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Psoma O, Makris M, Tselepis A, Tsimihodimos V. Short-term Glycemic Variability and Its Association With Macrovascular and Microvascular Complications in Patients With Diabetes. J Diabetes Sci Technol 2024; 18:956-967. [PMID: 36576014 PMCID: PMC11307209 DOI: 10.1177/19322968221146808] [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: 12/29/2022]
Abstract
The introduction of continuous glucose monitoring inaugurated a new era in clinical practice by shifting the characterization of glycemic control from HbA1c to novel metrics. The one that gained widespread attention over the past decades was glycemic variability (GV), which typically refers to peaks and nadirs of blood glucose measured over a given time interval. GV can be dichotomized into two main categories: short-term and long-term. Short-term GV reflects within-day and between-day glycemic oscillations, and its contribution to diabetic complications remains an enigma. In this review, we summarize the available data about short-term GV and its possible association with both microvascular and macrovascular complications, evaluating different pathogenic mechanisms and demonstrating nonpharmaceutical, as well as pharmaceutical, therapeutic interventions.
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Affiliation(s)
- Ourania Psoma
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Marios Makris
- UCL Medical School, University College London, London, UK
| | - Alexandros Tselepis
- Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
| | - Vasilis Tsimihodimos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Vergès B. Cardiovascular disease in type 1 diabetes, an underestimated danger: Epidemiological and pathophysiological data. Atherosclerosis 2024; 394:117158. [PMID: 37369617 DOI: 10.1016/j.atherosclerosis.2023.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Cardiovascular disease (CV) is a common complication of type 1 diabetes (T1D) and a leading cause of death. T1D patients are more likely to develop CV disease (CVD) early in life and show a reduction of life expectancy of at least 11 years. Patients with a young age of T1D onset have a substantially higher CV risk. The reasons for increased atherosclerosis in T1D patients are not entirely explained. In addition to the typical CV risk factors, long-term hyperglycemia has a significant impact by inducing oxidative stress, vascular inflammation, monocyte adhesion, arterial wall thickening and endothelial dysfunction. Additionally, CVD in T1D is also associated with nephropathy. However, CVD risk is still significantly increased in T1D patients, in good glycemic control without additional CV risk factors, indicating the involvement of supplementary potential factors. By increasing oxidative stress, vascular inflammation, and endothelial dysfunction, hypoglycemia and glucose variability may exacerbate CVD. Moreover, significant qualitative and functional abnormalities of lipoproteins are present in even well-controlled T1D patients and are likely to play a role in the development of atherosclerosis and the promotion of CVD. According to recent research, immune system dysfunction, which is typical of auto-immune T1D, may also promote CVD, likely via inflammatory pathways. In addition, T1D patients who are overweight or obese exhibit an additional CV risk due to pathophysiological mechanisms that are similar to those seen in T2D.
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Affiliation(s)
- Bruno Vergès
- Endocrinology-Diabetology Department, University-Hospital of Dijon, Dijon, France; INSERM LNC-UMR1231, Medicine University, 21000 Dijon, France; Service Endocrinologie, Diabétologie et Maladies Métaboliques, CHU-Dijon, 14 rue Gaffarel, F-21000 Dijon, France.
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Ma L, Liu J, Deng M, Zhou L, Zhang Q, Xiao X. Metabolomics analysis of serum and urine in type 1 diabetes patients with different time in range derived from continuous glucose monitoring. Diabetol Metab Syndr 2024; 16:21. [PMID: 38238828 PMCID: PMC10797982 DOI: 10.1186/s13098-024-01257-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Time in range (TIR), as an important glycemic variability (GV) index, is clearly associated with disease complications in type 1 diabetes (T1D). Metabolic dysregulation is also involved in the risks of T1D complications. However, the relationship between metabolites and TIR remains poorly understood. We used metabolomics to investigate metabolic profile changes in T1D patients with different TIR. METHODS This study included 85 T1D patients and 81 healthy controls. GV indices, including TIR, were collected from continuous glucose monitoring system. The patients were compared within two subgroups: TIR-L (TIR < 50%, n = 21) and TIR-H (TIR > 70%, n = 14). To screen for differentially abundant metabolites and metabolic pathways, serum and urine samples were obtained for untargeted metabolomics by ultra-performance liquid chromatography‒mass spectrometry. Correlation analysis was conducted with GV metrics and screened biomarkers. RESULTS Metabolites were significantly altered in T1D and subgroups. Compared with healthy controls, T1D patients had higher serum levels of 5-hydroxy-L-tryptophan, 5-methoxyindoleacetate, 4-(2-aminophenyl)-2,4-dioxobutanoate, and 4-pyridoxic acid and higher urine levels of thromboxane B3 but lower urine levels of hypoxanthine. Compared with TIR-H group, The TIR-L subgroup had lower serum levels of 5-hydroxy-L-tryptophan and mevalonolactone and lower urine levels of thromboxane B3 and phenylbutyrylglutamine. Dysregulation of pathways, such as tryptophan, vitamin B6 and purine metabolism, may be involved in the mechanism of diabetic complications related to glycemic homeostasis. Mevalonolactone, hypoxanthine and phenylbutyrylglutamine showed close correlation with TIR. CONCLUSIONS We identified altered metabolic profiles in T1D individuals with different TIR. These findings provide new insights and merit further exploration of the underlying molecular pathways relating to diabetic complications.
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Affiliation(s)
- Liyuan Ma
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jieying Liu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Mingqun Deng
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Liyuan Zhou
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qian Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xinhua Xiao
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Benson M, Hossain J, Darmaun D. Improved glycemic control either alone, or combined with antioxidant supplementation, fails to restore blood glutathione or markers of oxidative stress in adolescents with poorly controlled type 1 diabetes. Nutr Res 2023; 117:83-90. [PMID: 37515943 DOI: 10.1016/j.nutres.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 07/31/2023]
Abstract
In earlier studies, we showed that adolescents with type 1 diabetes mellitus (T1DM) have significant glutathione (GSH) depletion and that GSH is reciprocally related to glycemic control. In both the general population and in those with diabetes, the use of over-the-counter antioxidant supplements is widespread. We hypothesized that improved glycemic control, alone or in combination with dietary antioxidants, would restore blood GSH pool. The study included 41 participants who were 15.8 ± 2.4 years of age (mean ± standard deviation) and with poorly controlled T1DM (hemoglobin A1c [HbA1c] 8.2 ± 0.6%). Erythrocyte GSH, and 3-nitrotyrosine, F2-isoprostane, and 8-hydroxy-2'-deoxy-guanosine (as markers of protein, lipid, and DNA oxidative stress, respectively) were determined in the postabsorptive state after blood glucose was maintained overnight near euglycemia. Participants were then randomized to a mix of antioxidants (vitamin C, selenium, zinc, vitamin E, β-carotene) or placebo for 3 to 6 months, and diabetes management was intensified using CSII (n = 30) or multiple daily injections (n = 11) coupled with CDE phone calls and visits with a Nutritionist. A second, identical study was performed when/if a drop in HbA1c ≥0.5% was achieved. HbA1c levels dropped similarly in both groups (from 8.9 ± 1.0% to 7.9 ± 0.9% and 8.5 ± 0.6% to 7.7 ± 0.7% in placebo and antioxidant group, respectively). Neither total nor reduced GSH was altered by improved metabolic control. Markers of protein, lipid, and DNA oxidation remained unaltered. We conclude that, in youngsters with T1DM, neither a significant improvement in diabetes control over a 3-month period nor the regimen of dietary antioxidant supplied in the current study can mitigate oxidative stress. These findings suggest that, in adolescents with T1DM, (1) more sustained improvement of diabetes control may be needed to alleviate oxidative stress and (2) the putative benefit of antioxidant supplements remains to be proven.
