Risk Factors For Diabetic Complications Research Articles

Post-prandial glucose and diabetic complications: systematic review of observational studies

Post-prandial hyperglycemia is considered a relevant therapeutic target in type 2 diabetic patients, and it could represent per se an independent risk factor for diabetic complications. Aim of the present systematic review is to collect and summarize evidence from observational studies on the relationship between post-prandial glucose (PPG) and cardiovascular or microvascular disease in patients with diabetes. An extensive search of Medline (any date up to December 31, 2010) was performed for all longitudinal epidemiological studies with a cohort design. The following endpoints were taken into consideration: death from any cause; cardiovascular death and micro- and macrovascular complications. The number of epidemiological studies assessing the relationship between PPG and microvascular or cardiovascular disease in subjects with diabetes is surprisingly scarce. In fact, of the 391 retrieved studies, only 8 fulfilled the inclusion criteria. Most of those investigations enrolled small samples, which in many instances were not representative of the general population. Furthermore, the assessment of PPG varied widely across studies. These considerations prevent any formal meta-analysis. Despite this, the few available studies show that higher PPG is associated with increased all-cause and cardiovascular death, incidence of major cardiovascular events (including myocardial infarction and stroke), and progression of diabetic retinopathy.

Hepatitis C virus infection in a population with high incidence of type 2 diabetes: Impact on diabetes complications

A growing number of reports suggest a connection between hepatitis C virus (HCV) infection and type 2 diabetes (T2D). However, the association of HCV infection with diabetes-related complications has not yet been clarified. The aim of this study was to determine the prevalence of HCV infection in T2D-patients in Kuwait which has a high incidence of type 2 diabetes, and to investigate the association between HCV viremia and diabetes-related complications. A total of 438 patients with T2D (325 Kuwaitis and 113 Egyptians), and 440 control subjects, were enrolled for this study. HCV infection was assessed by testing for serum HCV-specific antibodies, and by detection of HCV RNA. HCV viral load and hemoglobin A1c (HbA1c) levels were assessed in patients with and without diabetes complications. Thirty one (7%) out of 438 T2D-patients had evidence of HCV infection compared to 4 (1%) out of 440 control adults (p<0.0001). The prevalence of HCV infection in Kuwaiti and Egyptian T2D-patients was 3% and 18%, respectively. Most of the HCV sequences detected in T2D patients and control subjects were of genotype 4. The HbA1c levels in T2D-patients with HCV viremia were significantly higher than those in HCV-negative patients. HCV viremia, female sex, age, family history of diabetes were found to be independent risk factors for diabetes complications. The results suggest that T2D-patients in Kuwait have higher prevalence of HCV infection than controls, and that HCV viremia is associated with diabetes-related complications.

Postprandial and Basal Glucose in Type 2 Diabetes: Assessment and Respective Impacts

The independent contribution of postprandial glucose (PPG) excursions to the overall glucose exposure and its role in the development of both micro- and macrovascular complications of diabetes remain subject to continuing debate in type 2 diabetes. Discussion continues on whether postprandial hyperglycemia is the main contributor to the overall hyperglycemia in fairly well-controlled individuals, whereas basal hyperglycemia becomes the preponderant contributor in poorly controlled patients. The concern about the role of PPG as a risk factor for diabetes complications is related to the controversial data obtained in individuals with impaired glucose tolerance. It remains, however, that the total glucose exposure as reflected by hemoglobin A1c (HbA1c) levels is an undoubted major vascular risk factor. Excluding the contribution of PPG is nonsensical. In support of this position is the fact that the absolute impact of PPG on HbA1c, expressed as percentage levels of HbA1c, remains constant at 1% across the HbA1c continuum in non-insulin-treated type 2 diabetes patients. This key feature clearly depicts the absolute contribution of PPG in contrast to its relative contribution and better explains why PPG contributes to the excess of glycation with the basal hyperglycemia.

