Cardiovascular Risk Factors In Type Research Articles

Assessment of Serum Lipoprotein(a) Status in Type 2 Diabetes Mellitus

Introduction: Lipoprotein (a) is made up of an atherogenic LDL lipoparticle and a potentially thrombogenic apoprotein a and is therefore responsible for cardiovascular disease. The objective of this study is to evaluate serum lipoprotein (a) status and to investigate the correlation of elevated serum lipoprotein (a) levels with other cardiovascular risk factors in type 2 diabetics.
 Materials and Methods: This is a case-control study involving 82 patients, 37 type 2 diabetic patients and 45 non-diabetic control subjects. Sociodemographic data were collected and each patient underwent routine lipid assessment and lipoprotein (a) testing.
 Results: The prevalence of hyperlipoproteinemia (a) is 17.8% in control subjects and 29.7% in type 2 diabetics. HDL cholesterolemia is significantly higher in controls than in type 2 diabetics (p =0.028) while LDL cholesterol and serum lipoprotein (a) levels are higher in type 2 diabetics than in controls with a statistically significant difference (p=0.025 and p=0.026 respectively). The mean lipoprotein (a) values ​​of 0.36±0.34 g/l in women are higher than those of male subjects which are 0.28±0.20 g/l (p=0.171). Mean serum lipoprotein (a) levels of 0.39±0.32 g/l in type 2 diabetics are significantly higher than those of controls which are 0.25±0.21 g/l (p= 0.026). Plasma concentrations of lipoprotein (a) vary with age and appear to be increased beyond the age of 45. There is no correlation between lipoprotein (a) and other cardiovascular risk factors.
 Conclusion: Hyperlipoproteinemia (a) is common in type 2 diabetics and women have the highest plasma levels. Serum lipoprotein (a) concentrations are not correlated with other cardiovascular risk factors and therefore constitute an independent risk factor.

Assessing the potential for precision medicine of glucose-lowering drugs in type 2 diabetes mellitus: a meta-regression analysis considering body weight variability from 120 randomized trials

Abstract Background Thus far, randomized controlled trials (RCTs) of glucose-lowering drugs reporting on treatment effects on body weight (BW) as cardiovascular risk factor in type 2 diabetes mellitus have not included precision medicine approaches. However, taking into account treatment response heterogeneity, their potential may be analyzed from published data of RCTs using meta-regression analyses. Both treatment response variation and predictors are required conditions for precision medicine to work. Purpose To assess the potential benefits of precision medicine by quantifying the variation of body weight as patient response to treatment, and to identify predictors which could explain this variation. Methods We used four recent systematic reviews on RCTs comparing pharmacological treatment of type 2 diabetes (included but not limited to sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and thiazolidinediones) to placebo. RCTs reporting on BW at baseline and after follow-up to allow for calculation of its logarithmic standard deviation (Log(SD)) in treatment and placebo groups were included. Meta-regression models accounting for treatment means, differing sample sizes, and correlation across treatment from the same trial were used. A separate meta-regression model to evaluate interactions of treatment and individual predictor variables (age, male sex, pre-randomization BW, duration of disease, duration of treatment, year of study and drug class) was applied. Results 120 randomized trials with a total of 43,663 participants were included. The median BW after treatment was 85.2 kg in the placebo groups and 86.2 kg in the therapy groups. A slightly greater treatment response heterogeneity was shown in the therapy groups with a median Log(SD)=2.83 compared to 2.79 from the placebo. After full adjustment in the meta-regression model the difference in BW Log(SD)s was -0.020 (95% CI: -0.063; 0.022) (Figure 1). Scatter plots adjusted for different sample sizes did not show any interaction (i.e. slope divergence) between predictors and the respective treatment (therapy or placebo). Figure 2 demonstrates this using pre-randomization BW as an example. Conclusions We found no major treatment response heterogeneity in RCTs of glucose-lowering drugs reporting on body weight in type 2 diabetes. In addition, none of the considered predictors were able to explain a potential variation in treatment response. The precision medicine approach may thus be of limited value in this setting.

