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Tordai DZ, Hajdú N, Rácz R, Istenes I, Békeffy M, Vági OE, Kempler M, Körei AE, Tóbiás B, Illés A, Pikó H, Kósa JP, Árvai K, Papp M, Lakatos PA, Kempler P, Putz Z. Genetic Factors Associated with the Development of Neuropathy in Type 2 Diabetes. Int J Mol Sci 2024; 25:1815. [PMID: 38339094 PMCID: PMC10855482 DOI: 10.3390/ijms25031815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Neuropathy is a serious and frequent complication of type 2 diabetes (T2DM). This study was carried out to search for genetic factors associated with the development of diabetic neuropathy by whole exome sequencing. For this study, 24 patients with long-term type 2 diabetes with neuropathy and 24 without underwent detailed neurological assessment and whole exome sequencing. Cardiovascular autonomic function was evaluated by cardiovascular reflex tests. Heart rate variability was measured by the triangle index. Sensory nerve function was estimated by Neurometer and Medoc devices. Neuropathic symptoms were characterized by the neuropathy total symptom score (NTSS). Whole exome sequencing (WES) was performed on a Thermo Ion GeneStudio S5 system determining the coding sequences of approximately 32,000 genes comprising 50 million base pairs. Variants were detected by Ion Reporter software and annotated using ANNOVAR, integrating database information from dbSNP, ClinVar, gnomAD, and OMIM. Integrative genomics viewer (IGV) was used for visualization of the mapped reads. We have identified genetic variants that were significantly associated with increased (22-49-fold) risk of neuropathy (rs2032930 and rs2032931 of recQ-mediated genome instability protein 2 (RMI2) gene), rs604349 of myosin binding protein H like (MYBPHL) gene and with reduced (0.07-0.08-fold) risk (rs917778 of multivesicular body subunit 12B (MVB12B) and rs2234753 of retinoic acid X receptor alpha (RXRA) genes). The rs2032930 showed a significant correlation with current perception thresholds measured at 5 Hz and 250 Hz for n. medianus (p = 0.042 and p = 0.003, respectively) and at 5 Hz for n. peroneus (p = 0.037), as well as the deep breath test (p = 0.022) and the NTSS (p = 0.023). The rs2032931 was associated with current perception thresholds (p = 0.003 and p = 0.037, respectively), deep breath test (p = 0.022), and NTSS (p = 0.023). The rs604349 correlated with values measured at 2000 (p = 0.049), 250 (p = 0.018), and 5 Hz (p = 0.005) for n. medianus, as well as warm perception threshold measured by Medoc device (p = 0.042). The rs2234753 showed correlations with a current perception threshold measured at 2000 Hz for n. medianus (p = 0.020), deep breath test (p = 0.040), and NTSS (p = 0.003). There was a significant relationship between rs91778 and cold perception threshold (p = 0.013). In our study, genetic variants have been identified that may have an impact on the risk of neuropathy developing in type 2 diabetic patients. These results could open up new opportunities for early preventive measures and might provide targets for new drug developments in the future.
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Affiliation(s)
- Dóra Zsuszanna Tordai
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
| | - Noémi Hajdú
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
| | - Ramóna Rácz
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
| | - Ildikó Istenes
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
| | - Magdolna Békeffy
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
| | - Orsolya Erzsébet Vági
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
| | - Miklós Kempler
- Department of Internal Medicine and Hematology, Semmelweis University, 1085 Budapest, Hungary;
| | - Anna Erzsébet Körei
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
| | - Bálint Tóbiás
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
- PentaCore Laboratory, 1134 Budapest, Hungary;
- Vascular Diagnostics Ltd., 1026 Budapest, Hungary
- Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
| | - Anett Illés
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
- PentaCore Laboratory, 1134 Budapest, Hungary;
- Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
| | - Henriett Pikó
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
- PentaCore Laboratory, 1134 Budapest, Hungary;
- Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
| | - János Pál Kósa
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
- PentaCore Laboratory, 1134 Budapest, Hungary;
- Vascular Diagnostics Ltd., 1026 Budapest, Hungary
- Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
| | - Kristóf Árvai
- PentaCore Laboratory, 1134 Budapest, Hungary;
- Vascular Diagnostics Ltd., 1026 Budapest, Hungary
| | - Márton Papp
- Centre for Bioinformatics, University of Veterinary Medicine, 1078 Budapest, Hungary;
| | - Péter András Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
- PentaCore Laboratory, 1134 Budapest, Hungary;
- Vascular Diagnostics Ltd., 1026 Budapest, Hungary
- Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
| | - Zsuzsanna Putz
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (N.H.); (I.I.); (M.B.); (O.E.V.); or (A.E.K.); (B.T.); (A.I.); (H.P.); (J.P.K.); (P.A.L.); (P.K.); or (Z.P.)
- Eötvös Lóránd Scientific Network ENDOMOLPAT, Semmelweis University, 1085 Budapest, Hungary
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Gomes DA, Presume J, de Araújo Gonçalves P, Almeida MS, Mendes M, Ferreira J. Association Between the Magnitude of Glycemic Control and Body Weight Loss With GLP-1 Receptor Agonists and Risk of Atherosclerotic Cardiovascular Disease: A Systematic Review and Meta-analyses of Randomized Diabetes Cardiovascular Outcomes Trials. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07547-3. [PMID: 38214869 DOI: 10.1007/s10557-024-07547-3] [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] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
PURPOSE Reduction of major atherosclerotic cardiovascular events (MACE) has not been consistent among different glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to assess the association between the magnitude of glycemic control, body weight loss, and reductions in systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) achieved through GLP-1 RA therapy and MACE. METHODS Electronic databases (MEDLINE, CENTRAL, SCOPUS) were searched through March 2023. Studies were eligible if they were cardiovascular outcome trials (CVOTs) comparing GLP-1 RAs versus placebo in T2DM patients. The outcome of interest was 3-point MACE - cardiovascular death, myocardial infarction, or stroke. Random-effects meta-regression analyses evaluated the associations between reductions of HbA1c, body weight, SBP and LDL-C and reduction of MACE. RESULTS Overall, 8 CVOTs were included (60079 patients, 30693 with GLP-1 RAs). Reductions of HbA1C were associated with the reduction of 3P-MACE (Log RR -0.290 [95% CI -0.515;-0.064], p = 0.012), with an estimated RR reduction of 25% for each 1% absolute reduction in HbA1C levels. Body weight loss was associated with the reduction of 3P-MACE (Log RR -0.068 [95% CI -0.135;-0.001], p = 0.047), with an estimated RR reduction of 7% for each 1 kg reduction in body weight. Reductions of SBP (Log RR -0.058 [95% CI -0.192;0.076], p = 0.396) and LDL-C (Log RR -0.602 [95% CI -4.157;2.953], p = 0.740) were not associated with the reduction of 3P-MACE. CONCLUSIONS In T2DM patients, more potent GLP-1 RAs in reducing HbA1c and body weight were associated with greater reductions of MACE.
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Affiliation(s)
- Daniel A Gomes
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, Carnaxide, 2790-134, Lisbon, Portugal.
| | - João Presume
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Manuel Sousa Almeida
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Mendes
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Jorge Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
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Huang Y, Xie P, Zhang S, Liu M, Huang R, Xiong Z, Zhong X, Lin Y, Zhou Z, Zhang W, Guo Y, Yang D, Zhuang X, Liao X. Intensive Glycemic Therapy in Type 2 Diabetes Patients With Cardiac Autonomic Dysfunction: The ACCORD Trial. Mayo Clin Proc 2024; 99:90-101. [PMID: 37690012 DOI: 10.1016/j.mayocp.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To assess whether the presence of cardiac autonomic dysfunction denoted by low heart rate variability (HRV) modifies the effect of intensive glycemic therapy on outcomes in patients with type 2 diabetes. PATIENTS AND METHODS This study included 7946 participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial from January 2001 through June 2009. Heart rate variability measures included standard deviation of all normal-to-normal intervals (SDNN) and root mean square of successive differences between normal-to-normal intervals (rMSSD). Abnormal values were defined based on less than the 10th percentile for SDNN and rMSSD. RESULTS Compared with standard therapy, intensive therapy was associated with improved primary outcome (composite of cardiovascular events) in the low-HRV group (SDNN: HR, 0.57; 95% CI, 0.39 to 0.84; rMSSD: HR, 0.57; 95% CI, 0.38 to 0.84), but not in the normal-HRV group (SDNN: HR, 0.90; 95% CI, 0.77 to 1.05; rMSSD: HR, 0.90; 95% CI, 0.77 to 1.05). A similar pattern was found for coronary heart disease. Conversely, intensive therapy had a neutral effect on all cause death in the low-HRV group (SDNN: HR, 0.88; 95% CI, 0.54 to 1.41; rMSSD: HR, 0.71; 95% CI, 0.43 to 1.17;), but increase risk of all-cause death in the normal-HRV group (SDNN: HR, 1.21; 95% CI, 1.00 to 1.46; rMSSD: HR, 1.25; 95% CI, 1.03 to 1.51). Intensive therapy induced a greater risk of hypoglycemia in the normal-HRV group than that in the low-HRV group. CONCLUSION Cardiac autonomic dysfunction expressed as low HRV identified subpopulations in ACCORD with more benefits and less harms from intensive therapy.
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Affiliation(s)
- Yiquan Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Peihan Xie
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Shaozhao Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Menghui Liu
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Rihua Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Zhenyu Xiong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xiangbin Zhong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yifen Lin
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Ziwei Zhou
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Wenjing Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yue Guo
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Daya Yang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, and the NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
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Lee KJ, Bae HJ. What have clinical trials taught us about brain health? CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100199. [PMID: 38235315 PMCID: PMC10792690 DOI: 10.1016/j.cccb.2023.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
The Global Burden of Disease Study projects an almost tripling of dementia cases worldwide in the next 30 years making it important to recognize and understand modifiable risks and preventatives for cognitive impairment. Recent studies suggest that prevention or treatment of cardiovascular risks may be an important strategy to prevent or slow the progression of cognitive impairment. In 2017, the American Heart Association and American Stroke Association introduced metrics for "optimal brain health". These metrics defined brain health in terms of ideal health behaviors and factors. Since then and leading up to 2017, a number of clinical trials have been conducted to investigate the potential of modification of cardiovascular risks on prevention of dementia or cognitive impairment and thus, enhancement of brain health. This discussion is a review of findings from clinical trials focusing on interventions, including antihypertensive agents, glycemic control and lipid-lowering therapies, multidomain approaches, and antithrombotic medications. Notably, the results highlight the promise of intensive blood pressure lowering strategies and multidomain approaches, as evidenced by the FINGER trial. The review also discusses the potential of treatment or prevention of cerebral small vessel disease (cSVD) and the application of Mendelian randomization as a strategy to preserve brain structure and function.