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Affiliation(s)
- Matthew Benson
- Division of Endocrinology & Metabolism, Nemours Children's Health, Jacksonville, FL, 32207
| | | | - Dominique Darmaun
- Division of Endocrinology & Metabolism, Nemours Children's Health, Jacksonville, FL, 32207; UMR 1280, INRAE and Nantes University, CRNH, Nantes, France.
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Tynjälä A, Harjutsalo V, Jansson Sigfrids F, Groop PH, Gordin D. Higher HbA 1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes. Cardiovasc Diabetol 2023; 22:47. [PMID: 36871019 PMCID: PMC9985852 DOI: 10.1186/s12933-023-01770-2] [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: 12/05/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Both long-term glycaemic variability and arterial stiffness have been recognized as cardiovascular risk factors. This study aims to investigate whether an association between these phenomena exists in individuals with type 1 diabetes. METHODS This cross-sectional study included 673 adults (305 men, 368 women) with type 1 diabetes and combined available retrospective laboratory data on HbA1c from the preceding 10 years with outcome data on arterial stiffness and clinical variables from a comprehensive study visit. HbA1c variability was calculated as adjusted standard deviation (adj-HbA1c-SD), coefficient of variation (HbA1c-CV) and average real variability (HbA1c-ARV). As measures of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV; n = 335) and augmentation index (AIx; n = 653) were assessed using applanation tonometry. RESULTS The study population had a mean age of 47.1 (± 12.0) years and a median duration of diabetes of 31.2 (21.2-41.3) years. The median number of HbA1c assessments per individual was 17 (12-26). All three indices of HbA1c variability were significantly correlated with both cfPWV and AIx after adjustment for sex and age (p < 0.001). In separate multivariable linear regression models, adj-HbA1c-SD and HbA1c-CV were significantly associated with cfPWV (p = 0.032 and p = 0.046, respectively) and AIx (p = 0.028 and p = 0.049, respectively), even after adjustment for HbA1c-mean. HbA1c-ARV was not associated with cfPWV or AIx in the fully adjusted models. CONCLUSIONS An association independent of HbA1c-mean was found between HbA1c variability and arterial stiffness, suggesting a need to consider multiple HbA1c metrics in studies assessing cardiovascular risk in type 1 diabetes. Longitudinal and interventional studies are needed to confirm any causal relationship and to find strategies for reducing long-term glycaemic variability.
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Affiliation(s)
- Anniina Tynjälä
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Fanny Jansson Sigfrids
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. .,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. .,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.
| | - Daniel Gordin
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Minerva Foundation Institute for Medical Research, Helsinki, Finland.,Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Tan JK, Lim GH, Mohamed Salim NN, Chia SY, Thumboo J, Bee YM. Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study. Clin Epidemiol 2023; 15:137-149. [PMID: 36721457 PMCID: PMC9884453 DOI: 10.2147/clep.s391749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Background We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes. Methods We performed a retrospective cohort study using patients present in the Singapore Health Services diabetes registry (SDR) during 2013 to 2014. We assessed mean HbA1c using three models: a baseline mean HbA1c for 2013-14, the mean across the whole follow-up period, and a time-varying yearly updated mean. We assessed HbA1c variability at baseline using the patient's HbA1c variability score (HVS) for 2013-14. The association between mean HbA1c, HVS, and 6 outcomes were assessed using Cox proportional hazard models. Results We included 43,837-53,934 individuals in the analysis; 99.3% had type 2 diabetes mellitus. The data showed a J-shaped distribution in adjusted hazard ratios (HRs) for all-cause mortality, ischemic heart disease, acute myocardial infarction, peripheral arterial disease, and ischemic stroke, with an increased risk of developing these outcomes at HbA1c <6% (42 mmol/mol) and ≥8% (64 mmol/mol). With the addition of HVS, the J-shaped distribution was maintained for the above outcomes, but HRs were greater at HbA1c <6.0% (42 mmol/mol) and reduced at HbA1c ≥8.0% (64 mmol/mol) when compared to models without HVS. The risk for all outcomes increased substantially with increasing glycaemic variability. Conclusion Both low (<6.0% [42 mmol/mol]) and high (≥8.0% [64 mmol/mol]) levels of glycaemic control are associated with increased all-cause mortality and diabetes-related macrovascular complications. Glycaemic variability is independently associated with increased risk for these outcomes. Therefore, patients with stable glycaemic level of 6-8% (42-64mmol/mol) are at lowest risk of all-cause mortality and diabetes-related macrovascular complications.
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Affiliation(s)
- Joshua Kuan Tan
- Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore
| | - Gek Hsiang Lim
- Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore
| | | | - Sing Yi Chia
- Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore,Correspondence: Yong Mong Bee, Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore, Tel +65 6321 3753, Email
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Lin YH, Lin CH, Huang YY, Chen HY, Tai AS, Fu SC, Hsieh SH, Sun JH, Chen ST, Lin SH. Regimen comprising GLP-1 receptor agonist and basal insulin can decrease the effect of food on glycemic variability compared to a pre-mixed insulin regimen. Eur J Med Res 2022; 27:273. [PMID: 36463197 PMCID: PMC9719195 DOI: 10.1186/s40001-022-00892-9] [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: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that glucagon-like peptide 1 (GLP-1) receptor agonists (RA) can stabilize glycemic variability (GV) and interfere with eating behavior. This study compared the impact of insulin, GLP-1 RA, and dietary components on GV using professional continuous glucose monitoring (CGM). METHODS Patients with type 2 diabetes underwent CGM before and after switching from a twice-daily pre-mixed insulin treatment regimen to a GLP-1 RA (liraglutide) plus basal insulin regimen. The dietary components were recorded and analyzed by a certified dietitian. The interactions between the medical regimen, GV indices, and nutrient components were analyzed. RESULTS Sixteen patients with type 2 diabetes were enrolled in this study. No significant differences in the diet components and total calorie intake between the two regimens were found. Under the pre-mixed insulin regimen, for increase in carbohydrate intake ratio, mean amplitude of glucose excursion (MAGE) and standard deviation (SD) increased; in contrast, under the new regimen, for increase in fat intake ratio, MAGE and SD decreased, while when the protein intake ratio increased, the coefficient of variation (CV) decreased. The impact of the food intake ratio on GV indices disappeared under the GLP-1 RA regimen. After switching to the GLP-1 RA regimen, the median MAGE, SD, and CV values decreased significantly. However, the significant difference in GV between the two regimens decreased during the daytime. CONCLUSION A GLP-1 RA plus basal insulin regimen can stabilize GV better than a regimen of twice-daily pre-mixed insulin, especially in the daytime, and can diminish the effect of food components on GV.
