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Peña AS, Harrington J, Peters Black SK, Gent R, Hirte C, Couper JJ, Wiltshire E. Vascular Function and Distribution of Adiponectin Isomers during Puberty in Children and Adolescents with Obesity. Horm Res Paediatr 2022; 94:186-193. [PMID: 34348299 DOI: 10.1159/000518649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/21/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Youth with obesity have abnormal vascular function that relates to the anti-atherogenic adipose-derived hormone, adiponectin. The distribution of adiponectin isomers changes during normal puberty, but there are no data in relation to vascular function. We aimed to evaluate vascular function, adiponectin, and its isomers longitudinally in peri-pubertal youth with obesity and controls. METHODS The study is a cohort longitudinal study involving 30 children and adolescents with obesity (body mass index [BMI] z-score 2.31 ± 0.24; age 12.8 ± 3 years, 17 male participants) and 28 age-/sex-matched healthy controls (12.8 ± 3 years, 14 male participants). Vascular function (flow-mediated dilatation [FMD], glyceryl trinitrate-mediated dilatation [GTN]), total adiponectin and isomers, and laboratory and clinical variables were assessed at 0, 18, and 36 months. RESULTS FMD and GTN were stable during puberty in both groups, remaining consistently lower in obese children (p = 0.02, p < 0.001). The change in total (p = 0.02) and high-molecular weight (HMW) (p = 0.02) adiponectin differed between the groups: falling in controls by the end of puberty but not falling further during puberty in obesity. In obesity, impaired GTN was associated longitudinally with lower total (B = 7.85, p = 0.006) and HMW (B = 3.72, p = 0.03) adiponectin. In controls, more favourable GTN was longitudinally associated with a lower BMI z-score (B = -3.04, p = 0.027) and lower waist circumference (B = -0.35, p = 0.009). CONCLUSIONS Vascular dysfunction and lower levels of adiponectin are associated in children and adolescents with obesity during puberty and do not deteriorate further. Healthy children's better vascular function, within the normal range, is associated with a lower BMI z-score and waist circumference.
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Affiliation(s)
- Alexia Sophie Peña
- Robinson Research Institute and Discipline of Paediatrics, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jennifer Harrington
- Robinson Research Institute and Discipline of Paediatrics, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Sarah Kate Peters Black
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Roger Gent
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Craig Hirte
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jennifer J Couper
- Robinson Research Institute and Discipline of Paediatrics, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Esko Wiltshire
- Paediatrics and Child Health, University of Otago Wellington, Wellington South, New Zealand
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Cao L, Hou M, Zhou W, Sun L, Shen J, Chen Y, Tang Y, Wang B, Li X, Lv H. Decreased Flow-Mediated Dilatation in Children With Type 1 Diabetes: A Systematic Review and Meta-Analysis. Angiology 2021; 72:908-915. [PMID: 33896228 DOI: 10.1177/00033197211010096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Type 1 diabetes (T1DM) is a strong risk factor for the development of cardiovascular disease. Flow-mediated dilatation (FMD) is an early noninvasive marker of endothelial function and it predicts future cardiovascular disease. However, the changes in FMD among T1DM children are still controversial. The present meta-analysis aimed to investigate whether FMD is impaired in children with T1DM. PubMed, EMBASE, Cochrane library, and Web of Science were searched for studies comparing FMD in children with T1DM and healthy controls. The Newcastle-Ottawa quality assessment scale for case-control studies was used to assess study quality. Data were pooled using a random effects models to obtain the weighted mean differences (WMD) in FMD and 95% CIs. Overall, 19 studies with 1245 patients and 872 healthy controls were included in this meta-analysis. Children with T1DM had significantly lower FMDs compared with healthy controls (WMD: -2.58; 95% CI: -3.36 to -1.81; P < .001). Meta-regression analysis revealed that low-density lipoprotein cholesterol levels impacted the observed difference in FMD between T1DM and healthy children. This meta-analysis showed that T1DM children have impaired endothelial function, which indicates they are at higher risk of developing cardiovascular disease in later life.
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Affiliation(s)
- Lei Cao
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Miao Hou
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wanping Zhou
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ling Sun
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jie Shen
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ye Chen
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yunjia Tang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bo Wang
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xuan Li
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
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Pastore I, Bolla AM, Montefusco L, Lunati ME, Rossi A, Assi E, Zuccotti GV, Fiorina P. The Impact of Diabetes Mellitus on Cardiovascular Risk Onset in Children and Adolescents. Int J Mol Sci 2020; 21:ijms21144928. [PMID: 32664699 PMCID: PMC7403998 DOI: 10.3390/ijms21144928] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022] Open
Abstract
The prevalence of diabetes mellitus is rising among children and adolescents worldwide. Cardiovascular diseases are the main cause of morbidity and mortality in diabetic patients. We review the impact of diabetes on establishing, during childhood and adolescence, the premises for cardiovascular diseases later in life. Interestingly, it seems that hyperglycemia is not the only factor that establishes an increased cardiovascular risk in adolescence. Other factors have been recognized to play a role in triggering the onset of latent cardiovascular diseases in the pediatric population. Among these cardiovascular risk factors, some are modifiable: glucose variability, hypoglycemia, obesity, insulin resistance, waist circumference, hypertension, dyslipidemia, smoking alcohol, microalbuminuria and smoking. Others are unmodifiable, such as diabetes duration and family history. Among the etiological factors, subclinical endothelial dysfunction represents one of the earliest key players of atherosclerosis and it can be detected during early ages in patients with diabetes. A better assessment of cardiovascular risk in pediatric population still represents a challenge for clinicians, and thus further efforts are required to properly identify and treat pediatric patients who may suffer from cardiovascular disease later in early adulthood.
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Affiliation(s)
- Ida Pastore
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Andrea Mario Bolla
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Maria Elena Lunati
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Emma Assi
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, 20157 Milan, Italy;
| | - Gian Vincenzo Zuccotti
- Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano and Department of Pediatrics, Buzzi Children’s Hospital, 20157 Milan, Italy;
| | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, 20157 Milan, Italy;
- Nephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-617-919-2624
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Lespagnol E, Dauchet L, Pawlak-Chaouch M, Balestra C, Berthoin S, Feelisch M, Roustit M, Boissière J, Fontaine P, Heyman E. Early Endothelial Dysfunction in Type 1 Diabetes Is Accompanied by an Impairment of Vascular Smooth Muscle Function: A Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:203. [PMID: 32362871 PMCID: PMC7180178 DOI: 10.3389/fendo.2020.00203] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background: A large yet heterogeneous body of literature exists suggesting that endothelial dysfunction appears early in type 1 diabetes, due to hyperglycemia-induced oxidative stress. The latter may also affect vascular smooth muscles (VSM) function, a layer albeit less frequently considered in that pathology. This meta-analysis aims at evaluating the extent, and the contributing risk factors, of early endothelial dysfunction, and of the possible concomitant VSM dysfunction, in type 1 diabetes. Methods: PubMed, Web of Sciences, Cochrane Library databases were screened from their respective inceptions until October 2019. We included studies comparing vasodilatory capacity depending or not on endothelium (i.e., endothelial function or VSM function, respectively) in patients with uncomplicated type 1 diabetes and healthy controls. Results: Fifty-eight articles studying endothelium-dependent function, among which 21 studies also assessed VSM, were included. Global analyses revealed an impairment of standardized mean difference (SMD) (Cohen's d) of endothelial function: -0.61 (95% CI: -0.79, -0.44) but also of VSM SMD: -0.32 (95% CI: -0.57, -0.07). The type of stimuli used (i.e., exercise, occlusion-reperfusion, pharmacological substances, heat) did not influence the impairment of the vasodilatory capacity. Endothelial dysfunction appeared more pronounced within macrovascular than microvascular beds. The latter was particularly altered in cases of poor glycemic control [HbA1c > 67 mmol/mol (8.3%)]. Conclusions: This meta-analysis not only corroborates the presence of an early impairment of endothelial function, even in response to physiological stimuli like exercise, but also highlights a VSM dysfunction in children and adults with type 1 diabetes. Endothelial dysfunction seems to be more pronounced in large than small vessels, fostering the debate on their relative temporal appearance.
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Affiliation(s)
- Elodie Lespagnol
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Luc Dauchet
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Mehdi Pawlak-Chaouch
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Costantino Balestra
- Environmental and Occupational (Integrative) Physiology Laboratory, Haute École Bruxelles-Brabant HE2B, Brussels, Belgium
| | - Serge Berthoin
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Matthieu Roustit
- Univ. Grenoble Alpes, HP2, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Julien Boissière
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Pierre Fontaine
- Département d'endocrinologie, Diabète et maladies métaboliques, Hôpital Huriez, Université de Lille, Lille, France
| | - Elsa Heyman
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
- *Correspondence: Elsa Heyman
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Guo X, Dai X, Ni J, Cao N, Yang G, Xue J, Wang X. High concentration of sugars is genotoxic to folate-deficient cells. Mutat Res 2019; 814:15-22. [DOI: 10.1016/j.mrfmmm.2019.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/29/2018] [Accepted: 01/08/2019] [Indexed: 04/08/2023]
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An Update on Hypertension in Children With Type 1 Diabetes. Can J Diabetes 2018; 42:199-204. [DOI: 10.1016/j.jcjd.2018.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/21/2018] [Indexed: 12/21/2022]
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Anderson J, Couper JJ, Toome S, Mpundu-Kaambwa C, Giles LC, Gent R, Coppin B, Peña AS. Dietary sodium intake relates to vascular health in children with type 1 diabetes. Pediatr Diabetes 2018; 19:138-142. [PMID: 28488397 DOI: 10.1111/pedi.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/14/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children with type 1 diabetes (T1D) have vascular dysfunction and frequently struggle to adhere to dietary recommendations. Limited data exist for the vascular consequences of poor diet quality in children. We aimed to evaluate the association between dietary components and vascular function in children with T1D. METHODS Cross-sectional study including 90 children (13.6 [3.5] years, 41 boys) with T1D. They had evaluation of dietary micro and macronutrients (Australian Child and Adolescent Eating Survey), vascular endothelial and smooth muscle function (flow-mediated dilatation and glyceryl trinitrate mediated dilatation [GTN], respectively), clinical and biochemical variables. RESULTS Children had a sodium intake of 3.013 (0.76) (mean [SD]) g/day. Vascular smooth muscle dysfunction, as measured by GTN, related to higher daily sodium intake (r = -0.31, P = .003), independent of the inverse relationships between GTN and total energy (r = -0.30, P = .005) and fat intake (r = -0.28, P = .007). Multiregression model showed that an increase in 1 g of daily sodium intake was independently associated with a deterioration of 3 percentage units in GTN (95% CI -4.3, -0.9; P = .003). There was an association between sodium intake and systolic blood pressure after adjustment for age and gender (regression coefficient 2.4; 95% CI 0.5, 4.3; P = .01). CONCLUSIONS High dietary sodium intake in children with T1D is common and relates to vascular dysfunction, independently of other dietary intake, blood pressure, and glycemic control.