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Affiliation(s)
- Keon-Joo Lee
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Zhou Y, Chai X, Yang G, Sun X, Xing Z. Changes in body mass index and waist circumference and heart failure in type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1305839. [PMID: 38179309 PMCID: PMC10764620 DOI: 10.3389/fendo.2023.1305839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Background To determine the association of unintentional changes in body mass index (BMI) and waist circumference (WC) with the risk of heart failure (HF) among adults with type 2 diabetes mellitus (T2DM). Methods This was a randomized controlled trial (the Action to Control Cardiovascular Risk in Diabetes [ACCORD] study), with a double 2×2 factorial design conducted at 77 clinical centers across the United States and Canada. In total, the study comprised 10,251 patients with T2DM and cardiovascular disease (CVD) or at a high risk of CVD. The outcome of interest in the present analysis was incident HF, defined as the first hospitalization event for HF or death due to HF. Hospitalization for HF was based on documented clinical and radiological evidence. Death due to HF was based on clinical, radiological, or postmortem evidence of HF, with an absence of an acute ischemic event according to clinical or postmortem evidence. Results Participants with class III obesity had the smallest BMI and WC changes, followed by those with normal weight, overweight, class I obesity, and class II obesity. Increasing BMI (hazard ratio [HR] per standard deviation increase, 1.24; 95% confidence interval [CI], 1.07-1.45) and WC (1.27; 1.10-1.47) were significantly associated with a higher risk of HF. The relationship between BMI and WC changes and HF formed a J-shaped curve, while stable BMI and WC were associated with lower risks of HF. Compared with participants in the first tertiles of BMI and WC change, those in the third tertiles had HRs of 1.41 (95% CI, 1.07-1.45) and 1.48 (1.12-1.95), respectively. Conclusion In conclusion, our findings suggest a noteworthy association between BMI and WC changes among adults with T2DM in HF. We observed a distinctive J-shaped curve in this relationship, indicating that participants with both low and high BMI and WC changes were more susceptible to developing HF. Trial registration http://www.clinicaltrials.gov. Unique identifier: NCT00000620.
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Affiliation(s)
- Yang Zhou
- Department of Critical Care Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangping Chai
- Department of Emergency Department, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guifang Yang
- Department of Emergency Department, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xin Sun
- College of nursing, Changsha Medical University, Changsha, Hunan, China
| | - Zhenhua Xing
- Department of Emergency Department, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
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Dragoi II, Popescu FG, Bowling FL, Bondor CI, Ionac M. Patients' Buying Behavior for Non-Reimbursed Off-Loading Devices Used in Diabetic Foot Ulcer Treatment-An Observational Study during COVID-19 Pandemic from a Romanian Physical Therapy Unit. J Clin Med 2023; 12:6516. [PMID: 37892654 PMCID: PMC10607790 DOI: 10.3390/jcm12206516] [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: 08/27/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Diabetic foot ulcer non-reimbursed treatment depends on multiple factors, including the patient's buying behaviors. Factors affecting buying behaviors for the removable off-loading devices are not completely understood. The aim of this study was to investigate the patients' buying behaviors of the removable off-loading devices and their influence on the DFU treatment outcomes remotely monitored during the COVID-19 pandemic. In this prospective observational study, 45 patients affected by diabetic peripheral neuropathy, with/without peripheral arterial disease, with foot ulcers treated with removable devices were remotely monitored. Prefabricated removable cast walkers, insoles, and therapeutic footwear were the proposed off-loading methods. Patients affected by high blood pressure (p = 0.018), peripheral arterial disease (p = 0.029), past amputations (p = 0.018), and ulcer on the left foot (p = 0.007) bought removable cast walkers. Rural provenience (p = 0.011) and male (p = 0.034) did not buy a removable walker. The healing rate was 69.4%, while the median healing time was 20 weeks. High blood pressure negatively influenced healing time (p = 0.020). Patients who bought the most efficient treatment method for DFUs were females from urban provenience, with amputation in the past, with peripheral arterial disease, and with high blood pressure.
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Affiliation(s)
- Iulia Iovanca Dragoi
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
| | - Florina Georgeta Popescu
- Discipline of Occupational Health, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Frank L. Bowling
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
- Department of Surgery & Translational Medicine, Faculty of Medical and Human Sciences, University of Manchester, Oxford Rd., Manchester M13 9PL, UK
| | - Cosmina Ioana Bondor
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8 Victor Babeș, 400000 Cluj-Napoca, Romania;
| | - Mihai Ionac
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
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The Role of Platelets in Hypoglycemia-Induced Cardiovascular Disease: A Review of the Literature. Biomolecules 2023; 13:biom13020241. [PMID: 36830610 PMCID: PMC9953659 DOI: 10.3390/biom13020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death globally as well as the leading cause of mortality and morbidity in type 2 diabetes (T2D) patients. Results from large interventional studies have suggested hyperglycemia and poor glycemic control to be largely responsible for the development of CVDs. However, the association between hypoglycemia and cardiovascular events is also a key pathophysiological factor in the development of CVDs. Hypoglycemia is especially prevalent in T2D patients treated with oral sulfonylurea agents or exogenous insulin, increasing the susceptibility of this population to cardiovascular events. The adverse cardiovascular risk of hypoglycemia can persist even after the blood glucose levels have been normalized. Hypoglycemia may lead to vascular disease through mechanisms such as enhanced coagulation, oxidative stress, vascular inflammation, endothelial dysfunction, and platelet activation. In the following review, we summarize the evidence for the role of hypoglycemia in platelet activation and the subsequent effects this may have on the development of CVD. In addition, we review current evidence for the effectiveness of therapies in reducing the risk of CVDs.
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Aroda VR, Eckel RH. Reconsidering the role of glycaemic control in cardiovascular disease risk in type 2 diabetes: A 21st century assessment. Diabetes Obes Metab 2022; 24:2297-2308. [PMID: 35929480 PMCID: PMC9804800 DOI: 10.1111/dom.14830] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/09/2023]
Abstract
It is well known that the multiple factors contributing to the pathogenesis of type 2 diabetes (T2D) confer an increased risk of developing cardiovascular disease (CVD). Although the relationship between hyperglycaemia and increased microvascular risk is well established, the relative contribution of hyperglycaemia to macrovascular events has been strongly debated, particularly owing to the failure of attempts to reduce CVD risk through normalizing glycaemia with traditional therapies in high-risk populations. The debate has been further fuelled by the relatively recent discovery of the cardioprotective properties of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors. Further, as guidelines now recommend individualizing glycaemic targets, highlighting the importance of achieving glycated haemoglobin (HbA1c) goals safely, the previously observed negative influences of intensive therapy on CVD risk might not present if trials were repeated using current-day treatments and individualized HbA1c goals. Emerging longitudinal data illuminate the overall effect of excess glucose, the impacts of magnitude and duration of hyperglycaemia on disease progression and risk of CVD complications, and the importance of glycaemic control at or early after diagnosis of T2D for prevention of complications. Herein, we review the role of glucose as a modifiable cardiovascular (CV) risk factor, the role of microvascular disease in predicting macrovascular risk, and the deleterious impact of therapeutic inertia on CVD risk. We reconcile new and old data to offer a current perspective, highlighting the importance of effective, early treatment in reducing latent CV risk, and the timely use of appropriate therapy individualized to each patient's needs.
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Affiliation(s)
- Vanita R. Aroda
- Division of Endocrinology, Diabetes, and HypertensionBrigham and Women's HospitalBostonMassachusetts
| | - Robert H. Eckel
- Division of Endocrinology, Metabolism, and Diabetes, and the Division of CardiologyUniversity of Colorado School of MedicineAuroraColorado
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9
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Corneal Confocal Microscopy Identifies People with Type 1 Diabetes with More Rapid Corneal Nerve Fibre Loss and Progression of Neuropathy. J Clin Med 2022; 11:jcm11082249. [PMID: 35456342 PMCID: PMC9030140 DOI: 10.3390/jcm11082249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
There is a need to accurately identify patients with diabetes at higher risk of developing and progressing diabetic peripheral neuropathy (DPN). Fifty subjects with Type 1 Diabetes Mellitus (T1DM) and sixteen age matched healthy controls underwent detailed neuropathy assessments including symptoms, signs, quantitative sensory testing (QST), nerve conduction studies (NCS), intra epidermal nerve fiber density (IENFD) and corneal confocal microscopy (CCM) at baseline and after 2 years of follow-up. Overall, people with type 1 diabetes mellitus showed no significant change in HbA1c, blood pressure, lipids or neuropathic symptoms, signs, QST, neurophysiology, IENFD and CCM over 2 years. However, a sub-group (n = 11, 22%) referred to as progressors, demonstrated rapid corneal nerve fiber loss (RCNFL) with a reduction in corneal nerve fiber density (CNFD) (p = 0.0006), branch density (CNBD) (p = 0.0002), fiber length (CNFL) (p = 0.0002) and sural (p = 0.04) and peroneal (p = 0.05) nerve conduction velocities, which was not related to a change in HbA1c or cardiovascular risk factors. The majority of people with T1DM and good risk factor control do not show worsening of neuropathy over 2 years. However, CCM identifies a sub-group of people with T1DM who show a more rapid decline in corneal nerve fibers and nerve conduction velocity.