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Affiliation(s)
- Yi-Hsuan Lin
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Chia-Hung Lin
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yao Huang
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Hsin-Yun Chen
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - An-Shun Tai
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
| | - Shih-Chen Fu
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
| | - Sheng-Hwu Hsieh
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Jui-Hung Sun
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Szu-Tah Chen
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Sheng-Hsuan Lin
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
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Kim HJ, Jeong IK, Hur KY, Kim SK, Noh JH, Chun SW, Kang ES, Rhee EJ, Choi SH. Comparison of Efficacy of Glimepiride, Alogliptin, and Alogliptin-Pioglitazone as the Initial Periods of Therapy in Patients with Poorly Controlled Type 2 Diabetes Mellitus: An Open-Label, Multicenter, Randomized, Controlled Study. Diabetes Metab J 2022; 46:689-700. [PMID: 35295073 PMCID: PMC9532178 DOI: 10.4093/dmj.2021.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The choice of an optimal oral hypoglycemic agent in the initial treatment periods for type 2 diabetes mellitus (T2DM) patients remains difficult and deliberate. We compared the efficacy and safety of glimepiride (GLIM), alogliptin (ALO), and alogliptin-pioglitazone (ALO-PIO) in poorly controlled T2DM patients with drug-naïve or metformin failure. METHODS In this three-arm, multicenter, open-label, randomized, controlled trial, poorly controlled T2DM patients were randomized to receive GLIM (n=35), ALO (n=31), or ALO-PIO (n=33) therapy for 24 weeks. The primary endpoint was change in the mean glycosylated hemoglobin (HbA1c) levels at week 24 from baseline. Secondary endpoints were changes in HbA1c level at week 12 from baseline, fasting plasma glucose (FPG) levels, lipid profiles at weeks 12 and 24, and parameters of glycemic variability, assessed by continuous glucose monitoring for 24 weeks. RESULTS At weeks 12 and 24, the ALO-PIO group showed significant reduction in HbA1c levels compared to the ALO group (-0.96%±0.17% vs. -0.37%±0.17% at week 12; -1.13%±0.19% vs. -0.18%±0.2% at week 24). The ALO-PIO therapy caused greater reduction in FPG levels and significant increase in high-density lipoprotein cholesterol levels at weeks 12 and 24 than the ALO therapy. Compared to low-dose GLIM therapy, ALO-PIO therapy showed greater improvement in glycemic variability. The adverse events were similar among the three arms. CONCLUSION ALO-PIO combination therapy during the early period exerts better glycemic control than ALO monotherapy and excellency in glycemic variability than low-dose sulfonylurea therapy in uncontrolled, drug-naïve or metformin failed T2DM patients.
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Affiliation(s)
- Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - In Kyung Jeong
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyu Yeon Hur
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Kyung Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Sung Wan Chun
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Corresponding author: Sung Hee Choi https://orcid.org/0000-0003-0740-8116 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea
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Valente T, Valente F, Lucchesi MBB, Punaro GR, Mouro MG, Gabbay MAL, Higa EMS, Dib SA. Relationship between short and long-term glycemic variability and oxidative stress in type 1 diabetes mellitus under daily life insulin treatment. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:570-578. [PMID: 33740334 PMCID: PMC10528580 DOI: 10.20945/2359-3997000000338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the heterogeneity of the association between glycemic variability and oxidative stress markers in T1DM patients under daily life insulin treatment. METHODS We studied, in a cross-sectional analysis, 76 T1DM patients without clinical chronic diabetes complications and 22 healthy individuals. Were evaluated the short-term glycemic variability (STGV), long-term glycemic variability (LTGV), oxidative stress markers [8-isoprostaglandin-F2α (Ur-8-iso-PGF2α), nitric oxide (NO), thiobarbituric acid reactive substances (TBARS) and erythrocytes reduced/oxidized glutathione (GSH/GSSG)] and biochemical dosages (glycaemia, HbA1c, lipidogram, albuminuria). RESULTS Plasmatic NO was positively associated with LTGV (last year average of HbA1c) (8.7 ± 1.6% or 71 ± 18 mmol) (rS: 0.278; p: 0.042). Plasmatic TBARS, erythrocytes GSH/GSSH and Ur-8-iso-PGF-2α didn't show correlation with glycemic variability. GSH/GSSG was inversely correlated with LDL-cholesterol (rS: - 0.417; p: 0.047) and triglycerides (rS: -0.521; p: 0.013). Albuminuria was positive correlated with age (rS: 0.340; p: 0.002), plasmatic NO (rS: 0.267; p 0.049) and TBARS (rS: 0.327; p: 0.015). CONCLUSION In daily life insulin treatment, young T1DM patients have higher plasmatic NO than healthy subjects. However, the correlation between glycemic variability and oxidative stress markers is heterogeneous. Lipid profile and albuminuria are associated with different oxidative stress markers. These data collaborate to explain the controversial results in this issue.
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Affiliation(s)
- Tatiana Valente
- Departamento de Medicina, Divisão de Endocrinologia, Centro de Diabetes da Universidade Federal de São Paulo, São Paulo, SP, Brasil,
| | - Fernando Valente
- Departamento de Medicina, Divisão de Endocrinologia, Centro de Diabetes da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Maria Beatriz Bastos Lucchesi
- Departamento de Medicina, Divisão de Endocrinologia, Centro de Diabetes da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Giovana Rita Punaro
- Departamento de Medicina, Divisão de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Margaret Gori Mouro
- Departamento de Medicina, Divisão de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Monica Andrade Lima Gabbay
- Departamento de Medicina, Divisão de Endocrinologia, Centro de Diabetes da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Elisa Mieko Suemitsu Higa
- Departamento de Medicina, Divisão de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Sergio Atala Dib
- Departamento de Medicina, Divisão de Endocrinologia, Centro de Diabetes da Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Brandt R, Park M, Wroblewski K, Quinn L, Tasali E, Cinar A. Sleep quality and glycaemic variability in a real-life setting in adults with type 1 diabetes. Diabetologia 2021; 64:2159-2169. [PMID: 34136937 PMCID: PMC9254230 DOI: 10.1007/s00125-021-05500-9] [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: 01/04/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS Suboptimal subjective sleep quality is very common in adults with type 1 diabetes. Reducing glycaemic variability is a key objective in this population. To date, no prior studies have examined the associations between objectively measured sleep quality and overnight glycaemic variability in adults with type 1 diabetes. We aimed to test the hypothesis that poor sleep quality would be associated with greater overnight glycaemic variability. METHODS Data were collected in the home setting from 20 adults (ten male and ten female participants) with type 1 diabetes who were current insulin pump users. Simultaneous assessments of objective sleep quality (Zmachine Insight+) and continuous glucose monitoring (CGM) were performed over multiple nights (up to 15 nights) in each participant. Due to the real-life nature of this study, the participants kept their usual CGM alerts for out-of-range glucose values. Sleep quality was categorised as 'good' or 'poor' using a composite of objective sleep features (i.e. sleep efficiency, wake after sleep onset and number of awakenings) based on the National Sleep Foundation's consensus criteria. Glycaemic variability was quantified using SD and CV of overnight glucose values based on overnight CGM profiles. RESULTS A total of 170 nights were analysed. Overall, 86 (51%) nights were categorised as good sleep quality, and 84 (49%) nights were categorised as poor sleep quality. Using linear mixed-effects models, poor sleep quality was significantly associated with greater glycaemic variability as quantified by SD (coefficient: 0.39 [95% CI 0.10, 0.67], p = 0.009) and CV (coefficient: 4.35 [95% CI 0.8, 7.9], p = 0.02) of overnight glucose values, after accounting for age, sex, BMI and overnight insulin dose. There was large inter- and intra-individual variability in sleep and glycaemic characteristics. Both pooled and individual-level data revealed that the nights with poor sleep quality had larger SDs and CVs, and, conversely, the nights with good sleep quality had smaller SDs and CVs. No associations were found between sleep quality and time spent in the target glucose range, or above or below the target glucose range, where CGM alarms are most likely to occur. CONCLUSIONS/INTERPRETATION Objectively measured sleep quality is associated with overnight glycaemic variability in adults with type 1 diabetes. These findings highlight an important role of sleep quality in overnight glycaemic control in type 1 diabetes. They also provide a strong incentive to both patients and healthcare providers for considering sleep quality in personalised type 1 diabetes glycaemic management plans. Future studies should investigate the mechanisms linking sleep quality to glycaemic variability.
