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Mohammedi K, Hess S, McQueen M, Pigeyre M, Lee SF, Pare G, Gerstein HC. Determinants of serious health outcome-free status in middle-aged and older people with dysglycaemia: Exploratory analysis of the ORIGIN trial. Diabetes Obes Metab 2024; 26:3272-3280. [PMID: 38747213 DOI: 10.1111/dom.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 07/10/2024]
Abstract
AIM To assess clinical and biochemical measurements that can identify people with dysglycaemia (i.e. diabetes or pre-diabetes) who remain free of serious outcomes during follow-up. MATERIALS AND METHODS We conducted exploratory analyses using data from the Outcomes Reduction with an Initial Glargine Intervention (ORIGIN) study to identify independent determinants of outcome-free status in 12 537 middle-aged and older adults with prediabetes and early type 2 diabetes from 40 countries. Serious outcome-free status was defined as the absence of major cardiovascular outcomes, kidney or retinal outcomes, peripheral artery disease, dementia, cancer, any hospitalization, or death during follow-up. RESULTS In total, 3328 (26.6%) participants remained free of serious outcomes during a median follow-up of 6.2 years (IQR 5.8, 6.7). Independent clinical determinants of outcome-free status included younger age, female sex, non-White ethnicity, shorter diabetes duration, absence of previous cardiovascular disease, current or former smokers, higher grip strength, Mini-Mental State Examination score, and ankle-brachial index, lower body mass index and kidney disease index, and non-use of renin-angiotensin system drugs and beta-blockers. In a subset of 8401 people with baseline measurements of 238 biomarkers, growth differentiation factor 15, kidney injury molecule-1, N-terminal pro-brain natriuretic peptide, uromodulin, C-reactive protein, factor VII and ferritin were independent determinants. The combination of clinical determinants and biomarkers best identified participants who remained outcome-free (C-statistics 0.71, 95% confidence interval 0.70-0.73; net reclassification improvement 0.55, 95% confidence interval 0.48-0.58). CONCLUSIONS A set of routinely measured clinical characteristics and seven protein biomarkers identify middle-aged and older people with prediabetes or early type 2 diabetes as least likely to experience serious outcomes during follow-up.
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Affiliation(s)
- Kamel Mohammedi
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
- Université de Bordeaux, INSERM, BMC, U1034, Avenue de Magellan, Pessac, France
| | - Sibylle Hess
- Sanofi, Global Medical Diabetes, Frankfurt, Germany
| | - Matthew McQueen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Marie Pigeyre
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Shun Fu Lee
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Guillaume Pare
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
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2
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Patel HP, Decter D, Thakkar S, Anantha-Narayanan M, Kumar A, Sheth AR, Zahid S, Patel BA, Patel T, Devani H, Shah V, Doshi PM, Patel S, Shariff M, Adalja D, Vallabhajosyula S, Doshi R. Impact of Chronic Kidney Disease on In-Hospital Outcomes of Hospitalizations With Acute Limb Ischemia Undergoing Endovascular Therapy. J Endovasc Ther 2024; 31:606-614. [PMID: 36401519 DOI: 10.1177/15266028221134887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE Studies on outcomes related to endovascular treatment (EVT) in advanced stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among hospitalizations with acute limb ischemia (ALI) are limited. METHODS The Nationwide Inpatient Sample was quarried from October 2015 to December 2017 to identify the hospitalizations with ALI and undergoing EVT. The study population was subdivided into 3 groups based on their CKD stages: group 1 (No CKD, stage I, stage II), group 2 (CKD stage III, stage IV), and group 3 (CKD stage V and ESRD). The primary outcome was all-cause in-hospital mortality. RESULTS A total of 51 995 hospitalizations with ALI undergoing EVT were identified. The in-hospital mortality was significantly higher in group 2 (OR = 1.17; 95% CI 1.04 - 1.32, p=0.009) and group 3 (OR = 3.18; 95% CI 2.74-3.69, p<0.0001) compared with group 1. Odds of minor amputation, vascular complication, atherectomy, and blood transfusion were higher among groups 2 and 3 compared with group 1. Group 2 had higher odds of access site hemorrhage compared with groups 1 and 3, whereas group 3 had higher odds of major amputation, postprocedural infection, and postoperative hemorrhage compared with groups 1 and 2. Besides, groups 2 and 3 had lower odds of discharge to home compared with group 1. Finally, the length of hospital stay and cost of care was significantly higher with the advancing CKD stages. CONCLUSION Advanced CKD stages and ESRD are associated with higher mortality, worse in-hospital outcomes and higher resource utilization among ALI hospitalizations undergoing EVT. CLINICAL IMPACT Current guidelines are not clear for the optimum first line treatment of acute limb ischemia, especially in patients with advanced kidney disease as compared to normal/mild kidney disease patients. We found that advanced kidney disease is a significant risk factor for worse in-hospital morbidity and mortality. Furthermore, patients with acute limb ischemia and advanced kidney disease is associated with significantly higher resource utilization as compared to patients with normal/mild kidney disease. This study suggests shared decision making between treating physician and patients when considering endovascular therapy for the treatment of acute limb ischemia in patients with advanced kidney disease.