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10
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Ziegler D, Tesfaye S, Spallone V, Gurieva I, Al Kaabi J, Mankovsky B, Martinka E, Radulian G, Nguyen KT, Stirban AO, Tankova T, Varkonyi T, Freeman R, Kempler P, Boulton AJ. Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations. Diabetes Res Clin Pract 2022; 186:109063. [PMID: 34547367 DOI: 10.1016/j.diabres.2021.109063] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022]
Abstract
Diabetic sensorimotor polyneuropathy (DSPN) affects around one third of people with diabetes and accounts for considerable morbidity, increased risk of mortality, reduced quality of life, and increased health care costs resulting particularly from neuropathic pain and foot ulcers. Painful DSPN is encountered in 13-26% of diabetes patients, while up to 50% of patients with DSPN may be asymptomatic. Unfortunately, DSPN still remains inadequately diagnosed and treated. Herein we provide international expert consensus recommendations and algorithms for screening, diagnosis, and treatment of DSPN in clinical practice derived from a Delphi process. Typical neuropathic symptoms include pain, paresthesias, and numbness particularly in the feet and calves. Clinical diagnosis of DSPN is based on neuropathic symptoms and signs (deficits). Management of DSPN includes three cornerstones: (1) lifestyle modification, optimal diabetes treatment aimed at near-normoglycemia, and multifactorial cardiovascular risk intervention, (2) pathogenetically oriented pharmacotherapy (e.g. α-lipoic acid and benfotiamine), and (3) symptomatic treatment of neuropathic pain including analgesic pharmacotherapy (antidepressants, anticonvulsants, opioids, capsaicin 8% patch and combinations, if required) and non-pharmacological options. Considering the individual risk profile, pain management should not only aim at pain relief, but also allow for improvement in quality of sleep, functionality, and general quality of life.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Solomon Tesfaye
- Diabetes Research Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Vincenza Spallone
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Irina Gurieva
- Department of Endocrinology, Federal Bureau of Medical and Social Expertise, Moscow, Russia; Department of Endocrinology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Juma Al Kaabi
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Boris Mankovsky
- Department of Diabetology, National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - Emil Martinka
- National Institute of Endocrinology and Diabetology, Lubochna, Slovak Republic; Faculty of Health Sciences University of Ss. Cyril and Methodius in Trnava, Slovak Republic
| | - Gabriela Radulian
- "N. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Khue Thy Nguyen
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Tsvetalina Tankova
- Department of Endocrinology, Medical University - Sofia, Sofia, Bulgaria
| | - Tamás Varkonyi
- Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Andrew Jm Boulton
- Faculty of Biology, Medicine and Health, University of Manchester and Manchester University Foundation Trust, Manchester, UK
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11
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Bloomgarden Z, Chan JCN. Rationale for glycemic control to improve cardiovascular outcome: Lessons from east and west. J Diabetes 2021; 13:698-700. [PMID: 34047497 DOI: 10.1111/1753-0407.13204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Zachary Bloomgarden
- Department of Medicine - Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR China
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12
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Kloecker DE, Khunti K, Davies MJ, Pitocco D, Zaccardi F. Microvascular Disease and Risk of Cardiovascular Events and Death From Intensive Treatment in Type 2 Diabetes: The ACCORDION Study. Mayo Clin Proc 2021; 96:1458-1469. [PMID: 33952397 DOI: 10.1016/j.mayocp.2020.08.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether the presence of microvascular complications modifies the effect of intensive glucose reduction on long-term outcomes in patients with type 2 diabetes. PATIENTS AND METHODS Using ACCORD and ACCORDION study data, we investigated the risk of the primary outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) or death in relation to the prerandomization type and extent of microvascular complications. Interaction terms were fitted in survival models to estimate the risk of both outcomes across levels of an overall microvascular disease score (range 0 to 100) and its individual components: diabetic nephropathy, retinopathy, and neuropathy. RESULTS During a mean follow-up of 7.7 years, 1685 primary outcomes and 1806 deaths occurred in 9405 participants. The outcome-specific microvascular score was ≤30 in 97.9% of subjects for the primary outcome and in 98.5% for death. For participants with scores of 0 and 30, respectively, the 10-year absolute risk difference between intensive glucose control and standard treatment ranged from -0.8% (95% CI, -2.6, 1.1) to -3.0% -7.1, 1.1) for the primary outcome and from -0.5% (-2.1, 1.1) to 0.7% (-4.2, 5.6) for mortality. Retinopathy was associated with the largest effects, with a 10-year absolute risk difference of -6.5% (-11.1 to -2.0) for the primary outcome and -3.9% (-7.8 to 0.1) for mortality. CONCLUSION This hypothesis-generating study identifies diabetic retinopathy as predictor of the beneficial effect of intensive glucose control on the risk of cardiovascular disease and possibly death. Further long-term studies are required to confirm these findings.
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Affiliation(s)
- David E Kloecker
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom.
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom
| | - Dario Pitocco
- Diabetes Care Unit, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom
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13
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Twiddy H, Frank B, Alam U. A Consideration of the Psychological Aspects to Managing Patients with Painful Diabetic Neuropathy: An Insight into Pain Management Services at a Tertiary Centre in the UK. Diabetes Ther 2021; 12:487-498. [PMID: 33367982 PMCID: PMC7846618 DOI: 10.1007/s13300-020-00983-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 01/07/2023] Open
Abstract
Painful diabetic neuropathy (pDN) is characterised by both sensory and affective disturbances, suggesting a complex bidirectional relationship of neuropathic pain and mood disorders. Data on pDN indicate that neuropathic pain reduces quality of life, including mood and physical and social functioning. Depression and pain coping strategies such as catastrophising and social support predict pain severity. There is a significant and reciprocal relationship between depressed mood and increased pain. The key features of assessing people with neuropathic pain in relation to psychological aspects of their health are discussed in the context of management in a tertiary pain management centre (The Walton Centre, Liverpool, UK) including cognitive behavioural interventions amongst others to improve the quality of life in patients with pDN. We consider psychological issues as a factor influencing treatment and outcome in patients with pDN.
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Affiliation(s)
- Hannah Twiddy
- Department of Pain Medicine, The Walton Centre, Liverpool, UK.
| | - Bernhard Frank
- Department of Pain Medicine, The Walton Centre, Liverpool, UK
| | - Uazman Alam
- Diabetes and Endocrinology Research, Institute of Cardiovascular and Metabolic Medicine and The Pain Research Institute, University of Liverpool and Liverpool University NHS Hospital Trust, Liverpool, UK
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK
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14
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Abstract
Courtesy of the development of the Internet, bursts of information technology, and globalization, huge multicenter studies along with meta-analyses have been introduced to the medical sciences society. Meta-analyses and multicenter studies revolutionized modern medicine and drug development, and empowered evidence based medicine by providing extremely high levels of evidence. Nevertheless, there are occasions that while results of local multi/single center studies showed efficacy of a new treatment, larger multicenter studies or meta-analyses failed to show efficacy, and vice versa. Generally, bigger studies are more powerful and we rely on their results in clinical decision making. Nevertheless, we should keep in mind that in certain circumstances, single center studies are of great importance, and are preferred to multicenter studies and meta-analyses. In order to have a better understanding of why and when multicenter studies along with meta-analyses might not be the best options, we have discussed three different scenarios.
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Affiliation(s)
- Soroush Seifirad
- Department of Medicine, Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, USA
| | - Lance Alquran
- Department of Medicine, Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, USA
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15
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Taylor SI, Yazdi ZS, Beitelshees AL. Pharmacological treatment of hyperglycemia in type 2 diabetes. J Clin Invest 2021; 131:142243. [PMID: 33463546 PMCID: PMC7810496 DOI: 10.1172/jci142243] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus is a major public health problem, affecting about 10% of the population. Pharmacotherapy aims to protect against microvascular complications, including blindness, end-stage kidney disease, and amputations. Landmark clinical trials have demonstrated that intensive glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). Long-term follow-up has demonstrated that intensive glycemic control also decreases risk of macrovascular disease, albeit rigorous evidence of macrovascular benefit did not emerge for over a decade. The US FDA's recent requirement for dedicated cardiovascular outcome trials ushered in a golden age for understanding the clinical profiles of new type 2 diabetes drugs. Some clinical trials with sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists reported data demonstrating cardiovascular benefit (decreased risk of major adverse cardiovascular events and hospitalization for heart failure) and slower progression of diabetic kidney disease. This Review discusses current guidelines for use of the 12 classes of drugs approved to promote glycemic control in patients with type 2 diabetes. The Review also anticipates future developments with potential to improve the standard of care: availability of generic dipeptidylpeptidase-4 (DPP4) inhibitors and SGLT2 inhibitors; precision medicine to identify the best drugs for individual patients; and new therapies to protect against chronic complications of diabetes.
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16
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Ziegler D, Papanas N, Schnell O, Nguyen BDT, Nguyen KT, Kulkantrakorn K, Deerochanawong C. Current concepts in the management of diabetic polyneuropathy. J Diabetes Investig 2020; 12:464-475. [PMID: 32918837 PMCID: PMC8015839 DOI: 10.1111/jdi.13401] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022] Open
Abstract
Diabetic sensorimotor polyneuropathy (DSPN) is encountered in approximately one-third of people with diabetes. This, in turn, might markedly impoverish their quality of life, mainly owing to neuropathic pain and foot ulcerations. Painful DSPN might be as frequent as 25% in diabetes patients. Symptoms as a result of DSPN typically comprise pain, paresthesia and numbness in the distal lower limbs. Asymptomatic DSPN might reach 50% among patients with this condition. Unfortunately, DSPN is still not adequately diagnosed and treated. Its management has three priorities: (i) lifestyle improvement, near-normoglycemia and multifactorial cardiovascular risk intervention; (ii) pathogenesis-oriented pharmacotherapy; and (iii) symptomatic alleviation of pain. Intensive diabetes therapy showed evidence for favorable effects on the incidence and deterioration of DSPN in type 1 diabetes, but not type 2 diabetes. Among pathogenesis-oriented treatments, α-lipoic acid, actovegin, benfotiamine and epalrestat are currently authorized to treat DSPN in several countries. Symptomatic therapy uses analgesics, notably antidepressants, opioids and anticonvulsants, reducing pain by ≥50% in approximately 50% of individuals, but might be limited, particularly by central nervous system-related adverse events. Local treatment with the capsaicin 8% patch might offer an alternative. In addition to pain relief, therapy should improve sleep, mobility and quality of life. In conclusion, multimodal treatment of DSPN should consider the individual risk profile, pathogenetic treatment and pain management using pharmacotherapy (combinations, if required), as well as non-pharmacological options.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Oliver Schnell
- Forschergruppe Diabetes e.V at the Helmholtz Center, Munich-Neuherberg, Germany
| | - Bich Dao Thi Nguyen
- Endocrinology and Diabetes Unit, Tam Duc Heart Hospital, Ho Chi Minh City, Vietnam
| | - Khue Thy Nguyen
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Chaicharn Deerochanawong
- Diabetes and Endocrinology Unit, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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17
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Meher M, Panda JK. Impact of glycemic control over cardiac autonomic neuropathy. J Diabetes Metab Disord 2020; 19:1339-1344. [PMID: 33520839 DOI: 10.1007/s40200-020-00653-7] [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: 08/13/2020] [Revised: 08/13/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Purpose Cardiovascular autonomic neuropathy (CAN) is one of the most common and serious complications associated with diabetes and is defined as the impairment of the autonomic control of the cardiovascular system, whose prevalence in Indian population has been reported to be > 50%. The risk factors associated with CAN include hyperglycemia, duration of diabetes, hypertension, dyslipidemia, and obesity. This study was conducted to examine the association of CAN with its determinants among diabetics. Methods Socio-demographic characteristics were noted alongwith performance of biochemical analyses of blood samples according to standard hospital pathology laboratory protocols. Clinical assessment of CAN comprised a of 5 indexes, including 3 heart rate variability parameters (resting tachycardia, Qtc interval > 440 msec, exercise intolerance) and 2 blood pressure parameters (orthostatic hypotension, abnormal hand gripping test). Results The odds of CAN increased with poor glycemic control (FBS ≥ 126 mg/dL (OR = 1.17 (1.02-10.68); 2 hr PPBS ≥ 200 mg/dL (OR 1.63 (1.26-8.82) and HbA1c ≥ 6.5% (OR = 10.68 (1.54-208.02). Significant difference was also found in relation to duration of diabetes, weight and body mass index of the participants with various grades of CAN. Conclusions CAN is associated strongly with poor glycemic control. Obesity seems to be involved in the impairments of the cardiac autonomic function and this factor must therefore be taken into account in future studies when interpreting the results. Body mass control and glycemic control could provide an important approach to reducing CAN.