Evaluation of left ventricular systolic function by speckle tracking echocardiography in type 2 diabetic patients

Background: Cardiovascular complications are the leading cause of death in diabetic patients. Speckle tracking echocardiography can early detect left ventricular systolic dysfunction even when normal ejection fraction. The study aims to evaluate left ventricular systolic function by Speckle tracking echocardiography and its correlation with some cardiovascular risk factors in type 2 diabetic patients; Materials and method: Controlled cross-sectional descriptive study in 60 subjects (30 in type 2 diabetic patients and 30 controls) at Hue University of Medicine and Pharmacy Hospital. Data collection: age, sex, time to detect diabetes, body mass index, waist circumference, blood pressure, fasting blood glucose, HbA1c, lipid blood, traditional Doppler echocardiographic parameters, values of left ventricular longitudinal strain in 2-chamber, 3-chamber, 4-chamber view and value of total left ventricular longitudinal strain; Results: Type 2 diabetic patients had 2-chamber longitudinal strain (-17.01 ± 3.26%), 3-chamber longitudinal strain (-16.41 ± 3.69%), 4-chamber longitudinal strain (-18.46 ± 3.23%, global longitudinal strain (-17.31 ± 2.87%), was lower than control group (p < 0.05). The global longitudinal strain was positively correlated with diabetes duration (r = 0.3), heart rate (r = 0.3), systolic blood pressure (r=0.4), diastolic blood pressure (r = 0.4), fasting plasma glucose (r = 0.4), HbA1c (r = 0.4) (p < 0.05); Conclusion: Type 2 diabetic patients have reduced global longitudinal strain. The reduction of global longitudinal strain was correlated with diabetes duration, heart rate, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, and HbA1c. Key words: diabetes, speckle tracking echocardiography, left ventricular ejection fraction, global longitudinal strain, cardiovascular risk factors.

Association Between Left Ventricular Strains and Cardiovascular Risk Factors in Type 2 Diabetic Patients: a Controlled Cross-sectional Study.

Cardiovascular complications are the leading cause of death in diabetic patients. Speckle tracking echocardiography can early detect left ventricular systolic dysfunction even when normal ejection fraction. The study aims to evaluate left ventricular systolic function by Speckle tracking echocardiography and its relation with cardiovascular risk factors in type 2 diabetic patients. A controlled cross-sectional descriptive study was conducted on 150 patients (75 type 2 diabetic patients and 75 controls). Type 2 diabetic patients had global longitudinal strain (-17.02±3.06%), global circumferential strain (-29.04±6.39%) were lower than the control group (p<0.05). Global longitudinal strain was correlated with systolic blood pressure (r=0.3), diastolic blood pressure (r=0.2), fasting plasma glucose (r=0.5), HbA1c (r=0.2), total cholesterol (r=-0.25), (p<0.05). Global circumferential strain was correlated with systolic blood pressure (r=0.2), diastolic blood pressure (r=0.2), HDL (r=-0.3), (p<0.05). Type 2 diabetic patients have reduced global longitudinal strain and global circumferential strain. The reduction of global longitudinal strain, global circumferential strain was correlated with cardiovascular risk factors (hypertension, not good glycemia control, increasing BMI, dyslipidemia).

Serum leptin level as a cardiovascular risk factor in type 2 diabetic patients

Type 2 diabetes mellitus ( T2DM ) is a metabolic disease that is associated with an increased risk for atherosclerosis. Leptin is a hormone – like cytokine that is derived mainly from adipose tissue and has multiple functions. Recently, many vascular and atherogenic effects for leptin have been demonstrated. The aim was to study serum leptin level and its relationship with some cardiovascular risk factors in T2DM patients. Forty diabetic males with ischemic heart disease (IHD group), aged ≥ 40 years old, were compared with 40 diabetic males of similar ages who had no clinical history of IHD (DM group). Each main study group was divided into two subgroups according to the presence or absence of metabolic syndrome. The IHD group was also subdivided according to their clinical endpoints into stable angina pectoris (angina group), significant coronary artery disease on angiography (angiography group ) and myocardial infarction (MI group ). In addition to anthropometric measurements; serum lipid profile, thiobarbituric acid -reactive substances (TBARS) and leptin levels as well as plasma fibrinogen level were quantified .A highly significant increase of mean serum leptin level was observed in IHD group iin comparriison wiitth tthatt off DM grroup (11.56  10.27 vs. 7.39  3.54 ng /3ml, p&lt;0.01). IIHD pattiientts showed a hiighlly siigniiffiicantt iincrrease iin serrum llevell offTBARS iin comparriison wiitth tthatt off DM grroup ((9.00  3.61vs. 6.65  2.41 mol (MDA)/L, P&lt;0.001). The mean plasma level of fibrinogen is significantly higher in IHD group than in DM group (3.30  0.65 vs. 2.99  0.63 g/dl, p &lt; 0.05). Serum leptin level was significantly higher in (angiography group) but not in (angina group) while the level was even lower in (MI group) when compared with that of DM group. A significant increase of mean serum leptin level was observed in IHD subgroup with non-metabolic syndrome in comparison with the D.M subgroup with non-metabolic syndrome (13.06  11.01 vs. 7.06  3.08 ng/ml, P&lt;0.05). In IHD group, serum leptin level showed a positive correlation with BMI ,W/h ratio, serum TBARS, and plasma fibrinogen. In DM group, serum leptin level showed a positive correlation with BMI, W/h ratio, and plasma fibrinogen, while insignificantly correlated with TBARS. In conclusion, T2DM patients with IHD have an elevated serum leptin level that is associated with oxidative stress, inflammation and active or worsening ischemic heart disease independent of metabolic syndrome. Thus, serum leptin level could be an additional factor to assess cardiovascular risk