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MESH Headings
- Humans
- Endovascular Procedures/adverse effects
- Endovascular Procedures/mortality
- Male
- Female
- Ischemia/mortality
- Ischemia/therapy
- Ischemia/surgery
- Aged
- Hospital Mortality
- Risk Factors
- Treatment Outcome
- Peripheral Arterial Disease/mortality
- Peripheral Arterial Disease/therapy
- Peripheral Arterial Disease/complications
- Middle Aged
- Time Factors
- Databases, Factual
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/mortality
- Renal Insufficiency, Chronic/therapy
- Renal Insufficiency, Chronic/diagnosis
- Risk Assessment
- United States
- Acute Disease
- Retrospective Studies
- Aged, 80 and over
- Kidney Failure, Chronic/therapy
- Kidney Failure, Chronic/mortality
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/diagnosis
- Amputation, Surgical
- Limb Salvage
- Inpatients
- Hospitalization
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Affiliation(s)
- Harsh P Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Dean Decter
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Mahesh Anantha-Narayanan
- Department of Interventional Cardiology, The University of Arizona and Banner University Medical Center, Phoenix, AZ, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Aakash R Sheth
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA
| | - Salman Zahid
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Bhavin A Patel
- Department of Cardiology, Apex Heart Institute, Ahmedabad, India
| | - Toralben Patel
- Department of Cardiovascular Diseases, AdventHealth Medical Group, Orlando, FL, USA
| | - Hiteshkumar Devani
- Department of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vrushali Shah
- Department of Endocrinology, University of Massachusetts, Worcester, MA, USA
| | | | - Smit Patel
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | | | - Devina Adalja
- Department of Medicine, Gujarat Medical Education & Research Society Gotri Medical College, Vadodara, India
| | | | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, NV, USA
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3
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Luo YH, Wang DW, Yao J, Hu Y, Zhao L, Wen JX, Zhang JM, Wu LL, Fan GJ, Song W. Integrated metabolomics and transcriptomics analysis reveals the mechanism of Tangbi capsule for diabetic lower extremities arterial disease. Front Microbiol 2024; 15:1423428. [PMID: 39104587 PMCID: PMC11299497 DOI: 10.3389/fmicb.2024.1423428] [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: 04/25/2024] [Accepted: 07/04/2024] [Indexed: 08/07/2024] Open
Abstract
Objective Tangbi capsule (TBC) is a traditional Chinese medicine prescription, which has the potential to improve the vascular insufficiency of lower extremities and limb numbness in diabetes. However, the potential mechanism remains unknown. This study aims to investigate the pharmacological effects and mechanism of TBC on rats with diabetic lower extremities arterial disease (LEAD). Methods The mechanism of TBC on diabetic LEAD was investigated through metabolomics and transcriptomics analysis, and the main components of TBC were determined by mass spectrometry. The efficacy and mechanism of TBC on diabetic LEAD rats were investigated through in vitro experiments, histopathology, blood flow monitoring, western blot, and real-time polymerase chain reaction. Results Mass spectrometry analysis identified 31 active chemical components in TBC including (2R)-2,3-Dihydroxypropanoic acid, catechin, citric acid, miquelianin, carminic acid, salicylic acid, formononetin, etc. In vitro analysis showed that TBC could reduce endothelial cell apoptosis and promote angiogenesis. Histopathological analysis showed that TBC led to an obvious improvement in diabetic LEAD as it improved fibrous tissue proliferation and reduced arterial wall thickening. In addition, TBC could significantly increase the expression levels of HIF-1α, eNOS, and VEGFA proteins and genes while reducing that of calpain-1 and TGF-β, suggesting that TBC can repair vascular injury. Compared with the model group, there were 47 differentially expressed genes in the whole blood of TBC groups, with 25 genes upregulated and 22 downregulated. Eighty-seven altered metabolites were identified from the serum samples. Combining the changes in differentially expressed genes and metabolites, we found that TBC could regulate arginine biosynthesis, phenylalanine metabolism, pyrimidine metabolism, arachidonic acid metabolism, pyrimidine metabolism, arachidonic acid metabolism, nucleotide metabolism, vitamin B6 metabolism and other metabolic pathways related to angiogenesis, immune-inflammatory response, and cell growth to improve diabetic LEAD. Conclusion TBC improved vascular endothelial injury, apoptosis, lipid accumulation, liver and kidney function, and restored blood flow in the lower extremities of diabetic LEAD rats. The mechanism of TBC in the treatment of diabetic LEAD may be related to the modulation of inflammatory immunity, lipid metabolism, and amino acid metabolism. This study presented preliminary evidence to guide the use of TBC as a therapy option for diabetic LEAD.
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Affiliation(s)
- Ye-hao Luo
- School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - Da-wei Wang
- Shunde Hospital Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia Yao
- Department of Endocrinology Guangzhou 12th People’s Hospital, Guangzhou, China
| | - Yue Hu
- School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling Zhao
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-xuan Wen
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin-ming Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lu-Lu Wu
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guan-jie Fan
- School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - Wei Song
- School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China
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4
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Mahé G, Aboyans V, Cosson E, Mohammedi K, Sarlon-Bartoli G, Lanéelle D, Mirault T, Darmon P. Challenges and opportunities in the management of type 2 diabetes in patients with lower extremity peripheral artery disease: a tailored diagnosis and treatment review. Cardiovasc Diabetol 2024; 23:220. [PMID: 38926722 PMCID: PMC11210102 DOI: 10.1186/s12933-024-02325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Lower extremity peripheral artery disease (PAD) often results from atherosclerosis, and is highly prevalent in patients with type 2 diabetes mellitus (T2DM). Individuals with T2DM exhibit a more severe manifestation and a more distal distribution of PAD compared to those without diabetes, adding complexity to the therapeutic management of PAD in this particular patient population. Indeed, the management of PAD in patients with T2DM requires a multidisciplinary and individualized approach that addresses both the systemic effects of diabetes and the specific vascular complications of PAD. Hence, cardiovascular prevention is of the utmost importance in patients with T2DM and PAD, and encompasses smoking cessation, a healthy diet, structured exercise, careful foot monitoring, and adherence to routine preventive treatments such as statins, antiplatelet agents, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. It is also recommended to incorporate glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) in the medical management of patients with T2DM and PAD, due to their demonstrated cardiovascular benefits. However, the specific impact of these novel glucose-lowering agents for individuals with PAD remains obscured within the background of cardiovascular outcome trials (CVOTs). In this review article, we distil evidence, through a comprehensive literature search of CVOTs and clinical guidelines, to offer key directions for the optimal medical management of individuals with T2DM and lower extremity PAD in the era of GLP-1RA and SGLT2i.