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Affiliation(s)
- Rachel Brandt
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Minsun Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Lauretta Quinn
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Esra Tasali
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ali Cinar
- Department of Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, IL, USA.
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11
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Tong ZWM, Grant E, Gras S, Wu M, Smith C, Barrett HL, Gallo LA, Short KR. The role of T-cell immunity in COVID-19 severity amongst people living with type II diabetes. FEBS J 2021; 288:5042-5054. [PMID: 34216102 PMCID: PMC8420365 DOI: 10.1111/febs.16105] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/05/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022]
Abstract
The COVID‐19 pandemic has highlighted the vulnerability of people with diabetes mellitus (DM) to respiratory viral infections. Despite the short history of COVID‐19, various studies have shown that patients with DM are more likely to have increased hospitalisation and mortality rates as compared to patients without. At present, the mechanisms underlying this susceptibility are unclear. However, prior studies show that the course of COVID‐19 disease is linked to the efficacy of the host’s T‐cell responses. Healthy individuals who can elicit a robust T‐cell response are more likely to limit the severity of COVID‐19. Here, we investigate the hypothesis that an impaired T‐cell response in patients with type 2 diabetes mellitus (T2DM) drives the severity of COVID‐19 in this patient population. While there is currently a limited amount of information that specifically addresses T‐cell responses in COVID‐19 patients with T2DM, there is a wealth of evidence from other infectious diseases that T‐cell immunity is impaired in patients with T2DM. The reasons for this are likely multifactorial, including the presence of hyperglycaemia, glycaemic variability and metformin use. This review emphasises the need for further research into T‐cell responses of COVID‐19 patients with T2DM in order to better inform our response to COVID‐19 and future disease outbreaks.
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Affiliation(s)
- Zhen Wei Marcus Tong
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Emma Grant
- La Trobe University - La Trobe Institute for Molecular Science (LIMS), Melbourne, Australia.,Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Australia
| | - Stephanie Gras
- La Trobe University - La Trobe Institute for Molecular Science (LIMS), Melbourne, Australia.,Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Australia
| | - Melanie Wu
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Corey Smith
- QIMR Berghofer Medical Research Institute - QIMR Berghofer Centre for Immunotherapy and Vaccine Development Brisbane, Australia
| | - Helen L Barrett
- Department of Endocrinology, Mater Health, Brisbane, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Linda A Gallo
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - Kirsty R Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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12
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New Insights into the Role of Visit-to-Visit Glycemic Variability and Blood Pressure Variability in Cardiovascular Disease Risk. Curr Cardiol Rep 2021; 23:25. [PMID: 33655430 DOI: 10.1007/s11886-021-01454-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW There is evidence from epidemiologic studies that variability in cardiovascular risk factors influences risk of cardiovascular disease. We review new studies and novel findings in the relationship between visit-to-visit glycemic variability and blood pressure variability and risk of adverse outcomes. RECENT FINDINGS Visit-to-visit glycemic variability is consistently linked to macrovascular disease. This relationship has been observed in both clinical trials and retrospective studies of electronic health records. Long-term blood pressure variability also predicts cardiovascular outcomes, and the association appears stronger in those with lower levels of systolic and diastolic function. As epidemiologic evidence increases in support of a role for metabolic risk factor variability in cardiovascular risk, there is a corresponding rise in interest in applying this information toward improving risk factor prediction and treatment. Future investigation of underlying mechanisms for these associations as well as implications for therapy is also warranted. The potential additive contribution of variability of multiple parameters also merits additional scrutiny. As our technology for capturing risk factor variability continues to improve, this will only enhance our understanding of its links with vascular disease and how to best utilize this information to reduce cardiovascular outcomes.
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13
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Rodrigues R, Rossi ICB, Rossi BF, Gomes DC, Penha-Silva N. New glycemic metrics and traditional clinical and laboratory profiles of children and adolescents with type 1 diabetes mellitus in an outpatient follow-up. Diabetes Res Clin Pract 2021; 173:108680. [PMID: 33516782 DOI: 10.1016/j.diabres.2021.108680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION This study evaluated the demographic, clinical, and laboratory data - including traditional (as glycated hemoglobin, HbA1c) and new glycemic metrics (as time in range, TiR) - and the complications present in children and adolescents (CA) in outpatient follow-up, as well as their possible associations. METHODS This retrospective observational study's data were compiled from the CA's medical records with T1DM (n = 78) being followed up at the Pediatric Endocrinology Service of the Federal University of Uberlândia. RESULTS The average participants' age was 10.2 years (1-16), most of them (55%) being male, with a diagnosis time of 4.5 years (1-13), and a body mass index of 18 kg/m2. The group had HbA1c levels of 9.6% and an estimated average glycemia of 229.5 ± 103 mg/dL. TiR was 25% (7-54%); the short- (CV%) and medium-term (ΔHbA1c) glycemic variability was 45.7% and 1.5%, respectively. Approximately 10% had diabetes ketoacidosis in the last year of follow-up, about 6% had chronic complications, such as nephropathy or retinopathy, and 20% had some other associated autoimmune disease. 49% of the participants reported regular physical activity. CONCLUSION The high values of HbA1c and glycemic variability amplitude, short TiR, and the early presence of chronic complications reveal that the treatment did not reach its goal in this population. Better education of patients and their families about the disease and greater adherence to intensive insulin treatment can optimize the control of diabetes in pediatric patients.
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Affiliation(s)
- Ricardo Rodrigues
- Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
| | - Isabela Cristina Borges Rossi
- Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | | | - Nilson Penha-Silva
- Instituto de Biotecnologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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14
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Knychala MA, Garrote-Filho MDS, Batista da Silva B, Neves de Oliveira S, Yasminy Luz S, Marques Rodrigues MO, Penha-Silva N. Red cell distribution width and erythrocyte osmotic stability in type 2 diabetes mellitus. J Cell Mol Med 2021; 25:2505-2516. [PMID: 33591627 PMCID: PMC7933938 DOI: 10.1111/jcmm.16184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/30/2020] [Accepted: 11/07/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed to investigate the relationship between red cell distribution width (RDW) and erythrocyte osmotic stability in non‐diabetic and diabetic individuals in both sexes. The study sample (N = 122) was constituted by 53 type 2 diabetics (DM) and 69 non‐diabetics (ND), being 21 and 22 men in each group, respectively. The osmotic stability of erythrocytes was obtained by the variation in saline concentration (dX) capable of determining hypoosmotic lysis. Higher RDW values and lower serum iron concentrations were found in the diabetic group when compared to the non‐diabetic volunteers. In the group of diabetic women, RDW was positively correlated with the reticulocyte index, and both RDW and dX were negatively correlated with iron, haemoglobin, transferrin saturation index, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration. In all the groups studied, RDW was positively correlated with dX, especially in the diabetic group, where the correlation was the strongest. RDW elevation in both women and men with type 2 diabetes mellitus was associated with decreased serum iron indicators. Furthermore, RDW has a similar meaning to dX, as small erythrocytes have less haemoglobin, resulting in both an increase of RDW and dX.
