Of two major forms (myo- and chiro-inositol) of inositols, only chiro-inositol enhances the activity of proteins involved in intracellular glucose metabolism. This study aims to determine the urinary myo-/chiro-inositol ratio in type 1 and type 2 diabetes patients and compare its ratio with the normal control group. The 24-hour urinary myo- and chiro-inositols in 71 Korean diabetes patients and 39 control subjects have been quantified using high-performance liquid chromatography, and their ratios have been evaluated as indices of insulin resistance. The level of 24-hour urinary myo-inositol was significantly higher in both type 1 and type 2 diabetes than with the control group, whereas the urinary chiro-inositol in type 1 or type 2 diabetes was lower than that in normal subjects. The myo-/chiro-inositol ratio in diabetes patients was higher than that in the control group. Twenty four-hour urinary myo-/ chiro-inositol ratios were significantly elevated in type 1 and type 2 diabetes patients compared to the control group, suggesting that a high ratio of urinary myo-/chiro- inositol in type 2 diabetes patients might be used for an index of insulin resistance.
Adult ; Aged ; Diabetes Mellitus, Type 1/*urine ; Diabetes Mellitus, Type 2/*urine ; Female ; Humans ; Inositol/*urine ; Insulin Resistance ; Male ; Middle Aged

OBJECTIVETo determine whether urinary type IV collagen can serve as an indicator specific for diabetic nephropathy.

METHODSUsing a novel sandwich ABC-ELISA to measure type IV collagen directly, the 24-hour urinary type IV collagen excretion rate was determined in 120 diabetic patients and some groups of controls. Urinary albumin determinations were made with a RIA kit at the same time. A total of 13 diabetic patients with microalbuminuria underwent percutaneous renal biopsy for definitive diagnosis of diabetic nephropathy. Type IV collagen and TGF-beta 1 immunoreactivities were detected with ABC methods in renal biopsies.

RESULTSUrinary type IV collagen excretion was significantly increased in diabetic patients with microalbuminuria, especially those with albumin excretion above 200 mg/24 h. By comparison, collagen excretion was equivalent to that in healthy controls when measured in diabetics with normalbuminuria and in patients with primary glomerular disease, primary hypertension, or coronary heart disease. Urinary type IV collagen excretion in diabetics was negatively correlated with creatinine clearance. In renal biopsies from subjects with elevated collagen excretion, the glomeruli showed pathological changes typical of diabetic nephropathy. Also, excessive type IV collagen and TGF-beta 1 immunoreactivity were detected in the glomeruli, Bowman's capsule and interstitium.

CONCLUSIONSExcretion of type IV collagen, possibly reflecting increased production or decreased degradation of this protein, may be a clinically useful indicator of incipient diabetic nephropathy.

Albuminuria ; urine ; Biomarkers ; urine ; Collagen Type IV ; urine ; Diabetes Mellitus, Type 2 ; urine ; Diabetic Nephropathies ; diagnosis ; Humans ; Transforming Growth Factor beta ; analysis

OBJECTIVETo examine the urinary level of tissue factor (uTF) and its procoagulant activity (PCA) in patients with diabetes mellitus, and explore the relationship between uTF and renal damage in diabetes mellitus.

METHODSEighty-six patients with type 2 diabetes mellitus were divided into 3 groups according to urine albumin excretion (UACR), namely normal albuminuria group, microalbuminuria group and macroalbuminuria group. The levels of uTF, PCA, blood urea nitrogen (BUN), serum creatinine (CRE), serum cystatin C (CYSC), glycohemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hs-CRP) were measured in all the patients and 21 healthy controls.

RESULTSCompared with normal control, the diabetic patients showed significantly increased levels of uTF and PCA. The urinary TF-PCA was positively correlated to BUN, CYSC, CRE, UACR, fasting glucose and hs-CRP, but not to uTF; only hs-CRP, UACR were positively correlated to uTF.

CONCLUSIONuTF is probably implicated in the development and progression of diabetic nephropathy.

