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Steiman De Visser H, Fast I, Brunton N, Arevalo E, Askin N, Rabbani R, Abou-Setta AM, McGavock J. Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes: A Systemic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e240235. [PMID: 38393727 PMCID: PMC10891480 DOI: 10.1001/jamanetworkopen.2024.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/22/2023] [Indexed: 02/25/2024] Open
Abstract
Importance It is unclear whether cardiorespiratory fitness (CRF) and physical activity are lower among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with youths without diabetes. Objective To describe the magnitude, precision, and constancy of the differences in CRF and physical activity among youths with and without diabetes. Data Sources MEDLINE, Embase, CINAHL, and SPORTDiscus were searched from January 1, 2000, to May 1, 2022, for eligible studies. Study Selection Observational studies with measures of CRF and physical activity in children and adolescents aged 18 years or younger with T1D or T2D and a control group were included. Data Extraction and Synthesis Data extraction was completed by 2 independent reviewers. A random-effects meta-analysis model was used to estimate differences in main outcomes. The pooled effect estimate was measured as standardized mean differences (SMDs) with 95% CIs. The Preferred Reporting Items for Systematic Review and Meta-Analyses guideline was followed. Main Outcomes and Measures The main outcomes were objectively measured CRF obtained from a graded maximal exercise test and subjective or objective measures of physical activity. Subgroup analyses were performed for weight status and measurement type for outcome measures. Results Of 7857 unique citations retrieved, 9 studies (755 participants) with measures of CRF and 9 studies (1233 participants) with measures of physical activity for youths with T2D were included; for youths with T1D, 23 studies with measures of CRF (2082 participants) and 36 studies with measures of PA (12 196 participants) were included. Random-effects models revealed that directly measured CRF was lower in youths with T2D (SMD, -1.06; 95% CI, -1.57 to -0.56; I2 = 84%; 9 studies; 755 participants) and in youths with T1D (SMD, -0.39; 95% CI, -0.70 to -0.09; I2 = 89%; 22 studies; 2082 participants) compared with controls. Random-effects models revealed that daily physical activity was marginally lower in youths with T1D (SMD, -0.29; 95% CI, -0.46 to -0.11; I2 = 89%; 31 studies; 12 196 participants) but not different among youths with T2D (SMD, -0.56; 95% CI, -1.28 to 0.16; I2 = 91%; 9 studies; 1233 participants) compared with controls. When analyses were restricted to studies with objective measures, physical activity was significantly lower in youths with T2D (SMD, -0.71; 95% CI, -1.36 to -0.05; I2 = 23%; 3 studies; 332 participants) and T1D (SMD, -0.67; 95% CI, -1.17 to -0.17; I2 = 93%; 12 studies; 1357 participants) compared with controls. Conclusions and Relevance These findings suggest that deficits in CRF may be larger and more consistent in youths with T2D compared with youths with T1D, suggesting an increased risk for cardiovascular disease-related morbidity in adolescents with diabetes, particularly among those with T2D. The findings reinforce calls for novel interventions to empower youths living with diabetes to engage in regular physical activity and increase their CRF.
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Affiliation(s)
| | - Isaak Fast
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Brunton
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Arevalo
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John MacLean Library, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, Manitoba, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
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2
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Abushamat LA, Enge D, Fujiwara T, Schäfer M, Clark EW, Englund EK, Scalzo RL, Johnston A, Rafferty D, Schauer IE, Whipple MO, Hunter K, Huebschmann AG, Nadeau KJ, Jarvis K, Barker AJ, Regensteiner JG, Reusch JEB. Obesity dominates early effects on cardiac structure and arterial stiffness in people with type 2 diabetes. J Hypertens 2023; 41:1775-1784. [PMID: 37589719 PMCID: PMC10592255 DOI: 10.1097/hjh.0000000000003534] [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] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Type 2 diabetes (T2D) and obesity are global epidemics leading to excess cardiovascular disease (CVD). This study investigates standard and novel cardiac MRI parameters to detect subclinical cardiac and central vascular dysfunction in inactive people with and without T2D. METHODS Physically inactive age and BMI-similar premenopausal women and men with ( n = 22) and without [ n = 34, controls with overweight/obesity (CWO)] uncomplicated T2D were compared to an age-similar and sex-similar reference control cohort ( n = 20). Left ventricular (LV) structure, function, and aortic stiffness were assessed by MRI. Global arterial pulse wave velocity (PWV) was assessed using carotid-to-femoral applanation tonometry. Regional PWV was measured via 2D phase-contrast MRI and 4D flow MRI. RESULTS Global arterial PWV did not differ between CWO and T2D. 2D PC-MRI PWV in the ascending aorta was higher in people with T2D compared with CWOs ( P < 0.01). 4D flow PWV in the thoracic aorta was higher in CWO ( P < 0.01), and T2D ( P < 0.001) compared with RC. End-diastolic volume, end-systolic volume, stroke volume, and cardiac output were lower in CWO and T2D groups compared with reference control. CONCLUSION Subclinical changes in arterial stiffening and cardiac remodeling in inactive CWO and T2D compared with reference control support obesity and/or physical inactivity as determinants of incipient CVD complications in uncomplicated T2D. Future studies should determine the mechanistic causes of the CVD complications in greater detail in order to create therapeutic targets. CLINICAL TRIAL REGISTRATION Cardiovascular Mechanisms of Exercise Intolerance in Diabetes and the Role of Sex (NCT03419195).
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Affiliation(s)
- Layla A Abushamat
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Daniel Enge
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Department of Bioengineering
| | - Takashi Fujiwara
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Michal Schäfer
- Division of General Internal Medicine
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus
| | - Ethan W Clark
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Erin K Englund
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Rebecca L Scalzo
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | - Aspen Johnston
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | | | - Irene E Schauer
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | - Mary O Whipple
- Division of General Internal Medicine
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | | | - Amy G Huebschmann
- Ludeman Family Center for Women's Health Research
- Division of General Internal Medicine
| | - Kristen J Nadeau
- Ludeman Family Center for Women's Health Research
- Pediatric Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kelly Jarvis
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Bioengineering
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Judith G Regensteiner
- Ludeman Family Center for Women's Health Research
- Division of General Internal Medicine
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus
| | - Jane E B Reusch
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
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3
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Kourek C, Karatzanos E, Raidou V, Papazachou O, Philippou A, Nanas S, Dimopoulos S. Effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in type 2 diabetes: A systematic review. World J Cardiol 2023; 15:184-199. [PMID: 37124974 PMCID: PMC10130888 DOI: 10.4330/wjc.v15.i4.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/22/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic metabolic syndrome characterized by insulin resistance and hyperglycemia that may lead to endothelial dysfunction, reduced functional capacity and exercise intolerance. Regular aerobic exercise has been promoted as the most beneficial non-pharmacological treatment of cardiovascular diseases. High intensity interval training (HIIT) seems to be superior than moderate-intensity continuous training (MICT) in cardiovascular diseases by improving brachial artery flow-mediated dilation (FMD) and cardiorespiratory fitness to a greater extent. However, the beneficial effects of HIIT in patients with T2DM still remain under investigation and number of studies is limited.
AIM To evaluate the effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in patients with T2DM.
METHODS We performed a search on PubMed, PEDro and CINAHL databases, selecting papers published between December 2012 and December 2022 and identified published randomized controlled trials (RCTs) in the English language that included community or outpatient exercise training programs in patients with T2DM. RCTs were assessed for methodological rigor and risk of bias via the Physiotherapy Evidence Database (PEDro). The primary outcome was peak VO2 and the secondary outcome was endothelial function assessed either by FMD or other indices of microcirculation.
RESULTS Twelve studies were included in our systematic review. The 12 RCTs resulted in 661 participants in total. HIIT was performed in 310 patients (46.8%), MICT to 271 and the rest 80 belonged to the control group. Peak VO2 increased in 10 out of 12 studies after HIIT. Ten studies compared HIIT with other exercise regimens (MICT or strength endurance) and 4 of them demonstrated additional beneficial effects of HIIT over MICT or other exercise regimens. Moreover, 4 studies explored the effects of HIIT on endothelial function and FMD in T2DM patients. In 2 of them, HIIT further improved endothelial function compared to MICT and/or the control group while in the rest 2 studies no differences between HIIT and MICT were observed.
CONCLUSION Regular aerobic exercise training has beneficial effects on cardiorespiratory fitness and endothelial function in T2DM patients. HIIT may be superior by improving these parameters to a greater extent than MICT.