Associations Between General and Abdominal Adiposity and Mortality in Individuals With Diabetes Mellitus

Individuals with diabetes mellitus are advised to achieve a healthy weight to prevent complications. However, fat mass distribution has hardly been investigated as a risk factor for diabetes complications. The authors studied associations between body mass index, waist circumference, waist/hip ratio, and waist/height ratio and mortality among individuals with diabetes mellitus. Within the European Prospective Investigation into Cancer and Nutrition, a subcohort was defined as 5,435 individuals with a confirmed self-report of diabetes mellitus at baseline in 1992-2000. Participants were aged 57.3 (standard deviation, 6.3) years, 54% were men, the median diabetes duration was 4.6 (interquartile range, 2.0-9.8) years, and 22% of the participants used insulin. Body mass index, as indicator of general obesity, was not associated with higher mortality, whereas all measurements of abdominal obesity showed a positive association. Associations generally were slightly weaker in women. The strongest association was observed for waist/height ratio: In the fifth quintile, the hazard rate ratio was 1.88 (95% confidence interval: 1.33, 2.65) for men and 2.46 (95% confidence interval: 1.46, 4.14) for women. Measurements of abdominal, but not general, adiposity were associated with higher mortality in diabetic individuals. The waist/height ratio showed the strongest association. Respective indicators might be investigated in risk prediction models.

Are PON1 Q/R 192 and M/L 55 polymorphisms risk factors for diabetes complications in Turkish population?

Objectives We investigated whether the human serum paraoxonase (PON1) Q/R 192 and M/L 55 polymorphisms are associated with the complications of the type 2 diabetes (T2D). Design and methods Study group was consisted of 50 healthy subjects and 100 type 2 diabetes mellitus (DM) patients. Following measuring of serum PON1 activity, isolation of DNA and genotyping analyses were performed. Results PON1 activity of the patients with complications was significantly reduced by 23.5% compared to the group of diabetic patients and by 26.3% than the controls. According to multivariate analysis, we observed a three times significant effect of Q/R 192 polymorphism on the susceptibility to the occurrence of complications. Conclusions Protective effects of paraoxonase against peroxidation of LDL particles are important in T2D complications. Although both of the two polymorphisms are associated, 192 polymorphism seems to be stronger predictor of the risk of diabetic complications.

Associations between periodontal disease and selected risk factors of early complications among youth with type 1 and type 2 diabetes: a pilot study

Most studies evaluating the relation between periodontal disease and diabetes in children have not considered diabetes type. To evaluate the relationship between periodontal damage and risk factors of diabetes complications among youth by diabetes type in a pilot study. 155 participants (126 with type 1 diabetes; 29 with type 2 diabetes) from the SEARCH for Diabetes in Youth study in South Carolina who were <20 yr of age at diagnosis. Cross-sectional analysis of periodontal damage (bone loss ≥3 mm on ≥1 permanent tooth site on pre-existing bitewing radiographs) and diabetes type assigned by the provider at diagnosis. Periodontal damage was observed in 52 individuals (34%) overall, but was more common in type 2 (16/29, 55%) vs. type 1 diabetes (37/126, 29%). Among youth with type 2 diabetes, those with periodontal damage had lower fasting c-peptide (2.3 vs. 3.4 ng/mL, p-value=0.01), and higher triglyceride levels (171.8 vs. 87.2, p-value=0.01) than those without periodontal damage after adjustment for age, sex, race, education level, family income, duration of diabetes, diabetes control, time between study visit and date of radiograph, tooth brushing, and visits to the dentist. Blood pressure, waist circumference, LDL cholesterol and A1c were not associated with periodontal damage. The associations between periodontal disease and risk factors for diabetes complications differ by diabetes type. Periodontal damage is associated with impaired beta cell function and metabolic syndrome components in type 2 but not type 1 diabetes. These findings need to be confirmed in larger, prospective studies.