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Affiliation(s)
| | | | | | | | - Sarah Yasminy Luz
- Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Nilson Penha-Silva
- Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, Brazil
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15
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Cardiovascular disease in type 1 diabetes: A review of epidemiological data and underlying mechanisms. DIABETES & METABOLISM 2020; 46:442-449. [PMID: 32998054 DOI: 10.1016/j.diabet.2020.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 12/15/2022]
Abstract
Cardiovascular disease (CVD) is highly prevalent in patients with type 1 diabetes (T1D) and a major cause of mortality. CVD arises earlier in life in T1D patients and is responsible for a significant reduction of at least 11 years' life expectancy. Also, the incidence of CVD is much more pronounced in patients with T1D onset at an earlier age. However, the factors responsible for increased atherosclerosis and CVD in T1D are not yet totally clarified. In addition to the usual cardiovascular (CV) risk factors, chronic hyperglycaemia plays an important role by promoting oxidative stress, vascular inflammation, monocyte adhesion, arterial wall thickening and endothelial dysfunction. Diabetic nephropathy and cardiac autonomic neuropathy are also associated with increased CVD in T1D. In fact, the CVD risk remains significantly increased even in well-controlled T1D patients who have no additional CV risk factors, indicating that other potential factors are likely to be involved. Hypoglycemia and glucose variability could enhance CV disease by promoting oxidative stress, vascular inflammation and endothelial dysfunction. Furthermore, even well-controlled T1D patients show significant qualitative and functional abnormalities of lipoproteins that are likely to be implicated in the development of atherosclerosis and premature CVD. In addition, recent data suggest that a dysfunctional immune system, which is typical of autoimmune T1D, might also promote CVD possibly through inflammatory pathways. Moreover, overweight and obese T1D patients can manifest additional CV risk through pathophysiological mechanisms resembling those observed in type 2 diabetes (T2D).
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16
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Calloni C, Martínez LS, Gil DF, da Silva DM, Rosales PF, Agostini F, Moura E Silva S, Parmegiani Jahn M, Salvador M. Jabuticaba (Plinia trunciflora (O. Berg) Kausel) improved the lipid profile and immune system and reduced oxidative stress in streptozotocin-induced diabetic rats. J Food Biochem 2020; 44:e13383. [PMID: 32696535 DOI: 10.1111/jfbc.13383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022]
Abstract
The aim of this study was evaluating the effects of jabuticaba aqueous extract (JPE - 0.5 g/kg) on serum lipid levels, immune system, and oxidative stress parameters of streptozotocin-induced diabetic rats. Administration of JPE for 30 days, by gavage, was able to reduce serum levels of total cholesterol, non-high density lipoprotein (HDL) cholesterol, and triglycerides in diabetic rats. The HDL cholesterol levels increased in both diabetic and healthy rats after JPE treatment. Total leukocyte and lymphocyte counts reduced in diabetic rats, and JPE treatment prevented these diabetes mellitus (DM)-induced changes in the immune system. In addition, the induction of DM also led to dysregulation in the activity of superoxide dismutase and catalase antioxidant enzymes as well as an increase in oxidative stress markers. Treatments with JPE reduced oxidative stress and modulated antioxidant enzyme activities. These data demonstrate the potential of JPE as an adjuvant treatment option for diabetic patients. PRACTICAL APPLICATIONS: Considering that it is very common to observe dyslipidemia in diabetic patients and that these alterations, combined with the increased oxidative stress levels, also common in these patients, can lead to the development of cardiovascular diseases, JPE would be an alternative treatment adjunct to reduce these risks. In addition, although more studies are needed, JPE has the potential to improve the count of total lymphocytes and leukocytes, which could assist in improving the immune response of these patients, who also commonly have a higher risk of infectious diseases. Thus, JPE could be used by these patients, in combination with conventional treatment, in the form of a nutraceutical rich in phenolic compounds.
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Affiliation(s)
- Caroline Calloni
- Laboratório de Estresse Oxidativo e Antioxidantes, Instituto de Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Luana Soares Martínez
- Laboratório de Estresse Oxidativo e Antioxidantes, Instituto de Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Daniela Franciele Gil
- Laboratório de Estresse Oxidativo e Antioxidantes, Instituto de Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Douglas Machado da Silva
- Laboratório de Estresse Oxidativo e Antioxidantes, Instituto de Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Pauline Fagundes Rosales
- Laboratório de Produtos Naturais e Sintéticos, Instituto de Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Fabiana Agostini
- Laboratório de Produtos Naturais e Sintéticos, Instituto de Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Sidnei Moura E Silva
- Laboratório de Produtos Naturais e Sintéticos, Instituto de Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Matheus Parmegiani Jahn
- Laboratório de Fisiologia e Farmacologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - Mirian Salvador
- Laboratório de Estresse Oxidativo e Antioxidantes, Instituto de Biotecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
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17
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Zhou Z, Sun B, Huang S, Zhu C, Bian M. Glycemic variability: adverse clinical outcomes and how to improve it? Cardiovasc Diabetol 2020; 19:102. [PMID: 32622354 PMCID: PMC7335439 DOI: 10.1186/s12933-020-01085-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/02/2020] [Indexed: 12/26/2022] Open
Abstract
Glycemic variability (GV), defined as an integral component of glucose homoeostasis, is emerging as an important metric to consider when assessing glycemic control in clinical practice. Although it remains yet no consensus, accumulating evidence has suggested that GV, representing either short-term (with-day and between-day variability) or long-term GV, was associated with an increased risk of diabetic macrovascular and microvascular complications, hypoglycemia, mortality rates and other adverse clinical outcomes. In this review, we summarize the adverse clinical outcomes of GV and discuss the beneficial measures, including continuous glucose monitoring, drugs, dietary interventions and exercise training, to improve it, aiming at better addressing the challenging aspect of blood glucose management.
