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Fuhri Snethlage CM, Meijnikman AS, Mak AL, Rampanelli E, Voermans B, Callender CAK, de Groen P, Roep BO, van Raalte DH, Knop FK, Holleboom AG, Nieuwdorp M, Hanssen NMJ. Prevalence and predictive features of metabolic dysfunction-associated steatotic liver disease in type 1 diabetes. Eur J Endocrinol 2024; 190:391-400. [PMID: 38679966 DOI: 10.1093/ejendo/lvae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/19/2023] [Accepted: 02/06/2024] [Indexed: 05/01/2024]
Abstract
AIMS/HYPOTHESIS The prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in type 1 diabetes remain unclear. Therefore, we investigated the prevalence and severity of MASLD in type 1 diabetes and assessed which clinical features are most important in predicting MASLD severity. METHODS A total of 453 individuals with type 1 diabetes (41.6 ± 15.0 years, 64% female, body mass index [BMI] 25.4 ± 4.2 kg/m2, and HbA1c 55.6 ± 12 mmol/mol) underwent vibration-controlled transient elastography (VCTE), with a controlled attenuation parameter (CAP) score for steatosis (≥280.0 dB/m) and a liver stiffness measurement (LMS) for fibrosis (≥8.0 kPa). A machine learning Extra-Trees classification model was performed to assess the predictive power of the clinical features associated with type 1 diabetes with respect to steatosis and fibrosis. RESULTS The prevalence of hepatic steatosis and fibrosis was 9.5% (95% CI, 6.8-12.2) and 3.5% (95% CI, 1.8-5.2). Higher LMS was associated with a longer duration of type 1 diabetes (median 30.5 [IQR 18.0-39.3] years vs 15.0 [IQR 6.0-27.0] years), and individuals were older, had a higher BMI (mean 27.8 ± 5.2 vs 25.3 ± 4.1 kg/m2), and a higher CAP score (mean 211.4 ± 51.7 dB/m vs 241.4 ± 75.6 dB/m). The most important predictive features of fibrosis were duration of type 1 diabetes, age, and systolic blood pressure, with a mean ± SD area under the curve of 0.73 ± 0.03. CONCLUSION Individuals with type 1 diabetes and high blood pressure, older age, higher BMI, and longer duration of disease could be considered at high-risk for developing MASLD.
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Affiliation(s)
- Coco M Fuhri Snethlage
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Abraham S Meijnikman
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Anne Linde Mak
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Elena Rampanelli
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Bas Voermans
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
- HORAIZON Technology B.V. Delft, GZ Delft 2625, The Netherlands
| | - Cengiz A K Callender
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Pleun de Groen
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Bart O Roep
- Internal Medicine, Leids Universitair Medisch Centrum, Leiden, ZA 2333, The Netherlands
| | - Daniël H van Raalte
- Department of Endocrinology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Department of Clinical and Translational Research, 2730 Herlev, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Adriaan G Holleboom
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Nordin M J Hanssen
- Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
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Zhang Y, Sun W, Zhang Q, Bai Y, Ji L, Zheng H, Zhu X, Liu X, Zhang S, Xiong Q, Li Y, Chen L, Lu B. Estimated glucose disposal rate predicts the risk of diabetic peripheral neuropathy in type 2 diabetes: A 5-year follow-up study. J Diabetes 2024; 16:e13482. [PMID: 38225901 PMCID: PMC11045912 DOI: 10.1111/1753-0407.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/01/2023] [Accepted: 09/16/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Insulin resistance is associated with chronic complications of diabetes, including diabetic peripheral neuropathy (DPN). Estimated glucose disposal rate (eGDR), calculated by the common available clinical factors, was proved to be an excellent tool to measure insulin resistance in large patient population. Few studies have explored the association between eGDR and DPN longitudinally. Therefore, we performed the current study to analyze whether eGDR could predict the risk of DPN. METHODS In this prospective study, 366 type 2 diabetes (T2DM) subjects without DPN were enrolled from six communities in Shanghai in 2011-2014 and followed up until 2019-2020. Neuropathy was assessed by Michigan Neuropathy Screening Instrument (MSNI) at baseline and at the end of follow-up. FINDINGS After 5.91 years, 198 of 366 participants progressed to DPN according to MNSI examination scores. The incidence of DPN in the low baseline eGDR (eGDR < 9.15) group was significantly higher than in the high baseline eGDR (eGDR ≥ 9.15) group (62.37% vs. 45.56%, p = .0013). The incidence of DPN was significantly higher in patients with sustained lower eGDR level (63.69%) compared with those with sustained higher eGDR level (35.80%). Subjects with low baseline eGDR (eGDR < 9.15) had significantly higher risk of DPN at the end of follow-up (odds ratio = 1.75), even after adjusting for other known DPN risk factors. CONCLUSIONS The 5-year follow-up study highlights the importance of insulin resistance represented by eGDR in the development of DPN in T2DM. Diabetic patients with low eGDR are more prone to DPN and, therefore, require more intensive screening and more attention.
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Affiliation(s)
- Yuanpin Zhang
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Wanwan Sun
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Qi Zhang
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Yuetian Bai
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Lijin Ji
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Hangping Zheng
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Xiaoming Zhu
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Xiaoxia Liu
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Shuo Zhang
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Qian Xiong
- Department of EndocrinologyShanghai Gonghui HospitalShanghaiChina
| | - Yiming Li
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Lili Chen
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Bin Lu
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
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3
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Sammut MJ, McBey DP, Sayal AP, Melling CWJ. The Effects of Resistance Exercise Training on Skeletal Muscle Metabolism and Insulin Resistance Development in Female Rodents with Type 1 Diabetes. J Diabetes Res 2024; 2024:5549762. [PMID: 38435452 PMCID: PMC10904684 DOI: 10.1155/2024/5549762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
The etiology of insulin resistance (IR) development in type 1 diabetes mellitus (T1DM) remains unclear; however, impaired skeletal muscle metabolism may play a role. While IR development has been established in male T1DM rodents, female rodents have yet to be examined in this context. Resistance exercise training (RT) has been shown to improve IR and is associated with a lower risk of hypoglycemia onset in T1DM compared to aerobic exercise. The purpose of this study was to investigate the effects of RT on IR development in female T1DM rodents. Forty Sprague Dawley eight-week-old female rats were divided into four groups: control sedentary (CS; n = 10), control trained (CT; n = 10), T1DM sedentary (DS; n = 10), and T1DM trained (DT; n = 10). Multiple low-dose streptozotocin injections were used to induce T1DM. Blood glucose levels were maintained in the 4-9 mmol/l range with intensive insulin therapy. CT and DT underwent weighted ladder climbing 5 days/week for six weeks. Intravenous glucose tolerance tests (IVGTT) were conducted on all animals following the six-week period. Results demonstrate that DS animals exhibited significantly increased weekly blood glucose measures compared to all groups including DT (p < 0.0001), despite similar insulin dosage levels. This was concomitant with a significant increase in insulin-adjusted area under the curve following IVGTT in DS (p < 0.05), indicative of a reduction in insulin sensitivity. Both DT and DS exhibited greater serum insulin concentrations compared to CT and CS (p < 0.05). DS animals also exhibited significantly greater glycogen content in white gastrocnemius muscle compared to CS and DT (p < 0.05), whereas DT and DS animals exhibited greater p-Akt: Akt ratio in the white vastus lateralis muscle and citrate synthase activity in the red vastus lateralis muscle compared to CS and CT (p < 0.05). These results indicate that female rodents with T1DM develop poor glycemic control and IR which can be attenuated with RT, possibly related to differences in intramyocellular glycogen content.
