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Agrawal S, Ganie MA, Goyal A, Praveen PA, Philip DM, Tandon N. Metabolic syndrome in patients with type 1 diabetes mellitus at a tertiary centre in North India: A five year follow up study. Diabetes Metab Syndr 2023; 17:102781. [PMID: 37216855 DOI: 10.1016/j.dsx.2023.102781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/30/2022] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MS) is prevalent in the Indian population and has been traditionally linked to Type 2 diabetes mellitus (T2DM). Its presence is now being increasingly recognized in patients with Type 1 diabetes mellitus (T1DM). Presence of MS may increase the risk of diabetes related complications. This study was designed to determine the prevalence of MS in a cohort of patients with T1DM at baseline and at 5 years of follow up. METHODS Longitudinal cohort study in a tertiary care center in North India. Patients with T1DM attending the Diabetes of the Young (DOY) Clinic from January 2015 to March 2016 included. Microvascular and macrovascular complications assessed. The cohort was followed after a period of 5 years. RESULTS We included 161 patients (males, 49.4%) with a median (IQR) age of 23 (18-34) years and median (IQR) diabetes duration of 12 (7, 17) years. At baseline, 31 (19.2%) patients had MS. Patients with MS were more likely to have microvascular complications: retinopathy (p = 0.003), neuropathy (p = 0.02) and nephropathy (p = 0.04). Independent predictors of MS: insulin sensitivity (IS) (adjusted OR (aOR) 0.02 [95% CI, 0.003-0.118]), body weight (aOR 1.05 [95% CI, 1.007-1.108]), diastolic blood pressure (aOR 1.08 [95% CI, 1.01-1.15]) and duration of diabetes (aOR 1.09 [95% CI, 1.02-1.16]). On follow-up (n = 100), 13 (13%) had MS. CONCLUSIONS One in 5 patients with T1DM suffers from MS, and is therefore predisposed to its attendant risks, calling for early identification and targeted interventions.
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Affiliation(s)
- Sweety Agrawal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mohammad Ashraf Ganie
- Department of Endocrinology & Metabolism, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Alpesh Goyal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P A Praveen
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Dona Maria Philip
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Stagi S, Papacciuoli V, Ciofi D, Piccini B, Farello G, Toni S, Ferrari M, Chiarelli F. Retrospective Evaluation on the Use of a New Polysaccharide Complex in Managing Paediatric Type 1 Diabetes with Metabolic Syndrome (MetS). Nutrients 2021; 13:nu13103517. [PMID: 34684518 PMCID: PMC8540288 DOI: 10.3390/nu13103517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Children and adolescents affected by type 1 diabetes have an increased risk of being overweight or obese and of suffering from cardiometabolic symptoms. Aims: To retrospectively evaluate the effects of a new complex of polysaccharide macromolecules, Policaptil Gel Retard® (PGR), on auxological and metabolic parameters, glycaemic variability and control parameters in paediatric patients with type 1 diabetes and metabolic syndrome (MetS). Patients and Methods: Data for 27 paediatric patients with a diagnosis of type 1 diabetes in conjunction with obesity and MetS of at least 5 years’ standing were collected and retrospectively studied. Of these, 16 (median age 12.9, range 9.5–15.8 years) had been adjunctively treated with PGR and 11 (median age 12.6, range 9.4–15.6 years) had not been treated with PGR. Auxological, metabolic and glycaemic control and variability parameters and insulin dosing were compared after 6 months in the two groups. Results: PGR significantly reduced BMI standard deviation score (SDS) (p < 0.005), waist SDS (p < 0.005), HbA1c (p < 0.05) and daily mean insulin dose requirement (p < 0.005). A significant improvement was also observed in the metabolic and glycaemic variability parameters of mean daily blood glucose (BG) levels (p < 0.005), SD of daily BG levels (p < 0.0001), mean coefficient of variation (p < 0.05), LBGI (p < 0.0001), HBGI (p < 0.0001), J-index (p < 0.005), total cholesterol (p < 0.005), HDL-cholesterol (p < 0.005) and LDL-cholesterol (p < 0.005) and triglycerides (p < 0.05). Conclusions: PGR produces a good auxological and metabolic response in obese patients with MetS who are affected by type 1 diabetes. It led to a significant reduction in BMI SDS, waist SDS and an improvement in glucose control and variability as well as in other MetS parameters. The use of polysaccharide compounds, especially if associated with appropriate dietary changes, may help achieve treatment targets in type 1 diabetes and reduce the risk that patients develop metabolic syndrome.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, 50139 Florence, Italy; (D.C.); (M.F.)