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Affiliation(s)
- Guillaume Mahé
- Vascular Medicine Unit, University Hospital of Rennes, Rennes, France.
- Clinical Investigation Center, CIC 1414, INSERM, Rennes, France.
- M2S- EA 7470, University of Rennes, Rennes, France.
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Emmanuel Cosson
- AP-HP, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
- Nutritional Epidemiology Research Unit, UMR U557 INSERM/U11125 INRAE/CNAM, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Kamel Mohammedi
- Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Bordeaux, Pessac, France
- INSERM, BMC, U1034, University of Bordeaux, Pessac, France
| | - Gabrielle Sarlon-Bartoli
- Vascular Medicine and Hypertension Department, La Timone University Hospital of Marseille, Marseille, France
- Centre for Nutrition and Cardiovascular Disease (C2VN), Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Damien Lanéelle
- Department of Vascular Medicine, Caen Normandy University Hospital, Caen, France
- COMETE, INSERM, GIP Cyceron, University of Caen Normandy, Caen, France
| | - Tristan Mirault
- Vascular Medicine Department, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut des Sciences Cardiovasculaires, Paris Cardiovascular Research Center, INSERM U970, Université Paris Cité, Paris, France
| | - Patrice Darmon
- Centre for Nutrition and Cardiovascular Disease (C2VN), Faculty of Medicine, Aix-Marseille University, Marseille, France
- Department of Endocrinology, Metabolic Diseases, and Nutrition, Assistance Publique-Hôpitaux de Marseille (AP-HM), University Hospital Conception, Marseille, France
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5
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Antignani PL, Gargiulo M, Gastaldi G, Jawien A, Mansilha A, Poredos P. Lower extremity arterial disease perspective: IUA consensus document on "lead management". Part 1. INT ANGIOL 2023; 42:382-395. [PMID: 37822195 DOI: 10.23736/s0392-9590.23.05110-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is defined as coronary heart disease (CHD), cerebrovascular disease, or lower extremity arterial disease (LEAD) also named peripheral arterial disease (PAD). ASCVD is considered to be of atherosclerotic origin and is the leading cause of morbidity and mortality mainly for individuals with diabetes mellitus (DM). In this consensus document of the International Union of Angiology the authors discuss epidemiology, risk factors, primary and secondary prophylaxis, the correlation between diabetes mellitus and LEAD, conservative and surgical treatment.
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Affiliation(s)
| | - Mauro Gargiulo
- Section of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, S. Orsola and Maggiore Polyclinic Hospitals, Bologna, Italy
| | - Giacomo Gastaldi
- DiaCenTRE, Hirslanden Grangettes SA, Diabetology Unit, Geneva University Hospital, Geneva, Switzerland
| | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Department of Angiology and Vascular Surgery, S. João Hospital, Porto, Portugal
| | - Pavel Poredos
- University Clinical Center Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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6
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Ghareghani O, Ghareghani S, Takhshid MA. Diagnostic values of ischemia modified albumin in diabetes-related complications: a narrative review. J Diabetes Metab Disord 2023; 22:35-46. [PMID: 37255772 PMCID: PMC10225390 DOI: 10.1007/s40200-022-01152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/19/2022] [Indexed: 06/01/2023]
Abstract
Purpose Oxidative stress (OS) plays a critical role in the onset and progression of macro and microvascular complications of diabetes mellitus (DM). Ischemia-modified albumin (IMA) is a novel and simple test for evaluating OS. In the present study, we reviewed the available information on the alteration of circulating IMA in DM and its possible prognostic and diagnostic value in DM-related complications. Methods Relevant studies regarding IMA alteration in DM published until May 30, 2022 were extracted from Google Scholar, PubMed, Scopus, and Science Direct databases. The following key words were used: IMA, DM, diabetes complications, retinopathy, nephropathy, diabetic foot, and vascular complications. Results This review revealed increased circulating IMA levels in the patients with type 1, type 2, and gestational DM. Furthermore, IMA showed a close relationship with the severity of DM complications including hyperglycemia, dyslipidemia, diabetic retinopathy, diabetic nephropathy, peripheral arterial disease, and diabetic foot ulcer. However, lack of assay standardization and low specificity are major obstacles to the use of IMA as a promising biomarker. Conclusion IMA levels are associated with DM complications and can be applied as a practical test for evaluating the risk and predicting the severity of DM complications.
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Affiliation(s)
- Oranoos Ghareghani
- Laboratory Sciences Department, Faculty of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shagayegh Ghareghani
- Laboratory Sciences Department, Faculty of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Takhshid
- Laboratory Sciences Department, Faculty of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Diagnostic Laboratory Sciences and Technology Research Center, Faculty of Paramedical Sciences, Shiraz University of Medical Sciences, Meshkinfam Street, Shiraz, Iran
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7
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Foussard N, Dari L, Ducasse E, Rigalleau V, Mohammedi K, Caradu C. Lower-limb peripheral arterial disease and amputations in people with diabetes: Risk factors, prognostic value and management. Presse Med 2023; 52:104164. [PMID: 36863662 DOI: 10.1016/j.lpm.2023.104164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023] Open
Abstract
Lower-limb peripheral arterial disease (PAD), is a common manifestation of systemic atherosclerosis, resulting from a partial or complete obstruction of at least one lower-limb arteries. PAD is a major endemic disease with an excess risk of major cardiovascular events and death. It also leads to disability, high rates of lower-limb adverse events and non-traumatic amputation. In patients with diabetes, PAD is particularly frequent and has a worse prognosis than in patients without diabetes. The risk factors of PAD are comparable to those for cardiovascular disease. The ankle-brachial index is usually recommended to screen PAD despite its limited performance in patients with diabetes, affected by the presence of peripheral neuropathy, medial arterial calcification, incompressible arteries and infection. Toe brachial index and toe pressure emerge as alternative screening tools. The management of PAD requires strict control of cardiovascular risk factors including diabetes, hypertension and dyslipidaemia, the use of antiplatelet agents and lifestyle management, to reduce cardiovascular adverse events, but few randomized controlled trials have evaluated the benefits of these treatments in PAD. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in PAD prognosis. Further studies are required to increase our understanding of the pathophysiology of PAD and to evaluate the interest of different therapeutic strategies in the occurrence and progression of PAD in patients with diabetes. Here, we present a narrative and contemporary review to synthesize the key epidemiology findings, screening and diagnosis methods, and major therapeutic advances regarding PAD in patients with diabetes.
