Association between Insulin Resistance and Hematopoietic Stem Cell Functions in Patients with Type 2 Diabetes Mellitus
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/066Keywords:
Insulin resistance, Hematopoietic stem cells, Type 2 Diabetes Mellitus, HOMA-IR, Platelet countAbstract
Background: Intestinal obstruction is a common surgical emergency with significant morbidity and mortality, but postoperative adhesions are its most frequent cause. Patients with a virgin abdomen, those without any prior abdominal surgery, pose diagnostic challenges; this study explored the etiological spectrum, clinical features, and outcomes of such cases in a tertiary care hospital in Pakistan.
Methods: A six-month prospective observational study at Lady Reading Hospital, Peshawar, enrolled 73 eligible adult patients, categorizing them into Group 1 (surgical management for mechanical causes such as hernias, tumours, or volvulus) and Group 2 (conservative management for functional or self-resolving causes). Data collected encompassed demographics, presenting symptoms, vital signs, symptom duration, and etiological factors, supplemented by relevant laboratory investigations and imaging studies. Statistical analysis was performed using SPSS version 26, with continuous variables summarized as mean ± standard deviation and compared using the independent t-test, categorical variables presented as frequencies and percentages, and analysed using the Chi-square or Fisher’s exact test, and a p-value of <0.05 was considered statistically significant.
Results: The mean age of Group 1 was significantly higher (55.73 ± 4.86 years) than that of Group 2 (44.13 ± 6.32 years, p < 0.001). Tumours were the most common cause (24.7%), followed by hernias (20.5%) and volvulus (13.7%). Group 1 had longer hospital stays (12.45 ± 2.94 days vs. 7.76 ± 2.03 days, p < 0.001) and higher clinical severity. Complications and mortality rates were low and comparable between groups, with effective management in both cohorts.
Conclusion: The cause of intestinal obstruction differs in patients with a virgin abdomen, which has a vast clinical impact. It demands early diagnosis and proper treatment plans to enhance the quality of life and reduce mortality. Further investigations of patient follow-up with a focus on discharge and ways of minimizing the number of days patients spend in the hospital are important.
References
1. Adachi M, Muroya K, Hanakawa J, Asakura Y. Metreleptin worked in a diabetic woman with a history of hematopoietic stem cell transplantation (HSCT) during infancy: further support for the concept of “HSCT-associated lipodystrophy”. Endocr J. 2021 Apr;68(4):399-407. Epub 2020 Nov 21. doi:10.1507/endocrj.EJ20-0325.
2. Algaba-Chueca F, Maymo-Masip E, Ejarque M, Ballesteros M, Llaurado G, Lopez C, et al. Gestational diabetes impacts fetal precursor cell responses with potential consequences for offspring. Stem Cells Transl Med. 2020 Mar;9(3):351-363. Epub 2019 Dec 27. doi:10.1002/sctm.19-0242.
3. Almind K, Inoue G, Pedersen O, Kahn CR. A common amino acid polymorphism in insulin receptor substrate-1 causes impaired insulin signaling: evidence from transfection studies. J Clin Invest. 1996 Jun;97(11):2569-2575. doi:10.1172/JCI118705.
4. Bielorai B, Pinhas-Hamiel O. Type 2 diabetes mellitus, the metabolic syndrome, and its components in adult survivors of acute lymphoblastic leukemia and hematopoietic stem cell transplantations. Curr Diab Rep. 2018 Jun;18(6):32. Epub 2018 Apr. doi:10.1007/s11892-018-0998-0.
5. Dassie F, Albiero M, Bettini S, Cappellari R, Milan G, Ciciliot S, et al. Hematopoietic stem cells and metabolic deterioration in Alstrom syndrome, a rare genetic model of the metabolic syndrome. Endocrinology. 2023 Mar;164(3). Epub 2023 Jan. doi:10.1210/endocr/bqad011.
6. Du JY, Jin CC, Wang GH, Huang XQ, Cheng JD, Wen XJ, et al. LNK deficiency aggravates palmitate-induced preadipocyte apoptosis. Biochem Biophys Res Commun. 2017 Jul;490(2):91-97. Epub 2017 May. doi:10.1016/j.bbrc.2017.05.057.
7. Engelhardt BG, Jagasia SM, Crowe JE Jr, Griffith ML, Savani BN, Kassim AA, et al. Predicting posttransplantation diabetes mellitus by regulatory T-cell phenotype: implications for metabolic intervention to modulate alloreactivity. Blood. 2012 Mar;119(10):2417-2421. Epub 2012 Feb. doi:10.1182/blood-2011-10-384750.
8. Engelhardt BG, Savani U, Jung DK, Powers AC, Jagasia M, Chen H, et al. New-onset post-transplant diabetes mellitus after allogeneic hematopoietic cell transplant is initiated by insulin resistance, not immunosuppressive medications. Biol Blood Marrow Transplant. 2019 Jun;25(6):1225-1231. Epub 2019 Feb. doi:10.1016/j.bbmt.2019.02.001.
