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Andellini M, Castaldo R, Cisuelo O, Franzese M, Haleem MS, Ritrovato M, Pecchia L, Schiaffini R. Are the variations in ECG morphology associated to different blood glucose levels? implications for non-invasive glucose monitoring for T1D paediatric patients. Diabetes Res Clin Pract 2024; 212:111708. [PMID: 38754787 DOI: 10.1016/j.diabres.2024.111708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
AIMS Recent clinical trials and real-world studies highlighted those variations in ECG waveforms and HRV recurrently occurred during hypoglycemic and hyperglycemic events in patients with diabetes. However, while several studies have been carried out for adult age, there is lack of evidence for paediatric patients. The main aim of the study is to identify the correlations of variations in ECG Morphology waveforms with blood glucose levels in a paediatric population. METHODS T1D paediatric patients who use CGM were enrolled. They wear an additional non-invasive wearable device for recording physiological data and respiratory rate. Glucose metrics, ECG parameters and HRV features were collected, and Wilcoxon rank-sum test and Spearman's correlation analysis were used to explore if different levels of blood glucose were associated to ECG morphological changes. RESULTS Results showed that hypoglycaemic events in paediatric patients with T1D are strongly associated with variations in ECG morphology and HRV. CONCLUSIONS Results showed the opportunity of using the ECG as a non-invasive adding instrument to monitor the hypoglycaemic events through the integration of the ECG continuous information with CGM data. This innovative approach represents a promising step forward in diabetes management, offering a more comprehensive and effective means of detecting and responding to critical changes in glucose levels.
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Affiliation(s)
- Martina Andellini
- University of Warwick, School of Engineering, Coventry, UK; Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | | | - Owain Cisuelo
- University of Warwick, School of Engineering, Coventry, UK
| | | | - Muhammad Salman Haleem
- University of Warwick, School of Engineering, Coventry, UK; Queen Mary University of London, School of Electronic Engineering and Computer Science, UK
| | | | - Leandro Pecchia
- University of Warwick, School of Engineering, Coventry, UK; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128 Roma, Italy
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Choi YJ, Wi WY, Cho GJ, Na JO. Association between cardiac arrhythmia before pregnancy and gestational diabetes: a nationwide population-based study in Korea. Epidemiol Health 2023; 45:e2023103. [PMID: 38062711 PMCID: PMC10876443 DOI: 10.4178/epih.e2023103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 02/22/2024] Open
Abstract
Given the higher prevalence of cardiac arrhythmias in individuals with diabetes, we investigated the relationship between cardiac arrhythmias and the incidence of gestational diabetes (GDM). This retrospective cohort study utilized data from the Korean Health Insurance Service database, encompassing 1,113,729 women who gave birth between January 2007 and December 2015. After excluding those who did not undergo National Health Screening tests within 1 year prior to pregnancy, those with multifetal pregnancies, and those diagnosed with diabetes, we analyzed 365,880 singleton pregnancies without a history of diabetes. Of these, 3,253 (0.9%) had cardiac arrhythmias, including premature extra beats, supraventricular tachyarrhythmias, and/or atrial flutter/fibrillation. GDM occurred in 31,938 (8.7%) subjects during pregnancy, and was more prevalent in women with cardiac arrhythmia than in those without (14.9% vs. 8.7%, p<0.001). In the multivariate analysis, the association between cardiac arrhythmia and GDM remained statistically significant (adjusted odds ratio, 1.78; 95% CI, 1.615-1.970; p<0.001). Subgroup analysis revealed that the risk of GDM was consistently statistically significant in subjects with cardiac arrhythmia, regardless of age, body mass index, and the presence or absence of chronic hypertension. Therefore, cardiac arrhythmias before and during pregnancy appear to be associated with an increased risk of developing GDM.
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Affiliation(s)
- You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Won Young Wi
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
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Aguiar Mesquita Galdino G, Eduardo Virgilio Silva L, Cristina Garcia Moura-Tonello S, Cristina Milan-Mattos J, Nogueira Linares S, Porta A, Marques da Silva T, Fazan R, Beltrame T, Maria Catai A. Heart rate fragmentation is impaired in type 2 diabetes mellitus patients. Diabetes Res Clin Pract 2023; 196:110223. [PMID: 36529300 DOI: 10.1016/j.diabres.2022.110223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
AIMS To evaluate the heart rate fragmentation (HRF) of type 2 diabetes mellitus (T2DM) patients and its relationship with heart rate variability (HRV) indices. METHODS One hundred sixty-four men, aged 47-57 years were retrospectively analyzed from a database. Participants were T2DM (n = 82) and apparently healthy (n = 82). R-R interval time series recorded by electrocardiogram were collected at the supine position for 10 to 15 min. From HRF, the percentage of inflection points (PIP), percentage of words with zero, one, two, or three inflections points (W0, W1, W2, W3), and percentage with only type hard, soft, or mixed inflections points type (WH, WS, WM) were quantified. RESULTS T2DM presented higher PIP, WS, WM and W3, while WH and W1 was lower compared with healthy (p < 0.05). Moreover, a positive moderate correlation was found between WH and root mean square of the successive R-R differences (RMSSD) and high frequency (HF) indices. In contrast, a negative moderate correlation was found between WS and WM with RMSSD and HF indices. CONCLUSIONS T2DM have increased fragmentation patterns, and words grouped by inflection type are more closely related to HRV. The HRF approach might be useful to assess heart rate dynamic abnormalities in males with type 2 diabetes.
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Affiliation(s)
- Gabriela Aguiar Mesquita Galdino
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Luiz Eduardo Virgilio Silva
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil; Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Juliana Cristina Milan-Mattos
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Stephanie Nogueira Linares
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Thaís Marques da Silva
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Rubens Fazan
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Thomas Beltrame
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Samsung R&D Institute Brazil - SRBR, Campinas, São Paulo, Brazil
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.
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Zhang YT, Li HY, Sun XT, Tong XW, Shan YY, Xu YX, Pu SD, Gao XY. Relationship Between Index of Cardiac Electrophysiological Balance, Frontal QRS-T Angle and Retinopathy in People with Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:861-871. [PMID: 36974327 PMCID: PMC10039660 DOI: 10.2147/dmso.s403210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is strongly associated with cardiovascular disease, which is a risk factor for sudden cardiac death (SCD). The index of cardiac electrophysiological balance (iCEB) and the frontal QRS-T angle are recommended to predict the risk of ventricular arrhythmias more than other ECG parameters. However, the relationships between these two markers and DR have not yet been explored. The aim of this study was to investigate the variation in the iCEB, corrected iCEB (iCEBc) and frontal QRS-T angle in different stages of DR and determine whether there are associations between these markers and DR. METHODS The sample comprised 665 patients with Type 2 diabetes mellitus (T2DM) who were classified into three groups: no DR (NDR), mild to moderate non-proliferative DR (NPDR), and vision-threatening DR (VTDR). Twelve-lead ECG was performed and the QT, QTc, QRS duration, iCEB, iCEBc and frontal QRS-T angle were recorded and compared across the groups. RESULTS The VTDR group had a significantly higher iCEBc and frontal QRS-T angle than the NDR and NPDR groups. After controlling for confounding variables, the correlations between the iCEBc (OR=2.217, 95% CI=1.464-3.358, P<0.001), frontal QRS-T angle (OR=1.017, 95% CI=1.008-1.025, P<0.001) and DR risk remained (P<0.05). Subjects in the fourth iCEBc quartile (adjusted OR=2.612, 95% CI=1.411-4.834, p=0.002) had a much higher chance of developing DR compared to those in the first quartile. In comparison to the first frontal QRS-T angle quartile, subjects in the third (adjusted OR=1.998, 95% CI=1.167-3.422, P=0.012) and fourth (adjusted OR=2.430, 95% CI=1.420-4.160, P=0.001) frontal QRS-T angle quartiles had significantly greater risks of DR. CONCLUSION With the progression of DR, the iCEBc and frontal QRS-T angle increase. An increased iCEBc and frontal QRS-T angle are associated with an increased risk of DR.
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Affiliation(s)
- Yi-Tong Zhang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Hui-Yao Li
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xiao-Tong Sun
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xue-Wei Tong
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Yong-Yan Shan
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Yu-Xin Xu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Sheng-Dan Pu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xin-Yuan Gao
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
- Correspondence: Xin-Yuan Gao, Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Harbin, 150001, People’s Republic of China, Email
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Safi M, Borup A, Stevns Hansen C, Rossing P, Thorsten Jensen M, Christoffersen C. Association between plasma apolipoprotein M and cardiac autonomic neuropathy in type 1 diabetes. Diabetes Res Clin Pract 2022; 189:109943. [PMID: 35690270 DOI: 10.1016/j.diabres.2022.109943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022]
Abstract
AIM Diabetes may lead to severe complications e.g. cardiac autonomic neuropathy (CAN) characterized by an increased risk of cardiovascular mortality. CAN is diagnosed by a decreased heart rate viability (HRV). Sphingosine-1-Phosphate (S1P) carried by the HDL-associated apolipoprotein M (apoM) is linked to a reduction in the heart rate, and treatment with an S1P-agonist increases HRV. The present study aimed to investigate if plasma apoM was associated with an increased risk of CAN. METHODS The study includes 278 individuals with Type 1 Diabetes recruited from Steno Diabetes Center in Copenhagen from 2010 to 2012. RESULTS A change of 0.1 µM plasma apoM was associated with the diagnosis of CAN (Odds ratio: 1.11 (1.02; 1.21), p = 0.013). ApoM plasma levels were also positively associated with CAN when adjusted for age and gender (Odds ratio: 1.11 (1.02; 1.21), p = 0.013) as well as lipids, beta-blockers, blood pressure, and alcohol (Odds ratio: 1.14 (1.04; 1.26), p = 0.005) and Hbga1c and time with diabetes (Odds ratio: 1.13 (1.02; 1.25), p = 0.01). Plasma apoM was also associated with a significantly lower SDNN as well as high frequency power in all adjusted models. CONCLUSION Increased plasma apoM was associated with an increased risk of CAN as well as a significant reduction in HRV indices. This could represent changes in parasympathetic activity, but, further studies are needed to also explore additional molecular alterations behind such observations.
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Affiliation(s)
- Mostafa Safi
- Department of Clinical Biochemistry, Rigshospitalet, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark
| | - Anna Borup
- Department of Clinical Biochemistry, Rigshospitalet, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Magnus Thorsten Jensen
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Amager Hvidovre, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark.
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Sanabria-de la Torre R, García-Fontana C, González-Salvatierra S, Andújar-Vera F, Martínez-Heredia L, García-Fontana B, Muñoz-Torres M. The Contribution of Wnt Signaling to Vascular Complications in Type 2 Diabetes Mellitus. Int J Mol Sci 2022; 23:6995. [PMID: 35805996 PMCID: PMC9266892 DOI: 10.3390/ijms23136995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/01/2023] Open
Abstract
Vascular complications are the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). These vascular abnormalities result in a chronic hyperglycemic state, which influences many signaling molecular pathways that initially lead to increased oxidative stress, increased inflammation, and endothelial dysfunction, leading to both microvascular and macrovascular complications. Endothelial dysfunction represents the initial stage in both types of vascular complications; it represents "mandatory damage" in the development of microvascular complications and only "introductory damage" in the development of macrovascular complications. Increasing scientific evidence has revealed an important role of the Wnt pathway in the pathophysiology of the vascular wall. It is well known that the Wnt pathway is altered in patients with T2DM. This review aims to be an update of the current literature related to the Wnt pathway molecules that are altered in patients with T2DM, which may also be the cause of damage to the vasculature. Both microvascular complications (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary artery disease, cerebrovascular disease, and peripheral arterial disease) are analyzed. This review aims to concisely concentrate all the evidence to facilitate the view on the vascular involvement of the Wnt pathway and its components by highlighting the importance of exploring possible therapeutic strategy for patients with T2DM who develop vascular pathologies.