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Affiliation(s)
- Christos Kourek
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
- Department of Cardiology, 417 Army Share Fund Hospital of Athens, Athens 11521, Greece
| | - Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
| | - Vasiliki Raidou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Ourania Papazachou
- Department of Cardiology, "Helena Venizelou" Hospital, Athens 10676, Greece
| | - Anastassios Philippou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
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4
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Adolfsson P, Taplin CE, Zaharieva DP, Pemberton J, Davis EA, Riddell MC, McGavock J, Moser O, Szadkowska A, Lopez P, Santiprabhob J, Frattolin E, Griffiths G, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1341-1372. [PMID: 36537529 PMCID: PMC10107219 DOI: 10.1111/pedi.13452] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Craig E Taplin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - John Pemberton
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Michael C Riddell
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Jonathan McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Action Canada SPOR Network, Toronto, Ontario, Canada
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.,Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & Nephrology, Medical University of Lodz, Lodz, Poland
| | - Prudence Lopez
- Department of Paediatrics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeerunda Santiprabhob
- Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Linda A DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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5
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Redel JM, DiFrancesco M, Lee GR, Ziv A, Dolan LM, Brady CC, Shah AS. Cerebral blood flow is lower in youth with type 2 diabetes compared to obese controls: A pilot study. Pediatr Diabetes 2022; 23:291-300. [PMID: 35001473 DOI: 10.1111/pedi.13313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
AIM The cerebral vasculature may be susceptible to the adverse effects of type 2 diabetes. In this pilot study, we compared cerebral blood flow (CBF) in youth with type 2 diabetes to obese, euglycemic controls, and explored the association between CBF and a non-invasive measure of atherosclerosis, carotid intima-medial thickness (IMT). METHODS Global and regional CBF were compared between youth with type 2 diabetes (mean age 16.7 ± 2.0 years, n = 20) and age, race, and sex similar obese youth without diabetes (17.4 ± 1.9 years, n = 19) using arterial spin labeling magnetic resonance imaging. Mean CBF values were compared between groups. Voxel-wise results were evaluated for statistical significance (p < 0.05) after adjustment for multiple comparisons. Carotid IMT in the type 2 diabetes group was correlated with CBF. RESULTS Compared to obese controls, the type 2 diabetes group had significantly lower global CBF (49.7 ± 7.2 vs. 63.8 ± 11.5 ml/gm/min, p < 0.001). Significantly lower CBF was observed in multiple brain regions for the type 2 diabetes group, while no regions with higher CBF were identified. In the type 2 diabetes group, carotid IMT was inversely correlated with CBF, both globally (r = -0.70, p = 0.002) and in regional clusters. CONCLUSIONS In this pilot study, lower CBF was seen in youth with type 2 diabetes compared to youth with obesity and IMT was inversely correlated with CBF. Cerebrovascular impairment may be present in youth with type 2 diabetes. These findings could represent a mechanistic link to explain previously reported brain volume and neurocognitive differences.
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Affiliation(s)
- Jacob M Redel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Endocrinology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Mark DiFrancesco
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gregory R Lee
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adi Ziv
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Adolescent Medicine Unit, Department of Day Care Hospitalization, Schneider Children's Hospital Medical Center of Israel, Petah Tikva, Israel
| | - Lawrence M Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cassandra C Brady
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Division of Endocrinology and Diabetes, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Amy S Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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6
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Zhang L, Han L, Ma J, Wu T, Wei Y, Zhao L, Tong X. Exploring the synergistic and complementary effects of berberine and paeoniflorin in the treatment of type 2 diabetes mellitus by network pharmacology. Eur J Pharmacol 2022; 919:174769. [DOI: 10.1016/j.ejphar.2022.174769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/08/2021] [Accepted: 01/12/2022] [Indexed: 01/19/2023]
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7
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Shah AS, Sadayappan S, Urbina EM. Lipids: a Potential Molecular Pathway Towards Diastolic Dysfunction in Youth-Onset Type 2 Diabetes. Curr Atheroscler Rep 2022; 24:109-117. [PMID: 35080716 PMCID: PMC8930525 DOI: 10.1007/s11883-022-00989-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF THE REVIEW Obesity and type 2 diabetes (T2D) with onset in youth are emerging public health concerns. Youth with obesity and T2D are at risk for the development of heart failure with preserved ejection fraction (HFpEF) due to diabetes-related cardiomyopathy with evidence of precursor stages, namely diastolic dysfunction, present in youth. We review the literature regarding diastolic dysfunction in youth with obesity and T2D; discuss the potential mechanisms including the role of lipids, contractile proteins and their post-translational modifications, and conclude with studies to guide future treatments. RECENT FINDINGS The diabetes milieu namely hyperglycemia, hyperinsulinemia, and lipotoxicity favor development of diastolic dysfunction and HFpEF. Recent studies show HFpEF is associated with slow left ventricular relaxation and sarcomere stiffness induced by reduced calcium (Ca2+) and β-adrenergic responses. There are currently no effective therapies available for treating HFpEF. Targeting the sarcomere is an area of ongoing research.
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Affiliation(s)
- Amy S. Shah
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, 3333 Burnet Ave ML 7012, Cincinnati, OH, 45229, USA
| | - Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elaine M. Urbina
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, 3333 Burnet Ave ML 7012, Cincinnati, OH, 45229, USA,The Heart Institute, Cincinnati Children’s Hospital, and the University of Cincinnati, Cincinnati, Ohio, USA
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8
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Zaidi H, Byrkjeland R, Njerve IU, Åkra S, Solheim S, Arnesen H, Seljeflot I, Opstad TB. Adiponectin in relation to exercise and physical performance in patients with type 2 diabetes and coronary artery disease. Adipocyte 2021; 10:612-620. [PMID: 34779349 PMCID: PMC8726619 DOI: 10.1080/21623945.2021.1996699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Adipokines, expressed by adipose tissue (AT), have been associated with metabolic disturbances and coronary artery disease (CAD). The impact of exercise training on the AT in patients suffering from both diabetes and CAD is unknown. To gain knowledge on changes in ATs’ inflammatory profile in such a population, we investigated the effects of long-term exercise on selected adipokines and their associations with physical performance and glucometabolic variables. Adiponectin was selected based on its anti-atherogenic and anti-diabetic properties and visfatin and tumour necrosis factor (TNF) for their association with atherosclerosis and metabolic disorders. Not many studies have focused on the effects of long-term exercise training on adipokines in patients with concomitant T2DM and CAD. Methods: Patients with type 2 diabetes and CAD (n = 137), 41–81 years, 17.2% females, were randomized in a 1:1 manner to an exercise group, who underwent 1 year of 150 min weekly combined strength and endurance exercise, or a control group. AT from the gluteal region and blood samples were obtained at baseline and after 12 months, along with a physical performance test, assessed by the VO2 peak. Circulating protein levels were measured by ELISA. RNA was extracted from AT and expression levels were relatively quantified by PCR. Results: After 1 year, no significant difference in the change in the investigated markers between the intervention group and the control group was observed. Changes in circulating adiponectin and VO2 peak correlated in the total population (r = 0.256, p = 0.008). At baseline, circulating adiponectin and TNF correlated inversely with insulin and with C-peptide and VO2peak, respectively (p < 0.001, all). Conclusion: In this population with concomitant diabetes and CAD, ATs’ inflammatory profile remained unchanged apparently after 1 year of exercise intervention. Changes in the VO2peak were nevertheless, related to changes in circulating adiponectin levels. Trial registration: http://www.clinicaltrials.gov NCT01232608.
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Affiliation(s)
- Hani Zaidi
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway
- Faculty of Medicine, University of Oslo, Oslo Norway
| | - Rune Byrkjeland
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway
| | - Ida U. Njerve
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway
| | - Sissel Åkra
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway
| | - Svein Solheim
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway
- Faculty of Medicine, University of Oslo, Oslo Norway
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway
- Faculty of Medicine, University of Oslo, Oslo Norway
| | - Trine B. Opstad
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway
- Faculty of Medicine, University of Oslo, Oslo Norway
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9
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Burden S, Weedon B, Whaymand L, Rademaker J, Dawes H, Jones A. The effect of overweight/obesity on diastolic function in children and adolescents: A meta-analysis. Clin Obes 2021; 11:e12476. [PMID: 34278720 PMCID: PMC8767098 DOI: 10.1111/cob.12476] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
Left ventricular diastolic function (LVDF) is an important marker of early cardiovascular remodelling, which has not been well summarized in young people with overweight/obesity. Weighted, random-effects regression was used to determine the strength of associations of both body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) with LVDF measures, adjusting for age and sex. Six databases were searched after PROSPERO registration (CRD42020177470) from inception to July 2020 for studies that compared LVDF between overweight/obesity and control groups aged ≤24 years, yielding 70 studies (9983 individuals). Quality and risk of bias were assessed using NHLBI tools, with scores of good, fair, and poor for 6, 48, and 16 studies, respectively. Increased BMI was associated with worse LVDF in all measures except early mitral inflow deceleration time, with septal early diastolic tissue peak velocity to late diastolic tissue peak velocity ratio having the strongest association (n = 13 studies, 1824 individuals; r = -0.69; P < 0.001). Elevated HOMA-IR was also associated with worse LVDF. Although we could not determine the causality of reduced LVDF in young people, our findings should aid the development of paediatric guidelines for the assessment of LVDF and support further work to address the longitudinal consequences of childhood obesity and IR on LVDF.