The effects of omega-3 fatty acids in type 2 diabetes: A systematic review and meta-analysis

Background: The effect of omega-3 polyunsaturated fatty acids (n-3 PUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on cardiovascular risk modification in type 2 diabetes and related complications remain unclear. We aim to assess the published effects of n-3 PUFA interventions on lipid risk factors in type 2 diabetes. Methods: We searched the literature on Pubmed, Embase, CENTRAL, and Web of Science databases in order to perform a pooled analysis of randomized clinical trials (RCTs) assessing n-3 PUFA interventions in type 2 diabetes. The primary outcomes analyzed were the effect of n -3 PUFAs on metabolic biomarkers in type 2 diabetes. Results: 46 RCTs involving 4991 patients with type 2 diabetes were identified for further analysis. Analysis of results showed that n-3 PUFAs interventions significantly improved total cholesterol (TC, WMD = -0.22; 95% CI: -0.32∼ -0.11), triglyceride (TG,WMD = -0.36; 95% CI: -0.48∼-0.25), high-density lipoprotein cholesterol (HDL-C,WMD = 0.05; 95% CI: 0.02∼ 0.08), hemoglobin A1c (HbA1c, WMD = -0.19; 95% CI: -0.31∼-0.06) and C-reactive protein (CRP,WMD = -0.40; 95% CI: -0.74∼-0.07) levels compared to controls (p < 0.05). There was no significant effect on renal function, fasting blood sugar (FBS), insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-C), adiponectin and leptin (p > 0.05). Conclusions: The results of this systematic review suggest that n-3 PUFAs can improve cardiovascular risk factors in type 2 diabetes.

Modulation of physical activity, adiposity, diet composition and cardiovascular risk factors in type 2 diabetic patients

Modulation of physical activity, adiposity, diet composition and cardiovascular risk factors in type 2 diabetic patients

Effects of medical plants from Zingiberaceae family on cardiovascular risk factors of type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials.

We performed a meta-analysis on randomized controlled trials (RCTs) to evaluate the efficacy of Zingiberaceae on cardiovascular risk factors in type 2 diabetes mellitus (T2DM). PubMed, Web of Science, Embase, The Cochrane Library, and Scopus were searched systematically until October 18, 2021. Thirty-four RCTs with 2154 patients met our inclusion. Pooled analysis indicated that Zingiberaceae can significantly improve body weight (BW) (WMD = -1.012, 95% CI: -1.673, -0.351, p = .003), fasting blood glucose (FBG) (WMD = -14.292, 95% CI: -18.588, -9.995, p < .001), glycosylated hemoglobin 1c (HbA1c) (WMD = -0.432, 95% CI: -0.607, -0.257, p < .001), serum insulin (WMD = -2.036, 95% CI: -2.857, -1.216, p < .001), homeostasis model assessment insulin resistance (HOMA-IR) (WMD = -0.886, 95% CI: -1.375, -0.398, p < .001), high density lipoprotein-cholesterol (HDL-C) (WMD = 0.850, 95% CI: 0.018, 1.682, p = .045), triglyceride (TG) (WMD = -17.636, 95% CI: -27.121, -8.151, p < .001), diastolic blood pressure (DBP) (WMD = -0.642, 95% CI: -1.148, -0.137, p = .013), C-reactive protein (CRP) (WMD = -0.623, 95% CI: -1.061, -0.186, p = .005), tumor necrosis factor-α (TNF-α) (WMD = -3.020, 95% CI: -4.327, -1.712, p < .001), and interleukin 6 (IL-6) (WMD = -1.147, 95% CI: -1.887, -0.406, p = .002). The supplementation of Zingiberaceae may be an effective adjunctive therapy in management of T2DM and prevention cardiovascular complications by decreasing BW, improving blood glucose control, insulin resistance, lipid profiles (HDL-C and TG), blood pressure (DBP), and reducing inflammation (CRP, TNF-α, and IL-6). PRACTICAL APPLICATIONS: Approximately half of the deaths of individuals with diabetes mellitus (DM) are attributable to cardiovascular disease (CVD), and individuals with T2DM have a two-fold increased risk of cardiovascular mortality than healthy individuals. Currently, T2DM is mainly treated with hypoglycemic medication such as sulfonylureas, thiazolidinediones, meglitinides, and biguanides. Nevertheless, most of them with long-term usage could cause side effects, including hypoglycemia and gastrointestinal troubles. Several species of the Zingiberaceae family are used in traditional herbal medicines, which have been widely used in traditional and complementary medicine. Proving the potential benefits of Zingiberaceae on T2DM and its cardiovascular complications has positive clinical implications for the use of this practical herb.