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Affiliation(s)
- Jemma Anderson
- Discipline of Paediatrics, The University of Adelaide and Robinson Research Institute, North Adelaide, SA, Australia.,Endocrinology and Diabetes Department, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Jennifer J Couper
- Discipline of Paediatrics, The University of Adelaide and Robinson Research Institute, North Adelaide, SA, Australia.,Endocrinology and Diabetes Department, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Sarah Toome
- Dietetics Department, Women's and Children's Hospital, North Adelaide, SA, Australia
| | | | - Lynne C Giles
- Epidemiology and Biostatistics Unit, The University of Adelaide, Adelaide, SA, Australia
| | - Roger Gent
- Medical Imaging, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Brian Coppin
- Department of Paediatrics, Flinders Medical Centre and Flinders University, North Adelaide, SA, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, The University of Adelaide and Robinson Research Institute, North Adelaide, SA, Australia.,Endocrinology and Diabetes Department, Women's and Children's Hospital, North Adelaide, SA, Australia
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8
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Dayem SMAE, Battah AA, Bohy AEME, Yousef RN, Ahmed AM, Talaat AA. Apelin, Nitric Oxide and Vascular Affection in Adolescent Type 1 Diabetic Patients. Open Access Maced J Med Sci 2017; 5:934-939. [PMID: 29362622 PMCID: PMC5771298 DOI: 10.3889/oamjms.2017.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 01/22/2023] Open
Abstract
AIM To evaluate the relationship of apelin and nitric oxide (NO) to endothelial dysfunction in type 1 diabetics. PATIENTS AND METHODS Sixty two type 1 diabetics and 30 healthy age and sex matched controls were included. Blood samples for apelin, NO, glycosylated hemoglobin (HbA1c), and lipid profile were collected. Albumin/creatinine ratio was assessed in urine. Flow mediated dilatation (FMD) via ultrasound was done. RESULTS The mean age of diabetics were 16.3 ± 1.5 yrs (14.0 - 19.0 yrs), and duration of disease, were 9.4 ± 2.9 yrs (5.0 - 16.5 yrs). FMD and FMD/nitrate mediated dilatation (NMD) ratio were lower in diabetics. NO was decreased, while apelin and albumin/creatinine ratio were increased significantly in diabetics. There was a positive correlation between apelin and HbA1c. On the contrary, NO had a negative correlation with HbA1c, albumin/creatinine ratio, LDL-c and OxLDL. CONCLUSION Diabetic patients had endothelial dysfunction and high apelin level, with no related to each other. High level of apelin is associated with bad glycemic control. Obesity had no role to increase in apelin level. NO is related to diabetic nephropathy and atherosclerosis. We recommend a further large study to evaluate the relationship of apelin with endothelial dysfunction.
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Affiliation(s)
| | - Ahmed A Battah
- Critical Care Department, Cairo University, Cairo, Egypt
| | | | - Rash Nazih Yousef
- Clinical Pathology Department, National Research Centre, Cairo, Egypt
| | - Azza M Ahmed
- Pediatrics Department, National Research Centre, Cairo, Egypt
| | - Ahmed A Talaat
- Pediatrics Department, National Research Centre, Cairo, Egypt
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9
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Anderson JJA, Couper JJ, Giles LC, Leggett CE, Gent R, Coppin B, Peña AS. Effect of Metformin on Vascular Function in Children With Type 1 Diabetes: A 12-Month Randomized Controlled Trial. J Clin Endocrinol Metab 2017; 102:4448-4456. [PMID: 29040598 DOI: 10.1210/jc.2017-00781] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 10/03/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Children with type 1 diabetes have vascular dysfunction preceding atherosclerosis. Early interventions are needed to reduce cardiovascular disease. OBJECTIVE To evaluate the effect of metformin on vascular function in children with type 1 diabetes. DESIGN Twelve-month double-blind, randomized, placebo-controlled trial. SETTING Tertiary pediatric diabetes clinic. PARTICIPANTS Ninety children (8 to 18 years of age), >50th percentile body mass index (BMI), with type 1 diabetes. INTERVENTION Metformin (up to 1 g twice a day) or placebo. MAIN OUTCOME MEASURE Vascular function measured by brachial artery ultrasound [flow-mediated dilatation/glyceryl trinitrate-mediated dilatation (GTN)]. RESULTS Ninety participants were enrolled [41 boys, 13.6 (2.5) years of age, 45 per group], 10 discontinued intervention, and 1 was lost to follow-up. On metformin, GTN improved, independent of glycosylated hemoglobin (HbA1c), by 3.3 percentage units [95% confidence interval (CI) 0.3, 6.3, P = 0.03] and insulin dose reduced by 0.2 U/kg/d (95% CI 0.1, 0.3, P = 0.001) during 12 months, with effects from 3 months. Metformin had a beneficial effect on HbA1c at 3 months (P = 0.001) and difference in adjusted HbA1c between groups during 12 months was 1.0%; 95% CI 0.4, 1.5 (10.9 mmol/mol; 95% CI 4.4, 16.4), P = 0.001. There were no effects on carotid/aortic intima media thickness, BMI, lipids, blood pressure, or other cardiovascular risk factors. Median (95% CI) adherence, evaluated by electronic monitoring, was 75.5% (65.7, 81.5), without group differences. More gastrointestinal side effects were reported on metformin (incidence rate ratio 1.65, 95% CI 1.08, 2.52, P = 0.02), with no difference in hypoglycemia or diabetic ketoacidosis. CONCLUSIONS Metformin improved vascular smooth muscle function and HbA1c, and lowered insulin dose in type 1 diabetes children. These benefits and good safety profile warrant further consideration of its use.
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Affiliation(s)
- Jemma J A Anderson
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Australia
- Endocrinology and Diabetes Department, Women's and Children's Hospital, Australia
| | - Jennifer J Couper
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Australia
- Endocrinology and Diabetes Department, Women's and Children's Hospital, Australia
| | - Lynne C Giles
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Catherine E Leggett
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Australia
- Pharmacy, Women's and Children's Hospital, Australia
| | - Roger Gent
- Medical Imaging, Women's and Children's Hospital, Australia
| | - Brian Coppin
- Flinders Medical Centre, Bedford Park, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Australia
- Endocrinology and Diabetes Department, Women's and Children's Hospital, Australia
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Tacito LHB, Pires AC, Yugar-Toledo JC. Impaired flow-mediated dilation response and carotid intima-media thickness in patients with type 1 diabetes mellitus with a mean disease duration of 4.1 years. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:542-549. [PMID: 28724057 PMCID: PMC10522057 DOI: 10.1590/2359-3997000000281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 03/26/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed at assessing the endothelial function in patients with Type 1 diabetes (T1DM) using flow-mediated dilation (FMD) response and carotid artery intima-media thickness (CIMT). MATERIALS AND METHODS This study enrolled 32 T1DM patients (mean disease duration 4.1 years) and 28 age-matched controls (CTL Group). Endothelial function and CIMT were assessed with high-resolution ultrasound using standardized offline measurements. RESULTS FMD was significantly lower in patients in the T1DM Group (8.9 ± 3.2%) compared with those in the CTL Group (13.3 ± 4.3%; P-value < 0.0001). Similarly, CIMT differed significantly between T1DM patients (0.525 ± 0.03 mm) and controls (0.508 ± 0.03 mm; P-value = 0.041). Even though, the values are within the normal range for age. CONCLUSIONS Patients with T1DM have impaired endothelial function characterized by reduced FMD when compared to controls. However, vascular remodeling as seen by increases in CIMT was not found in this study.
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Affiliation(s)
- Lúcia Helena Bonalume Tacito
- Departamento de MedicinaFaculdade de Medicina de São José do Rio PretoSão PauloSPBrasil Disciplina de Endocrinologia, Departamento de Medicina, Faculdade de Medicina de São José do Rio Preto (Famerp), São Paulo, SP, Brasil
| | - Antonio Carlos Pires
- Departamento de MedicinaFaculdade de Medicina de São José do Rio PretoSão PauloSPBrasil Disciplina de Endocrinologia, Departamento de Medicina, Faculdade de Medicina de São José do Rio Preto (Famerp), São Paulo, SP, Brasil
| | - Juan Carlos Yugar-Toledo
- Instituto de Cardiologia e Endocrinologia de São José do Rio PretoSão PauloSPBrasil Endocor – Instituto de Cardiologia e Endocrinologia de São José do Rio Preto, São Paulo, SP, Brasil
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Children With Type 1 Diabetes Have Delayed Flow-Mediated Dilation. Can J Diabetes 2017; 42:276-280. [PMID: 28754435 DOI: 10.1016/j.jcjd.2017.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Children with type 1 diabetes have accelerated atherosclerosis with early endothelial dysfunction as measured by reduced flow-mediated dilation (FMD) at 60 seconds postischemic stress (early FMD). Delayed dilation may also occur in the presence of cardiovascular risk factors and may be a more sensitive marker. No data exist that evaluate FMD beyond 60 seconds (delayed FMD) in children with type 1 diabetes. We aimed to compare early and delayed FMD in children with type 1 diabetes and in healthy children. METHODS We studied 66 children 13.5±2.8 years of age; 29 were males. Of the 66 children, 38 had type 1 diabetes, and 28 were healthy age- and gender-matched controls. Evaluation of brachial artery FMD was performed at 60 seconds (FMD60s) and 120 seconds (FMD120s) postischemic stress. Early FMD was defined as peak FMD60s and delayed FMD as peak FMD120s. RESULTS: Children with type 1 diabetes had diabetes durations of 5.4±4.6 years and median glycated hemoglobin levels of 8.8 (6.6 to 14)% (73 [49 to 130] mmol/mol). Of the children, 8 with type 1 diabetes and 1 healthy child had delayed FMD; a relationship was seen between the prevalence of early FMD and delayed FMD in children with type 1 diabetes and healthy children, respectively (p=0.019). Children with type 1 diabetes and delayed FMD had lower FMD60s than children without delayed FMD (2.50±3.61 vs. 6.14±3.83 percentage units; p=0.02). Children with type 1 diabetes had lower FMD60s than healthy children (5.38±4.0 percentage units; p=0.03) but not FMD120s (7.56±3.5 percentage units; p=0.47). CONCLUSIONS Delayed FMD patterns occur in children with type 1 diabetes and detect children who have more severe vascular abnormalities. The standard FMD60s remains the better marker to identify children at increased risk for cardiovascular disease.
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do Nascimento AMMDA, Sequeira IJ, Vasconcelos DF, Gandolfi L, Pratesi I, Nóbrega YKDM. Endothelial dysfunction in children with type 1 diabetes mellitus. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:476-483. [PMID: 28658349 PMCID: PMC10522258 DOI: 10.1590/2359-3997000000271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/01/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to verify the presence of endothelial dysfunction and initial structural atherosclerotic changes in children with Type 1 diabetes mellitus (T1DM). SUBJECTS AND METHODS The study population comprised 31 diabetic children aged 6 to 12 years, divided into two subgroups according to the duration of the T1DM diagnosis: subgroup 1, with less than 5 years elapsed since diagnosis, and subgroup 2, with more than 5 years elapsed since diagnosis. The control group comprised 58 age-matched healthy children. Ultrasonographic techniques were used to measure the flow-mediated dilatation (FMD) of the brachial artery and the intima-media thickness (IMT) of the carotid arteries. RESULTS Children with T1DM with longer disease duration showed significantly decreased mean values of FMD compared with those in the control group. No significant differences between the groups were found in relation to IMT. The FMD percentage presented a moderate negative correlation with glycated hemoglobin (HbA1c) and fasting glucose levels. CONCLUSION Our findings suggest that endothelial dysfunction may be already present in children with 5 years or more elapsed since diagnosis, even in the absence of atherosclerotic structural changes. The decreased vasodilation response correlated with hyperglycemia.