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Affiliation(s)
- Mitchell J. Sammut
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - David P. McBey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Amit P. Sayal
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - C. W. James Melling
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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4
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Bielka W, Przezak A, Molęda P, Pius-Sadowska E, Machaliński B. Double diabetes-when type 1 diabetes meets type 2 diabetes: definition, pathogenesis and recognition. Cardiovasc Diabetol 2024; 23:62. [PMID: 38341550 PMCID: PMC10859035 DOI: 10.1186/s12933-024-02145-x] [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: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Currently, the differentiation between type 1 diabetes (T1D) and type 2 diabetes (T2D) is not straightforward, and the features of both types of diabetes coexist in one subject. This situation triggered the need to discriminate so-called double diabetes (DD), hybrid diabetes or type 1.5 diabetes, which is generally described as the presence of the insulin resistance characteristic of metabolic syndrome in individuals diagnosed with T1D. DD not only raises the question of proper classification of diabetes but is also associated with a significantly greater risk of developing micro- and macroangiopathic complications, which was independent of glycaemic control. When considering the global obesity pandemic and increasing incidence of T1D, the prevalence of DD may also presumably increase. Therefore, it is of the highest priority to discover the mechanisms underlying the development of DD and to identify appropriate methods to prevent or treat DD. In this article, we describe how the definition of double diabetes has changed over the years and how it is currently defined. We discuss the accuracy of including metabolic syndrome in the DD definition. We also present possible hypotheses connecting insulin resistance with T1D and propose possible methods to identify individuals with double diabetes based on indirect insulin resistance markers, which are easily assessed in everyday clinical practice. Moreover, we discuss adjuvant therapy which may be considered in double diabetic patients.
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Affiliation(s)
- Weronika Bielka
- Department of Diabetology and Internal Diseases, Pomeranian Medical University, 72-009, Police, Poland.
| | - Agnieszka Przezak
- Department of Diabetology and Internal Diseases, Pomeranian Medical University, 72-009, Police, Poland
| | - Piotr Molęda
- Department of Diabetology and Internal Diseases, Pomeranian Medical University, 72-009, Police, Poland
| | - Ewa Pius-Sadowska
- Department of General Pathology, Pomeranian Medical University, 70-111, Szczecin, Poland
| | - Bogusław Machaliński
- Department of General Pathology, Pomeranian Medical University, 70-111, Szczecin, Poland
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Xu YX, Pu SD, Zhang YT, Tong XW, Sun XT, Shan YY, Gao XY. Insulin resistance is associated with the presence and severity of retinopathy in patients with type 2 diabetes. Clin Exp Ophthalmol 2024; 52:63-77. [PMID: 38130181 DOI: 10.1111/ceo.14344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/15/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND To assess the relationship between novel insulin resistance (IR) indices and the presence and severity of diabetic retinopathy (DR) in patients with type 2 diabetes. METHODS This is a cross-sectional study involving 2211 patients. The study outcomes were DR events. The study exposures were IR indices including estimated glucose disposal rate (eGDR), natural logarithm of glucose disposal rate (lnGDR), metabolic insulin resistance score (METS-IR), triglyceride glucose index-body mass index (TyG-BMI), triglyceride glucose index-waist-to-hip ratio (TyG-WHR), and triglyceride/high-density lipoprotein cholesterol(TG/HDL-c ratio). We used binary and multivariate ordered logistic regression models to estimate the association between different IR indices and the presence and severity of DR. Subject work characteristic curves were used to assess the predictive power of different IR indices for DR. RESULTS DR was present in 25.4% of participants. After adjusting for all covariates, per standard deviation (SD) increases in eGDR (ratio [OR] 0.38 [95% CI 0.32-0.44]), lnGDR (0.34 [0.27-0.42]) were negatively associated with the presence of DR. In contrast, per SD increases in METS-IR (1.97 [1.70-2.28]), TyG-BMI (1.94 [1.68-2.25]), TyG-WHR (2.34 [2.01-2.72]) and TG/HDL-c ratio (1.21 [1.08-1.36]) were positively associated with the presence of DR. eGDR was strongly associated with severity of DR. Of all variables, eGDR had the strongest diagnostic value for DR (AUC = 0.757). CONCLUSIONS Of the six IR indices, eGDR was significantly associated with the presence and severity of DR in patients with type 2 diabetes. eGDR has a good predictive value for DR. Thus, eGDR maybe a stronger marker of DR.
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Affiliation(s)
- Yu-Xin Xu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Sheng-Dan Pu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Yi-Tong Zhang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xue-Wei Tong
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xiao-Tong Sun
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Yong-Yan Shan
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xin-Yuan Gao
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
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Heneberg P. Diabetes in stiff-person syndrome. Trends Endocrinol Metab 2023; 34:640-651. [PMID: 37586963 DOI: 10.1016/j.tem.2023.07.005] [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: 02/28/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
Anti-glutamic acid decarboxylase (GAD) autoantibodies are a hallmark of stiff-person syndrome (SPS) and insulin-dependent diabetes mellitus (IDDM). However, patients with concurrent IDDM and SPS often manifest insulin resistance, and SPS-associated IDDM probably has heterogeneous causes. Some patients manifest IDDM associated only with high titers of anti-GAD65 caused by SPS. By contrast, other patients develop IDDM only after being treated with high-dose corticosteroids or they progress to insulin dependency following their treatment with high-dose corticosteroids. The profile of autoantibodies differs markedly between type 1 diabetes mellitus (T1DM), late-onset diabetes mellitus, and SPS-associated IDDM. Therefore, as with new-onset diabetes after transplantation (NODAT), SPS-associated IDDM should be classified as a specific diabetes entity, the pathophysiology of which requires increased attention.
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Affiliation(s)
- Petr Heneberg
- Charles University, Third Faculty of Medicine, Prague, Czech Republic.
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8
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Peng J, Li A, Yin L, Yang Q, Pan J, Yi B. Estimated Glucose Disposal Rate Predicts Renal Progression in Type 2 Diabetes Mellitus: A Retrospective Cohort Study. J Endocr Soc 2023; 7:bvad069. [PMID: 37304203 PMCID: PMC10251298 DOI: 10.1210/jendso/bvad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 06/13/2023] Open
Abstract
Context Insulin resistance is a feature of type 2 diabetes mellitus (T2DM). The estimated glucose disposal rate (eGDR), a validated marker for insulin resistance, is associated with complications of diabetes, but few studies have explored the relationship between eGDR and renal outcomes in T2DM. Objective This study investigated the value of eGDR in predicting renal progression in T2DM. Methods A total of 956 T2DM patients with a baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 and 5 years of follow-up were enrolled. Primary outcomes were rapid eGFR decline, eGFR <60 mL/min/1.73 m2, and composite renal endpoint consisting of 50% eGFR decline, doubling of serum creatinine, or end-stage renal disease. A continuous scale with restricted cubic spline curves and a generalized linear model were applied to evaluate the associations between eGDR and primary outcomes. Results Rapid eGFR decline was experienced by 23.95% of patients, 21.97% with eGFR <60 mL/min/1.73 m2, and 12.13% with the composite renal endpoint. The eGDR showed a relationship with follow-up eGFR and percentage change in eGFR (P < .001). An eGDR <6.34 mg/kg/min was an independent risk factor for rapid eGFR decline, eGFR < 60 mL/min/1.73 m2, or the composite renal endpoint(P < .05). Compared with eGDR of 5.65∼6.91 mg/kg/min, eGDR levels >8.33 mg/kg/min decreased the risk of rapid eGFR decline by 75%, eGFR < 60 mL/min/1.73 m2 by 60%, and the composite renal endpoint by 61%. Subgroup analysis was performed by sex, age, and diabetes duration, which showed that eGDR was associated with primary outcomes. Conclusion Lower eGDR is a predictive factor for renal deterioration in T2DM patients.
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Affiliation(s)
- Juan Peng
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Aimei Li
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Liangqingqing Yin
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Qi Yang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Jinting Pan
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Bin Yi
- Correspondence: Bin Yi, MD, PhD, Department of Nephrology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China.