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Affiliation(s)
- Meghanad Meher
- Department of General Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha 751019 India
| | - Jayanta Kumar Panda
- Department of General Medicine, SCB Medical College & Hospital, Cuttack, Odisha 753007 India
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18
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Singleton MJ, Soliman EZ, Bertoni AG, Whalen SP, Bhave PD, Yeboah J. Effect of Intensive Glycemic and Blood Pressure Control on QT Prolongation in Diabetes: The ACCORD Trial. Diabetes 2020; 69:2186-2193. [PMID: 32732305 PMCID: PMC7809716 DOI: 10.2337/db20-0401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/16/2020] [Indexed: 01/14/2023]
Abstract
Compared with standard glycemic control, intensive glycemic control caused increased mortality in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Preliminary data from several studies suggest that intensive glycemic control is associated with QT prolongation, which may lead to ventricular arrhythmias as a possible explanation of this increased mortality. We sought to assess the effects of intensive glycemic control and intensive blood pressure control on the risk of incident QT prolongation. Cox proportional hazards models were used to compare the risk of incident QT prolongation (>460 ms in women or >450 ms in men) in the intensive versus standard glycemic control arms. Over a combined 48,634 person-years of follow-up (mean 4.9), 634 participants (6.4%) developed a prolonged QTc. Participants in the intensive glycemic control arm did not have an increased risk of QT prolongation. Similarly, a strategy of intensive blood pressure control did not result in a significant change in risk of prolonged QTc. Sensitivity analyses using alternative QT correction formulas (Hodges and Bazett) yielded overall similar findings. In conclusion, the increased mortality observed in the intensive glycemic control arm in the ACCORD trial is not likely to be explained by QT prolongation leading to lethal ventricular arrhythmias.
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Affiliation(s)
- Matthew J Singleton
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elsayed Z Soliman
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - S Patrick Whalen
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Prashant D Bhave
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph Yeboah
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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19
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Azmi S, Alam U, Burgess J, Malik RA. State-of-the-art pharmacotherapy for diabetic neuropathy. Expert Opin Pharmacother 2020; 22:55-68. [PMID: 32866410 DOI: 10.1080/14656566.2020.1812578] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The global epidemic of diabetes has led to an epidemic of diabetes complications. Diabetic neuropathy is the most common microvascular complication, of which diabetic peripheral neuropathy (DPN) and autonomic neuropathy (AN) are the most prevalent, affecting ~50% of patients. DPN results in pain with a poor quality of life and a loss of sensation with an increased risk of foot ulceration. Autonomic neuropathy can cause significant morbidity in a minority and is associated with increased mortality. The cornerstone of treatment to prevent or limit the progression of DPN/AN is multifactorial risk factor modification including treatment of glycemia, lipids and blood pressure. Whilst, there are no FDA-approved disease-modifying therapies, there are a number of therapies to relieve symptoms in DPN and AN. AREAS COVERED The authors discuss current approved therapies for painful diabetic neuropathy and autonomic neuropathy. They also address the potential role of improving risk factors to limit the development and progression of diabetic neuropathy and new pathogenetic and pain-relieving treatments. EXPERT OPINION The FDA-approved Pregabalin and Duloxetine over 25 years ago and Tapentadol, 6 years ago for painful diabetic neuropathy. There are currently no FDA-approved disease-modifying treatments for diabetic neuropathy which has been attributed to inappropriate models of the disease with limited translational capacity and major limitations of trial designs and endpoints in clinical trials.
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Affiliation(s)
- Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester and Manchester NHS Foundation Trust , Manchester, UK
| | - Uazman Alam
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester , Manchester, UK.,Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool , Liverpool, UK.,Department of Diabetes and Endocrinology, Liverpool University Hospital NHS Foundation Trust , Liverpool, UK
| | - Jamie Burgess
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool , Liverpool, UK
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar , Doha, Qatar
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20
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Understanding Diabetic Neuropathy: Focus on Oxidative Stress. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:9524635. [PMID: 32832011 PMCID: PMC7422494 DOI: 10.1155/2020/9524635] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
Diabetic neuropathy is one of the clinical syndromes characterized by pain and substantial morbidity primarily due to a lesion of the somatosensory nervous system. The burden of diabetic neuropathy is related not only to the complexity of diabetes but also to the poor outcomes and difficult treatment options. There is no specific treatment for diabetic neuropathy other than glycemic control and diligent foot care. Although various metabolic pathways are impaired in diabetic neuropathy, enhanced cellular oxidative stress is proposed as a common initiator. A mechanism-based treatment of diabetic neuropathy is challenging; a better understanding of the pathophysiology of diabetic neuropathy will help to develop strategies for the new and correct diagnostic procedures and personalized interventions. Thus, we review the current knowledge of the pathophysiology in diabetic neuropathy. We focus on discussing how the defects in metabolic and vascular pathways converge to enhance oxidative stress and how they produce the onset and progression of nerve injury present in diabetic neuropathy. We discuss if the mechanisms underlying neuropathy are similarly operated in type I and type II diabetes and the progression of antioxidants in treating diabetic neuropathy.
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21
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Nahmias A, Stahel P, Xiao C, Lewis GF. Glycemia and Atherosclerotic Cardiovascular Disease: Exploring the Gap Between Risk Marker and Risk Factor. Front Cardiovasc Med 2020; 7:100. [PMID: 32582769 PMCID: PMC7296136 DOI: 10.3389/fcvm.2020.00100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/11/2020] [Indexed: 01/11/2023] Open
Abstract
There is consistent, unequivocal and reproducible epidemiological evidence derived from diverse populations that various indices of glycemia (fasting plasma glucose, post-prandial or post oral glucose challenge plasma glucose, HbA1c) are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD), even in the prediabetic state. Furthermore, there is abundant experimental evidence demonstrating that hyperglycemia per se accelerates and aggravates the atherosclerotic process, providing biological plausibility to the concept that hyperglycemia is causally related or a true risk factor for ASCVD. Two studies in particular, DCCT and UKPDS, that enrolled a younger cohort of patients with type 1 diabetes or an older cohort with newly diagnosed type 2 diabetes, respectively, showed trends toward a reduction in ASCVD. The reductions in ASCVD reached statistical significance only after prolonged follow up, and when differences in HbA1c were no longer maintained (referred to by some as a “legacy effect”). More recent studies in those with established type 2 diabetes, in which glycemic control was improved by a variety of strategies, failed to demonstrate reductions in ASCVD. The gap in evidence supporting hyperglycemia as a true causative risk factor for ASCVD or simply a risk marker for some other confounding causative factor is discussed in this review. We conclude that hyperglycemia does appear to be at least partially causative of ASCVD (i.e., an ASCVD risk factor). We discuss how this evidence can be incorporated into an overall therapeutic strategy to prevent ASCVD in those with prediabetes and established diabetes.
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Affiliation(s)
- Avital Nahmias
- Division of Endocrinology, Department of Medicine, Banting & Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Priska Stahel
- Division of Endocrinology, Department of Medicine, Banting & Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Changting Xiao
- Division of Endocrinology, Department of Medicine, Banting & Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Gary F Lewis
- Division of Endocrinology, Department of Medicine, Banting & Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
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22
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Rosenberger DC, Blechschmidt V, Timmerman H, Wolff A, Treede RD. Challenges of neuropathic pain: focus on diabetic neuropathy. J Neural Transm (Vienna) 2020; 127:589-624. [PMID: 32036431 PMCID: PMC7148276 DOI: 10.1007/s00702-020-02145-7] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
Abstract
Neuropathic pain is a frequent condition caused by a lesion or disease of the central or peripheral somatosensory nervous system. A frequent cause of peripheral neuropathic pain is diabetic neuropathy. Its complex pathophysiology is not yet fully elucidated, which contributes to underassessment and undertreatment. A mechanism-based treatment of painful diabetic neuropathy is challenging but phenotype-based stratification might be a way to develop individualized therapeutic concepts. Our goal is to review current knowledge of the pathophysiology of peripheral neuropathic pain, particularly painful diabetic neuropathy. We discuss state-of-the-art clinical assessment, validity of diagnostic and screening tools, and recommendations for the management of diabetic neuropathic pain including approaches towards personalized pain management. We also propose a research agenda for translational research including patient stratification for clinical trials and improved preclinical models in relation to current knowledge of underlying mechanisms.
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Affiliation(s)
- Daniela C Rosenberger
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Vivian Blechschmidt
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Hans Timmerman
- Department of Anesthesiology, Pain Center, University Medical Center of Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - André Wolff
- Department of Anesthesiology, Pain Center, University Medical Center of Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
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23
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Yang H, Sloan G, Ye Y, Wang S, Duan B, Tesfaye S, Gao L. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine. Front Endocrinol (Lausanne) 2020; 10:929. [PMID: 32010062 PMCID: PMC6978915 DOI: 10.3389/fendo.2019.00929] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes mellitus. It leads to distressing and expensive clinical sequelae such as foot ulceration, leg amputation, and neuropathic pain (painful-DPN). Unfortunately, DPN is often diagnosed late when irreversible nerve injury has occurred and its first presentation may be with a diabetic foot ulcer. Several novel diagnostic techniques are available which may supplement clinical assessment and aid the early detection of DPN. Moreover, treatments for DPN and painful-DPN are limited. Only tight glucose control in type 1 diabetes has robust evidence in reducing the risk of developing DPN. However, neither glucose control nor pathogenetic treatments are effective in painful-DPN and symptomatic treatments are often inadequate. It has recently been hypothesized that using various patient characteristics it may be possible to stratify individuals and assign them targeted therapies to produce better pain relief. We review the diagnostic techniques which may aid the early detection of DPN in the clinical and research environment, and recent advances in precision medicine techniques for the treatment of painful-DPN.
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Affiliation(s)
- Heng Yang
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gordon Sloan
- Diabetes Research Unit, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Yingchun Ye
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuo Wang
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bihan Duan
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Ling Gao
- Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China
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24
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Pafili K, Trypsianis G, Papazoglou D, Maltezos E, Papanas N. Cardiovascular Autonomic Neuropathy and Distal Symmetric Sensorimotor Polyneuropathy: These Two Diabetic Microvascular Complications do not Invariably Co-Exist. Curr Vasc Pharmacol 2019; 18:50-56. [PMID: 30156161 DOI: 10.2174/1570161116666180829120101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
Abstract
Background:
Cardiovascular autonomic neuropathy (CAN) and distal symmetrical sensorimotor
polyneuropathy (DSPN) are serious microvascular complications of diabetes mellitus (DM).
Their simultaneous development remains disputable. The aim of the present study was to examine the
correlation between CAN and the presence/severity of DSPN in DM.
Methods:
Subjects with type 1 (group A: n=51; mean age 40.4 years) and type 2 DM (group B: n=153;
mean age 64.6 years) were studied. Evaluation of DSPN was based on neuropathy disability score. Assessment
of CAN was based on the battery of 4 standardized cardiovascular autonomic function tests.
Results:
In group A, patients with moderate/severe DSPN exhibited a 12-fold higher likelihood of CAN
in univariate analysis (p=0.035). However, significance was lost after adjustment for gender, age, DM
duration, and haemoglobin A1c. In group A, likelihood for CAN did not correlate with the presence of
mild DSPN in univariate and multivariate analysis. In group B, likelihood of CAN was similar in patients
with mild and in those with moderate/severe DSPN compared with patients without DSPN in
univariate and multivariate analysis. In between group comparison CAN was similarly distributed in the
2 groups (p for interaction=0.367), in patients with no, mild and moderate/severe DSPN.
