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Koullias E, Papavdi M, Athanasopoulos S, Mitrakou A, Deutsch M, Zoumpoulis P, Manesis E, Thanopoulou A, Koskinas J. Addition of Dulaglutide or Empagliflozin to Standard-of-Care Treatment: Effect on Liver Steatosis in Patients With Type 2 Diabetes Mellitus. Cureus 2024; 16:e53813. [PMID: 38465109 PMCID: PMC10924185 DOI: 10.7759/cureus.53813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Background Patients with liver steatosis and diabetes mellitus can benefit from medications like glucagon-like peptide 1 receptor agonists or sodium-glucose co-transporter 2 inhibitors, as far as both hyperglycemia and fatty liver are concerned. Studies comparing members of both these families have not yet been published. We aimed to compare the effects of Empagliflozin and Dulaglutide, focusing primarily on liver steatosis. Methodology This prospective, observational, controlled study enrolled 78 patients from two centers in Athens, Greece. Adults with type 2 diabetes mellitus (DM2) and nonalcoholic fatty liver disease were assigned to one of three groups and received either Empagliflozin or Dulaglutide or any other medical treatment deemed appropriate by their physician. The primary endpoint was the reduction in liver fat fraction, assessed using magnetic resonance imaging-proton density fat fraction. Additionally, we evaluated the proportion of patients achieving a relative reduction above 30% of their initial liver fat concentration. Results The Empagliflozin group exhibited a reduction in liver fat fraction. Furthermore, the percentage of patients with a relative reduction of liver steatosis, >30%, was significantly larger in this group, compared to the Dulaglutide and Control groups. Significant body weight reduction was observed in all three groups, but no improvement in fibrosis assessing scores was noted. Conclusions Empagliflozin is effective in improving liver steatosis, while Dulaglutide does not exhibit a similar effect. Larger studies, comparing these or related agents, are necessary, to further assess benefits in patients with DM2 and nonalcoholic fatty liver.
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Affiliation(s)
- Emmanouil Koullias
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, GRC
| | - Maria Papavdi
- 2nd Department of Internal Medicine, Medical School, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Stavros Athanasopoulos
- Department of Therapeutic, Medical School, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Asimina Mitrakou
- Department of Therapeutic, Medical School, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Melanie Deutsch
- 2nd Department of Internal Medicine, Medical School, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | | | | | - Anastasia Thanopoulou
- 2nd Department of Internal Medicine, Medical School, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - John Koskinas
- 2nd Department of Internal Medicine, Medical School, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, GRC
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Amanatidou AI, Mikropoulou EV, Amerikanou C, Milanovic M, Stojanoski S, Bjelan M, Cesarini L, Campolo J, Thanopoulou A, Banerjee R, Kurth MJ, Milic N, Medic-Stojanoska M, Trivella MG, Visvikis-Siest S, Gastaldelli A, Halabalaki M, Kaliora AC, Dedoussis GV. Plasma Amino Acids in NAFLD Patients with Obesity Are Associated with Steatosis and Fibrosis: Results from the MAST4HEALTH Study. Metabolites 2023; 13:959. [PMID: 37623902 PMCID: PMC10456787 DOI: 10.3390/metabo13080959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have been linked to changes in amino acid (AA) levels. The objective of the current study was to examine the relationship between MRI parameters that reflect inflammation and fibrosis and plasma AA concentrations in NAFLD patients. Plasma AA levels of 97 NAFLD patients from the MAST4HEALTH study were quantified with liquid chromatography. Medical, anthropometric and lifestyle characteristics were collected and biochemical parameters, as well as inflammatory and oxidative stress biomarkers, were measured. In total, subjects with a higher MRI-proton density fat fraction (MRI-PDFF) exhibited higher plasma AA levels compared to subjects with lower PDFF. The concentrations of BCAAs (p-Value: 0.03), AAAs (p-Value: 0.039), L-valine (p-Value: 0.029), L-tyrosine (p-Value: 0.039) and L-isoleucine (p-Value: 0.032) were found to be significantly higher in the higher PDFF group compared to lower group. Plasma AA levels varied according to MRI-PDFF. Significant associations were also demonstrated between AAs and MRI-PDFF and MRI-cT1, showing the potential utility of circulating AAs as diagnostic markers of NAFLD.
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Affiliation(s)
- Athina I. Amanatidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (G.V.D.)
| | - Eleni V. Mikropoulou
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, 15771 Athens, Greece; (E.V.M.); (M.H.)
| | - Charalampia Amerikanou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (G.V.D.)
| | - Maja Milanovic
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
| | - Stefan Stojanoski
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
- Center for Diagnostic Imaging, Oncology Institute of Vojvodine, 21204 Sremska Kamenica, Serbia
| | - Mladen Bjelan
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
| | - Lucia Cesarini
- Division of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano, 20162 Milan, Italy;
| | - Jonica Campolo
- Institute of Clinical Physiology, CNR, 56124 Milan, Italy;
| | - Anastasia Thanopoulou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 15772 Athens, Greece;
| | | | - Mary Jo Kurth
- Clinical Studies Group, Randox Laboratories Ltd., Crumlin BT29 4RN, UK;
| | - Natasa Milic
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
| | - Milica Medic-Stojanoska
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia
| | - Maria Giovanna Trivella
- Institute of Clinical Physiology National Research Council, 56124 Pisa, Italy; (M.G.T.); (A.G.)
- ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Sophie Visvikis-Siest
- INSERM UMR U1122, IGE-PCV, Faculté de Pharmacie, Université de Lorraine, 30 Rue Lionnois, 54000 Nancy, France;
| | - Amalia Gastaldelli
- Institute of Clinical Physiology National Research Council, 56124 Pisa, Italy; (M.G.T.); (A.G.)
| | - Maria Halabalaki
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, 15771 Athens, Greece; (E.V.M.); (M.H.)
| | - Andriana C. Kaliora
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (G.V.D.)
| | - George V. Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (G.V.D.)
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Miller V, Reedy J, Cudhea F, Zhang J, Shi P, Erndt-Marino J, Coates J, Micha R, Webb P, Mozaffarian D, Abbott P, Abdollahi M, Abedi P, Abumweis S, Adair L, Al Nsour M, Al-Daghri N, Al-Hamad N, Al-Hooti S, Al-Zenki S, Alam I, Ali JH, Alissa E, Anderson S, Anzid K, Arambepola C, Arici M, Arsenault J, Asciak R, Barbieri HE, Barengo N, Barquera S, Bas M, Becker W, Beer-Borst S, Bergman P, Biró L, Boindala S, Bovet P, Bradshaw D, Bukhary NBI, Bundhamcharoen K, Caballero M, Calleja N, Cao X, Capanzana M, Carmikle J, Castetbon K, Castro M, Cerdena C, Chang HY, Charlton K, Chen Y, Chen MF, Chiplonkar S, Cho Y, Chuah KA, Costanzo S, Cowan M, Damasceno A, Dastgiri S, De Henauw S, DeRidder K, Ding E, Dommarco R, Don R, Duante C, Duleva V, Duran Aguero S, Ekbote V, El Ati J, El Hamdouchi A, El-kour T, Eldridge A, Elmadfa I, Esteghamati A, Etemad Z, Fadzil F, Farzadfar F, Fernandez A, Fernando D, Fisberg R, Forsyth S, Gamboa-Delgado E, Garriguet D, Gaspoz JM, Gauci D, Geleijnse M, Ginnela B, Grosso G, Guessous I, Gulliford M, Gunnarsdottir I, Hadden W, Hadziomeragic A, Haerpfer C, Hakeem R, Haque A, Hashemian M, Hemalatha R, Henjum S, Hinkov H, Hjdaud Z, Hoffman D, Hopping B, Houshiar-rad A, Hsieh YT, Hung SY, Huybrechts I, Hwalla NC, Ibrahim HM, Ikeda N, Illescas-Zarate D, Inoue M, Janakiram C, Jayawardena R, Jeewon R, Jitnarin N, Johansson L, Jonsdottir O, Jundishapur A, Kally O, Kandiah M, Karupaiah T, Keinan-Boker L, Kelishadi R, Khadilkar A, Kim CI, Koksal E, Konig J, Korkalo L, Koster J, Kovalskys I, Krishnan A, Kruger H, Kuriyan-Raj R, Kweon S, Lachat C, Lai Y, Lanerolle P, Laxmaiah A, Leclercq C, Lee MS, Lee HJ, Lemming EW, Li Y, Lindström J, Ling A, Liputo NIL, Lopez-Jaramillo P, Luke A, Lukito W, Lupotto E, Ma Y, Mahdy ZA, Malekzadeh R, Manan W, Marchioni D, Marques LL, Marques-Vidal P, Martin-Prevel, Y, Mathee A, Matsumura Y, Mazumdar P, Memon A, Mensink G, Meyer A, Mirmiran P, Mirzaei M, Misra P, Misra A, Mitchell C, Mohamed HJBJ, Mohammadi-Nasrabadi F, Mohammadifard N, Moy FM, Musaiger A, Mwaniki E, Myhre J, Nagalla B, Naska A, Ng SA, Ng SW, Ngoan LTN, Noshad S, Ochoa A, Ocke M, Odenkirk J, Oh K, Oleas M, Olivares S, Orfanos P, Ortiz-Ulloa J, Otero J, Ovaskainen ML, Pakseresht M, Palacios C, Palmer P, Pan WH, Panagiotakos D, Parajuli R, Park M, Pekcan G, Petrova S, Piaseu N, Pitsavos C, Polasa K, Posada L, Pourfarzi F, Preston AM, Rached I, Rahbar AR, Rehm C, Richter A, Riley L, Salanave B, Sánchez-Romero LM, Sarrafzadegan N, Sawada N, Sekiyama M, Selamat R, Shamsuddin K, Shariff ZM, Sharma S, Sibai AM, Sinkko H, Sioen I, Sisa I, Skeaff S, Steingrimsdottir L, Strand T, Suarez-Ortegon MF, Swaminathan S, Swan G, Sygnowska E, Szabo M, Szponar L, Tan-Khouw I, Tapanainen H, Tayyem R, Tedla B, Tedstone A, Templeton R, Termote C, Thanopoulou A, Thorgeirsdottir H, Thorsdottir I, Trichopoulos D, Trichopoulou A, Tsugane S, Turrini A, van Oosterhout C, Vartiainen E, Veerman JL, Virtanen S, Vollenweider P, Vossenaar M, Waidyatilaka I, Waskiewicz A, Waterham E, Wieler L, Wondwossen T, Wu S, Yaakub R, Yap M, Yusof S, Zaghloul S, Zajkás G, Zapata M, Zarina K, Zohoori FV. Global, regional, and national consumption of animal-source foods between 1990 and 2018: findings from the Global Dietary Database. The Lancet Planetary Health 2022; 6:e243-e256. [PMID: 35278390 PMCID: PMC8926870 DOI: 10.1016/s2542-5196(21)00352-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023]
Abstract
Background Methods Findings Interpretation Funding
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Meritsi A, Latsou D, Manesis E, Gatos I, Theotokas I, Zoumpoulis P, Rapti S, Tsitsopoulos E, Moshoyianni H, Manolakopoulos S, Pektasides D, Thanopoulou A. Noninvasive, Blood-Based Biomarkers as Screening Tools for Hepatic Fibrosis in People With Type 2 Diabetes. Clin Diabetes 2022; 40:327-338. [PMID: 35983425 PMCID: PMC9331611 DOI: 10.2337/cd21-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is dramatically increasing in parallel with the pandemic of type 2 diabetes. Here, the authors aimed to assess the performance of the most commonly used noninvasive, blood-based biomarkers for liver fibrosis (FibroTest, NAFLD fibrosis score, BARD score, and FIB-4 Index) in subjects with type 2 diabetes. Liver stiffness measurement was estimated by two-dimensional shear wave elastography. Finally, the authors assessed the diagnostic role of ActiTest and NashTest 2 in liver fibrosis in the examined population.