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Bongiorno C, Moscatiello S, Baldari M, Saudelli E, Zucchini S, Maltoni G, Ribichini D, Bruco A, Lo Preiato V, Laffi G, Pagotto U, Di Dalmazi G. Sleep quality and sex-related factors in adult patients with immune-mediated diabetes: a large cross-sectional study. Acta Diabetol 2023; 60:663-672. [PMID: 36800003 PMCID: PMC9936122 DOI: 10.1007/s00592-023-02036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/14/2023] [Indexed: 02/18/2023]
Abstract
AIM To analyze sleep quality and its relationships with clinical and biochemical features in a large cohort of adults with autoimmune diabetes. METHODS We administered to 553 patients with autoimmune diabetes the questionnaires: Pittsburgh Sleep Quality Index (PSQI), diabetes distress scale, diabetes-related quality of life and diabetes treatment satisfaction questionnaire. We excluded patients with missing HbA1c ± 4 months from PSQI administration or incorrect PSQI compilation (n = 110). RESULTS Altered sleep quality was recorded in 142/443 subjects (32%), insufficient total sleep time in 177/443 (40%). The altered sleep quality group had higher HbA1c (median 56 mmol/mol [interquartile range-IQR 49-62] vs 59 [IQR 52-68]; P < 0.001), higher average HbA1c in the previous 36 months (59 mmol/mol [IQR 54-68] vs 56 [IQR 51-62]; P < 0.001), and more individuals with HbA1c > 53 mmol/mol (74.6% vs 62.8%; P = 0.014). Diabetes duration (P = 0.63), type of insulin delivery (P = 0.48) and glucose monitoring (P = 0.35) were uninfluential. Patients with altered sleep quality showed higher prevalence of autoimmune (42 vs 28%; P = 0.005) and mental diseases (12 vs 4%; P = 0.002); there were greater emotional distress, and lower quality of life and treatment satisfaction (P < 0.001 for all), irrespective of sex. Men with altered sleep quality had higher HbA1c and prevalence of autoimmune diseases. Women showed greater prevalence of psychiatric disorders. Average HbA1c of the previous 36 months, autoimmune or psychiatric disorders were independent predictive factors for altered sleep quality. CONCLUSION One-third of the patients with autoimmune diabetes showed altered sleep quality, which associates with worse glycemic control, and autoimmune and mental disorders, with sex-specific differences.
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Affiliation(s)
- Claudio Bongiorno
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simona Moscatiello
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Michele Baldari
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Enrico Saudelli
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Zucchini
- Pediatric Unit,, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giulio Maltoni
- Pediatric Unit,, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Danilo Ribichini
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Alessia Bruco
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valentina Lo Preiato
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gilberto Laffi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
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10
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Popa SG, Simion AM, Soare M, Arcomita D. Insulin resistance and hepatic steatosis in type 1 diabetes mellitus and their association with diabetic chronic complications. Minerva Endocrinol (Torino) 2023; 48:27-34. [PMID: 33006467 DOI: 10.23736/s2724-6507.20.03290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The aim of this study was to evaluate insulin resistance and hepatic steatosis and their association with diabetes duration, control and chronic complications in patients with type 1 diabetes. METHODS We studied medical records of 181 consecutive hospitalized adult patients with type 1 diabetes. Estimated glucose disposal rate (eGDR), Insulin Sensitivity Score (ISS), Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) were calculated. RESULTS Patients in the 1st tertile of eGDR (<4.1 mg/kg-1-min-1) and ISS (<4.8) had higher prevalence of ischemic cardiovascular disease (ICVD) (P<0.001), hepatic steatosis, higher gamma glutamyl transpeptidase, HSI, FLI compared with participants from the 2nd and 3rd tertile of eGDR and ISS. Compared with those without steatosis, patients with ultrasound-diagnosed steatosis (30.5%) had a lower ISS (4.4±1.9 vs. 6.3±2.4, P<0.001), eGDR (4.5±3.0 vs. 5.8±2.7, P=0.01), higher FLI (72.5±25.1 vs. 51.0±27.2, P<0.001), HSI (37.5±6.1 vs. 35.2±4.7, P=0.03) and prevalence of ICVD (71.7 vs. 45.7%, P=0.004) and retinopathy (69.6 vs. 52.4%, P=0.03). Factors independently associated with hepatic steatosis were only ICVD (OR=2.584, P=0.029), ISS (OR 0.148, P<0.001), aspartate aminotransferase (OR=1.025, P=0.038) and male gender (OR=2.726, P=0.016). CONCLUSIONS Insulin resistance and hepatic steatosis are common in type 1 diabetes and have a significant association with ICVD, independently of diabetes duration, control and insulin doses.
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Affiliation(s)
- Simona G Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy, Craiova, Romania -
| | - Ana M Simion
- Department of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical Hospital, Craiova, Romania
| | - Mariana Soare
- Department of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical Hospital, Craiova, Romania
| | - Doina Arcomita
- Department of Internal Medicine, Emergency Clinical Hospital Sibiu, Sibiu, Romania
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11
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1088] [Impact Index Per Article: 1088.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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12
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Gouda SI, Aboelnaga MM, Elbeltagy AMG, Elbaz A. Testosterone deficiency in non-obese type 2 diabetic male patients. Arch Ital Urol Androl 2022; 94:464-469. [PMID: 36576479 DOI: 10.4081/aiua.2022.4.464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND AIMS it is unclear whether male hypogonadism is ascribable to the diabetic state per se, or because of other factors, such as obesity or age. We aimed to investigate the prevalence and identify the predictors for testosterone deficiency among non-obese type 2 diabetic males. METHODS This cross-sectional study was conducted on 95 nonobese type 2 diabetic males with BMI below 30. We evaluated the total testosterone (TT) levels to determine prevalence and risk factors of testosterone deficiency. Serum TT ≤ 300 ng/dl defined testosterone deficiency. RESULTS The prevalence of testosterone deficiency was 29.1%. Testosterone deficient patients had statistically significantly higher visceral adiposity index (VAI), waist, and triglyceride in comparison with normal testosterone patients. TT level correlated with VAI, waist, BMI, LH, and age. VAI was the only significant predictor of TT levels even after adjustment for age and BMI in regression analysis. Furthermore, VAI was a statistically significant risk factor for testosterone deficiency in binary logistic analysis. CONCLUSIONS testosterone deficient non-obese type 2 diabetic male patients had elevated VAI, waist, and triglyceride. Moreover, elevated VAI was a risk factor for testosterone deficiency. VAI could be an easily applicable and reliable index for the evaluation and prediction in type 2 non-obese diabetic males.
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Affiliation(s)
- Sherihan I Gouda
- Endocrinology and Diabetes Unit, Faculty of Medicine, Mansoura University, Mansoura.
| | - Mohamed M Aboelnaga
- Endocrinology and Diabetes Unit, Faculty of Medicine, Mansoura University, Mansoura.
| | - Ahmed M G Elbeltagy
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura.
| | - Amro Elbaz
- Endocrinology and Diabetes Unit, Faculty of Medicine, Mansoura University, Mansoura.
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13
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Ren X, Jiang M, Han L, Zheng X. Estimated glucose disposal rate and risk of cardiovascular disease: evidence from the China Health and Retirement Longitudinal Study. BMC Geriatr 2022; 22:968. [PMID: 36517754 PMCID: PMC9753298 DOI: 10.1186/s12877-022-03689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Previous studies had reported that insulin resistance (assessed by estimated glucose disposal rate; eGDR) was associated with higher risk of cardiovascular events (CVD) in diabetes patients. The aim of present study was to investigate the potential association between eGDR and CVD in general population. METHODS The China Health and Retirement Longitudinal Study with 8,267 individuals were included in analysis. Participants were divided into four subgroups according to eGDR quartile. Cox proportional hazards regression models were used to examine the associations of eGDR with CVD (stroke or cardiac events). RESULTS During 6 years of follow-up, a total of 1,476 respondents experienced a CVD (494 stroke and 1,110 cardiac events). In multivariable-adjusted analyses, the corresponding hazard ratio (95% confidence intervals) for the highest eGDR versus lowest quartile of eGDR was 0.58(0.49-0.67) for CVD. Each 1-SD increase of eGDR was associated with 16% (HRs = 0.84; 0.79-0.88) decreased risk of CVD. There was also a significant linear association between eGDR and CVD (P for linearity < 0.001). Similar associations were also found between eGDR and stroke and cardiac events. CONCLUSION A higher eGDR (a measure of insulin resistance) was associated with a decreased risk of CVD, stroke and cardiac events in general Chinese population, suggesting that eGDR could be considered as a preferential predictor and treatment target of CVD. Future well-designed prospective clinical studies are needed to verify our findings and to assess the effect of eGDR interventions in CVD prevention and therapy.
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Affiliation(s)
- Xiao Ren
- grid.258151.a0000 0001 0708 1323Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, 1800 Lihu Road, Binhu District, Jiangsu Province 214122 Wuxi, China
| | - Minglan Jiang
- grid.258151.a0000 0001 0708 1323Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, 1800 Lihu Road, Binhu District, Jiangsu Province 214122 Wuxi, China
| | - Longyang Han
- grid.258151.a0000 0001 0708 1323Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, 1800 Lihu Road, Binhu District, Jiangsu Province 214122 Wuxi, China
| | - Xiaowei Zheng
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, 1800 Lihu Road, Binhu District, Jiangsu Province, 214122, Wuxi, China.