English

BACKGROUND India is one of the countries which has seen a rise in diabetes mellitus type 2 patient in last 2 decade. It is a known fact that patients suffering from diabetes mellitus have risk of developing many diseases like angiopathies and retionopathies. . The purpose of this study was to assess cardiovascular disease (CVD) risk factors and find out current clinical practices for prevention of cardiovascular diseases in diabetes type 2 patient attending diabetes out-patient department (OPD). METHODS This is a cross sectional study on 96 randomly selected patients who were diagnosed for diabetes mellitus type 2 for more than 3 months. CVD risk factors were studied using structured questionnaire about sociodemographic factors such as age, gender, family history, dyslipidaemia, hypertension, inactive physique, unsuitable food, excessive use of alcohol and all types of cigarettes; current medicines [anti-platelet medication, statins, angiotensin blocker, angiotensin converting enzyme inhibitors (ACEI)]; history of diabetes or CVD; time since diabetes is diagnosed; average number of times or frequency of follow-up and physical activity visits to health centres. RESULTS Present study shows abdominal obesity (84 %), unhealthy diet (86 %), physical inactivity (81%), dyslipidaemia (n = 68, 70.83 %), uncontrolled diabetes (63 %), hypertension (50 %) and age more than 60 years (41%) as the major cardiovascular diseases risk factors. Use of anti-platelet was present in 55 %; 74 % of hypertensives were using angiotensin receptor blockers (ARBs)/ACEI; 63 % of dyslipidaemia patients were using atorvastatin. This study showed that lifestyle modification has a sustained effect in preventing cardiovascular risk factors in type 2 diabetes patient. CONCLUSIONS Behavioural risk factors like unhealthy diet, physical inactivity, control of hypertension and hypercholesterolemia is a cause of concern in diabetes patient for preventing cardiovascular risk factor. KEY WORDS Type 2 Diabetes Mellitus, Clinical Practices and CVD Prevention.

Overt hypogonadism is a cardiovascular risk factor in type 2 diabetic males: An observational study.

We aimed to evaluate the effects of hypogonadism on metabolic and chronic complications in type 2 diabetic males. 261 nonobese males with type 2 diabetes aged 18-70 were involved in the study. Hypononadal males were divided into 2 groups as overt hypogonadism (total testosterone≤230ng/dl) and borderline hypogonadism (230-345ng/dl). The control group involved eugonadal diabetic males. Micro-macrovascular complications were recorded. 101 patients had hypogonadism (38.7%), and 160 patients were eugonadal (61.3%). Microvascular complication rate was not different, but macrovascular complication rate was significantly higher in hypogonadal males (42.6%/31.3%, p=0.042). Optimal glycosylated haemoglobin (HbA1c) achievement(<7%) was significantly lower in hypogonadal patients (20.8%/31.3%, p=0.043). Poor glycaemic control (HbA1c≥7%), presence of microvascular complication and increased triglyceride levels were independent risk factors for hypogonadism (OR: 1.5, p=0.044;OR:3.89,p=0.025 and OR: 1.0, p=0.016 respectively). Overt hypogonadism, hypertension, hypercholesterolaemia and severe hypoglycaemia were independent risk factors for macrovascular complications (OR: 1.0, p=0.027; OR:2.6, p=0.002; OR: 1.8, p=0.047 and OR: 1.0, p=0.007 respectively), diabetes duration (≥5years) and poor glycaemic control for microvascular complication (OR: 1.0, p=0.031 and OR:2.0, p=0.028). As a result, hypogonadism is frequent among diabetic males and poor glycaemic control may be an important contributing factor. Furthermore overt hypogonadism is an important cardiovascular risk marker. Therefore, ensuring eugonadism in diabetic patients may positively affect both glycaemic control and complications.