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Affiliation(s)
- Ninon Foussard
- Bordeaux University Hospital, Hôpital Haut-Lévêque, Department of Endocrinology, Diabetes and Nutrition, Pessac, France; University of Bordeaux, Faculty of Medicine, Bordeaux, France; INSERM unit 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Loubna Dari
- University of Bordeaux, Faculty of Medicine, Bordeaux, France; Bordeaux University Hospital, Hôpital Saint-André, Vascular Medicine Department, Bordeaux, France
| | - Eric Ducasse
- University of Bordeaux, Faculty of Medicine, Bordeaux, France; INSERM unit 1034, Biology of Cardiovascular Diseases, Pessac, France; Bordeaux University Hospital, Department of Vascular Surgery, Bordeaux, France
| | - Vincent Rigalleau
- Bordeaux University Hospital, Hôpital Haut-Lévêque, Department of Endocrinology, Diabetes and Nutrition, Pessac, France; University of Bordeaux, Faculty of Medicine, Bordeaux, France
| | - Kamel Mohammedi
- Bordeaux University Hospital, Hôpital Haut-Lévêque, Department of Endocrinology, Diabetes and Nutrition, Pessac, France; University of Bordeaux, Faculty of Medicine, Bordeaux, France; INSERM unit 1034, Biology of Cardiovascular Diseases, Pessac, France.
| | - Caroline Caradu
- Bordeaux University Hospital, Department of Vascular Surgery, Bordeaux, France
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8
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Camoin M, Velho G, Saulnier PJ, Potier L, Abouleka Y, Carpentier C, Dubois S, Larroumet A, Rigalleau V, Gand E, Bourron O, Bordier L, Scheen A, Hadjadj S, Roussel R, Marre M, Mohammedi K. Differential prognostic burden of cardiovascular disease and lower-limb amputation on the risk of all-cause death in people with long-standing type 1 diabetes. Cardiovasc Diabetol 2022; 21:71. [PMID: 35534880 PMCID: PMC9088124 DOI: 10.1186/s12933-022-01487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cardiovascular disease (CVD) and nontraumatic lower-limb amputation (LLA) each results in reduced life expectancy in patients with type 1 diabetes, but the differential burden between these conditions is unknown. We compared the effects of CVD and LLA on the risk of mortality in people with type 1 diabetes. Methods We used pooled data from the SURGENE, GENEDIAB, and GENESIS prospective cohorts. Data were divided into: 1/absence of CVD (myocardial infarction and/or stroke) nor LLA, 2/history of CVD alone without LLA, 3/LLA alone without CVD or 4/both conditions at baseline. Participants with baseline history of peripheral artery disease were excluded from groups 1 and 2. The study endpoint was any death occurring during follow-up, regardless of the causes. Results Among 1169 participants (male 55%, age 40 ± 13 years, diabetes duration 23 ± 11 years), CVD, LLA or both were present at baseline in 49 (4.2%), 62 (5.3%) and 20 (1.7%) subjects, respectively. All-cause death occurred in 304 (26%) participants during 17-year follow-up, corresponding to 18,426 person-years and an incidence rate of 16 (95%CI, 15–18) per 1000 person-years. The risk of death increased in individuals with baseline history of CVD (adjusted HR 2.00 [95% CI 1.34–3.01], p = 0.0008) or LLA (2.26 [1.56–3.28], p < 0.0001), versus no condition, with an additive effect in people with both conditions (5.32 [3.14–9.00], p < 0.0001). No incremental risk of death was observed in people with CVD versus LLA (0.87 [0.54–1.41]). Compared with no condition, CVD and LLA were similarly associated with reduced life expectancy during follow-up: 2.79 (95% CI 1.26–4.32) and 3.38 (1.87–4.88) years, respectively. Combined conditions expose to 7.04 (4.76–9.31) less years of life expectancy (all p < 0.0001). Conclusions CVD and LLA conferred a similar burden regarding mortality in type 1 diabetes population. Our findings encourage a careful consideration of people with type 1 diabetes and LLA as usually recommended for those with CVD, in terms of management of risk factors, treatments and prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01487-8.
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Affiliation(s)
- Marion Camoin
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France
| | | | - Pierre-Jean Saulnier
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.,Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France.,Inserm, CIC 1402, Poitiers, France
| | - Louis Potier
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France.,INEM, INSERM, Université de Paris, Paris, France
| | - Yawa Abouleka
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France
| | - Charlyne Carpentier
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Severine Dubois
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Alice Larroumet
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France
| | - Vincent Rigalleau
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France.,INSERM U1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Elise Gand
- Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
| | - Olivier Bourron
- Service de Diabétologie et Métabolisme, APHP, Groupe Hospitalier La Pitié-Salpêtrière, Sorbonne Université, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Sorbonne Université, Paris, France
| | - Lyse Bordier
- Service d'Endocrinologie, Hôpital Bégin, Saint Mandé, France
| | | | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Ronan Roussel
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France.,INEM, INSERM, Université de Paris, Paris, France
| | - Michel Marre
- INEM, INSERM, Université de Paris, Paris, France.,Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Kamel Mohammedi
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France. .,Faculty of Medicine, University of Bordeaux, Bordeaux, France. .,Biology of Cardiovascular Diseases, INSERM Unit 1034, Pessac, France.
