Microangiopathic Complications Research Articles

High HbA1C and Glycemic Control as Diabetic Nephropathy Etiology

Background: Type 2 Diabetes Mellitus (T2DM) is a metabolic disorder characterized by insulin resistance, leading to microangiopathic complications such as diabetic nephropathy (DN). DN involves changes in the kidney's glomeruli, leading to albuminuria and potentially progressing to end-stage renal disease (ESRD). Hyperglycemia, a hallmark of diabetes, contributes to long-term organ damage, making DM a significant global health concern. Methods: This study included 48 participants aged 30 to 65 years, divided into diabetic patients and controls. Blood samples were collected for analysis of urea, creatinine, and HbA1c levels. Results: The HbA1c levels in the patient group (8.57 ± 1.75) exhibited a statistically significant increase (P≤0.05) compared to the control group (5.28 ±0.78). However, there was no significant difference in urea levels between patients (45.88 ± 37.91) and controls (33.02 ± 18.87) (P≤0.05). Similarly, there was no significant variance in creatinine levels between patients (1.37±1.78) and controls (1.06±1.55) (P≤0.05). Elevated HbA1c levels might be a cause of disease severity and complexity in diabetes, emphasizing the need for comprehensive glycemic control. Conclusion: Regular monitoring of HbA1c levels is crucial for early detection and management of DN in diabetic patients. Increased microalbuminuria correlates with elevated HbA1c levels, highlighting the importance of glycemic control in preventing kidney function impairment. This study demonstrated the significance of comprehensive glycemic management strategies in mitigating DN progression and reducing morbidity in diabetic populations.

Endothelial Dysfunction in Type 2 Diabetes Patients and its Association with Microvascular Complications: A Cross-sectional Study

Introduction: The prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing worldwide. Microangiopathic and macroangiopathic complications are the main causes of morbidity and mortality in diabetes. Endothelial dysfunction is important in the early pathophysiology of vascular complications. Screening is very important in order to prevent these complications. Aim: To investigate endothelial dysfunction, as measured by Flow Mediated Vasodilation (FMD) of the brachial artery, in diabetic individuals. It also aims to explore the correlation between FMD and Glycated Haemoglobin (HbA1c), as well as the association between FMD and microvascular complications such as diabetic neuropathy, diabetic retinopathy, and albuminuria. Materials and Methods: This cross-sectional study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, India, between 2020 and 2021 on 160 patients. All patients diagnosed with T2DM, attending the Outpatient Department (OPD) or admitted to the ward, were enrolled in the study using consecutive sampling. FMD was measured for each patient, and Urine Albumin Creatinine Ratio (UACR) was also assessed. Diabetic retinopathy was evaluated through fundus examination, and diabetic neuropathy was screened using the monofilament test. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27.0 to determine the correlation between FMD and these variables. Results: A total of 160 patients were enrolled in this study, including 104 (65%) males and 56 (35%) females. The median age was 52 years, and the participants had a median Body Mass Index (BMI) of 29.5 kg/m2 . The median HbA1c was 8.7%. The median Fasting Blood Sugar (FBS) and Postprandial Blood Sugar (PPBS) levels were 145 mg/dL and 242 mg/dL, respectively. The median FMD among all patients was 5.6%, with an Interquartile Range (IQR) of 4.9% to 6.6%. There was an inverse correlation between HbA1C and FMD values, with a correlation coefficient of -0.718 (p-value <0.01), indicating a strong and significant inverse correlation. Patients with significant macroalbuminuria had a lower median FMD compared to non albuminuric patients, and this difference was statistically significant. The median FMD was also lower in patients with diabetic neuropathy and retinopathy. Conclusion: The study findings suggest that endothelial dysfunction, as measured by FMD, is significantly impaired in patients with elevated HbA1c and microvascular complications of diabetes mellitus.

ATG5 gene expression analysis supports the involvement of autophagy in microangiopathic complications of type 2 diabetes

Background and aimsType 2 diabetes (T2D) hyperglycaemia alters basal autophagy. Since autophagy is an essential cellular process, our aim was to investigate the ATG5 (autophagy-related 5) gene expression level and genetic variants in a cohort of diabetic patients, characterized for the presence of microangiopathic complications. Methods and Resultsthe expression levels of ATG5 were evaluated in PBMCs from 48 T2D patients with an extensive evaluation for microangiopathic complications. Our analyses revealed a significant lower expression of ATG5 in T2D patients with retinopathy compared to those without retinopathy. We also highlighted a significant lower expression of ATG5 in T2D patients with early-cardiovascular autonomic neuropathy compared to those without it, after correction for sex, age, body mass index and levels of hemoglobin A1c. Conclusionour results highlight that dysregulation in the autophagy process could be involved in the development of severe microangiopathic complications.