Conclusion:
CAN does not always co-exist with degrees of DSPN, ranging from mild to moderate/
severe and is similarly distributed in T1DM and T2DM patients with mild and moderate/severe
DSPN and in patients without DSPN.
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Affiliation(s)
- Kalliopi Pafili
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Grigoris Trypsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Alexandroupolis, Greece
| | - Dimitrios Papazoglou
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Maltezos
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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25
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Selvarajah D, Kar D, Khunti K, Davies MJ, Scott AR, Walker J, Tesfaye S. Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. Lancet Diabetes Endocrinol 2019; 7:938-948. [PMID: 31624024 DOI: 10.1016/s2213-8587(19)30081-6] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of both type 1 and 2 diabetes. It is a leading cause of lower-limb amputation and disabling neuropathic pain. Amputations in patients with diabetes have a devastating effect on quality of life and are associated with an alarmingly low life expectancy (on average only 2 years from the amputation). Amputation also places a substantial financial burden on health-care systems and society in general. With the introduction of national diabetes eye screening programmes, the prevalence of blindness in working-age adults is falling. This is not the case, however, with diabetes related amputations. In this Review, we appraise innovative point-of-care devices that enable the early diagnosis of DPN and assess the evidence for early risk factor-based management strategies to reduce the incidence and slow the progression of DPN. We also propose a framework for screening and early multifactorial interventions as the best prospect for preventing or halting DPN and its devastating sequelae.
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Affiliation(s)
- Dinesh Selvarajah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - Debasish Kar
- Derbyshire Community Health Services NHS Foundation Trust, Bakewell, UK; Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Adrian R Scott
- Academic Unit of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jeremy Walker
- Department of Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Solomon Tesfaye
- Academic Unit of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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de Vries TI, Dorresteijn JAN, van der Graaf Y, Visseren FLJ, Westerink J. Heterogeneity of Treatment Effects From an Intensive Lifestyle Weight Loss Intervention on Cardiovascular Events in Patients With Type 2 Diabetes: Data From the Look AHEAD Trial. Diabetes Care 2019; 42:1988-1994. [PMID: 31416897 PMCID: PMC7364666 DOI: 10.2337/dc19-0776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/25/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the presence of heterogeneity of treatment effect (HTE) of an intensive lifestyle intervention on the occurrence of major cardiovascular events (MACE) in overweight or obese patients with type 2 diabetes, and to identify patient characteristics associated with individual treatment effect. RESEARCH DESIGN AND METHODS In 4,901 participants from the Action for Health in Diabetes (Look AHEAD) trial, a penalized Cox regression model to predict treatment effect of intensive lifestyle intervention for the risk of MACE was derived, including all possible treatment-by-covariate interaction terms. The ability of the model to predict HTE was confirmed by calculating hazard ratios (HRs) and absolute risk change in quartiles of predicted treatment effect, and baseline patient characteristics were compared between quartiles. RESULTS In quartile 1 of predicted treatment effect, with the highest predicted risk reduction, there was a significant treatment benefit of intensive lifestyle intervention (HR 0.64 [95% CI 0.49-0.83]), whereas there was no effect from treatment in quartiles 2 and 3 (HR 0.81 [95% CI 0.58-1.14] and 1.13 [95% CI 0.80-1.60], respectively) and a detrimental effect in quartile 4 (HR 1.37 [95% CI 1.09-1.73]). Several patient characteristics in demographics, medical history, physical examination, and laboratory values were associated with the level of treatment effect. CONCLUSIONS This post hoc analysis of the Look AHEAD trial showed that an intensive lifestyle intervention aimed at weight loss may reduce cardiovascular events in selected patients but may have a detrimental treatment effect in others.
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Affiliation(s)
- Tamar I de Vries
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Durán AM, Salto LM, Câmara J, Basu A, Paquien I, Beeson WL, Firek A, Cordero-MacIntyre Z, De León M. Effects of omega-3 polyunsaturated fatty-acid supplementation on neuropathic pain symptoms and sphingosine levels in Mexican-Americans with type 2 diabetes. Diabetes Metab Syndr Obes 2019; 12:109-120. [PMID: 30662277 PMCID: PMC6329345 DOI: 10.2147/dmso.s187268] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine whether dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) reduces neuropathic pain symptoms in Mexican-Americans with type 2 diabetes. METHODS Forty volunteers with type 2 diabetes enrolled in the "En Balance-PLUS" program, which provided weekly nutrition-diabetes education and daily supplementation with 1,000 mg docosahexaenoic acid (DHA)-200 mg eicosapentaenoic acid over 3 months. The study assessed self-reported neuropathic pain symptoms pre/postintervention using the short-form McGill Pain Questionnaire (SF-MPQ), monitored clinical laboratory values at baseline and 3 months, and performed baseline and 3-month metabolomic analysis of plasma samples. RESULTS A total of 26 participants self-reported neuropathic pain symptoms at baseline. After 3 months of omega-3 PUFA supplementation, participants reported significant improvement in SF-MPQ scores (sensory, affective, and visual analogue scale; P<0.001, P=0.012, and P<0.001, respectively). Untargeted metabolomic analysis revealed that participants in the moderate-high SF-MPQ group had the highest relative plasma sphingosine levels at baseline compared to the low SF-MPQ group (P=0.0127) and the nonpain group (P=0.0444). Omega-3 PUFA supplementation increased plasma DHA and reduced plasma sphingosine levels in participants reporting neuropathic pain symptoms (P<0.001 and P<0.001, respectively). Increased plasma DHA levels significantly correlated with improved SF-MPQ sensory scores (r=0.425, P=0.030). Improved SF-MPQ scores, however, did not correlate with clinical/laboratory parameters. CONCLUSION The data suggest that omega-3 PUFAs dietary supplementation may reduce neuropathic pain symptoms in individuals with type 2 diabetes and correlates with sphingosine levels in the plasma.
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Affiliation(s)
- Alfonso M Durán
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA,
| | - Lorena M Salto
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA,
| | - Justin Câmara
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA,
| | - Anamika Basu
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA,
| | - Ivette Paquien
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA,
| | - W Lawrence Beeson
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA,
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Anthony Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Zaida Cordero-MacIntyre
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA,
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Marino De León
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA,
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Wang Y, Zhang J, Ma Y, Song X, Li S, Zhan X, Wu L. Different lipid profiles, insulin sensitivity, and insulin resistance among Han, Uygur, and Kazak men with normal glucose tolerance in Xinjiang, China. Lipids Health Dis 2018; 17:209. [PMID: 30193578 PMCID: PMC6128984 DOI: 10.1186/s12944-018-0863-9] [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] [Received: 07/03/2018] [Accepted: 08/31/2018] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to determine the differences in clinical parameters among Han, Uygur, and Kazak men with normal glucose tolerance. Methods Participants’ data from the China National Diabetes and Metabolic Disorders Study pertaining to Han, Uygur, and Kazak men from the Xinjiang province were used (n = 930). Pearson’s correlation was used to examine the relationship between HOMA-IR, Matsuda Index, and clinical characteristics. Results HOMA-IR of Han men was significantly higher than in Uygurs and Kazaks (P < 0.001). The Matsuda Index of Kazaks was significantly higher than that of Hans and Uygurs (P < 0.001). While Kazaks had the highest BMI, WC, SBP, and DBP; they also had the highest HDL-C and lowest TG (P < 0.001). TG of Uygurs was significantly higher than that of Hans and Kazaks (P < 0.001). In Hans and Kazaks, the TG/HDL-C ratio increased with HOMA-IR quartiles; there was no association in Uygurs. In Hans and Kazaks, the TG/HDL-C ratio decreased with Matsuda index quartiles; there was no association in Uygurs. Multivariate linear regression showed that HOMA-IR was independently associated with ethnicity, BMI and TG/HDL-C ratio (P < 0.01), while Matsuda index was independently associated with ethnicity, BMI, LDL-C levels (P < 0.001) and TG/HDL-C ratio (P < 0.001). Conclusions In conclusion, Han, Uygur, and Kazak men had different lipid profiles, BMI, and WC. Han men had the highest insulin resistance while Kazak men had the highest insulin sensitivity.
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Affiliation(s)
- Yan Wang
- Endocrinology Department of Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, Xinjiang, 830001, China.
| | - Jun Zhang
- School of Medicine, Shihezi University, Shihezi, Xinjiang, 832000, China
| | - Yanrong Ma
- Endocrinology Department of Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, Xinjiang, 830001, China
| | - Xiangxin Song
- Endocrinology Department of Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, Xinjiang, 830001, China
| | - Suli Li
- Endocrinology Department of Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, Xinjiang, 830001, China
| | - Xianqin Zhan
- Xinjiang Medicine University, Urumqi, Xinjiang, 830001, China
| | - Lan Wu
- Endocrinology Department of Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, Xinjiang, 830001, China
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30
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Moţăţăianu A, Maier S, Bajko Z, Voidazan S, Bălaşa R, Stoian A. Cardiac autonomic neuropathy in type 1 and type 2 diabetes patients. BMC Neurol 2018; 18:126. [PMID: 30149797 PMCID: PMC6112121 DOI: 10.1186/s12883-018-1125-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 08/14/2018] [Indexed: 01/28/2023] Open
Abstract
Background Cardiac autonomic neuropathy (CAN) in diabetes is among the strongest risk markers for future global and cardiovascular mortality. The aim of this study was to analyse CAN prevalence and to compare the associations between CAN, the glycaemic control, cardiovascular risk factors, peripheral neuropathy, retinopathy and macroangiopathy in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Methods One hundred ninety-five diabetic patients were included in this study. All patients were evaluated for detection of CAN (with standardised cardiovascular reflex tests), diabetes-related microvascular complications (polyneuropathy, retinopathy), common carotid artery intima-media thickness (IMT) and ankle-brachial index (ABI). Results The prevalence of CAN was 39.1% in T2DM and 61.8% in T1DM patients. Multivariate logistic regression analysis demonstrated that in T2DM, the odds [OR (95% confidence intervals)] of CAN increased with diabetes duration [1.67(1.42–1.92)], HbA1c [1.74(1.34–2.27)], cholesterol [1.01(1.00–1.01)], triglycerides [1.01(0.99–1.00)], smoking [2.35(1.23–4.49)], systolic blood pressure [1.01(1.00–1.03)], BMI [1.16(1.08–1.24)], glomerular filtration rate [0.91(0.88–0.93)], peripheral neuropathy [25.94(11.04–44.25)], retinopathy [13.13(3.03–84.73)] and IMT [10.12 (7.21–15.32)]. In T1DM, the odds of CAN increased with diabetes duration [1.62(1.13–2.31)], HbA1c [4.49(1.27–15.9)], age of patients [1.14(1.03–1.27)], glomerular filtration rate [0.94(0.89–0.99)], peripheral neuropathy [31.6(4.5–45.8)] and IMT [5.5(2.3–8.3)]. Conclusion This study indicated that CAN is a more frequent complication in T1DM. Apart from glycaemic control, the existence of CAN is associated with potentially modifiable cardiovascular risk only in T2DM patients. The presence of other micro- and macrovascular complications increases the probability of having CAN in both types of DM (but more pronounced in T2DM).