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Affiliation(s)
- Angeliki Meritsi
- Diabetic Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Latsou
- Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece
| | | | - Ilias Gatos
- Diagnostic Echotomography, SA, Kifissia, Athens, Greece
| | | | | | - Stamatia Rapti
- Laboratory of Molecular Genetics, Biomedicine, SA, Athens, Greece
| | | | | | - Spilios Manolakopoulos
- Liver and Gastrointestinal Unit, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Pektasides
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetic Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Meritsi A, Manesis E, Koussis P, Rapti S, Latsou D, Tsitsopoulos E, Moshoyianni H, Manolakopoulos S, Pektasides D, Thanopoulou A. PNPLA3 rs 738409 and Other Nongenetic Factors Associated with Hepatic Steatosis Estimated by Magnetic Resonance Imaging Proton Density Fat Fraction in Adult Greek Subjects with Type 2 Diabetes Mellitus. Metab Syndr Relat Disord 2021; 20:124-131. [PMID: 34962148 DOI: 10.1089/met.2021.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: Nonalcoholic fatty liver disease is dramatically increasing in parallel with the pandemic of type 2 diabetes mellitus. We investigated factors associated with hepatic steatosis (HS) in adult Greek individuals with established type 2 diabetes mellitus. Materials and Methods: We investigated 120 consecutive people with type 2 diabetes attending the Diabetic Outpatient Clinic at an Academic Hospital in Athens, Greece. All of them had demographic, clinical, and biochemical data recorded. HS was estimated by magnetic resonance imaging determined by proton density fat fraction software and defined as the percentage of total liver fat divided by the liver volume. HS of >5% was considered abnormal. The PNPLA3 (I148M) variant was evaluated as a genetic factor by standard molecular techniques. FibroMax™ was also calculated. Results: Of the 120 participants, median age was 61.7, 46% were females, diabetes duration was 10 years, and HbA1c (glycated hemoglobin) was 6.7%. The median value of HS was 7.8. The PNPLA3 rs738409 CC/CG/GG genotype frequencies were 54.2%, 35%, and 10.8%, respectively. In multivariate analysis, PNPLA3 rs738409 (β = 0.425, P = 0.001), waist circumference (β = 2.448, P = 0.001), and female sex (β = 0.419, P = 0.002) had a direct association with HS, while duration of diabetes (β = -0.179, P = 0.011) had an inverse association with HS. Conclusions: HS in type 2 diabetes is the sum of interplay of various factors exerting a direct or an inverse association, the most prominent among them being abdominal obesity and PNPLA3 molecular variability.
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Affiliation(s)
- Angeliki Meritsi
- Diabetic Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Stamatia Rapti
- Laboratory of Molecular Genetics, Biomedicine SA, Athens, Greece
| | - Dimitra Latsou
- Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece
| | | | | | - Spilios Manolakopoulos
- Liver & Gastrointestinal Unit, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Pektasides
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetic Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Antonopoulos AS, Siasos G, Oikonomou E, Gouliopoulos N, Konsola T, Tsigkou V, Moschos M, Tentolouris N, Kassi E, Paschou SA, Thanopoulou A, Vavuranakis M, Stone P, Antoniades C, Tousoulis D. Arterial stiffness and microvascular disease in type 2 diabetes. Eur J Clin Invest 2021; 51:e13380. [PMID: 33368197 DOI: 10.1111/eci.13380] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The clustering of arterial stiffness with microvascular disease (MD) and their effects on the clinical outcome of patients with type 2 diabetes (T2D) remains not fully clarified. METHODS In a prospective study of 414 patients with T2D, we investigated the prognostic value of arterial stiffness and MD for clinical outcomes. Participants were assessed for the presence of MD (ie diabetic retinopathy, nephropathy and neuropathy) and arterial stiffness by pulse wave velocity (PWV) and followed-up for a median of 30 (range 1-60) months. The primary endpoint of the study was the composite endpoint of major adverse cardiovascular events, that is, cardiovascular and non-cardiovascular mortality and non-fatal myocardial infarction/stroke. RESULTS A total of 146 (35.3%) patients had evidence of MD at baseline. In cox regression models, MD and PWV were independently associated with the composite clinical endpoint; for MD hazard ratio (HR), 3.24, 95%CI, 1.10-9.54, P=.032, and for PWV HR, 1.20, 95%CI, 1.06-1.36, P=.004) after adjustment for traditional risk factors, and enhanced risk discrimination and reclassification. The subgroup of patients with MD and high PWV was associated with increased incidence of the composite clinical endpoint (20.9% vs 1.8% in those with no MD & low PWV, P=.001). Importantly, absence of MD at baseline was associated with no mortality events during the follow-up period. PWV at baseline was not associated with MD progression during follow-up. CONCLUSIONS These findings support that screening for arterial stiffness and MD in the routine clinical assessment of patients with T2D may enhance prognostication and cardiovascular risk reclassification.
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Affiliation(s)
- Alexios S Antonopoulos
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Evangelos Oikonomou
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Nikolaos Gouliopoulos
- 1st Department of Opthalmology, School of Medicine, Gennimatas General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodosia Konsola
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Vasiliki Tsigkou
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Marilita Moschos
- 1st Department of Opthalmology, School of Medicine, Gennimatas General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- 1st Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eva Kassi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- 2nd Department of Internal Medicine, Division of Diabetes, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens Medical School, Sotiria Hospital, Athens, Greece
| | - Peter Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Dimitris Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
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Koliaki C, Tzeravini E, Papachristoforou E, Severi I, El Deik E, Karaolia M, Noutsou M, Thanopoulou A, Kountouri A, Balampanis K, Lambadiari V, Tentolouris N, Kokkinos A. Eligibility and Awareness Regarding Metabolic Surgery in Patients With Type 2 Diabetes Mellitus in the Real-World Clinical Setting; Estimate of Possible Diabetes Remission. Front Endocrinol (Lausanne) 2020; 11:383. [PMID: 32582036 PMCID: PMC7292012 DOI: 10.3389/fendo.2020.00383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 01/06/2023] Open
Abstract
Despite high-quality evidence highlighting metabolic surgery as an effective treatment option for type 2 diabetes mellitus (T2DM), the number of patients receiving bariatric surgery (BS) remains low. Since the introduction of the Diabetes Surgery Summit II (DSS-II) eligibility criteria, data on eligibility rates for BS in T2DM cohorts remain scarce. The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of T2DM patients visiting diabetes outpatient clinics who meet the DSS-II eligibility criteria, (ii) how many of these have been informed about the option of BS, and (iii) what are the characteristics associated with eligibility and awareness of BS. Demographic, anthropometric, clinical and socioeconomic data were obtained for all patients with T2DM who were consecutively examined in the outpatient clinics of three large-volume university hospitals (n = 1167). A medical registry form was completed to screen for BS eligibility. Patients were considered eligible if the recommendation by DSS-II criteria was either to "consider" or "recommend" BS. Eligible patients were further inquired whether they had ever been informed about the option of BS by their physicians. The advanced DiaRem score (ADRS) was applied to eligible patients to assess their probability of achieving postoperative T2DM remission. A significant percentage of T2DM patients who are routinely assessed in outpatient clinics meet the DSS-II eligibility criteria (15.3%). Eligible patients are younger and more obese, have a shorter T2DM duration, worse glycaemic control and better renal function, compared to non-eligible ones. Among eligible patients, only 39.3% have been medically informed about the option of BS. Informed patients are younger and more severely obese than non-informed ones. A significant percentage of non-informed patients (35%) have an ADRS ≤10, indicating a considerable probability for T2DM remission after BS, and are thus deprived of this opportunity due to lack of appropriate medical counseling. Screening and awareness of BS remain an unmet need in current T2DM management. Future research should focus on intensifying screening for BS eligibility at every medical visit and promoting evidence-based clinical recommendations for patients expected to benefit the most.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Severi
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Elina El Deik
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Melina Karaolia
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Konstantinos Balampanis
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- *Correspondence: Alexander Kokkinos
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8
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Bletsa E, Antonopoulos A, Siasos G, Stampouloglou PK, Batzias K, Paschou SA, Oikonomou E, Gouliopoulos N, Tsigkou V, Kassi E, Thanopoulou A, Vryonidou A, Tentolouris N, Pallantza Z, Tousoulis D. P2483Differential effects of novel antidiabetics on arterial stiffness in patients with type 2 diabetes mellitus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Arterial stiffness flags increased cardiovascular disease risk in type 2 diabetes mellitus (T2DM) patients. There is limited data on how novel anti-diabetic agents affect arterial stiffness.