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9
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Li S, Chen X, Yang H, Li H, Ren B. Value of IMA, IMAR, the IMA Index, and Other Hematological Features in Predicting AIS Caused by MCA Stenosis/Occlusion. Curr Neurovasc Res 2022; 19:137-149. [PMID: 35578847 DOI: 10.2174/1567202619666220516145120] [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: 02/10/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE In this study, we investigated the relationship between serum ischemic modified albumin (IMA) levels and other hematologic features and middle cerebral artery (MCA) severe stenosis/occlusion in acute ischemic stroke (AIS) patients. METHODS The levels of serum IMA and Albumin (ALB) of 169 AIS patients were measured, and the ratio of IMA to albumin (IMAR) and the albumin-adjusted ischemia-modified albumin index (IMA index) were calculated. Different combinations of other hematologic changes and clinical features of the patients were analyzed. RESULTS The results indicated that the levels of blood IMA and IMAR were significantly higher in the group with severe intracranial stenosis/occlusion than in the group with non-severe stenosis/ occlusion in AIS patients, while the CHE levels were significantly lower than those in the other groups. In the MCA severe stenosis/occlusion group, the levels of blood IMA and IMAR were significantly higher than that in the other vascular severe stenosis/occlusion groups, while the IMA index, ALB, and CHE were significantly lower than that in the other groups. Multiple linear regression analysis showed a significant negative correlation between IMA and albumin. A combined diagnostic ROC curve analysis showed that among AIS patients, the best combination for determining severe stenosis/occlusion of the great intracranial arteries was the admission NIHSS score + CHE (AUC = 0.783). The best combination for determining severe stenosis or occlusion of the MCA in AIS patients was IMAR combined with the admission NIHSS score and CHE (AUC = 0.827). CONCLUSION The combined use of IMA, IMAR, and the IMA index has some diagnostic value in AIS caused by severe stenosis or occlusion of the MCA. IMAR, CHE, and the admission NIHSS scores are the best combinations to determine whether an AIS patient has severe stenosis or occlusion of the MCA.
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Affiliation(s)
- Sijin Li
- School of Clinical Medicine, Hunan University of Chinese Medicine, Hunan, China
| | - Xing Chen
- Department of Blood Transfusion, Loudi Central Hospital, Loudi, Hunan 417000, China
| | - Huan Yang
- School of Clinical Medicine, Hunan University of Chinese Medicine, Hunan, China
| | - Huiyang Li
- School of Clinical Medicine, Hunan University of Chinese Medicine, Hunan, China
| | - Biqiong Ren
- School of Clinical Medicine, Hunan University of Chinese Medicine, Hunan, China.,Department of Laboratory Medicine, Second People's Hospital of Hunan Province, Changsha, Hunan 410007, China
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10
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Mohammedi K, Harrap S, Mancia G, Marre M, Poulter N, Chalmers J, Woodward M. History of lower-limb complications and risk of cancer death in people with type 2 diabetes. Cardiovasc Diabetol 2021; 20:3. [PMID: 33397352 PMCID: PMC7784290 DOI: 10.1186/s12933-020-01198-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: 10/26/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Individuals with diabetes and lower-limb complications are at high risk for cardiovascular and all-cause mortality, but uncertainties remain in terms of cancer-related death in this population. We investigated this relationship in a large cohort of people with type 2 diabetes. METHODS We used data from the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) study. The primary outcome was adjudicated cancer death; secondary outcomes were overall and site-specific incident cancers, determined according to the International Classification of Diseases Code (ICD-10). We compared outcomes in individuals with (versus without) a baseline history of lower-limb complications (peripheral artery disease (PAD) or sensory peripheral neuropathy) using Cox regression models. RESULTS Among 11,140 participants (women 42%, mean age 66 years), lower-limb complications were reported at baseline in 4293 (38%) individuals: 2439 (22%) with PAD and 2973 (27%) with peripheral neuropathy. Cancer death occurred in 316 (2.8%) participants during a median of 5.0 (25th-75th percentile, 4.7-5.1) years of follow-up corresponding to 53,550 person-years and an incidence rate of 5.9 (95% CI 5.3-6.6) per 1000 person-years. The risk of cancer death was higher in individuals with (versus without) lower-limb complication [hazard ratio 1.53 (95% CI, 1.21-1.94), p = 0.0004], PAD [1.32 (1.02-1.70), p = 0.03] or neuropathy (1.41 (1.11-1.79), p = 0.004], adjusting for potential confounders and study allocations. PAD, but not neuropathy, was associated with excess risk of incident cancers. CONCLUSIONS PAD and peripheral neuropathy were independently associated with increased 5-year risk of cancer death in individuals with type 2 diabetes. PAD was also associated with increased risk of incident cancers. Our findings provide new evidence on the non-cardiovascular prognostic burden of lower-limb complications in people with type 2 diabetes.
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Affiliation(s)
- Kamel Mohammedi
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Bordeaux, France. .,Faculty of Medicine, The University of Bordeaux, Bordeaux, France. .,INSERM Unit 1034, Bordeaux, France.