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Affiliation(s)
- Anca Moţăţăianu
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Gh Marinescu 50, 540136, Târgu Mureş, Romania.
| | - Smaranda Maier
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Gh Marinescu 50, 540136, Târgu Mureş, Romania
| | - Zoltan Bajko
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Gh Marinescu 50, 540136, Târgu Mureş, Romania
| | - Septimiu Voidazan
- Department of Epidemiology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania
| | - Rodica Bălaşa
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Gh Marinescu 50, 540136, Târgu Mureş, Romania
| | - Adina Stoian
- Department of Pathophysiology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania
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Bloomgarden Z, Einhorn D, Handelsman Y, Misra A, Zonszein J, Grunberger G, Jellinger PS, Garber AJ. American College of Physicians diabetes guidelines attempt to turn back the clock, conflating good HbA1c with hypoglycemia. J Diabetes 2018; 10:618-620. [PMID: 29655268 DOI: 10.1111/1753-0407.12668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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32
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Iqbal Z, Azmi S, Yadav R, Ferdousi M, Kumar M, Cuthbertson DJ, Lim J, Malik RA, Alam U. Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther 2018; 40:828-849. [PMID: 29709457 DOI: 10.1016/j.clinthera.2018.04.001] [Citation(s) in RCA: 251] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Diabetic peripheral neuropathy (DPN) is the commonest cause of neuropathy worldwide, and its prevalence increases with the duration of diabetes. It affects approximately half of patients with diabetes. DPN is symmetric and predominantly sensory, starting distally and gradually spreading proximally in a glove-and-stocking distribution. It causes substantial morbidity and is associated with increased mortality. The unrelenting nature of pain in this condition can negatively affect a patient's sleep, mood, and functionality and result in a poor quality of life. The purpose of this review was to critically review the current literature on the diagnosis and treatment of DPN, with a focus on the treatment of neuropathic pain in DPN. METHODS A comprehensive literature review was undertaken, incorporating article searches in electronic databases (EMBASE, PubMed, OVID) and reference lists of relevant articles with the authors' expertise in DPN. This review considers seminal and novel research in epidemiology; diagnosis, especially in relation to novel surrogate end points; and the treatment of neuropathic pain in DPN. We also consider potential new pharmacotherapies for painful DPN. FINDINGS DPN is often misdiagnosed and inadequately treated. Other than improving glycemic control, there is no licensed pathogenetic treatment for diabetic neuropathy. Management of painful DPN remains challenging due to difficulties in personalizing therapy and ascertaining the best dosing strategy, choice of initial pharmacotherapy, consideration of combination therapy, and deciding on defining treatment for poor analgesic responders. Duloxetine and pregabalin remain first-line therapy for neuropathic pain in DPN in all 5 of the major published guidelines by the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, National Institute of Clinical Excellence (United Kingdom), and the American Diabetes Association, and their use has been approved by the US Food and Drug Administration. IMPLICATIONS Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition.
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Affiliation(s)
- Zohaib Iqbal
- Department of Endocrinology, Pennine Acute Hospitals NHS Trust, Greater Manchester, United Kingdom
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester and the Manchester Royal Infirmary, Central Manchester Hospital Foundation Trust, Manchester, United Kingdom
| | - Rahul Yadav
- Department of Endocrinology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Maryam Ferdousi
- Institute of Cardiovascular Science, University of Manchester and the Manchester Royal Infirmary, Central Manchester Hospital Foundation Trust, Manchester, United Kingdom
| | - Mohit Kumar
- Department of Endocrinology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Daniel J Cuthbertson
- Diabetes and Endocrinology 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, United Kingdom
| | - Jonathan Lim
- Diabetes and Endocrinology 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, United Kingdom
| | - Rayaz A Malik
- Institute of Cardiovascular Science, University of Manchester and the Manchester Royal Infirmary, Central Manchester Hospital Foundation Trust, Manchester, United Kingdom; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Uazman Alam
- Diabetes and Endocrinology 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, United Kingdom; Department of Diabetes and Endocrinology, Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, United Kingdom; Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, United Kingdom.
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Kirkman MS, Mahmud H, Korytkowski MT. Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes Mellitus. Endocrinol Metab Clin North Am 2018; 47:81-96. [PMID: 29407058 DOI: 10.1016/j.ecl.2017.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
People with type 2 diabetes mellitus are at high risk of morbidity and mortality from cardiovascular disease (CVD). Based on observed relationships between hyperglycemia and CVD, several large clinical trials have investigated the ability of treatment strategies to achieve hemoglobin A1c less than 7% (53 mmol/mol) as a way of reducing this risk. These studies demonstrate that intensified glycemic therapy may reduce CVD risk in younger patients with recent-onset type 2 diabetes mellitus but not in high-risk older individuals with established disease. Attention to blood pressure and lipid-lowering therapies with modified glycemic goals for older high-risk individuals is recommended.
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Affiliation(s)
- Marian Sue Kirkman
- Division of Endocrinology, University of North Carolina at Chapel Hill, 8025 Burnett Womack Building, Campus Box #7172 UNC-CH, Chapel Hill, NC 27599-7170, USA
| | - Hussain Mahmud
- Division of Endocrinology, University of Pittsburgh Medical Center, 3601 Fifth Avenue, Suite 562, Pittsburgh, PA 15213, USA
| | - Mary T Korytkowski
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Falk Medical Building, Room 560, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA.
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34
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Németh N, Putz Z, Istenes I, Körei AE, Vági OE, Kempler M, Gandhi R, Jermendy G, Tesfaye S, Tabák ÁG, Kempler P. Is there a connection between postprandial hyperglycemia and IGT related sensory nerve dysfunction? Nutr Metab Cardiovasc Dis 2017; 27:609-614. [PMID: 28676377 DOI: 10.1016/j.numecd.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS To assess the risk factors for sensory nerve dysfunction in subjects with isolated impaired glucose tolerance (IGT). METHODS AND RESULTS Seventy-two people with isolated IGT (WHO 1999 criteria) and 39 gender and age-matched healthy volunteers underwent detailed clinical and neurological assessment including quantitative sensory testing using the Neurometer device (current perception threshold measurement on four limbs at three different frequencies). Sensory nerve dysfunction was defined as at least two abnormalities on any frequencies on the upper or lower limbs. Sensory nerve dysfunction was more prevalent among subjects with IGT compared to controls (58.3 vs. 10.3%, OR: 11.23, 95%CI: 3.57-35.35). This association was not influenced by BMI, systolic and diastolic blood pressure, heart rate and autonomic neuropathy (multiple adjusted OR: 13.87, 95%CI: 3.18-60.58), but further adjustment for glycaemic measures abolished the association (OR: 1.58, 95%CI: 0.07-35.68). Assessing the components of glycaemic measures separately, the association between sensory nerve dysfunction and IGT was not affected by HbA1c (OR: 13.94, 95%CI: 1.84-105.5). It was, however, substantially attenuated by fasting plasma glucose (OR: 6.75, 95%CI: 1.33-34.27) while the significance was lost after adjustment for 120 min postload glucose level (OR: 3.76, 95%CI: 0.26-54.10). In the pooled population assessed, independent determinants of sensory nerve dysfunction were older age, 120 min glucose, higher height and cardiovascular autonomic neuropathy at near significance. CONCLUSIONS Sensory nerve dysfunction amongst subjects with IGT was not explained by cardiovascular covariates, only by glycaemic measures. In addition to 120 min glucose, cardiovascular autonomic neuropathy at borderline significance, age, and height were the independent determinants of sensory nerve dysfunction.
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Affiliation(s)
- N Németh
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
| | - Z Putz
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - I Istenes
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - A E Körei
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - O E Vági
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - M Kempler
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary; 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - R Gandhi
- Royal Hallamshire Hospital, Sheffield, UK
| | - G Jermendy
- 3rd Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - S Tesfaye
- Royal Hallamshire Hospital, Sheffield, UK
| | - Á G Tabák
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary; Department of Epidemiology and Public Health, University College London, London, UK
| | - P Kempler
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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35
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Sankaranarayanan A, Malik RA. Can corneal confocal microscopy help in early detection of neuronal damage and cognitive dysfunction as a consequence of metabolic syndrome in schizophrenia? Early Interv Psychiatry 2017; 11:271-274. [PMID: 26177108 DOI: 10.1111/eip.12258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Affiliation(s)
| | - Rayaz A Malik
- Weill Cornell Medical College in Qatar, Qatar Foundation, Education City, Doha, Qatar
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36
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Ziegler D, Schleicher E, Strom A, Knebel B, Fleming T, Nawroth P, Häring HU, Papanas N, Szendrödi J, Müssig K, Al-Hasani H, Roden M. Association of transketolase polymorphisms with measures of polyneuropathy in patients with recently diagnosed diabetes. Diabetes Metab Res Rev 2017; 33. [PMID: 27103086 DOI: 10.1002/dmrr.2811] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/18/2016] [Accepted: 04/06/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Shunting of glycolytic intermediates into the pentose phosphate pathway has been suggested to protect from hyperglycaemia-induced microvascular damage. We hypothesized that genetic variability in the gene encoding transketolase, a key pentose phosphate pathway enzyme, contributes to early nerve dysfunction in recent-onset diabetes. METHODS In this cross-sectional study, we assessed nine single nucleotide polymorphisms (SNPs) in the transketolase gene, plasma methylglyoxal concentrations, and clinical and quantitative measures of peripheral nerve function in 165 type 1 and 373 type 2 diabetic patients with a diabetes duration up to 1 year. RESULTS The Total Symptom Score was associated with transketolase SNPs rs7648309, rs62255988, and rs7633966, while peroneal motor nerve conduction velocity (MNCV) correlated only with rs7648309 (P < 0.01). Cold thermal detection threshold (TDT) (foot) was associated with transketolase SNPs rs11130362 and rs7648309, while warm TDT (hand) correlated with rs62255988 and rs7648309 (P < 0.01). After Bonferroni correction, the correlations of transketolase SNP rs7648309 with Total Symptom Score and rs62255988 with warm TDT (hand) remained statistically significant. Among subgroups, men with type 2 diabetes showed the strongest associations. No associations were observed between each of the nine tagged transketolase SNPs and plasma methylglyoxal concentrations. CONCLUSIONS The observed associations of genetic variation in transketolase enzyme with neuropathic symptoms and reduced thermal sensation in recent-onset diabetes suggest a role of pathways metabolizing glycolytic intermediates in early diabetic neuropathy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Erwin Schleicher
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Birgit Knebel
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Thomas Fleming
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - Peter Nawroth
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Häring
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Julia Szendrödi
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Hadi Al-Hasani
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Bloomgarden ZT, Einhorn D, Handelsman Y. Is HbA 1c <7% a Marker of Poor Performance in Individuals >65 Years Old? Diabetes Care 2017; 40:526-528. [PMID: 28325800 DOI: 10.2337/dci16-0043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Daniel Einhorn