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14
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Liu C, Liu X, Ma X, Cheng Y, Sun Y, Zhang D, Zhao Q, Zhou Y. Predictive worth of estimated glucose disposal rate: evaluation in patients with non-ST-segment elevation acute coronary syndrome and non-diabetic patients after percutaneous coronary intervention. Diabetol Metab Syndr 2022; 14:145. [PMID: 36203208 PMCID: PMC9535978 DOI: 10.1186/s13098-022-00915-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measurement of estimated glucose disposal rate (eGDR) has been demonstrated to be an indicator of insulin resistance (IR) and a risk sign for long-term outcomes in those with ischemic heart disease and type 2 diabetes mellitus (T2DM) having coronary artery bypass grafting (CABG). After elective percutaneous coronary intervention (PCI), the usefulness of eGDR for prognosis in those with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and non-diabetes is yet unknown. METHODS 1510 NSTE-ACS patients with non-diabetes who underwent elective PCI in 2015 (Beijing Anzhen Hospital) were included in this study. Major adverse cardio-cerebral events (MACCEs), such as all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, and also ischemia-driven revascularization, were the main outcome of follow-up. The average number of follow-up months was 41.84. RESULTS After multivariate Cox regression tests with confounder adjustment, the occurrence of MACCE in the lower eGDR cluster was considerably higher than in the higher eGDR cluster, demonstrating that eGDR is an independent prognostic indicator of MACCEs. In particular, as continuous variate: hazard ratio (HR) of 1.337, 95% confidence interval (CI) of 1.201-1.488, P < 0.001. eGDR improves the predictive power of usual cardiovascular risk factors for the primary endpoint. Specifically, the results for the area under the receiver operating characteristic (ROC) curve, this is AUC, were: baseline model + eGDR 0.699 vs. baseline model 0.588; P for contrast < 0.001; continuous net reclassification improvement (continuous-NRI) = 0.089, P < 0.001; and integrated discrimination improvement (IDI) = 0.017, P < 0.001. CONCLUSION Low eGDR levels showed a strong correlation with poor NSTE-ACS prognosis for nondiabetic patients undergoing PCI.
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Affiliation(s)
- Chi Liu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Yujing Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Yan Sun
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Dai Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China
| | - Qi Zhao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
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Flotyńska J, Klause D, Kulecki M, Cieluch A, Chomicka-Pawlak R, Zozulińska-Ziółkiewicz D, Uruska A. Higher NADH Dehydrogenase [Ubiquinone] Iron–Sulfur Protein 8 (NDUFS8) Serum Levels Correlate with Better Insulin Sensitivity in Type 1 Diabetes. Curr Issues Mol Biol 2022; 44:3872-3883. [PMID: 36135178 PMCID: PMC9497649 DOI: 10.3390/cimb44090266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of the study was to evaluate NADH dehydrogenase [ubiquinone] iron–sulfur protein 8 (NDUFS8) serum concentration as a marker of Complex I, and the relationship with insulin resistance in type 1 diabetes mellitus (T1DM). Design and methods: Participants were adults with T1DM, recruited over the course of 1 year (2018–2019). NDUFS8 protein serum concentration was measured using the ELISA test. Insulin resistance was evaluated with indirect marker estimated glucose disposal rate (eGDR). The group was divided on the base of median value of eGDR (higher eGDR—better insulin sensitivity). Results: The study group consists of 12 women and 24 men. Medians of eGDR and NDUFS8 protein concentration are 7.6 (5.58–8.99) mg/kg/min and 2.25 (0.72–3.81) ng/mL, respectively. The group with higher insulin sensitivity has higher NDUFS8 protein serum concentration, lower waist to hip ratio (WHR), body mass index (BMI), and they are younger. A negative correlation is observed between NDUFS8 protein serum concentration and WHR (rs = −0.35, p = 0.03), whereas a positive correlation is observed between NDUFS8 protein serum concentration and eGDR (rs = 0.43, p = 0.008). Univariate logistic regression shows a significant association between insulin sensitivity and lower age, as well as a higher NDUFS8 serum level. A multivariate logistic regression model confirms the significance (AOR 2.38 (1.04–5.48). p = 0.042). Multivariate linear regression confirms a significant association between insulin sensitivity and better mitochondrial function (beta = 0.54, p = 0.003), independent of age, duration of diabetes, and smoking. Conclusions: Higher NDUFS8 protein serum concentration is associated with higher insulin sensitivity among adults with T1DM.
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Affiliation(s)
- Justyna Flotyńska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Collegium Stomatologicum, Bukowska 70, 60-812 Poznan, Poland
- Correspondence: ; Tel.: +48-61-8474579
| | - Daria Klause
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - Michał Kulecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - Aleksandra Cieluch
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - Regina Chomicka-Pawlak
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, University Hospital of Lord’s Transfiguration, Długa ½, 61-848 Poznan, Poland
| | - Dorota Zozulińska-Ziółkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
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Oza C, Khadilkar A, Karguppikar M, Gondhalekar K, Khadilkar V. Comparison of insulin sensitivity indices for detection of double diabetes in Indian adolescents with type 1 diabetes. J Pediatr Endocrinol Metab 2022; 35:1010-1019. [PMID: 35705059 DOI: 10.1515/jpem-2022-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The role of insulin sensitivity (IS) in the development and progression of metabolic syndrome (MS) in subjects with type-1 diabetes (T1D) is being increasingly recognized. As patients with T1D lack endogenous insulin secretion, measurement of insulin concentration by immunoassay or by indices such as homeostasis model of assessment for insulin resistance (HOMA-IR) is not helpful in assessing IS. Hence, some equations have been developed and validated against data from euglycemic-hyper-insulinemic clamp tests (the gold standard) to estimate IS. 1) To assess IS using available equations (EDC, SEARCH and CACTI) and relationship of IS with MS and microalbuminuria in adolescents with T1D, (2) To compare the predictive value of these equations for detection of MS and derive a cut-off to predict the future risk of development of MS and microalbuminuria and (3) To identify the most accurate non-invasive and easy-to-use equation for detecting patients with double diabetes (DD) in a clinical setting. METHODS This cross-sectional study included 181 adolescents aged 12-18 years with T1D. Demographic data and laboratory measurements were performed using standard protocols. IS was calculated using following equations:(1) EDC=24.31-12.22×(WHR)-3.29×(hypertension)-0.57×(HbA1c), (2) SEARCH=exp(4.64725-0.02032(waist)-0.09779(HbA1c)-0.00235(Triglycerides), (3)CACTI-exA=exp(4.1075-0.01299×(waist)-1.05819×(insulin dose)-0.00354×(Triglycerides)-0.00802×(DBP)). RESULTS IS determined by all three methods had significant negative correlation (p<0.05) with MS as well as with microalbuminuria. The cut-off value of 5.485 mg/kg/min by SEARCH method for determining IS had the highest sensitivity and specificity in identifying MS. CONCLUSIONS IS by SEARCH equation may be used in routine clinical practice to detect DD in Indian adolescents with T1D at risk of developing metabolic as well as microvascular complications.