Purpose
To investigate the effects of novel anti-diabetic agents on arterial stiffness in T2DM patients.
Patients and methods
We enrolled 64 consecutive patients under stable antidiabetic therapy who did not achieve therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=21), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=21) or long-acting insulin (n=8). Glycosylated hemoglobin (HbA1c) as well as carotid-femoral pulse wave velocity (PWV) and augmentation index (Alx) were measured (as indices of arterial stiffness) were measured at baseline and 3 months after treatment intensification.
Results
There were no differences between the study groups in traditional risk factors, or baseline HbA1c, PWV and Alx levels (p=NS for all). All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up (for DPP4i: 7.4±0.2% vs 6.7±0.2%, for GLP1RA: 8.3±0.2% vs 6.9±0.1%, for SGLT2i: 7.5±0.1% vs 6.7±0.1% and for insulin 9.8±0.5% vs 7.7±0.4%, p<0.001 for all). PWV decreased from 10.0±0.84 to 9.1±0.43 m/sec (p=0.092) in the DPP4i group, from 11.7±0.72 to 10.2±0.74 m/sec (p<0.001) in the GLP1RA group, from 1.3±0.54 to 9.6±0.59 m/sec (p=0.001) in the SGLT2i group and from 11.6±1.04 to 11.1±1.02 m/sec (p=0.219) in the insulin group. Alx was also decreased from 34.2±1.89 to 31.5±2.17% (p=0.023) in the DPP4i group, from 29.1±1.52 to 25.6±2.09% (p<0.001) in the GLP1RA group, from 29.9±1.44 to 24.2±1.48% (p<0.001) in SGLT2i group, and from 28.2±2.33 to 26.2±1.64% (p=0.153) in insulin group.
Conclusions
These preliminary data provide evidence that treatment intensification -particularly with GLP1RA, and SGLT2i- benefits vascular properties, a finding which could partly explain the positive findings of recent randomized clinical trails in this field.
Acknowledgement/Funding
None
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Affiliation(s)
- E Bletsa
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - A Antonopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - P K Stampouloglou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - K Batzias
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - S A Paschou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - N Gouliopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - V Tsigkou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Kassi
- Laiko University General Hospital, 1st Department of Internal Medicine, Athens Medical School, Athens, Greece
| | - A Thanopoulou
- Hippokration General Hospital, 2nd Department of Internal Medicine, Athens Medical School, Athens, Greece
| | - A Vryonidou
- Hellenic Red Cross Hospital, Department of Endocrinology and Diabetes, Athens, Greece
| | - N Tentolouris
- Laiko University General Hospital, Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Athens Medical School, Athens, Greece
| | - Z Pallantza
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
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9
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Stampouloglou PK, Antonopoulos A, Siasos G, Bletsa E, Batzias K, Paschou SA, Oikonomou E, Gouliopoulos N, Tsigkou V, Kassi E, Thanopoulou A, Vryonidou A, Tentolouris N, Pallantza Z, Tousoulis D. P2481The effect of DPP-4i, GLP-1RA, SGLT-2i and long-acting insulin on platelet function in patients with type 2 diabetes mellitus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Patients with type 2 diabetes mellitus (T2DM) are at higher risk for thrombotic events. Platelet function may be used to assess prothrombotic state in patients with cardiovascular disease.
Purpose
We aimed to investigate whether the administration of novel antidiabetic agents influence platelet function in TDM2 patients.
Patients and methods
We 60 enrolled consecutive patients with T2DM, on stable antidiabetic therapy, who did not achieve therapeutic targets. Subjects were assessed to receive an additional anti-diabetic agent; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=24), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=22). Platelet reactivity was measured with PFA-200 collagen/epinephrine (c-EPI) and PFA-200 collagen/ADP (c-ADP) closure time. Glycosylated hemoglobin (HbA1c), c-EPI and c-ADP were assessed at baseline and 3 months after treatment intensification.
Results
There was no difference between the study groups regarding gender, age, hypertension, dyslipidemia, smoking, Hba1c and CADP or CEPI (p=NS for all) at baseline. All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up (for DPP4i: 7.4±0.2% vs 6.7±0.2%, for GLP1RA: 8.3±0.2% vs 6.9±0.1%, for SGLT2i: 7.5±0.1% vs 6.7±0.1% and for insulin 9.8±0.5% vs 7.7±0.4%, p<0.001 for all). After a 3 month-period, treatment intensification with these novel agents did not influence c-EPI and c-ADP values [155.4±6.64 sec vs 152.9±8.28 sec (p=0.678) and 106.6±4.30 sec vs 106.8±3.93 sec (p=0.955) respectively] in whole population. In subgroup analysis, for patients off antiplatelet treatment (n=31), c-EPI was significantly decreased from 148.4±8.5 to 129.8±13.9 sec (p=0.036), but not c-ADP (from 105.4±5.3 to 99.3±4.9 sec, p=0.094). In patients who did receive antiplatelets (n=37), c-EPI and c-ADP were not significantly changed (c-EPI 163.1±10.9 to 179.6±13.9 sec p=0.201 and c-ADP from 106.6±8.2 sec to 114.6±7.3 sec, p=0.318) respectively.
Conclusion
Antiplatelet treatment prevents thrombotic risk in T2DM patients receiving novel antidiabetics. The effects of novel antidiabetics on platelet reactivity -as well as any distinct class properties- merits further investigation.
Acknowledgement/Funding
None
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Affiliation(s)
- P K Stampouloglou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - A Antonopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Bletsa
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - K Batzias
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - S A Paschou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - N Gouliopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - V Tsigkou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Kassi
- Laiko University General Hospital, 1st Department of Internal Medicine, Athens Medical School, Athens, Greece
| | - A Thanopoulou
- Hippokration General Hospital, 2nd Department of Internal Medicine, Athens Medical School, Athens, Greece
| | - A Vryonidou
- Hellenic Red Cross Hospital, Department of Endocrinology and Diabetes, Athens, Greece
| | - N Tentolouris
- Laiko University General Hospital, Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Athens Medical School, Athens, Greece
| | - Z Pallantza
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
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10
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Doupis J, Alexandrides T, Elisaf M, Melidonis A, Bousboulas S, Thanopoulou A, Pagkalos EM, Avramidis I, Pappas A, Arvaniti E, Karamousouli E, Voss B, Tentolouris N. Influence of Supervised Disease Understanding and Diabetes Self-Management on Adherence to Oral Glucose-Lowering Treatment in Patients with Type 2 Diabetes. Diabetes Ther 2019; 10:1407-1422. [PMID: 31222592 PMCID: PMC6612340 DOI: 10.1007/s13300-019-0648-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Systematic patient education has been reported to improve adherence to treatment, leading to better clinical outcomes. This cluster randomized real-world study investigated the effect of a systematic education program and telephone support on self-reported adherence to oral glucose-lowering treatment in patients with type 2 diabetes mellitus (T2DM). METHODS Centers were randomized (1:1) to provide either standard-of-care (control group) or standard-of-care along with the education program and telephone support (empowerment group). Adherence to treatment and satisfaction with treatment were assessed using the four-item Morisky Medication Adherence Scale (MMAS-4) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The study population included 457 patients (258/199 male/female) with T2DM and non-optimal glycemic control, on oral antidiabetic treatment (age 62.7 [11.4]; disease duration 8.5 [6.5] years). RESULTS MMAS-4 high adherence rates for the control and empowerment groups were increased by 3.8% and 16.8% at 4 months (Breslow-Day test p = 0.04) and by 8.5% and 18.8% at 8 months of follow-up, respectively (Breslow-Day test p = 0.09), compared to baseline. Intense physical activity was increased in both control and empowerment groups by 2.3% and 13.9% at 4 months (Breslow-Day test p = 0.082) and by 4.0% and 22.5% at 8 months of follow-up (Breslow-Day test p < 0.001). Baseline mean (SD) HbA1c was significantly lower in the control group compared with the empowerment group [7.7% versus 8.0%, p = 0.001] and decreased in both groups at 4 months by 0.7% and 0.9%, respectively. The change from baseline in the mean DTSQ status score at 4 months was greater in the empowerment group, and the effect was sustained at 8 months (control group: 29.1, 30.5, and 30.9; empowerment group: 25.0, 28.7, and 29.4 at baseline, 4 and 8 months, respectively, p < 0.001). CONCLUSION Systematic education combined with telephone support delivered by physicians might be associated with improvement in treatment adherence and treatment satisfaction in patients with T2DM. FUNDING MSD, Greece.