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Affiliation(s)
- Antonella Márcia Mercadante de Albuquerque do Nascimento
- Universidade de BrasíliaCampus Universitário Darcy RibeiroBrasíliaDFBrasilPrograma de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
- Hospital Universitário de BrasíliaCampus Universitário Darcy RibeiroBrasíliaDFBrasilHospital Universitário de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
- Faculdade de Ciências da SaúdeUnBCampus Universitário Darcy RibeiroBrasíliaDFBrasilDepartamento de Ciências Farmacêuticas, Faculdade de Ciências da Saúde, UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
| | - Inês Jorge Sequeira
- Escola de Ciências e TecnologiaDepartamento de Matemática, Matemática e AplicaçõesUniversidade Nova de LisboaCaparicaLisboaPortugalEscola de Ciências e Tecnologia, Departamento de Matemática, Matemática e Aplicações, Universidade Nova de Lisboa, Quinta da Torre, Caparica, Lisboa, Portugal
| | - Daniel França Vasconcelos
- Hospital Universitário de BrasíliaCampus Universitário Darcy RibeiroBrasíliaDFBrasilHospital Universitário de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
| | - Lenora Gandolfi
- Universidade de BrasíliaCampus Universitário Darcy RibeiroBrasíliaDFBrasilPrograma de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
- Laboratório de Metodologias Aplicadas às Doenças InfecciosasUnBCampus Universitário Darcy RibeiroBrasíliaDFBrasilMetodologias Aplicadas, Laboratório de Metodologias Aplicadas às Doenças Infecciosas, UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
| | - iccardo Pratesi
- Universidade de BrasíliaCampus Universitário Darcy RibeiroBrasíliaDFBrasilPrograma de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
- Laboratório de Metodologias Aplicadas às Doenças InfecciosasUnBCampus Universitário Darcy RibeiroBrasíliaDFBrasilMetodologias Aplicadas, Laboratório de Metodologias Aplicadas às Doenças Infecciosas, UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
| | - Yanna Karla de Medeiros Nóbrega
- Universidade de BrasíliaCampus Universitário Darcy RibeiroBrasíliaDFBrasilPrograma de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
- Faculdade de Ciências da SaúdeUnBCampus Universitário Darcy RibeiroBrasíliaDFBrasilDepartamento de Ciências Farmacêuticas, Faculdade de Ciências da Saúde, UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
- Laboratório de Metodologias Aplicadas às Doenças InfecciosasUnBCampus Universitário Darcy RibeiroBrasíliaDFBrasilMetodologias Aplicadas, Laboratório de Metodologias Aplicadas às Doenças Infecciosas, UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, Brasil
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Abstract
AbstractThe endothelium, a thin single sheet of endothelial cells, is a metabolically active layer that coats the inner surface of blood vessels and acts as an interface between the circulating blood and the vessel wall. The endothelium through the secretion of vasodilators and vasoconstrictors serves as a critical mediator of vascular homeostasis. During the development of the vascular system, it regulates cellular adhesion and vessel wall inflammation in addition to maintaining vasculogenesis and angiogenesis. A shift in the functions of the endothelium towards vasoconstriction, proinflammatory and prothrombic states characterise improper functioning of these cells, leading to endothelial dysfunction (ED), implicated in the pathogenesis of many diseases including diabetes. Major mechanisms of ED include the down-regulation of endothelial nitric oxide synthase levels, differential expression of vascular endothelial growth factor, endoplasmic reticulum stress, inflammatory pathways and oxidative stress. ED tends to be the initial event in macrovascular complications such as coronary artery disease, peripheral arterial disease, stroke and microvascular complications such as nephropathy, neuropathy and retinopathy. Numerous strategies have been developed to protect endothelial cells against various stimuli, of which the role of polyphenolic compounds in modulating the differentially regulated pathways and thus maintaining vascular homeostasis has been proven to be beneficial. This review addresses the factors stimulating ED in diabetes and the molecular mechanisms of natural polyphenol antioxidants in maintaining vascular homeostasis.
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Cazeau RM, Huang H, Bauer JA, Hoffman RP. Effect of Vitamins C and E on Endothelial Function in Type 1 Diabetes Mellitus. J Diabetes Res 2016; 2016:3271293. [PMID: 26783536 PMCID: PMC4689966 DOI: 10.1155/2016/3271293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/14/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/OBJECTIVES Endothelial dysfunction due to hyperglycemia-induced oxidative damage is an important predictor of future cardiovascular risk in patients with type 1 diabetes mellitus (T1DM) and is present in adolescent T1DM. We hypothesized that combined treatment with the antioxidant vitamins C and E might improve endothelial function (EF) and other biochemical risk factors in adolescents with T1DM. SUBJECTS/METHODS Open-label antioxidant supplementation was given for six weeks with endpoint measurements collected at baseline and study completion. Endpoints measured included EF and plasma measurements of biochemical endothelial risk. RESULTS Two males and 7 females were studied. Mean age was 12.9 ± 0.9 yrs; mean T1DM duration was 5.5 ± 2.5 yrs; mean BMI was 22.1 ± 3.8 kg/m(2); and mean hemoglobin A1c was 9.3 ± 1.1%. No differences were found for EF, high sensitivity CRP, total antioxidant capacity, adiponectin, or endothelial progenitor cells (EPCs) between before and after combined vitamin C and E therapy. CONCLUSIONS Our negative study results do not support previous findings of decreased oxidative damage, improved endothelial function, and increased vascular repair capacity with antioxidant therapy. Longer term studies may be needed to determine the effects, if any, of combined antioxidant therapy on EPCs, EF, and markers of micro- and macrovascular complications in T1DM.
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Affiliation(s)
- Rachel-Marie Cazeau
- Section of Endocrinology, Metabolism and Diabetes, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
- Division of Pediatric Endocrinology, Metabolism and Diabetes, Department of Pediatrics, The Clinical Research Center, The Ohio State University College of Medicine and Public Health, Columbus, OH 43205, USA
- *Rachel-Marie Cazeau:
| | - Hong Huang
- Department of Pediatrics, University of Kentucky, Lexington, KY 40506, USA
| | - John A. Bauer
- Department of Pediatrics, University of Kentucky, Lexington, KY 40506, USA
| | - Robert P. Hoffman
- Section of Endocrinology, Metabolism and Diabetes, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
- Division of Pediatric Endocrinology, Metabolism and Diabetes, Department of Pediatrics, The Clinical Research Center, The Ohio State University College of Medicine and Public Health, Columbus, OH 43205, USA
- The Research Institute, Nationwide Children's Hospital, Columbus, OH 43205, USA
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Kontos A, Pamula Y, Martin J, Gent R, Lushington K, Baumert M, Willoughby S, Richardson M, Couper J, Kennedy D. Flow-mediated dilatation, using time course data, shows maturation of the brachial artery from young children to mid-adolescents. Clin Exp Pharmacol Physiol 2015; 42:240-5. [PMID: 25491271 DOI: 10.1111/1440-1681.12349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/29/2014] [Indexed: 11/26/2022]
Abstract
Flow-mediated dilatation (FMD) is a tool widely used to measure arterial responsiveness to sheer stress. However, there is scant literature to show how the peripheral arterial response changes as the vascular system matures. One reason for this is that the feasibility of measuring FMD in younger children has not been established. The aim of the present study was to assess brachial artery function at rest and during the FMD response after 4 min ischaemia of the forearm in children aged 6-15 years. Time to reach maximum FMD (FMDmax ) was found to be correlated with age (r = 0.4, P < 0.05), resting brachial artery diameter (r = 0.4, P < 0.05), height (r = 0.4, P < 0.05), body mass index (BMI; r = 0.45, P < 0.05), body surface area (r = 0.44, P < 0.05) and resting blood flow (r = 0.37, P < 0.05). However, there was no correlation between the traditional FMD response at 60 s or FMD maximal dilation and age, resting brachial artery diameter, height, weight, BMI, body surface area and resting blood flow. In conclusion, the time taken to reach the maximal dilation response is related to age, brachial artery luminal diameter and body habitus, but not the traditional measure of FMD response at 60 s or the maximal dilatation percentage.
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Affiliation(s)
- Anna Kontos
- Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
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A NOS3 polymorphism determines endothelial response to folate in children with type 1 diabetes or obesity. J Pediatr 2015; 166:319-25.e1. [PMID: 25477161 DOI: 10.1016/j.jpeds.2014.10.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/05/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the effect of polymorphisms in NOS3 and folate pathway enzymes on vascular function and folate status and endothelial response to folate in children with diabetes or obesity. STUDY DESIGN A total of 244 subjects (age 13.8 ± 2.8 years, 125 males) were studied for NOS3 and/or folate pathway polymorphisms using polymerase chain reaction/restriction fragment length polymorphism, including at baseline: 139 with type 1 diabetes; 58 with obesity; and 47 controls. The effect of NOS3 genotype on endothelial response to folate (5 mg) was assessed in 85 subjects with diabetes and 28 obese subjects who received active treatment during intervention trials. Vascular function (flow-mediated dilatation [FMD] and glyceryl trinitrate-mediated dilatation), clinical, and biochemical measurements were assessed at baseline and 8 weeks in folate intervention studies. RESULTS Folate pathway enzyme and NOS3 polymorphisms did not significantly affect baseline vascular function. The polymorphism in intron 4 of endothelial nitric oxide synthase altered endothelial response to folate significantly: in subjects with diabetes FMD improved by 6.4 ± 5% (insertion carriers) vs 2.3 ± 6.6% (deletion carriers), P = .01; in obese subjects FMD improved by 1.8 ± 5.4% (insertion carriers) and deteriorated by -3.2 ± 7.2% (deletion carriers), P = .05. More subjects carrying the insertion normalized FMD after folate supplementation (insertion 64% vs deletion 28%, χ(2) = 10.14, P = .001). CONCLUSIONS A NOS3 polymorphism predicts endothelial response to folate in children with diabetes or obesity, with implications for vascular risk and folate intervention studies.
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Fang P, Zhang D, Cheng Z, Yan C, Jiang X, Kruger WD, Meng S, Arning E, Bottiglieri T, Choi ET, Han Y, Yang XF, Wang H. Hyperhomocysteinemia potentiates hyperglycemia-induced inflammatory monocyte differentiation and atherosclerosis. Diabetes 2014; 63:4275-90. [PMID: 25008174 PMCID: PMC4237991 DOI: 10.2337/db14-0809] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hyperhomocysteinemia (HHcy) is associated with increased diabetic cardiovascular diseases. However, the role of HHcy in atherogenesis associated with hyperglycemia (HG) remains unknown. To examine the role and mechanisms by which HHcy accelerates HG-induced atherosclerosis, we established an atherosclerosis-susceptible HHcy and HG mouse model. HHcy was established in mice deficient in cystathionine β-synthase (Cbs) in which the homocysteine (Hcy) level could be lowered by inducing transgenic human CBS (Tg-hCBS) using Zn supplementation. HG was induced by streptozotocin injection. Atherosclerosis was induced by crossing Tg-hCBS Cbs mice with apolipoprotein E-deficient (ApoE(-/-)) mice and feeding them a high-fat diet for 2 weeks. We demonstrated that HHcy and HG accelerated atherosclerosis and increased lesion monocytes (MCs) and macrophages (MØs) and further increased inflammatory MC and MØ levels in peripheral tissues. Furthermore, Hcy-lowering reversed circulating mononuclear cells, MC, and inflammatory MC and MC-derived MØ levels. In addition, inflammatory MC correlated positively with plasma Hcy levels and negatively with plasma s-adenosylmethionine-to-s-adenosylhomocysteine ratios. Finally, l-Hcy and d-glucose promoted inflammatory MC differentiation in primary mouse splenocytes, which was reversed by adenoviral DNA methyltransferase-1. HHcy and HG, individually and synergistically, accelerated atherosclerosis and inflammatory MC and MØ differentiation, at least in part, via DNA hypomethylation.