- University of California, San Diego, San Diego, CA.,Scripps Whittier Diabetes Institute, San Diego, CA
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Ziegler D, Winter K, Strom A, Zhivov A, Allgeier S, Papanas N, Ziegler I, Brüggemann J, Ringel B, Peschel S, Köhler B, Stachs O, Guthoff RF, Roden M. Spatial analysis improves the detection of early corneal nerve fiber loss in patients with recently diagnosed type 2 diabetes. PLoS One 2017; 12:e0173832. [PMID: 28296936 PMCID: PMC5352008 DOI: 10.1371/journal.pone.0173832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/27/2017] [Indexed: 12/15/2022] Open
Abstract
Corneal confocal microscopy (CCM) has revealed reduced corneal nerve fiber (CNF) length and density (CNFL, CNFD) in patients with diabetes, but the spatial pattern of CNF loss has not been studied. We aimed to determine whether spatial analysis of the distribution of corneal nerve branching points (CNBPs) may contribute to improving the detection of early CNF loss. We hypothesized that early CNF decline follows a clustered rather than random distribution pattern of CNBPs. CCM, nerve conduction studies (NCS), and quantitative sensory testing (QST) were performed in a cross-sectional study including 86 patients recently diagnosed with type 2 diabetes and 47 control subjects. In addition to CNFL, CNFD, and branch density (CNBD), CNBPs were analyzed using spatial point pattern analysis (SPPA) including 10 indices and functional statistics. Compared to controls, patients with diabetes showed lower CNBP density and higher nearest neighbor distances, and all SPPA parameters indicated increased clustering of CNBPs (all P<0.05). SPPA parameters were abnormally increased >97.5th percentile of controls in up to 23.5% of patients. When combining an individual SPPA parameter with CNFL, ≥1 of 2 indices were >99th or <1st percentile of controls in 28.6% of patients compared to 2.1% of controls, while for the conventional CNFL/CNFD/CNBD combination the corresponding rates were 16.3% vs 2.1%. SPPA parameters correlated with CNFL and several NCS and QST indices in the controls (all P<0.001), whereas in patients with diabetes these correlations were markedly weaker or lost. In conclusion, SPPA reveals increased clustering of early CNF loss and substantially improves its detection when combined with a conventional CCM measure in patients with recently diagnosed type 2 diabetes.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- * E-mail:
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrey Zhivov
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Stephan Allgeier
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Nikolaos Papanas
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Iris Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Jutta Brüggemann
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Bernd Ringel
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Sabine Peschel
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Bernd Köhler
- Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Oliver Stachs
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Rudolf F. Guthoff
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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39
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van Steen SC, Schrieks IC, Hoekstra JB, Lincoff AM, Tardif JC, Mellbin LG, Rydén L, Grobbee DE, DeVries JH. The haemoglobin glycation index as predictor of diabetes-related complications in the AleCardio trial. Eur J Prev Cardiol 2017; 24:858-866. [PMID: 28186441 DOI: 10.1177/2047487317692664] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The haemoglobin glycation index (HGI) quantifies the interindividual variation in the propensity for glycation and is a predictor of diabetes complications and adverse effects of intensive glucose lowering. We investigated the relevance of HGI as independent predictor of complications by using data of the AleCardio trial. The AleCardio trial randomized 7226 type 2 diabetes patients with an acute coronary syndrome to aleglitazar or placebo. From 6458 patients with baseline glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG), a linear regression equation, HbA1c (%) = 5.45 + 0.0158 * FPG (mg/dl), was used to calculate predicted HbA1c and derive HGI (= observed - predicted HbA1c). With multivariate Cox regression we examined the association with major adverse cardiac events, cardiovascular mortality, total mortality and hypoglycaemia, irrespective of treatment allocation, using HGI subgroups (low, intermediate and high) and HGI as continuous variable. Patients with high HGI were younger, more often non-Caucasian, had a longer duration of diabetes, showed more retinopathy and used insulin more often. Hypoglycaemia occurred less often in the low HGI subgroup, but this difference disappeared after adjustment for duration of diabetes, insulin and sulphonylurea use. Low HGI patients were at lower risk for cardiovascular mortality (hazard ratio 0.64; 95% confidence interval 0.44-0.93, p = 0.020) and total mortality (hazard ratio 0.69; 95% confidence interval 0.50-0.95, p = 0.025), as compared with high HGI patients. Every percentage increase in HGI was associated with a 16% increase in the risk for cardiovascular mortality ( p = 0.005). The association between HGI and mortality disappeared with additional adjustment for HbA1c. HGI predicts mortality in diabetes patients with acute coronary syndromes, but no better than HbA1c.
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Affiliation(s)
- Sigrid Cj van Steen
- 1 Department of Endocrinology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Ilse C Schrieks
- 2 Julius Clinical, Zeist, The Netherlands.,3 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Joost Bl Hoekstra
- 1 Department of Endocrinology, Academic Medical Centre, University of Amsterdam, The Netherlands.,2 Julius Clinical, Zeist, The Netherlands
| | - A Michael Lincoff
- 4 Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, USA
| | - Jean-Claude Tardif
- 5 Montreal Heart Institute Coordinating Center, Université de Montréal, Canada
| | - Linda G Mellbin
- 6 Department of Medicine, Cardiology Unit, Karolinska Institutet, Sweden
| | - Lars Rydén
- 6 Department of Medicine, Cardiology Unit, Karolinska Institutet, Sweden
| | - Diederick E Grobbee
- 2 Julius Clinical, Zeist, The Netherlands.,3 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - J Hans DeVries
- 1 Department of Endocrinology, Academic Medical Centre, University of Amsterdam, The Netherlands
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40
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Bozkurt B, Aguilar D, Deswal A, Dunbar SB, Francis GS, Horwich T, Jessup M, Kosiborod M, Pritchett AM, Ramasubbu K, Rosendorff C, Yancy C. Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e535-e578. [DOI: 10.1161/cir.0000000000000450] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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van der Leeuw J, Visseren FLJ, Woodward M, van der Graaf Y, Grobbee DE, Harrap S, Heller S, Mancia G, Marre M, Poulter N, Zoungas S, Chalmers J. Estimation of individual beneficial and adverse effects of intensive glucose control for patients with type 2 diabetes. Diabetologia 2016; 59:2603-2612. [PMID: 27586250 PMCID: PMC6518074 DOI: 10.1007/s00125-016-4082-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/27/2016] [Indexed: 12/23/2022]
Abstract
AIMS/HYPOTHESIS Intensive glucose control reduces the risk of vascular complications while increasing the risk of severe hypoglycaemia at a group level. We sought to estimate individual beneficial and adverse effects of intensive glucose control in patients with type 2 diabetes. METHODS We performed a post hoc analysis of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial, a randomised controlled trial evaluating standard vs intensive glucose control (HbA1c target ≤6.5% [48 mmol/mol]). In 11,140 participants, we estimated the individual 5 year absolute risk reduction (ARR) for the composite outcome of major micro- and macrovascular events and absolute risk increase (ARI) for severe hypoglycaemia for intensive vs standard glucose control. Predictions were based on competing risks models including clinical characteristics and randomised treatment. RESULTS Based on these models, 76% of patients had a substantial estimated 5 year ARR for major vascular events (>1%, 5 year number-needed-to-benefit [NNTB5] <100) and 1% had a small ARR (<0.5%, NNTB5 >200). Similarly, 36% of patients had a substantial estimated ARI for severe hypoglycaemia (5 year number-needed-to-harm [NNTH5] <100) and 29% had a small ARI (NNTH5 >200). When assigning similar or half the weight to severe hypoglycaemia compared with a major vascular event, net benefit was positive in 85% or 99% of patients, respectively. Limiting intensive treatment to the 85% patient subgroup had no significant effect on the overall incidence of major vascular events and severe hypoglycaemia compared with treating all patients. CONCLUSIONS/INTERPRETATION Taking account of the effects of intensive glucose control on major micro- and macrovascular events and severe hypoglycaemia for individual patients, the estimated net benefit was positive in the majority of the participants in the ADVANCE trial. The estimated individual effects can inform treatment decisions once individual weights assigned to positive and adverse effects have been specified. TRIAL REGISTRATION ClinicalTrials.gov NCT00145925.
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Affiliation(s)
- Joep van der Leeuw
- Department of Vascular Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
| | - Mark Woodward
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yolanda van der Graaf
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Stephen Harrap
- The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Heller
- University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Giuseppe Mancia
- Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy
| | - Michel Marre
- Hôpital Bichat-Claude Bernard and Université Paris 7, Paris, France
| | - Neil Poulter
- International Centre for Circulatory Health, Imperial College, London, UK
| | - Sophia Zoungas
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
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Papanas N, Ziegler D. Emerging drugs for diabetic peripheral neuropathy and neuropathic pain. Expert Opin Emerg Drugs 2016; 21:393-407. [DOI: 10.1080/14728214.2016.1257605] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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43
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Li J, Dong Y, Wu T, Tong N. Differences between Western and Asian type 2 diabetes patients in the incidence of vascular complications and mortality: A systematic review of randomized controlled trials on lowering blood glucose. J Diabetes 2016; 8:824-833. [PMID: 26663605 DOI: 10.1111/1753-0407.12361] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Differences exist between Western and Asian people with type 2 diabetes (T2D). The aim of the present systematic review was to determine whether there are differences in chronic diabetic vascular complications (CDVCs) and mortality between Western and Asian patients with T2D. METHODS Three databases (EMBASE, MEDLINE, and Cochrane library) were searched for publications from 1966 to March 2013 describing interventional randomized control trials (RCTs) targeting to lower blood glucose levels. The RCTs included had follow-up durations of at least 4 years as an endpoint or in their initial design, analyzed effects on mortality and/or CDVCs in T2D and compared differences in mortality and/or CDVCs among patients of different ethnicities. RESULTS Two studies, including 19 439 patients with advanced diabetes, were eligible for analysis. Patients were divided into those of Western (including Australia and New Zealand) and Asian ethnicities. The incidence of all-cause mortality, cardiovascular death, and major coronary events was significantly higher in Western than Asian patients, whereas the incidence of major cerebrovascular events, microvascular events (except for peripheral neuropathy), new or worsening nephropathy, and retinopathy was significantly lower in Western patients. There were no-between group differences in macrovascular events, including cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. CONCLUSIONS There are differences in CDVCs and mortality rates between Western and Asian patients with advanced T2D, primarily due to ethnicity-specific factors (e.g. different genetic background, lifestyle). Knowledge of these disparities may allow more effective monitoring and management of individual patients based on ethnic differences.
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Affiliation(s)
- Jing Li
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University
| | - Yajie Dong
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University
| | - Taixiang Wu
- Chinese Cochrane Center, Chinese Evidence-Based Medicine Center of International Clinical Epidemiology Network (INCLEN), Local Resource and Training Center, Chengdu, China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University.