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Affiliation(s)
- Samuel Burden
- Centre for Movement, Occupational and Rehabilitation SciencesOxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes UniversityOxfordUK
- Department of PaediatricsUniversity of OxfordOxfordUK
| | - Benjamin Weedon
- Centre for Movement, Occupational and Rehabilitation SciencesOxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes UniversityOxfordUK
- Department of PaediatricsUniversity of OxfordOxfordUK
| | - Luke Whaymand
- Centre for Movement, Occupational and Rehabilitation SciencesOxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes UniversityOxfordUK
| | | | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation SciencesOxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes UniversityOxfordUK
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Health Biomedical Research CentreOxford Health NHS Foundation TrustOxfordUK
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10
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Wolf RM, Jaffe AE, Rodriguez S, Lei X, Sarver DC, Straub AT, Wong GW, Magge SN. Altered adipokines in obese adolescents: a cross-sectional and longitudinal analysis across the spectrum of glycemia. Am J Physiol Endocrinol Metab 2021; 320:E1044-E1052. [PMID: 33900848 PMCID: PMC8285597 DOI: 10.1152/ajpendo.00626.2020] [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: 11/22/2022]
Abstract
Obesity and type 2 diabetes are rapidly increasing in the adolescent population. We sought to determine whether adipokines, specifically leptin, C1q/TNF-related proteins 1 (CTRP1) and CTRP9, and the hepatokine fibroblast growth factor 21 (FGF21), are associated with obesity and hyperglycemia in a cohort of lean and obese adolescents, across the spectrum of glycemia. In an observational, longitudinal study of lean and obese adolescents, we measured fasting laboratory tests, oral glucose tolerance tests, and adipokines including leptin, CTRP1, CTRP9, and FGF21. Participants completed baseline and 2-year follow-up study visits and were categorized as lean (LC, lean control; n = 30), obese normoglycemic (ONG; n = 61), and obese hyperglycemic (OHG; n = 31) adolescents at baseline and lean (n = 8), ONG (n = 18), and OHG (n = 4) at follow-up. Groups were compared using ANOVA and regression analysis, and linear mixed effects modeling was used to test for differences in adipokine levels across baseline and follow-up visits. Results showed that at baseline, leptin was higher in all obese groups (P < 0.001) compared with LC. FGF21 was higher in OHG participants compared with LC (P < 0.001) and ONG (P < 0.001) and positively associated with fasting glucose (P < 0.001), fasting insulin (P < 0.001), Homeostasis Model Assessment-Insulin Resistance Index (HOMA-IR; P < 0.001), and hemoglobin A1c (HbA1c; P = 0.01). CTRP1 was higher in OHG compared with ONG (P = 0.03). CTRP9 was not associated with obesity or hyperglycemia in this pediatric cohort. At 2 years, leptin decreased in ONG (P = 0.003) and FGF21 increased in OHG (P = 0.02), relative to lean controls. Altered adipokine levels are associated with the inflammatory milieu in obese youth with and without hyperglycemia. In adolescence, the novel adipokine CTRP1 was elevated with hyperglycemia, whereas CTRP9 was unchanged in this cohort.NEW & NOTEWORTHY Leptin is higher in obese adolescents and FGF21 is higher in obese hyperglycemic adolescents. The novel adipokine CTRP1 is higher in obese hyperglycemic adolescents, whereas CTRP9 was unchanged in this adolescent cohort.
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Affiliation(s)
- Risa M Wolf
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew E Jaffe
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Human Genetics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susana Rodriguez
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xia Lei
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Biochemistry, Oklahoma State University, Stillwater, Oklahoma
- Department of Molecular Biology, Oklahoma State University, Stillwater, Oklahoma
| | - Dylan C Sarver
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander T Straub
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- University of Maryland, College Park, Maryland
| | - G William Wong
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheela N Magge
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Cardiorespiratory Fitness Predicted by Fibrinogen and Leptin Concentrations in Children with Obesity and Risk for Diabetes: A Cross-Sectional Study and a ROC Curve Analysis. Nutrients 2021; 13:nu13020674. [PMID: 33669882 PMCID: PMC7923274 DOI: 10.3390/nu13020674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. The ability to exercise is affected by adiposity, and this mechanism involves low-grade chronic inflammation and homeostatic stress produced mainly in adipocytes, which can result in abnormal adipokine secretion. To date, the gold standard for cardiorespiratory fitness assessment is considered to be the maximum oxygen uptake (VO2max). The aim of the present study was to assess the prognostic value of hematological parameters of childhood obesity, as potential predictors of cardiorespiratory fitness (VO2max), using a sample of children and adolescents with obesity and risk for diabetes. A total of 84 clinically healthy children and adolescents were recruited, of which 21 were considered lean, 22 overweight and 41 obese, with a mean age of 12.0 ± 1.9, 11.4 ± 2.0, and 11.2 ± 2.1 years old, in each weight status category, respectively. Age and sex did not differ between groups. Hematologic testing was performed after 12 h of fasting including glucose, serum lipids, insulin, hc-CRP, adiponectin, leptin and fibrinogen levels. Cardiorespiratory capacity for exercise was assessed to determine VO2max, using a cycle ergometer. The VO2max was negatively correlated with progressive strength to the BMIz (-0.656, p ≤ 0.001), hs-CRP (r = -0.341, p ≤ 0.002), glucose (r = -0.404, p ≤ 0.001) and insulin levels (r = -0.348, p ≤ 0.001), the homeostasis model assessment of insulin resistance (HOMA-IR) (r = -0.345, p ≤ 0.002), as well as to the leptin (r = -0.639, p ≤ 0.001) and fibrinogen concentrations (r = -0.520, p ≤ 0.001). The multivariate analysis revealed that only leptin and fibrinogen concentrations could predict the VO2max adjusted for the BMIz of participants. The receiver operating characteristic (ROC) curve for the diagnostic accuracy of leptin, hs-CRP and fibrinogen concentrations for the prediction of VO2max revealed a good diagnostic ability for all parameters, with leptin being the most promising one (area under the curve (AUC): 99%). The results verify that in children with obesity, VO2max may be predicted from hematological parameters (leptin and fibrinogen), possibly bypassing more invasive methods.
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12
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Scalzo RL, Schauer IE, Rafferty D, Knaub LA, Kvaratskhelia N, Johnson TK, Pott GB, Abushamat LA, Whipple MO, Huebschmann AG, Cree-Green M, Reusch JEB, Regensteiner JG. Single-leg exercise training augments in vivo skeletal muscle oxidative flux and vascular content and function in adults with type 2 diabetes. J Physiol 2021; 600:963-978. [PMID: 33569797 DOI: 10.1113/jp280603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/28/2021] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS People with type 2 diabetes (T2D) have impaired skeletal muscle oxidative flux due to limited oxygen delivery. In the current study, this impairment in oxidative flux in people with T2D was abrogated with a single-leg exercise training protocol. Additionally, single-leg exercise training increased skeletal muscle CD31 content, calf blood flow and state 4 mitochondrial respiration in all participants. ABSTRACT Cardiorespiratory fitness is impaired in type 2 diabetes (T2D), conferring significant cardiovascular risk in this population; interventions are needed. Previously, we reported that a T2D-associated decrement in skeletal muscle oxidative flux is ameliorated with acute use of supplemental oxygen, suggesting that skeletal muscle oxygenation is rate-limiting to in vivo mitochondrial oxidative flux during exercise in T2D. We hypothesized that single-leg exercise training (SLET) would improve the T2D-specific impairment in in vivo mitochondrial oxidative flux during exercise. Adults with (n = 19) and without T2D (n = 22) with similar body mass indexes and levels of physical activity participated in two weeks of SLET. Following SLET, in vivo oxidative flux measured by 31 P-MRS increased in participants with T2D, but not people without T2D, measured by the increase in initial phosphocreatine synthesis (P = 0.0455 for the group × exercise interaction) and maximum rate of oxidative ATP synthesis (P = 0.0286 for the interaction). Additionally, oxidative phosphorylation increased in all participants with SLET (P = 0.0209). After SLET, there was no effect of supplemental oxygen on any of the in vivo oxidative flux measurements in either group (P > 0.02), consistent with resolution of the T2D-associated oxygen limitation previously observed at baseline in subjects with T2D. State 4 mitochondrial respiration also improved in muscle fibres ex vivo. Skeletal muscle vasculature content and calf blood flow increased in all participants with SLET (P < 0.0040); oxygen extraction in the calf increased only in T2D (P = 0.0461). SLET resolves the T2D-associated impairment of skeletal muscle in vivo mitochondrial oxidative flux potentially through improved effective blood flow/oxygen delivery.