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Affiliation(s)
- Pu Fang
- Center for Metabolic Disease Research, School of Medicine, Temple University, Philadelphia, PA Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA
| | - Daqing Zhang
- Center for Metabolic Disease Research, School of Medicine, Temple University, Philadelphia, PA Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA
| | - Zhongjian Cheng
- Center for Metabolic Disease Research, School of Medicine, Temple University, Philadelphia, PA Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA
| | - Chenghui Yan
- Cardiovascular Research Institute and Key Laboratory of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning, P.R. China
| | - Xiaohua Jiang
- Center for Metabolic Disease Research, School of Medicine, Temple University, Philadelphia, PA Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA
| | | | - Shu Meng
- Center for Metabolic Disease Research, School of Medicine, Temple University, Philadelphia, PA Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA
| | - Erland Arning
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, TX
| | | | - Eric T Choi
- Center for Metabolic Disease Research, School of Medicine, Temple University, Philadelphia, PA Department of Surgery, School of Medicine, Temple University, Philadelphia, PA
| | - Yaling Han
- Cardiovascular Research Institute and Key Laboratory of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning, P.R. China
| | - Xiao-Feng Yang
- Center for Metabolic Disease Research, School of Medicine, Temple University, Philadelphia, PA Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA Cardiovascular Research Center, School of Medicine, Temple University, Philadelphia, PA Sol Sherry Thrombosis Research Center, School of Medicine, Temple University, Philadelphia, PA
| | - Hong Wang
- Center for Metabolic Disease Research, School of Medicine, Temple University, Philadelphia, PA Department of Pharmacology, School of Medicine, Temple University, Philadelphia, PA Cardiovascular Research Center, School of Medicine, Temple University, Philadelphia, PA Sol Sherry Thrombosis Research Center, School of Medicine, Temple University, Philadelphia, PA
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Maftei O, Pena AS, Sullivan T, Jones TW, Donaghue KC, Cameron FJ, Davis E, Cotterill A, Craig ME, Gent R, Dalton N, Daneman D, Dunger D, Deanfield J, Couper JJ. Early atherosclerosis relates to urinary albumin excretion and cardiovascular risk factors in adolescents with type 1 diabetes: Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT). Diabetes Care 2014; 37:3069-75. [PMID: 25071076 DOI: 10.2337/dc14-0700] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The origins of cardiovascular and renal disease in type 1 diabetes begin during childhood. We aimed to evaluate carotid (cIMT) and aortic intima-media thickness (aIMT) and their relationship with cardiovascular risk factors and urinary albumin excretion in adolescents with type 1 diabetes in the Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT). RESEARCH DESIGN AND METHODS A total of 406 adolescents with type 1 diabetes, who were 14.1 ± 1.9 years old with type 1 diabetes duration of 6.7 ± 3.7 years, and 57 age-matched control subjects provided clinical and biochemical data and ultrasound measurements of vascular structure (cIMT and aIMT). Vascular endothelial and smooth muscle function was also measured in 123 of 406 with type 1 diabetes and all control subjects. RESULTS In type 1 diabetic subjects, mean/maximal aIMT (P < 0.006; <0.008), but not mean/maximal cIMT, was greater than in control subjects. Mean/maximal aIMT related to urinary albumin-to-creatinine ratio (multiple regression coefficient [SE], 0.013 [0.006], P = 0.03; 0.023 [0.007], P = 0.002), LDL cholesterol (0.019 [0.008], P = 0.02; 0.025 [0.011], P = 0.02), and age (0.010 [0.004], P = 0.004; 0.012 [0.005], P = 0.01), independent of other variables. Mean/maximal cIMT was greater in males (0.023 [0.006], P = 0.02; 0.029 [0.007], P < 0.0001), and mean cIMT related independently to systolic blood pressure (0.001 [0.001], P = 0.04). Vascular smooth muscle function related to aIMT and cIMT but not to urinary albumin excretion. CONCLUSIONS aIMT may be a more sensitive marker of atherosclerosis than cIMT in type 1 diabetes during mid-adolescence. Higher urinary albumin excretion, even within the normal range, is associated with early atherosclerosis and should direct clinical attention to modifiable cardiovascular risk factors.
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Affiliation(s)
- Oana Maftei
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia
| | - Alexia S Pena
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia Robinson Institute and Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
| | - Thomas Sullivan
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Australia Telethon Institute for Child Health Research, University of Western Australia, Subiaco, Australia School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Fergus J Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia Murdoch Childrens Research Institute, Melbourne, Melbourne, Australia
| | - Elizabeth Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Australia Telethon Institute for Child Health Research, University of Western Australia, Subiaco, Australia School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia
| | - Andrew Cotterill
- Department of Paediatric Endocrinology, Mater Children's Hospital, Brisbane, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Roger Gent
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia
| | - Neil Dalton
- WellChild Laboratory, St. Thomas' Hospital, London, U.K
| | - Denis Daneman
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - David Dunger
- University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, U.K
| | - John Deanfield
- National Centre for Cardiovascular Disease Prevention and Outcomes, University College London, London, U.K
| | - Jenny J Couper
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia Robinson Institute and Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
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de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ, Magge SN, Marx N, McGuire DK, Orchard TJ, Zinman B, Eckel RH. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care 2014; 37:2843-63. [PMID: 25114297 PMCID: PMC4170130 DOI: 10.2337/dc14-1720] [Citation(s) in RCA: 261] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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20
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de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ, Magge SN, Marx N, McGuire DK, Orchard TJ, Zinman B, Eckel RH. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Circulation 2014; 130:1110-30. [PMID: 25114208 DOI: 10.1161/cir.0000000000000034] [Citation(s) in RCA: 233] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Keenan N, Sadlier LG, Wiltshire E. Vascular function and risk factors in children with epilepsy: Associations with sodium valproate and carbamazepine. Epilepsy Res 2014; 108:1087-94. [DOI: 10.1016/j.eplepsyres.2014.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 04/03/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
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Kyrgios I, Maggana I, Giza S, Stergidou D, Mouzaki K, Kotanidou EP, Papadakis E, Galli-Tsinopoulou A. Suboptimal glycaemic control enhances the risk of impaired prothrombotic state in youths with type 1 diabetes mellitus. Diab Vasc Dis Res 2014; 11:208-16. [PMID: 24668409 DOI: 10.1177/1479164114528821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate markers of prothrombotic state and endothelial dysfunction in youths with type 1 diabetes mellitus (T1DM) and investigate possible associations with anthropometric/demographic data, glycaemic control and lipid profile. METHODS In a cross-sectional design, we recruited 155 youths with T1DM and determined levels of plasminogen activator inhibitor-1-antigen (PAI-1-Ag), von Willebrand factor-antigen (vWF-Ag), fibrinogen (FB), lipids and glycosylated haemoglobin (HbA1c). RESULTS Of all the participants, 76 (49%) had increased levels of at least one of prothrombotic factors. Suboptimal glycaemic control was associated with a worse lipid profile and an eightfold increased risk of elevated vWF-Ag levels. Higher vWF-Ag concentrations were also correlated with impaired lipid profile and increased HbA1c values, whereas PAI-1-Ag was positively correlated only with triglyceride levels. After adjustment for potential confounders, only HbA1c contributed independently to the variation in vWF-Ag levels. CONCLUSION Impaired prothrombotic state and consequently endothelial dysfunction are present in youths with T1DM, representing a cumulative risk factor for future cardiovascular disease (CVD). Achievement and maintenance of euglycaemia and normolipidaemia are crucial to decelerate progress of this process.
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Affiliation(s)
- Ioannis Kyrgios
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Bruzzi P, Predieri B, Patianna VD, Salvini A, Rossi R, Modena MG, Iughetti L. Longitudinal evaluation of endothelial function in children and adolescents with type 1 diabetes mellitus: a long-term follow-up study. Pediatr Int 2014; 56:188-95. [PMID: 24020908 DOI: 10.1111/ped.12220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 07/02/2013] [Accepted: 09/03/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type 1 diabetes (T1DM) predisposes to cardiovascular disease, increasing the risk to develop atherosclerosis. In the pediatric population, the cardiovascular risk may be evaluated examining endothelial function by a non-invasive ultrasound technique, namely flow-mediated dilation (FMD) of the brachial artery. The aims of this study were the longitudinal evaluation of the potential change in the endothelium-dependent vasomotor function in children and adolescents with T1DM and the identification of clinical and laboratory data correlated to modifications. METHODS We studied 39 T1DM patients (20 girls and 19 boys; aged 11.2 ± 3.72 years). FMD and blood samples were obtained from all patients at baseline (time 0) and after a follow up of at least 1 year (time 1). FMD was also evaluated in 45 healthy controls (22 boys, 23 girls) aged 10.2 ± 3.05 years. RESULTS At time 0, 43.6% of T1DM patients presented an impaired FMD. FMD at time 1 revealed a dramatic impairment of endothelial function: altered FMD values were shown in 61.5% of patients and it got worse in 74.3% of them. Longitudinally, boys had a greater impairment of FMD than girls. At baseline, multivariate analysis identified only sex as significant predictor of FMD (β = 0.470, P = 0.029). CONCLUSIONS Because endothelial dysfunction appears earlier in diabetic children, they are at higher risk to develop atherosclerosis. Our results suggest the usefulness of FMD as a tool to stratify pediatric T1DM patients according to their cardiovascular risk and to follow them up longitudinally.
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Affiliation(s)
- Patrizia Bruzzi
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
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Raczyńska D, Zorena K, Urban B, Zalewski D, Skorek A, Malukiewicz G, Sikorski BL. Current trends in the monitoring and treatment of diabetic retinopathy in young adults. Mediators Inflamm 2014; 2014:492926. [PMID: 24688225 PMCID: PMC3944937 DOI: 10.1155/2014/492926] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/13/2013] [Accepted: 12/29/2013] [Indexed: 12/31/2022] Open
Abstract
The diagnosis and treatment of diabetic retinopathy (DR) in young adults have significantly improved in recent years. Research methods have widened significantly, for example, by introducing spectral optical tomography of the eye. Invasive diagnostics, for example, fluorescein angiography, are done less frequently. The early introduction of an insulin pump to improve the administration of insulin is likely to delay the development of diabetic retinopathy, which is particularly important for young patients with type 1 diabetes mellitus (T1DM). The first years of diabetes occurring during childhood and youth are the most appropriate to introduce proper therapeutic intervention before any irreversible changes in the eyes appear. The treatment of DR includes increased metabolic control, laserotherapy, pharmacological treatment (antiangiogenic and anti-inflammatory treatment, enzymatic vitreolysis, and intravitreal injections), and surgery. This paper summarizes the up-to-date developments in the diagnostics and treatment of DR. In the literature search, authors used online databases, PubMed, and clinitrials.gov and browsed through individual ophthalmology journals, books, and leading pharmaceutical company websites.