Insulin resistance in type 1 diabetes managed with metformin (INTIMET): Study protocol of a double-blind placebo-controlled, randomised trial.

Insulin resistance is an under-recognised metabolic defect and cardiovascular risk factor in Type 1 diabetes. Whether metformin improves hepatic, muscle or adipose tissue insulin sensitivity has not been studied in adults with Type 1 diabetes. We initiated the INTIMET study (INsulin resistance in Type 1 diabetes managed with METformin), a double-blind randomised, placebo-controlled trial to measure the effect of metformin on tissue-specific insulin resistance in adults with Type 1 diabetes. We will study 40 adults aged 20-55years with Type 1 diabetes (HbA1c 80mmol/mol [9.5%], fasting C-peptide <0.3nmol/L) and 20 age-, gender- and body mass index (BMI)-matched controls. Insulin sensitivity will be determined by the two-step hyperinsulinaemic-euglycaemic clamp method with deuterated glucose to document liver, muscle and adipose insulin sensitivity. Subjects with Type 1 diabetes will be randomised to metformin extended-release 1500mg daily or matched placebo for 26weeks. The primary outcome is change in hepatic insulin sensitivity, assessed by change in basal rate of appearance (Ra) of glucose and suppression of endogenous glucose production (EGP) during the low-dose stage of the clamp. The INTIMET study is the first clinical trial to quantify the impact of metformin on liver, muscle and adipose insulin resistance in adults with Type 1 diabetes. This study may identify factors that predict an individual's response to metformin in Type 1 diabetes. ACTRN12619001440112.

Plasma Free Fatty Acids and Metabolic Effect in Type 2 Diabetes, an Ancillary Study from a Randomized Clinical Trial.

Most nutrition studies looking at the association of food with cardiometabolic markers rely on food frequency questionnaires, which are prone to recall bias. Pentadecanoic acid, heptadecanoic acid and trans-palmitoleic acid are fatty acids that are not synthesized endogenously but are obtained from the diet, particularly dairy, making them reasonable biomarkers of dairy consumption. We investigated the association of dairy fatty acid biomarkers with glycated hemoglobin (HbA1c) and cardiovascular risk factors in type 2 diabetes (T2D). In a clinical trial, 111 participants with T2D (age 58.5 ± 8.9 years, HbA1c 8.09 ± 0.96%) were randomized into three groups: a control group that maintained baseline dairy intake, a low-fat (LF) group that incorporated ≥3 servings/day of LF dairy and a high-fat (HF) group that incorporated ≥3 servings/day of HF dairy. We compared the fatty acids (FA) composition between the three groups at 24 weeks. Pentadecanoic acid and trans-palmitoleic acid increased in the HF group by 14.1% ± 5.4% and 17.5% ± 5.1%, respectively, but not in the control and LF groups (p = 0.0474 and p = 0.0025 for group-by-time interaction, respectively). Those increases were positively associated with changes in total cholesterol, very-low-density lipoprotein cholesterol VLDL-C and triglycerides but were not associated with changes in HbA1c from baseline to 24 weeks. These results suggest that the intervention was successful and that participants were likely compliant, which supports the validity of the main trial.

Comparison between different types of exercise training in patients with type 2 diabetes mellitus: A systematic review and network metanalysis of randomized controlled trials

