[Microvascular and macrovascular complications in children and adolescents with type 1 diabetes mellitus]

Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review

BACKGROUND

Motivational interviewing (MI) is a strategy for promoting adherence to treatment regimens among patients with diabetes. However, limited evidence exists regarding its effectiveness in reducing A1C.

OBJECTIVE

To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among patients with type 1 diabetes.

DESIGN

This was a systematic review of randomized controlled trials.

METHODS

A search was conducted of the scientific databases MEDLINE, Elsevier, CINAHL, Google Scholar, ProQuest, Ovid, and PubMed without imposing any time limit. Only four documents met the inclusion criteria and were included in the final analysis. The methodological quality of these four articles was reviewed by three reviewers using the Jadad Scale. The main intervention and the primary outcome in this study were MI or motivational enhancement therapy and A1C, respectively.

RESULTS

The retrieved studies reported that MI promotes self-monitoring of blood glucose and reduces A1C.

CONCLUSION

MI is effective in enhancing patients' adherence to the treatment regimen and thereby decreasing A1C. Given the fact that the reviewed studies had not eliminated the effects of confounding factors, further studies are needed to assess the pure effects of MI on adherence to treatment regimens and A1C levels.

Factors Affecting Cardiovascular Risk in Children, Adolescents, and Young Adults with Type 1 Diabetes

Cardiovascular risk and obesity are becoming major health issues among individuals with type 1 diabetes (T1D). The aim of this study was to evaluate cardiovascular risk factors and obesity in youth with T1D in Lithuania. Methods. 883 patients under 25 years of age with T1D for at least 6 months were investigated. Anthropometric parameters, blood pressure, and microvascular complications were evaluated, and the lipid profile and HbA1c were determined for all patients. Results. Study subjects' mean HbA1c was 8.5 ± 2%; 19.5% were overweight and 3.6% obese. Hypertension and dyslipidemia were diagnosed in 29.8% and 62.6% of participants, respectively. HbA1c concentration was directly related to levels of total cholesterol (r = 0.274, p < 0.001), LDL (r = 0.271, p < 0.001), and triglycerides (r = 0.407, p < 0.001) and inversely associated with levels of HDL (r = 0.117, p = 0.001). Prevalence of dyslipidemia increased with duration of diabetes (p < 0.05). Hypertension was more prevalent in overweight and obese compared to normal-weight patients (40.6 and 65.6 vs. 25.6%, respectively, p < 0.001). Frequency of microvascular complications was higher among patients with dyslipidemia (27.2 vs. 18.8%, p = 0.005) and among those with hypertension (25.9 vs. 23.2%, p < 0.001). Conclusion. The frequency of cardiovascular risk factors is high in youth with T1D and associated with diabetes duration, obesity, and metabolic control.

Actin cytoskeletal rearrangement and dysfunction due to activation of the receptor for advanced glycation end products is inhibited by thymosin beta 4

KEY POINTS

Thymosin beta 4 (Tβ4 ) attenuates the vascular cellular toxicity induced by advanced glycation end products (AGEs) in human umbilical vein endothelial cells (HUVECs). Tβ4 reduces expression of both the receptor of AGEs (RAGE) and the filamentous actin (F-actin) to globular actin (G-actin) ratio. RAGE expression was regulated by actin cytoskeleton involved in Tβ4 . Tβ4 attenuates the vascular cellular toxicity induced by AGEs via remodelling of the actin cytoskeleton. AGEs attenuate vascular-like tube formation of HUVECs, which is reversed by Tβ4 via remodelling of the actin cytoskeleton.

ABSTRACT

The receptor of advanced glycation end products (RAGE) is a cell-surface receptor that is a key factor in the pathogenesis of diabetic complications, including vascular disorders. Dysfunction of the actin cytoskeleton contributes to disruption of cell membrane repair in response to various type of endothelial cell damage. However, mechanism underlying RAGE remodelling of the actin cytoskeleton, by which globular actin (G-actin) forms to filamentous actin (F-actin), remains unclear. In this study we examined the role of thymosin beta 4 (Tβ4 ) - which binds to actin, blocks actin polymerization, and maintains the dynamic equilibrium between G-actin and F-actin in human umbilical vein endothelial cells (HUVECs) - in the response to RAGE. Tβ4 increased cell viability and decreased levels of reactive oxygen species in HUVECs incubated with AGEs. Tβ4 reduced the expression of RAGE, consistent with a down-regulation of the F-actin to G-actin ratio. The effect of remodelling of the actin cytoskeleton on RAGE expression was clarified by adding Phalloidin, which stabilizes F-actin. Moreover, small interfering RNA was used to determine whether intrinsic Tβ4 regulates RAGE expression in the actin cytoskeleton. The absence of intrinsic Tβ4 in HUVECs evoked actin cytoskeleton disorder and increased RAGE expression. These findings suggest that regulation of the actin cytoskeleton by Tβ4 plays a pivotal role in the RAGE response to AGEs.

The risk of early cardiovascular disease in Lithuanian diabetic children and adolescents: a type 1 diabetes register database based study

AIMS

The aim was to assess the frequency and correlates of selected cardiovascular disease risk factors among Lithuanian children and adolescents with type 1 diabetes mellitus (T1DM).

METHODS

A cohort of 539 T1DM children was investigated. Total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), glycated haemoglobin (HbA1c) was determined.

RESULTS

The mean of HbA1c was 8.5 ± 1.8%. Overweight was present in 72 (13.4%, 95% CI 10.6-16.9) and 113 (21.0%, 95% CI 17.5-25.3) had arterial hypertension. Hypercholesterolemia was diagnosed in 120 (22.3%; 95% CI 18.6-26.7), decreased HDL in 22 (4.1%; 95% CI 2.7-6.2), high LDL in 79 (14.7%; 95% CI 11.8-18.3), and high TG in 96 (17.8%, 95% CI 14.7-21.9) subjects. There were positive linear correlations between TG and high HbA1c levels (r=0.192; p<0.001), and between LDL and high HbA1c levels (r=0.238; p<0.001). Two cardiovascular risk factors were present 14.3%, three risk factors in 6.9%, four in 2.4% and five in 0.9%. The frequency of two cardiovascular risk factors was higher among 10-17-year-old T1DM patients than among 1-9-year-old children (27.0% vs. 13.3% respectively, p<0.01).

CONCLUSION

The frequency of cardiovascular risk factors is common in young people with T1DM and was associated with poor glycaemic control.