Macrovascular Complications In Type Research Articles

Prediction of Micro- and Macrovascular Complications in Type 2 Diabetes Mellitus using Heart Rate Variability.

To explore the utility of heart rate variability (HRV), a noninvasive marker of cardiac autonomic activity, as a prescreening tool for the prediction of micro- and macrovascular complications in type 2 diabetes mellitus (T2DM). Consenting type 2 diabetic patients of both genders between 30 and 70 years, without known micro- and macrovascular complications of diabetes, were enrolled. Patients with medications affecting the HRV were excluded. Prior to other screening tests, 15 minutes of resting electrocardiogram (ECG) (1 kHz) was recorded in enrolled patients, followed by an exercise stress test and assessment for nephropathy, retinopathy, and peripheral neuropathy. The patients with positive stress tests were referred for coronary angiography to confirm coronary artery disease. Based on screening test results, patients were grouped as Group I-T2DM without complications (n = 31) and Group II-T2DM with micro/macrovascular complications (n = 29), (total = 60). Group comparison and test for association were employed, and p-value of <0.05 was considered significant. Significantly reduced HRV (decreased standard deviation of NN interval) between groups and a strong association of HRV indices with complications of diabetes were observed. Logistic regression to classify complicated vs noncomplicated group was used, and an accuracy of 0.78 with 85% sensitivity, 74% specificity with area under the curve (AUC) of 0.83 was observed. Significantly reduced HRV, stronger association with complications, and 85% sensitivity, 74% specificity, and 78% accuracy of classification make HRV indices a promising prescreening tool to predict micro- and macrovascular complications in type 2 diabetes.

Fasting pancreatic polypeptide predicts incident microvascular and macrovascular complications of type 2 diabetes: An observational study.

Pancreatic polypeptide (PP) is elevated in people with vascular risk factors such as type 2 diabetes or increased visceral fat. We investigated potential relationships between PP and microvascular and macrovascular complications of diabetes. Animal study: Subcutaneous PP infusion for 4weeks in high fat diet mouse model. Retinal mRNA submitted for Ingenuity Pathway Analysis. Human study: fasting PP measured in 1478 participants and vascular complications recorded over median 5.5 (IQR 4.9-5.8) years follow-up. Animal study: The retinal transcriptional response to PP was indicative of cellular stress and damage, and this footprint matched responses described in previously published studies of retinal disease. Of mechanistic importance the transcriptional landscape was consistent with upregulation of folliculin, a recently identified susceptibility gene for diabetic retinopathy. Human study: Adjusting for established risk factors, PP was associated with prevalent and incident clinically significant retinopathy (odds ratio (OR) 1.289 (1.107-1.501) p=0.001; hazard ratio (HR) 1.259 (1.035-1.531) p=0.0213), albuminuria (OR 1.277 (1.124-1.454), p=0.0002; HR 1.608 (1.208-2.141) p=0.0011), and macrovascular disease (OR 1.021 (1.006-1.037) p=0.0068; HR 1.324 (1.089-1.61), p=0.0049), in individuals with type 2 diabetes, and progression to diabetes in non-diabetic individuals (HR 1.402 (1.081-1.818), p=0.0109). Elevated fasting PP is independently associated with vascular complications of diabetes and affects retinal pathways potentially influencing retinal neuronal survival. Our results suggest possible new roles for PP-fold peptides in the pathophysiology of diabetes complications and vascular risk stratification.

Noninvasive Liver Fibrosis Indices as Indicators of Microvascular and Macrovascular Complications in Type 2 Diabetes.

Objective: Nonalcoholic fatty liver disease (NAFLD) is more prevalent in patients with obesity, diabetes, and metabolic syndrome, which are risk factors for nonalcoholic steatohepatitis and liver fibrosis. NAFLD is related to cardiovascular outcomes in diabetes. We aimed to investigate the relationship between diabetic complications and NAFLD fibrosis score (NFS) and Fibrosis-4 score (FIB-4). Methods: Three hundred patients with type 2 diabetes mellitus (T2DM) were retrospectively evaluated according to NAFLD diagnosis on ultrasound in outpatient clinic. Risk of advanced fibrosis was estimated using FIB-4 and NFS. Diabetic complications of the patients were noted. Results: Presence of diabetic retinopathy is related to FIB-4 (P = 0.001) and NFS (P < 0.001) scores. NFS score (P = 0.037), not FIB-4 (P = 0.517), is related to diabetic nephropathy. Among macrovascular complications, only coronary artery disease is related to NFS and FIB-4 scores (P = 0.037 and P = 0.004, respectively). Although we cannot establish any association between fasting blood glucose, glycosylated hemoglobin (HbA1c) values and noninvasive liver fibrosis scores (P > 0.05), diabetes duration, and age positively correlated with the FIB-4 score (P = 0.033, P = 0.001). In logistic regression analysis, NFS > 0.676 values are associated with increased rates of diabetic retinopathy, independent of age, sex, HbA1c, and duration diabetes (odds ratio: 1.155, P = 0.030). FIB-4 has no relation with microvascular complications according to logistic regression analysis (P > 0.05 for all). Neither FIB-4 nor NFS has an effect on the presence of macrovascular complications (P > 0.05 for all). Conclusion: Our findings suggest that increase in NFS score is associated with the presence of diabetic retinopathy, independent of confounding factors. Further studies are needed on the applicability of noninvasive fibrosis scores in monitoring the presence of diabetic microvascular and macrovascular complications.