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Affiliation(s)
- Rebecca L Scalzo
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Irene E Schauer
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Deirdre Rafferty
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Leslie A Knaub
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Nina Kvaratskhelia
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Taro Kaelix Johnson
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gregory B Pott
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Layla A Abushamat
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Mary O Whipple
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy G Huebschmann
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Melanie Cree-Green
- Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jane E B Reusch
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Administration Medical Center, Aurora, Colorado, USA
| | - Judith G Regensteiner
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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13
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Li T, Li G, Guo X, Li Z, Yang J, Sun Y. The influence of diabetes and prediabetes on left heart remodeling: A population-based study. J Diabetes Complications 2021; 35:107771. [PMID: 33144026 DOI: 10.1016/j.jdiacomp.2020.107771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diabetes was regarded as an independent risk factor for abnormal left heart remodeling. However, there was lacking population-based data on the relationship of glucose status with left ventricular hypertrophy (LVH) or left atrial enlargement (LAE). This study intended to clarify the influence of diabetes and prediabetes on the prevalence and incidence of LVH and LAE based on a northeast rural population of China. METHODS We analyzed clinical, laboratory and echocardiographic data of a total of 2824 participants aged over 35 years from a population-based prospective cohort NCRCHS study with 2 years of follow-up, which was carried out in rural areas of northeast China. All measurements were performed according to standardized protocols. RESULTS There were 2179 controls, 342 subjects with prediabetes and 303 ones with diabetes. The baseline distribution of LAD, IVSd, LVIDd, LVIDs, LVMI, E wave, A wave, E/A, E/e', diastolic dysfunction, LVEDV, LVESV and SV was significantly different among three groups (all Ptrend<0.05). After the adjustment for age, gender, BMI, waist circumference, heart rate, hypertension and dyslipidemia, glucose status remained associated with LVIDd and E/e' (all P < 0.05). At baseline, diabetes was independently related to the prevalence of LVH (OR = 1.53; 95%CI = 1.12-2.10; P < 0.01) and LAE (OR = 1.71; 95%CI = 1.19-2.43; P < 0.01) in the overall population, and the same significant results were also found in gender specific subgroups. During the 2-year follow-up, Cox regression models revealed that baseline diabetes had an independent association with the incidence of LAE in the total subjects (HR = 1.83; 95%CI = 1.10-3.06; P = 0.02) and females (HR = 1.90; 95%CI = 1.05-3.46; P = 0.04) after adjusting the potential confounders. CONCLUSION Diabetes, but not prediabetes, is an independent predictor for the prevalence of LVH and LAE, and for the new-onset LAE, it should be considered in the assessment of diabetes and cardiac structural remodeling.
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Affiliation(s)
- Tan Li
- Department of Cardiovascular Ultrasound, the First Hospital of China Medical University, Shenyang 110001, China.
| | - Guangxiao Li
- Department of Medical Record Management Center, the First Hospital of China Medical University, Shenyang 110001, China.
| | - Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China.
| | - Zhao Li
- Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China.
| | - Jun Yang
- Department of Cardiovascular Ultrasound, the First Hospital of China Medical University, Shenyang 110001, China.
| | - Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University, Shenyang 110001, China.
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14
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Shah AS, Jaiswal M, Dabelea D, Divers J, Isom S, Liese AD, Lawrence JM, Kim G, Urbina EM. Cardiovascular risk and heart rate variability in young adults with type 2 diabetes and arterial stiffness: The SEARCH for Diabetes in Youth Study. J Diabetes Complications 2020; 34:107676. [PMID: 32713707 PMCID: PMC7502460 DOI: 10.1016/j.jdiacomp.2020.107676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate cardiovascular risk factors and heart rate variability (HRV) in young adults with type 2 diabetes and arterial stiffness and to explore the relationship between HRV and arterial stiffness. METHODS We studied 185 young adults with youth-onset T2D enrolled in the SEARCH for Diabetes in Youth Study. Cardiovascular risk factors and HRV were compared between individuals with and without type 2 diabetes and arterial stiffness (defined as a pulse wave velocity greater than the 90th percentile of healthy controls, >6.767 m/s). Semiparametric regression evaluated the independent relationship between HRV and PWV. RESULTS Participants with T2D and arterial stiffness were more likely to be older, non-Hispanic Black, have higher systolic and diastolic blood pressure, greater adiposity and obesity-related dyslipidemia (higher triglycerides and lower HDLC). Participants with T2D and arterial stiffness also had lower overall HRV (lower SDNN) with parasympathetic loss (lower RMSSD and PNN50), p < 0.05. Lower HRV tended to be but was not significantly associated with arterial stiffness after adjustment for age, race/ethnicity, sex and cardiovascular risk factors (beta coefficient = -1.11, p = 0.08). CONCLUSIONS Youth with T2D and arterial stiffness have a worse cardiovascular risk profile, specifically risk factors related to the metabolic syndrome and lower HRV.
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Affiliation(s)
- Amy Sanghavi Shah
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati, United States of America.
| | - Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Jasmin Divers
- Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY, United States of America
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Grace Kim
- Seattle Children's Hospital, Seattle, WA, United States of America
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati, United States of America
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15
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Nesti L, Pugliese NR, Sciuto P, Natali A. Type 2 diabetes and reduced exercise tolerance: a review of the literature through an integrated physiology approach. Cardiovasc Diabetol 2020; 19:134. [PMID: 32891175 PMCID: PMC7487838 DOI: 10.1186/s12933-020-01109-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) is well established. Early in the course of the diabetic disease, some degree of impaired exercise capacity (a powerful marker of health status with prognostic value) can be frequently highlighted in otherwise asymptomatic T2DM subjects. However, the literature is quite heterogeneous, and the underlying pathophysiologic mechanisms are far from clear. Imaging-cardiopulmonary exercise testing (CPET) is a non-invasive, provocative test providing a multi-variable assessment of pulmonary, cardiovascular, muscular, and cellular oxidative systems during exercise, capable of offering unique integrated pathophysiological information. With this review we aimed at defying the cardiorespiratory alterations revealed through imaging-CPET that appear specific of T2DM subjects without overt cardiovascular or pulmonary disease. In synthesis, there is compelling evidence indicating a reduction of peak workload, peak oxygen assumption, oxygen pulse, as well as ventilatory efficiency. On the contrary, evidence remains inconclusive about reduced peripheral oxygen extraction, impaired heart rate adjustment, and lower anaerobic threshold, compared to non-diabetic subjects. Based on the multiparametric evaluation provided by imaging-CPET, a dissection and a hierarchy of the underlying mechanisms can be obtained. Here we propose four possible integrated pathophysiological mechanisms, namely myocardiogenic, myogenic, vasculogenic and neurogenic. While each hypothesis alone can potentially explain the majority of the CPET alterations observed, seemingly different combinations exist in any given subject. Finally, a discussion on the effects -and on the physiological mechanisms-of physical activity and exercise training on oxygen uptake in T2DM subjects is also offered. The understanding of the early alterations in the cardiopulmonary response that are specific of T2DM would allow the early identification of those at a higher risk of developing HF and possibly help to understand the pathophysiological link between T2DM and HF.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy. .,Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Paolo Sciuto
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
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16
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Abushamat LA, McClatchey PM, Scalzo RL, Schauer I, Huebschmann AG, Nadeau KJ, Liu Z, Regensteiner JG, Reusch JEB. Mechanistic Causes of Reduced Cardiorespiratory Fitness in Type 2 Diabetes. J Endocr Soc 2020; 4:bvaa063. [PMID: 32666009 PMCID: PMC7334033 DOI: 10.1210/jendso/bvaa063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes (T2D) has been rising in prevalence in the United States and worldwide over the past few decades and contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable cardiovascular (CV) risk factor in the general population and in people with T2D. Young people and adults with T2D have reduced CRF when compared with their peers without T2D who are similarly active and of similar body mass index. Furthermore, the impairment in CRF conferred by T2D is greater in women than in men. Various factors may contribute to this abnormality in people with T2D, including insulin resistance and mitochondrial, vascular, and cardiac dysfunction. As proof of concept that understanding the mediators of impaired CRF in T2D can inform intervention, we previously demonstrated that an insulin sensitizer improved CRF in adults with T2D. This review focuses on how contributing factors influence CRF and why they may be compromised in T2D. Functional exercise capacity is a measure of interrelated systems biology; as such, the contribution of derangement in each of these factors to T2D-mediated impairment in CRF is complex and varied. Therefore, successful approaches to improve CRF in T2D should be multifaceted and individually designed. The current status of this research and future directions are outlined.