AimAim of the present meta-analysis and network metanalysis (NMA) is the assessment of the effects of physical exercise on glucose control and cardiovascular risk factors in type 2 diabetes. Data synthesisThis metanalysis includes all available trials exploring the effects of different exercise modalities in type 2 diabetes, with a duration of ≥3 months. The standardized difference in means (SDM) with 95% Confidence Intervals were calculated. Data were analyzed using MetaXL and Rev Man 5.0. Primary endpoint was the effect of exercise versus no exercise on HbA1c and fasting plasma glucose (FPG) at endpoint. Secondary endpoints were body weight and fat, waist circumference, and blood pressure. A comparison of different exercise training modalities (aerobic, resistance and combined) for the same endpoints was also performed, choosing ‘no exercise’ as the reference for indirect comparisons. We included 25 trials fulfilling all inclusion criteria. Physical exercise versus no exercise produced a small, but significant, improvement of HbA1c, body fat, and systolic blood pressure at endpoint (−0.3 [-0.1;-0.4]%, −1.44 [-2.22, −0.66]%, and −5.6 [-9.5, −1.6] mmHg, respectively). Combined, supervised aerobic and resistance exercise were associated with a significantly greater reduction of HbA1c (SDM, −0.4 [-0.6;-0.3], −0.2 [-0.4;-0.1], and −0.2 [-0.3;-0.1]%, respectively), but not of FPG, in comparison with no exercise. ConclusionsPhysical exercise produces small, but detectable, advantages on glycemic control and cardiovascular risk factors and should be suggested in type 2 diabetes. Combined aerobic/resistance training seems to be superior to aerobic training alone, but differences are small and the reliability of supporting evidence limited.

Ankle brachial index in patients with type II diabetes mellitus undergoing coronary angiography

ObjectiveThe aim was to determine the relation between ankle-brachial index (ABI) with angiographic stenosis and major cardiovascular risk factors in type II diabetes mellitus (DM) patients.BackgroundThe role of DM in relation to coronary artery disease (CAD) was believed to be as important as CAD itself. Patients with DM were frequently combined with peripheral arterial disease. ABI is a noninvasive tool for identifying atherosclerosis, CAD.Patients and methodsPatients under study were those admitted to Menoufia University Hospital and who had undergone coronary angiography. A total of 80 patients over 35 years of age with suspected CAD had been enrolled. All patients were subjected to ABI measurements and coronary angiography and risk factor. Patients had been divided into four groups according to ABI measurements and type II DM.ResultsABI is a simple, inexpensive method for diagnosing patients with peripheral arterial disease. ABI is a sensitive, noninvasive predictor of CAD in diabetic patients.ConclusionABI is a sensitive, noninvasive predictor of CAD in diabetic patients. It needs other markers for better specificity for predicting CAD.

&lt;p&gt;Assessment of Cardiovascular Risk Factors in Patients with Type 2 Diabetes in Upper Egypt Villages&lt;/p&gt;

BackgroundA large percentage of diabetic patients also have other components of metabolic syndrome, which is a group of cardiovascular (CV) hazard factors related to both diabetes mellitus (DM) and cardiovascular diseases (CVD). We do not know about the prevalence of CV risk factors in diabetic patients in Upper Egypt. We aimed to assess the CV risk factors in type 2 diabetic patients in Upper Egypt villages.MethodsWe conducted a cross-sectional study that included 800 patients with type 2 DM. We classified the participants into three groups according to the hemoglobin A1c (HbA1c) levels. We assessed the prevalence of other cardiovascular risk factors and their association with HbA1c levels through a detailed history, full clinical examination, and laboratory tests.ResultsWe found that 75% of the participants were males, 25.5% elderly, 60.25% had hypertension, 60.75% had dyslipidemia, 33.25% were overweight or obese, 19.75% had a family history of coronary artery disease (CAD), 55.75% had established CVD, 42.5% were smokers, and only 12.25% were physically inactive. We found that 84% of the participants had ≥ two cardiovascular risk factors other than DM. HbA1c level was ≥ 7% in 77% of patients. After multivariate regression analysis, we found a significant association of higher systolic blood pressure (BP), more elevated diastolic BP, higher body mass index (BMI), increased waist circumference, old age, long duration of DM, and an increase in the number of clustered CV risk factors with a higher HbA1c level. At the same time, insulin therapy was significantly associated with a lower HbA1c level.ConclusionAll type 2 diabetic patients in Upper Egypt villages have other associated CV risk factors. The clustering of cardiovascular risk factors showed a significant association with higher HbA1c levels. These findings require the thought of associated CV risk factors in choosing medical treatments to optimize glycemic control and multifactorial intervention to improve CV risk.

