was 38.3% and 24.9%, respectively (P and [P.sub.adj] = .011). Improvement of self-reported oral health complaints did not differ between groups. The intervention had no effect on general health--related QoL, with the exception of the concept scale score for changes in health over time ([P.sub.adj] = .033). CONCLUSIONS Implementation of an oral care protocol in primary diabetes care improved oral health-related QoL in patients with type 2 diabetes. Key words: type 2 diabetes mellitus; primary care; oral care; oral health; quality of life

Stillbirth is defined in the United Kingdom as intrauterine fetal death after 24-weeks gestation and in 2017 the stillbirth rate was 4.2 per 1000 total births. (1) The stillbirth rate [...], * Context.--Women with diabetes have increased stillbirth risk. Although the underlying pathophysiological processes are poorly understood, stillbirth is frequently related to abnormal placental structure and function. Objective.--To investigate placental morphology and cellular characteristics in the placentas of women with diabetes who had stillbirths and stillbirths of unexplained cause. Design.--Placentas from women with uncomplicated live births, live births in women with diabetes, unexplained stillbirths, and stillbirths related to diabetes (n = 10/group) underwent clinical histopathologic assessment and were also investigated using immunohistochemical staining to quantify syncytial nuclear aggregates, proliferation, trophoblast area, vascularization, T cells, placental macrophages (Hofbauer cells), and the receptor for advanced glycation end products. Results.--[Ki67.sup.+] cells were decreased in unexplained stillbirths compared with live births in women with diabetes. Both stillbirth groups had increased cytokeratin 7+/nuclear area compared with controls. Blood vessels/villi were decreased in unexplained stillbirth compared with live births from women with diabetes. Compared with uncomplicated controls, [CD163.sup.+] macrophages were increased in live births in women with diabetes and unexplained stillbirths, and further increased in stillbirths related to diabetes. There was no change in [CD3.sup.+] T cells or syncytial nuclear aggregates. Receptor for advanced glycation end products-positive cells were decreased in both stillbirth groups compared with diabetes-related live births. Co-localization of receptor for advanced glycation end products in macrophages was increased in both stillbirth groups compared with live birth groups. Conclusions.--Stillbirths related to diabetes exhibit placental phenotypic differences compared with live births. Further investigation of these parameters may provide understanding of the pathologic mechanisms of stillbirth and aid the development of stillbirth prevention strategies. (Arch Pathol Lab Med. 2021;145:82-89; doi: 10.5858/arpa.2019-0524-OA)