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Affiliation(s)
- Layla A Abushamat
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | - Rebecca L Scalzo
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Irene Schauer
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Amy G Huebschmann
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Zhenqi Liu
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Judith G Regensteiner
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Jane E B Reusch
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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17
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Longitudinal Changes in Cardiac Structure and Function From Adolescence to Young Adulthood in Participants With Type 2 Diabetes Mellitus: The TODAY Follow-Up Study. Circ Heart Fail 2020; 13:e006685. [PMID: 32498621 DOI: 10.1161/circheartfailure.119.006685] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure is a prominent complication of type 2 diabetes mellitus (T2D). The goal of this study was to provide longitudinal data on cardiac structure and function (and cross-sectional comparison to normal-weight and obese controls without T2D) in individuals followed from adolescence with youth-onset T2D. METHODS In the TODAY study (Treatment Options for Type 2 Diabetes Mellitus in Adolescents and Youth), echocardiograms were performed at study years 4 to 5 and 9 to 10. Echocardiograms were also obtained at years 8 to 9 in a control population of age, race/ethnicity, and sex-matched normal-weight and obese individuals without diabetes mellitus. Study outcomes were measures of left ventricular structure and function. The cohort included 411 participants with T2D, 194 obese controls, and 51 normal-weight controls. RESULTS At follow-up, mean participant age was 23 years, 65% women, 20% non-Hispanic white, 35% non-Hispanic black, and 39% Hispanic. Ejection fraction was <52% in 11.7% of male participants with T2D. Diastolic function declined during follow-up in participants with T2D (mitral valve lateral E/Em increased 0.72±0.12 in women and 0.50±0.17 in men; P<0.01) and was significantly higher than obese controls (women, 6.65±1.89 versus 5.66±1.37; men, 6.15±1.90 versus 5.26±1.31; P<0.0001). Predictors of adverse changes included hypertension, obesity, female sex, Hispanic and non-Hispanic black ethnicity, worse glycemic control, and elevated heart rate. Cardiac structural abnormalities, left ventricular hypertrophy, or concentric geometry, were highest in those with T2D (15.8% versus 5.7% obese versus 0% normal weight). CONCLUSIONS Adverse changes in cardiac structure and function changed significantly from adolescence to early adulthood in participants with youth-onset T2D. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00081328.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Case-Control Studies
- Cross-Sectional Studies
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/drug therapy
- Diabetic Cardiomyopathies/diagnostic imaging
- Diabetic Cardiomyopathies/etiology
- Diabetic Cardiomyopathies/physiopathology
- Disease Progression
- Echocardiography
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Hypoglycemic Agents/therapeutic use
- Longitudinal Studies
- Male
- Randomized Controlled Trials as Topic
- Risk Factors
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Remodeling
- Young Adult
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18
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Abstract
The purpose of this review is to provide an update on the changing face of paediatric type 1 diabetes and type 2 diabetes. Paediatric diabetes is on the rise, with extensive research dedicated to understanding its pathophysiology, comorbidities and complications. As obesity continues to increase among all youth, differentiating between type 1 diabetes and type 2 diabetes has become increasingly difficult but remains important for optimising treatment, anticipating complications and predicting disease risk. Novel treatments are emerging, with the ultimate goal being to achieve glycaemic control, limit weight gain, improve quality of life and reduce comorbidities. In this review, we focus on updates regarding the epidemiology, clinical presentation, comorbidities and complications of paediatric type 1 diabetes and type 2 diabetes and conclude with current and emerging treatments.
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Affiliation(s)
- Amy S Shah
- University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA.
- Cincinnati Children's Hospital Medical Center, Division of Endocrinology, 3333 Burnet Ave, ML 7012, Cincinnati, OH, 45229, USA.
| | - Kristen J Nadeau
- University of Denver, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Division of Endocrinology, Aurora, CO, USA
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19
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Haley JE, Zhiqian G, Philip KR, Nicolas ML, Thomas KR, Lawrence DM, Elaine UM. Reduction in myocardial strain is evident in adolescents and young adults with obesity and type 2 diabetes. Pediatr Diabetes 2020; 21:243-250. [PMID: 31825129 DOI: 10.1111/pedi.12961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 01/19/2023] Open
Abstract
AIMS/HYPOTHESIS Heart failure is a complication of type 2 diabetes (T2DM). Echocardiography can identify subclinical systolic dysfunction in adults with T2DM. We hypothesized that reduced systolic strain was present in youth with T2DM. METHODS Global longitudinal strain (GLS) was measured in 151 subjects with T2DM matched to lean (L = 146), and obese (O = 162) subjects (23.0 ± 4.0 years, 35% male, 63% African American). Anthropometrics, BP, HR, labs, and echocardiograms were obtained. ANOVA was performed to compare differences among groups, and ANCOVA to determine if T2DM remained an independent predictor after corrections. RESULTS BP, lipid levels, and metabolic control worsened and GLS was reduced from L to O to T2DM. BMI was lower in L than O or T2DM. Global longitudinal strain rate (GLSR) was lower and LVM/ht2.7 was higher in O and T2DM as compared to L (all P ≤ .05). Presence of T2DM was an independent determinant of GLS and GLSR adjusted for most CV risk factors, but lost significance when BMI was added to the model. GLS = -21.6-age*0.088 - male*1.8 + 0.12*BMI + 0.045*DBP + 0.058*HR - 0.023*HDL (R2 = 0.38, P ≤ .0001); GLSR = -1.20-male*0.093 + WHR*0.48 + DBP*0.0029 (R2 = 0.23, P ≤ .0001). CONCLUSION Both adiposity and T2DM have a deleterious effect on systolic cardiac function. Treatment of obesity in youth is necessary for prevention of future heart failure.
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Affiliation(s)
- Jessica E Haley
- Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Diego and Rady Children's Hospital, San Diego, California
| | - Gao Zhiqian
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Khoury R Philip
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Madsen L Nicolas
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Kimball R Thomas
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Dolan M Lawrence
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Urbina M Elaine
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
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Varda NM, Medved M, Ojsteršek L. The associations between some biological markers, obesity, and cardiovascular risk in Slovenian children and adolescents. BMC Pediatr 2020; 20:81. [PMID: 32085704 PMCID: PMC7033855 DOI: 10.1186/s12887-020-1978-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/12/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The occurrence of cardiovascular diseases and metabolic disorders steadily increases with the body mass index (BMI). Since the latter is not the best and earliest indicator of obesity and cardiovascular risk, the aim of the study was to evaluate some potential biological markers that would allow us to detect children and adolescents at higher risk at an early stage. METHODS A sample of 330 children and adolescents were included in the study and divided into four groups: obese patients with hypertension, normal-weight patients with hypertension, patients with mildly elevated lipids and a control group of healthy children and adolescents. Some clinical parameters (age, body weight, body height, BMI, waist circumference, hip circumference, blood pressure), biochemical parameters (glucose, total cholesterol, triglycerides, HDL, LDL, apolipoprotein A1, homocysteine) and biological markers of obesity (ghrelin, adiponectin, leptin) were evaluated. RESULTS Ghrelin and adiponectin were found to have a strong negative statistically significant correlation with BMI in all three observed groups (p < 0.001), but not in the control group (p = 0.053 and p = 0.316, respectively). In addition, leptin had a strong positive statistically significant correlation with BMI in all four groups (p < 0.001 for the research groups, p = 0.009 for the controls). In the group of obese patients with hypertension, statistically significant differences in all three markers of obesity were found in comparison to the control group (p < 0.001 for all markers). In the group of patients with mildly elevated lipids, ghrelin and leptin were significantly different (p = 0.002 and p < 0.001, respectively). In the group of normal-weight hypertensive patients, only values of ghrelin were different compared to the control group (p = 0.001). CONCLUSION In the research groups, significant differences were found in clinical, biochemical and biological parameters compared to the control group. The observed biological markers of obesity are useful early markers for identifying groups of patients that are at cardiovascular risk.
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Affiliation(s)
- Nataša Marčun Varda
- Department of Pediatrics, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Martina Medved
- University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Laura Ojsteršek
- University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
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Shah AS, Nadeau KJ, Helmrath MA, Inge TH, Xanthakos SA, Kelsey MM. Metabolic outcomes of surgery in youth with type 2 diabetes. Semin Pediatr Surg 2020; 29:150893. [PMID: 32238292 PMCID: PMC7125189 DOI: 10.1016/j.sempedsurg.2020.150893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Youth-onset type 2 diabetes (T2D) is a formidable threat to the health of obese adolescents because of its potential for early-onset and aggressive co-morbidities and complications. The physiology of youth-onset T2D differs from T2D in adults and is associated with a greater degree of insulin resistance, a more rapid decline in pancreatic β-cell function, and a poorer response to medications. Medical management in youth is focused on combining lifestyle intervention and pharmacological treatment, but these therapies have yet to demonstrate improvements in disease progression. Metabolic bariatric surgery (MBS) is now recommended for the treatment of T2D in adults largely because of the beneficial effects on weight, ability to improve glycemic control, and, in a large proportion of people, induce diabetes remission. MBS is now being performed in adolescents with severe obesity and T2D, with initial results also showing high rates of T2D remission. Here, we review the state of medical management of youth-onset T2D and the outcomes of MBS studies in youth with T2D published to date.