Study of High sensitive C - reactive protein and Gamma-glutamyl transferase in Type 2 Diabetes Mellitus with Hypertension

C-reactive protein (CRP), produced by the hepatocytes is a primary inflammatory marker of T2DM. Higher levels of gamma-glutamyl transferase enzyme (GGT) and Hs CRP (High sensitive CRP)are associated with the complication of poor glycemic control.This study was aimed to find the association of Hs CRP and GGT for cardiovascular risk factors in Type 2 diabetes mellitus (T2DM)and Hypertension in the suburbs of Chennai. This study includes 57 subjects with T2DM and Hypertension (Group A) and 62 subjects with T2DM (GroupB) within the age group of 40-60 years. FBS, HbA1C, Hs CRP, GGT and blood pressure were determined. Statistical analysis was performed using Statistical Package for the SPSS 17 version. Mean values of FBS, blood HbA1C, Hs CRP and GGT were significantly higher among participants of Group A than Group B. Significant difference of FBS, HbA1C were found between the two groups. In contrast, no significant difference of GGT was found between the groups. Differences were considered statistically significant at two-sided P &lt; 0.05. Within the group, Hs CRP shows the significance and positive correlation with FBS, SBP and DBP. Still, GGT does not show any significance in Group A. In contrast, in Group B, both Hs CRP and GGT shows the importance and positive correlation with FBS and HbA1C.It is concluded that high levels of HsCRP are associated with T2DM and Hypertension, indicating increased cardiovascular risk, and it should be included in regular monitoring of type-2 diabetic patients.

2143-PUB: Beneficial Impact of a Routine Clinical Practice Multifactorial Approach on the Progression of Subclinical Arterial Disease in Type 2 Diabetes: 3.2 Years Follow-Up Study

Diabetes is associated with higher incidence of cardiovascular (CV) disease complications due to accelerated arterial damage. The beneficial effect of multi-factorial treatment of CV risk factors in type 2 diabetes is well established from randomized clinical trials. We prospectively examined the impact of such a treatment in a real-world setting, on the development of subclinical arterial damage (SAD), as determined by structural and functional non-invasive biomarkers of vascular pathology (atheromatosis [presence of atheromatous plaques in carotid/femoral arteries, ankle-brachial index], arteriosclerosis [carotid-femoral pulse wave velocity, carotid distensibility], carotid hypertrophy [intima-media thickness, cross-sectional wall artery area]). We prospectively studied 116 persons with type 2 diabetes, treated with a multi-factorial approach of CV risk factors in routine clinical practice at a tertiary medical center, and 324 individuals without diabetes, for 3.2 years. The primary outcome was changes in vascular biomarkers related to SAD. At baseline, participants in the diabetes group had higher prevalence of subclinical arterial disease. At study end, changes in clinical, biochemical and lifestyle characteristics, as well as antihypertensive and lipid-lowering treatments, were comparable between the two groups. During follow-up, classical CV risk factors (smoking, blood pressure, LDL-cholesterol, triglycerides), and behavioral features were significantly improved in both groups. Multivariate analysis, after adjusting for all classical CV risk factors and use of anti-hypertensive/lipid-lowering therapies, demonstrated that all evaluated SAD biomarkers were similarly changed between the two groups. Implementation of a multi-modality approach of type 2 diabetes treatment is feasible and effective in decelerating progression rates of SAD in routine clinical practice. Disclosure K. Makrilakis: None. G. Konstantonis: None. A. Arida: None. E. Aissopou: None. A. Argyris: None. A. Protogerou: None. P.P. Sfikakis: None. N. Tentolouris: None.

4-OR: Diabetes Duration and the Relative Importance of Cardiovascular Risk Factors in Type 1 Diabetes

Based on a Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) report and their own findings, Pittsburgh Epidemiology of Diabetes Complications investigators concluded that the relative impact of HbA1c and kidney disease in type 1 diabetes (T1D) on cardiovascular disease (CVD) varies according to T1D duration. We investigate the relative importance of HbA1c and other CVD risk factors during ∼ 30 years of DCCT/EDIC follow-up within the primary (RET-: subjects with a mean T1D duration of 2.6 years and without retinopathy at baseline) and within the secondary DCCT cohort (RET+: subjects with a mean T1D duration of 8.6 years and with mild to moderate retinopathy at baseline). CVD included fatal/nonfatal myocardial infarction (MI) or stroke, silent MI, revascularization, confirmed angina, or congestive heart failure. Cox regression models with robust error variances were used to find the most significant CVD risk factors (p&amp;lt;0.05) within RET- and within RET+. The importance of risk factors was determined by evaluating the z value, a measure of association strength between risk factor and CVD. In case of hazard assumption violation, time by covariate interaction was included in model. DCCT enrolled 1441 subjects (age 13-39); 115 of 715 RET+ subjects and 69 of 726 RET- subjects had a CVD event. For RET+, the most important risk factors were baseline (B) age (z ∼4.2), time dependent (T) mean (M) systolic blood pressure (SBP) (z ∼4.0), any severe hypoglycemia (z ∼3.7), and TM HbA1c (z ∼3.2). Other significant risk factors included B autonomic neuropathy, TM insulin dose, TM LDL, T current (C) ACE inhibitor use, TC insulin regimen and B severity of retinopathy but not T1D duration. For RET-, B age, TM HbA1c, TC triglycerides and TM SBP with an increasing CVD effect over follow-up time were significant. The relative importance of CVD risk factors in a young T1D cohort varies according to microvascular complications, which correlate with T1D duration. Disclosure E.R. Fahrmann: None. H. Driscoll: None.