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Affiliation(s)
- John Doupis
- Internal Medicine and Diabetes Department, NS Naval Hospital, Athens, Greece.
| | - Theodoros Alexandrides
- Division of Endocrinology, Department of Medicine, University General Hospital of Patras, Patras, Greece
| | - Moses Elisaf
- School of Health Sciences, Faculty of Medicine, Department of Internal Medicine, University of Ioannina, Ioannina, Greece
| | | | | | - Anastasia Thanopoulou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokratio General Hospital, Athens, Greece
| | | | - Iakovos Avramidis
- First Medical Department, G. Papanikolaou General Hospital, Thessaloniki, Greece
| | - Angelos Pappas
- Diabetic Center, Venizelio General Hospital Heraklion, Crete, Greece
| | - Eleni Arvaniti
- General Hospital of Ioannina "G. Hatzikosta", Ioannina, Greece
| | | | | | - Nikolaos Tentolouris
- 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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11
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Siasos G, Stampouloglou P, Bletsa E, Tsigkou V, Mourouzis K, Gouliopoulos N, Zaromytidou M, Mazaris S, Oikonomou E, Antonopoulos A, Tsalamandris S, Vogiatzi G, Thanopoulou A, Vryonidou A, Paschou SA, Politou M, Tentolouris N, Tousoulis D. THE ASSOCIATION OF VASCULAR DYSFUNCTION AND PLATELET REACTIVITY IS REGULATED BY THE INTERACTION BETWEEN ANTIDIABETIC AND ANTIPLATELET TREATMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Schizophrenia is associated with increased risk for type 2 diabetes mellitus, resulting in elevated cardiovascular risk and limited life expectancy, translated into a weighted average of 14.5 years of potential life lost and an overall weighted average life expectancy of 64.7 years. The exact prevalence of type 2 diabetes among people with schizophrenia varies across studies and ranges 2-5fold higher than in the general population, whereas the aetiology is complex and multifactorial. Besides common diabetogenic factors, applied similarly in the general population, such as obesity, hyperlipidemia, smoking, hypertension, poor diet and limited physical activity, the co-occurrence of schizophrenia and diabetes is also attributed to unique conditions. Specifically, excessive sedentary lifestyle, social determinants, adverse effects of antipsychotic drugs and limited access to medical care are considered aggravating factors for diabetes onset and low quality of diabetes management. Schizophrenia itself is further proposed as causal factor for diabetes, given the observed higher prevalence of diabetes in young patients, newly diagnosed with schizophrenia and unexposed to antipsychotics. Furthermore, studies support genetic predisposition to diabetes among people with schizophrenia, suggesting shared genetic risk and disclosing a number of overlapped risk loci. Therefore, special attention should be paid in preventing diabetes in people with schizophrenia, through intervention in all possible modifiable risk factors. Implementation of careful antipsychotic prescription, provision of adequate motivation for balanced diet and physical activity and facilitating access to primary health care, could serve in reducing diabetes prevalence. On the other hand, increasing calls are made for early diagnosis of diabetes, application of the appropriate anti-diabetic therapy and strict inspection of therapy adherence, to limit the excess mortality due to cardiovascular events in people with schizophrenia. Moreover, population health programs could help counseling and preventing diabetes risk, additionally to early screening and diagnosis set, aiming to reduce disparities in populations. Finally, mental health-care providers might greatly promote offered health services to patients with schizophrenia, through a holistic individualized approach, considering additionally the physical health of the patients and working closely, preventively and therapeutically, in collaboration with the physicians and diabetologists.
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Affiliation(s)
- V Mamakou
- Medical School, National and Kapodistrian University of Athens, Athens.,Dromokaiteio Psychiatric Hospital, Athens
| | - A Thanopoulou
- Diabetes Centre, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens
| | - F Gonidakis
- 1st Psychiatric Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens
| | - N Tentolouris
- First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece
| | - V Kontaxakis
- 1st Psychiatric Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens
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13
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Tentolouris A, Thanopoulou A, Tentolouris N, Eleftheriadou I, Voulgari C, Andrianakos A, Sfikakis PP. Low prevalence of rheumatoid arthritis among patients with pre-existing type 2 diabetes mellitus. Ann Transl Med 2018; 6:399. [PMID: 30498726 DOI: 10.21037/atm.2018.09.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Type 2 diabetes mellitus (T2DM) is a non-autoimmune disease characterized by chronic hyperglycemia and increased non-enzymatic glycation of amino groups. Glycation occurs through a series of events eventually leading to the formation of irreversible "advanced glycation end-products" (AGEs). AGEs may affect the function of long-lived proteins, including cytokines, immunoglobulins and their receptors, resulting in a "less active" immune system. We aimed to test the hypothesis that a common inflammatory chronic disease, such as rheumatoid arthritis (RA), in which the earliest event is an inflammatory response to unknown stimulus, has a lower prevalence in these patients than in normoglycemic, non-diabetic subjects. Methods In this study, we compared the prevalence of RA in a prospectively followed outpatient cohort of patients with T2DM patients (n=1,630) with a control, matched, non-diabetic population (n=1,630). Results Among non-diabetic controls, 13 patients (prevalence 0.80%) with RA were identified. An almost 3-fold lower prevalence of RA (0.25%) was found in consecutive patients with T2DM (P=0.029). Most of the RA cases among participants with T2DM were diagnosed early after diabetes onset. The onset of RA in patients with T2DM occurred at significantly older age (64±15 years) as compared to the non-diabetes group (48±18 years; P=0.004). Conclusions The prevalence of RA is lower and occurs in an older age in patients with pre-existing T2DM in comparison with people without T2DM.
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Affiliation(s)
- Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Anastasia Thanopoulou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Christina Voulgari
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexandros Andrianakos
- Rheumatic Disease Epidemiology Section, Hellenic Foundation for Rheumatological Research, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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14
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Mamakou V, Hackinger S, Zengini E, Tsompanaki E, Marouli E, Serafetinidis I, Prins B, Karabela A, Glezou E, Southam L, Rayner NW, Kuchenbaecker K, Lamnissou K, Kontaxakis V, Dedoussis G, Gonidakis F, Thanopoulou A, Tentolouris N, Zeggini E. Combination therapy as a potential risk factor for the development of type 2 diabetes in patients with schizophrenia: the GOMAP study. BMC Psychiatry 2018; 18:249. [PMID: 30071838 PMCID: PMC6090901 DOI: 10.1186/s12888-018-1826-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Schizophrenia (SCZ) is associated with increased risk of type 2 diabetes (T2D). The potential diabetogenic effect of concomitant application of psychotropic treatment classes in patients with SCZ has not yet been evaluated. The overarching goal of the Genetic Overlap between Metabolic and Psychiatric disease (GOMAP) study is to assess the effect of pharmacological, anthropometric, lifestyle and clinical measurements, helping elucidate the mechanisms underlying the aetiology of T2D. METHODS The GOMAP case-control study (Genetic Overlap between Metabolic and Psychiatric disease) includes hospitalized patients with SCZ, some of whom have T2D. We enrolled 1653 patients with SCZ; 611 with T2D and 1042 patients without T2D. This is the first study of SCZ and T2D comorbidity at this scale in the Greek population. We retrieved detailed information on first- and second-generation antipsychotics (FGA, SGA), antidepressants and mood stabilizers, applied as monotherapy, 2-drug combination, or as 3- or more drug combination. We assessed the effects of psychotropic medication, body mass index, duration of schizophrenia, number of hospitalizations and physical activity on risk of T2D. Using logistic regression, we calculated crude and adjusted odds ratios (OR) to identify associations between demographic factors and the psychiatric medications. RESULTS Patients with SCZ on a combination of at least three different classes of psychiatric drugs had a higher risk of T2D [OR 1.81 (95% CI 1.22-2.69); p = 0.003] compared to FGA alone therapy, after adjustment for age, BMI, sex, duration of SCZ and number of hospitalizations. We did not find evidence for an association of SGA use or the combination of drugs belonging to two different classes of psychiatric medications with increased risk of T2D [1.27 (0.84-1.93), p = 0.259 and 0.98 (0.71-1.35), p = 0.885, respectively] compared to FGA use. CONCLUSIONS We find an increased risk of T2D in patients with SCZ who take a combination of at least three different psychotropic medication classes compared to patients whose medication consists only of one or two classes of drugs.
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Affiliation(s)
- Vasiliki Mamakou
- Medical School, National and Kapodistrian University Athens, 75 M. Assias Street, 115 27, Athens, Greece. .,Dromokaiteio Psychiatric Hospital, 124 61, Athens, Greece.
| | - Sophie Hackinger
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | - Eleni Zengini
- Dromokaiteio Psychiatric Hospital, 124 61 Athens, Greece ,0000 0004 1936 9262grid.11835.3eDepartment of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Evgenia Tsompanaki
- 0000 0001 2179 8267grid.16299.35School of Information Sciences and Technology, Department of Statistics, Athens University of Economics and Business, 10434 Athens, Greece
| | - Eirini Marouli
- 0000 0001 2171 1133grid.4868.2William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQ, London, UK
| | - Ioannis Serafetinidis
- grid.414012.2Department of Gastroenterology, Gennimatas General Hospital, 11527 Athens, Greece
| | - Bram Prins
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | | | - Eirini Glezou
- Dromokaiteio Psychiatric Hospital, 124 61 Athens, Greece
| | - Lorraine Southam
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK ,0000 0004 1936 8948grid.4991.5Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Nigel W. Rayner
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK ,0000 0004 1936 8948grid.4991.5Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK ,0000 0004 0606 4224grid.470392.bOxford Centre for Diabetes Endocrinology and Metabolism, Oxford, UK
| | - Karoline Kuchenbaecker
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
| | - Klea Lamnissou
- 0000 0001 2155 0800grid.5216.0National and Kapodistrian University of Athens, Department of Biology, Athens, Panepistimioupolis, AnoIlisia, 15771 Athens, Greece
| | - Vassilis Kontaxakis
- 0000 0001 2155 0800grid.5216.0Early Psychosis Unit, 1st Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Dedoussis
- 0000 0004 0622 2843grid.15823.3dDepartment of Nutrition-Dietetics, Harokopio University, 17671 Athens, Greece
| | - Fragiskos Gonidakis
- 0000 0001 2155 0800grid.5216.01st Psychiatric Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasia Thanopoulou
- 0000 0001 2155 0800grid.5216.0Diabetes Centre, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, 11527 Athens, Greece
| | - Eleftheria Zeggini
- 0000 0004 0606 5382grid.10306.34Wellcome Sanger Institute, Hinxton, Cambridge, HH CB10 1 UK
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15
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Batzias K, Antonopoulos AS, Oikonomou E, Siasos G, Bletsa E, Stampouloglou PK, Mistakidi CV, Noutsou M, Katsiki N, Karopoulos P, Charalambous G, Thanopoulou A, Tentolouris N, Tousoulis D. Effects of Newer Antidiabetic Drugs on Endothelial Function and Arterial Stiffness: A Systematic Review and Meta-Analysis. J Diabetes Res 2018; 2018:1232583. [PMID: 30622967 PMCID: PMC6304901 DOI: 10.1155/2018/1232583] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Newer antidiabetic drugs, i.e., dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may exert distinct cardiovascular effects. We sought to explore their impact on vascular function. METHODS Published literature was systematically searched up to January 2018 for clinical studies assessing the effects of DPP-4 inhibitors, GLP-1 RAs, and SGLT-2 inhibitors on endothelial function and arterial stiffness, assessed by flow-mediated dilation (FMD) of the brachial artery and pulse wave velocity (PWV), respectively. For each eligible study, we used the mean difference (MD) with 95% confidence intervals (CIs) for FMD and PWV. The pooled MD for FMD and PWV were calculated by using a random-effect model. The presence of heterogeneity among studies was evaluated by the I 2 statistic. RESULTS A total of 26 eligible studies (n = 668 patients) were included in the present meta-analysis. Among newer antidiabetic drugs, only SGLT-2 inhibitors significantly improved FMD (pooled MD 1.14%, 95% CI: 0.18 to 1.73, p = 0.016), but not DPP-4 inhibitors (pooled MD = 0.86%, 95% CI: -0.15 to 1.86, p = 0.095) or GLP-1 RA (pooled MD = 2.37%, 95% CI: -0.51 to 5.25, p = 0.107). Both GLP-1 RA (pooled MD = -1.97, 95% CI: -2.65 to -1.30, p < 0.001) and, to a lesser extent, DPP-4 inhibitors (pooled MD = -0.18, 95% CI: -0.30 to -0.07, p = 0.002) significantly decreased PWV. CONCLUSIONS Newer antidiabetic drugs differentially affect endothelial function and arterial stiffness, as assessed by FMD and PWV, respectively. These findings could explain the distinct effects of these drugs on cardiovascular risk of patients with type 2 diabetes.