Diabetes-related molecular signatures in infrared spectra of human saliva

BackgroundThere is an ongoing need for improvements in non-invasive, point-of-care tools for the diagnosis and prognosis of diabetes mellitus. Ideally, such technologies would allow for community screening.MethodsIn this study, we employed infrared spectroscopy as a novel diagnostic tool in the prediction of diabetic status by analyzing the molecular and sub-molecular spectral signatures of saliva collected from subjects with diabetes (n = 39) and healthy controls (n = 22).ResultsSpectral analysis revealed differences in several major metabolic components - lipid, proteins, glucose, thiocyanate and carboxylate - that clearly demarcate healthy and diseased saliva. The overall accuracy for the diagnosis of diabetes based on infrared spectroscopy was 100% on the training set and 88.2% on the validation set. Therefore, we have established that infrared spectroscopy can be used to generate complex biochemical profiles in saliva and identify several potential diabetes-associated spectral features.ConclusionsInfrared spectroscopy may represent an appropriate tool with which to identify novel diseases mechanisms, risk factors for diabetic complications and markers of therapeutic efficacy. Further study into the potential utility of infrared spectroscopy as diagnostic and prognostic tool for diabetes is warranted.

Dietary patterns of Korean patients with type 2 diabetes and their relation to risk factors of diabetic complications

We characterized dietary patterns and their relation to risk factors of diabetic complications in 901 Korean patients with type 2 diabetes from an ongoing, prospective study. Two dietary patterns were empirically derived by principal component analysis composed of 39 food groups: pork and noodle pattern characterized by high intake of pork, boiled pork, processed fish, noodles, pizza, eggs and beverages and vegetable and legume pattern characterized by high intake of vegetables, legumes, mushrooms, seaweed, tofu, Kimchi, anchovy and low fat dairies. The quality of diet measured by Mini Dietary Assessment was lowest in the highest tertile of pork and noodles pattern scores but highest in the highest tertile of vegetable and legume pattern. The highest tertile of pork and noodle pattern scores had significantly greater triglyceride and C‐peptide levels than the lowest tertile whereas the highest tertile of vegetable and legume pattern had significantly lower levels of triglyceride and insulin compared to the lowest tertile. Moreover, subjects with the highest tertile of pork and noodle pattern had a significantly greater risk of having high waist circumferences (OR=1.59, 95% CI=1.11–2.29), BMI (OR=1.53, 95% CI=1.08–2.17) and diastolic blood pressure (OR=1.56, 95% CI=1.09–2.22) than the lowest tertile. Multiple food groups affect diabetic complication risk beyond that of the individual food groups.This work was supported by the Second stage of BK21 Project in 2008 and Seoul R&amp;BD Program, No. 10526.

Is Depression a Modifiable Risk Factor for Diabetes Burden?

The purpose of this review article was to examine the empirical evidence supporting depression as a risk factor for diabetes complications and associated burden. A database search using keywords located recent clinical and population studies addressing the association between depression and type 2 diabetes. Both cross-sectional and cohort studies were reviewed. Depression appears to exacerbate the progression of type 2 diabetes. The evidence is strong supporting the hypothesis that depression in persons with diabetes increases the risk of diabetes-related burden, including suboptimal glycemic control, complications, functionality, mortality, and health care utilization. Screening for depression among patients with diabetes should be increased in primary care. Newer approaches to diabetes care management may help to slow the progression of diabetes.

Carbohydrate Intake is Associated with Diet Quality in Patients with Type 2 Diabetes

Recently, high carbohydrate intake has been reported to be related to low diet quality and risk factors of diabetic complications. Traditionally, Koreans consume high quantities of carbohydrates, mainly from white rice. This study was to examine whether excessively high carbohydrate intake (&gt;65% of energy from carbohydrate) was negatively associated with diet balance and quality in Korean patients with type 2 diabetes. Subjects from an ongoing, prospective study (n=948) were classified according to the percent of energy from carbohydrate intake (4 groups: &lt;55%, 55–59%, 60–64%, and ≥65%). A high carbohydrate diet (≥ 65% of energy) was associated with insulin resistance, hypertension, and dyslipidemia. Most of the nutrient and food group intakes per 1000kcal and diet quality decreased with an increase in the percent of energy from carbohydrates. Excessive carbohydrate intake is related to diabetic complications, which may be through unbalanced and low‐quality diet. Carbohydrate intake that constitutes around 50%–55% of total energy intake and a high‐quality diet with adequate vitamins and minerals that includes protein foods, fruits, and vegetables may be recommended to manage and prevent diabetic complications of patients with type 2 diabetes in populations where white rice is consumed as the main staple food.This work was supported by the Second stage of BK21 Project in 2008 and Seoul R&amp;BD Program, No. 10526.