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Affiliation(s)
- Dorota Raczyńska
- Department of Anesthesiology and Intensive Care Medicine, Department of Ophthalmology, Medical University of Gdańsk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland
| | - Katarzyna Zorena
- Department of Clinical and Experimental Endocrinology, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Powstania Styczniowego 9b, 81-519 Gdynia, Poland
| | - Beata Urban
- Department of Pediatric Ophthalmology and Strabismus, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
| | - Dominik Zalewski
- Diagnostic and Microsurgery Center of the Eye Lens, Budowlana 3A, 10-424 Olsztyn, Poland
| | - Andrzej Skorek
- Department of Otolaryngology, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Grażyna Malukiewicz
- Department of Ophthalmology, Nicolaus Copernicus University, M. Sklodowskiej-Curie 9, 85-090 Bydgoszcz, Poland
| | - Bartosz L. Sikorski
- Department of Ophthalmology, Nicolaus Copernicus University, M. Sklodowskiej-Curie 9, 85-090 Bydgoszcz, Poland
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Effects of glucose control and variability on endothelial function and repair in adolescents with type 1 diabetes. ISRN ENDOCRINOLOGY 2013; 2013:876547. [PMID: 24490081 PMCID: PMC3893838 DOI: 10.1155/2013/876547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/08/2013] [Indexed: 12/27/2022]
Abstract
Background. Endothelial dysfunction and increased inflammation are precursors of cardiovascular disease in type 1 diabetes (T1D) and occur even in adolescents with T1D. The goal of this study was to determine the relationship of endothelial dysfunction to various measures of glycemia. Research Design and Methods. Forearm blood flow (FBF, venous occlusion plethysmography) was measured before and after 5 min of upper arm vascular occlusion in 17 adolescents with uncomplicated type 1 diabetes. Endothelial function was assessed as postocclusion FBF and forearm vascular resistance (FVR, mean arterial pressure/FBF). Fasting glucose, 72 hour mean glucose and standard deviation from continuous glucose monitoring, hemoglobin A1c, and hemoglobin A1c by duration area under the curve were used to assess immediate, short-term, and intermediate- and long-term glycemia. Results. Postocclusion FBF (r = −0.53, P = 0.030) negatively correlated and postocclusion FVR positively correlated (r = 0.52, P = 0.031) with hemoglobin A1c levels. FVR was positively associated with log 3 day mean glucose (r = 0.55, P = 0.027). Postocclusion FBF (2.8 ± 1.1 versus 3.4 ± 0.5 mL/dL/min, mean ± SE, P = 0.084) tended to be lower and FVR (31.4 ± 10.4 versus 23.9 ± 4.4 mmHg dL min/mL, P = 0.015) was significantly higher in subjects with hemoglobin A1c above the median (8.3%) compared to those with lower hemoglobin A1c levels. Conclusions. These results demonstrate that poor intermediate-term glycemic control is associated with impaired endothelial function.
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Harrington J, Peña AS, Wilson L, Gent R, Dowling K, Baghurst P, Couper J. Vascular function and glucose variability improve transiently following initiation of continuous subcutaneous insulin infusion in children with type 1 diabetes. Pediatr Diabetes 2013; 14:504-11. [PMID: 23659762 DOI: 10.1111/pedi.12050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 04/01/2013] [Accepted: 04/10/2013] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The effect of continuous subcutaneous insulin infusion (CSII) and glucose variability on vascular health in type 1 diabetes (T1D) is not known. We aimed to determine whether initiation of CSII improves vascular function and reduces glucose variability, independent of changes in HbA1c. METHODS Twenty-two children with T1D (12.5 ± 2.9 yr) were reviewed immediately prior, 3 wk, and 12 months after initiation of CSII. Vascular function [flow-mediated dilatation (FMD), glyceryl trinitrate-mediated dilatation (GTN)], glucose variability [mean of daily differences (MODD), mean amplitude of glycaemic excursions (MAGE) and continuous overlapping net glycaemic action (CONGA)], and clinical and biochemical data were measured at each visit. Results for the first two visits were compared to a previously studied cohort of 31 children with T1D who remained on multiple daily injections (MDI). RESULTS FMD, GTN, blood pressure, HbA1c, fructosamine, and glucose variability significantly improved 3 wk after CSII commencement (all p < 0.05), but there was no change in the MDI control group. At 3 wk, vascular function related to glucose variability [(FMD: MODD, r = -0.62, p = 0.002) and (GTN: MAGE, r = -0.59, p = 0.004; CONGA-4, r = -0.51, p = 0.01; MODD, r = -0.62, p = 0.002)] but not to blood pressure, HbA1c, or fructosamine. At 12 months, FMD, GTN, blood pressure, and glucose variability returned to baseline levels, while HbA1c deteriorated. Carotid intima media thickness was unchanged over 12 months. CONCLUSIONS Initiation of CSII rapidly improves vascular function in association with decreased glucose variability; however, the effects are not sustained with deterioration of metabolic control and glucose variability.
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Affiliation(s)
- Jennifer Harrington
- Endocrinology and Diabetes Department, The University of Adelaide, SA, Australia
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Gökşen D, Levent E, Kar S, Özen S, Darcan Ş. Serum adiponectin and hsCRP levels and non-invasive radiological methods in the early diagnosis of cardiovascular system complications in children and adolescents with type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol 2013; 5:174-81. [PMID: 24072086 PMCID: PMC3814533 DOI: 10.4274/jcrpe.1003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Adiponectin and high-sensitivity C-reactive protein (hsCRP) can be used as early biochemical markers of cardiovascular diseases (CVDs). Radiologically, non-invasive flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (CIMT) measurements may be used as indicators in the early diagnosis of CVDs. To compare the biochemical markers of atherosclerosis with radiological markers of CVDs (CIMT, FMD, ventricular systolic and diastolic functions) and to assess the relationship of these parameters with metabolic control in diabetic children and adolescents. METHODS A total of 55 patients with type 1 diabetes mellitus (T1DM) of at least 5-year duration and 30 healthy subjects were included in the study. Serum adiponectin, hsCRP, hemoglobin A1c (HbA1c), and lipid levels were evaluated in the patients and in the controls. CIMT, FMD, ventricular systolic and diastolic functions were assessed by echocardiography. RESULTS Mean age of the patients with diabetes was 17.6 years; mean diabetes duration was 10.4 years. Mean serum hsCRP was elevated in children with diabetes (0.21±0.31 vs. 0.10±0.16 μg/mL, p=0.00), while no significant difference from the controls was found in adiponectin levels. Mean CIMT was significantly higher in diabetic children compared to the control group (0.53±0.11 vs. 0.34±0.46 mm, p=0.00). Mean FMD of the diabetic children was significantly lower than that of the controls (6.86±2.85% vs. 12.13±1.99%, p=0.00). Diabetes duration was positively correlated with CIMT and negatively correlated with FMD. Right ventricular (RV) and left ventricular (LV) myocardial performance index (MPI) were higher in the patient group (p=0.00). CONCLUSIONS Our data suggest that in addition to standard echocardiography, tissue Doppler echocardiography, FMD, and CIMT can be used as early-stage radiological markers and hsCRP as an early-stage biochemical marker of atherosclerosis in the routine follow-up of T1DM patients.
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Affiliation(s)
- Damla Gökşen
- Ege University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey. E-mail:
| | - Ertürk Levent
- Ege University, Department of Pediatric Cardiology, School of Medicine, İzmir, Turkey
| | - Sakine Kar
- Ege University, Department of Pediatrics, School of Medicine, İzmir, Turkey
| | - Samim Özen
- Ege University Department of Pediatric Endocrinology, School of Medicine, İzmir, Turkey
| | - Şükran Darcan
- Ege University Department of Pediatric Endocrinology, School of Medicine, İzmir, Turkey
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Anderson J, Peña AS, Sullivan T, Gent R, D'Arcy B, Olds T, Coppin B, Couper J. Does metformin improve vascular health in children with type 1 diabetes? Protocol for a one year, double blind, randomised, placebo controlled trial. BMC Pediatr 2013; 13:108. [PMID: 23865839 PMCID: PMC3728146 DOI: 10.1186/1471-2431-13-108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of mortality in Type 1 diabetes (T1D). Vascular dysfunction is an early and critical event in the development of cardiovascular disease. Children with T1D have vascular dysfunction therefore early interventions to improve vascular health are essential to reduce cardiovascular mortality in T1D. Metformin is an insulin sensitising agent which is known to improve vascular health outcomes in type 2 diabetes (T2D) and other individuals with insulin resistance. It has been used safely in children and adolescents with T2D for over 10 years. This study aims to assess the effect of metformin on vascular health in children with T1D. METHODS/DESIGN This study is a 12 month, double blind, randomised, placebo controlled trial to determine the effect of metformin on vascular health in children (age 8-18) with T1D. The sample size is 76 with 38 children in the metformin group and 38 children in the placebo group. Vascular health and biochemical markers will be measured at baseline, 3, 6 and 12 months. Vascular function will be measured using flow mediated dilatation and glyceryl trinitrate mediated dilatation of the brachial artery and vascular structure will be measured with carotid and aortic intima media thickness, using standardised protocols. DISCUSSION This study will be the first to investigate the effect of metformin on vascular health in children with T1D. It will provide important information on a potential intervention to improve cardiovascular morbidity and mortality in this population at high risk from cardiovascular disease. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12611000148976.
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Peña AS, Maftei O, Dowling K, Gent R, Wiltshire E, MacKenzie K, Couper J. Folate fortification and supplementation do not provide vascular health benefits in type 1 diabetes. J Pediatr 2013; 163:255-60. [PMID: 23374677 DOI: 10.1016/j.jpeds.2012.12.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/02/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the lowest effective dose-response of folic acid on endothelial function in children with type 1 diabetes. STUDY DESIGN A randomized, double-blind, crossover, placebo-controlled trial was conducted in 20 children with type 1 diabetes (age range 10-18 years) after mandatory folate fortification in Australia. Each child received orally 4 interventions (1 per month)-3 folic acid doses (0.5, 2, and 5 mg) and 1 placebo dose--in random order. The primary outcome was 2-hour postintervention change in endothelial function measured with flow-mediated dilatation (FMD). Thirty-five children with type 1 diabetes from our folic acid interventional trial before folate fortification were used for comparison. RESULTS All children completed the study. There were no differences in baseline FMD or folate status between the visits. Folic acid supplementation increased serum folate (P = .0001) and red cell folate (P < .0001), but none of the doses improved FMD (P = .96). Baseline serum folate and red cell folate levels and FMD and glyceryl trinitrate-mediated dilatation were significantly higher in these children compared with children from our trial before mandatory folate fortification (P = .0001, .0001, .014, and .04, respectively). CONCLUSIONS Folate status and vascular function have improved in children with type 1 diabetes since the introduction of mandatory folate fortification, but the beneficial endothelial effects of additional folic acid are no longer present.
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Affiliation(s)
- Alexia Sophie Peña
- Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia.