Skin microvascular reactivity in patients with diabetic retinopathy.

Early detection of microangiopathic complications of diabetes mellitus (DM) is necessary to analyze the patient's condition and prevent disease progression. The study was aimed to investigate the relationship between the presence of retinopathy and decreased reactivity of the microcirculatory bed in patients with diabetes. The study involved 130 subjects: healthy volunteers (n=48), DM patients without retinopathy (n=53) and with retinopathy (n=29). Skin microvascular reactivity was assessed on the forearm using laser Doppler flowmetry with a local heating test combined with occlusion. The slope of local thermal hyperemia curve (Slope-120) and other parameters of microvascular reactivity showed difference in pairwise comparisons between the groups. Slope-120 had the highest sensitivity (0.759) and specificity (0.717) in detection of diabetic retinopathy. The decrease of Slope-120 was associated with retinopathy (odds ratio (OR) - 8.3 (2.9-24.1), p<0.001), even after adjusting for other factors (OR - 11.0 (1.6-77.2), p=0.016). Thus, assessment of skin microvascular reactivity may be a useful test for detecting signs of microangiopathic complications and for screening patients in risk group. Decreased microvascular reactivity has been shown to be prospective as an independent indicator of retinopathy in type 1 DM.

Cardiovascular profile of patients with type 2 Diabetes

The diabetic patient is a subject at high cardiovascular risk. Accurate determination of cardiovascular risk requires reliable tools to implement preventive measures. Can risk equations, and in particular the SCORE (Systematic Coronary Risk Evaluation) equation, still be of interest in assessing the risk of the type 2 diabetic patient in the face of new methods such as the coronary calcium score? The objective of the work is to determine the cardiovascular profile of type 2 diabetic patients through Score. Material and methods: Observational and descriptive study involving 176 type 2 diabetic patients conducted during the month of April 2021. All of them benefited from a clinical examination, a metabolic, degenerative and cardiovascular risk calculation according to the Score. Results: The average age is 58.7 years with extremes of 28 to 85 years. A female predominance was noted (74.4%) with a sex ratio of 0.3. The average duration of diabetes evolution is 8.84 years with extremes ranging from 1 month to 44 years. 57.1% of patients were on oral treatment, versus 36.3% on insulin and 6.5% on diabetic diet only. Glycemic imbalance exists in more than 62% (estimated by HbA1c). The other associated risk factors found are: hypertension (56%), obesity and overweight (82.1%), smoking (12%) and sedentary lifestyle (60.7%), dyslipidemia was found in 66 patients (56.5%); 89.6% of women were menopausal. Microangiopathic complications are noted in 60.7% of cases: nephropathy (38.2%), retinopathy (33.3%), neuropathy (59.8%). Macroangiopathic complications affect 23.2%. In our population, 67.3% have a very high cardiovascular risk (&gt; 10%) according to the SCORE. Conclusion: Type 2 diabetic patients are already at high cardiovascular risk. The seriousness of cardiovascular complications in diabetic patients reflects the importance of assessing their cardiovascular risk and of comprehensive management integrating the various risk factors. The Score remains an important and simple tool for estimating cardiovascular risk in patients with type 2 diabetes.

Detection of Cutaneous Blood Flow Changes Associated with Diabetic Microangiopathies in Type 2 Diabetes Patients Using Incoherent Optical Fluctuation Flowmetry

The aim of the present study was to evaluate changes in cutaneous blood flow detected by incoherent optical fluctuation flowmetry (IOFF) in diabetic patients with diagnosed microangiopathies. The study includes 52 patients with type 2 diabetes mellitus (12 males, 40 females, median age 57 (51; 60) years). All patients were examined using the IOFF method using functional tests: occlusion test on the index finger, local heat test on the dorsum of the foot, and local heat test on the big toe. The patients were divided into 2 groups: 13 patients with both diabetic retinopathy and diabetic nephropathy (Group 2, severe microcirculatory disorders) and 39 patients with only 1 microangiopathic complication or without any (Group 1). Local thermal hyperaemia (LTH2_1) was higher in Group 1 than in Group 2 (p = 0.011). Post-occlusive reactive hyperaemia (PORH_2) was higher in Group 2 than in Group 1 (p = 0.009). No changes were detected on the big toe. When PORH_2 and LTH2_1 were used in combination, the area under the ROC curve (95% CI) was 0.733 (0.62 to 0.846). Thus, the IOFF method has the potential to accurately detect blood flow abnormalities associated with diabetic microangiopathies.