Investigation of the Systemic Immune Inflammation (SII) Index as an Indicator of Morbidity and Mortality in Type 2 Diabetic Retinopathy Patients in a 4-Year Follow-Up Period.

Background and Objectives: This study aimed to investigate the relationship between the systemic immune inflammation (SII) index and the development of micro and macro complications and mortality within the first year and the following three years in type 2 diabetic retinopathy patients. Materials and Methods: The retrospective study included 523 type 2 diabetic retinopathy patients seen in the endocrinology outpatient clinic of our hospital between January and December 2019. Their demographic and clinical characteristics were analyzed using descriptive statistics. The normal distribution of quantitative data was assessed by the Shapiro-Wilk test. Mann-Whitney U, McNemar-Chi-square, and Cochran's Q tests were used to analyze the SII values and complication rates over time. An ROC analysis determined the sensitivity and specificity of SII. A multiple linear regression analysis examined the relationship between variables and SII, while Spearman's test assessed the correlation between CRP and SII. p < 0.05 was accepted as significant. Results: The mean age of patients was 63.5 ± 9.3 years, with mean SII values of 821.4 ± 1010.8. Higher SII values were significantly associated with acute-chronic renal failure, peripheral arterial disease, and hospitalization rates in both the first year and the following three years (p < 0.05 for all). Significant cut-off values for SII were found for micro- and macrovascular complications and death within the first year (p < 0.05 for all). The ROC curve analysis identified an optimal SII cut-off value of >594.0 for predicting near-term (1-year) complications and mortality, with a sensitivity of 73.8% and specificity of 49.4% (area under the ROC curve: 0.629, p = 0.001). Multiple linear regression indicated that smoking of at least 20 pack-years had a significant positive effect on SII. The Spearman test showed a weak positive correlation between SII and CRP. Conclusions: High SII values predict both early and late acute-chronic renal failure, peripheral arterial disease, and hospitalizations in patients with type 2 diabetic retinopathy. The study also shows that high SII values may predict microvascular and macrovascular complications of type 2 DM and mortality risk in the early period in patients with type 2 diabetic retinopathy. In addition, comorbidities and inflammatory habits, such as long-term smoking, should be considered in the clinical use of SII.

Cardiovascular disease and sleep apnea in patients with type 2 diabetes mellitus

The article provides information on concomitant conditions of type 2 diabetes mellitus such as cardiovascular diseases, sleep apnea syndrome. Questions about the types of sleep breathing disorders and factors predisposing to this condition are discussed. Data on the prevalence of sleep apnea in the world are demonstrated. The main approaches to the diagnosis of this condition are shown. Differences in therapy approaches for obstructive sleep apnea and central sleep apnea have been demonstrated. The issues of the relationship between obstructive sleep apnea, type 2 diabetes mellitus and cardiovascular diseases are considered. The data of clinical studies evaluating the relationship of sleep apnea and cardiovascular diseases are presented. Their mutually aggravating influence is shown. Information is provided on the effect of sleep apnea on the main clinical outcomes according to clinical research data. The relationship between sleep apnea and heart failure is discussed. The main issues of the inflammatory profile of sleep apnea are discussed, which are closely related to cardiovascular diseases and type 2 diabetes and include: macrophage recruitment and inflammatory biomarkers such as C-reactive protein, chemokines and cytokines such as interleukin 6, tumor necrosis factor α, nuclear kappa factor B, as well as adhesion molecules such as selectins, intracellular adhesion molecule-1 (ICAM-1) and intracellular vascular adhesion molecule (VCAM-1), imbalance between prooxidant and antioxidant factors. These factors contribute to the development of microvascular and macrovascular complications in type 2 diabetes mellitus. Special attention is paid in the publication to the discussion of the main factors predisposing to the development of sleep apnea in heart failure in patients with type 2 diabetes mellitus. The data on the main diagnostic tests for patients with heart failure and type 2 diabetes are presented. Information is provided on the use of drugs from the group of sodiumglucose cotransporter type 2 inhibitors in patients with type 2 diabetes and sleep apnea syndrome. Reasonable recommendations on the use of these drugs are presented, taking into account the modern strategy for the treatment of type 2 diabetes.