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Affiliation(s)
- Zheng Zhou
- Department of Chinese Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Bao Sun
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, 410000, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, 410000, China
| | - Shiqiong Huang
- Department of Pharmacy, The First Hospital of Changsha, Changsha, 410005, China
| | - Chunsheng Zhu
- Department of Chinese Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
| | - Meng Bian
- Department of Chinese Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
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18
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Kacarevic D, Bogavac-Stanojevic N, Spasojevic-Kalimanovska V, Bojanin D, Milenkovic T, Stefanovic A, Mihajlovic M, Vujcic S, Vukovic R, Zeljkovic A, Todorovic S, Mitrovic K, Vekic J. Factors associated with oxidative stress status in pediatric patients with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2020; 33:591-598. [PMID: 32229673 DOI: 10.1515/jpem-2019-0555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
Background Oxidative stress is implicated in both, the onset and the progression of type 1 diabetes mellitus (T1DM). There is accumulated evidence of increased biomarkers of oxidative stress in newly diagnosed, T1DM patients without complications, and in those with advanced disease. In this cross-sectional study, we investigated factors affecting oxidative stress status in pediatric patients with T1DM. Methods Advanced oxidation protein products (AOPP), prooxidant-antioxidant balance (PAB), total sulfhydryl (SH) groups, and superoxide dismutase (SOD) activity were determined in 170 children and adolescents with T1DM. Principal component analysis was used to investigate clustering of clinical and laboratory variables associated with elevated oxidative stress and reduced antioxidative defense biomarkers. Results Factor analysis extracted five factors, interpreted as (1) "weight status factor" including age, BMI, waist and hip circumferences; (2) "proatherogenic factor" that included LDL-cholesterol, non-HDL-cholesterol, and triglycerides; (3) "metabolic control factor" including glucose and HbA1c; (4) "renal marker factor" with positive loading of urinary albumin excretion rate and negative loading of GFR; and (5) "antiatherogenic factor" that included HDL-cholesterol. High AOPP levels were independently predicted by "proatherogenic" (OR: 2.32; 95% CI: 1.44-3.71; p < 0.001), "metabolic control" (OR: 2.24; 95% CI: 1.35-3.73; p < 0.01), and "renal marker" (OR: 1.65; 95% CI: 1.03-2.65; p < 0.05) factors. "Renal marker factor" was a significant predictor of PAB (OR: 0.52; 95% CI: 0.34-0.81; p < 0.01). Regarding antioxidative defense markers, reduced SH groups were predicted by "proatherogenic factor" (OR: 0.56; 95% CI: 0.34-0.94; p < 0.05), while "weight status factor" predicted lower SOD activity (OR: 1.66; 95% CI: 1.03-2.67; p < 0.05). Conclusions Cardiometabolic risk factors and renal function are associated with oxidative stress in pediatric T1DM patients.
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Affiliation(s)
- Dragana Kacarevic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | | | - Dragana Bojanin
- Biochemical Laboratory, Department for Clinical Chemistry and Hematology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Aleksandra Stefanovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Marija Mihajlovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Sanja Vujcic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, P. Box 146, 11000 Belgrade, Serbia
| | - Rade Vukovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Zeljkovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Sladjana Todorovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Katarina Mitrovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Jelena Vekic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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19
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Arita T, Maruyama T, Yokoyama T, Hieda M, Fukata M, Fujino T, Mawatari S, Akashi K. Impaired deformability and association with density distribution of erythrocytes in patients with type 2 diabetes mellitus under treatment. Clin Hemorheol Microcirc 2020; 76:73-83. [PMID: 32417767 DOI: 10.3233/ch-200873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Disturbed microcirculation is related to diabetic complications, and erythrocyte deformability is a critical factor regulating microcirculation. OBJECTIVES To know the relationship between the impaired deformability and density profile in diabetic erythrocytes. METHODS We recruited patients with type 2 diabetes (n = 15, diabetic group) and age- and sex-matched non-diabetic subjects (n = 15, control group). Erythrocyte density (ED) profile was obtained by the phthalate ester separation technique. ED distribution was fitted by sigmoidal curve, yielding specific gravity of phthalate ester allowing passage of half erythrocytes population (ED50) and slope factor. Erythrocyte deformability was estimated by our specific filtration technique. RESULTS Diabetic group showed significantly (p < 0.001) higher HbA1c and fasting blood glucose concentration. Erythrocyte deformability in diabetic group was impaired as compared with that in control group (p < 0.001) and proportional to HbA1c (p = 0.009). However, ED50 and the slope factor in diabetic group did not differ from respective parameters in control group. CONCLUSIONS This study demonstrated that erythrocyte deformability was impaired in diabetic patients even under treatment. HbA1c up to 7.5% is concluded not to alter the erythrocyte density but to impair the deformability, which might be a warning to clinicians for prevention of diabetic complications.
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20
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Effects of Hydroalcoholic Leaf Extract of Avicennia marina on Apoptotic, Inflammatory, Oxidative Stress, and Lipid Peroxidation Indices and Liver Histology of Type 1 Diabetic Rats. HEPATITIS MONTHLY 2020. [DOI: 10.5812/hepatmon.99454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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21
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Yazıcı MU, Ayar G, Çetinkaya S, Keskin M, Azapağası E, Neşelioğlu S, Erel Ö, Bayrakçı B. Evaluation of Thiol/Disulfide Homeostasis in Pediatric Patients with Diabetic Ketoacidosis. Comb Chem High Throughput Screen 2020; 23:185-190. [PMID: 32067611 DOI: 10.2174/1386207323666200218114331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/22/2022]
Abstract
AIMS AND OBJECTIVE This study aimed to investigate the value of Thiol/Disulfide homeostasis in pediatric diabetic ketoacidosis patients suffering from type 1 diabetes mellitus. MATERIALS AND METHODS This study featured children who were diagnosed with diabetic ketoacidosis and who were consecutively admitted to pediatric intensive care within one year of their diagnosis. Thiol/disulfide homeostasis was evaluated in 45 pediatric patients suffering from DKA, as well as 45 healthy controls of parallel gender and age. Thiol/disulfide homeostasis parameters were measured using a novel automated measurement method and the correlation between demographic data and parameters was measured. RESULTS Pediatric patients were found to have low native thiols, total thiols and disulfide levels with type 1 diabetes after DKA (331.82±106.40, 362.71±113.31, 17.02±5.33 μmol/L, respectively) as compared to the control group (445.08±24.41, 481.21± 28.47, 18.06±5.12 μmol/L, respectively). CONCLUSION Thiol/disulfide homeostasis was distorted in pediatric patients with DKA. Furthermore, it was found that they are not likely to return to normal, immediately after treatment.
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Affiliation(s)
- Mutlu U Yazıcı
- Department of Pediatrics, University of Health Sciences, Pediatric Intensive Care Unit, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Ganime Ayar
- Department of Pediatrics, University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Semra Çetinkaya
- Department of Pediatric, University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Endocrinology and Adolescent Clinic, Ankara, Turkey
| | - Meliksah Keskin
- Department of Pediatric, University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Endocrinology and Adolescent Clinic, Ankara, Turkey
| | - Ebru Azapağası
- Department of Pediatrics, University of Health Sciences, Pediatric Intensive Care Unit, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Saim Neşelioğlu
- Department of Biochemistry, University of Yildirim Beyazit, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Özcan Erel
- Department of Biochemistry, University of Yildirim Beyazit, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Benan Bayrakçı
- Department of Pediatrics, University of Hacettepe, Pediatric Intensive Care Unit, İhsan Doğramacı Children Hospital, Ankara, Turkey
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22
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Feng L, Chen H, Chen J, Xiong C, Shao X, Wang X, Ning J, Xiang Z, Wang X, Chen T, Xiao H, Tang H, Li X, Hong G, Zou H. The Product of Red Blood Cells and Hematocrit Can Be Used as a Novel Indicator of Impaired Fasting Blood Glucose Status. Diabetes Metab Syndr Obes 2020; 13:4007-4015. [PMID: 33149640 PMCID: PMC7602892 DOI: 10.2147/dmso.s270276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/03/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To explore whether the red blood cell count multiplied by hematocrit index (RBCHct) in blood routine parameters can indicate the risk of impaired fasting blood glucose (IFG), and whether it is related to insulin resistance and inflammation. METHODS In this cross-sectional study, previous history of diabetes was excluded, and people with normal and impaired IFG were included. We use Spearman analysis to evaluate the correlation between RBCHct index and fasting plasma glucose, insulin resistance homeostasis model assessment (HOMA-IR), and hypersensitive C-reactive protein (hs-CRP). Binary logistic regression analysis was used to evaluate the RBCHct index for assessing the potential risk of IFG, and the receiver operating characteristic (ROC) curve was used to evaluate the RBCHct index for diagnosing insulin resistance and chronic low-grade inflammatory efficacy among those with IFG. RESULTS Correlation analysis showed that the RBCHct index and fasting plasma glucose (r=0.088, P=0.003); HOMA-IR (r=0.199, P<0.001); and hs-CRP (r=0.097, P=0.001) were positively correlated. After adjusting for confounding factors, the risk of IFG in the third and fourth quartiles of the RBCHct index increased to 1.889 and 3.048 times. The area under the ROC curve of the RBCHct index for diagnosis of insulin resistance state (HOMA-IR) was 0.695 (p<0.001), and the area under the ROC curve of the RBCHct index for the diagnosis of chronic low-inflammatory state (hs-CRP) was 0.641 (P=0.010). CONCLUSION The RBCHct index may be a potential indicator for assessing the risk of prediabetes and is closely related to whether the body is in a state of insulin resistance and inflammation under IFG.