| | - Stephen Harrap
- The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Giuseppe Mancia
- The University of Milan-Bicocca and Istituto Auxologico Italiano, Milan, Italy
| | - Michel Marre
- Université de Paris, UFR de Médecine, Paris, France.,Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Neil Poulter
- The International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, UK
| | - John Chalmers
- The George Institute for Global Health, Sydney, NSW, Australia.,The University of New South Wales, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney, NSW, Australia.,The University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine, Imperial College London, London, UK.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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11
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Wang Y, Zheng Z, Yang Y, Lang J, Zhang N, Yang L, Zhao D. Angiopoietin-like 2 is a potential biomarker for diabetic foot patients. BMC Endocr Disord 2020; 20:178. [PMID: 33256685 PMCID: PMC7706189 DOI: 10.1186/s12902-020-00657-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 11/22/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Circulating angiopoietin-like 2 (ANGPTL2) protein levels are known to be significantly increased in numerous chronic inflammatory diseases and are associated with the diagnosis and/or prognosis of cardiovascular diseases, diabetes, chronic kidney disease, and various types of cancers. However, no data regarding the relationship between ANGPTL2 and diabetic foot ulcers (DFUs) are available. Here, we explored the potential link between ANGPTL2 and DFUs. METHODS A total of 68 participants with type 2 diabetes mellitus (T2DM) were recruited, including 28 patients with DFU and 40 diabetic patients without DFUs. The clinical characteristics of T2DM patients with and without DFUs were compared. Serum concentrations of ANGPTL2 and VEGF were measured using enzyme-linked immunosorbent assay (ELISA) kits. The correlations between ANGPTL2 and clinical variables were analyzed. Multiple linear regression and logistic regression models were constructed to test the associations between ANGPTL2 and the severity and presence of DFUs. RESULTS Serum levels of ANGPTL2 were higher in patients with DFUs than those in diabetic controls. Serum ANGPTL2 levels were higher in the advanced stages of DFUs. Spearman correlation analysis revealed strong positive associations of ANGPTL2 with CRP, VEGF and ESR in all subjects. In addition, serum ANGPTL2 was still positively correlated with DFUs stage after adjusting the risk factors. After adjusting for age, sex, HbA1C and duration of diabetes, ANGPTL2 was found to be independently associated with the presence of DFUs. CONCLUSIONS Circulating ANGPTL2 levels are an independent risk factor for DFUs. This suggests that ANGPTL2 may play important roles in the development of DFUs, a possibility that needs to investigated in prospective studies.
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Affiliation(s)
- Yan Wang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149 China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149 China
| | - Zhaohui Zheng
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149 China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149 China
| | - Yuxian Yang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149 China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149 China
| | - Jianan Lang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149 China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149 China
| | - Ning Zhang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149 China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149 China
| | - Longyan Yang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149 China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149 China
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149 China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149 China
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12
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Foussard N, Saulnier PJ, Potier L, Ragot S, Schneider F, Gand E, Monlun M, Baillet-Blanco L, Velho G, Marre M, Roussel R, Rigalleau V, Mohammedi K, Hadjadj S. Relationship Between Diabetic Retinopathy Stages and Risk of Major Lower-Extremity Arterial Disease in Patients With Type 2 Diabetes. Diabetes Care 2020; 43:2751-2759. [PMID: 33055101 DOI: 10.2337/dc20-1085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/05/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluated the association between diabetic retinopathy stages and lower-extremity arterial disease (LEAD), its prognostic value, and the influence of potential contributors to this relationship in a prospective cohort of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Diabetic retinopathy was staged at baseline as absent, nonproliferative, or proliferative. A Cox regression model was fitted in order to compute the hazard ratio (HR) (95% CI) for major LEAD (lower-limb amputation or revascularization) during follow-up by baseline retinopathy stages. The retinopathy-LEAD association was assessed in subgroups by age, sex, diabetes duration, HbA1c, systolic blood pressure, diabetic kidney disease, smoking, and macrovascular disease at baseline. The performance of retinopathy in stratifying LEAD risk was assessed by using the C statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). RESULTS Among 1,320 participants without a history of LEAD at baseline, 94 (7.1%) developed a major LEAD during a 7.1-year median follow-up (incidence rate 9.6 per 1,000 person-years [95% CI 7.8-11.7]). The LEAD incidence rate (per 1,000 person-years) increased as retinopathy worsened: it was 5.5 (95% CI 3.9-7.8) in participants in whom retinopathy was absent, 14.6 (11.1-19.3) in those with nonproliferative retinopathy, and 20.1 (11.1-36.3) in those with proliferative retinopathy. Nonproliferative retinopathy (adjusted HR 2.31 [95% CI 1.43-3.81], P = 0.0006) and proliferative retinopathy (3.14 [1.40-6.15], P = 0.007) remained associated with major LEAD. No heterogeneity was observed across subgroups. Retinopathy enhanced the C statistic (+0.023 [95% CI 0.003-0.044], P = 0.02), IDI (0.209 [0.130-0.321], P < 0.001), and NRI (0.562 [0.382-0.799], P < 0.001) values for risk of LEAD, beyond traditional risk factors. CONCLUSIONS An independent dose-response relationship was identified between diabetic retinopathy stages and major LEAD. Retinopathy yielded incremental prognostic information for stratifying risk of LEAD, suggesting its usefulness as a predictor of LEAD.