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Affiliation(s)
- Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India.,Senior Pediatric Endocrinologist, Jehangir Hospital, Pune, India.,Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | | | | | - Vaman Khadilkar
- Senior Pediatric Endocrinologist, Jehangir Hospital, Pune, India.,Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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Okada S, Watanabe T, Okada J, Yamada E, Okada K, Kikkawa K, Ohsima K. Correlation between insulin resistance score and daily total insulin dosage in patient with type 1 diabetes mellitus: a pilot study. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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18
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Lecumberri E, Nattero-Chávez L, Quiñones Silva J, Alonso Díaz S, Fernández-Durán E, Dorado Avendaño B, Escobar-Morreale HF, Luque-Ramírez M. Impact of excluding hyperglycemia from international diabetes federation metabolic syndrome diagnostic criteria on prevalence of the syndrome and its association with microvascular complications, in adult patients with type 1 diabetes. Endocrine 2022; 76:601-611. [PMID: 35349030 DOI: 10.1007/s12020-022-03041-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/11/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND We aimed to determine, in patients with type 1 diabetes (T1DM), the impact of excluding hyperglycemia as a criterion from the International Diabetes Federation (IDF) definition of the metabolic syndrome (MetS), both on its prevalence and on its association with micro and macrovascular complications and markers of subclinical inflammation. METHODS A cross-sectional design, including 280 patients with T1DM. We defined MetS by three different models: (i) the standard IDF criteria, (ii) a modification consisting of excluding of hyperglycemia as a criterion (modified IDF criteria) and (iii) a modification consisting in changing the hyperglycemia by insulin resistance (MetS + IR model) defined by the estimated glucose disposal rate. Microvascular complications and cardioautonomic neuropathy were assessed. We measured an inflammatory panel including high sensitivity C reactive protein, erythrocyte sedimentation rate, homocysteine, and fibrinogen concentrations. RESULTS After excluding hyperglycemia, the prevalence of MetS was 6.4% (95%CI: 4.1 to 9.9) compared with 20.7% (95%CI: 16.3 to 25.8) using standard IDF criteria. After adjusting for duration of diabetes, all three MetS definitions increased the odds for having microvascular complications [OR: 6.012 (2.208-16.307) for modified definition; OR: 5.176 (2.555-10.486) for standard definition and [OR: 3.374 (1.649-8.456) for MetS+IR model]. However, the both modified IDF models for MetS showed better predictive performance than standard criteria for suffering from neuropathy, nephropathy, cardiovascular disease and were associated with markers of subclinical inflammation. CONCLUSIONS The prevalence of MetS significantly varies as a function whether or not hyperglycemia is included as a diagnostic criterion. The subset of patients fulfilling the modified MetS definitions may reflect better the concept of metabolic syndrome in T1DM. These modified definitions were accompanied by a poorer metabolic control and lipid profile, showing the worse inflammatory biomarker profiles and higher odds for micro- and macrovascular complications. In patients with T1DM, the inclusion of insulin resistance instead of hyperglycemia as a criterion of MetS may be of interest in routine clinical practice.
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Affiliation(s)
- Edurne Lecumberri
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Lía Nattero-Chávez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Jhonatan Quiñones Silva
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital General Universitario de Alicante, Alicante, Spain
| | - Sara Alonso Díaz
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario de Elche, Elche, Spain
| | - Elena Fernández-Durán
- Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Dorado Avendaño
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Manuel Luque-Ramírez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2307] [Impact Index Per Article: 1153.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Pujia R, Maurotti S, Coppola A, Romeo S, Pujia A, Montalcini T. The Potential Role of C-peptide in Sexual and Reproductive Functions in Type 1 Diabetes Mellitus: An Update. Curr Diabetes Rev 2022; 18:e051021196983. [PMID: 34636302 DOI: 10.2174/1573399817666211005093434] [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: 12/07/2020] [Revised: 07/09/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although hyperglycaemia is known to be the leading cause of diabetic complications, the beneficial effect of optimal glucose control in preventing diabetic complications is still far from being proven. In fact, such complications may not be related to glycaemic control alone. OBJECTIVE This review summarizes several studies that suggest that a C-peptide deficiency could be new and common pathophysiology for complications in type 1 diabetes, including sexual and reproductive dysfunction. METHODS We reviewed in vitro, in vivo, and human studies on the association between C-peptide deficiency or C-peptide replacement therapy and complications in type 1 diabetes. It seems that Cpeptide replacement therapy may interrupt the connection between diabetes and sexual/reproductive dysfunction. RESULTS The Diabetes Control and Complications Trial suggested that maintaining C-peptide secretion is associated with a reduced incidence of retinopathy, nephropathy, and hypoglycaemia. Risk of vascular, hormonal, and neurologic damage in the structures supplying blood to the penis increases with increasing levels of HbA1. However, several human studies have suggested an association between C-peptide production and hypothalamic/pituitary functions. When exposed to C-peptide, cavernosal smooth muscle cells increase the production of nitric oxide. C-peptide in diabetic rats improves sperm count, sperm motility, testosterone levels, and nerve conduction compared to non-treated diabetic rats. CONCLUSION C-peptide deficiency may be involved, at least partially, in the development of several pathological features associated with type 1 diabetes, including sexual/reproductive dysfunction. Preliminary studies have reported that C-peptide administration protects against diabetic microand macrovascular damages as well as sexual/reproductive dysfunction. Therefore, further studies are needed to confirm these promising findings.
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Affiliation(s)
- Roberta Pujia
- Department of Health Science, University Magna Grecia, Catanzaro,Italy
| | - Samantha Maurotti
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro,Italy
| | | | - Stefano Romeo
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro,Italy
| | - Arturo Pujia
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro,Italy
| | - Tiziana Montalcini
- Department of Experimental and Clinical Medicine, Clinical Nutrition Unit, University Magna Græcia of Catanzaro, Catanzaro,Italy
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21
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Valente F, Valente T, Crispim F, Bittencourt CS, Piveta VM, Moises RCMS, de Sá JR, Dib SA. Parents' cardiovascular risk factors are related to overweight and obesity in young Brazilians with type 1 diabetes. J Diabetes Complications 2022; 36:108082. [PMID: 34865986 DOI: 10.1016/j.jdiacomp.2021.108082] [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: 03/02/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/20/2022]
Abstract
AIM To identify family background characteristics and cardiovascular disease (CVD) risk factors linked to overweight and obesity in Brazilian with type 1 diabetes (T1D). METHODS We performed cross-sectional anthropometric and laboratory analyses in young individuals with T1D. RESULTS Among 181 participants, 87 were women and 94 were men (64%/78% normal weight, 27%/15% overweight and 9%/7% obese). Obese men were older; were more likely to be Black; had higher triglyceride levels and diastolic blood pressure (BP), lower estimated glucose disposal rate (eGDR) and higher prevalence of first-degree relatives (FDR) with hypertension and early CVD. Overweight and obese women were more likely to have lower eGDR, and obese women were more likely to have FDR with obesity. CONCLUSION One third of young people with T1D were overweight or obese. Excess weight was associated with family history (FH) of obesity for women and FH of early CVD or hypertension for men. BMI was related to decreased insulin sensitivity in both genders, but only men with T1D had metabolic impairment. Our data highlight the importance of considering family background in individuals with T1D.
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Affiliation(s)
- Fernando Valente
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil.
| | - Tatiana Valente
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
| | - Felipe Crispim
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
| | | | - Valdecira Maria Piveta
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
| | | | - João Roberto de Sá
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
| | - Sérgio Atala Dib
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
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22
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Alchujyan N, Hovhannisyan M, Movsesyan N, Melkonyan A, Shaboyan V, Aghajanova Y, Minasyan G, Kevorkian G. Sexual Dimorphism in Alternative Metabolic Pathways of L-Arginine in Circulating Leukocytes in Young People with Type 1 Diabetes Mellitus. Endocr Res 2021; 46:149-159. [PMID: 33944639 DOI: 10.1080/07435800.2021.1920608] [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] [Indexed: 10/21/2022]
Abstract
Background: Sexual dimorphism in specific biochemical pathways and immune response, underlies the heterogeneity of type 1 diabetes mellitus (T1DM) and affects the outcome of immunotherapy. Arginase and nitric oxide (NO) synthase (NOS) metabolize L-arginine and play opposite roles in the immune response and autoimmune processes.Objective: We hypothesized that the above mentioned enzymes can be involved in sex and age differences in T1DM and its treatment. Based on this, the enzymes have been studied in peripheral blood leukocytes (PBL) and plasma of young people with T1DM.Methods: Patients were recruited from Muratsan University Hospital (Yerevan, Armenia) and were divided into groups: girls and boys by age, from children to adolescents and adolescents/young adults with recent-onset T1DM (RO-T1DM) (0.1-1 years) and long-term T1DM (LT-T1DM) (1.6-9.9 years). Arginase activity was assessed by L-arginine-dependent production of L-ornithine, and the NOS activity was assessed by NO/nitrite production. Glycemic control was assessed using hemoglobin A1c test. Plasma HbA1c concentration below 7.5% (median (range) 6.7 [6.2-7.5]) was taken as good glycemic control (+) and above 7.5% (median (range) 10.5 [7.6-13]) as poor glycemic control (-). Healthy volunteers with corresponding sex and age were used as the control group.Results: All the patients with RO-T1DM, with poor glycemic control, had increased arginase activity in the cytoplasm (cARG) and mitochondria (mARG) in PBL. In girls with RO-T1DM, with good glycemic control, the subcellular arginase activity decreased, and normalized in LT-T1DM, regardless of age. In contrast, boys from both age groups showed high arginase activity, regardless of glycemic control and duration of T1DM along with insulin therapy. At the same time, a significant decrease in the subcellular production of bioavailable NO was observed in children/preadolescents, regardless of glycemic control and duration of diabetes. In adolescents/young adult boys with RO-T1DM, with (-), the subcellular production of NO decreased significantly, and with LT-T1DM, the decrease was attenuated, but even with (+) remained lower than in healthy people. In contrast, in the group of same age girls with RO-T1DM, NO production increased above normal in both cellular compartments, while with LT-T1DM it normalized in the cytoplasm. In adolescents/young adults with LT-T1DM, NO production in PBL mitochondria decreased by almost a half, regardless of glycemic control and gender. Changes in the metabolic pathways of L-arginine in plasma differed and were less substantial than in the PBL cellular compartments in T1DM.Conclusions: Glycemic status and duration of T1DM along with insulin therapy affect the activity of arginase and NOS-dependent production of bioavailable NO in the cytoplasm and mitochondria in PBL of young patients with T1DM, depending on sex and age. Arginase and NOS can directly affect the processes occurring in the pancreas and the outcome of therapy through infiltrated leukocytes. Obtained data can be useful for understanding the heterogeneity of T1DM and using it to develop available criteria for assessing the severity and treatment of autoimmune diabetes.