Adult ; Albuminuria ; urine ; Blood Coagulation ; Case-Control Studies ; Creatinine ; urine ; Diabetes Mellitus, Type 2 ; physiopathology ; urine ; Female ; Humans ; Male ; Middle Aged ; Thromboplastin ; urine

BACKGROUND: Albuminuria is generally known as a sensitive marker of renal and cardiovascular dysfunction. It can be used to help predict the occurrence of nephropathy and cardiovascular disorders in diabetes. Individuals with prediabetes have a tendency to develop macrovascular and microvascular pathology, resulting in an increased risk of retinopathy, cardiovascular diseases, and chronic renal diseases. We evaluated the clinical value of a strip test for measuring the urinary albumin-to-creatinine ratio (ACR) in prediabetes and diabetes. METHODS: Spot urine samples were obtained from 226 prediabetic and 275 diabetic subjects during regular health checkups. Urinary ACR was measured by using strip and laboratory quantitative tests. RESULTS: The positive rates of albuminuria measured by using the ACR strip test were 15.5% (microalbuminuria, 14.6%; macroalbuminuria, 0.9%) and 30.5% (microalbuminuria, 25.1%; macroalbuminuria, 5.5%) in prediabetes and diabetes, respectively. In the prediabetic population, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the ACR strip method were 92.0%, 94.0%, 65.7%, 99.0%, and 93.8%, respectively; the corresponding values in the diabetic population were 80.0%, 91.6%, 81.0%, 91.1%, and 88.0%, respectively. The median [interquartile range] ACR values in the strip tests for measurement ranges of <30, 30-300, and >300 mg/g were 9.4 [6.3-15.4], 46.9 [26.5-87.7], and 368.8 [296.2-575.2] mg/g, respectively, using the laboratory method. CONCLUSIONS: The ACR strip test showed high sensitivity, specificity, and negative predictive value, suggesting that the test can be used to screen for albuminuria in cases of prediabetes and diabetes.
Adult ; Aged ; Aged, 80 and over ; Albumins/*analysis ; Creatinine/*urine ; Diabetes Mellitus, Type 2/pathology/urine ; Female ; Humans ; *Immunoassay ; Male ; Middle Aged ; Prediabetic State/pathology/urine ; Reagent Strips/chemistry

BACKGROUNDCoronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria. The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients.

METHODSA total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older, who were given coronary angiography for diagnosis of possible coronary heart disease, participated. Their urinary albumin excretion rate was measured, and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis. The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined.

RESULTSThe incidence of coronary heart disease, the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal albuminuria group (P < 0.05). The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients (odds ratio (OR) = 1.058, P < 0.0001, 95% confidence interval (CI): 1.036 - 1.080). Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients (β = 0.476, P < 0.0001). The best predictive value of urinary albumin excretion rate was 10.45 µg/min for elderly type 2 diabetes mellitus patients. The area under the curve was 0.764, with a sensitivity and specificity of 70.0% and 72.2%, respectively.

CONCLUSIONSThe occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria, and the severity of the disease also increased in patients with microalbuminuria. In elderly type 2 diabetes mellitus patients, urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease.

Aged ; Albuminuria ; epidemiology ; physiopathology ; urine ; Coronary Artery Disease ; epidemiology ; physiopathology ; urine ; Diabetes Mellitus, Type 2 ; epidemiology ; physiopathology ; urine ; Female ; Humans ; Male ; Middle Aged ; Risk Factors

OBJECTIVES: The excretion of urinary vitamin D-binding protein (uVDBP) is related to the occurrence and development of early-stage renal damage in patients with Type 2 diabetes (T2DM). This study aims to explore the significance of detecting uVDBP in T2DM patients and its relationship with renal tubules, and to provide a new direction for the early diagnosis of T2DM renal damage. METHODS: A total of 105 patients with T2DM, who met the inclusion criteria, were included as a patient group, and recruited 30 individuals as a normal control group. The general information and blood and urine biochemical indicators of all subjects were collected; the levels of uVDBP, and a marker of tubular injury [urine kidney injury molecule 1 (uKIM-1), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine retinol-binding protein (uRBP)] were detected by enzyme-linked immunosorbent assay. The results were corrected by urinary creatinine (Cr) to uVDBP/Cr, uKIM-1/Cr, uNGAL/Cr and uRBP/Cr. The Pearson's and Spearman's correlation tests were used to analyze the correlation between uVDBP/Cr and urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) and markers of tubular injury, and multivariate linear regression and receiver operating characteristic curve were used to analyze the correlation between uVDBP/Cr and UACR or eGFR. RESULTS: Compared with the normal control group, the uVDBP/Cr level in the patient group was increased (P<0.05), and which was positively correlated with UACR (r=0.774, P<0.01), and negatively correlated with eGFR (r=-0.397, P<0.01). There were differences in the levels of uKIM-1/Cr, uNGAL/Cr, and uRBP/Cr between the 2 groups (all P<0.01). The uVDBP/Cr was positively correlated with uKIM-1/Cr (r=0.752, P<0.01), uNGAL/Cr (r=0.644, P<0.01) and uRBP/Cr (r=0.812, P<0.01). The sensitivity was 90.0% and the specificity was 82.9% (UACR>30 mg/g) for evaluation of uVDBP/Cr on T2DM patients with early-stage renal damage, while the sensitivity was 75.0% and the specificity was 72.6% for evaluation of eGFR on T2DM patients with early-stage renal damage. CONCLUSIONS The uVDBP/Cr can be used as a biomarker in early-stage renal damage in T2DM patients.
Humans ; Diabetes Mellitus, Type 2/complications* ; Creatinine ; Vitamin D-Binding Protein/urine* ; Lipocalin-2/urine* ; Kidney/metabolism* ; Glomerular Filtration Rate ; Biomarkers