Apolipoprotein-CIII O-Glycosylation Is Associated with Micro- and Macrovascular Complications of Type 2 Diabetes.

Apolipoprotein-CIII (apo-CIII) inhibits the clearance of triglycerides from circulation and is associated with an increased risk of diabetes complications. It exists in four main proteoforms: O-glycosylated variants containing either zero, one, or two sialic acids and a non-glycosylated variant. O-glycosylation may affect the metabolic functions of apo-CIII. We investigated the associations of apo-CIII glycosylation in blood plasma, measured by mass spectrometry of the intact protein, and genetic variants with micro- and macrovascular complications (retinopathy, nephropathy, neuropathy, cardiovascular disease) of type 2 diabetes in a DiaGene study (n = 1571) and the Hoorn DCS cohort (n = 5409). Mono-sialylated apolipoprotein-CIII (apo-CIII1) was associated with a reduced risk of retinopathy (β = -7.215, 95% CI -11.137 to -3.294) whereas disialylated apolipoprotein-CIII (apo-CIII2) was associated with an increased risk (β = 5.309, 95% CI 2.279 to 8.339). A variant of the GALNT2-gene (rs4846913), previously linked to lower apo-CIII0a, was associated with a decreased prevalence of retinopathy (OR = 0.739, 95% CI 0.575 to 0.951). Higher apo-CIII1 levels were associated with neuropathy (β = 7.706, 95% CI 2.317 to 13.095) and lower apo-CIII0a with macrovascular complications (β = -9.195, 95% CI -15.847 to -2.543). In conclusion, apo-CIII glycosylation was associated with the prevalence of micro- and macrovascular complications of diabetes. Moreover, a variant in the GALNT2-gene was associated with apo-CIII glycosylation and retinopathy, suggesting a causal effect. The findings facilitate a molecular understanding of the pathophysiology of diabetes complications and warrant consideration of apo-CIII glycosylation as a potential target in the prevention of diabetes complications.

Effects of long-term HbA1c variability on serious infection risks in patients with type 2 diabetes and the influence of age, sex and ethnicity: A cohort study of primary care data

AimsLong-term HbA1c (glycated haemoglobin) variability is associated with micro- and macrovascular complications in Type 2 diabetes (T2D). We explored prospective associations between HbA1c variability and serious infections, and how these vary by HbA1c level, age, sex and ethnicity. Methods411,963 T2D patients in England, aged 18–90, alive on 01/01/2015 in the Clinical Practice Research Datalink with ≥ 4 HbA1c measurements during 2011–14. Poisson regression estimated incidence rate ratios (IRRs) for infections requiring hospitalisation during 2015–19 by HbA1c variability score (HVS) and average level, adjusting for confounders, and stratified by age, sex, ethnicity and average level. Attributable risk fractions (AF) were calculated using reference categories for variability (HVS < 20) and average level (42–48 mmol/mol). ResultsAn increased infection risk (IRR > 1.2) was seen with even modest variability (HVS ≥ 20, 73 % of T2D patients), but only at higher average levels (≥64 mmol/mol, 27 % patients). Estimated AFs were markedly greater for variability than average level (17.1 % vs. 4.1 %). Associations with variability were greater among older patients, and those with lower HbA1c levels, but not observed among Black ethnicities. ConclusionsHbA1c variability between T2D patients’ primary care visits appears to be associated with more serious infections than average level overall. Well-designed trials could test whether these associations are causal.

The Study of Relationship between Plasma Fibrinogen Level and the Macrovascular Complications in Type 2 Diabetes Mellitus patients in a Tertiary Health Care Centre in Eastern India

Introduction: The macrovascular complications in patients of Type 2 Diabetes Mellitus (T2DM) are an expression of the generalized atherosclerotic process affecting the blood vessels of the body. Studies have revealed cardinal role of inflammation in the development of atherosclerosis. Literature review suggests that the level of plasma fibrinogen, an inflammatory marker, is elevated in T2DM and more so in those with the macrovascular complications. Therefore, this study was taken up with the aim to determine the association of plasma fibrinogen level with the macrovascular complications in patients of T2DM. Methods and aterials: This was a prospective observational study undertaken in Tata Main Hospital from November 2020 to October 2022. It included T2DM out-patients and those admitted in the Department of Medicine between the age group of 40 to 80 years. Patient’s clinical history and detailed physical examination were noted. Relevant blood tests (including HbA1c, lipid profile) and plasma fibrinogen levels were done. All patients were evaluated for complications of Coronary Artery Disease (CAD), cerebrovascular disease and peripheral vascular disease using appropriate investigations. The statistical association was determined by chi -square (χ2) and independent sample t-tests where appropriate. The relationship between plasma fibrinogen level and the macrovascular complications was determined using binary logistic regression. Results: The study involved 180 patients. Their mean age was 58.63 ± 7.177 years with most patients in 51-60 years age group. Male preponderance was seen and the male to female ratio was 1.86:1. While the average duration of T2DM in the study population was 6.744 ± 2.376 years, mean HbA1c level was 8.2 ± 1.9% (range: 6.2% to 9.8%). The mean Body Mass Index (BMI) was 24.57 ± 2.49 Kg/m2, with 61.67 % of cases having BMI of 25-29.9. The mean fibrinogen level in patients was 446.50 ± 28.449 mg/dl (ranged: 358.3 mg/dl to 513.0 mg/d). Diabetics without complications had mean fibrinogen level of 443.3 ± 28.3 mg/dl while those with complications had level of 469.6 ± 16.8 mg/dl (P = 0.000). 43 (23.9%) patients had macrovascular complications. Peripheral vascular disease was observed in 31(17.2%), cerebrovascular disease in 16 (8.9%) and CAD in 20 (11.1%) patients while hypertension was observed in 68 (37.8%) patients. Fibrinogen level showed a positive relation with age (R- 0.541, P &lt;0.001), male gender, BMI (R- 0.515, P=0.0001), total cholesterol levels more than 200 mg/dl (R-0.365, P = 0.0001) and HbA1c (R-0.355 with P = 0.0001). Binomial logistic regression demonstrated significant association between plasma fibrinogen level with macrovascular complications of diabetes (Wald test: 7.482, odds ratio-1.062, P&lt;0.01). Furthermore, the association was found to be independent after adjusting for the confounding factors. Conclusion: Our study suggests that plasma fibrinogen level may be viewed as an independent risk factor for the development of macrovascular complications in T2DM patients. Hence, in these patients, it can be used as a marker for the prediction of the macrovascular complications.

Correlation between HbA1c levels and left ventricular function in children with Type 1 Diabetes Mellitus

Background: Diabetic cardiomyopathy is one of the macrovascular complications in type 1 diabetes mellitus (T1DM). Left ventricular dysfunction primarily reflects diastolic dysfunction which is early sign of diabetic cardiomyopathy. Improved glycemic control can delay the onset and progression of this complication. An important indicator of long-term glycemic control is glycosylated hemoglobin (HbA1c). Objective: The aim of this study is to evaluate the correlation between HbA1c levels with left ventricular diastolic function in children with T1DM. Methods: This study was an observational study with cross-sectional design in children aged 1 month-18 years with T1DM, at Prof Dr. I.G.N.G. Ngoerah Hospital, Denpasar from November 2019–September 2021, using consecutive sampling. Glycosylated hemoglobin (HbA1c) was meassured by blood samping and LV function was assessed by using tissue Doppler imaging (TDI). Statistical analysis was done by Pearson and Spearman correlation test. A p-values of &lt;0.05 was considered statistically significant. Results: A total of 36 subjects were recruited in this study. There was a low positive correlation between HbA1c levels with E/e’ ratio (r=0.284, p=0.047), and MPI (r=0.358, p=0.020). After adjusting body mass index and duration of T1DM as confounding variables, we found a low positive correlation between HbA1c levels and E/e’ ratio (r=0.325, p=0.030), MPI (r = 0.390, p=0.020). Conclusion: HbA1C has a positive correlation with left ventricular diastolic function in children with T1DM.

Nε-Carboxymethyllysine Correlates with the Extent of Macrovascular Complications in Type 2 Diabetic Patients

Nε-Carboxymethyllysine Correlates with the Extent of Macrovascular Complications in Type 2 Diabetic Patients

Relationship between key continuous glucose monitoring-derived metrics and specific cognitive domains in patients with type 2 diabetes mellitus

BackgroundContinuous glucose monitoring (CGM)-derived time in range (TIR) is closely associated with micro- and macrovascular complications in type 2 diabetes mellitus (T2DM). This study was performed to investigate the relationship between key CGM-derived metrics and specific cognitive domains in patients with T2DM.MethodsOutpatients with T2DM who were otherwise healthy were recruited for this study. A battery of neuropsychological tests was performed to evaluate cognitive function, including memory, executive functioning, visuospatial ability, attention, and language. Participants wore a blinded flash continuous glucose monitoring (FGM) system for 72 h. The key FGM-derived metrics were calculated, including TIR, time below range (TBR), time above range (TAR), glucose coefficient of variation (CV), and mean amplitude of glycemic excursions (MAGE). Furthermore, the glycemia risk index (GRI) was also calculated by the GRI formula. Binary logistic regression was used to assess risk factors for TBR, and we further analysed the associations between neuropsychological test results and key FGM-derived metrics with multiple linear regressions.ResultsA total of 96 outpatients with T2DM were recruited for this study, with 45.8% experiencing hypoglycemia (TBR< 3.9 mmol/L). Spearman analysis results revealed that a higher TBR< 3.9 mmol/L was correlated with worse performance on the Trail Making Test A (TMTA), Clock Drawing Test (CDT), and cued recall scores (P < 0.05). Logistic regression analysis results indicated that the TMTA (OR = 1.010, P = 0.036) and CDT (OR = 0.429, P = 0.016) scores were significant factors influencing the occurrence of TBR< 3.9 mmol/L. Multiple linear regressions further demonstrated that TBR< 3.9 mmol/L (β = -0.214, P = 0.033), TAR> 13.9 mmol/L (β = -0.216, P = 0.030) and TAR10.1–13.9 mmol/L (β = 0.206, P = 0.042) were significantly correlated with cued recall scores after adjusting for confounding factors. However, TIR, GRI, CV and MAGE showed no significant correlation with the results of neuropsychological tests (P > 0.05).ConclusionsA higher TBR< 3.9 mmol/L and TAR> 13.9 mmol/L were associated with worse cognitive functions (memory, visuospatial ability, and executive functioning). Conversely, a higher TAR of 10.1–13.9 mmol/L was associated with better memory performance in memory tasks.

Impact of individual microvascular disease on the risks of macrovascular complications in type 2 diabetes: a nationwide population-based cohort study

BackgroundThis study compared the risks of cardiovascular morbidity and mortality between patients with type 2 diabetes (T2D) with and without microvascular diseases, and between matched patients with microvascular diseases.MethodsWe identified newly diagnosed type 2 diabetes patients from National Health Insurance Research Database in Taiwan from January 1, 2008, to December 31, 2019. Propensity score matching was applied to construct matched pairs of patients with diabetic kidney disease, retinopathy, or neuropathy. Multivariable Cox proportional-hazard models were adopted to compare the risks of cardiovascular morbidity and mortality.ResultsPatients with microvascular disease had a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. Among the matched cohorts, patients with diabetic retinopathy had a significantly higher risk of stroke development than those with diabetic kidney disease (aHR 1.11, 95%CI 1.03–1.2). Diabetic neuropathy showed a significantly higher risk of stroke development than diabetic kidney disease (aHR 1.17, 95%CI 1.1–1.25) and diabetic retinopathy (aHR 1.12, 95%CI 1.03–1.21). Diabetic retinopathy had a significantly higher risk of incident heart failure than diabetic kidney disease (aHR 1.43, 95%CI 1.3–1.57), and diabetic neuropathy had a significantly lower risk of incident heart failure than diabetic retinopathy (aHR 0.79, 95%CI 0.71–0.87).ConclusionsT2D patients with microvascular disease have a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. In the matched cohorts, diabetic neuropathy was significantly associated with stroke development, and diabetic retinopathy had a significant association with heart failure compared to other microvascular diseases.

Heterogeneity in cardiovascular death or hospitalization for heart failure benefits with flozins is linked to weight.

Cardiovascular outcome trials with sodium-glucose cotransporter 2 inhibitors (SGLT-2is) have documented a positive impact on micro- and macrovascular complications of type 2 diabetes (T2D). Most analyses suggest that these benefits are independent of achieving metabolic control. This meta-regression analysis was undertaken to explore the relationship between metabolic components positively influenced by SGLT-2is and a reduction in cardiovascular death (CV death) or hospitalization due to heart failure (hHF). A database search was conducted using the Cochrane Library to identify relevant studies. Analysis was conducted using CMA and RStudio (2022.07.1) software. The hazard ratios of the individual studies were used to compute the random effects model mean effect size for CV death or hHF, and the prediction interval was used to identify the uncertainty in the summary treatment effect. Heterogeneity was quantified using Q statistics. A pooled population of 46969 patients from five studies was included for analysis. The Cochrane risk of bias tool was used to assess the quality of the studies. There was a significant 23% reduction in CV deaths or hHFs in the SGLT-2i arm compared with the placebo arm [hazard ratio (HR): 0.77, 95% confidence interval (CI) 0.70-0.85]. However, the prediction interval (0.57-1.05) and the Q statistics [8.06>degrees of freedom (df) of 4] were indicative of uncertainty in the true effect or heterogeneity. Nearly 50% of the variance of the observed effects were related to the true effects (I2 =50%). Among the moderators selected, a significant correlation of the outcomes was found with the weight variable (P<0.01). Weight differential could explain the entire variance in true effect size (R2 =1.00) ruling out any sampling error. The results of this meta-regression analysis suggest that the beneficial effects of SGLT-2is in reducing CV deaths and hHFs are related to the weight variable.

Diabetic peripheral neuropathy in the outpatient department – a red-flag for associated risk factors and comorbidities

Objectives. To assess the characteristics of patients with type 2 diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN) as compared to patients with type 2 DM without DPN in an ambulatory setting, given the pandemic size of DM and its challenge for the healthcare systems worldwide in the 21st century. From the chronic complications of DM, DPN has a major impact on the patient’s life quality. DPN risk factors are both modifiable and unmodifiable and represent either other comorbidities per se, or predisposing factors for various comorbidities that alter the patient’s prognosis. Material and Methods. We conducted a retrospective observational study with 112 patients with type 2 DM treated in an out-patient department, in order to assess the characteristics and associated comorbidities of DPN. The group characteristics are a mean age of 60.28±9.76 years; 62.5% males; 77.67% from urban settlement; a prevalence of DPN of 52.67%. Outcomes. In the statistical analysis, DPN significantly associated with duration of DM, the need for insulin-therapy, risk factors such as smoking or obesity; with other complications of DM such as retinopathy, chronic kidney disease, atherosclerotic cardiovascular disease or peripheral artery disease; with comorbidities such as heart failure; and with the level of HDL-cholesterol and eGFR. Conclusions. A patient with DPN is more prone to also present other microvascular complications of type 2 DM, such as chronic kidney disease, retinopathy and, respectively with macrovascular complications of type 2 DM, and with other comorbidities such as heart failure and obesity. Its easily available diagnosis in an ambulatory setting by quantitative sensory testing should offer to DPN the status of a good marker for the presence of other chronic complications or comorbidities in type 2 DM, prompting the patient’s screening and an adequate medical management.

Combined evaluation of arterial stiffness, glycemic control and hypertension for macrovascular complications in type 2 diabetes

BackgroundArterial stiffness, glycemic control and blood pressure are risk factors of macrovascular complications in type 2 diabetes. This study aimed to investigate the combined association of arterial stiffness, glycemic control and hypertension status with the occurrence of diabetic macrovascular complication.MethodsA total of 1870 patients of diabetes were enrolled from Beijing Health Management Cohort between 2008 and 2018 as baseline, and then followed for macrovascular complication onset. We proposed a composite risk score (0–4) by arterial stiffness severity, pool glycemic control and hypertension status. Cox model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).ResultsThe mean age (SD) of this population was 59.90 (12.29) years. During a median follow-up of 4.0 years, 359 (19.2%) patients developed macrovascular complication. Compared to the normal arterial stiffness and good glycemic control group, patients with severe arterial stiffness and pool glycemic control had the highest risk of macrovascular complications (HR: 2.73; 95% CI: 1.42–5.25). Similarly, those of severe arterial stiffness and hypertension had the highest risk (HR: 2.69; 95% CI: 1.61–4.50). Patients of the composite score > 2 had a significantly increased risk of macrovascular complication.ConclusionThis study suggested the clinical importance of combined evaluation of arterial stiffness, glycemic control and hypertension status for the risk stratification and management of macrovascular complication of type 2 diabetes.

Cystatin C and Chronic Complications of Diabetes Mellitus in a Subsaharian Population

Background: Type 2 diabetes (T2D) is a chronic and progressive condition whose early management is crucial in preventing the occurrence of its chronic degenerative complications. Cystatin C (CysC) is a biomarker that may have a beneficial interest in the early detection of microvascular and macrovascular complications of T2D. Methods: We carried out a cross-sectional analytic study at the National Obesity Center of the Yaounde Central Hospital. We recruited 135 patients with T2D and performed a neurologic physical exam using the Toronto clinical score, a fundoscopy, ECG, ABI, and the following paraclinicals: dosage of serum levels of Cystatin C, lipid profile (with determination of Atherogenic indexes), Creatinine (with calculation of glomerular filtration rate using CKD-EPI formula) and hs-CRP. Results: Prevalences of diabetic retinopathy, nephropathy, neuropathy and PAD were 3.0%, 8.9%, 38.5%, 28.1% respectively. Electrocardiographic signs of myocardial ischemia were present in 5.9 % of the participants. We found 0.3[0.5-0.3] mg/l as median levels of the HDL-cholesterol and 0.9[1.2-0.7] mg/l for LDL-cholesterol. The median value of GFR was 105.7[119,0-85.7] ml/min/1.73m². The median serum CysC level was 0.8[0.9-0.6]mg/l and varied with age (p=0.01), A1C (p=0.016) and high blood pressure (HBP) (p=0.006). There was a relationship between serum CysC and diabetic nephropathy (p=0.01) and neuropathy (p=0.025). There was no significant relationship with diabetic retinopathy (p=0.225), PAD (p=0.169) and ECG signs of myocardial ischemia (p=0.669). Conclusion: Chronic microvascular and macrovascular complications of type 2 diabetes are common and in our study are predominantly represented by diabetic neuropathy and PAD. Serum CysC can be useful in the diagnosis of chronic complications of T2D.

Association Between the Tissue and Circulating Advanced Glycation End-Products and the Micro- and Macrovascular Complications in Type 1 Diabetes: The DIABAGE Study.

IntroductionType 1 diabetes is associated with an increased risk of vascular complications. We aimed to investigate the association between serum and tissue advanced glycation end-products (AGEs) and micro- and macrovascular complications in type 1 diabetes (T1D).MethodsWe conducted a cross-sectional study on 196 adults with T1D (mean age 44.53 ± 16, mean duration of diabetes 22 ± 12 years, mean HbA1c 8 ± 1.2%). AGEs were measured in blood serum (i.e., carboxymethyllysine (CML), methylglyoxal-hydroimidazolone-1 (MGH1), and pentosidine) and by measurement of skin autofluorescence (SAF). Associations between AGEs levels and vascular complications were analyzed using binary logistic regression. Correlations between AGEs and pulse wave velocity (PWV) were also assessed by linear regressions. Significant differences were set for p values less than 0.05.ResultsWe found positive associations between different AGEs and vascular complications. SAF was associated with both microangiopathy (retinopathy: OR = 1.92, p = 0.011; neuropathy: OR = 2.02, p = 0.04; any microangiopathy: OR = 2.83, p < 0.0001) and macroangiopathy (coronaropathy: OR = 3.11, p = 0.009; any macroangiopathy: OR = 2.78, p = 0.003). For circulating AGEs, pentosidine was significantly associated with coronaropathy (OR = 1.61, p = 0.01) and any macroangiopathy (OR = 1.52, p = 0.005) while MGH1 was associated with nephropathy (OR 1.72, p = 0.03). Furthermore, a significant linear correlation was found between PWV and SAF (r = 0.43, p < 0.001), pentosidine (r = 0.28, p < 0.001), and MGH1 (r = 0.16, p = 0.031), but not for CML (r = 0.03, p = 0.598).ConclusionsSkin autofluorescence appears to be a useful marker for investigating both micro- and macrovascular complications in T1D. In this study, pentosidine was associated with macroangiopathy and MGH1 with nephropathy among the circulating AGEs. Furthermore, the correlations between PWV and AGEs may suggest their value in early prediction of vascular complications in T1D.

Dyslipidaemia Among Bangladeshi Children and Adolescents with Type-1 Diabetes: An Observational Study

Introduction: Dyslipidemia increases the frequency and severity of micro and macrovascular complications of type 1 diabetes (T1D).&#x0D; Materials &amp; Methods: This cross-sectional study was aimed to evaluate the frequency of dyslipidaemia and its association with other risk factors in children and adolescents with type 1 diabetes. A total of 397 Type 1 diabetes (T1DM) patients aged 10-18 years who attended, Paediatric diabetes clinic in BIRDEM over one year period were included in this study.&#x0D; Results: The overall frequency of dyslipidaemia was 63.5% and median duration of diabetes was 3.0[2.0- 5.0 years]. The High LDL was most cmmmon dyslipidaemia (81%) in our study population. FBS was significantly higher 12.8[10.0-15.5] vs 10.8[7.7- 12.6] (p&lt;0.0001)) and higher median HbA1c 9.9 [8.5-11.9] vs 9.0[7.9-10.5] (p&lt;0.0001)) was found in dyslipidaemic patients. Median systolic blood pressure was higher (110 vs100) in dyslipidaemic patients ( p =.042).&#x0D; Conclusion: The frequency of dyslipidemia was high among the children and adolescents with T1DM which was associated with poor glycaemic control. Our results provide strong support for prior literature in emphasizing the importance of good glycemic control, to reduce the risk of dyslipidaemia.&#x0D; BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 79-82

Hyperglycemia and hypoglycemia exposure are differentially associated with micro- and macrovascular complications in adults with Type 1 Diabetes

AimsEvaluate the relationship between high and low exposure continuous glucose monitoring (CGM)-derived glucometrics and micro- and macrovascular complications in type 1 diabetes (T1D). MethodsCross-sectional study in T1D without cardiovascular disease (CVD) and with ≥ 1 of the following: ≥40 years, diabetic nephropathy, or ≥ 10 years of diabetes duration with CVD risk factors. Glucometrics were obtained over 14 consecutive days: glucose management indicator (GMI) and proportion of time < 54 (TBR < 54), <70, 70–180 (TIR), >180 (TAR). Carotid plaque was evaluated by ultrasonography. Logistic regression models adjusted for age, sex, and other risk factors were constructed to test the independent associations with chronic complications. ResultsWe included 152 patients (54.6% men, 48.7 ± 10.0 years-old). Sixty-seven patients had plaque and n = 71 microvascular complications. TAR (OR 1.28 [1.09–1.51]) and GMI (OR 3.05 [1.46–6.36]) were directly associated with the presence of microvascular complications, while TIR had an inverse relationship (OR 0.79 [0.66–0.93]). TBR < 54 was directly associated with the presence of plaque, even after adjusting for 5-year mean HbA1c (OR 1.51 [1.07–2.13]). ConclusionsHigh-glucose glucometrics were independently associated with microvascular complications. Only low-glucose exposure glucometrics was significantly associated with preclinical atherosclerosis. Our data support the role of hypoglycemia in the development of CVD in this population.

IDF21-0476 Macrovascular complications in type 1 diabetes mellitus patients with over 25 years of disease

Background: Macrovascular complications (MvC) are the most common cause of death in people with diabetes. Intensive glycemic control has proven to reduce its incidence in diabetes mellitus type 1 (T1DM). However, as for the general population, there are other factors influencing the development of cardiovascular disease. Aim: In a sample of T1DM patients with 25 years of disease: to evaluate the prevalence of MvC; to analyze the relationship between the development of MvC and several factors; to analyze the relationship between macrovascular and microvascular complications. Method: We performed a retrospective study based on the clinical files of T1DM patients with over 25 years of disease. Information was gathered regarding years of disease, average A1C per patient for each five year time period (A-A1C), types of treatment and complications. Statistical analysis was performed with SPSSv23, using: qui-square test for categorical variables, t-test (if normal distribution) or Mann-Whitney (if non-normal distribution) for continuous variables and Kaplan-Meier curves. The results were considered statistically significant if p<0,05. Results: The sample was constituted by 43 patients, 60,5% female, average age 52,6±1,5 years and average duration of T1DM 35,1±1,0 years. Arterial hypertension was present in 60,5% and dyslipidemia in 83,7%. The prevalence of MvC was 39,5% (average time for first MvC 29,4±2 years after diagnosis): 23,3% coronary heart disease; 20,9% heart failure; 20,9% peripheral artery disease and 9,3% cerebrovascular disease. All the patients were treated with intensive insulin therapy (median beginning time 1±7,5 years after diagnosis); 88,4% used functional insulin therapy (average start 19,5±2,0 years after diagnosis); 46,5% used subcutaneous continuous insulin perfusion (average start 21,7±1,5 years after diagnosis). A-A1C analysis was difficulted by several missing values, specially from the initial years of disease. However we observed that patients with MvC tended to have greater A-A1C values in most time periods, without statistical significance. The group with MvC had a longer course of disease (p=0,036) and predominance of the male gender (p=0,036). The patients with arterial hypertension had more (p=0,003) and more precocious (p=0,022) MvC. There were also more MvC in the patients with dyslipidemia (p=0,019). There was a tendency towards more prevalence of nephropathy, retinopathy and neuropathy in the group with MvC (p=0,068, 0,056 e 0,084, respectively). The group with MvC had more time of evolution of microvascular complications in average (p=0,019). Discussion: This work stands out the importance of dyslipidemia and arterial hypertension as contributors to MvC. There was a longer time of evolution of microvascular complications in the MvC group and a tendency towards a higher prevalence of each type of microvascular complications in this group. This data is likely explained by the importance of glycemic control in both types of complications. Although higher A-A1C values in the group with McV did not attain statistical significance, this is probably due to low sample size and several missing data.