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Visit-to-visit and 24-h blood pressure variability: association with endothelial and smooth muscle function in African Americans. J Hum Hypertens 2013; 27:671-7. [PMID: 23615389 PMCID: PMC3745784 DOI: 10.1038/jhh.2013.33] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 03/23/2013] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to investigate the association of visit-to-visit and 24-h BP variability with markers of endothelial injury and vascular function. We recruited 72 African Americans who were non-diabetic, non-smoking, and free of cardiovascular and renal disease. Office BP was measured at three visits and 24-h ambulatory BP monitoring was conducted to measure visit-to-visit and 24-h BP variability, respectively. The 5-min time-course of brachial artery flow-mediated dilation and nitroglycerin-mediated dilation were assessed as measures of endothelial and smooth muscle function. Fasted blood samples were analyzed for circulating endothelial microparticles. Significantly lower CD31+CD42− endothelial microparticles were found in participants with high visit-to-visit SBP variability or high 24-h DBP variability. Participants with high visit-to-visit DBP variability had significantly lower flow-mediated dilation and higher nitroglycerin-mediated dilation at multiple time-points. When analyzed as continuous variables, 24-h mean arterial pressure variability was inversely associated with CD62+ endothelial microparticles; visit-to-visit DBP variability was inversely associated with flow-mediated dilation normalized by smooth muscle function and was positively associated with nitroglycerin-mediated dilation; and 24-h DBP variability was positively associated with nitroglycerin-mediated dilation. All associations were independent of age, gender, BMI, and mean BP. In conclusion, in this cohort of African Americans visit-to-visit and 24-h BP variability were associated with measures of endothelial injury, endothelial function, and smooth muscle function. These results suggest that BP variability may influence the pathogenesis of cardiovascular disease, in part, through influences on vascular health.
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Joshi MS, Berger PJ, Kaye DM, Pearson JT, Bauer JA, Ritchie RH. Functional relevance of genetic variations of endothelial nitric oxide synthase and vascular endothelial growth factor in diabetic coronary microvessel dysfunction. Clin Exp Pharmacol Physiol 2013; 40:253-61. [DOI: 10.1111/1440-1681.12070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Mandar S Joshi
- Baker IDI Heart and Diabetes Institute; Melbourne; Victoria; Australia
| | - Philip J Berger
- The Ritchie Centre; Monash Institute of Medical Research; Melbourne; Victoria; Australia
| | - David M Kaye
- Baker IDI Heart and Diabetes Institute; Melbourne; Victoria; Australia
| | | | - John A Bauer
- Centre for Perinatal Research; The Research Institute at Nationwide Childrenís Hospital; Columbus; Ohio; USA
| | - Rebecca H Ritchie
- Baker IDI Heart and Diabetes Institute; Melbourne; Victoria; Australia
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Hyperglycemia increases muscle blood flow and alters endothelial function in adolescents with type 1 diabetes. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:170380. [PMID: 22701470 PMCID: PMC3371684 DOI: 10.1155/2012/170380] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/09/2012] [Indexed: 02/04/2023]
Abstract
Alterations of blood flow and endothelial function precede development of complications in type 1 diabetes. The effects of hyperglycemia on vascular function in early type 1 diabetes are poorly understood. To investigate the effect of hyperglycemia on forearm vascular resistance (FVR) and endothelial function in adolescents with type 1 diabetes, FVR was measured before and after 5 minutes of upper arm arterial occlusion using venous occlusion plethysmography in (1) fasted state, (2) euglycemic state (~90 mg/dL; using 40 mU/m2/min insulin infusion), and (3) hyperglycemic state (~200 mg/dL) in 11 adolescents with type 1 diabetes. Endothelial function was assessed by the change in FVR following occlusion. Seven subjects returned for a repeat study with hyperglycemia replaced by euglycemia. Preocclusion FVR decreased from euglycemia to hyperglycemia (P = 0.003). Postocclusion fall in FVR during hyperglycemia was less than during euglycemia (P = 0.002). These findings were not reproduced when hyperglycemia was replaced with a second euglycemia. These results demonstrate that acute hyperglycemia causes vasodilation and alters endothelial function in adolescents with type 1 diabetes. In addition they have implications for future studies of endothelial function in type 1 diabetes and provide insight into the etiology of macrovascular and microvascular complications of type 1 diabetes.
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Harrington J, Peña AS, Gent R, Hirte C, Couper J. Adolescents with congenital adrenal hyperplasia because of 21-hydroxylase deficiency have vascular dysfunction. Clin Endocrinol (Oxf) 2012; 76:837-42. [PMID: 22145701 DOI: 10.1111/j.1365-2265.2011.04309.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Patients with congenital adrenal hyperplasia (CAH) because of 21-hydroxylase deficiency have multiple vascular risk factors. Young adults with CAH have increased intima media thickness, but there have been no studies of vascular function and structure in children with CAH. OBJECTIVE To establish whether children with CAH have reduced vascular function and increased carotid intima media thickness (cIMT) when compared to healthy and obese children. DESIGN AND PATIENTS Cross-sectional study of 14 patients (14.8 years ± 3.2, seven boys) with CAH secondary to 21-hydroxylase deficiency compared to 28 obese and 53 healthy controls. MEASUREMENTS All subjects had assessment of endothelial function flow-mediated dilatation, (FMD), smooth muscle function glyceryl tri-nitrate dilatation (GTN) and cIMT. Anthropometric data, resting blood pressure and biochemical variables were also measured. RESULTS Congenital adrenal hyperplasia subjects had significantly reduced FMD (4.5 ± 3.0% vs 7.5 ± 5.2%; P = 0.04) and GTN (17.2 ± 1.6% vs 28.4 ± 8.4%; P < 0.001) when compared to controls and the impairment was comparable to the obese cohort. There was no significant difference in cIMT between groups. CAH subjects had increased homoeostasis model of assessment-insulin resistance [HOMA-IR 2.5 (0.2-2.9) vs 1.8 (0.5-4.2); P = 0.04], waist-to-height ratio (0.47 ± 0.05 vs 0.44 ± 0.04; P = 0.02) and higher systolic blood pressure Z score (0.29 ± 0.9 vs-0.24 ± 0.64, P = 0.01) compared to healthy controls but not when compared to obese controls. CONCLUSIONS Subjects with CAH have evidence of vascular dysfunction by adolescence.
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Affiliation(s)
- Jennifer Harrington
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006. Australia.
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Peña AS, Couper JJ, Harrington J, Gent R, Fairchild J, Tham E, Baghurst P. Hypoglycemia, but not glucose variability, relates to vascular function in children with type 1 diabetes. Diabetes Technol Ther 2012; 14:457-62. [PMID: 22313018 PMCID: PMC3359626 DOI: 10.1089/dia.2011.0229] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chronic sustained hyperglycemia unequivocally predicts vascular disease in diabetes. However, the vascular risk of glucose variability, including hypoglycemia, is uncertain. Vascular dysfunction is present in children with type 1 diabetes and is a critical precursor of atherosclerosis. We aimed to evaluate the relationship between glucose variability and vascular function in children with type 1 diabetes. SUBJECTS AND METHODS Fifty-two type 1 diabetes subjects (14 [SD 2.7] years old, 25 males) had continuous glucose monitoring that included 48 h of data used to evaluate glucose variability (mean amplitude of glycemic excursions [MAGE] and other measurements) and hypoglycemia indices (glycemic risk assessment diabetes equation [GRADE] hypoglycemia, Low Blood Glucose Index [LBGI], and observed duration of hypoglycemia). Children with type 1 diabetes and 50 age- and gender-matched controls had assessments of vascular function (flow-mediated dilatation [FMD] and glyceryl trinitrate-mediated dilatation [GTN]). RESULTS Children with type 1 diabetes had lower FMD and GTN than controls (P=0.02 and P<0.001, respectively). GRADE hypoglycemia and LBGI were inversely related to FMD (r=-0.36, P=0.009 and r=-0.302, P=0.03, respectively) but did not relate to GTN. GRADE hypoglycemia was independently related to FMD (regression coefficient=-0.25±0.09, P=0.006). MAGE and other measurements of glucose variability measurements did not relate to FMD or GTN. CONCLUSIONS Hypoglycemia, but not glucose variability, during continuous glucose monitoring relates to impaired vascular endothelial function in children with type 1 diabetes. Hypoglycemia may be an additional risk factor for early cardiovascular disease, but the effect of glucose variability, independent of glycosylated hemoglobin, on vascular function remains uncertain.
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Affiliation(s)
- Alexia S Peña
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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Tavares AC, Bocchi EA, Guimarães GV. Endothelial function in pre-pubertal children at risk of developing cardiomyopathy: a new frontier. Clinics (Sao Paulo) 2012; 67:273-8. [PMID: 22473410 PMCID: PMC3297038 DOI: 10.6061/clinics/2012(03)12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/03/2011] [Accepted: 11/22/2011] [Indexed: 01/22/2023] Open
Abstract
Although it is known that obesity, diabetes, and Kawasaki's disease play important roles in systemic inflammation and in the development of both endothelial dysfunction and cardiomyopathy, there is a lack of data regarding the endothelial function of pre-pubertal children suffering from cardiomyopathy. In this study, we performed a systematic review of the literature on pre-pubertal children at risk of developing cardiomyopathy to assess the endothelial function of pre-pubertal children at risk of developing cardiomyopathy. We searched the published literature indexed in PubMed, Bireme and SciELO using the keywords 'endothelial', 'children', 'pediatric' and 'infant' and then compiled a systematic review. The end points were age, the pubertal stage, sex differences, the method used for the endothelial evaluation and the endothelial values themselves. No studies on children with cardiomyopathy were found. Only 11 papers were selected for our complete analysis, where these included reports on the flow-mediated percentage dilatation, the values of which were 9.80±1.80, 5.90±1.29, 4.50±0.70, and 7.10±1.27 for healthy, obese, diabetic and pre-pubertal children with Kawasaki's disease, respectively. There was no significant difference in the dilatation, independent of the endothelium, either among the groups or between the genders for both of the measurements in children; similar results have been found in adolescents and adults. The endothelial function in cardiomyopathic children remains unclear because of the lack of data; nevertheless, the known dysfunctions in children with obesity, type 1 diabetes and Kawasaki's disease may influence the severity of the cardiovascular symptoms, the prognosis, and the mortality rate. The results of this study encourage future research into the consequences of endothelial dysfunction in pre-pubertal children.
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Affiliation(s)
- Aline Cristina Tavares
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Diaz KM, Veerabhadrappa P, Kashem MA, Feairheller DL, Sturgeon KM, Williamson ST, Crabbe DL, Brown MD. Relationship of visit-to-visit and ambulatory blood pressure variability to vascular function in African Americans. Hypertens Res 2011; 35:55-61. [PMID: 21814215 DOI: 10.1038/hr.2011.135] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Visit-to-visit clinic blood pressure variability (BPV) and 24-h BPV have both been identified as independent risk factors for cardiovascular (CV) morbidity and mortality; however, the mechanisms contributing to the increased CV risk as yet are unclear. The purpose of this study was to assess the relationship between BPV and endothelial function in a cohort of putatively healthy African Americans. A total of 36 African Americans who were sedentary, non-diabetic, non-smoking, free of CV and renal disease and not on antihypertensive medication followed an American Heart Association low fat, low salt diet for 6 weeks. Upon completion of the 6-week dietary stabilization period, participants underwent 24-h ambulatory BP monitoring and had their office blood pressure (BP) measured on 3 separate days. Right brachial artery diameter was assessed at rest, during reactive hyperemia (flow-mediated vasodilation: FMD), and after nitroglycerin administration (nitroglycerin-mediated vasodilation: NMD). Participants classified as having decreased endothelial function according to either %FMD or the FMD/NMD ratio had significantly higher 24-h BPV and a trend for higher visit-to-visit BPV when compared with participants with normal endothelial function. Continuous variable analyses revealed a significant positive association between NMD and 24-h diastolic BPV (DBPV). Visit-to-visit systolic BPV (SBPV), 24-h SBPV and 24-h DBPV were all negatively associated with the FMD/NMD ratio. All relationships remained significant after adjustment for age, body mass index and mean BP levels. These results may suggest that BPV is increased in African Americans with decreased endothelial function and is associated with the vascular smooth muscle response to nitric oxide.