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Affiliation(s)
- Nina Alchujyan
- Department of Pathological Biochemistry, Institute of Biochemistryafter H. Buniatyan, NAS RA, Yerevan, Armenia
| | - Margarita Hovhannisyan
- Department of Pathological Biochemistry, Institute of Biochemistryafter H. Buniatyan, NAS RA, Yerevan, Armenia
| | - Nina Movsesyan
- Department of Pathological Biochemistry, Institute of Biochemistryafter H. Buniatyan, NAS RA, Yerevan, Armenia
| | - Arthur Melkonyan
- Department of Endocrinology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Vanuhi Shaboyan
- Department of Endocrinology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Yelena Aghajanova
- Department of Endocrinology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Grigory Minasyan
- Department of Organic Chemistry, Scientific Technological Center of Organic and Pharmaceutical Chemistry, NAS RA, Yerevan, Armenia
| | - Guevork Kevorkian
- Department of Pathological Biochemistry, Institute of Biochemistryafter H. Buniatyan, NAS RA, Yerevan, Armenia
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23
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Wang Y, Zou X, Cai X, Liu W, Chen L, Zhang R, Zhou L, Gong S, Gao Y, Li S, Luo Y, Han X, Ji L. Urinary C-peptide/creatinine ratio: A useful biomarker of insulin resistance and refined classification of type 2 diabetes mellitus. J Diabetes 2021; 13:893-904. [PMID: 34051046 DOI: 10.1111/1753-0407.13203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The urinary C-peptide/creatinine ratio (UCPCR) is low in patients with type 1 diabetes mellitus, but it has not been well characterized in patients with type 2 diabetes mellitus (T2DM). We aimed to measure the UCPCRs in patients with T2DM and explore the relationships among UCPCR, insulin resistance (IR), and chronic vascular complications of diabetes. METHODS A cross-sectional study was performed of 1299 Chinese hospitalized patients with T2DM. Binary logistic regression was used to evaluate the relationships between the chronic vascular complications of diabetes and UCPCR. K-means analysis was used to allocate participants to subgroups with five to six variables (age at diagnosis, body mass index [BMI], glycosylated hemoglobin, homoeostasis model assessment 2-estimated beta-cell function (HOMA2-B), and HOMA2-insulin resistance (HOMA2-IR), with or without UCPCR). RESULTS UCPCR positively correlated with HOMA2-IR (r = 0.448, P < .001). After adjustment for sex, age, duration of diabetes, and other cardiovascular risk factors, UCPCR was positively associated with diabetic kidney disease (DKD) (odds ratio [OR] = 1.198, 95% CI 1.019-1.408, P = .029) and coronary heart disease (CHD) (OR = 1.312, 95% CI 1.079-1.594, P = .006). When UCPCR was added, cluster analysis using the six variables identified five subgroups of T2DM, characterized by differing age at diagnosis, BMI, beta-cell function, IR, and prevalence of vascular complications. CONCLUSIONS UCPCR is positively associated with IR, DKD, and CHD and represents a promising biomarker that could refine the classification of T2DM.
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Affiliation(s)
- Yanai Wang
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Xiantong Zou
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Xiaoling Cai
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Wei Liu
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Ling Chen
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Rui Zhang
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Lingli Zhou
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Siqian Gong
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Ying Gao
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Simin Li
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Yingying Luo
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Xueyao Han
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Linong Ji
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
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Behavior Characteristics and Risk for Metabolic Syndrome Among Women in Rural Communities in China. J Cardiovasc Nurs 2021; 37:490-498. [PMID: 34321435 DOI: 10.1097/jcn.0000000000000836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rapid economic growth and lifestyle changes in China have resulted in increased metabolic syndrome (MetS) rates. Few investigators have examined sex-specific risk factors and the role of menopause, stress, and sleep on MetS among women in China. OBJECTIVE In this study, we aimed to identify the risk factors for MetS among women in rural China. METHODS A cross-sectional study design was used, and participants were recruited from rural areas in China. Female participants older than 18 years were eligible to participate. Participants had their weight, height, waist circumference, blood pressure, and fasting blood measured at study sites. They also completed validated questionnaires regarding sociodemographic information and MetS-related health behaviors. RESULTS A total of 646 women were included in this study. The overall prevalence of MetS was 26.2%. The MetS group had a greater number of overweight/obese women than the non-MetS group did. For premenopausal women, a higher income, being overweight/obese, and eating salty/marinated food increased their risk for MetS (odds ratio [OR], 2.56, 4.55, and 3.1, respectively). For postmenopausal women, a low level of education (OR, 0.44) and being overweight/obese (OR, 4.98) increased their risk of MetS. CONCLUSION Almost half of the women in this study were overweight/obese, and many of them did not meet the national recommendations for a healthy lifestyle, increasing their risk for MetS. Developing cultural and behavioral interventions tailored for overweight/obese women is critical in reducing MetS.
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25
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Chai WF, Tang KS. Protective potential of cerium oxide nanoparticles in diabetes mellitus. J Trace Elem Med Biol 2021; 66:126742. [PMID: 33773280 DOI: 10.1016/j.jtemb.2021.126742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a non-communicable metabolic disease which is closely related to excessive oxidative stress after constant exposure to high plasma glucose. Although the current antidiabetic medications are effective in lowering blood glucose, these medications do not prevent or reverse the disease progression. Thus, there is a crucial need to explore new therapeutic interventions that could address this shortcoming. As cerium oxide nanoparticles (CONPs) possess antioxidant property, this agent may be used as a treatment option for the management of DM. PURPOSE This review aims to provide a critical evaluation of the pharmacological and antidiabetic effects of CONPs in cell and animal models. The roles of CONPs in attenuating DM complications are also presented in this report. METHODS We conducted a literature search in the PubMed database using the keywords "cerium oxide", "cerous oxide", "ceria", "nanoceria", and "diabetes" from inception to December 2020. The inclusion criteria were primary source articles that investigated the role of CONPs in DM and diabetic complications. RESULTS We identified 47 articles from the initial search. After the thorough screening, only 31 articles were included in this study. We found that CONPs can attenuate parameters that are related to DM and diabetic complications in various animals and cell culture models. CONCLUSION CONPs could potentially be used in the treatment of those with DM and complications caused by the disease.