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Affiliation(s)
- Konstantinos Batzias
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexios S. Antonopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evanthia Bletsa
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Panagiota K. Stampouloglou
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Chara-Vasiliki Mistakidi
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Niki Katsiki
- Second Department of Internal Medicine, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Periklis Karopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Charalambous
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic and Internal Medicine, Division of Diabetes, Laiko University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Pagkalos E, Thanopoulou A, Sampanis C, Bousboulas S, Melidonis A, Tentolouris N, Alexandrides T, Migdalis I, Karamousouli E, Papanas N. The Real-Life Effectiveness and Care Patterns of Type 2 Diabetes Management in Greece. Exp Clin Endocrinol Diabetes 2017; 126:53-60. [DOI: 10.1055/s-0043-109242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Aim To investigate the prevalence of hypoglycaemia during sulfonylurea (SU) treatment of type 2 diabetes mellitus (T2DM) in Greece and its influence on glycaemic control, treatment adherence and quality of life (QoL).
Patients and methods This was a retrospective cross-sectional study. We included 383 T2DM patients ≥30 years old on treatment with SU in monotherapy or in combination with metformin for at least 6 months. Patients were requested to fill in retrospective questionnaires on hypoglycaemia experience, adherence, weight gain and lifestyle/behavioural factors along with QoL (EQ-5D-3L), treatment satisfaction (TSQM), and fear of hypoglycaemia (HFS-II Worry scale).
Results HbA1c<7% was found in 161 (42.0%) patients. In total, 165 (43.1%) patients reported hypoglycaemic symptoms during the previous 6 months: 41.6% (67/161) of those with HbA1c <7% and 44.1% (98/222) of those with HbA1c ≥7%. Glycaemic control was achieved by 43.1% (94/218) of patients without hypoglycaemia and 50.0% (41/82), 36.8% (25/68) and 6.7% (1/15) of patients with mild, moderate or severe hypoglycaemia, respectively (p=0.013). In multivariate analysis, both occurrence (none vs. mild/moderate/severe) and severity (none vs. mild vs. moderate vs. severe) of hypoglycaemia were significantly associated with impaired global treatment satisfaction (p=0.002 and p<0.0001 respectively) and HFS-II Worry scale scores (both p<0.0001), while lower QoL (EQ-5D (UK) Index) was related to hypoglycaemia severity (p=0.024) only. Finally, treatment adherence was associated with increased (none/mild vs. moderate/severe) hypoglycaemia severity in univariate analysis (p=0.019).
Conclusion A high prevalence of patient treated with SU reported hypoglycaemia in Greek healthcare settings with negative effects on treatment satisfaction, patient worry and adherence. Severity of hypoglycaemic symptoms was associated with reduced glycaemic control.
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Affiliation(s)
| | - Anastasia Thanopoulou
- Second Department of Internal Medicine, General Hospital “Hippocratio”, National and Kapodistrian University, Athens, Greece
| | - Christos Sampanis
- Diabetes Centre, Second Propaedeutic Department of Internal Medicine “Hippocratio”, Thessaloniki, Greece
| | | | | | - Nicholas Tentolouris
- First Propaedeutic Department of Internal Medicine, General Hospital “Laiko”, National and Kapodistrian University, Athens, Greece
| | | | - Ilias Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, Greece
| | - Eugenia Karamousouli
- Merck Sharp & Dohme Pharmaceutical, Industrial and Commercial S.A, Athens, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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17
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Barmpari ME, Kokkorou M, Micheli A, Alexiou I, Spanou E, Noutsou M, Thanopoulou A. Thyroid Dysfunction among Greek Patients with Type 1 and Type 2 Diabetes Mellitus as a Disregarded Comorbidity. J Diabetes Res 2017; 2017:6505814. [PMID: 29214182 PMCID: PMC5682912 DOI: 10.1155/2017/6505814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/27/2017] [Accepted: 10/08/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of thyroid dysfunction in Greek patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus as well as its possible relations to glycaemic control and to diabetic complications. METHODS A total of 1015 patients, consecutively followed in the Outpatient Diabetes Center, were studied. Anthropometric and biochemical measurements, occurrence of diabetes complications, and classical comorbidities were assessed. Average HbA1c of the previous year was calculated. Wellbeing was determined, using a 10-point optimal scale. All the above parameters were compared between subjects with or without thyroid disease. RESULTS All patients were euthyroid at the time of the study, either on thyroid medications or not. Hypothyroidism occurrence did not differ between T2DM and T1DM patients (37.1% versus 43.5%, p > 0.05). Nodular goiter was observed more frequently in T2DM patients (34.1% versus 18.8%, p < 0.05). T2DM patients with hypothyroidism compared to those without hypothyroidism had higher HbA1c (7.27% versus 6.98%, p < 0.01), TChol (184.97 mg/dl versus 168.17 mg/dl, p < 0.001), and higher HDL-Chol (51.28 mg/dl versus 46.77 mg/dl, p < 0.01). T2DM patients without hypothyroidism had a better wellness feeling (7.5 versus 5.3 points, p < 0.01). CONCLUSIONS Screening for thyroid disease among T2DM patients should be routinely considered, as it is found to be an additional commorbidity. If it remains undiagnosed, it could aggravate the clinical course of the disease.
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Affiliation(s)
- Maria E. Barmpari
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Maria Kokkorou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Anastasia Micheli
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Irene Alexiou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Elefteria Spanou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
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18
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Wessel J, Chu AY, Willems SM, Wang S, Yaghootkar H, Brody JA, Dauriz M, Hivert MF, Raghavan S, Lipovich L, Hidalgo B, Fox K, Huffman JE, An P, Lu Y, Rasmussen-Torvik LJ, Grarup N, Ehm MG, Li L, Baldridge AS, Stančáková A, Abrol R, Besse C, Boland A, Bork-Jensen J, Fornage M, Freitag DF, Garcia ME, Guo X, Hara K, Isaacs A, Jakobsdottir J, Lange LA, Layton JC, Li M, Hua Zhao J, Meidtner K, Morrison AC, Nalls MA, Peters MJ, Sabater-Lleal M, Schurmann C, Silveira A, Smith AV, Southam L, Stoiber MH, Strawbridge RJ, Taylor KD, Varga TV, Allin KH, Amin N, Aponte JL, Aung T, Barbieri C, Bihlmeyer NA, Boehnke M, Bombieri C, Bowden DW, Burns SM, Chen Y, Chen YD, Cheng CY, Correa A, Czajkowski J, Dehghan A, Ehret GB, Eiriksdottir G, Escher SA, Farmaki AE, Frånberg M, Gambaro G, Giulianini F, Goddard WA, Goel A, Gottesman O, Grove ML, Gustafsson S, Hai Y, Hallmans G, Heo J, Hoffmann P, Ikram MK, Jensen RA, Jørgensen ME, Jørgensen T, Karaleftheri M, Khor CC, Kirkpatrick A, Kraja AT, Kuusisto J, Lange EM, Lee IT, Lee WJ, Leong A, Liao J, Liu C, Liu Y, Lindgren CM, Linneberg A, Malerba G, Mamakou V, Marouli E, Maruthur NM, Matchan A, McKean-Cowdin R, McLeod O, Metcalf GA, Mohlke KL, Muzny DM, Ntalla I, Palmer ND, Pasko D, Peter A, Rayner NW, Renström F, Rice K, Sala CF, Sennblad B, Serafetinidis I, Smith JA, Soranzo N, Speliotes EK, Stahl EA, Stirrups K, Tentolouris N, Thanopoulou A, Torres M, Traglia M, Tsafantakis E, Javad S, Yanek LR, Zengini E, Becker DM, Bis JC, Brown JB, Adrienne Cupples L, Hansen T, Ingelsson E, Karter AJ, Lorenzo C, Mathias RA, Norris JM, Peloso GM, Sheu WHH, Toniolo D, Vaidya D, Varma R, Wagenknecht LE, Boeing H, Bottinger EP, Dedoussis G, Deloukas P, Ferrannini E, Franco OH, Franks PW, Gibbs RA, Gudnason V, Hamsten A, Harris TB, Hattersley AT, Hayward C, Hofman A, Jansson JH, Langenberg C, Launer LJ, Levy D, Oostra BA, O'Donnell CJ, O'Rahilly S, Padmanabhan S, Pankow JS, Polasek O, Province MA, Rich SS, Ridker PM, Rudan I, Schulze MB, Smith BH, Uitterlinden AG, Walker M, Watkins H, Wong TY, Zeggini E, Laakso M, Borecki IB, Chasman DI, Pedersen O, Psaty BM, Shyong Tai E, van Duijn CM, Wareham NJ, Waterworth DM, Boerwinkle E, Linda Kao WH, Florez JC, Loos RJ, Wilson JG, Frayling TM, Siscovick DS, Dupuis J, Rotter JI, Meigs JB, Scott RA, Goodarzi MO. Low-frequency and rare exome chip variants associate with fasting glucose and type 2 diabetes susceptibility. Nat Commun 2015; 6:5897. [PMID: 25631608 PMCID: PMC4311266 DOI: 10.1038/ncomms6897] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/12/2014] [Indexed: 12/30/2022] Open
Abstract
Fasting glucose and insulin are intermediate traits for type 2 diabetes. Here we explore the role of coding variation on these traits by analysis of variants on the HumanExome BeadChip in 60,564 non-diabetic individuals and in 16,491 T2D cases and 81,877 controls. We identify a novel association of a low-frequency nonsynonymous SNV in GLP1R (A316T; rs10305492; MAF=1.4%) with lower FG (β=-0.09±0.01 mmol l(-1), P=3.4 × 10(-12)), T2D risk (OR[95%CI]=0.86[0.76-0.96], P=0.010), early insulin secretion (β=-0.07±0.035 pmolinsulin mmolglucose(-1), P=0.048), but higher 2-h glucose (β=0.16±0.05 mmol l(-1), P=4.3 × 10(-4)). We identify a gene-based association with FG at G6PC2 (pSKAT=6.8 × 10(-6)) driven by four rare protein-coding SNVs (H177Y, Y207S, R283X and S324P). We identify rs651007 (MAF=20%) in the first intron of ABO at the putative promoter of an antisense lncRNA, associating with higher FG (β=0.02±0.004 mmol l(-1), P=1.3 × 10(-8)). Our approach identifies novel coding variant associations and extends the allelic spectrum of variation underlying diabetes-related quantitative traits and T2D susceptibility.