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Affiliation(s)
- Amy S Shah
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kristen J Nadeau
- Denver and Children's Hospital Colorado, Division of Pediatric Endocrinology, University of Colorado, Aurora, CO, United States
| | - Michael A Helmrath
- Department of Pediatric Surgery, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Thomas H Inge
- Denver and Children's Hospital Colorado, Division of Pediatric Surgery, University of Colorado, Aurora, CO, United States
| | - Stavra A Xanthakos
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Megan M Kelsey
- Denver and Children's Hospital Colorado, Division of Pediatric Endocrinology, University of Colorado, Aurora, CO, United States
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22
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Brar PC, Chun A, Fan X, Jani V, Craft M, Bhatla P, Kutty S. Impaired myocardial deformation and ventricular vascular coupling in obese adolescents with dysglycemia. Cardiovasc Diabetol 2019; 18:172. [PMID: 31856856 PMCID: PMC6921397 DOI: 10.1186/s12933-019-0976-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022] Open
Abstract
Background It is unknown that dysglycemia in obese adolescents has effects on myocardial deformation that are more pronounced when compared to obesity alone. We hypothesized that obesity associated abnormal glucose tolerance (dysglycemia) would have adverse effects on two-dimensional speckle tracking echocardiography derived longitudinal, radial and circumferential strain (LS, RS, CS) compared to age and gender lean controls. We also examined if changes in deformation would be reflected in abnormal ventricular vascular coupling indices (VVI). Methods In a prospective cross-sectional design 39 obese adolescents (15.9 ± 1.7 years; 101.5 ± 39 kg; female − 58%) were compared to age and gender matched lean controls (15.7 ± 1.8 yrs, 60 ± 12.8 kg). Based on results from an oral glucose tolerance test (OGTT), obese adolescents were categorized as obese normoglycemic (ONG, n = 25) or obese dysglycemic (ODG, n = 14). Left ventricular (LV) global and average LS, CS, RS and strain rate were measured. LV ejection fraction and mass index were measured and VVI approximated as ratio of arterial elasticity (Ea) and end-systolic elastance (Ees). Results Adolescents with ODG had significantly (P = 0.005) impaired global LS (− 20.98% ± 2.8%) compared to controls (− 23.01% ± 2.3%). A similar (P = 0.0027) reduction was observed in average LS for adolescents with ODG (18.87% ± 2.5%) compared to controls (20.49% ± 2%). Global CS was also decreased (P = 0.03) in ODG (− 23.95%) compared to ONG (− 25.80). A similar trend was observed in average CS after multivariate regression for BMI and blood pressure. CS correlated with HbA1c in both groups (P = 0.05). VVI had a negative correlation with both LS (r = − 0.4, P = 0.025) and CS rate (r = − 0.36, P = 0.04). Conclusions Myocardial strain and strain rate were significantly altered in obese adolescents. Unfavorable subclinical reductions in global and average CS were more pronounced in adolescents with dysglycemia compared to obese adolescents with normoglycemia and controls. These data indicate progressive worsening of subendocardial function across the spectrum of glucose tolerance. Strain rate was predictive of VVI in obese adolescents, suggesting strain rate may be a sensitive marker for cardiac remodeling in abnormal glucose homeostasis states.
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Affiliation(s)
- Preneet Cheema Brar
- Division of Endocrinology and Diabetes, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Anne Chun
- Division of Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Xiazhou Fan
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Vivek Jani
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans Street, Baltimore, MD, 21205-2196, USA
| | - Mary Craft
- Division of Pediatric Cardiology, University of Nebraska College of Medicine, Omaha, NE, 68918, USA
| | - Puneet Bhatla
- Division of Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans Street, Baltimore, MD, 21205-2196, USA.
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23
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Nyambuya TM, Dludla PV, Mxinwa V, Nkambule BB. Obesity-induced inflammation and insulin resistance: A mini-review on T-cells. Metabol Open 2019; 3:100015. [PMID: 32812921 PMCID: PMC7424835 DOI: 10.1016/j.metop.2019.100015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/29/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022] Open
Abstract
Excessive lipid accumulation in an obese state is linked with activation and release of detrimental cytokines and chemokines that promote metabolic dysregulation. In fact, emerging experimental evidence shows that abnormal modulation of T-cells in an obese state correlates with the development and progression of insulin resistance. Importantly, the evolving concept linking insulin resistance with impaired immunological mechanisms such as T-cell responses provides new prospects for understanding the role of inflammation in moderating metabolic complications.
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Affiliation(s)
- Tawanda Maurice Nyambuya
- School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Health Sciences, Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia
| | - Phiwayinkosi Vusi Dludla
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, South Africa
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Vuyolwethu Mxinwa
- School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bongani Brian Nkambule
- School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Scalzo RL, Rafferty D, Schauer I, Huebschmann AG, Cree-Green M, Reusch JEB, Regensteiner JG. Sitagliptin improves diastolic cardiac function but not cardiorespiratory fitness in adults with type 2 diabetes. J Diabetes Complications 2019; 33:561-566. [PMID: 31182338 PMCID: PMC7278036 DOI: 10.1016/j.jdiacomp.2019.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND People with type 2 diabetes mellitus (T2D) have preclinical cardiac and vascular dysfunction associated with low cardiorespiratory fitness (CRF). This is especially concerning because CRF is a powerful predictor of cardiovascular mortality, a primary issue in T2D management. Glucagon-like pepetide-1 (GLP-1) augments cardiovascular function and our previous data in rodents demonstrate that potentiating the GLP-1 signal with a dipeptidyl peptidase-4 (DPP4) inhibitor augments CRF. Lacking are pharmacological treatments which can target T2D-specific physiological barriers to exercise to potentially permit adaptations necessary to improve CRF and thereby health outcomes in people with T2D. We therefore hypothesized that administration of a DPP4-inhibitor (sitagliptin) would improve CRF in adults with T2D. METHODS AND RESULTS Thirty-eight participants (64 ± 1 years; mean ± SE) with T2D were randomized in a double-blinded study to receive 100 mg/day sitagliptin, 2 mg/day glimepiride, or placebo for 3 months after baseline measurements. Fasting glucose decreased with both glimepiride and sitagliptin compared with placebo (P = 0.002). CRF did not change in any group (Placebo: Pre: 15.4 ± 0.9 vs. Post: 16.1 ± 1.1 ml/kg/min vs. Glimepiride: 18.5 ± 1.0 vs. 17.7 ± 1.2 ml/kg/min vs. Sitagliptin: 19.1 ± 1.2 vs. 18.3 ± 1.1 ml/kg/min; P = 0.3). Sitagliptin improved measures of cardiac diastolic function, however, measures of vascular function did not change with any treatment. CONCLUSIONS Three months of sitagliptin improved diastolic cardiac function, however, CRF did not change. These data suggest that targeting the physiological contributors to CRF with sitagliptin alone is not an adequate strategy to improve CRF in people with T2D. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov NCT01951339.
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Affiliation(s)
- Rebecca L Scalzo
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America.
| | - Deirdre Rafferty
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America
| | - Irene Schauer
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America
| | - Amy G Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America
| | - Melanie Cree-Green
- Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Division of Pediatric Endocrinology, University of Colorado School of Medicine, United States of America
| | - Jane E B Reusch
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America; Rocky Mountain Regional Veterans Administration Medical Center, United States of America
| | - Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States of America; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, United States of America
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Leffler KE, Abdel-Rahman AA. Estrogen-Dependent Disruption of Adiponectin-Connexin43 Signaling Underlies Exacerbated Myocardial Dysfunction in Diabetic Female Rats. J Pharmacol Exp Ther 2018; 368:208-217. [PMID: 30523063 DOI: 10.1124/jpet.118.254029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/04/2018] [Indexed: 12/27/2022] Open
Abstract
The reasons for the higher severity of type 2 diabetes (T2DM)-associated cardiomyopathy in women, despite their inherent estrogen (E2)-dependent cardioprotection, remain unknown. We hypothesized that the reliance of the healthy females' hearts on augmented adiponectin (APN)-connexin 43 (Cx43) signaling becomes paradoxically detrimental when disrupted by T2DM in an E2-dependent manner. We tested this hypothesis in high-fat, low- dose streptozotocin diabetic rats and their controls with the following designations: 1) sham-operated (SO), 2) ovariectomized (OVX), 3) ovariectomized with E2 supplementation (OVX + E2), and 4) male. E2-replete (SO or OVX + E2) diabetic rats exhibited higher mortality and greater increases in left ventricular (LV) mass and reduced LV developed pressure, LV contractility, and fractional shortening but preserved ejection fraction. Further, compared with respective nondiabetic counterparts, the hearts of these E2-replete diabetic rats exhibited greater upregulation of cardiac estrogen receptor α and reductions in Cx43 expression and in the phosphorylation levels of the survival molecules extracellular regulating kinases 1/2 and phosphorylated AKT (pAKT). Whereas serum APN was reduced, independent of sex and ovarian hormone status in all DM rats, cardiac APN was most drastically reduced in DM SO rats. The present translational findings are the first to implicate ovarian hormones/E2 in the exacerbated myocardial dysfunction in female diabetic subjects and to suggest a pivotal role for malfunctioning cardiac APN-Cx43 signaling in this sex/E2-specific clinical problem.