9. Fuji S, Einsele H, Savani BN, Kapp M. Systematic nutritional support in allogeneic hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant. 2015 Oct;21(10):1707-1713. Epub 2015 Jul. doi:10.1016/j.bbmt.2015.07.003.
10. Griffith ML, Jagasia M, Jagasia SM. Diabetes mellitus after hematopoietic stem cell transplantation. Endocr Pract. 2010 Jul-Aug;16(4):699-706. doi:10.4158/EP10027.RA.
11. Griffith ML, Jagasia MH, Misfeldt AA, Chen H, Engelhardt BG, Kassim A, et al. Pretransplantation C-peptide level predicts early posttransplantation diabetes mellitus and has an impact on survival after allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2011 Jan;17(1):86-92. Epub 2010 Jun. doi:10.1016/j.bbmt.2010.06.010.
12. Kanter JE, Kramer F, Barnhart S, Duggan JM, Shimizu-Albergine M, Kothari V, et al. A novel strategy to prevent advanced atherosclerosis and lower blood glucose in a mouse model of metabolic syndrome. Diabetes. 2018 May;67(5):946-959. Epub 2018 Feb. doi:10.2337/db17-0744.
13. Nakagawa R, Hosokawa-Tsuji A, Aoki Y, Takasawa K, Maru M, Nakajima K, et al. Total body irradiation for hematopoietic stem cell transplantation during early childhood is associated with the risk for diabetes mellitus. Endocrine. 2018 Jul;61(1):76-82. Epub 2018 May. doi:10.1007/s12020-018-1595-3.
14. Noguchi H. Stem cell applications in diabetes. J Stem Cells. 2012 Oct;7(4):229-244.
15. Oh J, Riek AE, Bauerle KT, Dusso A, McNerney KP, Barve RA, et al. Embryonic vitamin D deficiency programs hematopoietic stem cells to induce type 2 diabetes. Nat Commun. 2023 Jun 8;14(1):3278. doi:10.1038/s41467-023-38849-z.
16. Olausson JM, Hammer MJ, Brady V. The impact of hyperglycemia on hematopoietic cell transplantation outcomes: an integrative review. Oncol Nurs Forum. 2014 Sep;41(5):E302-E312. doi:10.1188/14.ONF.E302-E312.
17. Petrovic I, Pejnovic N, Ljujic B, Pavlovic S, Miletic Kovacevic M, Jeftic I, et al. Overexpression of galectin 3 in pancreatic beta cells amplifies beta-cell apoptosis and islet inflammation in type 2 diabetes in mice. Front Endocrinol (Lausanne). 2020 Jan 28;11:30. doi:10.3389/fendo.2020.00030.
18. Poljak-Blazi M, Slijepcevic M, Boranic M. CFUs reduction and adaptation in mice with experimental diabetes. Exp Hematol. 1980 Mar;8(2):174-178.
19. Potdar PD, D’Souza SB. Isolation of Oct4+, Nanog+ and SOX2- mesenchymal cells from peripheral blood of a diabetes mellitus patient. Hum Cell. 2011 Mar;24(1):51-55. Epub 2011 Feb. doi:10.1007/s13577-011-0011-6.
20. Quinn A, Melo M, Ethell D, Sercarz EE. Relative resistance to nasally induced tolerance in non-obese diabetic mice but not other I-A(g7)-expressing mouse strains. Int Immunol. 2001 Oct;13(10):1321-1333. doi:10.1093/intimm/13.10.1321.
21. Serreze DV, Gaedeke JW, Leiter EH. Hematopoietic stem-cell defects underlying abnormal macrophage development and maturation in NOD/Lt mice: defective regulation of cytokine receptors and protein kinase C. Proc Natl Acad Sci U S A. 1993 Oct 15;90(20):9625-9629. doi:10.1073/pnas.90.20.9625.
22. Shalitin S, Pertman L, Yackobovitch-Gavan M, Yaniv I, Lebenthal Y, Phillip M, et al. Endocrine and metabolic disturbances in survivors of hematopoietic stem cell transplantation in childhood and adolescence. Horm Res Paediatr. 2018 Feb;89(2):108-121. Epub 2018 Jan. doi:10.1159/000486034.
23. Wang J, Chakrabarty S, Bui Q, Ruf W, Samad F. Hematopoietic tissue factor–protease-activated receptor 2 signaling promotes hepatic inflammation and contributes to pathways of gluconeogenesis and steatosis in obese mice. Am J Pathol. 2015 Feb;185(2):524-535. Epub 2014 Nov. doi:10.1016/j.ajpath.2014.10.008.
24. Wedrychowicz A, Ciechanowska M, Stelmach M, Starzyk J. Diabetes mellitus after allogeneic hematopoietic stem cell transplantation. Horm Res Paediatr. 2013 Jan;79(1):44-50. Epub 2012 Dec. doi:10.1159/000345547.
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