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Affiliation(s)
- Jennifer Wessel
- Department of Epidemiology, Fairbanks School of Public Health, Indianapolis, Indiana 46202, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Audrey Y Chu
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
| | - Sara M Willems
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Shuai Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| | - Marco Dauriz
- Massachusetts General Hospital, General Medicine Division, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona Medical School and Hospital Trust of Verona, Verona 37126, Italy
| | - Marie-France Hivert
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts 02215, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada J1K 2R1
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Sridharan Raghavan
- Massachusetts General Hospital, General Medicine Division, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Leonard Lipovich
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan 48201, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan 48202, USA
| | - Bertha Hidalgo
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA
| | - Keolu Fox
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington 98195, USA
| | - Jennifer E Huffman
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, Scotland EH4 2XU, UK
| | - Ping An
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Yingchang Lu
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Niels Grarup
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Margaret G Ehm
- Quantitative Sciences, PCPS, GlaxoSmithKline, North Carolina 27709, USA
| | - Li Li
- Quantitative Sciences, PCPS, GlaxoSmithKline, North Carolina 27709, USA
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Alena Stančáková
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio FI-70211, Finland
| | - Ravinder Abrol
- Department of Medicine and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Materials and Process Simulation Center, California Institute of Technology, Pasadena, California 91125, USA
| | - Céline Besse
- CEA, Institut de Génomique, Centre National de Génotypage, 2 Rue Gaston Crémieux, EVRY Cedex 91057, France
| | - Anne Boland
- CEA, Institut de Génomique, Centre National de Génotypage, 2 Rue Gaston Crémieux, EVRY Cedex 91057, France
| | - Jette Bork-Jensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, Texas 77030, USA
| | - Daniel F Freitag
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Melissa E Garcia
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland 21224, USA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Kazuo Hara
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Aaron Isaacs
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | | | - Leslie A Lange
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Jill C Layton
- Indiana University, Fairbanks School of Public Health, Indianapolis, Indiana 46202, USA
| | - Man Li
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Karina Meidtner
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal DE-14558, Germany
| | - Alanna C Morrison
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77225, USA
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, Maryland 20892, USA
| | - Marjolein J Peters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
- The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Leiden/Rotterdam 2300 RC, The Netherlands
| | - Maria Sabater-Lleal
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Claudia Schurmann
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Angela Silveira
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Albert V Smith
- Icelandic Heart Association, Holtasmari 1, Kopavogur IS-201, Iceland
- University of Iceland, Reykjavik IS-101, Iceland
| | - Lorraine Southam
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
| | - Marcus H Stoiber
- Department of Genome Dynamics, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - Rona J Strawbridge
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Tibor V Varga
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Kristine H Allin
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Najaf Amin
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Jennifer L Aponte
- Quantitative Sciences, PCPS, GlaxoSmithKline, North Carolina 27709, USA
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
| | - Caterina Barbieri
- Division of Genetics and Cell Biology, San Raffaele Research Institute, Milano 20132, Italy
| | - Nathan A Bihlmeyer
- Predoctoral Training Program in Human Genetics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Maryland 21205, USA
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Cristina Bombieri
- Section of Biology and Genetics, Department of Life and Reproduction Sciences, University of Verona, Verona 37100, Italy
| | - Donald W Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Sean M Burns
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Yuning Chen
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Yii-DerI Chen
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, National University of Singapore, Singapore 169857, Singapore
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
| | - Jacek Czajkowski
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Georg B Ehret
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA
- Division of Cardiology, Geneva University Hospital Geneva 1211, Switzerland
| | | | - Stefan A Escher
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Aliki-Eleni Farmaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece
| | - Mattias Frånberg
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
- Department of Numerical Analysis and Computer Science, SciLifeLab, Stockholm University, Stockholm SE-106 91, Sweden
| | - Giovanni Gambaro
- Division of Nephrology, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli University Hospital, Catholic University, Rome 00168, Italy
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
| | - William A Goddard
- Materials and Process Simulation Center, California Institute of Technology, Pasadena, California 91125, USA
| | - Anuj Goel
- Department of Cardiovascular Medicine, The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Omri Gottesman
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Megan L Grove
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77225, USA
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala SE-751 85, Sweden
| | - Yang Hai
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Göran Hallmans
- Department of Biobank Research, Umeå University, Umeå SE-901 87, Sweden
| | - Jiyoung Heo
- Department of Biomedical Technology, Sangmyung University, Chungnam 330-720, Korea
| | - Per Hoffmann
- Institute of Human Genetics, Department of Genomics, Life & Brain Center, University of Bonn, Bonn DE-53127, Germany
- Human Genomics Research Group, Division of Medical Genetics, University Hospital Basel Department of Biomedicine 4031, Basel, Switzerland
- Institute of Neuroscience and Medicine (INM-1) Genomic Imaging Research Center Juelich, Juelich DE-52425, Germany
| | - Mohammad K Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, National University of Singapore, Singapore 169857, Singapore
- Memory Aging & Cognition Centre (MACC), National University Health System, Singapore 117599, Singapore
| | - Richard A Jensen
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| | | | - Torben Jørgensen
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup DK-2600, Denmark
- Faculty of Medicine, University of Aalborg, Aalborg DK-9220, Denmark
| | | | - Chiea C Khor
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Division of Human Genetics, Genome Institute of Singapore, Singapore 138672, Singapore
| | - Andrea Kirkpatrick
- Materials and Process Simulation Center, California Institute of Technology, Pasadena, California 91125, USA
| | - Aldi T Kraja
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Johanna Kuusisto
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio FI-70211, Finland
| | - Ethan M Lange
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - I T Lee
- Division of Endocrine and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Aaron Leong
- Massachusetts General Hospital, General Medicine Division, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Jiemin Liao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
| | - Chunyu Liu
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
| | - Yongmei Liu
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina 27106, USA
| | - Cecilia M Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Allan Linneberg
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup DK-2600, Denmark
- Department of Clinical Experimental Research, Copenhagen University Hospital Glostrup, Glostrup DK-2600, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Giovanni Malerba
- Section of Biology and Genetics, Department of Life and Reproduction Sciences, University of Verona, Verona 37100, Italy
| | - Vasiliki Mamakou
- National and Kapodistrian University of Athens, Faculty of Medicine, Athens 115 27, Greece
- Dromokaiteio Psychiatric Hospital, Athens 124 61, Greece
| | - Eirini Marouli
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece
| | - Nisa M Maruthur
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Angela Matchan
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles 90033, USA
| | - Olga McLeod
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Ginger A Metcalf
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Ioanna Ntalla
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece
- University of Leicester, Leicester LE1 7RH, UK
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27106, USA
| | - Dorota Pasko
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Andreas Peter
- Department of Internal Medicine, Division of Endocrinology, Metabolism, Pathobiochemistry and Clinical Chemistry and Institute of Diabetes Research and Metabolic Diseases, University of Tübingen, Tübingen DE-72076, Germany
- German Center for Diabetes Research (DZD), Neuherberg DE-85764, Germany
| | - Nigel W Rayner
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
- The Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, UK
| | - Frida Renström
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Ken Rice
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Biostatistics, University of Washington, Seattle, Washington 98195, USA
| | - Cinzia F Sala
- Division of Genetics and Cell Biology, San Raffaele Research Institute, Milano 20132, Italy
| | - Bengt Sennblad
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
- Science for Life Laboratory, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | | | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Nicole Soranzo
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- Department of Hematology, Long Road, Cambridge CB2 0XY, UK
| | - Elizabeth K Speliotes
- Department of Internal Medicine, Division of Gastroenterology and Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Eli A Stahl
- Division of Psychiatric Genomics, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Kathleen Stirrups
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Nikos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens 11527, Greece
| | - Anastasia Thanopoulou
- Diabetes Centre, 2nd Department of Internal Medicine, National University of Athens, Hippokration General Hospital, Athens 11527, Greece
| | - Mina Torres
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles 90033, USA
| | - Michela Traglia
- Division of Genetics and Cell Biology, San Raffaele Research Institute, Milano 20132, Italy
| | | | - Sundas Javad
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Lisa R Yanek
- The GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Eleni Zengini
- Dromokaiteio Psychiatric Hospital, Athens 124 61, Greece
- University of Sheffield, Sheffield S10 2TN, UK
| | - Diane M Becker
- The GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Joshua C Bis
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| | - James B Brown
- Department of Genome Dynamics, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Department of Statistics, University of California at Berkeley, Berkeley, California 94720, USA
| | - L Adrienne Cupples
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