PENGARUH DUKUNGAN KELUARGA TERHADAP KEPATUHAN PASIEN MENJALANI PERAWATAN LUKA ULKUS DIABETIK

Diabetic ulcers are open sores on the skin layer to the dermis, which usually occur on the soles of the feet. Wounds that arise in DM patients due to complications of microangiopathy and macroangiopathy. Peripheral neuropathy will cause loss of sensation in the distal area of ​​the foot. The length of time a person suffers from DM will cause microangiopathic complications so diabetic neuropathy will cause ulcers on the feet. This study aims to determine the relationship between family support in the healing process of diabetic ulcers with patient compliance in undergoing treatment at the Asri Wound Care Center clinic in Medan using a descriptive correlation research design with a cross-sectional design. The sample in this study was 36 respondents using an accidental sampling technique. The results of the Spearman rank test (rho) with a p-value = 0.004 with a coefficient value of 0.467 then p-value &lt;a (0.000 &lt;0.05), meaning that there is a relationship between family support in the healing process of diabetic ulcers with patient compliance in undergoing treatment at the Asri Wound clinic. Care Center Medan. For education, it is expected that educational institutions can increase the knowledge of students at the institution regarding the importance of family support in the process of healing diabetic ulcers with patient compliance in undergoing treatment.

The GSTO2 (rs156697) Polymorphism Modifies Diabetic Nephropathy Risk.

Background and Objectives: In the development of type 2 diabetes mellitus (T2DM) and its complications, genetic and environmental factors play important roles. Diabetic nephropathy (DN), one of the major microangiopathic chronic diabetic complications, is associated with an increased risk of major cardiovascular events and all-cause mortality. The present study was designed to investigate the possible modifying effect of glutathione transferase polymorphisms (GSTM1, GSTT1, GSTP1 rs1138272/rs1695, GSTO1 rs4925 and GSTO2 rs156697) in the susceptibility to T2DM and diabetic nephropathy. Materials and Methods: GSTM1 and GSTT1 deletion polymorphisms were determined by multiplex PCR, whereas GSTO1, GSTO2, and GSTP1 polymorphisms were determined by the real-time PCR in 160 T2DM patients and 248 age- and gender-matched controls. Advanced glycation end products (AGEs) were measured by ELISA. Results: Among six investigated GST polymorphisms, a significant association between the GST genotypes and susceptibility for development of diabetes mellitus was found for the GSTM1, GSTT1, GSTP1 (rs1138272) and GSTO1 polymorphisms. When the GST genotypes’ distribution in diabetes patients was assessed in the subgroups with and without diabetic nephropathy, a significant association was found only for the GSTO2 rs156697 polymorphism. Diabetic patients, carriers of the GSTM1 null, GSTT1 null and variant GSTO1*AA genotypes, had significantly increased levels of AGEs in comparison with carriers of the GSTM1 active, GSTT1 active and referent GSTO1*CC genotypes (p < 0.001, p < 0.001, p = 0.004, respectively). Conclusions: The present study supports the hypothesis that GST polymorphisms modulate the risk of diabetes and diabetic nephropathy and influence the AGEs concentration, suggesting the potential regulatory role of these enzymes in redox homeostasis disturbances.

Association between Hyperhomocysteinemia and Microangiopathic Complications (Neuropathy and Nephropathy) in Subjects with Type 1 and Type 2 Diabetes

Association between Hyperhomocysteinemia and Microangiopathic Complications (Neuropathy and Nephropathy) in Subjects with Type 1 and Type 2 Diabetes

Evaluation of Vascular and Perfusional Changes in the Retina and Choroid of Children with MIS-C.