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Affiliation(s)
- Ninon Foussard
- Hôpital Haut-Lévêque, Département d'Endocrinologie, Diabétologie, Nutrition, Pessac, Bordeaux, France
| | - Pierre-Jean Saulnier
- Université de Poitiers, UFR de Médecine et Pharmacie, Poitiers, France.,CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France.,INSERM, CIC 1402, Poitiers, France
| | - Louis Potier
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Département de Diabétologie, Endocrinologie, Nutrition, Paris, France.,Université de Paris, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Stéphanie Ragot
- Université de Poitiers, UFR de Médecine et Pharmacie, Poitiers, France.,CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France.,INSERM, CIC 1402, Poitiers, France
| | - Fabrice Schneider
- Université de Poitiers, UFR de Médecine et Pharmacie, Poitiers, France.,Département de Chirurgie Vasculaire, CHU de Poitiers, Poitiers, France
| | - Elise Gand
- CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France
| | - Marie Monlun
- Hôpital Haut-Lévêque, Département d'Endocrinologie, Diabétologie, Nutrition, Pessac, Bordeaux, France
| | - Laurence Baillet-Blanco
- Hôpital Haut-Lévêque, Département d'Endocrinologie, Diabétologie, Nutrition, Pessac, Bordeaux, France
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Michel Marre
- Université de Paris, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Ronan Roussel
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Département de Diabétologie, Endocrinologie, Nutrition, Paris, France.,Université de Paris, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Vincent Rigalleau
- Hôpital Haut-Lévêque, Département d'Endocrinologie, Diabétologie, Nutrition, Pessac, Bordeaux, France.,Université de Bordeaux, UFR de Médecine, Bordeaux, France.,INSERM U1219 "Bordeaux Population Health," Bordeaux, France
| | - Kamel Mohammedi
- Hôpital Haut-Lévêque, Département d'Endocrinologie, Diabétologie, Nutrition, Pessac, Bordeaux, France .,Université de Bordeaux, UFR de Médecine, Bordeaux, France.,INSERM U1034, Biologie des Maladies Cardiovasculaires, Bordeaux, France
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13
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Spychalska-Zwolińska M, Anaszewicz M, Wiśniewska J, Mieczkowski A, Kowalczyk G, Banaś W, Czerniak B, Suppan K, Lis K, Żbikowska-Gotz M, Bartuzi Z, Budzyński J. Blood adipocytokine concentration in patients with peripheral artery disease. INT ANGIOL 2020; 39:500-508. [PMID: 33086778 DOI: 10.23736/s0392-9590.20.04479-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inflammatory responses mediated by adipocytokines may affect both atherosclerosis development and progression, as well as the risk of in-stent restenosis. The aim of this study was to determine the relationships between blood leptin, adiponectin and tumor necrosis factor-α (TNF-α) concentrations and the 1-year outcome of superficial femoral artery (SFA) stenting. METHODS Blood concentrations of leptin, adiponectin and TNF-α were determined in 70 patients undergoing SFA stenting due to intermittent claudication and in 40 patients undergoing carotid artery stenting (CAS). All subjects were followed up for at least 1 year in relation to the occurrence of clinically driven target lesion revascularization (TLR) or a major adverse cardiovascular event (MACE). RESULTS Patients undergoing SFA stenting and CAS had similar blood adipocytokine concentrations. Patients with diabetes mellitus presented a higher leptin concentration, lower adiponectin-to-leptin ratio, and lower blood adiponectin concentration indexed to fat mass (FM) and to visceral adiposity score (VAS). In Kaplan-Meier analysis, blood concentration of TNF-α indexed to FM and to VAS was higher in patients who underwent TLR and MACE. However, in multifactorial analysis, the severity of atherosclerosis lesions in the femoropopliteal vascular region, estimated in relation to TASC-II classification, was the only predictor of TLR. CONCLUSIONS Circulating adipocytokines did not distinguish patients with different clinical manifestations of atherosclerosis. Higher ratios of TNF-α -to-FM and to VAS before SFA stenting were related to TLR and MACE occurrence. Dysregulation in adipocytokine secretion may be a potential mediator of a proatherogenic action of diabetes mellitus in patients with peripheral artery disease.
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Affiliation(s)
- Marta Spychalska-Zwolińska
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marzena Anaszewicz
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Joanna Wiśniewska
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Artur Mieczkowski
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Gabriel Kowalczyk
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Wioletta Banaś
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Beata Czerniak
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Karol Suppan
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Kinga Lis
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Magdalena Żbikowska-Gotz
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jacek Budzyński
- Department of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland -
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14
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Cheng D, Fei Y, Saulnier PJ, Wang N. Circulating TNF receptors and risk of renal disease progression, cardiovascular disease events and mortality in patients with diabetes: a systematic review and meta-analysis. Endocrine 2020; 68:32-43. [PMID: 31813103 DOI: 10.1007/s12020-019-02153-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Inflammation plays an important role in the pathogenesis of diabetes complications. This study aims to assess the association between circulating inflammatory biomarkers TNF receptors (TNFRs) and the risk of renal disease progression, cardiovascular disease (CVD) events, and mortality in patients with diabetes. METHODS PubMed and Embase databases were comprehensively searched up to March 2019. Data were extracted independently by two reviewers. A random effects model was performed for the pooled analyses. RESULTS Five studies in 3316 subjects assessed TNFRs with renal disease in patients with type 1 diabetes and showed both TNFR-1 and TNFR-2 were consistently associated with the renal outcomes. Fourteen studies in 7696 subjects evaluated TNFRs in patients with type 2 diabetes. The pooled risk ratio per doubling increase in TNFR-1 and TNFR-2 for renal disease progression was more than two (2.64 [1.98, 3.52] and 2.23 [1.69, 2.94]). The subgroup analyses and sensitivity analyses further illustrated these results of renal outcome and its robustness. Moreover, higher TNFR-1 and TNFR-2 was also significantly associated with CVD events and mortality in patients with type 2 diabetes. CONCLUSIONS Circulating TNFR-1 and TNFR-2 are independently associated with higher risk of renal disease progression, CVD events, and mortality in patients with diabetes and might contribute to the clinical risk assessment in the future.