To investigate the correlation of serum long noncoding RNA-metastasis associated lung adenocarcinoma transcript 1(LncRNA MALAT1) and serum amyloid A(SAA) with diabetic kidney disease. Retrospective research was used, and 40 patients with type 2 diabetes and 80 patients with type 2 diabetic kidney disease patients who were treated in Tianjin Medical University Chu Hsien-I Memorial Hospital from August 2021 to February 2022 were selected, and 40 healthy subjects were selected during the same period. Reverse transcription-polymerase chain reaction(RT-PCR) was used to detect serum LncRNA MALAT1. SAA were detected with enzyme linked immunosorbent assay (ELISA). Automatic biochemistry analyzer was used to detect serum creatinine (CREA) and low-density lipoprotein cholesterol(LDL-C),automatic blood glucose analyzer to detect serum fasting plasma glucose (FPG), automatic glycated hemoglobin analyzer to detect hemoglobin A1C (HbA1c), and automatic immunoassay analyzer to detect urinary albumin to creatinine ratio(UACR). Differences between groups were compared by t test and analysis of variance. Pearson analysis was used to analyze the correlation between MALAT1, SAA and other indicators. Receiver operating characteristic curve(ROC) was used to evaluate the auxiliary diagnostic value of MALAT1 and SAA for diabetic kidney disease. The results showed that MALAT1 and SAA in the diabetic kidney disease with mass albuminuria group were higher than those in the type 2 diabetes mellitus group (q=8.57, P<0.01; q=11.09, P<0.01) and the diabetic kidney disease with microalbuminuria group (q=3.96, P<0.05; q=7.85, P<0.01). MALAT1 had a high correlation with UACR, CREA, SAA, HbA1c and FPG (r value was 0.706, 0.643, 0.578, 0.553, and 0.524, all P<0.01), and SAA had a high correlation with UACR, HbA1c and FPG (r value was 0.664, 0.617, and 0.595, all P<0.01). ROC curve analysis of the diagnostic value of LncRNA MALAT1 and protein SAA for diabetic kidney disease showed that the areas under curve (AUC) were 0.741 and 0.744, respectively. The combined diagnostic value of the two was the greatest (AUC=0.801). In summary, MALAT1 and SAA were elevated in the serum of patients with type 2 diabetes. Their concentrations in the serum of group with diabetic kidney disease were higher than that in the type 2 diabetes group, and the serum concentrations of MALAT1 and SAA in group with mass albuminuria are higher than the group with microalbuminuria. MALAT1 and SAA were both closely related to UACR and HbA1c, and there is a correlation between them. Both of them may have ancillary diagnostic value for diabetic kidney disease.
Humans ; RNA, Long Noncoding/metabolism* ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies/urine* ; Retrospective Studies ; Glycated Hemoglobin ; Serum Amyloid A Protein ; Albuminuria

Objective: To explore the relationship between environmental factors as urinary cadmium and type 2 diabetes mellitus (DM) in adults. Methods: Case-control study was adopted, including 166 cases and 427 controls. General characteristics of the subjects were collected by a structured questionnaire. FPG, biochemical indexes and urinary cadmium (UCd) were detected respectively, while UCd was corrected with creatinine. Unconditioned logistic regression model was applied to analyze the relationship between UCd and DM. Results: Levels of UCd appeared higher in cases with the following characteristics as: having primary school education (P=0.016), being female (P=0.013), being non-smokers (P=0.014) or non-alcoholic (P=0.025), and with BMI>25.00 kg/m(2) (P=0.040, P=0.025) than those appeared in the control group. Same results were shown in the 60-69 years (P=0.024) old group. Data from the unconditional logistic regression analysis showed that family history of DM (OR=3.19, 95%CI: 1.45-7.03), education status (OR=1.50,95%CI: 1.08-2.08) and UCd (OR=1.61, 95%CI: 1.08-2.41) were influencing factors on DM. Conclusion: A close association between UCd and DM was noticed. UCd appeared a risk factor on DM that called for setting up related prevention program to reduce the exposure of Cd and to control the risk on DM.
Adult ; Cadmium/urine* ; Case-Control Studies ; China/epidemiology* ; Creatinine ; Diabetes Mellitus, Type 2/epidemiology* ; Female ; Humans ; Risk Factors ; Socioeconomic Factors

INTRODUCTIONOxidative stress, assessed using 8-hydroxy-2'-deoxyguanosine (8-OHdG), can be associated with arterial stiffness in patients with type 2 diabetes mellitus (T2DM) and/or hypertension (HT). We investigated the correlation between urinary 8-OHdG and pulse wave velocity (PWV) in hypertensive and non-hypertensive T2DM patients with fair glycaemic control to determine the clinical significance of HT as a comorbidity in the diabetic state.