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Affiliation(s)
- Ling Feng
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Haishan Chen
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Jianhui Chen
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Chongxiang Xiong
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Xiaofei Shao
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Xin Wang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Jing Ning
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Zhicong Xiang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Xuan Wang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Tong Chen
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Hua Xiao
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Hongjuan Tang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Xiaolin Li
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Guobao Hong
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Hequn Zou
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
- Correspondence: Hequn Zou; Xiaofei ShaoDepartment of Nephrology, The Third Affiliated Hospital, Southern Medical University, 183, Zhongshan West Avenue, Tianhe District, Guangzhou510630, People’s Republic of China Email ;
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23
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Kobayashi D, Noto H, Takahashi O, Shimbo T. Glycemic variability and subsequent malignancies among the population without diabetes. Diabetes Res Clin Pract 2020; 159:107987. [PMID: 31866528 DOI: 10.1016/j.diabres.2019.107987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/02/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Glycemic variability has been suggested to be related to some unfavorable outcomes, but malignancy development has not been evaluated. The aim of this study was to evaluate the association of glycemic variability with malignancy development among the population without diabetes. METHODS We conducted a retrospective cohort study at a large teaching hospital in Tokyo, Japan, from 2005 to 2016. We included all participants without diabetes who underwent voluntary health check-ups. Our outcome was the development of any malignancy. As a measure of glycemic variability, we calculated the quotient of CV in HbA1c and categorized subjects into quartile groups. A Cox proportional hazard model was applied, adjusting for patient demographics and social and family histories. RESULTS A total of 42,731 participants were included in this study; the mean age was 53.8 and 48.3% were male. During the median follow up of 2639 (interquartile range (IQR):1787-3662) days, 2435 participants (5.7%) developed malignancies. Participants who had larger glycemic variability (CV in HbA1c; hazard ratio (HR) 1.15, 95%confidence interval (CI):1.02-0.31 for the second quartile group; HR 2.20, 95%CI:1.95-2.48 for the third quartile group, HR 4.66, 95%CI:4.16-5.21 for the fourth quartile group, compared to first quartile group) had a significantly higher risk of malignancies. CONCLUSION We found an association between large glycemic variability and a high risk of future malignancies in a dose-dependent manner among people without diabetes. This finding suggests that maintaining a constant level of glucose may have favorable effects on cancer prevention in people without diabetes.
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Affiliation(s)
- Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan; Department of Epidemiology, St. Luke's International University Graduate School of Public Health, Tokyo, Japan; Fujita Health University, Toyoake, Japan.
| | - Hiroshi Noto
- Department of Endocrinology, St. Luke's International Hospital, Tokyo, Japan
| | - Osamu Takahashi
- Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan; Department of Epidemiology, St. Luke's International University Graduate School of Public Health, Tokyo, Japan
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24
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Yazıcı MU, Ayar G, Savas-Erdeve S, Azapağası E, Neşelioğlu S, Erel Ö, Çetinkaya S. Role of Ischemia Modified Albumin Serum Levels as an Oxidative Stress Marker in Children with Diabetic Ketoacidosis. Comb Chem High Throughput Screen 2019; 22:577-581. [PMID: 31595845 DOI: 10.2174/1386207322666191008214919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/15/2023]
Abstract
AIM AND OBJECTIVE Ischemia modified albumin (IMA) is a biomarker that has been introduced recently for use in the evaluation of oxidative stress. The aim of this study was to measure the ischemia modified albumin serum levels in pediatric patients with diabetic ketoacidosis (DKA) during acidosis and after the patient recovered from acidosis and to compare these with the control group. MATERIALS AND METHODS Pediatric patients with Type I diabetes mellitus (T1DM) who were admitted to the pediatric intensive care unit with the diabetic ketoacidosis were assigned as the study group and healthy children who were admitted to the outpatient clinic and decided as healthy after clinic and laboratory evaluation were selected as the control group. IMA and adjusted IMA levels were evaluated in the blood samples from the control group and the study group when admitted first time to the intensive care unit during the acidosis period (DKA before treatment, DKA-BT), and after recovering from acidosis (DKA after treatment, DKA-AT). RESULTS A total of 24 pediatric patients with diabetic ketoacidosis and 30 healthy control children matching age and sex were included in the current study. The albumin levels in pediatric patients with T1DM during DKA-BT were higher than the albumin levels after acidosis (4.101±0.373, 3.854±0.369 g/dL, respectively) (p<0.05). However, there was no significant difference when these values were compared to the control group. Mean values of IMA and Adj-IMA were statistically higher in DKAAT compared to the control group (0.748±0.150 vs 0.591±0.099, p< 0.001; 0.708±0.125 vs 0.607±0.824, p< 0.001, respectively). IMA and adjusted IMA levels measured after recovered from acidosis were significantly higher compared to the level of IMA during DKA (0.748±0.150 vs 0.606±0.105 as absorbance unit, p<0.001; 0.708±0.125 vs 0.625±0.100, p<0.05, respectively). CONCLUSION In children with T1DM, even though acidosis recovered following the treatment in diabetic ketoacidosis, which is an oxidative stress marker, the ischemia modified albumin levels and adjusted ischemia modified albumin levels were high.