MIS-C is hyperinflammation following Coronavirus Disease 2019 (COVID-19) and effects many organs. COVID-19 effects the retina and choroid through microangiopathy and thrombosis but the knowledge related to MIS-C in literature is limited. Thirty children (60 eyes) with MIS-C (Study group-SG) and age-and gender-matched, 32 healthy children (64 eyes) (Control group-CG) were included in the prospective case-control study. Complete ophthalmological examinations, measurements of the vessel densities of the retinal layers, and flow area of the outer retina and choriocapillaris in both groups were done with optical coherence tomography angiography (OCT-A). The mean age of the SG was 11.9±3.9 and CG was 12.5±4.6 years (p=0.197). In this study we found that the vessel density of the deep layer of the inner retina was significantly decreased and reduced in the outer retina of flow area in SG compared to CG (p<0.05, for all). However, there was no significant difference between the groups for other measurements. In MIS-C patients, vessel densities of the deep layer of the inner retina and flow area in the outer retina significantly decreased. This OCTA-A finding suggests; MIS-C is related with endothelial thrombotic condition problems in small branches of the retinal artery. The results of this study support the idea that there is a need for screening of MIS-C patients for the presence of these microangiopathic and perfusional complications.

АНАЛИЗ ВЕДУЩИХ ЭПИДЕМИОЛОГИЧЕСКИХ ПОКАЗАТЕЛЕЙ САХАРНОГО ДИАБЕТА СРЕДИ ВЗРОСЛОГО НАСЕЛЕНИЯ СЕВЕРНОГО РЕГИОНА

The study aims to analyze epidemiological situation for diabetes mellitus, with its complications and outcomes, in the adult population of the Khanty-Mansi Autonomous Okrug – Ugra by January 1, 2022. The analysis is conducted on the basis of the regional component of the Federal Register using diabetes mellitus data for 2021. It is determined that leading epidemiological indicators of diabetes mellitus in the region correspond to global and Russian trends and pace. Diabetic polyneuropathy, diabetic retinopathy, and diabetic nephropathy are leading microangiopathic complications in diabetes mellitus. Monitoring of leading clinical and demographical indicators of diabetes mellitus allows for optimization and planning of medical care for the region’s population, decision-making in primary and secondary preventive care of diabetes mellitus, patient logistics and routing, and advancing of screening and early diagnosis approaches.

Analysis and evaluation of correlation between DNA polymorphism in the genes MTHFR, PAI-1 and serum creatinine, creatinine clearance and albumin/creatinine ratio in morning urine of patients with type 2 diabetes mellitus and diabetic nephropathy.

Diabetic nephropathy is a major microangiopathic complication of type 2 diabetes and a leading cause of chronic kidney disease (CKD).

PSUN144 Impact of the COVID-19 Pandemic on the Follow-up and Treatment of Patients with Diabetes

Abstract Introduction During the coronavirus disease (COVID-19) pandemic a state of emergency was declared where people were instructed to stay at home to prevent disease transmission, which exerted severe disruptions in the routine care of patients. The aim of this study was to evaluate the impact of the COVID-19 pandemic in the treatment and follow-up of patients with diabetes. Methodology We conducted an observational, descriptive, cross-sectional study in 39 diabetic patients followed by the Endocrinology department at the Hospital de Clínicas during July-September 2021. We compared anthropometric data, blood pressure (BP), HbA1C, lipid profile, changes in eating habits, physical activity, medication access and number of medical care visits before and during the pandemic. Results Mean age was 61.3 ± 13 years, mostly females (56.4%). Type 2 was the most common diabetes form (82.1%). Mean diabetes duration was 12.5 years (range: 5-20). Eighty-four percent had microangiopathic complications; the most frequent was diabetic retinopathy (61.5%). Forty-eight percent had macroangiopathic complications. Most frequent comorbidities were high blood pressure (82.1%) and dyslipidemia (69.2%). Twenty eight percent reported smoking. Eighteen percent had changes in medication access during the pandemic, the main reason was the lack of a medical prescription (12.8%), followed by drug unavailability (10.2%). Thirty-three percent reported changes in eating habits, 30% increased the amount of food consumption, 61.5% decreased fruits and vegetables intake, and 2% increased alcohol drinking. There was a significant decrease in physical exercise (43.6%), medical appointments (4.4 vs. 2.9, p=0.006) and LDL (142±63,6 vs.136,7±96,9, p=0.01) during the pandemic. Forty-one percent and 23% lacked hbA1C testing before and during the pandemic, respectively. Most patients presented with hbA1C values more than 7% before and after the pandemic (65.2% and 70%, respectively). There was a non-significant increase in BMI (31,6±6,3 vs. 32,4±11,7, p=0,668), blood pressure (systolic BP: 132,5±20,2 vs. 136,7±23,5, p=0,32; diastolic BP: 76,7±13,3 vs. 80,5±14,3, p=0,089) and HbA1c (8,1±1,6 vs. 8,2±1,8, p=0,662). Conclusion We found a high percentage of micro and microangiopathic complications in diabetic patients. In addition, many patients had poor metabolic control without HbA1c monitoring. Given the increased risks of COVID-19 complications and death amid patients with uncontrolled diabetes changes in metabolic control may be of great significance. We found a decrease in medical visits, dietary changes, disruption in medication access and a decrease in physical activities during the pandemic. More studies are warranted to understand the indirect effects of the pandemic in patients with diabetes and its long-term effects on micro- and macroangiopathic complications and mortality. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Association of serum homocysteine with type II diabetic retinopathy.

