Diabetes Research and Treatment

Purpose: Visceral Adipose Tissue (VAT) as a source of pro inflammatory and biological mediators is implicated in adverse cardiac structure remodeling, functional alternations, and results in Heart Failure (HF) in central obese patients. However, the impact of different distributions of visceral fat on cardiac structural/functional changes still remains unclear. 

Methods: This retrospective analysis includes 354 subjects free from previous myocardial infarction, coronary arterial disease, stroke, or clinical HF. Regional VAT including Pericardial Fat (PCF) and Thoracic Periaortic Fat (TAT) volumes, fatty liver grades were all measured by Multi-Detector Computed Tomography (MDCT) (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA) and abdominal sonography (Toshiba Nemio SSA-550A). We measured Left ventricular mass/mass index (LVM/LVMI), LV Mass to Volume ratio (LVMVI), Left Atrium (LA) diameter represented as cardiac remodeling, and analyzed their association with adiposity measures.  

Results:  All VAT are significantly associated with worsening cardio-metabolic profiles (hs-CRP, metabolic scores, coronary calcium score) (all P<0.05). Excess PCF/TAT wassignificantly associated with larger LVM/LVMI, LVMVI, and LA diameter (all P<0.05); presented in LV concentric remodeling, it further worsens LV diastolic function. In multivariate models, this effect on LA remodeling was attenuated in TAT after adjusting for the clinical variable (P=0.052). However, there was no correlation between hepatic fat and LV/LA structural/ functional alternations.  

Conclusion: Accumulated visceral adiposity, especially PCF deposits, was associated with certain cardiac structural/functional remodeling characterized by impaired LV diastolic function. PCF may exhibit a local effect on adjacent cardiac structure more than TAT and hepatic fat. Our data suggested that PCF may serve as an independent predictor to screen subclinical heart failure in asymptomatic population. 

Obesity remains a leading cause of cardiovascular (CV) events and diabetes worldwide. Although there are at least two main body-size phenotypes (metabolically healthy and 
metabolically non-healthy) of individuals with established obesity, cardiac and metabolic risks amongst these patients’ populations extremely distinguishes. The editorial is discussed the controversies regarding obese paradox and the probabilities to stratify the patients with established obesity in cardiac and metabolic risks. It is suggested that the biomarkers could predict CV events in patients depending on obese phenotypes. The role of metabolic biomarkers, progenitor endothelial cells, natriuretic peptides, inflammatory cytokines and galectin-3 are discussed. 

Vascular Calcification (VC) is the major contributors of Cardiovascular (CV) morbidity and mortality in patients with established Coronary Artery Disease (CAD), diabetes mellitus and Chronic Kidney Disease (CKD). Amongst several factors in abundant involved in the molecular mechanisms of regulation of ectopic calcification, Osteopontin (OPN) appears to be promised, while its role in the VC is controversial. OPN is chemokine-like matricellular phosphor glycol proteins with abilities to regulate inflammation, bone formation, hematopoiesis, and angiogenesis. It is known that the elevated circulating level of OPN may independently predict VC in subjects with established CAD, diabetes mellitus and CKD. The peak concentration of OPN in peripheral blood used to assay aimed to assume the risk of the CV-related clinical outcomes. The editorial recaps our knowledge regarding OPN as a biological marker of VC with possible predictive value.

Background: To examine the incidence of traumatic and overuse Musculoskeletal Injuries (MSI) in children and adolescents with diagnosed diabetes mellitus, which has been understudied. 

Methods: Using a population-based, retrospective cohort design and South Carolina’s (USA) Medicaid claims dataset covering outpatient and inpatient medical services, and medication prescriptions over an 11-year period for patients < 17 years of age with > 2 visits for ICD-9 diagnostic codes for diabetes mellitus, a cohort of 5448 cases was identified and analyzed using logistic regression to compare risk factors for those who sustained MSIs with those who did not. 

Results: Incident joint, back, or muscle pain, contracture, spasms, or swelling were diagnosed, in addition to upper limb fractures and sprains, costochondritis, and stress fractures, usually in adolescence. Comorbid obesity (30.6%), dyslipidemia (22.9%), primary hypertension (18.7%), substance use disorder (7.4%), and arrhythmia (5.6%) were diagnosed in the cohort as were peripheral neuropathy (2.7%) and early cardiovascular disease (5.5%). While traumatic fractures and concussions were more closely associated with cardiovascular conditions and substance abuse, sprains, dislocations, and all micro-traumatic, overuse injuries were associated with comorbid obesity, dyslipidemia, and hypertension, as well as with less-frequent incident arrhythmia, and the cardiovascular and peripheral neuropathy complications of diabetes. 

Conclusions: These findings add to the existing, primarily adult, literature regarding the musculoskeletal manifestations of diabetes and cardio-metabolic disorders in youth and update the knowledge base of pediatric practitioners to enable them to better anticipate the clinical care needs of such patients and provide them more effective care.   

The recognition of the importance of overweigh / obesity and metabolic syndrome as leading risk factor for diabetes and cardiovascular (CV) complications has greatly increased within last decades. Endothelial dysfunction mediating the diabetic complications associates with several important mechanisms, one of which is secretion of extracellular microparticles (MPs) by activated or apoptotic endothelial cells. MPs coordinate wide spectrum biological processes, i.e. angiogenesis, neovascularization, cell growth / differentiation, proliferation, coagulation, and they are involved in the epigenetic regulation of post-processing that is essential for phenotype modification, tissue repair, cell death, malignancy, and immunity. The commentary is discussed the role of impaired balance between number of both 
immune subsets of endothelial MPs in CV events development among dysmetabolic subjects. It has revealed that increased numbers of apoptotic MPs, as well as decreased numbers of MPs derived from activated endothelial cells aggravate endothelial damage and contribute to the continuously deteriorating endothelial damage leading to diabetes-related complications.