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Affiliation(s)
- Korin E Leffler
- Department of Pharmacology and Toxicology, East Carolina University, Brody School of Medicine, Greenville, North Carolina
| | - Abdel A Abdel-Rahman
- Department of Pharmacology and Toxicology, East Carolina University, Brody School of Medicine, Greenville, North Carolina
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Abe T, Loenneke JP, Thiebaud RS. Fat-Free Adipose Tissue Mass: Impact on Peak Oxygen Uptake (VO2peak) in Adolescents with and without Obesity. Sports Med 2018; 49:9-15. [DOI: 10.1007/s40279-018-1020-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Scalzo RL, Knaub LA, Hull SE, Keller AC, Hunter K, Walker LA, Reusch JEB. Glucagon-like peptide-1 receptor antagonism impairs basal exercise capacity and vascular adaptation to aerobic exercise training in rats. Physiol Rep 2018; 6:e13754. [PMID: 29984491 PMCID: PMC6036104 DOI: 10.14814/phy2.13754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/18/2022] Open
Abstract
Cardiorespiratory fitness (CRF) inversely predicts cardiovascular (CV) mortality and CRF is impaired in people with type 2 diabetes (T2D). Aerobic exercise training (ET) improves CRF and is associated with decreased risk of premature death in healthy and diseased populations. Understanding the mechanisms contributing to ET adaptation may identify targets for reducing CV mortality of relevance to people with T2D. The antihyperglycemic hormone glucagon-like peptide-1 (GLP-1) influences many of the same pathways as exercise and may contribute to CV adaptation to ET. We hypothesized that GLP-1 is necessary for adaptation to ET. Twelve-week-old male Wistar rats were randomized (n = 8-12/group) to receive PBS or GLP-1 receptor antagonist (exendin 9-39 (Ex(9-39)) via osmotic pump for 4 weeks ± ET. CRF was greater with ET (P < 0.01). Ex(9-39) treatment blunted CRF in both sedentary and ET rats (P < 0.001). Ex(9-39) attenuated acetylcholine-mediated vasodilation, while this response was maintained with Ex(9-39)+ET (P = 0.04). Aortic stiffness was greater with Ex(9-39) (P = 0.057) and was made worse when Ex(9-39) was combined with ET (P = 0.004). Ex vivo aortic vasoconstriction with potassium and phenylephrine was lower with Ex(9-39) (P < 0.0001). Carotid strain improved with PBS + ET but did not change in the Ex(9-39) rats with ET (P < 0.0001). Left ventricular mitochondrial respiration was elevated with Ex(9-39) (P < 0.02). GLP-1 receptor antagonism impairs CRF with and without ET, attenuates the vascular adaptation to ET, and elevates cardiac mitochondrial respiration. These data suggest that GLP-1 is integral to the adaptive vascular response to ET.
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Affiliation(s)
- Rebecca L. Scalzo
- Division of EndocrinologyUniversity of Colorado School of MedicineAuroraColorado
| | - Leslie A. Knaub
- Division of EndocrinologyUniversity of Colorado School of MedicineAuroraColorado
| | - Sara E. Hull
- Division of EndocrinologyUniversity of Colorado School of MedicineAuroraColorado
| | - Amy C. Keller
- Division of EndocrinologyUniversity of Colorado School of MedicineAuroraColorado
- Department of MedicineDenver VA Medical CenterUniversity of Colorado School of MedicineAuroraColorado
| | - Kendall Hunter
- Division of BioengineeringUniversity of Colorado School of MedicineAuroraColorado
| | - Lori A. Walker
- Division of CardiologyUniversity of Colorado School of MedicineAuroraColorado
| | - Jane E. B. Reusch
- Division of EndocrinologyUniversity of Colorado School of MedicineAuroraColorado
- Department of MedicineDenver VA Medical CenterUniversity of Colorado School of MedicineAuroraColorado
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Cardiac Biomarkers in Youth with Type 2 Diabetes Mellitus: Results from the TODAY Study. J Pediatr 2018; 192:86-92.e5. [PMID: 29246363 PMCID: PMC5806514 DOI: 10.1016/j.jpeds.2017.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/28/2017] [Accepted: 09/07/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine cardiac biomarkers over time in youth-onset type 2 diabetes, and relate serum concentrations to cardiovascular disease risk factors, and left ventricular structure and function. STUDY DESIGN TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) was a multicenter randomized trial of 3 treatments including 521 participants with type 2 diabetes, aged 10-17 years, and with 2-6 years of follow-up. Participants were 36% male, obese, and ethnically diverse. Annual serum concentrations of brain natriuretic peptide, troponin, tumor necrosis factor (TNF)-α, receptors 1 and 2 were related to blood pressure, body mass index, hemoglobin A1c, and left ventricular ejection fraction, diastolic function, relative wall thickness, and mass. RESULTS Elevated concentrations of brain natriuretic peptide (≥100 pg/mL), TNF-α (≥5.6 pg/mL) and troponin (≥0.01 ng/mL), were present in 17.8%, 18.3%, and 34.2% of the cohort, respectively, at baseline, and in 15.4%, 17.1%, and 31.1% at the end of the study, with wide variability over time, without persistence in individuals or clear relationship to glycemia or cardiovascular structure/function. TNF receptors concentrations were increased at baseline and not significantly different from end-of-study concentrations. Adverse echocardiographic measures were more likely in the highest TNF receptor tertile (all P < .05): higher left ventricular mass (39.3 ± 9.0 g/m2.7), left atrial internal dimension (3.7 ± 0.4 cm) and E/Em ratio, a measure of diastolic dysfunction (6.2 ± 1.9). After adjustment for body mass index, these relationships were no longer significant. CONCLUSIONS Elevated serum concentrations of cardiac biomarkers were common in youth with type 2 diabetes, but their clinical significance is unclear and will require further long-term study. TRIAL REGISTRATION ClinicalTrials.govNCT00081328.
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Scalzo RL, Bauer TA, Harrall K, Moreau K, Ozemek C, Herlache L, McMillin S, Huebschmann AG, Dorosz J, Reusch JEB, Regensteiner JG. Acute vitamin C improves cardiac function, not exercise capacity, in adults with type 2 diabetes. Diabetol Metab Syndr 2018; 10:7. [PMID: 29456629 PMCID: PMC5813393 DOI: 10.1186/s13098-018-0306-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/04/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People with type 2 diabetes (T2D) have impaired exercise capacity, even in the absence of complications, which is predictive of their increased cardiovascular mortality. Cardiovascular dysfunction is one potential cause of this exercise defect. Acute infusion of vitamin C has been separately shown to improve diastolic and endothelial function in prior studies. We hypothesized that acute vitamin C infusion would improve exercise capacity and that these improvements would be associated with improved cardiovascular function. METHODS Adults with T2D (n = 31, 7 female, 24 male, body mass index (BMI): 31.5 ± 0.8 kg/m2) and BMI-similar healthy adults (n = 21, 11 female, 10 male, BMI: 30.4 ± 0.7 kg/m2) completed two randomly ordered visits: IV infusion of vitamin C (7.5 g) and a volume-matched saline infusion. During each visit peak oxygen uptake (VO2peak), brachial artery flow mediated dilation (FMD), reactive hyperemia (RH; plethysmography), and cardiac echocardiography were measured. General linear mixed models were utilized to assess the differences in all study variables. RESULTS Acute vitamin C infusion improved diastolic function, assessed by lateral and septal E:E' (P < 0.01), but did not change RH (P = 0.92), or VO2peak (P = 0.33) in any participants. CONCLUSION Acute vitamin C infusion improved diastolic function but did not change FMD, forearm reactive hyperemia, or peak exercise capacity. Future studies should further clarify the role of endothelial function as well as other possible physiological causes of exercise impairment in order to provide potential therapeutic targets.Trial registration NCT00786019. Prospectively registered May 2008.