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Affiliation(s)
- Raquel Sanabria-de la Torre
- Department of Medicine, University of Granada, 18016 Granada, Spain; (R.S.-d.l.T.); (S.G.-S.); (L.M.-H.); (M.M.-T.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
| | - Cristina García-Fontana
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Sheila González-Salvatierra
- Department of Medicine, University of Granada, 18016 Granada, Spain; (R.S.-d.l.T.); (S.G.-S.); (L.M.-H.); (M.M.-T.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
| | - Francisco Andújar-Vera
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
- Department of Computer Science and Artificial Intelligence, University of Granada, 18071 Granada, Spain
- Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI Institute), 18014 Granada, Spain
| | - Luis Martínez-Heredia
- Department of Medicine, University of Granada, 18016 Granada, Spain; (R.S.-d.l.T.); (S.G.-S.); (L.M.-H.); (M.M.-T.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
| | - Beatriz García-Fontana
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Manuel Muñoz-Torres
- Department of Medicine, University of Granada, 18016 Granada, Spain; (R.S.-d.l.T.); (S.G.-S.); (L.M.-H.); (M.M.-T.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Gateva A, Kamenov Z. Cardiac Autonomic Neuropathy in Patients with Newly Diagnosed Carbohydrate Disturbances. Horm Metab Res 2022; 54:308-315. [PMID: 35325930 DOI: 10.1055/a-1775-8251] [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] [Indexed: 11/04/2022]
Abstract
Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus that can predispose patients to higher risk for cardiovascular death. The aim of the present study was to evaluate the presence of cardiac autonomic neuropathy and sudomotor dysfunction in patients with newly diagnosed carbohydrate disturbances (prediabetes or diabetes) and to assess their relationship to metabolic disturbances and cardiovascular risk. In the present study, we included 160 patients -78 with obesity without carbohydrate disturbances, 52 with prediabetes, and 30 with newly diagnosed diabetes. CAN was diagnosed using cardiovascular reflex tests and sudomotor function was evaluated by SUDOSCAN. Cardiovascular risk was calculated using SCORE and FRMINGHAM risk scores. The prevalence of cardiac autonomic neuropathy was significantly higher in patients with newly diagnosed diabetes. Independently of their glycemic status, the patients who had blood glucose on the 60th-minute of OGTT>8.5 mmol/l had significantly higher prevalence of cardiac autonomic neuropathy (30.2% vs 15.6%, р=0.044). Patients with high cardiovascular risk according to FRAMINGHAM and SCORE had worse heart rate variability scores. Autonomic neuropathy risk assessed by SUDOSCAN was a good predictor for the presence of CAN. In conclusion, CAN has a higher prevalence on patients with newly diagnosed diabetes compared to prediabetic and normoglycemic subjects, while the patients with blood glucose>8.5 mmol/l on the 60th-minute of OGTT have higher prevalence of CAN independently of their glycemic status. SUDOSCAN testing can be used to assess the risk of CAN and to select patients that should undergo further testing.
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Affiliation(s)
- Antoaneta Gateva
- Department of Internal Medicine, Medical University, Sofia, Bulgaria
| | - Zdravko Kamenov
- Department of Internal Medicine, Medical University, Sofia, Bulgaria
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Yu TY, Hong W, Jin S, Hur KY, Jee JH, Bae JC, Kim JH, Lee M. Delayed heart rate recovery after exercise predicts development of metabolic syndrome: A retrospective cohort study. J Diabetes Investig 2022; 13:167-176. [PMID: 34313016 PMCID: PMC8756310 DOI: 10.1111/jdi.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS/INTRODUCTION Several cross-sectional studies have shown that delayed heart rate recovery (HRR) after exercise is associated with the development of metabolic syndrome (MetS). However, there has been a lack of comprehensively designed longitudinal studies. Therefore, our aim was to evaluate the longitudinal association of delayed HRR following a graded exercise treadmill test (GTX) with incident MetS. MATERIALS AND METHODS This was a retrospective longitudinal cohort study of participants without MetS, diabetes, or cardiovascular diseases. The HRR was calculated as the peak heart rate minus the resting heart rate after a 1 min rest (HRR1), a 2 min rest (HRR2), and a 3 min rest (HRR3). Multivariate Cox proportional hazards analysis was performed to investigate the association between HRR and development of MetS. RESULTS There were 676 (31.2%) incident cases of MetS identified during the follow-up period (9,683 person-years). The only statistically significant relationship was between HRR3 and the development of MetS. The hazard ratios (HRs) (95% confidence interval [CI]) of incident MetS comparing the first and second tertiles to the third tertile of HRR3 were 1.492 (1.146-1.943) and 1.277 (1.004-1.624) with P = 0.003 after adjustment for multiple risk factors. As a continuous variable, the HR (95% CI) of incident MetS associated with each one-beat decrease in HRR3 was 1.015 (1.005-1.026) with P = 0.004 after full adjustments. An HRR3 value ≤45 beats per minute (bpm) was associated with a higher risk of incident MetS compared with values >45 bpm, with an HR (95% CI) of 1.304 (1.061-1.602) and P = 0.001. CONCLUSIONS The slow phase of HRR, particularly HRR3, might be more sensitive at predicting the risk of MetS.
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Affiliation(s)
- Tae Yang Yu
- Division of Endocrinology and MetabolismDepartment of MedicineWonkwang Medical CenterWonkwang University School of MedicineIksanKorea
- Department of MedicineSungkyunkwan University Graduate School of MedicineSeoulKorea
| | - Won‐Jung Hong
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Sang‐Man Jin
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Kyu Yeon Hur
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jae Hwan Jee
- Department of Health Promotion CenterSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Ji Cheol Bae
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Changwon HospitalSungkyunkwan University School of MedicineChangwonKorea
| | - Jae Hyeon Kim
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Moon‐Kyu Lee
- Division of Endocrinology and MetabolismDepartment of Internal MedicineUijeongbu Eulji Medical CenterEulji University School of MedicineUijeongbuKorea
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Theodorakopoulou MP, Triantafyllou A, Zafeiridis A, Boutou AΚ, Grigoriadou I, Kintiraki E, Douma S, Goulis DG, Dipla K. Impaired vagal adaptation to an exercise task in women with gestational diabetes mellitus versus women with uncomplicated pregnancies. Hormones (Athens) 2021; 20:753-760. [PMID: 34308519 DOI: 10.1007/s42000-021-00311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is associated with an increased risk for maternal and fetal complications. Patients with GDM have an increased cardiovascular risk in later life. The aim of this study was to investigate cardiac autonomic nervous system (ANS) function at rest and during exercise in women with GDM vs. women with uncomplicated pregnancies. METHODS Thirty-six normotensive pregnant women (21 with GDM and 15 age- and parity-matched women with an uncomplicated pregnancy) were enrolled in this case-control study. Continuous beat-by-beat blood pressure (BP) measurements were recorded during rest, intermittent handgrip exercise, and recovery (via photoplethysmography, Finapres®). Heart rate variability (HRV) (Kubios®) was used for the assessment of autonomic nervous system function. RESULTS The groups were similar in age, gestational week, and handgrip strength. At rest, no differences in HRV indices [root mean square of successive differences (RMSSD), standard deviation Poincaré plot 1, and 2 (SD1, SD2), SD2/SD1 ratio] were detected between women with GDM and women with an uncomplicated pregnancy. However, during exercise, a different pattern in the HRV responses was detected: in the control group, RMSSD and SD1 (indices of parasympathetic function) significantly decreased (p < 0.001) during handgrip exercise and returned to baseline during recovery. In contrast, in GDM, the above HRV indices remained unaltered throughout the protocol. CONCLUSION Normotensive women with GDM present impaired parasympathetic system ability to adapt to an exercise stimulus, as suggested by the blunted sensitivity in RMSSD and SD1. This finding suggests early alterations in ANS may exist in women with GDM, even when no differences are detected in resting conditions.
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Affiliation(s)
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Department of Sports Science At Serres, Exercise Physiology and Biochemistry Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Κ Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Iris Grigoriadou
- Department of Sports Science At Serres, Exercise Physiology and Biochemistry Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kintiraki
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Konstantina Dipla
- Department of Sports Science At Serres, Exercise Physiology and Biochemistry Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Souza HCD, Philbois SV, Veiga AC, Aguilar BA. Heart Rate Variability and Cardiovascular Fitness: What We Know so Far. Vasc Health Risk Manag 2021; 17:701-711. [PMID: 34803382 PMCID: PMC8598208 DOI: 10.2147/vhrm.s279322] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
Fluctuation analysis in intervals between heartbeats provides important indices related to autonomic modulation of heart rate variability (HRV). These indices are considered predictors of morbidity and mortality as they are frequently altered in patients with chronic degenerative diseases, especially in those with cardiovascular and metabolic diseases. Similarly, a reduction in HRV is common with aging. In all cases, cardiovascular fitness is often reduced to below the predicted values. In turn, increases in cardiovascular fitness through regular physical exercise, especially aerobic exercise, represent an important therapeutic tool capable of promoting positive adjustments in cardiac autonomic modulation. These adjustments are characterized by reduced sympathetic modulatory influence and/or increased vagal modulatory influence on the heart, increasing the HRV. Therefore, several methodological tools have been used to assess the degree of impairment of autonomic modulation and the therapeutic effects of physical exercise. In contrast, establishment of strict protocols in experimental design is a main challenge in establishing HRV analysis as a robust parameter for evaluating cardiovascular homeostasis. Thus, this review aimed to contribute to the understanding of autonomic modulation of HRV and its relationship with cardiovascular fitness, highlighting the advances made thus far, the applicability of analysis tools, and the confounding factors observed frequently.
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Affiliation(s)
- Hugo Celso Dutra Souza
- Department of Health Science, Ribeirão Preto Medical School of University of São Paulo, São Paulo, Brazil
| | - Stella Vieira Philbois
- Department of Health Science, Ribeirão Preto Medical School of University of São Paulo, São Paulo, Brazil
| | - Ana Catarine Veiga
- Department of Health Science, Ribeirão Preto Medical School of University of São Paulo, São Paulo, Brazil
| | - Bruno Augusto Aguilar
- Department of Health Science, Ribeirão Preto Medical School of University of São Paulo, São Paulo, Brazil
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11
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Yu TY, Lee MK. Autonomic dysfunction, diabetes and metabolic syndrome. J Diabetes Investig 2021; 12:2108-2111. [PMID: 34622579 PMCID: PMC8668070 DOI: 10.1111/jdi.13691] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tae Yang Yu
- Division of Endocrinology and Metabolism, Department of Medicine, Wonkwang Medical Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
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12
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Cardiac Autonomic Neuropathy Is Not Reversed by Euglycemia Following Islet Transplantation. Transplantation 2021; 105:1125-1129. [PMID: 32590611 DOI: 10.1097/tp.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiac autonomic neuropathy (CAN) is a significant cause of morbidity and mortality for people with type 1 (T1D) and type 2 (T2D) diabetes. Heart rate variability (HRV) has been shown to be a marker of CAN with 24-hour Holter monitoring being a robust modality to assess HRV. METHODS To investigate the impact of hypoglycemia on CAN and its potential reversibility with islet transplantation, we compared HRV assessment by 24-hour Holter monitor on a total of 109 subjects from 5 cohorts: (1) T1D with recurrent severe hypoglycemia and on waiting list for islet transplant, (2) T1D following islet cell transplantation (ICT), (3) T2D without hypoglycemia, (4) individuals with prediabetes, and (5) controls without diabetes. SD of the normal-normal interval, square root of the mean squared differences of successive normal-normal intervals (rMSSD) and total spectral power were analyzed. RESULTS There was no significant difference in HRV parameters between T1D subjects and T1D post ICT suggesting CAN is not reversible at a median of 4 years postislet transplant. There was a significant difference in controls and T1D in rMSSD and between controls and T2D in total power. The differential effect on rMSSD in T1D and T2D suggests potential greater impact of hypoglycemia on rMSSD. CONCLUSIONS Achieving euglycemia after ICT may not reverse CAN once established with no significant difference in HRV parameters at a median of 4 years postislet transplant. Differential effects of T1D as compared with T2D on CAN were identified.
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13
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Takeshita Y, Tanaka T, Wakakuri H, Kita Y, Kanamori T, Takamura T. Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled study. J Diabetes Investig 2021; 12:1193-1201. [PMID: 33251697 PMCID: PMC8264393 DOI: 10.1111/jdi.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION This study compares the effects of two different insulin regimens - basal versus bolus insulin - on metabolic and cardiovascular autonomic function in Japanese participants with type 2 diabetes. MATERIALS AND METHODS Participants were randomly assigned to groups for therapy with insulin glulisine (IGlu) or insulin glargine (IGla). The primary efficacy end-point was glycemic variability, including M-values, mean of glucose levels, and a blood glucose profile of seven time points before and after the intervention. The secondary end-points included pleiotropic effects, including endothelial and cardiac autonomic nerve functions. RESULTS Blood glucose levels at all time points significantly decreased in both groups. Post-lunch, post-dinner, and bedtime blood glucose levels were significantly lower in the IGlu group than in the IGla group. Nadir fasting blood glucose levels at the end-point were significantly lower in the IGla group than in the IGlu group. The M-value and mean blood glucose levels were significantly decreased from baseline in both groups, although the former was significantly lower in the IGlu group than in the IGla group. IGla, but not IGlu, was found to elevate 24-h parasympathetic tone, especially during night-time, and it decreased 24-h sympathetic nerve activity, especially at dawn. CONCLUSIONS Both IGlu and IGla regimens reduced glucose variability, with IGlu bringing a greater reduction in M-value. IGla, but not IGlu, increased parasympathetic tone during night-time and decreased sympathetic nerve activity at dawn. These findings shed light on the previously unrecognized role of night-time basal insulin supplementation on sympathovagal activity in type 2 diabetes patients.
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Affiliation(s)
- Yumie Takeshita
- Department of Endocrinology and MetabolismKanazawa University Graduate School of Medical SciencesKanazawaIshikawaJapan
| | - Takeo Tanaka
- Department of Endocrinology and MetabolismKanazawa University Graduate School of Medical SciencesKanazawaIshikawaJapan
| | - Hitomi Wakakuri
- Department of Endocrinology and MetabolismKanazawa University Graduate School of Medical SciencesKanazawaIshikawaJapan
| | - Yuki Kita
- Department of Endocrinology and MetabolismKanazawa University Graduate School of Medical SciencesKanazawaIshikawaJapan
| | - Takehiro Kanamori
- Department of Endocrinology and MetabolismKanazawa University Graduate School of Medical SciencesKanazawaIshikawaJapan
| | - Toshinari Takamura
- Department of Endocrinology and MetabolismKanazawa University Graduate School of Medical SciencesKanazawaIshikawaJapan
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14
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Sayiner ZA, Uyar N, Yıldırım AE. Relationship between Pancreas Exocrine Insufficiency and Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2021; 32:481-487. [PMID: 34231479 DOI: 10.5152/tjg.2021.19373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The exocrine function of the pancreas is controlled by the autonomic nervous system (ANS), and autonomic neuropathy is a common and serious complication of diabetes. There are many factors contributing to the development of autonomic neuropathy in diabetic patients. Cardiovascular tests have been developed to evaluate the function of the ANS. This study investigated the relationship between cardiovascular autonomic neuropathy (CAN) and pancreas exocrine insufficiency (PEI) in diabetic patients. METHODS This study evaluated 110 individuals with type 2 diabetes mellitus (T2DM) and 40 healthy volunteers. Autonomous neuropathy tests were utilized to diagnose patients, and Ewing and Clarke's criteria were employed to assess the severity of autonomous dysfunction. Stool samples were also collected from patients to measure fecal elastase-1 (FE-1). RESULTS A 65.5% incidence of PEI was observed in DM patients. There was no significant correlation among the duration of disease, C-peptide, HbA1c, and PEI, respectively (P = .782, P = .521, P = .580). However, a significant difference between DM patients and controls in terms of cardiac dysautonomia (P = .001) was seen. Moreover, a statistically significant correlation between the degree of cardiac dysautonomia and FE-1 level was observed within the patient group (P =.001). CONCLUSION It is possible that the disruption of exocrine hormone secretion in the pancreas due to the impairment of enteropancreatic reflexes is secondary to diabetic autonomic neuropathy and resulting in PEI. This study also showed that autonomic neuropathy might develop and cause PEI in diabetic patients without known added confounding factors.
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Affiliation(s)
- Zeynel Abidin Sayiner
- Department of Endocrinology and Metabolism, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Nida Uyar
- Department of Internal Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Abdullah Emre Yıldırım
- Department of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey
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15
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Baranowska-Jurkun A, Matuszewski W, Bandurska-Stankiewicz E. Chronic Microvascular Complications in Prediabetic States-An Overview. J Clin Med 2020; 9:E3289. [PMID: 33066307 PMCID: PMC7602111 DOI: 10.3390/jcm9103289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
A prediabetic state is a major risk factor for the development of diabetes, and, because of an identical pathophysiological background of both conditions, their prevalence increases parallelly and equally fast. Long-term hyperglycemia is the main cause inducing chronic complications of diabetes, yet the range of glucose levels at which they start has not been yet unequivocally determined. The current data show that chronic microvascular complications of diabetes can be observed in patients with abnormal glucose metabolism in whom glycaemia is higher than optimal but below diagnostic criteria for diabetes. Prediabetes is a heterogenous nosological unit in which particular types are differently characterized and show different correlations with particular kinds of complications. Analysis of the latest research results shows the need to continue studies in a larger population and can imply the need to verify the currently employed criteria of diagnosing diabetes and chronic complications of diabetes in people with prediabetes.
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Affiliation(s)
- Angelika Baranowska-Jurkun
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland; (W.M.); (E.B.-S.)
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16
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Zilliox LA, Russell JW. Is there cardiac autonomic neuropathy in prediabetes? Auton Neurosci 2020; 229:102722. [PMID: 33011523 DOI: 10.1016/j.autneu.2020.102722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 06/09/2020] [Accepted: 08/24/2020] [Indexed: 02/09/2023]
Abstract
Although there is considerably more data showing an association between type 2 diabetes mellitus (T2DM) and autonomic neuropathy, accumulating evidence indicates that cardiovascular autonomic neuropathy (CAN) is common in persons with impaired glucose tolerance (IGT). Furthermore, CAN may occur early after a metabolic insult and obesity, especially among mean, and seems to play an important role in the early pathogenesis of CAN. Autonomic symptoms are common in subjects with IGT. In addition to defects in CAN, in subjects with IGT, there is impaired sudomotor function and abnormalities of endothelial peripheral vasoreactivity. At the present time, the only interventions that may be effective in preventing or reversing IGT associated autonomic neuropathy are lifestyle improvement. These include a tailored diet and exercise program. Other approaches that may be beneficial include modulation of oxidative stress and improvement of metabolic regulation in subjects with IGT. Interventions are most likely to be effective early in the course of disease and therefore it is extremely important to have early diagnosis of IGT and autonomic neuropathy.
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Affiliation(s)
- Lindsay A Zilliox
- Department of Neurology, University of Maryland and Maryland VA Healthcare System, Baltimore, MD, United States of America
| | - James W Russell
- Department of Neurology, University of Maryland and Maryland VA Healthcare System, Baltimore, MD, United States of America.
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17
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Role of the Immune System and the Circadian Rhythm in the Pathogenesis of Chronic Pancreatitis: Establishing a Personalized Signature for Improving the Effect of Immunotherapies for Chronic Pancreatitis. Pancreas 2020; 49:1024-1032. [PMID: 32833942 DOI: 10.1097/mpa.0000000000001626] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pancreatitis, in both acute and chronic forms, poses a major therapeutic challenge and is associated with great morbidity and several complications. The nature of pancreatic injury in chronic pancreatitis (CP) and the wide range of causative processes that lead to CP have made effective therapy a true unmet need. Multiple physiological, genetic, environmental, and behavioral factors contribute to the development of CP. As a result, several fields of research are aimed at identifying and addressing the factors that contribute to pancreatic injury. In this article, we review the current understanding of the pathogenesis and natural history of CP. We focus on the autonomous nervous system, immune system, and role of a chronobiological therapeutic approach to alleviate symptoms and prevent or reverse pancreatic injury associated with CP. We aim to demonstrate that individualizing chronopharmacological treatments for CP is a promising direction for future treatment using immune, nervous, and circadian systems.
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18
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Prevalence and correlates of sleep disorders in Greek patients with type 2 diabetes: comparison of an urban and a semi-urban population. Arch Med Sci Atheroscler Dis 2020; 5:e198-e199. [PMID: 32832720 PMCID: PMC7433781 DOI: 10.5114/amsad.2020.97434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022] Open
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19
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Murine model of left ventricular diastolic dysfunction and electro-mechanical uncoupling following high-fat diet. Int J Obes (Lond) 2019; 44:1428-1439. [PMID: 31792335 DOI: 10.1038/s41366-019-0500-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES It is well established that obesity is an independent risk factor for cardiac death. In particular various cardiac alterations have been described in obese patients such as long QT on ECG, impaired diastolic filling of the left ventricle (LV), and all-type arrhythmias. In the present study, the above alterations were all reproduced in a mouse model of fat diet-induced obesity. ANIMALS/METHODS In C57BL6 mice fed on a high fat (n = 20, HF-group) or standard diet (n = 20, C-group) for 13 weeks, balanced by sex and age, we examined heart morphology and function by high-frequency ultrasounds and electric activity by surface ECG. Besides, the autonomic sympathovagal balance (heart-rate variability) and the arrhythmogenic susceptibility to adrenergic challenge (i.p. isoproterenol) were compared in the two groups, as well as glucose tolerance (i.p. glucose test) and liver steatosis (ultrasounds). RESULTS Body weight in HF-group exceeded C-group at the end of the experiment (+28% p < 0.01). An abnormal ventricular repolarization (long QTc on ECG) together with impaired LV filling rate and increased LV mass was found in HF-group as compared to C. Moreover, HF-group showed higher heart rate, unbalanced autonomic control with adrenergic prevalence and a greater susceptibility to develop rhythm disturbances under adrenergic challenge (i.p. isoprenaline). Impaired glucose tolerance and higher liver fat accumulation were also found in HF mice compared to C. CONCLUSIONS The described murine model of 13 weeks on HF diet, well reproduced the cardiovascular and metabolic disorders reported in clinical obesity, suggesting its potential utility as translational mean suitable for testing new pharmaco-therapeutic approaches to the treatment of obesity and its comorbidity.
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20
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Williams SM, Eleftheriadou A, Alam U, Cuthbertson DJ, Wilding JPH. Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review. Diabetes Ther 2019; 10:1995-2021. [PMID: 31552598 PMCID: PMC6848658 DOI: 10.1007/s13300-019-00693-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a major complication of type 1 and type 2 diabetes mellitus (T1DM and T2DM). The increased morbidity, cardiovascular and all-cause mortality associated with CAN is established from numerous epidemiological studies. However, CAN is increasingly recognised in people with prediabetes (pre-DM) and the metabolic syndrome (MetS) with a reported prevalence up to 11% and 24% respectively. CAN is associated with components of MetS including hypertension and obesity, predating hyperglycaemia. The aetiology of CAN is multifactorial and there is a reciprocal relationship with insulin resistance and MetS. Obstructive sleep apnoea (OSA) is also associated with CAN possibly through MetS and an independent mechanism. An estimated global prevalence of the impaired glucose tolerance (IGT) form of pre-DM of 587 million people by 2045 means CAN will become a major clinical problem. CAN is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Screening for CAN in pre-DM using risk scores with analysis of heart rate variability (HRV) or Sudoscan is important to allow earlier treatment at a reversible stage. The link between obesity and CAN highlights the therapeutic potential of lifestyle interventions including diet and physical activity to reverse MetS and prevent CAN. Weight loss achieved using these dietary and exercise lifestyle interventions improves the sympathetic and parasympathetic HRV indices of cardiac autonomic function. Further research is needed to identify high-risk populations of people with pre-DM or obesity that might benefit from targeted pharmacotherapy including metformin, sodium/glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) analogues. Bariatric surgery also improves HRV through weight loss which might also prevent CAN in severe obesity. This article reviews the literature on CAN in obesity, pre-DM and MetS, to help determine a rationale for screening, early intervention treatment and formulate future research questions in this highly prevalent condition.
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Affiliation(s)
| | | | - Uazman Alam
- Diabetes and Neuropathy Research, Department of Eye and Vision Sciences and Pain Research Institute, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
- Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK
| | - Daniel J Cuthbertson
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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21
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Kaneko K, Chikamoto A, Hsu JCN, Tochinai R, Sekizawa SI, Yamamoto M, Kuwahara M. Effects of environmental enrichment on autonomic nervous activity in NSY mice. Exp Anim 2019; 69:161-167. [PMID: 31735765 PMCID: PMC7220714 DOI: 10.1538/expanim.19-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Environmental enrichment (EE) can reduce anxiety and stress in experimental animals,
while little is known about the influence on autonomic nervous activity especially in
disease animal models. Diabetes mellitus (DM) is associated with cardiovascular autonomic
dysfunction, which can be characterized by a higher resting heart rate and a lower heart
rate variability (HRV). We hypothesized that EE can enhance parasympathetic nervous
activity while reducing disease progression in type 2 diabetic mice. A telemetry
transmitter was implanted in NSY mice to continuously record electrocardiograms (ECG).
Animals were kept in a cage with or without a nest box as EE. The autonomic nervous
activity was evaluated using power spectral analysis of HRV. Four weeks of EE could
increase high frequency (HF) power, but no change was observed in the absence of EE.
Although animals showed impaired glucose tolerance at 48 weeks of age regardless of EE, a
worsen case was observed in control. These results indicate that EE can be necessary for
long-term housing of experimental animals and may reduce the risk of impaired glucose
tolerance in NSY mice by enhancing parasympathetic nervous activity. In future, it is
demanded whether increasing parasympathetic nervous activity, whatever the method is, can
prevent diabetes from worsening.
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Affiliation(s)
- Kentaro Kaneko
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.,School of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki 319-1295, Japan.,Graduate School of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki 319-1295, Japan
| | - Akitoshi Chikamoto
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Julia Chu-Ning Hsu
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Ryota Tochinai
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Shin-Ichi Sekizawa
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Machiko Yamamoto
- School of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki 319-1295, Japan.,Graduate School of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki 319-1295, Japan
| | - Masayoshi Kuwahara
- Laboratory of Veterinary Pathophysiology and Animal Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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22
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Lundqvist MH, Almby K, Abrahamsson N, Eriksson JW. Is the Brain a Key Player in Glucose Regulation and Development of Type 2 Diabetes? Front Physiol 2019; 10:457. [PMID: 31133864 PMCID: PMC6524713 DOI: 10.3389/fphys.2019.00457] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
Ever since Claude Bernards discovery in the mid 19th-century that a lesion in the floor of the third ventricle in dogs led to altered systemic glucose levels, a role of the CNS in whole-body glucose regulation has been acknowledged. However, this finding was later overshadowed by the isolation of pancreatic hormones in the 20th century. Since then, the understanding of glucose homeostasis and pathology has primarily evolved around peripheral mechanism. Due to scientific advances over these last few decades, however, increasing attention has been given to the possibility of the brain as a key player in glucose regulation and the pathogenesis of metabolic disorders such as type 2 diabetes. Studies of animals have enabled detailed neuroanatomical mapping of CNS structures involved in glucose regulation and key neuronal circuits and intracellular pathways have been identified. Furthermore, the development of neuroimaging techniques has provided methods to measure changes of activity in specific CNS regions upon diverse metabolic challenges in humans. In this narrative review, we discuss the available evidence on the topic. We conclude that there is much evidence in favor of active CNS involvement in glucose homeostasis but the relative importance of central vs. peripheral mechanisms remains to be elucidated. An increased understanding of this field may lead to new CNS-focusing pharmacologic strategies in the treatment of type 2 diabetes.
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Affiliation(s)
| | - Kristina Almby
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Jan W Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Spallone V. Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet. Diabetes Metab J 2019; 43:3-30. [PMID: 30793549 PMCID: PMC6387879 DOI: 10.4093/dmj.2018.0259] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 12/15/2022] Open
Abstract
The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to increase due to the diabetes epidemic and its early and widespread appearance. CAN has a definite prognostic role for mortality and cardiovascular morbidity. Putative mechanisms for this are tachycardia, QT interval prolongation, orthostatic hypotension, reverse dipping, and impaired heart rate variability, while emerging mechanisms like inflammation support the pervasiveness of autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: by promoting screening for symptoms and signs; by simplifying cardiovascular reflex tests; and by selecting the candidates for screening. CAN assessment allows for treatment of its manifestations, cardiovascular risk stratification, and tailoring therapeutic targets. Risk factors for CAN are mainly glycaemic control in type 1 diabetes mellitus (T1DM) and, in addition, hypertension, dyslipidaemia, and obesity in type 2 diabetes mellitus (T2DM), while preliminary data regard glycaemic variability, vitamin B12 and D changes, oxidative stress, inflammation, and genetic biomarkers. Glycaemic control prevents CAN in T1DM, whereas multifactorial intervention might be effective in T2DM. Lifestyle intervention improves autonomic function mostly in pre-diabetes. While there is no conclusive evidence for a disease-modifying therapy, treatment of CAN manifestations is available. The modulation of autonomic function by SGLT2i represents a promising research field with possible clinical relevance.
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Affiliation(s)
- Vincenza Spallone
- Division of Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Benichou T, Pereira B, Mermillod M, Tauveron I, Pfabigan D, Maqdasy S, Dutheil F. Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS One 2018; 13:e0195166. [PMID: 29608603 PMCID: PMC5880391 DOI: 10.1371/journal.pone.0195166] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/16/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cardiac autonomic neuropathy in type 2 dibetes mellitus (T2DM) patients is frequent and associated with high cardiovascular mortality. Heart rate variability (HRV) is the gold standard to measure cardiac autonomic neuropathy. We aimed to conduct a systematic review and meta-analysis to evaluate the impact of T2DM on HRV parameters. METHODS The PubMed, Cochrane Library, Embase and Science Direct databases were searched on 1st October 2017 using the keywords "diabetes" AND ("heart rate variability" OR "HRV"). Included articles had to report HRV parameters in T2DM patients and healthy controls measured during 24 hours with a Holter-electrocardiogram. Measurements of HRV retieved were: RR-intervals (or Normal to Normal intervals-NN), standard deviation of RR intervals (SDNN), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), square root of the mean squared difference of successive RR intervals (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio, as per Task Force recommendations. RESULTS We included twenty-five case-control studies with 2,932 patients: 1,356 with T2DM and 1,576 healthy controls. T2DM patients had significantly (P<0.01) lower RR-intervals (effect size = -0.61; 95%CI -1.21 to -0.01), lower SDNN (-0.65; -0.83 to -0.47), lower RMSSD (-0.92; -1.37 to -0.47), lower pNN50 (-0.46; -0.84 to -0.09), lower total power (-1.52; -2.13 to -0.91), lower LF (-1.08; -1.46 to -0.69]), and lower HF (-0.79; -1.09 to -0.50). LF/HF did not differ between groups. Levels of blood glucose and HbA1c were associated with several HRV parameters, as well as Time from diagnosis of T2DM. CONCLUSIONS T2DM was associated with an overall decrease in the HRV of T2DM patients. Both sympathetic and parasympathetic activity were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy.
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Affiliation(s)
- Thomas Benichou
- University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Clinical Research Direction, Clermont–Ferrand, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, LPNC & CNRS, LPNC, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Igor Tauveron
- Université Clermont Auvergne, CNRS, GReD, Inserm, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Daniela Pfabigan
- Peking University, Culture and Social Cognitive Neuroscience Laboratory, School of Psychological and Cognitive Sciences, Beijing, China
| | - Salwan Maqdasy
- Université Clermont Auvergne, CNRS, GReD, Inserm, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont–Ferrand, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
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Touati H, Ouali-Hassenaoui S, Dekar-Madoui A, Challet E, Pévet P, Vuillez P. Diet-induced insulin resistance state disturbs brain clock processes and alters tuning of clock outputs in the Sand rat, Psammomys obesus. Brain Res 2017; 1679:116-124. [PMID: 29196219 DOI: 10.1016/j.brainres.2017.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 01/16/2023]
Abstract
Reciprocal interactions closely connect energy metabolism with circadian rhythmicity. Altered clockwork and circadian desynchronization are often linked with impaired energy regulation. Conversely, metabolic disturbances have been associated with altered autonomic and hormonal rhythms. The effects of high-energy (HE) diet on the master clock in the suprachiasmatic nuclei (SCN) remain unclear.This question was addressed in the Sand rat (Psammomys obesus), a non-insulin-dependent diabetes mellitus (NIDDM) animal model. The aim of this work was to determine whether enriched diet in Psammomys affects locomotor activity rhythm, as well as daily oscillations in the master clock of the SCN and in an extra-SCN brain oscillator, the piriform cortex. Sand rats were fed during 3 months with either low or HE diet. Vasoactive intestinal peptide (VIP), vasopressin (AVP) and CLOCK protein cycling were studied by immunohistochemistry and running wheel protocol was used for behavioral analysis. High energy feeding dietary triggered hyperinsulinemia, impaired insulin/glucose ratio and disruption in pancreatic hormonal rhythms. Circadian disturbances in hyper-insulinemic animals include a lengthened rest/activity rhythm in constant darkness, as well as disappearance of daily rhythmicity of VIP, AVP and the circadian transcription factor CLOCK within the suprachiasmatic clock. In addition, daily rhythmicity of VIP and CLOCK was abolished by HE diet in a secondary brain oscillator, the piriform cortex. Our findings highlight a major impact of diabetogenic diet on central and peripheral rhythmicity. The Psammomys model will be instrumental to better understand the functional links between circadian clocks, glucose intolerance and insulin resistance state.
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Affiliation(s)
- Hanane Touati
- Regulation of Circadian Clocks Team, Institute of Cellular and Integrative Neurosciences, UPR3212, CNRS, University of Strasbourg, Strasbourg, France; USTHB, Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Neurobiology Team, BP 32, El Alia, 16111 Bab Ezzouar, Algiers, Algeria.
| | - Saliha Ouali-Hassenaoui
- USTHB, Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Neurobiology Team, BP 32, El Alia, 16111 Bab Ezzouar, Algiers, Algeria.
| | - Aicha Dekar-Madoui
- USTHB, Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Neurobiology Team, BP 32, El Alia, 16111 Bab Ezzouar, Algiers, Algeria.
| | - Etienne Challet
- Regulation of Circadian Clocks Team, Institute of Cellular and Integrative Neurosciences, UPR3212, CNRS, University of Strasbourg, Strasbourg, France.
| | - Paul Pévet
- Regulation of Circadian Clocks Team, Institute of Cellular and Integrative Neurosciences, UPR3212, CNRS, University of Strasbourg, Strasbourg, France.
| | - Patrick Vuillez
- Regulation of Circadian Clocks Team, Institute of Cellular and Integrative Neurosciences, UPR3212, CNRS, University of Strasbourg, Strasbourg, France.
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Dimova R, Tankova T, Chakarova N. Vitamin D in the Spectrum of Prediabetes and Cardiovascular Autonomic Dysfunction. J Nutr 2017; 147:1607-1615. [PMID: 28768837 DOI: 10.3945/jn.117.250209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/27/2017] [Accepted: 06/30/2017] [Indexed: 11/14/2022] Open
Abstract
Vitamin D is a fat-soluble secosteroid hormone with pleiotropic effects. 1,25-Dihydroxyvitamin D coordinates the biosynthesis of neurotransmitters in the central nervous system, which regulate cardiovascular autonomic function and may explain its putative role in the development of cardiovascular autonomic neuropathy (CAN). CAN is an independent risk factor for mortality in patients with diabetes and prediabetes and is associated with an increased risk of developing type 2 diabetes and cardiovascular disease. Accumulating data indicate the presence of peripheral nerve injury at these early stages of dysglycemia and its multifactorial pathogenesis. Prediabetes is associated with vitamin D insufficiency. Vitamin D is proposed to prevent the progression of glucose intolerance. The putative underlying mechanisms include maintenance of the intracellular calcium concentration, direct stimulation of insulin receptor expression, and enhancement of the insulin response to glucose transporters. Vitamin D exerts a protective effect on peripheral nerve fibers by decreasing the demyelination process and inducing axonal regeneration. The effects of vitamin D supplementation on glucose tolerance and related autonomic nerve dysfunction have been a recent focus of scientific interest. Although well-designed observational studies are available, the causative relation between vitamin D deficiency, glucose intolerance, and CAN is still debatable. One reason might be that interventional studies are unpersuasive with regard to the beneficial clinical effects of vitamin D supplementation. Because of its favorable side effect profile, vitamin D supplementation might represent an attractive therapeutic option for treating the pandemic prevalence of prediabetes and vitamin D deficiency. Vitamin D supplementation can improve glucose tolerance and cardiovascular autonomic function and can thus reduce cardiovascular mortality among subjects with different stages of glucose intolerance and autonomic dysfunction. However, more patient-centered trials on the use of vitamin D supplementation in different conditions are needed.
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Affiliation(s)
- Rumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University, Sofia, Sofia, Bulgaria
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University, Sofia, Sofia, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University, Sofia, Sofia, Bulgaria
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Abstract
Chronic hyperglycaemia of Type 2 diabetes mellitus causes long term damage to heart resulting in coronary artery disease (CAD), myocardial infarction (MI), congestive heart failure (CHF), and sudden death from arrhythmias. AIMS To study the prevalence of different types of arrhythmias in T2DM, particularly in association with Cardiac Autonomic Neuropathy (CAN). METHODS A cross-sectional study including 100 patients of Type 2 Diabetes Mellitus (T2DM) presenting with cardiac arrhythmias, was done at our hospital over 2 years. Detailed history along with physical examination and tests for CAN were done. Routine investigations along with echocardiography, stress test, Holter monitoring were done. RESULTS Sinus Tachycardia (ST) was the commonest arrhythmia, found in 32% of patients. 20% had Complete Heart Block (CHB), 15% had Sinus Bradycardia (SB), and 15% had Atrial Fibrillation (AF). Ventricular Premature Complex (VPC) was found in 10% and 3% had Atrial Premature Complex (APC). 3% had first degree AV block, whereas 1% had Paroxysmal Supra Ventricular Tachycardia (PSVT), and another 1% had Ventricular Tachycardia (VT). Poorly controlled diabetes and co-morbidities was associated with higher incidence of arrhythmias. 62% of patients had prolonged QTc, majority of which had CAN. Most of the patients responded to standard therapy.
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Affiliation(s)
- Gaurav Agarwal
- Department of Medicine, Nalanda Medical College Hospital, Patna, Bihar, India
| | - Satish Kumar Singh
- Department of Medicine, Nalanda Medical College Hospital, Patna, Bihar, India
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Rahman A, Fujisawa Y, Nakano D, Hitomi H, Nishiyama A. Effect of a selective SGLT2 inhibitor, luseogliflozin, on circadian rhythm of sympathetic nervous function and locomotor activities in metabolic syndrome rats. Clin Exp Pharmacol Physiol 2017; 44:522-525. [PMID: 28063156 DOI: 10.1111/1440-1681.12725] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Metabolic syndrome is often associated with disruption of circadian rhythm of systemic haemodynamics and cardiovascular disease. Experiments were conducted to investigate the effects of luseogliflozin, a selective SGLT2 inhibitor, on circadian rhythm of sympathetic nervous function and locomotor activity (LA) in metabolic syndrome rats. The difference in the low frequency component of systolic blood pressure between the dark and light period significantly increased in the luseogliflozin-treated SHRcp. LA also increased in the dark period compared with the light period following luseogliflozin treatment. These data suggest that circadian rhythm of sympathetic nervous function and LA is improved by luseogliflozin in metabolic syndrome rats, which may contribute to SGLT2 inhibitor-induced improvement of cardiovascular outcomes.
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Affiliation(s)
- Asadur Rahman
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshihide Fujisawa
- Life Science Research Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Daisuke Nakano
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hirofumi Hitomi
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Orosz A, Baczkó I, Nyiraty S, Körei AE, Putz Z, Takács R, Nemes A, Várkonyi TT, Balogh L, Ábrahám G, Kempler P, Papp JG, Varró A, Lengyel C. Increased Short-Term Beat-to-Beat QT Interval Variability in Patients with Impaired Glucose Tolerance. Front Endocrinol (Lausanne) 2017; 8:129. [PMID: 28659867 PMCID: PMC5468431 DOI: 10.3389/fendo.2017.00129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/29/2017] [Indexed: 01/02/2023] Open
Abstract
Prediabetic states and diabetes are important risk factors for cardiovascular morbidity and mortality. Determination of short-term QT interval variability (STVQT) is a non-invasive method for assessment of proarrhythmic risk. The aim of the study was to evaluate the STVQT in patients with impaired glucose tolerance (IGT). 18 IGT patients [age: 63 ± 11 years, body mass index (BMI): 31 ± 6 kg/m2, fasting glucose: 6.0 ± 0.4 mmol/l, 120 min postload glucose: 9.0 ± 1.0 mmol/l, hemoglobin A1c (HbA1c): 5.9 ± 0.4%; mean ± SD] and 18 healthy controls (age: 56 ± 9 years, BMI: 27 ± 5 kg/m2, fasting glucose: 5.2 ± 0.4 mmol/l, 120 min postload glucose: 5.5 ± 1.3 mmol/l, HbA1c: 5.4 ± 0.3%) were enrolled into the study. ECGs were recorded, processed, and analyzed off-line. The RR and QT intervals were expressed as the average of 30 consecutive beats, the temporal instability of beat-to-beat repolarization was characterized by calculating STVQT as follows: STVQT = Σ|QTn + 1 - QTn| (30x√2)-1. Autonomic function was assessed by means of standard cardiovascular reflex tests. There were no differences between IGT and control groups in QT (411 ± 43 vs 402 ± 39 ms) and QTc (431 ± 25 vs 424 ± 19 ms) intervals or QT dispersion (44 ± 13 vs 42 ± 17 ms). However, STVQT was significantly higher in IGT patients (5.0 ± 0.7 vs 3.7 ± 0.7, P < 0.0001). The elevated temporal STVQT in patients with IGT may be an early indicator of increased instability of cardiac repolarization during prediabetic conditions.
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Affiliation(s)
- Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Szabolcs Nyiraty
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna E. Körei
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Putz
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Takács
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- Second Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | | | - László Balogh
- Juhász Gyula Faculty of Education, Institute of Physical Education and Sport Science, University of Szeged, Szeged, Hungary
| | - György Ábrahám
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Kempler
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Julius Gy. Papp
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - Csaba Lengyel
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Tadic M, Vukomanovic V, Cuspidi C, Suzic-Lazic J, Stanisavljevic D, Celic V. Left atrial phasic function and heart rate variability in asymptomatic diabetic patients. Acta Diabetol 2017; 54:301-308. [PMID: 28083658 DOI: 10.1007/s00592-016-0962-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/30/2016] [Indexed: 12/11/2022]
Abstract
AIMS We evaluated left atrial (LA) phasic function and heart rate variability (HRV) in asymptomatic diabetic patients, and the relationship between HRV indices and LA phasic function assessed by volumes and speckle tracking imaging. METHOD This cross-sectional study included 55 asymptomatic patients with type 2 diabetes and 50 healthy controls without cardiovascular risk factors. All study subjects underwent laboratory analyses, complete two-dimensional echocardiography examination (2DE) and 24-h Holter monitoring. RESULTS Maximum, minimum LA and pre-A LA volumes and volume indexes are significantly higher in diabetic patients. Total and passive LA emptying fractions (EF), representing the LA reservoir and conduit function, are significantly lower in diabetic subjects. Active LA EF, the parameter of the LA booster pump function, is compensatory increased in diabetic patients. Similar results were obtained by 2DE strain analysis. Cardiac autonomic function, assessed by HRV, is significantly deteriorated in diabetic patients. Time and frequency-domain HRV measures are significantly lower in diabetic subjects than in controls. HbA1c, LV mass index and HRV are associated with total LA EF and longitudinal LA strain independently of age, body mass index and LV diastolic function in the whole study population. CONCLUSIONS LA phasic function and cardiac autonomic nervous system assessed by HRV are impacted by diabetes. HbA1c and HRV are independently associated with LA reservoir function evaluated by volumetric and strain methods in the whole study population. This study emphasizes the importance of determination of LA function and HRV as important markers of preclinical cardiac damage and autonomic function impairment in diabetic patients.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
| | - Vladan Vukomanovic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, Istituto Auxologico Italiano, University of Milan-Bicocca, Viale della Resistenza 23, 20036, Meda, Italy
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Doktora Subotica 15, 11000, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
- Faculty of Medicine, Doktora Subotica 6, 11000, Belgrade, Serbia
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Fang P, Dong J, Zeng F, Tang Z. Analysis of the association between glucose profiles and β-cell function for diabetic cardiovascular autonomic neuropathy in China. J Diabetes Investig 2016; 8:354-362. [PMID: 27736036 PMCID: PMC5415463 DOI: 10.1111/jdi.12584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/07/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION The purpose of the present study was to investigate the severity of glucose profiles and β-cell function associated with diabetic cardiovascular autonomic neuropathy (DCAN) in a Chinese sample. MATERIALS AND METHODS A community-based, cross-sectional study to analyze the risk factors of DCAN was carried out with 455 individuals recruited from a Chinese population. The glucose profile risk score was calculated to identify the association between the severity of the glucose profiles and DCAN. The associations of the severity of the glucose profiles and β-cell function with DCAN were analyzed using multivariable logistic regression. RESULTS Univariate analysis showed that the glucose profiles and homeostatic model assessment of insulin resistance were significantly associated with the DCAN outcome, respectively. Multivariable logistic regression showed that significant associations exist between glucose profile indices and DCAN, after controlling for potential confounding factors (P < 0.01 for all) in both models. Multivariable logistic regression also showed that parameters of β-cell function were associated with the DCAN outcome in the category model (P < 0.1 for all). The glucose profile risk score was independently and significantly associated with the DCAN outcome after controlling for confounding factors (P < 0.001 and P for a trend <0.001). CONCLUSIONS Our observations suggest that parameters of glucose profile indices and β-cell function are significantly and independently associated with DCAN, respectively. There was a tendency toward increased glucose profile risk score with increasing prevalence of DCAN.
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Affiliation(s)
- Ping Fang
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Department of Endocrinology, Shanghai Tongji Hospital, Tongji University, Shanghai, China
| | - Jingcheng Dong
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Institutes of Integrative Medicine, Fudan University, Shanghai, China
| | - Fangfang Zeng
- Department of Endocrinology and Metabolism, Fudan University Huashan Hospital, Shanghai, China
| | - Zihui Tang
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Institutes of Integrative Medicine, Fudan University, Shanghai, China
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Vukomanovic V, Tadic M, Suzic-Lazic J, Kocijancic V, Celic V. The relationship between heart rate variability and left ventricular layer-specific deformation in uncomplicated diabetic patients. Int J Cardiovasc Imaging 2016; 33:481-490. [PMID: 27853970 DOI: 10.1007/s10554-016-1023-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/12/2016] [Indexed: 12/25/2022]
Abstract
The aim of this study was to investigate heart rate variability (HRV) and left ventricular (LV) remodeling in uncomplicated diabetic patients. Furthermore, we sought to investigate the association between HRV indices and LV structural, functional and mechanical parameters. This cross-sectional study included 50 uncomplicated patients with type 2 diabetes and 40 healthy controls without cardiovascular risk factors. All study subjects underwent 24-h Holter monitoring, laboratory analyses and complete two-dimensional echocardiography examination (2DE). LV structure and diastolic function were significantly deteriorated in the diabetic patients comparing with the controls. LV global longitudinal, circumferential and radial strains were significantly reduced in the diabetic group. LV endocardial, mid-miocardial and epicardial longitudinal and circumferential strains were significantly decreased, whereas LV twist was significantly increased, in the diabetic patients; 24-h, daytime and nighttime heart rates were higher in the diabetic patients. All parameters of time and frequency domain of HRV were reduced in the diabetic subjects. LV mass index, mitral E/e' ratio and 2DE LV endocardial and mid-miocardial longitudinal and circumferential strains correlated with HRV parameters. A multivariate regression analysis showed that E/e' ratio and 2DE LV layer-specific strains were associated with HRV parameters independently of age, BMI, systolic blood pressure and LV mass index. HRV and LV mechanics are significantly deteriorated in uncomplicated diabetic individuals. Parameters of LV remodeling are independently associated with HRV indices, which could indicate the importance of HRV determination in diabetics.
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Affiliation(s)
- Vladan Vukomanovic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Doktora Subotica 6, 11000, Belgrade, Serbia.
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vesna Kocijancic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Doktora Subotica 6, 11000, Belgrade, Serbia
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RIBEIRO VICTORB, KOGURE GISLAINES, REIS ROSANAM, GASTALDI ADAC, DE ARAÚJO JOÃOE, MAZON JOSÉH, BORGHI AUDREY, SOUZA HUGOC. Polycystic Ovary Syndrome Presents Higher Sympathetic Cardiac Autonomic Modulation that is not altered by Strength Training. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2016; 9:554-566. [PMID: 27990221 PMCID: PMC5154718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Polycystic ovary syndrome (PCOS) may present important comorbidities, such as cardiovascular and metabolic diseases, which are often preceded by changes in cardiac autonomic modulation. Different types of physical exercises are frequently indicated for the prevention and treatment of PCOS. However, little is known about the effects of strength training on the metabolic, hormonal, and cardiac autonomic parameters. Therefore, our aim was to investigate the effects of strength training on the autonomic modulation of heart rate variability (HRV) and its relation to endocrine-metabolic parameters in women with PCOS. Fifty-three women were divided into two groups: CONTROL (n=26) and PCOS (n=27). The strength training lasted 4 months, which was divided into mesocycles of 4 weeks each. The training load started with 70% of one repetition maximum (1RM). Blood samples were collected before and after intervention for analysis of fasting insulin and glucose, HOMA-IR, testosterone, androstenedione and testosterone/androstenedione (T/A) ratio. Spectral analysis of HRV was performed to assess cardiac autonomic modulation indexes. The PCOS group presented higher insulin and testosterone levels, T/A ratio, along with increased sympathetic cardiac autonomic modulation before intervention. The training protocol used did not cause any change of endocrine-metabolic parameters in the CONTROL group. Interestingly, in the PCOS group, reduced testosterone levels and T/A ratio. Additionally, strength training did not have an effect on the spectral parameter values of HRV obtained in both groups. Strength training was not able to alter HRV autonomic modulation in women with PCOS, however may reduce testosterone levels and T/A ratio.
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Affiliation(s)
- VICTOR B. RIBEIRO
- Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, BRAZIL
| | - GISLAINE S. KOGURE
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, BRAZIL
| | - ROSANA M. REIS
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, BRAZIL
| | - ADA C. GASTALDI
- Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, BRAZIL
| | - JOÃO E. DE ARAÚJO
- Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, BRAZIL
| | - JOSÉ H. MAZON
- Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, BRAZIL
| | - AUDREY BORGHI
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, BRAZIL
| | - HUGO C.D. SOUZA
- Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, BRAZIL
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Catalogna M, Fishman S, Halpern Z, Ben-Shlomo S, Nevo U, Ben-Jacob E. Regulation of glucose dynamics by noninvasive peripheral electrical stimulation in normal and insulin-resistant rats. Metabolism 2016; 65:863-73. [PMID: 27173465 DOI: 10.1016/j.metabol.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/25/2016] [Accepted: 03/09/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The epidemic nature of type 2 diabetes mellitus (T2DM), along with the downsides of current treatments, has raised the need for therapeutic alternatives. METHODS We studied normo-glycemic and high-fat diet (HFD), induced insulin-resistant Wistar Han rats for 2 to 3weeks. Rats received peripheral electrical stimulation (PES) treatment (2Hz/16Hz bursts, 10mA) in their hind limbs for 3min, 3 times per week. Glucose tolerance was evaluated by using a glucose tolerance test at the beginning and again at the end of the study. The effect of an acute PES treatment on metabolic rates of glucose appearance and turnover was measured by using the hyperinsulinemic-euglycemic clamp (HEGC) test. RESULTS Repeated PES treatment significantly inhibited the progression of glucose intolerance in normal and insulin-resistant rats and prevented HFD-induced gains in body weight and fat mass. Acute treatment induced a prolonged effect on glucose turnover, as evaluated by the HEGC test. Increased hepatic glucose output was observed during the basal state (P<0.005). Under hyperinsulinemic conditions, PES improved tissue sensitivity to insulin (41.1%, P<0.01), improved suppression of hepatic glucose production (58.9±4.4% vs. 87.1±4.4%, P<0.02) and significantly elevated the rate of glycogenesis (P<0.01), compared with controls. CONCLUSIONS The present study indicates that a noninvasive PES treatment of very short duration is sufficiently potent to stimulate glucose utilization and improve hepatic insulin sensitivity in rats. Repeated PES treatment may have a beneficial effect on HFD-induced adiposity and control of body weight.
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Affiliation(s)
- Merav Catalogna
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
| | - Sigal Fishman
- Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv, Israel
| | - Zamir Halpern
- Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv, Israel
| | - Shani Ben-Shlomo
- Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv, Israel
| | - Uri Nevo
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel.
| | - Eshel Ben-Jacob
- School of Physics and Astronomy, Raymond & Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Israel; Center for Theoretical Biological Physics, Rice University, Houston, TX, USA
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Tiftikcioglu BI, Bilgin S, Duksal T, Kose S, Zorlu Y. Autonomic Neuropathy and Endothelial Dysfunction in Patients With Impaired Glucose Tolerance or Type 2 Diabetes Mellitus. Medicine (Baltimore) 2016; 95:e3340. [PMID: 27057914 PMCID: PMC4998830 DOI: 10.1097/md.0000000000003340] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Autonomic neuropathy is one of the most common complications of diabetes mellitus (DM). The etiology of autonomic impairment is not well-understood, yet. There is need for studies to investigate the cause-effect relationships of inflammation and/or endothelial dysfunction and diabetic autonomic neuropathy. Only a few reports have mentioned autonomic neuropathy in individuals with impaired glucose tolerance (IGT), previously. Furthermore, the association between the plasma markers of endothelial dysfunction (von Willebrand factor (vWF), soluble E-selectin) and autonomic neuropathy in patients with IGT or DM has not been studied before. In this study, we aimed to investigate the correlation between plasma markers of endothelial dysfunction and autonomic neuropathy in patients with IGT or type 2 DM (T2DM).In this case-control study, 25 IGT patients, 25 T2DM patients with autonomic symptoms, and 30 controls were included. Demographical data, HbA1c, vWF, and soluble E-selectin (sE-selectin) levels were analyzed. Sympathetic skin response (SSR) and heart rate variability (HRV) were used as the indicator of autonomic activity.Plasma levels of HbA1c, vWF, and sE-selectin were higher in patients with IGT than the controls; patients with T2DM had higher levels than both the controls and the patients with IGT. SSR measures were similar among the groups. However, higher number of T2DM patients had absent plantar SSR than controls. HRV analysis at rest revealed lower standard deviation of R-R interval, coefficient of variation of R-R interval, low-frequency (LF) power and total power in patients with IGT and T2DM than the controls. In addition, HRV analysis at deep breathing showed lower high-frequency (HF) power in IGT group. LF:HF ratio was lower in both patient groups at rest. No strong correlation was found between the levels of HbA1c, vWF, sE-selectin, HRV, and SSR measures.Our results support that endothelial dysfunction is evident in individuals with IGT or T2DM and HRV is impaired in early stages in the course of T2DM. However, increased levels of biomarkers of endothelial damage do not correlate with HRV or SSR. More studies are needed to clarify the disease pathogenesis and its clinical correlates. Impaired HRV in T2DM could be due to mechanisms other than endothelial dysfunction.
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Affiliation(s)
- Bedile Irem Tiftikcioglu
- From the Department of Neurology (BIT, SB, TD, YZ); and Department of Infectious Diseases and Clinical Microbiology (SK), Tepecik Education and Research Hospital, Izmir, Turkey
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Meyer ML, Gotman NM, Soliman EZ, Whitsel EA, Arens R, Cai J, Daviglus ML, Denes P, González HM, Moreiras J, Talavera GA, Heiss G. Association of glucose homeostasis measures with heart rate variability among Hispanic/Latino adults without diabetes: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Cardiovasc Diabetol 2016; 15:45. [PMID: 26983644 PMCID: PMC4793505 DOI: 10.1186/s12933-016-0364-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/09/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Reduced heart rate variability (HRV), a measure of cardiac autonomic function, is associated with an increased risk of cardiovascular disease (CVD) and mortality. Glucose homeostasis measures are associated with reduced cardiac autonomic function among those with diabetes, but inconsistent associations have been reported among those without diabetes. This study aimed to examine the association of glucose homeostasis measures with cardiac autonomic function among diverse Hispanic/Latino adults without diabetes. METHODS The Hispanic community Health Study/Study of Latinos (HCHS/SOL; 2008-2011) used two-stage area probability sampling of households to enroll 16,415 self-identified Hispanics/Latinos aged 18-74 years from four USA communities. Resting, standard 12-lead electrocardiogram recordings were used to estimate the following ultrashort-term measures of HRV: RR interval (RR), standard deviation of all normal to normal RR (SDNN) and root mean square of successive differences in RR intervals (RMSSD). Multivariable regression analysis was used to estimate associations between glucose homeostasis measures with HRV using data from 11,994 adults without diabetes (mean age 39 years; 52 % women). RESULTS Higher fasting glucose was associated with lower RR, SDNN, and RMSSD. Fasting insulin and the homeostasis model assessment of insulin resistance was negatively associated with RR, SDNN, and RMSSD, and the association was stronger among men compared with women. RMSSD was, on average, 26 % lower in men with higher fasting insulin and 29 % lower in men with lower insulin resistance; for women, the corresponding estimates were smaller at 4 and 9 %, respectively. Higher glycated hemoglobin was associated with lower RR, SDNN, and RMSSD in those with abdominal adiposity, defined by sex-specific cut-points for waist circumference, after adjusting for demographics and medication use. There were no associations between glycated hemoglobin and HRV measures among those without abdominal adiposity. CONCLUSIONS Impairment in glucose homeostasis was associated with lower HRV in Hispanic/Latino adults without diabetes, most prominently in men and individuals with abdominal adiposity. These results suggest that reduced cardiac autonomic function is associated with metabolic impairments before onset of overt diabetes in certain subgroups, offering clues for the pathophysiologic processes involved as well as opportunity for identification of those at high risk before autonomic control is manifestly impaired.
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Affiliation(s)
- Michelle L. Meyer
- />University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC 27514 USA
| | - Nathan M. Gotman
- />University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC 27514 USA
| | | | - Eric A. Whitsel
- />University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC 27514 USA
| | - Raanan Arens
- />Division of Respiratory and Sleep Medicine, The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Jianwen Cai
- />University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC 27514 USA
| | - Martha L. Daviglus
- />University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | | | | | | | | | - Gerardo Heiss
- />University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC 27514 USA
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Perticone M, Tassone EJ, Scarpino PE, Naccarato P, Addesi D, di Cello S, Sciacqua A, Maio R, Andreucci M, Carrao S, Licata A, Sesti G, Perticone F. Sympathovagal balance and 1-h postload plasma glucose in normoglucose tolerant hypertensive patients. Acta Diabetol 2016; 53:41-7. [PMID: 25813368 DOI: 10.1007/s00592-015-0740-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/11/2015] [Indexed: 01/19/2023]
Abstract
AIMS Normoglucose tolerant (NGT) subjects with a 1-h postload plasma glucose (PLPG) value ≥155 mg/dL have an increased risk of type-2 diabetes and subclinical organ damage. Heart rate variability (HRV) reflects cardiac autonomic balance, frequently impaired in course of diabetes. At this time, no data support the association between 1-h PLPG and HRV; thus, we investigated the possible association between 1-h PLPG and HRV. METHODS We enrolled 92 never-treated hypertensive subjects (56 women, 36 men), aged 55 ± 9.8 years. During OGTT, the patients underwent electrocardiographic recordings to evaluate HRV in the time domain (SDNN). Insulin sensitivity was assessed by Matsuda index. RESULTS Among participants, 56 were NGT, 20 had impaired glucose tolerance (IGT), and 16 had type-2 diabetes. According to the 1-h PLPG cutoff point of 155 mg/dL, we divided NGT subjects into: NGT < 155 (n = 38) and NGT ≥ 155 (n = 18). Glucose tolerance status was associated with a significant (P < 0.0001) increase in PLPG and insulin and the reduction in Matsuda index. In all groups, the SDNN values significantly (P < 0.0001) decreased during the first hour of OGTT. A complete recovery in NGT groups was observed at the end of the second hour; in IGT and type-2 diabetes, SDNN remained significantly lower with respect to baseline values. At multiple regression analysis, Matsuda index resulted in the only determinant of SDNN modification, explaining the 12.3 % of its variability. CONCLUSIONS Our data demonstrate that during OGTT, sympathovagal balance is acutely affected by both glucose and insulin modifications. Particularly, NGT ≥ 155 subjects behave in the same way of IGT and type-2 diabetes patients.
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Affiliation(s)
- Maria Perticone
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Eliezer J Tassone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Paola E Scarpino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Paola Naccarato
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Desirée Addesi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Serena di Cello
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Raffaele Maio
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Science, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Salvatore Carrao
- Biomedical Department of Internal Medicine and Speciality, University of Palermo, Palermo, Italy
| | - Anna Licata
- Biomedical Department of Internal Medicine and Speciality, University of Palermo, Palermo, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy.
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Russell NE, Higgins MF, Kinsley BF, Foley ME, McAuliffe FM. Heart rate variability in neonates of type 1 diabetic pregnancy. Early Hum Dev 2016; 92:51-5. [PMID: 26658058 DOI: 10.1016/j.earlhumdev.2015.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/02/2015] [Accepted: 11/08/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cardiomyopathy is a common finding in offspring of pre-gestational type 1 diabetic pregnancy. Echocardiographic and biochemical evidence of fetal cardiac dysfunction have also been reported. Studies suggest that offspring of diabetic mothers (ODM) undergo a fetal programming effect due to the hyperglycaemic intrauterine milieu which increases their risk of cardiovascular morbidity in adult life. Decreased neonatal heart rate variability (HRV) has been described in association with in-utero growth restriction, prematurity, sudden infant death syndrome and congenital heart disease. The effect of in-utero exposure to hyperglycaemia in diabetic pregnancy on neonatal HRV is unknown. AIMS Our aim was to determine if neonatal HRV differs between normal and diabetic pregnancy. STUDY DESIGN AND SUBJECTS This was a prospective observational study of 38 patients with pregestational type 1 diabetes and 26 controls. HRV assessment was performed using Powerlab (ADI Instruments Ltd). OUTCOME MEASURES Heart rate variability assessment and cord blood sampling for pH and glucose were performed for all neonates. Maternal glycaemic control was assessed via measurement of glycosylated haemoglobin in each trimester in the diabetic cohort. RESULTS Neonates of diabetic mothers had evidence of altered heart rate variability, with increased low frequency to high frequency ratio (LF: HF), suggestive of a shift towards sympathetic predominance (p<0.05). This altered HRV was significantly related to fetal acidaemia, cord blood glucose values and maternal glycaemic control during pregnancy (p<0.05). CONCLUSION Neonates of pregestational diabetic pregnancy have altered HRV which is related to maternal hyperglycaemia, fetal acidaemia and fetal glycaemia. Exposure of the developing heart to fluctuations in maternal glycaemia with subsequent alterations in HRV may explain why infants of diabetic mothers are at greater risk of cardiovascular disease in later life.
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Affiliation(s)
- Noirin E Russell
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin National Maternity Hospital, Dublin 2, Ireland
| | - Mary F Higgins
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin National Maternity Hospital, Dublin 2, Ireland
| | - Brendan F Kinsley
- Dublin Diabetes Pregnancy Care Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael E Foley
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin National Maternity Hospital, Dublin 2, Ireland
| | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin National Maternity Hospital, Dublin 2, Ireland.
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Scott EM. Circadian clocks, obesity and cardiometabolic function. Diabetes Obes Metab 2015; 17 Suppl 1:84-9. [PMID: 26332972 DOI: 10.1111/dom.12518] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
Life on earth is governed by the continuous 24-h cycle of light and dark. Organisms have adapted to this environment with clear diurnal rhythms in their physiology and metabolism, enabling them to anticipate predictable environmental fluctuations over the day and to optimize the timing of relevant biological processes to this cycle. These rhythms are regulated by molecular circadian clocks, and current evidence suggests that interactions between the central and peripheral molecular clocks are important in metabolic and vascular functions. Disrupting this process through mutations in the core clock genes or by interfering with the environmental zeitgebers that entrain the clock appear to modulate the function of cells and tissues, leading to an increased risk for cardiometabolic disease.
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Affiliation(s)
- E M Scott
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine Clarendon Way, University of Leeds, Leeds, UK
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Ziegler D, Voss A, Rathmann W, Strom A, Perz S, Roden M, Peters A, Meisinger C. Increased prevalence of cardiac autonomic dysfunction at different degrees of glucose intolerance in the general population: the KORA S4 survey. Diabetologia 2015; 58:1118-28. [PMID: 25724570 DOI: 10.1007/s00125-015-3534-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/30/2015] [Indexed: 02/08/2023]
Abstract
AIMS/HYPOTHESIS Cardiac autonomic nervous dysfunction (CAND) raises the risk of mortality, but the glycaemic threshold at which it develops is unclear. We aimed to determine the prevalence of, risk factors for and impact of CAND in glucose intolerance and diabetes. METHODS Among 1,332 eligible participants aged 55-74 years in the population-based cross-sectional KORA S4 study, 130 had known diabetes mellitus (k-DM), and the remaining 1,202 underwent an OGTT. Heart rate variability (HRV) and QT variability were computed from supine 5 min ECGs. RESULTS In all, 565 individuals had normal glucose tolerance (NGT), 336 had isolated impaired fasting glucose (i-IFG), 72 had isolated impaired glucose tolerance (i-IGT), 151 had combined IFG-IGT (IFG-IGT) and 78 had newly detected diabetes mellitus (n-DM). Adjusted normal HRV limits were defined in the NGT population (5th and 95th percentiles). Three HRV measures were more frequently abnormal in those with k-DM, n-DM, IFG-IGT and i-IFG than in those with NGT (p < 0.05). The rates of CAND (≥2 of 4 HRV indices abnormal) were: NGT, 4.5%; i-IFG, 8.1%; i-IGT, 5.9%; IFG-IGT, 11.4%; n-DM, 11.7%; and k-DM, 17.5% (p < 0.05 vs NGT, except for i-IGT). Reduced HRV was associated with cardiovascular risk factors used to construct a simple screening score for CAND. Mortality was higher in participants with reduced HRV (p < 0.05 vs normal HRV). CONCLUSIONS/INTERPRETATION In the general population aged 55-74 years, the prevalence of CAND is increased not only in individuals with diabetes, but also in those with IFG-IGT and, to a lesser degree, in those with i-IFG. It is associated with mortality and modifiable cardiovascular risk factors which may be used to screen for diminished HRV in clinical practice.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany,
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De Frène V, Vansteelandt S, T'Sjoen G, Gerris J, Somers S, Vercruysse L, De Sutter P. A retrospective study of the pregnancy, delivery and neonatal outcome in overweight versus normal weight women with polycystic ovary syndrome. Hum Reprod 2014; 29:2333-8. [PMID: 24963163 DOI: 10.1093/humrep/deu154] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY QUESTION Do overweight women with polycystic ovary syndrome (PCOS) have a higher risk of perinatal complications than normal weight women with PCOS? SUMMARY ANSWER Overweight women with PCOS with an ongoing singleton pregnancy have an increased risk of preterm birth as well as an increased risk of giving birth to a baby with a higher birthweight than normal weight women with PCOS. WHAT IS KNOWN ALREADY There is evidence that overweight (BMI > 25 kg/m²) has a negative influence on the prevalence of gestational diabetes mellitus and fetal macrosomia in women with PCOS. STUDY DESIGN, SIZE, DURATION We set up a retrospective comparative cohort study of 93 overweight (BMI ≥ 25 kg/m²) and 107 normal weight (BMI < 25 kg/m²) women with PCOS who were scheduled for fertility treatment between January 2000 and December 2009 and achieved a pregnancy as a result of a treatment cycle, or spontaneously before or between treatment cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS All data (patient characteristics, medical information, pregnancy, delivery and neonatal outcome) were retrieved from patient medical files. All pregnancy, delivery and neonatal outcome parameters were adjusted for age and pre-pregnancy smoking behaviour. The neonatal outcome parameters were additionally adjusted for gestational age. MAIN RESULTS AND THE ROLE OF CHANCE The median BMI in the overweight and normal weight women was, respectively, 30.8 kg/m² [interquartile quartile range (IQR) 5.8] and 20.9 kg/m² (IQR 2.3) (P < 0.001). Baseline characteristics did not differ between groups, except for free testosterone and fasting insulin levels, which were higher, and sex hormone-binding globulin, which was lower, in overweight versus normal weight women (all P < 0.001). The time-to-pregnancy was significantly higher in the overweight group (P = 0.01). Multivariate analyses of the ongoing singleton pregnancies showed significantly more preterm births in overweight (10/61) versus normal weight (2/71) women [adjusted odds ratio 0.1, 95% confidence interval (CI) 0-0.6, P = 0.01]. The mean birthweight of newborns was significantly higher in overweight (3386 ± 663 g) than in normal weight (3251 ± 528 g) women (adjusted mean difference 259.4, 95% CI 83.4-435.4, P = 0.004). LIMITATIONS, REASON FOR CAUTION Our results only represent the pregnancy, delivery and neonatal outcome of ongoing singleton pregnancies. The rather small sample size and observational nature of the study are further limitations. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest the importance of pre-pregnancy weight loss in overweight women with PCOS in order to reduce the risk of adverse perinatal outcomes. STUDY FUNDING/COMPETING INTERESTS Veerle De Frène is holder of a Special PhD Fellowship by the Flemish Foundation for Scientific Research (FWO-Vlaanderen). Petra De Sutter is holder of a fundamental clinical research mandate by the Flemish Foundation for Scientific Research (FWO-Vlaanderen). There are no competing interests.
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Affiliation(s)
- V De Frène
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - S Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281 (S9), B-9000 Ghent, Belgium
| | - G T'Sjoen
- Department of Endocrinology and Metabolic Diseases, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - J Gerris
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - S Somers
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - L Vercruysse
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
| | - P De Sutter
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
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Micronutrient and physiologic parameters before and 6 months after RYGB. Surg Obes Relat Dis 2014; 10:944-51. [PMID: 25264334 DOI: 10.1016/j.soard.2014.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bariatric surgery is considered an effective method for sustained weight loss, but may cause various nutritional complications. The aim of this study was to evaluate the nutritional status of minerals and vitamins, food consumption, and to monitor physiologic parameters in patients with obesity before and 6 months after Roux-en-Y gastric bypass surgery (RYGB). METHODS Thirty-six patients who had undergone RYGB were prospectively evaluated before and 6 months after surgery. At each phase their weight, height, body mass index (BMI), Electro Sensor Complex (ES Complex) data, food consumption, and total protein serum levels, albumin, prealbumin, parathyroid hormone (PTH), zinc (Zn), B12 vitamin (VitB12), iron (Fe), ferritin, copper (Cu), ionic calcium (CaI), magnesium (Mg), and folic acid were assessed. RESULTS The mean weight loss from baseline to 6 months after surgery was 35.34±4.82%. Markers of autonomic nervous system balance (P<.01), stiffness index (P<.01), standard deviation of normal-to-normal R-R intervals (SDNN) (P<.01), and insulin resistance (P<.001) were also improved. With regard to the micronutrients measured, 34 patients demonstrated some kind of deficiency. There was a high percentage of Zn deficiency in both pre- (55.55%) and postoperative (61.11%) patients, and 33.33% of the patients were deficient in prealbumin postoperatively. The protein intake after 6 months of surgery was below the recommended intake (<70 g/d) for 88.88% of the patients. Laboratory analyses demonstrated an average decrease in total protein (P<.05), prealbumin (P = .002), and PTH (P = .008) between pre- and postsurgery, and a decrease in the percentage of deficiencies for Mg (P<.05), CaI (P<.05), and Fe (P = .021). CONCLUSION Despite improvements in the autonomic nervous system balance, stiffness index markers and insulin resistance, we found a high prevalence of hypozincemia at 6 months post-RYGB. Furthermore, protein supplements were needed to maintain an adequate protein intake up to 6 months postsurgery.
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Abstract
OBJECTIVE To test the validity of the Patient Health Questionnaire-9 (PHQ-9) in adults with newly diagnosed Type 2 diabetes mellitus (T2DM) and compare the distribution of PHQ-9 items in those with and without Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) depression. METHODS A two-stage survey design was used in primary care centers (n = 96). In Stage 1, participants were administered the PHQ-9 and biopsychosocial measures. In Stage 2, PHQ-9 positives (score ≥ 10) and randomly selected PHQ-9 negatives (score <10) had a diagnostic interview, Schedule for Clinical Assessment in Neuropsychiatry 2.1. The sensitivity, specificity and receiver operating characteristics of the PHQ-9 were calculated. The means of PHQ-9 items were compared. RESULTS Stage 1: Prevalence of PHQ-9 positives (completing Stage 2) was 12.1% (n = 182). PHQ-9 positives were younger (mean [standard deviation] age = 52.8 [9.47] versus 56.2 [11.50] years, p < .001) and had higher body mass index (32.7 [7.08] versus 31.6 [6.25] kg/m(2), p = .028) than PHQ-9 negatives (n = 1278). Stage 2: Prevalence of DSM-IV depression was 5.6% (n = 84). The optimal cutoff was ≥ 12 (sensitivity = 86.9%, specificity = 80.3%). PHQ-9 true positives scored significantly higher than PHQ-9 false positives on all items, excluding sleep (mean [standard deviation] score = 2.4 [0.98] versus 2.2 [1.06]), fatigue (2.5 [0.80] versus 2.3 [0.86]), and appetite (1.6 [1.23] versus 1.5 [1.26]). CONCLUSIONS Over-identification of depression by PHQ-9 in T2DM may be driven by presence of symptoms in keeping with an organic origin.
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Intzilakis T, Hartmann G, Mouridsen MR, Eugen-Olsen J, Kumarathurai P, Madsbad S, Almdal TP, Haugaard SB, Sajadieh A. Soluble urokinase plasminogen activator receptor, C-reactive protein and triglyceride are associated with heart rate variability in non-diabetic Danes. Eur J Clin Invest 2013; 43:457-68. [PMID: 23517378 DOI: 10.1111/eci.12070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 02/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Heart rate variability (HRV) is associated with an increased risk of cardiovascular morbidity and mortality. HRV is in part a function of the activity of the autonomic nervous system and has been associated with low-grade inflammation. In patients with type 2 diabetes, HRV is decreased and is a predictor of poor outcome. As HRV and its determinants in non-diabetic individuals have not been studied properly, the aim of this observational study was to evaluate possible associations between HRV vs. impaired fasting glucose, insulin resistance, lipidaemia and markers of inflammation and immune activation in these individuals. MATERIALS AND METHODS Healthy individuals (n = 596, 55-75 years) from the community were evaluated with ambulant 48-h continuous electrocardiogram monitoring and fasting markers of lipidaemia, inflammation and immune activation, respectively. Insulin resistance was estimated by HOMA-IR. Time domain components of HRV were calculated. RESULTS Heart rate and HRV were not associated with glucose metabolic parameters but were inversely associated with soluble urokinase plasminogen activator receptor (suPAR), high-sensitive CRP and leucocyte number (P < 0·001), respectively. Both 24-h and night-time HRV were inversely associated with plasma triglyceride, whereas HDL, LDL and total cholesterol were not. A model including suPAR, CRP, gender, triglyceride, age, systolic blood pressure, physical activity and smoking status explained 12·2% (P < 0·0001) of the 24-h HRV and 7·3% (P < 0·0001) of the night-time HRV. The single strongest factor to explain 24-h and night-time HRV appeared to be suPAR (P = 0·001 and P = 0·0067, respectively). CONCLUSION A low HRV is not related to prediabetes, that is, insulin resistance and impaired fasting glucose, but is related to the immune and inflammatory markers suPAR and CRP and plasma triglyceride.
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Affiliation(s)
- Theodoros Intzilakis
- Department of Internal Medicine, Copenhagen University Hospital, Italiensvej 1, 2300 Amager, Denmark.
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Borgognoni L, Picciarella A, Di Stefano A, Fontana V, Russo A, Pascucci M, Paris A, Tubani L, Fiorentini A. Correlation between glycemic trends assessed by 24 h continuous monitoring and autonomic activity in patients with recent onset type 2 diabetes. Diabetes Res Clin Pract 2013; 100:e14-6. [PMID: 23497980 DOI: 10.1016/j.diabres.2013.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/31/2012] [Accepted: 01/03/2013] [Indexed: 11/21/2022]
Abstract
We observe, in patients with type 2 diabetes of recent onset, the activity of the autonomic nervous system and glucose metabolic impairment. The data indicate the hyperactivity of the sympathetic and minimal changes in glucose values. The role played by glycemia appeared to be less important than that represented by insulin resistance.
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Affiliation(s)
- Laura Borgognoni
- Department of Clinical Medicine, Policlinico Umberto I, University of Rome Sapienza, Italy
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Song Y, Ye X, Ye L, Li B, Wang L, Hua Y. Disturbed subjective sleep in Chinese females with type 2 diabetes on insulin therapy. PLoS One 2013; 8:e54951. [PMID: 23383010 PMCID: PMC3557283 DOI: 10.1371/journal.pone.0054951] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/17/2012] [Indexed: 02/02/2023] Open
Abstract
Objectives The aim of this study is to investigate the prevalence and determine the possible risk factors of poor sleep quality in Chinese type 2 diabetes patients with insulin treatment. Methods 140 type 2 diabetes patients with insulin treatments were enrolled in our study. General characteristics and laboratory testing such glycosylated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), post-prandial plasma glucose (PPG) were measured. Every patient completed Chinese version of Pittsburgh Sleep Quality Index (PSQI) questionnaire. PSQI global score>5 was defined as poor sleep quality. Results Global PSQI score was significantly higher in female type 2 diabetes patients with insulin treatment than male (7.52 vs 6.08, P<0.05). After adjusting for age, BMI, FPG, PPG, HbA1c and duration of diabetes, female is still an independent risk factor for poor sleep quality [OR = 2.55, 95% confidence interval (CI) = 1.24–5.27, P = 0.01]. Conclusion The results suggest that we found poor sleep quality in female Chinese type 2 diabetes patients with insulin treatment and these findings may contribute to sleep disorder control in female type 2 diabetes.
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Affiliation(s)
- Yingxiang Song
- Department of Endocrinology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China
| | - Xiao Ye
- Department of Endocrinology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China
| | - Leqin Ye
- Department of Endocrinology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China
| | - Bijun Li
- Department of Endocrinology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China
| | - Lijun Wang
- Department of Endocrinology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China
| | - Yanyin Hua
- Department of Endocrinology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China
- * E-mail:
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Jang EH, Kim NY, Park YM, Kim MK, Baek KH, Song KH, Lee KW, Kwon HS. Influence of visceral adiposity on cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus. Diabetes Metab J 2012; 36:285-92. [PMID: 22950060 PMCID: PMC3428417 DOI: 10.4093/dmj.2012.36.4.285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/12/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the influences of visceral adiposity on cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus. METHODS Two hundred eleven patients with type 2 diabetes participated in this study. Anthropometric and metabolic parameters were measured, and the visceral fat area was assessed using computed tomography. CAN was diagnosed using a cardiovascular reflex test. We analyzed the correlation between the visceral fat area and each parameter in this test. RESULTS The mean age, body mass index (BMI), and duration of diabetes of the study population were 60±14 years (mean±standard deviation), 25.1±4.2 kg/m(2), and 12.3±8.9 years, respectively. The visceral fat area showed positive correlations with age, BMI, waist circumference, and subcutaneous fat area. There was no statistically significant difference in the cardiovascular reflex test outcome between genders. Univariate linear regression analysis showed that an increased visceral fat area diminished good heart rate response to a Valsalva maneuver (R(2)=4.9%, P=0.013 in an unadjusted model), but only in women. This statistical association was preserved after adjusting for age and BMI (R(2)=9.8%, P=0.0072). CONCLUSION The results of this study suggest that visceral adiposity contributes to an autonomic imbalance to some degree, as demonstrated by the impaired cardiovascular reflex test among women with type 2 diabetes.
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Affiliation(s)
- Eun-Hee Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Na-Young Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong-Moon Park
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Mee-Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kwang Woo Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Abstract
It is now increasingly being appreciated that a substantial proportion of subjects with prediabetes may exhibit peripheral neuropathy and/or neuropathic pain. The reverse is also true, inasmuch as examining patients with idiopathic peripheral neuropathy will frequently reveal prediabetes. In the general population, the prevalence of neuropathy in prediabetes is intermediate between overt diabetes and subjects with normoglycemia. This prediabetic neuropathy is, generally, milder in comparison to diabetic neuropathy and mainly affects small fibers mediating sensory function. Hyperglycemia, microangiopathy, dyslipidemia and the metabolic syndrome have been implicated as pathogenic mechanisms. In practice, therapy of prediabetic neuropathy should be addressed towards normoglycemia and correction of cardiovascular risk factors. However, additional work is needed to establish the long-term results of this approach.
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Affiliation(s)
- Nikolaos Papanas
- Institute for Clinical Diabetology, German Diabetes Center at the Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.
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Hampel R, Breitner S, Schneider A, Zareba W, Kraus U, Cyrys J, Geruschkat U, Belcredi P, Müller M, Wichmann HE, Peters A. Acute air pollution effects on heart rate variability are modified by SNPs involved in cardiac rhythm in individuals with diabetes or impaired glucose tolerance. ENVIRONMENTAL RESEARCH 2012; 112:177-185. [PMID: 22071035 DOI: 10.1016/j.envres.2011.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 10/06/2011] [Accepted: 10/17/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Epidemiological studies have shown associations between particulate matter (PM) and heart rate variability (HRV). OBJECTIVES We investigated the effects of air pollution on the root mean square of successive differences (RMSSD) and the standard deviation of normal-to-normal intervals (SDNN) and effect modifications by single nucleotide polymorphisms (SNP). METHODS Between March 2007 and December 2008 207 ECG recordings comprising 1153 1 h-intervals were measured in 61 individuals with type 2 diabetes or impaired glucose tolerance (IGT) from Augsburg, Germany. Associations between 1 h-averages of air pollutants (PM, sulphate, black carbon, and ultrafine particles) and ECG parameters were analyzed using additive mixed models. Genotypes of 139 SNPs supposed to be involved in cardiac rhythm were identified in the literature. Using regression trees for longitudinal data, SNPs associated with ECG parameters were determined and included as potential air pollution effect modifiers. RESULTS We observed concurrent and lagged decreases in SDNN by about 2-5% in association with all air pollutants, especially in participants with at least one minor allele of rs332229. Increases in PM<2.5 μm (PM(2.5)) were associated with 4 h-lagged decreases of -6.6% [95%-confidence interval:-10.6;-2.6%] and -13.0% [-20.7;-5.1%] in SDNN in individuals with one or two minor alleles. We observed a -7.2% [-12.2;-1.8%] reduction in RMSSD associated with concurrent increases in PM(2.5.) Individuals with at least one minor allele of rs2096767 or at most one minor allele of rs2745967 exhibited stronger PM(2.5) effects. CONCLUSIONS We identified a genetic predisposition in persons with diabetes or IGT making them potentially more susceptible to air pollutants with regard to changes in HRV.
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Affiliation(s)
- Regina Hampel
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany.
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Lee S, Cowan PA, Wetzel GT, Velasquez-Mieyer P. Prediabetes and blood pressure effects on heart rate variability, QT-interval duration, and left ventricular hypertrophy in overweight-obese adolescents. J Pediatr Nurs 2011; 26:416-27. [PMID: 21930028 DOI: 10.1016/j.pedn.2010.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 08/09/2010] [Accepted: 08/12/2010] [Indexed: 11/18/2022]
Abstract
This ancillary, descriptive correlational study examined the effect of glucose regulation, blood pressure (BP), and their combined effects on cardiac autonomic function in 128 overweight-obese 11-18-year-olds. Measures included body mass index, resting BP, fasting glucose, glucose tolerance, and cardiac autonomic function (heart rate variability, QT, and Cornell voltage). After adjusting for age and gender, multivariate analysis of covariance revealed no differences in cardiac autonomic measures based on glucose regulation (p = .319), BP (p = .286), or the interaction between glucose regulation and BP (p = .132). The additive effect of prediabetes and elevated BP did not impact cardiac autonomic function in overweight-obese youth.
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