- Faculty of Health Science, University of Copenhagen, Copenhagen 1165, Denmark
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala SE-751 85, Sweden
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, Northern California Region, Oakland, California 94612, USA
| | - Carlos Lorenzo
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas 77030, USA
| | - Rasika A Mathias
- The GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado 80204, USA
| | - Gina M Peloso
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts 02142, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Wayne H.-H. Sheu
- Division of Endocrine and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- College of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Daniela Toniolo
- Division of Genetics and Cell Biology, San Raffaele Research Institute, Milano 20132, Italy
| | - Dhananjay Vaidya
- The GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Rohit Varma
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles 90033, USA
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27106, USA
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam Rehbrücke, Nuthetal DE-14558, Germany
| | - Erwin P Bottinger
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - George Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah 22254, Saudi Arabia
| | | | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
- Department of Public Health & Clinical Medicine, Umeå University, Umeå SE-901 87, Sweden
| | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Holtasmari 1, Kopavogur IS-201, Iceland
- University of Iceland, Reykjavik IS-101, Iceland
| | - Anders Hamsten
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Tamara B Harris
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland 21224, USA
| | - Andrew T Hattersley
- Genetics of Diabetes, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Caroline Hayward
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, Scotland EH4 2XU, UK
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Jan-Håkan Jansson
- Department of Public Health & Clinical Medicine, Umeå University, Umeå SE-901 87, Sweden
- Research Unit, Skellefteå SE-931 87, Sweden
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland 21224, USA
| | - Daniel Levy
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
- Framingham Heart Study, Framingham, Massachusetts 01702, USA
| | - Ben A Oostra
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Christopher J O'Donnell
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Stephen O'Rahilly
- University of Cambridge Metabolic Research Laboratories, MRC Metabolic Diseases Unit and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 1TN, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Ozren Polasek
- Department of Public Health, Faculty of Medicine, University of Split, Split 21000, Croatia
| | - Michael A Province
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia 22908, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
- Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Igor Rudan
- Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Scotland EH8 9YL, UK
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal DE-14558, Germany
- German Center for Diabetes Research (DZD), Neuherberg DE-85764, Germany
| | - Blair H Smith
- Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Hugh Watkins
- Department of Cardiovascular Medicine, The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, National University of Singapore, Singapore 169857, Singapore
| | | | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio FI-70211, Finland
| | - Ingrid B Borecki
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
- Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
- Department of Epidemiology, University of Washington, Seattle, Washington 98195, USA
- Department of Health Services, University of Washington, Seattle, Washington 98195, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98195, USA
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Cornelia M van Duijn
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
- Center for Medical Systems Biology, Leiden 2300, The Netherlands
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Dawn M Waterworth
- Genetics, PCPS, GlaxoSmithKline, Philadelphia, Pennsylvania 19104, USA
| | - Eric Boerwinkle
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77225, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - W H Linda Kao
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland 21205, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland 21205, USA
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Jose C Florez
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts 02142, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Ruth J.F. Loos
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Mindich Child Health and Development Institute, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi 38677, USA
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - David S Siscovick
- New York Academy of Medicine, New York, New York 10029, USA
- Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington 98195, USA
| | - Josée Dupuis
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - James B Meigs
- Massachusetts General Hospital, General Medicine Division, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Robert A Scott
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Mark O Goodarzi
- Department of Medicine and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Thanopoulou A, Pectasides D. Real life cancer comorbidity in Greek patients with diabetes mellitus followed up at a single diabetes center: an unappreciated new diabetes complication. J Diabetes Res 2014; 2014:231425. [PMID: 25136643 PMCID: PMC4129950 DOI: 10.1155/2014/231425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 11/21/2022] Open
Abstract
We determined cancer comorbidity in patients with diabetes followed up at a single Greek academic clinic and investigated the potential related factors. Cancer comorbidity was prospectively recorded for all patients with type 2 (T2DM, n = 759) or type 1 (T1DM, n = 134) diabetes of at least 10-year duration examined during one year. Patient characteristics, diabetes age of onset, duration, treatment, control, and complication rates were compared between subjects with and without cancer. Moreover, a retrospective collection of data from similar patients examined for the first time during the last 25 years, but lost to follow-up, after at least one-year's regular visits, was performed. In regularly followed-up T2DM patients cancer comorbidity was 12.6%. Patients with cancer were older and more frequently smokers. Prostate cancer was the most frequent (24.0%) type. In T1DM cancer comorbidity was 3.0%. Similar rates of comorbidity and types of cancer were observed in lost to follow-up patients. In conclusion, our patients with T2DM of at least 10-year' duration show high cancer comorbidity. No specific characteristics discriminate patients with cancer. Therefore presymptomatic cancer detection and prevention strategies may have to be incorporated into the annual systematic evaluation of our patients.
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Affiliation(s)
- Anastasia Thanopoulou
- Diabetes Centre, 2nd Department of Internal Medicine, National University of Athens, Hippokration General Hospital, 114 Vassilissis Sofias Avenue, 115 27 Athens, Greece
- *Anastasia Thanopoulou:
| | - Demetrios Pectasides
- Diabetes Centre, 2nd Department of Internal Medicine, National University of Athens, Hippokration General Hospital, 114 Vassilissis Sofias Avenue, 115 27 Athens, Greece
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Karamanos B, Thanopoulou A, Drossinos V, Charalampidou E, Sourmeli S, Archimandritis A. Study comparing the effect of pioglitazone in combination with either metformin or sulphonylureas on lipid profile and glycaemic control in patients with type 2 diabetes (ECLA). Curr Med Res Opin 2011; 27:303-13. [PMID: 21142615 DOI: 10.1185/03007995.2010.542081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore whether the improvement of lipid profile and glycaemic control observed in randomized control trials with pioglitazone (PIO) is replicated under conditions of general clinical practice. RESEARCH DESIGN AND METHODS We studied 2388 patients with type 2 diabetes (T2DM) not adequately controlled by monotherapy on either metformin (MET) or sulphonylurea (SU). Addition of a second drug, according to the treating physician's choice, resulted in three groups, PIO + MET, PIO + SU and MET + SU, followed for twelve months, while efficacy and safety parameters were measured at baseline, at six and at twelve months. RESULTS A total of 2116 (88.6%) patients completed the study. Diabetic control and lipid profile improved in all three groups, but the improvement was always greater in the two PIO groups. At 12 months PIO + SU and PIO + MET groups compared to SU + MET showed greater increase in HDL cholesterol (8.3% and 9.2 versus 4.3% p < 0.001) and greater decrease in HbA1c (1.53% and 1.46% versus 0.97%, p < 0.001 for both), in triglycerides (20.7% and 21.5% versus 15.2%, p < 0.001) and in LDL cholesterol (15.2% and 14.6% versus 11.3%, p < 0.001 and p < 0.01, respectively). All changes were greater in patients already taking hypolipidaemic drugs. As ECLA was an observational study, the major limitation is the introduction of confounding bias which, however, was accounted for in the statistical analysis. CONCLUSIONS Since improvement of both glycaemic control and lipid profile are considered main targets in the management of the diabetic patient, the results of the present study, conducted under conditions of everyday clinical practice, show that pioglitazone may be considered a potential choice for the treatment of type 2 diabetes, when lifestyle and metformin fail.
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Affiliation(s)
- B Karamanos
- Diabetes Center, 2nd Department of Internal Medicine and Research Laboratory, National University of Athens, Hippokration General Hospital, Athens, Greece.
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21
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Thanopoulou A, Karamanos B, Archimandritis A. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 2010; 362:2030-1; author reply 2031. [PMID: 20518103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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22
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Kravaritou M, Thanopoulou A, Karamanos B, Kofinis A, Noutsou M, Spanou E, Varsou A, Archimandritis A. Evidence that even "normal" albuminuria may denote incipient GFR reduction in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2009; 85:317-21. [PMID: 19596469 DOI: 10.1016/j.diabres.2009.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 06/11/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
Abstract
AIMS In patients with diabetes and microalbuminuria, small changes of GFR could have been missed, due to the lack of sensitive methodology for GFR determination in clinical practice (creatinine based calculations). Therefore we explored the relation of the degree of albumin excretion with Cystatin C, which has been recently proved to be a better marker of GFR, compared to serum creatinine. METHODS We studied 179 patients with type 2 diabetes, in whom renal function and microalbuminuria were evaluated. RESULTS In patients with normal renal function, GFR/MDRD>or=60 ml/min/1.73 m(2), (n=79), urinary albumin concentration (UAC) was significantly correlated with Cystatin C, both in patients with normoalbuminuria (r=0.547, p<0.023) or microalbuminuria (r=0.305, p<0.035), while it was not correlated either with serum creatinine or calculated creatinine clearance. In patients with GFR/MDRD<60 ml/min/1.73 m(2), (n=100), UAC was significantly correlated with Cystatin C, also both in patients with normoalbuminuria (r=0.536, p<0.032) or microalbuminuria (r=0.340, p<0.016), while it was significantly correlated with serum creatinine and calculated creatinine clearance only in those with microalbuminuria. CONCLUSIONS Subtle changes in renal function, as judged by Cystatin C concentration, may parallel the degree of albuminuria, even in the normoalbuminuric stage. This finding needs further confirmation by more appropriate methodology in prospective follow up studies.