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Shah HS, Gao H, Morieri ML, Skupien J, Marvel S, Paré G, Mannino GC, Buranasupkajorn P, Mendonca C, Hastings T, Marcovina SM, Sigal RJ, Gerstein HC, Wagner MJ, Motsinger-Reif AA, Buse JB, Kraft P, Mychaleckyj JC, Doria A. Genetic Predictors of Cardiovascular Mortality During Intensive Glycemic Control in Type 2 Diabetes: Findings From the ACCORD Clinical Trial. Diabetes Care 2016; 39:1915-1924. [PMID: 27527847 PMCID: PMC5079609 DOI: 10.2337/dc16-0285] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/20/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify genetic determinants of increased cardiovascular mortality among subjects with type 2 diabetes who underwent intensive glycemic therapy in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS A total of 6.8 million common variants were analyzed for genome-wide association with cardiovascular mortality among 2,667 self-reported white subjects in the ACCORD intensive treatment arm. Significant loci were examined in the entire ACCORD white genetic dataset (n = 5,360) for their modulation of cardiovascular responses to glycemic treatment assignment and in a Joslin Clinic cohort (n = 422) for their interaction with long-term glycemic control on cardiovascular mortality. RESULTS Two loci, at 10q26 and 5q13, attained genome-wide significance as determinants of cardiovascular mortality in the ACCORD intensive arm (P = 9.8 × 10-9 and P = 2 × 10-8, respectively). A genetic risk score (GRS) defined by the two variants was a significant modulator of cardiovascular mortality response to treatment assignment in the entire ACCORD white genetic dataset. Participants with GRS = 0 experienced a fourfold reduction in cardiovascular mortality in response to intensive treatment (hazard ratio [HR] 0.24 [95% CI 0.07-0.86]), those with GRS = 1 experienced no difference (HR 0.92 [95% CI 0.54-1.56]), and those with GRS ≥2 experienced a threefold increase (HR 3.08 [95% CI 1.82-5.21]). The modulatory effect of the GRS on the association between glycemic control and cardiovascular mortality was confirmed in the Joslin cohort (P = 0.029). CONCLUSIONS Two genetic variants predict the cardiovascular effects of intensive glycemic control in ACCORD. Further studies are warranted to determine whether these findings can be translated into new strategies to prevent cardiovascular complications of diabetes.
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Affiliation(s)
- Hetal S Shah
- Research Division, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - He Gao
- Research Division, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Mario Luca Morieri
- Research Division, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jan Skupien
- Research Division, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Skylar Marvel
- Bioinformatics Research Center and Department of Statistics, North Carolina State University, Raleigh, NC
| | - Guillaume Paré
- Department of Medicine and the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada
| | - Gaia C Mannino
- Research Division, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Patinut Buranasupkajorn
- Research Division, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Santica M Marcovina
- Department of Medicine, University of Washington, and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, WA
| | - Ronald J Sigal
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Alberta, Canada
| | - Hertzel C Gerstein
- Department of Medicine and the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada
| | - Michael J Wagner
- Center for Pharmacogenomics and Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alison A Motsinger-Reif
- Bioinformatics Research Center and Department of Statistics, North Carolina State University, Raleigh, NC
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Peter Kraft
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Josyf C Mychaleckyj
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Alessandro Doria
- Research Division, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Giorgino F, Home PD, Tuomilehto J. Glucose Control and Vascular Outcomes in Type 2 Diabetes: Is the Picture Clear? Diabetes Care 2016; 39 Suppl 2:S187-95. [PMID: 27440832 DOI: 10.2337/dcs15-3023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The overall impact of glucose lowering on vascular complications and major clinical outcomes, including mortality, in type 2 diabetes is still an open issue. While intensive glucose control has undoubted benefit for microvascular end points, the relationship between glucose-lowering approaches and reduced incidence and/or progression of macrovascular complications is less clear. This review article will discuss the effect of glucose lowering per se as well as the effects of specific glucose-lowering therapies on vascular outcomes in type 2 diabetes. The role of lifestyle changes on cardiovascular outcomes will be also addressed. Recent analyses from large cardiovascular outcome studies (ACCORD, ADVANCE, and VADT) provide new information on factors that modulate the impact of intensive glucose lowering on outcomes, helping to identify the specific clinical characteristics of the patients receiving the intervention that would show a better response. While several studies on cardiovascular outcomes with diabetes drugs are available, they do not clearly highlight a benefit from using a specific medication or will require additional evidence, as for the sodium-glucose cotransporter 2 blockers.
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Affiliation(s)
- Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Philip D Home
- Institute for Cellular Medicine-Diabetes, Newcastle University, Newcastle-upon-Tyne, U.K
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland Center for Vascular Prevention, Danube-University Krems, Krems, Austria Dasman Diabetes Institute, Dasman, Kuwait Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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Stecker M, Stevenson M. Effects of insulin on peripheral nerves. J Diabetes Complications 2016; 30:770-7. [PMID: 27134033 DOI: 10.1016/j.jdiacomp.2016.03.009] [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: 08/25/2015] [Revised: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 12/14/2022]
Abstract
AIMS To assess the effects of insulin on peripheral nerve under normoglycemic and hyperglycemic conditions in the presence and absence of anoxia. METHODS This study uses the in-vitro sciatic nerve model to assess the effect of insulin on peripheral nerve with the nerve action potential (NAP) as an index of nerve function. RESULTS Under normoglycemic conditions, low concentrations of regular insulin (0.01nM) reduced the conduction velocity of oxygenated nerves. Hyperglycemia increased the duration of the NAP and this increase was nearly completely eliminated by insulin in the 0.1nM-100nM concentration range. Insulin (1nM) also had effects on normoglycemic nerves exposed to intermittent anoxia, producing a decrease in the paired-pulse response and NAP amplitude and an increase in peak duration. This was associated with a reduced time to anoxia-induced conduction block. Similar effects were seen when regular insulin was replaced by insulin detemir, but the latter required much higher concentrations. CONCLUSIONS Insulin has concentration dependent effects on the peripheral nerve that are dependent on glucose and anoxia. These effects may be important in modulating neuropathic consequences of diabetes.
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Affiliation(s)
- Mark Stecker
- Department of Neuroscience, Winthrop University Hospital, Mineola NY 11530.
| | - Matthew Stevenson
- Department of Neuroscience, Winthrop University Hospital, Mineola NY 11530
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Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical Update: Cardiovascular Disease in Diabetes Mellitus: Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus - Mechanisms, Management, and Clinical Considerations. Circulation 2016; 133:2459-502. [PMID: 27297342 PMCID: PMC4910510 DOI: 10.1161/circulationaha.116.022194] [Citation(s) in RCA: 650] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease remains the principal cause of death and disability among patients with diabetes mellitus. Diabetes mellitus exacerbates mechanisms underlying atherosclerosis and heart failure. Unfortunately, these mechanisms are not adequately modulated by therapeutic strategies focusing solely on optimal glycemic control with currently available drugs or approaches. In the setting of multifactorial risk reduction with statins and other lipid-lowering agents, antihypertensive therapies, and antihyperglycemic treatment strategies, cardiovascular complication rates are falling, yet remain higher for patients with diabetes mellitus than for those without. This review considers the mechanisms, history, controversies, new pharmacological agents, and recent evidence for current guidelines for cardiovascular management in the patient with diabetes mellitus to support evidence-based care in the patient with diabetes mellitus and heart disease outside of the acute care setting.
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Affiliation(s)
- Cecilia C Low Wang
- From Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Aurora (C.C.L.); CPC Clinical Research, Aurora, CO (C.C.L., C.N.H., W.R.H.); Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H., W.R.H.); Joslin Diabetes Center, and Harvard Medical School, Boston, MA (A.B.G.)
| | - Connie N Hess
- From Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Aurora (C.C.L.); CPC Clinical Research, Aurora, CO (C.C.L., C.N.H., W.R.H.); Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H., W.R.H.); Joslin Diabetes Center, and Harvard Medical School, Boston, MA (A.B.G.)
| | - William R Hiatt
- From Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Aurora (C.C.L.); CPC Clinical Research, Aurora, CO (C.C.L., C.N.H., W.R.H.); Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H., W.R.H.); Joslin Diabetes Center, and Harvard Medical School, Boston, MA (A.B.G.)
| | - Allison B Goldfine
- From Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado School of Medicine, Aurora (C.C.L.); CPC Clinical Research, Aurora, CO (C.C.L., C.N.H., W.R.H.); Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H., W.R.H.); Joslin Diabetes Center, and Harvard Medical School, Boston, MA (A.B.G.).
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Nine-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes. Diabetes Care 2016; 39:701-8. [PMID: 26822326 PMCID: PMC4839177 DOI: 10.2337/dc15-2283] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/22/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, ∼4 years of intensive versus standard glycemic control in participants with type 2 diabetes and other cardiovascular risk factors had a neutral effect on the composite cardiovascular outcome, increased cardiovascular and total mortality, and reduced nonfatal myocardial infarction. Effects of the intervention during prolonged follow-up were analyzed. RESEARCH DESIGN AND METHODS All surviving ACCORD participants were invited to participate in the ACCORD Follow-on (ACCORDION) study, during which participants were treated according to their health care provider's judgment. Cardiovascular and other health-related outcomes were prospectively collected and analyzed using an intention-to-treat approach according to the group to which participants were originally allocated. RESULTS A total of 8,601 people, representing 98% of those who did not suffer a primary outcome or death during the ACCORD trial, were monitored for a median of 8.8 years and a mean of 7.7 years from randomization. Intensive glucose lowering for a mean of 3.7 years had a neutral long-term effect on the primary composite outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), death from any cause, and an expanded composite outcome that included all-cause death. Moreover, the risk of cardiovascular mortality noted during the active phase (hazard ratio 1.49; 95% CI 1.19, 1.87; P < 0.0001) decreased (HR 1.20; 95% CI 1.03, 1.39; P = 0.02). CONCLUSIONS In high-risk people with type 2 diabetes monitored for 9 years, a mean of 3.7 years of intensive glycemic control had a neutral effect on death and nonfatal cardiovascular events but increased cardiovascular-related death.
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Malik RA. Wherefore Art Thou, O Treatment for Diabetic Neuropathy? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2016; 127:287-317. [PMID: 27133154 DOI: 10.1016/bs.irn.2016.03.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As of March 2016, we continue to advocate the diagnosis of diabetic neuropathy using a simple foot examination or monofilament, which identifies only those with severe neuropathy and hence risk of foot ulceration. Given the fact that the 5-year mortality rate of diabetic patients with foot ulceration is worse than that of most common cancers, surely we should be identifying patients at an earlier stage of neuropathy to prevent its progression to a stage with such a high mortality? Of course, we lament that there is no licensed treatment for diabetic neuropathy. Who is to blame? As researchers and carers, we have a duty of care to our patients with diabetic neuropathy. So, we have to look forward not backwards, and move away from our firmly entrenched views on the design and conduct of clinical trials for diabetic neuropathy. Relevant organizations such as Neurodiab, the American Diabetes Association and the Peripheral Nerve Society have to acknowledge that they cannot continue to endorse a bankrupt strategy. The FDA needs an open and self-critical dialogue with these organizations, to give pharmaceutical companies at least a fighting chance to deliver effective new therapies for diabetic neuropathy.
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Affiliation(s)
- R A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.
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