- Correspondence: ; Tel.: +39-055-5662305
| | - Valeria Papacciuoli
- Pediatric Diabetology Unit, Anna Meyer Children’s University Hospital, 50139 Florence, Italy; (V.P.); (B.P.); (S.T.)
| | - Daniele Ciofi
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, 50139 Florence, Italy; (D.C.); (M.F.)
| | - Barbara Piccini
- Pediatric Diabetology Unit, Anna Meyer Children’s University Hospital, 50139 Florence, Italy; (V.P.); (B.P.); (S.T.)
| | - Giovanni Farello
- Department of Paediatrics, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Sonia Toni
- Pediatric Diabetology Unit, Anna Meyer Children’s University Hospital, 50139 Florence, Italy; (V.P.); (B.P.); (S.T.)
| | - Marta Ferrari
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, 50139 Florence, Italy; (D.C.); (M.F.)
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Labruna G, Marra M, Nardelli C, Mancini A, Buono P, Sacchetti L, Pasanisi F. Very light physical activity amount in FTO genetically predisposed obese individuals. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Huo L, Ji L, Deng W, Shaw JE, Zhang P, Zhao F, McGuire HC, Kissimova-Skarbek K, Whiting D. Age distribution and metabolic disorders in people with Type 1 diabetes in Beijing and Shantou, China: a cross-sectional study. Diabet Med 2018. [PMID: 29512926 DOI: 10.1111/dme.13616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To examine whether the age profile of people with Type 1 diabetes differs from that of the general population and in what manner, and to study the clinical characteristics related to metabolic disorders among people with Type 1 diabetes in China. METHODS We sequentially enrolled 849 people with Type 1 diabetes from hospital records review, inpatient wards and outpatient clinics. Data were collected via face-to-face interviews, medical records and venous blood samples. Beijing census data for 2011 were used to provide the general population statistics. Descriptive analysis of the results and tests for differences were performed. RESULTS The median (interquartile range) age at diagnosis of diabetes was 16 (9-28) years and the duration of diabetes was 4 (1-8) years. The mean ± sd HbA1c concentration was 76±28 mmol/mol (9.1±2.5%). Compared with the general population, the population with Type 1 diabetes comprised more young individuals and fewer elderly individuals. The overall prevalence of metabolic syndrome among those with Type 1 diabetes was 10.1% (95% CI 7.9-12.2). People with metabolic syndrome were older and were diagnosed with diabetes at an older age. Hypertension and dyslipidaemia were more common in obese individuals with Type 1 diabetes than in their non-obese counterparts. CONCLUSIONS Compared with the general population, people with Type 1 diabetes comprised more young and fewer elderly individuals. The prevalence of metabolic syndrome in the Type 1 diabetes population was 10.1%. Hypertension and dyslipidaemia were more prevalent in obese than non-obese individuals.
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Affiliation(s)
- L Huo
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
| | - L Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - W Deng
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
| | - J E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - P Zhang
- George Institute for Global Health, Peking University Health Science Centre, Beijing, China
| | - F Zhao
- George Institute for Global Health, Peking University Health Science Centre, Beijing, China
| | - H C McGuire
- International Diabetes Federation, Brussels, Belgium
- PATH, Washington, DC, USA
| | - K Kissimova-Skarbek
- International Diabetes Federation, Brussels, Belgium
- Department of Health Economics and Social Security, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - D Whiting
- International Diabetes Federation, Brussels, Belgium
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Privitera G, Spadaro L, Alagona C, Calanna S, Piro S, Rabuazzo AM, Purrello F. Hepatic insulin resistance in NAFLD: relationship with markers of atherosclerosis and metabolic syndrome components. Acta Diabetol 2016; 53:449-59. [PMID: 26496770 DOI: 10.1007/s00592-015-0816-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/07/2015] [Indexed: 01/30/2023]
Abstract
AIMS Fat accumulation in the liver and in the muscle results in hepatic and muscle insulin resistance and has been associated with increased cardiovascular risk. It is unclear whether the individual role of hepatic and muscle insulin resistance in the onset of dyslipidaemia is observed in nonalcoholic fatty liver disease (NAFLD) patients and whether this association is mediated through traditional risk factors. The aim of this study was to assess hepatic and muscle insulin resistance in NAFLD and its relationship with carotid artery intima-media thickness (IMT) and the apoB/apoAI ratio as markers of atherosclerosis. METHODS We studied 132 patients with a non-invasive diagnosis of NAFLD stratified into two groups according to the severity of steatosis at ultrasound scan. In all subjects, we measured hepatic insulin resistance (H-IR) and muscle insulin sensitivity index (MISI) by oral glucose tolerance test as proposed by DeFronzo, IMT, apoB/apoAI and the components of the metabolic syndrome (MS) as defined by ATP III. RESULTS H-IR was significantly higher in moderate/severe steatosis than in the mild steatosis group (p < 0.0001). By contrast, MISI did not differ between the two groups. There was a significant correlation between H-IR, MISI and all of the components of MS. H-IR was significantly correlated with carotid IMT (r = 0.35; p < 0.0001) and the apoB/apoAI ratio (r = 0.43; p < 0.0001). Otherwise, a significant correlation was observed only between MISI and apoB/apoAI ratio. Multivariate analysis revealed that H-IR is related to early markers of atherosclerosis independent of MS components. CONCLUSIONS In our study population, NAFLD was positively associated with carotid IMT, and this association is independent of MS components, but strictly related to H-IR that might contribute to the development of atherosclerosis through an impairment of the lipid profile in terms of the apoB/apoAI ratio. By contrast, no significant relation was observed between MISI and carotid IMT.