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Affiliation(s)
- Wui Fang Chai
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kim San Tang
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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26
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Helliwell R, Warnes H, Kietsiriroje N, Campbell M, Birch R, Pearson SM, Ajjan RA. Body mass index, estimated glucose disposal rate and vascular complications in type 1 diabetes: Beyond glycated haemoglobin. Diabet Med 2021; 38:e14529. [PMID: 33502032 DOI: 10.1111/dme.14529] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 12/16/2022]
Abstract
AIMS To understand the relationship between insulin resistance (IR), assessed as estimated glucose disposal rate (eGDR), and microvascular/macrovascular complications in people with type 1 diabetes. MATERIALS AND METHODS Individuals with a confirmed diagnosis of type 1 diabetes were included in this cross-sectional study. BMI was categorised into normal weight (18.0-24.9 kg m-2 ), overweight (25.0-29.9 kg m-2 ) and obese groups (≥30.0 kg m-2 ). We categorised eGDR into four groups: eGDR >8, 6-7.9, 4-5.9 and <4 mg kg-1 min-1 . Multiple logistic regression was used to identify associations with vascular complications, after adjusting for relevant confounders. RESULTS A total of 2151 individuals with type 1 diabetes were studied. Median [interquartile range (IQR)] age was 41.0 [29.0, 55.0] with diabetes duration of 20.0 [11, 31] years. Odds ratio (OR) for retinopathy and nephropathy in obese compared with normal weight individuals was 1.64 (95% CI: 1.24-2.19; p = 0.001) and 1.62 (95% CI: 1.10-2.39; p = 0.015), while the association with cardiovascular disease just failed to reach statistical significance (OR 1.66 [95% CI: 0.97-2.86; p = 0.066]). Comparing individuals with eGDR ≥8 mg kg-1 min-1 and <4 mg kg-1 min-1 showed OR for retinopathy, nephropathy and macrovascular disease of 4.84 (95% CI: 3.36-6.97; p < 0.001), 8.35 (95% CI: 4.86-14.34; p < 0.001) and 13.22 (95% CI: 3.10-56.38; p < 0.001), respectively. Individuals with the highest eGDR category (≥8 mg kg-1 min-1 ) had the lowest complication rates irrespective of HbA1c levels. CONCLUSIONS Obesity is prevalent in type 1 diabetes and diabetes complications are not only related to glucose control. IR, assessed as eGDR, is strongly associated with both microvascular and macrovascular complications, regardless of HbA1c levels.
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Affiliation(s)
| | | | - Noppadol Kietsiriroje
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Endocrinology and Metabolism Unit, Internal Medicine Department, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Matthew Campbell
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Rebecca Birch
- Division of Pathology and Data analytics, University of Leeds, Leeds, UK
| | - Sam M Pearson
- School of Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 2972] [Impact Index Per Article: 990.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Pemafibrate suppresses oxidative stress and apoptosis under cardiomyocyte ischemia-reperfusion injury in type 1 diabetes mellitus. Exp Ther Med 2021; 21:331. [PMID: 33732304 PMCID: PMC7903427 DOI: 10.3892/etm.2021.9762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022] Open
Abstract
Diabetes mellitus accelerates the hyperglycemia susceptibility-induced injury to cardiac cells. The activation of peroxisome proliferator-activated receptor α (PPARα) decreases ischemia-reperfusion (IR) injury in animals without diabetes. Therefore, the present study hypothesized that pemafibrate may exert a protective effect on the myocardium in vivo and in vitro. A type 1 diabetes mellitus (T1DM) rat model and H9c2 cells exposed to high glucose under hypoxia and reoxygenation treatments were used in the present study. The rat model and the cells were subsequently treated with pemafibrate. In the T1DM rat model, pemafibrate enhanced the expression of PPARα in the diabetic-myocardial ischemia-reperfusion injury (D-IRI) group compared with the D-IRI group. The infarct size in the D-IRI group was reduced following pemafibrate treatment relative to the untreated group. The disruption of the mitochondrial structure and myofibrils in the D-IRI group was partially recovered by pemafibrate. In addition, to evaluate the mechanism of action of pemafibrate in the treatment of diabetic myocardial IR injury, an in vitro model was established. PPARα protein expression levels were reduced in the high glucose and hypoxia/reoxygenation (H/R) groups compared with that in the control or high glucose-treated groups. Pemafibrate treatment significantly enhanced the ATP and superoxide dismutase levels, and reduced the mitochondrial reactive oxygen species and malondialdehyde levels compared with the high glucose combined with H/R group. Furthermore, pemafibrate inhibited the expression of cytochrome c and cleaved-caspase-3, indicating its involvement in the regulation of mitochondrial apoptosis. Pemafibrate also reduced the expression of nuclear factor-κB (NF-κB), the activation of which reversed the protective effects of pemafibrate on diabetic myocardial IR injury in vitro. Taken together, these results suggested that pemafibrate may activate PPARα to protect the T1DM rat myocardium against IR injury through inhibition of NF-κB signaling.
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Volsky SK, Shalitin S, Fridman E, Yackobovitch-Gavan M, Lazar L, Bello R, Oron T, Tenenbaum A, Vries LD, Lebenthal Y. Dyslipidemia and cardiovascular disease risk factors in patients with type 1 diabetes: A single-center experience. World J Diabetes 2021; 12:56-68. [PMID: 33520108 PMCID: PMC7807252 DOI: 10.4239/wjd.v12.i1.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) contributes to altered lipid profiles and increases the risk of cardiovascular disease (CVD). Youth with T1D may have additional CVD risk factors within the first decade of diagnosis.
AIM To examine risk factors for dyslipidemia in young subjects with T1D.
METHODS Longitudinal and cross-sectional retrospective study of 170 young subjects with T1D (86 males; baseline mean age 12.2 ± 5.6 years and hemoglobin A1c 8.4% ± 1.4%) were followed in a single tertiary diabetes center for a median duration of 15 years. Predictors for outcomes of lipid profiles at last visit (total cholesterol [TC], triglycerides [TGs], low-density lipoprotein-cholesterol [LDL-c], and high-density lipoprotein-cholesterol [HDL-c]) were analyzed by stepwise linear regression models.
RESULTS At baseline, 79.5% of the patients had at least one additional CVD risk factor (borderline dyslipidemia/dyslipidemia [37.5%], pre-hypertension/hypertension [27.6%], and overweight/obesity [16.5%]) and 41.6% had multiple (≥ 2) CVD risk factors. A positive family history of at least one CVD risk factor in a first-degree relative was reported in 54.1% of the cohort. Predictors of elevated TC: family history of CVD (β[SE] = 23.1[8.3], P = 0.006); of elevated LDL-c: baseline diastolic blood pressure (DBP) (β[SE] = 11.4[4.7], P = 0.003) and family history of CVD (β[SE] = 20.7[6.8], P = 0.017); of elevated TGs: baseline DBP (β[SE] = 23.8[9.1], P = 0.010) and family history of CVD (β[SE] = 31.0[13.1], P = 0.020); and of low HDL-c levels: baseline DBP (β[SE] = 4.8[2.1], P = 0.022]).
CONCLUSION Our findings suggest that elevated lipid profiles are associated with DBP and a positive family history of CVD. It is of utmost importance to prevent and control modifiable risk factors such as these, as early as childhood, given that inadequate glycemic control and elevation in blood pressure intensify the risk of dyslipidemia.
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Affiliation(s)
- Sari Krepel Volsky
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
| | - Shlomit Shalitin
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Elena Fridman
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
| | - Michal Yackobovitch-Gavan
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
| | - Liora Lazar
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Rachel Bello
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
| | - Tal Oron
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
| | - Ariel Tenenbaum
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Liat de Vries
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yael Lebenthal
- National Center for Childhood Diabetes, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach-Tikva 4920235, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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30
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Mertens J, Van Gaal LF, Francque SM, De Block C. NAFLD in type 1 diabetes: overrated or underappreciated? Ther Adv Endocrinol Metab 2021; 12:20420188211055557. [PMID: 34840719 PMCID: PMC8613893 DOI: 10.1177/20420188211055557] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in western countries, affecting 25-30% of the general population and up to 65% in those with obesity and/or type 2 diabetes. Accumulation of visceral adipose tissue and insulin resistance (IR) contributes to NAFLD. NAFLD is not an innocent entity as it not only may cause nonalcoholic steatohepatitis and cirrhosis but also contribute to cardiovascular morbidity and mortality. More and more people with type 1 diabetes (T1D) are becoming overweight and present with features of IR, but the prevalence and impact of NAFLD in this population are still unclear. The utility of noninvasive screening tools for NAFLD in T1D is being explored. Recent data indicate that based upon ultrasonographic criteria NAFLD is present in 27% (ranging between 19% and 31%) of adults with T1D. Magnetic resonance imaging data indicate a prevalence rate of 8.6% (ranging between 2.1% and 18.6%). There are, however, multiple factors affecting these data, ranging from study design and referral bias to discrepancies in between diagnostic modalities. Individuals with T1D have a 7-fold higher risk of cardiovascular disease (CVD) and cardiovascular mortality is the most prominent cause of death in T1D. Patients with T1D and NALFD are also more prone to develop CVD, but the independent contribution of NAFLD to cardiovascular events has to be determined in this population. Furthermore, limited data in T1D also point towards a 2 to 3 times higher risk for microvascular complications in those with NAFLD. In this article, we will discuss epidemiological and diagnostic challenges of NAFLD in T1D, explore the link between IR and NAFLD and chronic complications, and examine the independent contribution of NAFLD to the presence of macro-, and microvascular complications.