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Affiliation(s)
- M Kravaritou
- Diabetes Center, 2nd Department of Internal Medicine, National University of Athens, Hippokration General Hospital, 114, Vas Sofias av., Athens 115 27, Greece
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Thanopoulou A, Karamanos B, Angelico F, Assaad-Khalil S, Djordjevic P, Katsilambros N, Migdalis I, Mrabet M, Petkova M, Roussi D, Tenconi MT, Archimandritis A. Epidemiological evidence for the non-random clustering of the components of the metabolic syndrome: multicentre study of the Mediterranean Group for the Study of Diabetes. Eur J Clin Nutr 2006; 60:1376-83. [PMID: 16823407 DOI: 10.1038/sj.ejcn.1602467] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine: (a) whether the components of metabolic syndrome (MetS) cluster more frequently than predicted by chance alone and (b) whether increased risk for MetS is associated also with values of each component below, but close to the cutoff points defining MetS. RESEARCH DESIGN AND METHODS Anthropometrical and biochemical measurements were performed and a dietary questionnaire was filled-in in 1833 randomly selected non-diabetic subjects, 916 men and 917 women, 20-74 years old, in nine centres in five Mediterranean countries. The prevalence of MetS and of possible combinations of its individual components was measured. The expected frequencies of the above combinations were calculated according to the mathematical formula of probabilities. RESULTS The overall prevalence of MetS was 27.2%, but varied greatly among countries, from 5.8% in Algeria to 37.3% in Greece. The observed prevalence of each combination diagnostic of MetS was higher than the expected by chance. Thus, the observed overall prevalence of MetS was also higher than the expected, 27.2 vs 24.0%, P=0.03. Furthermore, for each individual component (except high-density lipoprotein), as values in the normal range, approached the cutoff point, the risk of having MetS (i.e. clustering of the other components) increased significantly (odds ratio 2.2-4.6, P<0.001). CONCLUSIONS The MetS is not related to the Mediterranean type of diet and its prevalence varies greatly among five Mediterranean countries. The clustering of the components defining the MetS is not due to chance and moreover even 'high normal' levels of each component confer increased risk for the syndrome.
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Affiliation(s)
- A Thanopoulou
- Diabetes Centre, 2nd Department of Internal Medicine, National University of Athens, Hippokration General Hospital, Athens, Greece
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Loizou T, Pouloukas S, Tountas C, Thanopoulou A, Karamanos V. An epidemiologic study on the prevalence of diabetes, glucose intolerance, and metabolic syndrome in the adult population of the Republic of Cyprus. Diabetes Care 2006; 29:1714-5. [PMID: 16801614 DOI: 10.2337/dc06-0696] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Thanopoulou A, Karamanos B, Archimandritis A. Comment on: McClung JA, Naseer N, Saleem M et al (2005) circulating endothelial cells are elevated in patients with type 2 diabetes mellitus independently of HbA1c. Diabetologia 48:345-350. Diabetologia 2005; 48:2687; author reply 2688. [PMID: 16273347 DOI: 10.1007/s00125-005-0020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 08/04/2005] [Indexed: 10/25/2022]
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26
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Thanopoulou A, Karamanos B, Angelico F, Assaad-Khalil S, Barbato A, Del Ben M, Djordjevic P, Dimitrijevic-Sreckovic V, Gallotti C, Katsilambros N, Migdalis I, Mrabet M, Petkova M, Roussi D, Tenconi MT. Nutritional habits of subjects with Type 2 diabetes mellitus in the Mediterranean Basin: comparison with the non-diabetic population and the dietary recommendations. Multi-Centre Study of the Mediterranean Group for the Study of Diabetes (MGSD). Diabetologia 2004; 47:367-376. [PMID: 14730377 DOI: 10.1007/s00125-003-1316-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 10/23/2003] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to compare the nutritional habits of Type 2 diabetic patients among Mediterranean countries and also with those of their background population and with the nutritional recommendations of the Diabetes and Nutrition Study Group. METHODS We did a cross-sectional study of 1833 non-diabetic subjects and 1895 patients with Type 2 diabetes, in nine centres in six Mediterranean countries. A dietary questionnaire validated against the 3-Day Diet Diary was used. RESULTS In diabetic patients the contribution of proteins, carbohydrates and fat to the energy intake varied greatly among centres, ranging from 17.6% to 21.0% for protein, from 37.7% to 53.0% for carbohydrates and from 27.2% to 40.8% for fat, following in every centre the trends of the non-diabetic population. Furthermore, diabetic patients compared to the corresponding background population had: (i). lower energy intake, (ii). lower carbohydrate and higher protein contribution to the energy intake, (iii). higher prevalence of obesity, ranging from 9 to 50%. The adherence to the nutritional recommendations for proteins, carbohydrate and fat was very low ranging from 1.4 to 23.6%, and still decreased when fibre was also considered. CONCLUSION/INTERPRETATION In diabetic patients of the Mediterranean area: (i). dietary habits vary greatly among countries, according to the same trends of the background population; (ii). the prevalence of obesity is much lower than the 80% reported for patients with diabetes in Western countries; (iii). Carbohydrate intake is decreased with a complementary increase of protein and fat consumption, resulting to a poor compliance with the nutritional recommendations.
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Affiliation(s)
- A Thanopoulou
- Diabetes Centre, 2nd Medical Department, Athens University Medical School, Hippokration Hospital, Vas. Sofias 114, Athens, 115 27, Greece
| | - B Karamanos
- Diabetes Centre, 2nd Medical Department, Athens University Medical School, Hippokration Hospital, Vas. Sofias 114, Athens, 115 27, Greece.
| | - F Angelico
- Department of Medical Therapy, University "La Sapienza", Rome, Italy
| | - S Assaad-Khalil
- Department of Internal Medicine, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - A Barbato
- Department of Medical Therapy, University "La Sapienza", Rome, Italy
| | - M Del Ben
- Department of Medical Therapy, University "La Sapienza", Rome, Italy
| | - P Djordjevic
- Diabetes Centre, Institute for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia and Montenegro
| | - V Dimitrijevic-Sreckovic
- Diabetes Centre, Institute for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia and Montenegro
| | - C Gallotti
- Department of Preventive, Occupational and Community Medicine. Section of Hygiene, University of Studies of Pavia, Pavia, Italy
| | - N Katsilambros
- Diabetes Centre, 1st Department of Medicine, Athens University School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - I Migdalis
- Diabetes Centre, "NIMTS" Hospital, Athens, Greece
| | - M Mrabet
- Service of Internal Medicine "A", C.H.U., Oran, Algeria
| | - M Petkova
- Diabetes Centre "St. Luca", Sofia, Bulgaria
| | - D Roussi
- Diabetes Centre, 2nd Medical Department, Athens University Medical School, Hippokration Hospital, Vas. Sofias 114, Athens, 115 27, Greece
| | - M T Tenconi
- Department of Preventive, Occupational and Community Medicine. Section of Hygiene, University of Studies of Pavia, Pavia, Italy
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Karamanos B, Thanopoulou A, Angelico F, Assaad-Khalil S, Barbato A, Del Ben M, Dimitrijevic-Sreckovic V, Djordjevic P, Gallotti C, Katsilambros N, Migdalis I, Mrabet M, Petkova M, Roussi D, Tenconi MT. Nutritional habits in the Mediterranean Basin. The macronutrient composition of diet and its relation with the traditional Mediterranean diet. Multi-centre study of the Mediterranean Group for the Study of Diabetes (MGSD). Eur J Clin Nutr 2002; 56:983-91. [PMID: 12373619 DOI: 10.1038/sj.ejcn.1601413] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2001] [Revised: 01/05/2002] [Accepted: 01/08/2002] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the nutritional habits among six Mediterranean countries and also with the various official recommendations and the 'Mediterranean diet' as originally described. DESIGN Cross-sectional study. SETTINGS Three centres in Greece, two in Italy and one in Algeria, Bulgaria, Egypt and Yugoslavia. SUBJECTS Randomly selected non-diabetic subjects from the general population, of age 35-60, not on diet for at least 3 months before the study. INTERVENTIONS A dietary questionnaire validated against the 3-Day Diet Diary was used. Demographic data were collected and anthropometrical measurements done. RESULTS All results were age adjusted. Energy intake varied in men, from 1825 kcal/day in Italy-Rome to 3322 kcal/day in Bulgaria and in women, from 1561 kcal/day in Italy-Rome to 2550 kcal/day in Algeria. Protein contribution (%) to the energy intake varied little, ranging from 13.4% in Greece to 18.5% in Italy-Rome, while fat ranged from 25.3% in Egypt to 40.2% in Bulgaria and carbohydrates from 41.5% in Bulgaria to 58.6% in Egypt. Fibre intake, g/1000 kcal, ranged from 6.8 in Bulgaria to 13.3 in Egypt and the ratio of plant to animal fat from 1.2 in Bulgaria to 2.8 in Greece. The proportion of subjects following the WHO and the Diabetes and Nutrition Study Group (DNSG) of the EASD recommendations for carbohydrates, fat and protein ranged from 4.2% in Bulgaria to 75.7% in Egypt. Comparison with the Mediterranean diet, as defined in the seven Country Study, showed significant differences especially for fruit, 123-377 vs 464 g/day of the Mediterranean diet, meat, 72-193 vs 35 g/day, cheese, 15-79 vs 13 g/day, bread, 126-367 vs 380 g/day. CONCLUSIONS (a) Dietary habits of the 'normal' population vary greatly among the Mediterranean countries studied. (b) Egypt is closest to the DNSG recommendations. (c) Significant differences from the originally described Mediterranean diet are documented in most Mediterranean countries, showing a Westernization of the dietary habits.
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Affiliation(s)
- B Karamanos
- Diabetes Center, 2nd Medical Department, Athens University Medical School, Hippokration Hospital, Athens, Greece.
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