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Affiliation(s)
- Dongsheng Cheng
- Department of Nephrology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Yang Fei
- Department of Nephrology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Pierre-Jean Saulnier
- Clinical Investigation Center CHU Poitiers, Poitiers, France
- Clinical Investigation Center CIC1402, INSERM, Poitiers, France
- Medical School, University of Poitiers, Poitiers, France
| | - Niansong Wang
- Department of Nephrology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
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15
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Sanchez M, Hoang S, Kannengiesser C, Potier L, Hadjadj S, Marre M, Roussel R, Velho G, Mohammedi K. Leukocyte Telomere Length, DNA Oxidation, and Risk of Lower-Extremity Amputation in Patients With Long-standing Type 1 Diabetes. Diabetes Care 2020; 43:828-834. [PMID: 31988064 DOI: 10.2337/dc19-0973] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/01/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Telomere shortening and DNA oxidation are associated with premature vascular aging, which may be involved in lower-extremity amputation (LEA). We sought to investigate whether leukocyte telomere length (LTL) and plasma 8-hydroxy-2'-deoxyguanosine (8-OHdG), a biomarker of DNA oxidation, were associated with LEA in subjects with type 1 diabetes at high vascular risk. RESEARCH DESIGN AND METHODS LTL (quantitative PCR) and plasma 8-OHdG concentrations (immunoassay method) were assessed at baseline in the GENEDIAB (Génétique de la Néphropathie Diabétique) type 1 diabetes cohort. Logistic and Cox proportional hazards regression models were fitted to estimate odds ratio (OR) (at baseline) and hazard ratio (HR) (during follow-up), with related 95% CI, by increasing biomarker tertiles (T1, T2, T3). RESULTS Among 478 participants (56% male, mean ± SD age 45 ± 12 years and diabetes duration 29 ± 10 years), 84 patients had LEA at baseline. Baseline history of LEA was associated with shorter LTL (OR for T2 vs. T1 0.62 [95% CI 0.32-1.22] and for T3 vs. T1 0.41 [0.20-0.84]) but not with plasma 8-OHdG (1.16 [0.56-2.39] and 1.24 [0.61-2.55], respectively). New cases of LEA occurred in 34 (12.3%) participants during the 10-year follow-up. LTL were shorter (HR T2 vs. T1 0.25 [95% CI 0.08-0.67] and T3 vs. T1 0.29 [0.10-0.77]) and plasma 8-OHdG higher (2.20 [0.76-7.35] and 3.11 [1.07-10.32]) in participants who developed LEA during follow-up compared with others. No significant interaction was observed between biomarkers on their association with LEA. CONCLUSIONS We report the first independent association between LTL shortening and excess risk of LEA in type 1 diabetes. High plasma 8-OHdG was also associated with incident LEA but partly dependent on cofounding variables.
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Affiliation(s)
- Manuel Sanchez
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France .,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Geriatric Medicine, Assistance Publique - Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Sophie Hoang
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Caroline Kannengiesser
- UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Genetics, Assistance Publique - Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France
| | - Louis Potier
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique - Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France
| | - Samy Hadjadj
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Michel Marre
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique - Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France
| | - Ronan Roussel
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Assistance Publique - Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France
| | - Gilberto Velho
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Kamel Mohammedi
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.,Department of Endocrinology, Diabetes and Nutrition, Hôpital Haut-Lévêque, Pessac, France.,UFR de médecine, Université de Bordeaux, Bordeaux, France
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Circulating Oxidative Stress Biomarkers in Clinical Studies on Type 2 Diabetes and Its Complications. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:5953685. [PMID: 31214280 PMCID: PMC6535859 DOI: 10.1155/2019/5953685] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/01/2019] [Accepted: 04/23/2019] [Indexed: 12/26/2022]
Abstract
Type 2 diabetes (T2DM) and its complications constitute a major worldwide public health problem, with high rates of morbidity and mortality. Biomarkers for predicting the occurrence and development of the disease may therefore offer benefits in terms of early diagnosis and intervention. This review provides an overview of human studies on circulating biomarkers of oxidative stress and antioxidant defence systems and discusses their usefulness from a clinical perspective. Most case-control studies documented an increase in biomarkers of oxidative lipid, protein, and nucleic acid damage in patients with prediabetes and in those with a diagnosis of T2DM compared to controls, and similar findings were reported in T2DM with micro- and macrovascular complications compared to those without. The inconsistence of the results regarding antioxidant defence systems renders difficulty to draw a general conclusion. The clinical relevance of biomarkers of oxidative lipid and protein damage for T2DM progression is uncertain, but prospective studies suggest that markers of oxidative nucleic acid damage such as 8-hydroxy-2'-deoxyguanosine and 8-hydroxyguanosine are promising for predicting macrovascular complications of T2DM. Emerging evidence also points out the relationship between serum PON1 and serum HO1 in T2DM and its complications. Overall, enhanced oxidative damage represents an underlying mechanism of glucose toxicity in T2DM and its related micro- and macrovascular complications suggesting that it may be considered as a potential additional target for pharmacotherapy. Therefore, further studies are needed to understand whether targeting oxidative stress may yield clinical benefits. In this view, the measurement of oxidative stress biomarkers in clinical trials deserves to be considered as an additional tool to currently used parameters to facilitate a more individualized treatment of T2DM in terms of drug choice and patient selection.
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Nativel M, Potier L, Alexandre L, Baillet-Blanco L, Ducasse E, Velho G, Marre M, Roussel R, Rigalleau V, Mohammedi K. Lower extremity arterial disease in patients with diabetes: a contemporary narrative review. Cardiovasc Diabetol 2018; 17:138. [PMID: 30352589 PMCID: PMC6198374 DOI: 10.1186/s12933-018-0781-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/17/2018] [Indexed: 12/24/2022] Open
Abstract
Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthfull to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patients and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes.
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Affiliation(s)
- Mathilde Nativel
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Louis Potier
- Département d'Endocrinologie, Diabétologie, Nutrition, Assistance Publique - Hôpitaux de Paris, Hospital Bichat, DHU FIRE, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Laure Alexandre
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France.,Faculté de Médecine, Université de Bordeaux, Bordeaux, France
| | - Laurence Baillet-Blanco
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Eric Ducasse
- Faculté de Médecine, Université de Bordeaux, Bordeaux, France.,Département de Chirurgie Vasculaire, CHU de Bordeaux, Bordeaux, France
| | - Gilberto Velho
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Michel Marre
- Département d'Endocrinologie, Diabétologie, Nutrition, Assistance Publique - Hôpitaux de Paris, Hospital Bichat, DHU FIRE, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.,Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Ronan Roussel
- Département d'Endocrinologie, Diabétologie, Nutrition, Assistance Publique - Hôpitaux de Paris, Hospital Bichat, DHU FIRE, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Vincent Rigalleau
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France.,Faculté de Médecine, Université de Bordeaux, Bordeaux, France
| | - Kamel Mohammedi
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France. .,Faculté de Médecine, Université de Bordeaux, Bordeaux, France.
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