METHODSClinical data, including traditional cardiovascular risk factors, diabetic complications, prescribed agents, urinary 8-OHdG level and brachial-ankle PWV, was collected from T2DM patients with and without HT.

RESULTSThere were 76 patients (45 men, 31 women; mean age 61 years; mean haemoglobin A1c level 6.5%) in the study cohort. T2DM patients with HT had significantly higher mean PWV than patients without HT (1,597 cm/s vs 1,442 cm/s; p < 0.05). Patients with HT showed no significant difference in 8-OHdG levels relative to those without HT (median 7.9 ng/mg creatinine vs 8.8 ng/mg creatinine; p > 0.05). Simple linear correlation and stepwise multiple linear regression analyses revealed that 8-OHdG levels correlated independently, significantly and positively with PWV among T2DM patients with HT (r = 0.33, p < 0.05; β= 0.23, p < 0.05). No significant correlation was observed between 8-OHdG levels and PWV among T2DM patients without HT.

CONCLUSIONIn the hypertensive state, oxidative stress can be responsible for the development of arterial stiffness, even in patients with fairly well controlled T2DM. Oxidative stress management may be necessary for the prevention of cardiovascular disease in this population.

Adult ; Aged ; Aged, 80 and over ; Ankle Brachial Index ; Cohort Studies ; Deoxyguanosine ; analogs & derivatives ; urine ; Diabetes Complications ; urine ; Diabetes Mellitus, Type 2 ; urine ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypertension ; complications ; urine ; Male ; Middle Aged ; Oxidative Stress ; Pulse Wave Analysis ; Vascular Stiffness

BACKGROUNDThe various risk factors for retinal hard exudates are still poorly understood in type 2 diabetic patients. The aim of this study was to determine the association between urinary albumin excretion rate (UAER) and hard exudates in macular region in north Chinese patients.

METHODSA total of 272 patients (272 eyes) were enrolled for this study, including 154 subjects from group 1 (mild hard exudates), 91 subjects from group 2 (moderate hard exudates) and 27 subjects from group 3 (severe hard exudates) confirmed using colour fundus photography, optical coherence tomography (OCT) as well as slit-lamp biomicroscopy with 78 diopter (D) lens. Each participant underwent a comprehensive assessment that included biochemical, clinical characteristics test and detailed ophthalmic evaluation. One-way analysis of variance (ANOVA) test and chi-square test were performed to analyze the fasting blood glucose (FBG), glycated hemoglobin (HbA1c), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), full blood counts, urinary albumin excretion rate (UAER), blood creatinine (CREA), duration of diabetes, body mass index (BMI), systolic blood pressures (SBP) and diastolic blood pressures (DBP) between groups. Ordinal logistic regression analysis was further performed in order to eliminating the possible confounding factors.

RESULTSThree groups were matched in terms of age and gender. Risk factors which showed significant difference between groups include FBG (P < 0.001), HbA1c (P < 0.001), LDL (P < 0.001), UAER (P < 0.001), duration of diabetes (P = 0.001), TC (P = 0.005), SBP (P = 0.026), CREA (P = 0.004) and haemoglobin (Hb) (P = 0.012). There was no significant difference between groups for the TG, HDL, DBP, platelet, total white blood cells and BMI. Using ordinal Logistic regression analyses, of all the variables, HbA1c, LDL and UAER which were independent risk factor for hard exudates showed a significantly odds ratio of 1.25, 3.07, and 1.39, respectively. There were also significant differences in UAER level between patients with mild, moderate, severe hard exudates groups (P < 0.001).

CONCLUSIONSUAER was an independent risk factor associated with retinal hard exudates in macular region in type 2 diabetic patients. This study highlights the need for close monitoring and fundus examination for hard exudates in patients with elevated UAER to prevent irreversible visual loss.

Aged ; Albuminuria ; physiopathology ; Diabetes Mellitus, Type 2 ; physiopathology ; urine ; Female ; Humans ; Macular Edema ; physiopathology ; urine ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors