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Liu B, Liu R, Gu Y, Shen X, Zhou J, Luo C. Polyunsaturated fatty acids and diabetic microvascular complications: a Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1406382. [PMID: 39170741 PMCID: PMC11335686 DOI: 10.3389/fendo.2024.1406382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background Observational studies and clinical trials have implicated polyunsaturated fatty acids (PUFAs) in potentially safeguarding against diabetic microvascular complication. Nonetheless, the causal nature of these relationships remains ambiguous due to conflicting findings across studies. This research employs Mendelian randomization (MR) to assess the causal impact of PUFAs on diabetic microvascular complications. Methods We identified instrumental variables for PUFAs, specifically omega-3 and omega-6 fatty acids, using the UK Biobank data. Outcome data regarding diabetic microvascular complications were sourced from the FinnGen Study. Our analysis covered microvascular outcomes in both type 1 and type 2 diabetes, namely diabetic neuropathy (DN), diabetic retinopathy (DR), and diabetic kidney disease (DKD). An inverse MR analysis was conducted to examine the effect of diabetic microvascular complications on PUFAs. Sensitivity analyses were performed to validate the robustness of the results. Finally, a multivariable MR (MVMR) analysis was conducted to determine whether PUFAs have a direct influence on diabetic microvascular complications. Results The study indicates that elevated levels of genetically predicted omega-6 fatty acids substantially reduce the risk of DN in type 2 diabetes (odds ratio (OR): 0.62, 95% confidence interval (CI): 0.47-0.82, p = 0.001). A protective effect against DR in type 2 diabetes is also suggested (OR: 0.75, 95% CI: 0.62-0.92, p = 0.005). MVMR analysis confirmed the stability of these results after adjusting for potential confounding factors. No significant effects of omega-6 fatty acids were observed on DKD in type 2 diabetes or on any complications in type 1 diabetes. By contrast, omega-3 fatty acids showed no significant causal links with any of the diabetic microvascular complications assessed. Conclusions Our MR analysis reveals a causal link between omega-6 fatty acids and certain diabetic microvascular complications in type 2 diabetes, potentially providing novel insights for further mechanistic and clinical investigations into diabetic microvascular complications.
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Affiliation(s)
- Bingyang Liu
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Ruiyan Liu
- Wenzhou Medical University Renji College, Wenzhou, China
| | - Yi Gu
- Ningbo Institute of Innovation for Combined Medicine and Engineering, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Xiaoying Shen
- Department of Endocrinology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Jianqing Zhou
- Department of Cardiovascular, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Chun Luo
- Department of Endocrinology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
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Foti Randazzese S, Bombaci B, Costantino S, Giorgianni Y, Lombardo F, Salzano G. Discordance between Glucose Management Indicator and Glycated Hemoglobin in a Pediatric Cohort with Type 1 Diabetes: A Real-World Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:210. [PMID: 38397323 PMCID: PMC10887365 DOI: 10.3390/children11020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024]
Abstract
The introduction of continuous glucose monitoring (CGM) systems in clinical practice has allowed a more detailed picture of the intra- and interdaily glycemic fluctuations of individuals with type 1 diabetes (T1D). However, CGM-measured glucose control indicators may be occasionally inaccurate. This study aims to assess the discrepancy between the glucose management indicator (GMI) and glycated hemoglobin (HbA1c) (ΔGMI-HbA1c) within a cohort of children and adolescents with T1D, exploring its correlation with other CGM metrics and blood count parameters. In this single-center, cross-sectional study, we gathered demographic and clinical data, including blood count parameters, HbA1c values, and CGM metrics, from 128 pediatric subjects with T1D (43% female; mean age, 13.4 ± 3.6 years). Our findings revealed higher levels of the coefficient of variation (CV) (p < 0.001) and time above range > 250 mg/dL (p = 0.033) among subjects with ΔGMI-HbA1c > 0.3%. No association was observed between blood count parameters and ΔGMI-HbA1c. In conclusion, despite the advancements and the widespread adoption of CGM systems, HbA1c remains an essential parameter for the assessment of glycemic control, especially in individuals with suboptimal metabolic control and extreme glycemic variability.
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Affiliation(s)
| | | | | | | | | | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy; (S.F.R.); (B.B.); (S.C.); (Y.G.); (F.L.)
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Liu X, Zhou Y, Liu Y, Wang Q, Pan L. MicroRNA-425-5p is involved in the development of diabetic retinopathy and regulates the proliferation and migration of retinal microvascular endothelial cells. Ophthalmic Res 2021; 65:60-67. [PMID: 34571504 DOI: 10.1159/000516906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/23/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Xia Liu
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yanhua Zhou
- Department of Oncology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yunxia Liu
- Department of Internal Medicine, Fuyanshan Branch of Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Qian Wang
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Lili Pan
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, China
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Quevedo-Martínez JU, Garfias Y, Jimenez J, Garcia O, Venegas D, Bautista de Lucio VM. Pro-inflammatory cytokine profile is present in the serum of Mexican patients with different stages of diabetic retinopathy secondary to type 2 diabetes. BMJ Open Ophthalmol 2021; 6:e000717. [PMID: 34263060 PMCID: PMC8246380 DOI: 10.1136/bmjophth-2021-000717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/22/2021] [Indexed: 12/29/2022] Open
Abstract
Aim It’s been reported that pro-inflammatory cytokines are elevated in patients with diabetic retinopathy (DR); this may contribute to the pathophysiology of the disease. The aim of this study is to measure the concentration of various inflammatory cytokines from the main CD4+ T helper inflammatory responses in blood serum from Mexican patients with DR in different stages using cytometric bead array (CBA) technology and correlate them with the presence and severity of DR in order to find possible DR biomarkers that serve as diagnostic or therapeutic predictors. Methods 64 subjects were included in the study, 16 in the control group, 16 in the type 2 diabetes mellitus no DR (NDR) group, 16 in the non-proliferative DR (NPDR) group and 16 in the proliferative DR (PDR) group. Cytokine concentrations of interleukin (IL) 1ß, IL‐2, IL‐4, IL‐6, IL‐8, IL‐10, IL‐12, IL‐17A, tumour necrosis factor alpha (TNFα) and interferon-gamma in serum samples were measured using Human Inflammatory and TH1/TH2/TH17 CBA Kit. Results IL-6, IL-12, IL-17a and TNFα were significantly higher in the patients with DR compared with the control group. The PDR group showed a slightly lower concentration of serum cytokines IL-6, IL-12 and IL-17a. TNFα showed a higher concentration compared with healthy controls, NDR and NPDR subjects. We also found a positive statistical correlation between the presence and severity of DR with the clinical parameters haemoglobin A1c, body mass index and serum creatinine and the concentration of serum cytokines IL-6 and TNFα. Conclusion Our findings suggest that patients with diabetes and DR have a stronger chronic inflammatory profile compared with non-diabetic subjects.
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Affiliation(s)
| | - Yonathan Garfias
- Unidad de Investigación, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico.,Department of Biochemistry, Faculty of Medicine, UNAM. Av. Universidad 3000, 04510. Ciudad Universitaria, Mexico City, Mexico
| | - Joanna Jimenez
- Affective Disorders, Instituto Nacional de Psiquiatria Ramon de la Fuente Muniz Centro de Documentacion e Informacion en Psiquiatria y Salud Mental, Ciudad de Mexico, Mexico
| | - Osvaldo Garcia
- Econometrics and Operation Research, Universidad Autonoma de Tamaulipas, Victoria, Mexico
| | - Diana Venegas
- Research Unit, Microbiology and Ocular Proteomics Department, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico
| | - Victor Manuel Bautista de Lucio
- Research Unit, Microbiology and Ocular Proteomics Department, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico
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Er E, Ata A, Evin F, Altınok YA, Demir G, Özen S, Darcan Ş, Gökşen D. Glycated hemoglobin variability and microvascular complications in patients with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2020; 33:1533-1537. [PMID: 33581707 DOI: 10.1515/jpem-2020-0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/03/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Glycated hemoglobin (HbA1c) has proven to be indicative in the development of microvascular complications. In this study, the contribution of HbA1c variability to microvascular complications was evaluated. METHODS Twenty-one cases with type 1 diabetes mellitus (T1DM) who developed microvascular complications and 39 cases without complications, that were similar in terms of gender, age of diagnosis, insulin treatment, insulin doses (U/kg), and mean HbA1c levels were included. RESULTS Mean age of T1DM diagnosis was 5.87 ± 3.93 years in the complication group and 4.63 ± 3.33 years in the control group. Nephropathy was detected in 17 cases, neuropathy in 8 cases, and retinopathy in 1 case. Nephropathy occurred at a mean age of 11.52 ± 4.12 years and neuropathy at 14.13 ± 5.68 years. The mean HbA1c during follow-up was similar in the group with complications and the control group (8.60 ± 0.63 vs. 8.84 ± 1.32). Adjusted HbA1c-standard deviation (SD) and HbA1c-variation coefficient (CV) values were 1.30 ± 0.65 and 14.36 ± 6.23 in the group with complications (p=0.014), and 0.91 ± 0.37 and 10.59 ± 4.01 in the control group (p=0.013). In the Receiver Operating Characteristic (ROC)-analysis for microvascular complications, the limit value HbA1c-CV was 11.99 (sensitivity: 61.9%, specificity: 71.9%). This value for HbA1c-SD was 0.9699 (sensitivity: 71.43%, specificity: 66.67%). CONCLUSIONS This study has shown that long-term fluctuations in HbA1c are associated with the development of microvascular complications in type 1 diabetes.
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Affiliation(s)
- Eren Er
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey
| | - Aysun Ata
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey
| | - Ferda Evin
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey
| | - Yasemin Atik Altınok
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey
| | - Günay Demir
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey
| | - Samim Özen
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey
| | - Şükran Darcan
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey
| | - Damla Gökşen
- Department of Pediatrics, Faculty of Medicine, Division of Pediatric Endocrinology, School of Medicine, Ege University, İzmir, Turkey
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Evaluation of microvascular changes in retinal zones and optic disc in pediatric patients with type 1 diabetes mellitus. Graefes Arch Clin Exp Ophthalmol 2020; 259:323-334. [PMID: 32960323 DOI: 10.1007/s00417-020-04935-x] [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: 04/16/2020] [Revised: 07/01/2020] [Accepted: 09/10/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the vascular parameters of the retinal zones and the optic disc (OD) with the use of optical coherence tomography angiography (OCTA) in pediatric patients with type 1 diabetes mellitus (T1DM). METHODS This study enrolled 60 patients with T1DM without clinically detectable diabetic retinopathy (DR), along with 59 age-, gender-, and pubertal stage-matched controls. The ages of the participants in both groups were < 18 years. Retinal and OD measurements were carried out with OCTA. Foveal avascular zone (FAZ) area, non-flow area (NFA), FAZ perimeter (PERIM), acircularity index of FAZ (AI, the rate of the perimeter of FAZ and the perimeter of a circle with equal area), foveal density (FD), superficial (SCP), and the deep capillary plexus (DCP) were analyzed in the macular region. SCP and DCP were also scanned centered on the OD. Correlations between the OCTA parameters with duration of DM, glycated hemoglobin (HbA1c) levels, and microalbuminuria were evaluated among patients with T1DM. RESULTS The mean values for NFA were significantly higher and mean FD were significantly lower in the diabetic group compared with the controls (p = 0.02 and p = 0.01, respectively). The mean values for SCP and DCP were significantly lower in diabetic group (p < 0.05). The mean values for capillary density in the OD were also significantly lower in diabetic group (p < 0.05). There were correlations between the duration of T1DM, HbA1c levels and microalbuminuria, and the investigated parameters of OCTA. CONCLUSIONS The presence of microvascular changes in both retinal zones and the OD in children with T1DM without retinopathy is an important data. OCTA can be used for the early detection of DR in children.
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Herskin CW, Olsen BS, Madsen M, Kjaersgaard P, Fredheim S, Johansen A, Kristensen K, Birkebaek NH, Svensson J, Pilgaard KA, Johannesen J. Screening for retinopathy in children with type 1 diabetes in Denmark. Pediatr Diabetes 2020; 21:106-111. [PMID: 31618523 DOI: 10.1111/pedi.12936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/OBJECTIVE Children with type 1 diabetes (T1D) are screened regularly for retinopathy with fundus photography to prevent visual impairment. According to Danish national guidelines, screening should take place at age 12, 15, and 18 years after minimum 3 years of diabetes. As glycemic control has improved, prevalence of retinopathy is expected to be decreased. The aim of this study is to investigate the prevalence, degree, and progression of retinopathy in children with T1D and to explore if screening at 12 years is currently indicated in Denmark. METHODS Data on all Danish children with onset of T1D from 2003 to 2013 (n = 2943) were collected from the "DanDiabKids" registry. For children with registered screenings (n = 2382), prevalence of retinopathy at 12, 15, and 18 years was determined. In children with retinopathy, subsequent screenings were studied to reveal if retinopathy was persistent or temporary. RESULTS Prevalence of retinopathy at 12, 15, and 18 years was 0.9%, 2.3%, and 3.1%, respectively. Minimal background retinopathy was seen in over 90% and 100% at 12 years. In available re-screenings, retinopathy resolved spontaneously in 87.5% of all cases and 100% of cases at 12 years. CONCLUSIONS The prevalence of retinopathy in Danish children with T1D was low. At 12 years, prevalence was 0.9% and exclusively minimal background retinopathy with 100% remission in re-screenings. Thus, screening at this age does not seem to have significant clinical relevance. We propose more individualized screening selection before the age of 15.
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Affiliation(s)
- Camilla W Herskin
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Birthe S Olsen
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Mette Madsen
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Per Kjaersgaard
- Department of Paediatrics, Herning Hospital, Herning, Denmark
| | - Siri Fredheim
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Anders Johansen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H Birkebaek
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jannet Svensson
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Kasper A Pilgaard
- Pediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
| | - Jesper Johannesen
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
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