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Affiliation(s)
- Keith M Diaz
- Hypertension, Molecular and Applied Physiology Laboratory, Department of Kinesiology, College of Health Professions, Temple University, Philadelphia, PA 19122, USA.
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Giménez M, Gilabert R, Lara M, Conget I. Preclinical arterial disease in patients with type 1 diabetes without other major cardiovascular risk factors or micro-/ macrovascular disease. Diab Vasc Dis Res 2011; 8:5-11. [PMID: 21109602 DOI: 10.1177/1479164110388674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate preclinical atherosclerosis in T1D and its relationship with glucose profile and endothelial/ inflammatory markers. Thirty-eight T1D patients without additional cardiovascular risk factors or micro-/macrovascular complications and 22 healthy matched subjects were included. FMD and cIMT/fIMT were performed in addition to 72-h continuous glucose monitoring and the measurement of endothelial/inflammatory markers. Lower FMD percentages and greater cIMT/fIMT were observed in patients with T1D in comparison with controls (FMD 7.0 ± 3.1% vs. 9.6 ± 2.2%; p<0.005; cIMT 0.523 ± 0.091 mm vs. 0.471 ± 0.061 mm; p<0.05 and fIMT 0.512 ± 0.172 mm vs. 0.394 ± 0.061 mm; p<0.01, for patients and controls, respectively). T1D subjects in the highest tertile of cIMT were older than those in the lowest group (39.9 ± 9.5 vs. 29.6 ± 4.7 years; p<0.005) and had a longer duration of the disease (18.7 ± 5.4 years vs. 11.8 ± 6.4 years). The higher the cIMT tertile, the greater the fIMT (0.397 ± 0.114 mm vs. 0.431 ± 0.082 mm vs. 0.583 ± 0.197 mm; p<0.05). MAGE was negatively correlated to FMD (r=-0.328; p<0.05) and positively to cIMT (r=0.322; p<0.05). There were no differences between cIMT tertiles in terms of metabolic parameters or endothelial and inflammatory markers. Signals of preclinical atherosclerosis in T1D even in the absence of cardiovascular risk factors and micro- / macrovascular disease are reported. Our findings suggest that daily glucose instability could negatively impact vascular function and structure.
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Affiliation(s)
- Marga Giménez
- Endocrinology and Diabetes Unit, Hospital Clínic I Universitari, Bareclona, Spain
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Bellien J, Costentin A, Dutheil-Maillochaud B, Iacob M, Kuhn JM, Thuillez C, Joannides R. Early stage detection of conduit artery endothelial dysfunction in patients with type 1 diabetes. Diab Vasc Dis Res 2010; 7:158-66. [PMID: 20382780 DOI: 10.1177/1479164109360470] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Flow-mediated dilatation evaluation using hand skin heating may possibly be more accurate than post-ischaemic hyperaemia to detect conduit artery endothelial dysfunction in type 1 diabetes. We measured in 24 type 1 diabetic patients (n=16 without microangiopathy) and 24 healthy matched subjects radial artery diameter (echotracking), blood flow and mean wall shear stress during heating and post-ischaemic hyperaemia. Compared with controls, flow-mediated dilatation was lower in diabetic patients during post-ischaemic hyperaemia and heating. However, in the subgroup of uncomplicated patients, a decreased flow-mediated dilatation was only apparent during heating (17.1+/-1.6% vs. 24.3+/-0.7%, p<0.05) but not during post-ischaemic hyperaemia (10.1+/-1.1% vs. 10.5+/-0.6%, NS). This was confirmed by the lower slope of the diameter-mean wall shear stress relationship in these patients in the absence of modification in endothelium-independent dilatation. We conclude that hand skin heating permits the early detection of conduit artery endothelial dysfunction in type 1 diabetic patients with normal response to post-ischaemic hyperaemia. This procedure could be useful to investigate the prognostic role of vascular dysfunction and the impact of vasculoprotective treatments in this patient population.
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Aortic intima media thickness is an early marker of atherosclerosis in children with type 1 diabetes mellitus. J Pediatr 2010; 156:237-41. [PMID: 19853860 DOI: 10.1016/j.jpeds.2009.08.036] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 06/10/2009] [Accepted: 08/17/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare aortic intima media thickness (aIMT) to carotid intima media thickness (cIMT) as a marker of early atherosclerosis in children with type 1 diabetes mellitus and to examine the associations of aIMT to known cardiovascular risk factors. STUDY DESIGN 66 children with type 1 diabetes mellitus (age, 14.1 +/- 2.5 years; 37 male) and 32 healthy control subjects (age, 14.2 +/- 3 years; 15 male) underwent assessment of vascular structure (cIMT and aIMT) and vascular function (flow mediated dilatation [FMD] and glyceryl trinitrate induced dilatation [GTN]). Fasting blood tests were taken to measure levels of hemoglobin A1c, high sensitive C reactive protein, total homocyst(e)ine, serum folate, red cell folate, and lipids. RESULTS aIMT, but not cIMT, was significantly greater in the children with type 1 diabetes mellitus than in control subjects (P < .001). In children with type 1 diabetes mellitus, aIMT correlated with glycosylated hemoglobin (r = 0.31, P = .01) and was independently associated with age (beta = 0.38, P = .001) and low-density lipoprotein cholesterol level (beta = 0.38, P = .001). Vascular function (GTN) was worse in children with type 1 diabetes mellitus who had an aIMT >95th percentile, as defined with the control subjects. CONCLUSIONS aIMT is an earlier marker than cIMT of preclinical atherosclerosis in children with type 1 diabetes mellitus and relates to known cardiovascular risk factors and metabolic control.
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Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Hayman L, Jacobson M, Mahoney L, Mietus-Snyder M, Rocchini A, Steinberger J, McCrindle B. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension 2009; 54:919-50. [PMID: 19729599 DOI: 10.1161/hypertensionaha.109.192639] [Citation(s) in RCA: 467] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deterioration in endothelial function and arterial stiffness are early events in the development of cardiovascular diseases. In adults, noninvasive measures of atherosclerosis have become established as valid and reliable tools for refining cardiovascular risk to target individuals who need early intervention. With limited pediatric data, the use of these techniques in children and adolescents largely has been reserved for research purposes. Therefore, this scientific statement was written to (1) review the current literature on the noninvasive assessment of atherosclerosis in children and adolescents, (2) make recommendations for the standardization of these tools for research, and (3) stimulate further research with a goal of developing valid and reliable techniques with normative data for noninvasive clinical evaluation of atherosclerosis in pediatric patients. Precise and reliable noninvasive tests for atherosclerosis in youth will improve our ability to estimate future risk for heart attack and stroke. Currently, large longitudinal studies of cardiovascular risk factors in youth, such as the Bogalusa and Muscatine studies, lack sufficient adult subjects experiencing hard outcomes, such as heart attack and stroke, to produce meaningful risk scores like those developed from Framingham data.
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Abstract
PURPOSE OF REVIEW Albuminuria is a marker of present and future cardiovascular and renal morbidity, and mortality, in adults. Because the roots of these diseases extend back into childhood, assessment of albuminuria has become relevant to child and adolescent clinical care. RECENT FINDINGS Normal levels of albumin excretion in children are well below the cut-off for microalbuminuria. In healthy children, albuminuria relates to fasting insulin, but not blood pressure, BMI, lipid levels, fasting glucose, or insulin resistance. In obese children, albuminuria relates to multiple measures of insulin resistance. In children with type 1 diabetes, hemoglobin A1c seems to be the most consistent clinical predictor of microalbuminuria although multiple mechanisms seem to be involved, including genetic polymorphisms. Children with type 2 diabetes and hypertension already exhibit microalbuminuria. SUMMARY When considering the population as a whole, children make ideal subjects in which to study the natural history of albuminuria given their relative lack of multiple morbidities commonly seen in adults. The unfortunate rise in 'adult' diseases in the pediatric age group makes this especially relevant. There is a need for longitudinal studies examining predictors of elevated urinary albumin levels as well as potential treatment strategies.
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Selamet Tierney ES, Newburger JW, Gauvreau K, Geva J, Coogan E, Colan SD, de Ferranti SD. Endothelial pulse amplitude testing: feasibility and reproducibility in adolescents. J Pediatr 2009; 154:901-5. [PMID: 19217124 DOI: 10.1016/j.jpeds.2008.12.028] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 11/26/2008] [Accepted: 12/17/2008] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To test prospectively the reproducibility and feasibility of endothelial pulse amplitude testing (Endo-PAT), a novel Food and Drug Administration-approved technology, in healthy adolescents. STUDY DESIGN We performed Endo-PAT testing on 2 different days separated by no more than 7 days in 30 healthy fasting adolescents, ages 13 to 19 years, to assess reproducibility and feasibility. The reported level of discomfort, as measured on a pain scale of 1 to 5, was documented. RESULTS The mean difference in paired Endo-PAT indices was 0.12 (95% CI, -0.09-0.33; P = .24; intraclass correlation coefficient, 0.78), and the within-subject variation of Endo-PAT index was 0.16. The Endo-PAT index on test days 1 and 2 were 1.91 +/- 0.57 and 1.78 +/- 0.51 (mean plus or minus SD), respectively. All attempted studies (100%) were completed (95% CI, 88%-100%), and all completed studies (100%) could be analyzed (95% CI, 88%-100%). The median pain score was 1 on both days. CONCLUSION In healthy adolescents, Endo-PAT is feasible and has excellent reproducibility. This technology may provide an easy and reliable means of assessing endothelial function in the pediatric population.
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MacKenzie KE, Wiltshire EJ, Peña AS, Gent R, Hirte C, Piotto L, Couper JJ. Hs-CRP is associated with weight, BMI, and female sex but not with endothelial function in children with type 1 diabetes. Pediatr Diabetes 2009; 10:44-51. [PMID: 18798827 DOI: 10.1111/j.1399-5448.2008.00456.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Atherosclerosis is an inflammatory process, and high-sensitivity C-reactive protein (Hs-CRP), a marker of inflammation, predicts cardiovascular events in adults. Vascular endothelial and smooth muscle dysfunction, measurable precursors of atherosclerosis, begin in childhood. Therefore, we sought to determine if Hs-CRP is associated with vascular endothelial and smooth muscle dysfunction in children with type 1 diabetes mellitus (T1DM) and healthy control subjects. METHODS Hs-CRP and endothelial function assessed by flow-mediated dilatation (FMD) and smooth muscle function assessed by glyceryl-trinitrate (GTN)-induced dilatation were measured in 121 subjects with T1DM aged 14.1 (2.9) yr, of whom 31 were also studied at 4 and 8 wk, and in 33 healthy controls aged 14.2 (3.6) yr. RESULTS Hs-CRP did not differ between subjects with T1DM and healthy, age-matched controls. In both controls and subjects with T1DM, Hs-CRP did not relate to FMD or GTN at baseline or at intervals over 8 wk in T1DM. Hs-CRP did not change over time. In T1DM, but not healthy controls, Hs-CRP related to body mass index (BMI) z-score (r = 0.47, p < 0.001), weight z-score (r = 0.41, p < 0.001), and female sex (p = 0.008). CONCLUSIONS Hs-CRP is not associated with early vascular dysfunction in children with T1DM. However, in children and adolescents with T1DM, Hs-CRP was associated with female sex and children with higher BMI, suggesting that these groups may be at greater cardiovascular risk. Maintenance of a healthy BMI may be important in the prevention of vascular disease of T1DM.