Objective: To elucidate the association of serum homocysteine with diabetic retinopathy. Study Design: Case Control study. Setting: Department of Physiology and Centre for Research in Experimental and Applied Medicine (CREAM), Army Medical College, in Collaboration with Armed Forces Institute of Ophthalmology, Rawalpindi. Period: December 2019 to December 2020. Material &amp; Methods: A total of ninety subjects were enrolled in the study which were subdivided into three groups; healthy subjects, diabetic subjects and patients with diabetic retinopathy (DR). The permission for carrying out the study was obtained from ethical review committee. Confidentiality of the data was maintained. The data obtained was analyzed and processed using SPSS software. Results: The mean Fasting Blood Glucose (FBG) levels were found to be 5.51 ± 0.34 (mmol/l), 8.11 ± 0.67 (mmol/l) and 8.73 ± 0.90 (mmol/l) in healthy controls, diabetic subjects and patients with DR respectively (p=0.001). The mean serum homocysteine levels were found to be 10.12 + 1.95 (µmol/l), 24.99 ± 4.25 (µmol/l) and 45.78 + 9.66 (µmol/l) in healthy controls, diabetic subjects and patients with DR respectively (p=0.001). Conclusion: Our research can be concluded that serum homocysteine levels have a strong association with the development of diabetic retinopathy. Monitoring the serum levels of this inflammatory biomarker can therefore be helpful in obviating the development of diabetic microangiopathic complications, particularly diabetic retinopathy. Serum homocystein can be used a prognostic tool in the progression of microangiopathic complications of diabetes.

Emicizumab for the treatment of acquired hemophilia A: Retrospective review of a single-institution experience.

Acquired haemophilia A (AHA) is a rare and potentially life-threatening bleeding disorder arising from autoantibodies that inhibit coagulation factor VIII (FVIII). Treatment entails achieving haemostasis with bypassing agents or factor replacement, and eradication of the inhibitor with immunosuppressive therapy (IST). Due to the rarity of AHA, there are few prospective data to guide management. We present a retrospective report of 11 AHA patients treated with emicizumab, a FVIII-mimetic bispecific antibody, administered at 3mg/kg weekly for 4 weeks in conjunction with rituximab-based immunosuppressive therapy. The chromogenic FVIII inhibitor assay was used to assess for inhibitor eradication. The median follow-up was 13.9 months. The median number of days of additional haemostatic therapy or red blood cell transfusions after initiating emicizumab was 2 (range 0-15). The median was 0 days (range 0-8) for patients who did not require vascular embolization to achieve haemostasis. Eight patients achieved a complete remission (defined as recovery of FVIII activity to>50% with a negative inhibitor test in the absence of haemostatic and IST); two patients achieved a partial remission (FVIII activity>50% but with detectable inhibitor); one patient experienced refractory disease. One patient experienced rebleeding and two patients experienced inhibitor recurrence. No thrombotic, thrombotic microangiopathic or infectious complications occurred. Our observations suggest emicizumab can facilitate haemostasis for AHA patients and be combined with safer, lower-intensity immunosuppressive therapies to achieve remission.

Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville.

Erectile dysfunction (ED) is very common in diabetic males, especially type 2 diabetes mellitus (T2DM). Many factors and complications of diabetes such as macro- and micro-angiopathy are associated with risks leading to ED in male patients. Analysis of factors associated with ED in T2DM. The purpose of this study is to shed light on potential associations between ED, type 2 diabetes, and some risks factors. This was a prospective analytic study of T2DM over 18. The study population consisted of diabetic patients seen at the endocrinology and urology departments of the University Hospital during the study period. Evaluation of ED was made by IIEF 5 score. A total of 333 patients were selected for the study. The mean age was 56.6 ± 9.8 and the prevalence of ED was 82.6% (n=275). In univariate analysis, several associated factors were identified such as micro-angiopathic type complications including diabetic retinopathy (OR 4.88 [2.31-10.33], P < .001), diabetic nephropathy (OR 12.67 [1.71-93.66], P=.002) and macro-angiopathic type including arterial hypertension (OR 3.12 [1.69-5.75], P < .001). In multivariate analysis, duration of diabetes, micro and macroangiopathic complications, and hyperuricemia were independent risk factors for the occurrence of ED (P < .05). The presence of certain complications of diabetes such as micro or macro angiopathy or hyperuricemia should lead to a search for a ED. The presence of these associated factors identified in type 2 diabetic patients should systematically prompt an ED diagnosis which is often moderate or severe. That diagnosis would help design a protocol for the management and improvement of the life quality of these patients. The strength of this work is that it was conducted in the biggest hospital in the country which gives us a good idea of the trend of this ailment in the country. But the limitation of the study is that it only included patients who visited the hospital. This is monocentric hospital study was also transversal which does allow to establish a causal link. ED has a significant prevalence in T2DM. Several associated factors identified in uni and multivariate analyses, including duration of diabetes, micro and macro angiopathic complications, and hyperuricemia, increase ED risk. Therefore, it is essential to investigate the existence of these factors to improve the management of ED, which may allow the patient to regain a better overall health status. SNN Milama, A Mougougou, S G Olagui, et al. Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville. Sex Med 2022;10:100564.

Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review.

Diabetes mellitus (DM) has been frequently associated with an impaired immune response against infectious agents, making affected patients at risk for more severe disease and sometimes causing worse outcomes. The recent COVID-19 pandemic has seriously affected patients with both diabetes, in particular those carrying comorbidities or with poor glycemic control. As regards pediatric diabetes mellitus, the availability of more accurate and technological tools for glycemic management and the improved markers of metabolic control might mitigate the negative impact of infections. Notably, good metabolic control of diabetes since its diagnosis reduces not only the risk of microangiopathic complications but also of impaired immune response to infectious diseases. Therefore, vaccinations are strongly recommended. Our paper aims to provide the most updated evidence regarding infectious diseases in type 1 pediatric DM.

Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children - From Disease Pathogenesis to Complications.

The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children’s population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.

Relationship between soluble protein ST2 (sST2) levels and microvascular complications in a cohort of patients with type 1 diabetes

AimTo determine the association and the prognostic value of soluble ST2 (sST2) levels in the development of diabetic retinopathy (DR), diabetic macular oedema (DMO) or diabetic nephropathy (DN), in a cohort of patients with type 1 diabetes (T1D). MethodsA total of 269 individuals with T1D (154 males and 115 females) were recruited. The overall mean age was 43.2±14.9 years, and the diabetes duration was 17.1±12.1 years. Levels of sST2 in serum were evaluated, and the presence as well as the degree of DR, DMO and DN was recorded. Additionally, other clinical and analytical parameters including demographic variables were recovered from patients’ electronic health record. Ten years later, the presence and stage of DR, DMO and DN were again recorded under the same criteria.The association between previously mentioned parameters with DR and DN was analysed by univariate and multivariate logistic regression. The variables in the final multivariate models were adjusted from complete models via backward elimination and maintained only when significant. ResultsAn increase of 10ng/ml in the levels of sST2 was associated with a 1.50 (1.02–2.19) and 1.48 (1.05–2.08) prevalence odds ratio (OR) in DMO and DR, respectively. There was no association between sST2 levels and DN. Meanwhile, sST2 levels did not display a prognostic effect in any of the microangiopathic diabetic complications studied. ConclusionsLevels of sST2 are associated with the presence of DR and DMO, they do not seem to be predictive for the development or deterioration of DR, DMO or DN.

Beyond the Glycaemic Control of Dapagliflozin: Microangiopathy and Non-classical Complications.

Dapagliflozin is a selective sodium-glucose cotransporter 2 inhibitor (SGLT2i) indicated for the treatment of type 2 diabetes mellitus (T2DM), heart failure (HF) with reduced ejection fraction (EF) and chronic kidney disease (CKD). In monotherapy or as an additive therapy, dapagliflozin aids glycaemic control, is associated with reductions in blood pressure and weight, and promotes a favourable lipid profile. In this review, we address the impact of dapagliflozin on cardiovascular risk factors and common microangiopathic complications such as kidney disease and retinopathy in patients with T2DM. Furthermore, we evaluate its potential beneficial effects on other less frequent complications of diabetes, such as macular oedema, cognitive impairment, non-alcoholic fatty liver disease and respiratory disorders during sleep. Moreover, the underuse of SGLT2i in clinical practice is discussed. Our goal is to help translate this evidence into clinical practice.