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Affiliation(s)
- Graziella Privitera
- Department of Clinical and Molecular Biomedicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Luisa Spadaro
- Department of Clinical and Molecular Biomedicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Corradina Alagona
- Department of Clinical and Molecular Biomedicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Salvatore Calanna
- Department of Clinical and Molecular Biomedicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Salvatore Piro
- Department of Clinical and Molecular Biomedicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Agata Maria Rabuazzo
- Department of Clinical and Molecular Biomedicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Francesco Purrello
- Department of Clinical and Molecular Biomedicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy.
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Franzese A, Mozzillo E, Fattorusso V, Raia V, Valerio G. Screening of glucose metabolism derangements in pediatric cystic fibrosis patients: how, when, why. Acta Diabetol 2015; 52:633-8. [PMID: 25863781 DOI: 10.1007/s00592-015-0743-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
Diabetes mellitus is the most common comorbidity in cystic fibrosis (CF), occurring in a variable number of children and adolescents. Glucose metabolism derangements (GMDs) are responsible for a negative impact on the general health status of CF patients. Screening of GMDs is important since the youngest age and should be performed by means of OGTT, including its intermediate times, that could detect other non-traditional GMDs. Insulin treatment, administered before overt diabetes, could be beneficial in reducing the number of pulmonary infections, in improving both pulmonary function and nutritional status. Early screening of GMDs in pediatric age can exert an important preventing role regarding all aspects of health status of patients with CF.
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Affiliation(s)
- Adriana Franzese
- Department of Medical and Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy,
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Billow A, Anjana RM, Ngai M, Amutha A, Pradeepa R, Jebarani S, Unnikrishnan R, Michael E, Mohan V. Prevalence and clinical profile of metabolic syndrome among type 1 diabetes mellitus patients in southern India. J Diabetes Complications 2015; 29:659-64. [PMID: 25899474 DOI: 10.1016/j.jdiacomp.2015.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 01/08/2023]
Abstract
AIM To assess the prevalence of metabolic syndrome (MetS) among patients with type 1 diabetes mellitus(T1DM) and to look at prevalence of diabetes complications in T1DM with and without MetS. METHODS We studied 451 T1DM patients attending a tertiary diabetes centre in Chennai, South India. T1DM was diagnosed based on absence of beta cell reserve and requirement of insulin from the time of diagnosis. Data on clinical and biochemical characteristics as well as complications details to study the prevalence were also extracted from electronic records. T1DM patients were divided into those with and without MetS[diagnosed according to the harmonizing the metabolic syndrome criteria(IDF/NHLBI/AHA/WHF/IAS/IASO)]. RESULTS The overall prevalence of MetS among T1DM was 22.2%(100/451). Patients with MetS were older, had longer diabetes duration, acanthosis nigricans, and increased serum cholesterol. In the unadjusted logistic regression analysis, retinopathy, nephropathy and neuropathy were associated with MetS. However after adjustment for age, gender, diabetes duration, HbA1C and BMI significant association was seen only between MetS and retinopathy [odds ratio (OR) 2.82, 95% CI 1.18-6.74, p = 0.020] and nephropathy [OR 4.92, 95% CI 2.59-9.33, p < 0.001]. CONCLUSION Prevalence of MetS is high among Asian Indian T1DM patients, and its presence is associated with increased risk of diabetic retinopathy and nephropathy.
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Affiliation(s)
- Amy Billow
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Michelle Ngai
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Anandakumar Amutha
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Saravanan Jebarani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Edwin Michael
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India.
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