Undertreatment of cardiovascular risk factors in the type 1 diabetes exchange clinic network (United States) and the prospective diabetes follow-up (Germany/Austria) registries.

To examine the control of cardiovascular risk factors in type 1 diabetes (T1D) registries from the United States and Germany/Austria. Data on individuals aged ≥12 years with T1D for ≥1 year, from the T1D Exchange Clinic Network (T1DX, United States) and the Prospective Diabetes Follow-up Registry (DPV, Germany/Austria) from 1 January 2016 to 31 March 2018 were analysed. Linear and logistic regression models adjusted for age groups, sex, duration of diabetes and minority status were used to compare clinical characteristics and achievement of diabetes management targets between registries. The cohort consisted of 47 936 patients (T1DX, n = 19 442; DPV, n = 28 494). Achievement of HbA1c goals (<7.0%, ages 18-65 years; all others, <7.5%) was better in the DPV for those aged <65 years (all P < .001). However, more older adults (aged ≥65 years) in the T1DX achieved an HbA1c goal of <7.5% compared with DPV (70% vs. 50%, P < .001). The frequency of patients with overweight (53% vs. 51%, P < .001) and obesity (19% vs. 9%, P < .001) was higher in T1DX. The frequency of meeting blood pressure goals (84% vs. 66%, P < .001) and lipid goals (73% vs. 62%, P < .001) was higher in T1DX; this was observed across all age groups (all P < .001). Few young adults aged <26 years received antihypertensive and lipid-lowering medications, respectively, despite indications in both registries (T1DX: 5% and 3%, DPV: 3% and 1%). A minority of patients with T1D achieve glycaemic targets and the majority are inadequately treated for hypertension and dyslipidaemia. This highlights the need for improved diabetes and cardiovascular risk management strategies in T1D.

MON-LB113 Insulin Resistance in Type 1 Diabetes Managed With Metformin (INTIMET): Rationale and Study Design of a Randomised Placebo-Controlled Trial

Background: Insulin resistance is an under-recognised cardiovascular risk factor in type 1 diabetes (T1D). Individuals with T1D exhibit insulin resistance relative to those without diabetes. In T1D, tissue-specific insulin resistance (muscle, hepatic, adipose) is likely to partly drive increased cardiovascular risk. Adjunctive metformin improves muscle insulin sensitivity in T1D adolescents, but factors that predict responsiveness remain unknown.Objective: To report the rationale and design of the INTIMET study, a double-blind randomised, placebo-controlled trial of metformin in T1D.Methods: Forty adults aged 20-50 years with T1D, and 20 age- gender- and BMI- matched non-diabetic controls will be studied. T1D inclusion criteria are diagnosis > 10 years, HbA1c 9.5% and fasting C-peptide < 0.3nmol/L. Liver and muscle insulin sensitivity will be determined by the 2-stage hyperinsulinemic (20 and 60 mUm2)-euglycemic (5.5 mmol/L) clamp method with deuterated glucose. Subjects with T1D will be randomised to metformin extended-release 1500mg/d or matched placebo for 26 weeks. The primary endpoint is the change in hepatic insulin sensitivity, measured by suppression of endogenous glucose production (EGP) with the low-dose insulin clamp. Secondary endpoints include change in muscle and adipose tissue insulin sensitivity, arterial stiffness, HbA1c, glucose variability, frequency of hypoglycemia, insulin dose, anthropometry, body composition, lipid profile, liver fat and stiffness. Conclusion: The INTIMET study will quantify muscle, liver and adipose insulin-resistance in T1D, determine whether metformin is effective in improving insulin resistance in T1D and identify factors that predict metformin-responsiveness.The trial is registered (Australian New Zealand Clinical Trial Registry, ACTRN12619001440112) and is actively recruiting in Sydney, Australia.