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Affiliation(s)
- Karen E MacKenzie
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
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Couper JJ, Peña AS. Folate, homocysteine, and candidate genes for vascular disease in children with type 1 diabetes. Pediatr Diabetes 2008; 9:345-7. [PMID: 18774993 DOI: 10.1111/j.1399-5448.2008.00445.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 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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Wiltshire EJ, Mohsin F, Chan A, Donaghue KC. Methylenetetrahydrofolate reductase and methionine synthase reductase gene polymorphisms and protection from microvascular complications in adolescents with type 1 diabetes. Pediatr Diabetes 2008; 9:348-53. [PMID: 18774994 DOI: 10.1111/j.1399-5448.2008.00374.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Folate status has been associated with endothelial dysfunction in adolescents with type 1 diabetes, and elevated total plasma homoocyst(e)ine (tHcy) is a risk for vascular disease in the non-diabetic population. Polymorphisms in genes involved in folate and homocysteine metabolism are implicated in vascular disease. We aimed to determine whether polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR) genes are risk factors for early microvascular disease in a large group of adolescents with type 1 diabetes. Four hundred and eighty adolescents were screened annually for retinopathy and microalbuminuria for a median of 4 yr. Molecular analysis for the polymorphisms 677C-->T, 1298A-->C in MTHFR, and 66A-->G in MTRR was performed. The MTRR 66GG genotype reduced the risk for elevated albumin excretion rate (AER) (OR 0.47, CI 0.25, 0.88, p = 0.018) and showed a trend to reduced risk for microalbuminuria (OR 0.27, CI 0.06-1.21, p = 0.09). Survival without elevated AER was increased with the MTRR 66GG genotype (12.4 vs. 9.7 yr, p = 0.04) and with the MTHFR 1298CC genotype (15.2 vs. 10.2 yr, p = 0.007). Conversely, survival without retinopathy was reduced with the MTHFR 677TT and MTRR 66GG combined genotype (6.2 vs. 10.2 yr, p = 0.015). The MTRR 66GG and MTHFR 1298 CC genotypes may confer protection against early nephropathy, possibly because they are associated with lower tHcy. The MTHFR 677 TT was only related to earlier onset retinopathy in combination with MTRR 66GG.
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Affiliation(s)
- Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington South, New Zealand.
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Abstract
Type 1 diabetes is associated with a substantially increased risk of cardiovascular disease that might not always be appreciated in view of the fairly young age of patients with this condition. In fact, in type 1 diabetes, the heart is subject to a variety of pathological insults, including accelerated atherosclerosis, cardiac autonomic neuropathy, and possibly intrinsic cardiomyopathy. Although the relation between hyperglycaemia and microvascular complications has been well established, a direct effect of hyperglycaemia on cardiovascular disease in type 1 diabetes has long been debated. More recently, several studies, most notably the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications, have clarified this issue and provided conclusive evidence that hyperglycaemia is indeed a mediator of cardiovascular risk in type 1 diabetes and that intensive diabetes therapy can reduce cardiovascular disease outcomes. We review current concepts in type 1 diabetes and the heart, focusing on recent insights into the central role of hyperglycaemia.
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Affiliation(s)
- Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
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Fernhall B, Agiovlasitis S. Arterial function in youth: window into cardiovascular risk. J Appl Physiol (1985) 2008; 105:325-33. [PMID: 18450990 DOI: 10.1152/japplphysiol.00001.2008] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Noninvasive measures of arterial function, such as intima-media thickness (IMT), endothelial function, and arterial stiffness are associated with and are prognostic of cardiovascular events in adults. Postmortem evidence, however, has established that the atherosclerotic process starts in childhood. Furthermore, cardiovascular morbidities in childhood disrupt arterial health and may lead to adverse outcomes in adulthood. Thus it is important to examine the developmental changes in IMT, endothelial function, and arterial stiffness in healthy youth in contrast to the arterial health profile of youth with cardiovascular morbidities and to examine the effect of lifestyle interventions. In healthy youth, IMT may increase slightly, arterial stiffness increases, but there is no change in endothelial function from 5 to 20 years of age. In youth with cardiovascular risk factors there are larger increases in IMT and arterial stiffness, and reductions in endothelial function compared with healthy youth. The reduced arterial function in youth with cardiovascular risk factors may be related to the atherosclerotic process. Exercise and physical activity appear to exert a protective effect on arterial function, and exercise training can improve arterial function in children with cardiovascular risk factors. Furthermore, although diet alone can improve arterial function in children, the combination of exercise and diet appears to be more effective than either intervention alone. Future studies need to focus on the mechanism by which exercise and diet improve arterial function, the most effective types of diet and exercise, and if intervening in childhood leads to favorable outcomes in adulthood.
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Affiliation(s)
- Bo Fernhall
- Exercise and Cardiovascular Research Laboratory, Kinesiology and Community Health Department, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illiois, USA.
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Hadi HAR, Suwaidi JA. Endothelial dysfunction in diabetes mellitus. Vasc Health Risk Manag 2008. [PMID: 18200806 DOI: 10.2147/vhrm.s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is associated with an increased risk of cardiovascular disease, even in the presence of intensive glycemic control. Substantial clinical and experimental evidence suggest that both diabetes and insulin resistance cause a combination of endothelial dysfunctions, which may diminish the anti-atherogenic role of the vascular endothelium. Both insulin resistance and endothelial dysfunction appear to precede the development of overt hyperglycemia in patients with type 2 diabetes. Therefore, in patients with diabetes or insulin resistance, endothelial dysfunction may be a critical early target for preventing atherosclerosis and cardiovascular disease. Microalbuminuria is now considered to be an atherosclerotic risk factor and predicts future cardiovascular disease risk in diabetic patients, in elderly patients, as well as in the general population. It has been implicated as an independent risk factor for cardiovascular disease and premature cardiovascular mortality for patients with type 1 and type 2 diabetes mellitus, as well as for patients with essential hypertension. A complete biochemical understanding of the mechanisms by which hyperglycemia causes vascular functional and structural changes associated with the diabetic milieu still eludes us. In recent years, the numerous biochemical and metabolic pathways postulated to have a causal role in the pathogenesis of diabetic vascular disease have been distilled into several unifying hypotheses. The role of chronic hyperglycemia in the development of diabetic microvascular complications and in neuropathy has been clearly established. However, the biochemical or cellular links between elevated blood glucose levels, and the vascular lesions remain incompletely understood. A number of trials have demonstrated that statins therapy as well as angiotensin converting enzyme inhibitors is associated with improvements in endothelial function in diabetes. Although antioxidants provide short-term improvement of endothelial function in humans, all studies of the effectiveness of preventive antioxidant therapy have been disappointing. Control of hyperglycemia thus remains the best way to improve endothelial function and to prevent atherosclerosis and other cardiovascular complications of diabetes. In the present review we provide the up to date details on this subject.
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Affiliation(s)
- Hadi A R Hadi
- Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar, UAE.
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Jin SM, Noh CI, Yang SW, Bae EJ, Shin CH, Chung HR, Kim YY, Yun YS. Endothelial dysfunction and microvascular complications in type 1 diabetes mellitus. J Korean Med Sci 2008; 23:77-82. [PMID: 18303203 PMCID: PMC2526502 DOI: 10.3346/jkms.2008.23.1.77] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We examined whether alterations in vascular endothelial function and early structural changes in atherosclerosis are associated with microvascular complications in patients with type 1 diabetes mellitus (DM). Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) measurement were performed in 70 young adults (aged 19 to 35 yr), 48 with type 1 DM, and 22 normal controls. Patients with diabetes had a lower peak FMD response (7.8+/-3.9 vs. 11.1+/-1.9%, p<0.001) and increased IMT (0.51+/-0.10 vs. 0.42+/-0.07 mm, p<0.001) compared with controls. Twenty (41.7%) of the patients had microvascular complications including neuropathy, nephropathy, or retinopathy. In these complicated diabetic patients, we found a lower FMD response (6.1+/-2.5 vs. 9.9+/-3.5%, p=0.001) compared with diabetics without microvascular complications. The presence of microvascular complications was also associated with older age and longer duration of the disease. However, no differences were observed in IMT, body size, blood pressure, HbA1c, C-reactive protein, low-density lipoprotein or high-density lipoprotein cholesterol levels between complicated and non-complicated patients. Endothelial dysfunction and early structural atherosclerotic changes are common manifestations in type 1 DM, and endothelial dysfunction is thought to be an early event in the atherosclerotic process and important in the pathogenesis of microvascular complications.
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Affiliation(s)
- Seon Mi Jin
- Department of Pediatrics, Eulji Medical Center, Seoul, Korea
| | - Chung Il Noh
- Department of Pediatrics, Seoul National University Children's Hospitall, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children's Hospitall, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospitall, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospitall, Seoul, Korea
| | - Hae Rim Chung
- Department of Pediatrics, Seoul National University Children's Hospitall, Seoul, Korea
| | - You Yeh Kim
- Department of Pediatrics, Seoul National University Children's Hospitall, Seoul, Korea
| | - Yong Soo Yun
- Department of Pediatrics, Seoul National University Children's Hospitall, Seoul, Korea
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Idzior-Waluś B, Cyganek K, Sztefko K, Seghieri G, Breschi MC, Waluś-Miarka M, Kawalec E, Seretny M, Sieradzki J. Total plasma homocysteine correlates in women with gestational diabetes. Arch Gynecol Obstet 2008; 278:309-13. [PMID: 18236055 DOI: 10.1007/s00404-008-0571-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
Abstract
AIM We aim to assess serum total homocysteine (tHcy) associations with metabolic syndrome components and B-vitamins in women with gestational diabetes mellitus (GDM). METHODS We studied 61 consecutive pregnant women, 44 with GDM and 17 with normal glucose tolerance (CG). Serum homocysteine levels were analyzed by ELISA, using Bio-Rad reagents. Serum folates and vitamin B(12) concentrations were determined by chemiluminescent immunoassay, free fatty acids (FFA) and lipids enzymatically. RESULTS Serum homocysteine levels were similar in both the GDM and the CG groups (8+/-2.0 vs 7.4+/-1.1 micromol/l, respectively). Women with GDM in comparison to CG women were characterized by higher values of homeostasis model of insulin resistance (HOMA-IR) (2.8+/-1.7 vs 1.6+/-0.9, P<0.01), serum triglycerides (2.7+/-0.9 vs 1.9+/-0.5 mmol/l, P<0.01) and FFA (0.6+/-0.2 vs 0.46+/-0.2 mmol/l, P<0.05). In GDM women serum tHcy correlated with vitamin B(12) (r= -0.47, P<0.01) and folates (r= -0.51, P<0.001); in CG women with HOMA-IR, a marker of insulin resistance (r= -0.49, P<0.05). In multiple regression analysis with serum tHcy as a dependent variable, folate and vitamin B(12) entered the analysis in GDM women (beta= -0.42 and -0.34, respectively, P<0.05), whereas in CG cystatin C and HOMA-IR entered the analysis (P<0.05). CONCLUSIONS In women with GDM, serum homocysteine is significantly associated with vitamin B(12) and folate levels, while in healthy pregnant women with HOMA-IR and with kidney function. The results suggest the importance of the B-group vitamins in regulation of serum tHcy levels in women with insulin resistance/gestational diabetes, what might be relevant in protection against pregnancy complications associated with elevated tHcy in GDM women.
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Affiliation(s)
- B Idzior-Waluś
- Department of Metabolic Diseases, Jagiellonian University, Medical College, 15 Kopernika Street, 31-501 Kraków, Poland.
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