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Affiliation(s)
- Rebecca L. Scalzo
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine (UCSOM), 12801 E17th Ave, Aurora, CO 80045 USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Timothy A. Bauer
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Kylie Harrall
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Kerrie Moreau
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- VAMC-Geriatric Research Education and Clinical Center (GRECC), Denver, CO 80215 USA
| | - Cemal Ozemek
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Leah Herlache
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Shawna McMillin
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Amy G. Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Jennifer Dorosz
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
| | - Jane E. B. Reusch
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine (UCSOM), 12801 E17th Ave, Aurora, CO 80045 USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- Veterans Administration Medical Center (VAMC), Denver, CO 80215 USA
| | - Judith G. Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
- Department of Medicine, Center for Women’s Health Research, University of Colorado School of Medicine (UCSOM), Aurora, CO USA
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MicroRNAs and adipocytokines: Promising biomarkers for pharmacological targets in diabetes mellitus and its complications. Biomed Pharmacother 2017; 93:1326-1336. [DOI: 10.1016/j.biopha.2017.07.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 02/06/2023] Open
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Scalzo RL, Moreau KL, Ozemek C, Herlache L, McMillin S, Gilligan S, Huebschmann AG, Bauer TA, Dorosz J, Reusch JEB, Regensteiner JG. Exenatide improves diastolic function and attenuates arterial stiffness but does not alter exercise capacity in individuals with type 2 diabetes. J Diabetes Complications 2017; 31:449-455. [PMID: 27884660 PMCID: PMC5787373 DOI: 10.1016/j.jdiacomp.2016.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/19/2016] [Accepted: 10/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Exercise is recommended as a cornerstone of treatment for type 2 diabetes mellitus (T2DM), however, it is often poorly adopted by patients. Even in the absence of apparent cardiovascular disease, persons with T2DM have an impaired ability to carry out maximal and submaximal exercise and these impairments are correlated with cardiac and endothelial dysfunction. Glucagon-like pepetide-1 (GLP-1) augments endothelial and cardiac function in T2DM. We hypothesized that administration of a GLP-1 agonist (exenatide) would improve exercise capacity in T2DM. METHODS AND RESULTS Twenty-three participants (64±4years; mean±SE) with uncomplicated T2DM were randomized in a double-blinded manner to receive either 10μg BID of exenatide or matching placebo after baseline measurements. Treatment with exenatide did not improve VO2peak (P=0.1464) or VO2 kinetics (P=0.2775). Diastolic function, assessed via resting lateral E:E', was improved with administration of exenatide compared with placebo (Placebo Pre: 7.6±1.0 vs. Post: 8.4±1.2 vs. Exenatide Pre: 8.1±0.7 vs. Post: 6.7±0.6; P=0.0127). Additionally, arterial stiffness measured by pulse wave velocity, was reduced with exenatide treatment compared with placebo (Placebo Pre: 10.5±0.8 vs. Post: 11.5±1.1s vs. Exenatide Pre: 11.4±1.8 vs. Post: 10.2±1.4s; P=0.0373). Exenatide treatment did not improve endothelial function (P=0.1793). CONCLUSIONS Administration of exenatide improved cardiac function and reduced arterial stiffness, however, these changes were not accompanied by improved functional exercise capacity. In order to realize the benefits of this drug on exercise capacity, combining exenatide with aerobic exercise training in participants with T2DM may be warranted.
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Affiliation(s)
- Rebecca L Scalzo
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Kerrie L Moreau
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; VAMC-Geriatric Research Education and Clinical Center (GRECC), Denver, Colorado 80215
| | - Cemal Ozemek
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Leah Herlache
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Shawna McMillin
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Sarah Gilligan
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Amy G Huebschmann
- Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Tim A Bauer
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Jennifer Dorosz
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215
| | - Jane E B Reusch
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Veterans Administration Medical Center (VAMC), Denver, Colorado 80215
| | - Judith G Regensteiner
- Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine (UCSOM), Denver, Colorado 80215.
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Changes of adipocytokine expression after diabetic rats received sitagliptin and the molecular mechanism. ASIAN PAC J TROP MED 2016; 9:893-897. [DOI: 10.1016/j.apjtm.2016.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/16/2016] [Accepted: 07/01/2016] [Indexed: 11/23/2022] Open
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Bjornstad P, Truong U, Pyle L, Dorosz JL, Cree-Green M, Baumgartner A, Coe G, Regensteiner JG, Reusch JEB, Nadeau KJ. Youth with type 1 diabetes have worse strain and less pronounced sex differences in early echocardiographic markers of diabetic cardiomyopathy compared to their normoglycemic peers: A RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) Study. J Diabetes Complications 2016; 30:1103-10. [PMID: 27133451 PMCID: PMC4949075 DOI: 10.1016/j.jdiacomp.2016.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/09/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Diabetic cardiomyopathy is a major cause of morbidity, but limited data are available on early cardiac abnormalities in type 1 diabetes (T1D). We investigated differences in myocardial strain in adolescents with and without T1D. We hypothesized that adolescents with T1D would have worse strain than their normoglycemic peers, which boys would have worse strain than girls, and that strain would correlate with glycemic control and adipokines. METHODS We performed fasting laboratory measures and echocardiograms with speckle tracking to evaluate traditional echocardiographic measures in addition to longitudinal (LS) and circumferential (CS) strain, and in adolescents (15±2years) with (19 boys; 22 girls) and without (16 boys; 32 girls) type 1 diabetes. RESULTS Compared to controls, adolescents with type 1 diabetes had significantly lower CS (-20.9 vs. -22.7%, p=0.02), but not LS (p=0.83). Boys with T1D had significantly lower LS than girls with T1D (-17.5 vs. -19.7%, p=0.047), adjusted for Tanner stage. The significant sex differences observed in indexed left ventricular mass, left end-diastolic volume, diastolic septal and posterior wall thickness in our controls were lacking in adolescents with T1D. CONCLUSIONS Our observations suggest that youth with T1D have worse myocardial strain than normoglycemic peers. In addition, the relatively favorable cardiac profile observed in girls vs. boys in the control group, was attenuated in T1D. These early cardiovascular changes in youth with T1D are concerning and warrant longitudinal and mechanistic studies.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Uyen Truong
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Laura Pyle
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Jennifer L Dorosz
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Melanie Cree-Green
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Amy Baumgartner
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Gregory Coe
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Judith G Regensteiner
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States; Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jane E B Reusch
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States; Division of Endocrinology, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, CO, United States
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
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Bjornstad P, Truong U, Dorosz JL, Cree-Green M, Baumgartner A, Coe G, Pyle L, Regensteiner JG, Reusch JEB, Nadeau KJ. Cardiopulmonary Dysfunction and Adiponectin in Adolescents With Type 2 Diabetes. J Am Heart Assoc 2016; 5:e002804. [PMID: 26994128 PMCID: PMC4943257 DOI: 10.1161/jaha.115.002804] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Myocardial mechanics are altered in adults with obesity and type 2 diabetes (T2D); insulin resistance and adipokines have been implicated as important risk factors for cardiovascular disease, but these relationships are poorly described in adolescents. We hypothesized that obese adolescents and adolescents with T2D would have abnormal cardiac function compared to lean adolescents. In addition, we hypothesized that insulin sensitivity (IS), adiposity, and adipokines would be associated with altered cardiac strain and cardiopulmonary fitness in adolescents with T2D. Methods and Results Adolescents (15±2 years) with T2D (n=37), obesity without diabetes (n=41), and lean controls (n=31) of similar age and pubertal stage underwent echocardiography with speckle tracking, assessment of IS by hyperinsulinemic–euglycemic clamp, body composition by dual‐energy x‐ray absorptiometry, peak oxygen consumption (VO2peak) by cycle ergometry, adiponectin, and leptin. Compared to lean and to obese controls, adolescents with T2D had significantly lower cardiac circumferential strain (CS) (−18.9±4.6 [T2D] versus −21.5±3.5 [obese] versus −22.0±4.2% [lean], P=0.04) and VO2peak (37.6±7.5 [T2D] versus 43.4±8.2 [obese] versus 47.6±8.6 mL/lean kg/min [lean], P<0.0001). In T2D youth, VO2peak was associated with CS, and the association remained significant after adjusting for age, sex, and IS (β±SE: −0.73±0.26, P=0.02). Among adolescents with T2D, CS was also associated with adiponectin, longitudinal strain with leptin, and VO2peak with adiponectin and IS. Conclusions Adolescents with T2D had abnormal CS and reduced VO2peak compared to obese and lean controls, which may represent the earliest evidence of cardiac functional impairment in T2D. Low adiponectin, rather than conventional risk factors and IS, correlated with CS, while both adiponectin and IS related to cardiopulmonary fitness.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Uyen Truong
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Jennifer L Dorosz
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Melanie Cree-Green
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Amy Baumgartner
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Gregory Coe
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Judith G Regensteiner
- Divisions of General Internal Medicine and Cardiology, Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO
| | - Jane E B Reusch
- Division of Endocrinology, Center for Women's Health Research, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, CO
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
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