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Affiliation(s)
- Jonathan Mertens
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology & Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Luc F. Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sven M. Francque
- Department of Gastroenterology & Hepatology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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31
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Amor AJ, Castelblanco E, Hernández M, Gimenez M, Granado-Casas M, Blanco J, Soldevila B, Esmatjes E, Conget I, Alonso N, Ortega E, Mauricio D. Advanced lipoprotein profile disturbances in type 1 diabetes mellitus: a focus on LDL particles. Cardiovasc Diabetol 2020; 19:126. [PMID: 32772924 PMCID: PMC7416413 DOI: 10.1186/s12933-020-01099-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background Lipoprotein disturbances have been associated with increased cardiovascular disease (CVD) risk in type 1 diabetes mellitus (T1DM). We assessed the advanced lipoprotein profile in T1DM individuals, and analysed differences with non-diabetic counterparts. Methods This cross-sectional study involved 508 adults with T1DM and 347 controls, recruited from institutions in a Mediterranean region of Spain. Conventional and advanced (assessed by nuclear magnetic resonance [NMR] spectroscopy) lipoprotein profiles were analysed. Crude and adjusted (by age, sex, statin use, body mass index and leukocyte count) comparisons were performed. Results The median (interquartile range) age of the study participants was 45 (38–53) years, 48.2% were men. In the T1DM group, the median diabetes duration was 23 (16–31) years, and 8.1% and 40.2% of individuals had nephropathy and retinopathy, respectively. The proportion of participants with hypertension (29.5 vs. 9.2%), and statin use (45.7% vs. 8.1%) was higher in the T1DM vs. controls (p < 0.001). The T1DM group had a better conventional (all parameters, p < 0.001) and NMR-lipid profile than the control group. Thus, T1DM individuals showed lower concentrations of atherogenic lipoproteins (VLDL-particles and LDL-particles) and higher concentrations of anti-atherogenic lipoproteins (HDL-particles) vs. controls, even after adjusting for several confounders (p < 0.001 for all). While non-diabetic women had a more favourable lipid profile than non-diabetic men, women with T1DM had a similar concentration of LDL-particles compared to men with T1DM (1231 [1125–1383] vs. 1257 [1128–1383] nmol/L, p = 0.849), and a similar concentration of small-LDL-particles to non-diabetic women (672.8 [614.2–733.9] vs. 671.2 [593.5–761.4] nmol/L, respectively; p = 0.790). Finally, T1DM individuals showed higher discrepancies between NMR-LDL-particles and conventional LDL-cholesterol than non-diabetic subjects (prevalence of LDL-cholesterol < 100 mg/dL & LDL-particles > 1000 nmol/L: 38 vs. 21.2%; p < 0.001). All these differences were largely unchanged in participants without lipid-lowering drugs (T1DM, n = 275; controls, n = 317). Conclusions Overall, T1DM participants showed a more favourable conventional and NMR-lipid profile than controls. However, the NMR-assessment identified several lipoprotein derangements in LDL-particles among the T1DM population (higher discrepancies in NMR-LDL-particles vs. conventional LDL-cholesterol; a worse profile in T1DM women) that were overlooked in the conventional analysis. Further studies are needed to elucidate their role in the development of CVD in this population.
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Affiliation(s)
- Antonio J Amor
- Department of Endocrinology & Nutrition, Diabetes Unit, Hospital Clínic de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.,Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Esmeralda Castelblanco
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Sant Quintí, 89, 08041, Barcelona, Spain.,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.,DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08006, Barcelona, Spain
| | - Marta Hernández
- Department of Endocrinology & Nutrition, Hospital Arnau de Vilanova & Institut d'Investigació Biomédica de Lleida (IRB Lleida), Lleida, Spain
| | - Marga Gimenez
- Department of Endocrinology & Nutrition, Diabetes Unit, Hospital Clínic de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.,Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain.,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Minerva Granado-Casas
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Sant Quintí, 89, 08041, Barcelona, Spain.,DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08006, Barcelona, Spain.,Biomedical Research Institute of Lleida & University of Lleida, Lleida, Spain
| | - Jesús Blanco
- Department of Endocrinology & Nutrition, Diabetes Unit, Hospital Clínic de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.,Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Berta Soldevila
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.,Department of Endocrinology & Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Enric Esmatjes
- Department of Endocrinology & Nutrition, Diabetes Unit, Hospital Clínic de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.,Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain.,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Ignacio Conget
- Department of Endocrinology & Nutrition, Diabetes Unit, Hospital Clínic de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.,Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain.,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Nuria Alonso
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.,Department of Endocrinology & Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Emilio Ortega
- Department of Endocrinology & Nutrition, Diabetes Unit, Hospital Clínic de Barcelona, Villarroel, 170, 08036, Barcelona, Spain. .,Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain. .,Center for Biomedical Research on Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Sant Quintí, 89, 08041, Barcelona, Spain. .,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain. .,Biomedical Research Institute of Lleida & University of Lleida, Lleida, Spain.
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Ferreira-Hermosillo A, Ibarra-Salce R, Rodríguez-Malacara J, Molina-Ayala MA. Comparison of indirect markers of insulin resistance in adult patients with Double Diabetes. BMC Endocr Disord 2020; 20:87. [PMID: 32539854 PMCID: PMC7296956 DOI: 10.1186/s12902-020-00570-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The presence of insulin resistance (IR) and metabolic syndrome (MS) in patients with type 1 diabetes (T1D) has been called "double diabetes". This entity increases the risk for development of micro and macrovascular complications and cardiovascular mortality. The gold standard for IR quantification is the hyperinsulinemic euglycemic clamp (HEC) but it is invasive, time-consuming and not available in the majority of the clinical settings. Because of this, some formulas for IR quantification have been proposed. We aimed to compare the utility of those methods for MS detection in patients with T1D. METHODS We conducted a cross-sectional study in 112 patients with T1D and determined the presence of MS using the Joint Statement Criteria. We calculated the estimated glucose disposal rate (eGDR), estimated insulin sensitivity index (eIS), natural logarithm of glucose disposal rate (lnGDR), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), visceral adipose index (VAI) and waist-to-height ratio (WHtR), and compared among patients with and without MS using Student t-test or Mann-Whitney U test. Receiver Operating Characteristics curves for the different indexes were used to identify the best cut-off points for MS detection. RESULTS Thirty three percent of the patients were considered to have MS. The patients with MS had lower eGDR (5.49 [4.37-6.80] vs. 8.93 [8.03-9.94] mg/kg/min), eIS (2.89 [1.54-3.54] vs. 3.51 [2.68-4.68]) and lnGDR (1.69 ± 0.27 vs. 1.95 ± 0.21 mg/kg/min), and higher WHtR (0.55 ± 0.05 vs. 0.50 ± 0.05), VAI (3.4 [1.92-5.70] vs. 1.39 [0.97-1.92]) and TG/HDL-c (3.78 [2.63-5.73] vs. 1.77 [1.18-2.75]) in comparison with patients without MS. The cut-off points of TG-HDL-c > 2.0, eGDR < 7.32 mg/kg/min, lnGDR < 1.8 mg/kg/min, VAI > 1.84, WHtR > 0.52 and eIS < 2.92 had a sensitivity of 86, 85, 82, 77 and 70% respectively, for MS detection. The TG/HDL-c, lnGDR and eIS sensitivity changed depending on sex meanwhile eGDR, WHtR and VAI did not need adjust by sex. CONCLUSION Our data show that an eGDR < 7.32 mg/kg/min have the highest sensitivity and specificity to detect the presence of MS in patients with T1D.
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Affiliation(s)
- Aldo Ferreira-Hermosillo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtémoc No. 330, Colonia Doctores, Mexico City, Mexico
| | - Raúl Ibarra-Salce
- Servicio de Endocrinología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtémoc No. 330, Colonia Doctores, Mexico City, Mexico
| | - Joshua Rodríguez-Malacara
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtémoc No. 330, Colonia Doctores, Mexico City, Mexico
| | - Mario Antonio Molina-Ayala
- Servicio de Endocrinología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtémoc No. 330, Colonia Doctores, Mexico City, Mexico
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