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Affiliation(s)
- Mutlu U Yazıcı
- Dr. Sami Ulus Maternity and Children Training and Research Hospital, University of Health Sciences, Pediatric Intensive Care, Ankara, Turkey
| | - Ganime Ayar
- University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Senay Savas-Erdeve
- Department of Pediatric Endocrinology, University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ebru Azapağası
- Dr. Sami Ulus Maternity and Children Training and Research Hospital, University of Health Sciences, Pediatric Intensive Care, Ankara, Turkey
| | - Salim Neşelioğlu
- Department of Biochemistry, University of Yildirim Beyazit, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Özcan Erel
- Department of Biochemistry, University of Yildirim Beyazit, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Semra Çetinkaya
- Department of Pediatric Endocrinology, University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey
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25
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Raspante Cerqueira Teixeira K, de Medeiros LA, Mendes JA, Vaz ER, Cunha TM, de Oliveira EP, Penha-Silva N, Crispim CA. The erythrocyte membrane stability is associated with sleep time and social jetlag in shift workers. PLoS One 2019; 14:e0222698. [PMID: 31545844 PMCID: PMC6756543 DOI: 10.1371/journal.pone.0222698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/05/2019] [Indexed: 11/19/2022] Open
Abstract
The osmotic stability of the erythrocyte membrane (OSEM) has been associated with changes in lipid profile, blood glucose and blood pressure. Changes in these parameters are very frequent in shift workers, possibly because of the lack of synchronization of biological rhythms, which results in the social jetlag. However, the existence of association between OSEM and circadian misalignment has not been investigated in this population. Therefore, this study investigated whether shift work, sleep time and social jetlag (SJL) are associated with biochemical and hematological variables. A population consisting of 79 men working at night (n = 37) or during the day (n = 42), aged between 21 and 65 years and with a mean BMI of 27.56 ± 4.0 kg/m2, was investigated cross-sectionally in relation to sleep time, SJL, anthropometric (height, weight and waist circumference) and blood variables, with emphasis on the OSEM. SJL was calculated by the absolute difference between the midpoint of sleep on work and rest days. The Generalized Linear Model (GzLM) was used to investigate the existence of associations between SJL and average sleep time in relation to the analyzed variables. Workers without SJL presented lower baseline lysis values of erythrocytes in isotonic medium in relation to workers with SJL. In addition, workers who slept on average less than 6 hours had higher OSEM, and higher total and LDL-cholesterol in relation to those who slept more than 6 hours, regardless of the shift. It is possible that the association of sleep deprivation and SJL with erythrocyte membrane stability is mediated through changes in the lipid profile.
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Affiliation(s)
| | | | | | - Emília Rezende Vaz
- Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | | | | | - Nilson Penha-Silva
- Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, MG, Brazil
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26
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Abdel-Moneim A, Zanaty MI, El-Sayed A, Khalil RG, Rahman HA. Relation Between Oxidative Stress and Hematologic Abnormalities in Children With Type 1 Diabetes. Can J Diabetes 2019; 44:222-228. [PMID: 31630989 DOI: 10.1016/j.jcjd.2019.07.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/20/2019] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Recently, numerous studies have renewed attention to the hematologic profile in the early identification of diabetic inflammation and complications. The objective of this study was to investigate the relationship between hematologic indices abnormalities and oxidative stress among children with type 1 diabetes mellitus (T1DM). METHODS This study included 70 children diagnosed with T1DM and 30 healthy control subjects. The children with T1DM were divided into 2 groups according to the duration of diabetes: children with newly diagnosed T1DM and children with established T1DM. RESULTS Erythrocyte count and platelet count were decreased significantly in children with established T1DM, whereas leukocyte count and neutrophil count were increased significantly in children with newly diagnosed T1DM compared with healthy control subjects. Moreover, hemoglobin and hematocrit values revealed a significant depletion in both T1DM groups; however, values of red blood cell distribution width, mean platelet volume and platelet distribution width were significantly elevated in both T1DM groups compared with healthy control subjects. Also, microalbuminuria levels showed a significant increase in children with established T1DM, whereas lipid peroxidation biomarker (malondialdehyde) and nitric oxide levels were elevated markedly in both T1DM groups compared with the healthy group. CONCLUSIONS The data demonstrated that the hematologic profile showed noticeable alterations in children with T1DM, and the inflammation and oxidative stress markers were contributed to the hematologic abnormalities. The results revealed that some hematologic indices can be used in the early detection of children with T1DM at risk for diabetic complications.
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Affiliation(s)
- Adel Abdel-Moneim
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt.
| | - Mohamed I Zanaty
- Biotechnology Department, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Beni-Suef, Egypt
| | - Amr El-Sayed
- Biotechnology Department, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Beni-Suef, Egypt
| | - Rehab G Khalil
- Immunology Division, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - Hanan Abdel Rahman
- Biotechnology Department, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Beni-Suef, Egypt
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27
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Jenkins A, Januszewski A, O’Neal D. The early detection of atherosclerosis in type 1 diabetes: why, how and what to do about it. Cardiovasc Endocrinol Metab 2019; 8:14-27. [PMID: 31646294 PMCID: PMC6739889 DOI: 10.1097/xce.0000000000000169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
Abstract
The major cause of morbidity and often premature mortality in people with type I diabetes (T1D) is cardiovascular disease owing to accelerated atherosclerosis. We review publications relating to the rationale behind, and clinical tests for, detecting and treating early atherosclerosis in people with T1D. Currently available tools for atherosclerosis assessment include risk equations using vascular risk factors, arterial intima-media thickness, the ankle-brachial index, coronary artery calcification and angiography, and for more advanced lesions, intravascular ultrasound and optical coherence tomography. Evolving research tools include risk equations incorporating novel clinical, biochemical and molecular tests; vascular MRI and molecular imaging. As yet there is little information available to quantify early atherosclerosis. With better means to control the vascular risk factors, such as hypertension, dyslipidaemia and glycaemic control, and emerging therapies to control novel risk factors, further epidemiologic and clinical trials are merited to facilitate the translation into clinical practice of robust means to detect, monitor and treat early atherosclerosis in those with T1D.
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Affiliation(s)
- Alicia Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - Andrzej Januszewski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - David O’Neal
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
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28
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Warnes H, Helliwell R, Pearson SM, Ajjan RA. Metabolic Control in Type 1 Diabetes: Is Adjunctive Therapy the Way Forward? Diabetes Ther 2018; 9:1831-1851. [PMID: 30209797 PMCID: PMC6167310 DOI: 10.1007/s13300-018-0496-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 12/21/2022] Open
Abstract
Despite advances in insulin therapies, patients with type 1 diabetes (T1DM) have a shorter life span due to hyperglycaemia-induced vascular disease and hypoglycaemic complications secondary to insulin therapy. Restricting therapy for T1DM to insulin replacement is perhaps an over-simplistic approach, and we focus in this work on reviewing the role of adjuvant therapy in this population. Current data suggest that adding metformin to insulin therapy in T1DM temporarily lowers HbA1c and reduces weight and insulin requirements, but this treatment fails to show a longer-term glycaemic benefit. Agents in the sodium glucose co-transporter-2 inhibitor (SGLT-2) class demonstrate the greatest promise in correcting hyperglycaemia, but there are safety concerns in relation to the risk of diabetic ketoacidosis. Glucagon-like peptide-1 agonists (GLP-1) show a modest effect on glycaemia, if any, but significantly reduce weight, which may make them suitable for use in overweight T1DM patients. Treatment with pramlintide is not widely available worldwide, although there is evidence to indicate that this agent reduces both HbA1c and weight in T1DM. A criticism of adjuvant studies is the heavy reliance on HbA1c as the primary endpoint while generally ignoring other glycaemic parameters. Moreover, vascular risk markers and measures of insulin resistance-important considerations in individuals with a longer T1DM duration-are yet to be fully investigated following adjuvant therapies. Finally, studies to date have made the assumption that T1DM patients are a homogeneous group of individuals who respond similarly to adjuvant therapies, which is unlikely to be the case. Future longer-term adjuvant studies investigating different glycaemic parameters, surrogate vascular markers and harder clinical outcomes will refine our understanding of the roles of such therapies in various subgroups of T1DM patients.
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Affiliation(s)
- Harriet Warnes
- School of Medical Sciences, The University of Leeds, Leeds, UK
| | | | - Sam Matthew Pearson
- School of Medical Sciences, The University of Leeds, Leeds, UK
- Department of Diabetes and Endocrinology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ramzi A Ajjan
- School of Medical Sciences, The University of Leeds, Leeds, UK.
- Department of Diabetes and Endocrinology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- The Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK.
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