Early onset type 2 diabetes mellitus: a harbinger for complications in later years--clinical observation from a secondary care cohort

Little is known about the complication burden in later years among early onset type 2 diabetes mellitus (T2DM). To determine the magnitude of diabetes complications and adequacy of risk factor management and to test the hypothesis that diabetes duration is an important contributing factor to these complications. A cross-sectional study of secondary care diabetes population. Data on glycaemic control, cardiovascular risk factors (overweight/obesity, hypertension, dyslipidaemia), cardiovascular disease (CVD) and microvascular complications among those diagnosed before (early onset) and after (later onset) 40 years of age at different diabetes durations (<10, 10-20 and >20 years) were analysed. A total of 2733 subjects were identified, of which 527 had diabetes diagnosed below the age of 40 years. By the sixth decade of life, early onset cohort experienced high complication burden (CVD: 37.2%, retinopathy: 59.3% and neuropathy: 53.1%). Complication prevalence increased with diabetes duration but the increment rate was greater among early onset cohort. Compared with those diagnosed after 40, early onset cohort experienced similar burden of microvascular complications approximately 13-20 years earlier. Diabetes duration was a significant predictor for microvascular and CVD complications. Prevalence of CVD risk factors was high ( approximately 80-93%) regardless of the age of diagnosis and diabetes duration. Early onset subjects were more likely to have poorer glucose control ( approximately 70-78%), untreated hypertension (26.3%) and a substantial number did not receive statin treatment for primary prevention (34.8%). Early onset T2DM subjects are at substantial risk of developing diabetes complications in later years but at an earlier stage than later onset cohort and prolonged exposure to adverse diabetic milieu is an important contributing factor. Management of risk factors for diabetes complications was inadequate among early onset subjects.

Smoking cessation and diabetes control in Kerala, India: an urgent need for health education.

This study documented the tobacco use among male diabetes patients in a clinic-based population of urban India, patient reports of physician cessation messages and patients' perception of tobacco use as a risk factor for diabetes complications. All the 444 male diabetes patients who attended three public sector hospitals in Thiruvananthapuram district, Kerala, were surveyed to ascertain their tobacco use as well as the frequency and content of quit messages received from health staff. A significant proportion (59%) of diabetes patients were tobacco users prior to diagnosis and more than half of them continued to use tobacco, many daily, even after diagnosis. Of the 100 current smokers, 75% were asked about their tobacco use at the time of diagnosis; of those, 52% were advised to quit. However, a lack of patient awareness existed regarding the linkages of smoking and diabetes complications. Notably, 52% of patients did not associate smoking with diabetes complications. Given the magnitude of tobacco use among diabetics, there is clearly a need for more proactive cessation efforts. The times of illness diagnosis, illness flare-ups and emerging illness complications are teachable moments when patients are primed to change their behavior and more motivated to quit tobacco.

Smoking among diabetes patients in Yogyakarta, Indonesia: cessation efforts are urgently needed

To document the prevalence of tobacco use among male diabetes patients in a clinic based population of Yogyakarta Province, Indonesia; to examine patient's perceptions of smoking as a risk factor for diabetes complications; and to investigate whether patients had received cessation messages from their doctors. Twelve in-depth interviews and five focus groups (n = 21) with diabetic patients in 2004-2005, followed by a cross-sectional survey of 778 male diabetic patients in diabetes clinics in 2006-2007. 65% of male diabetes patients smoked before being diagnosed, and 32% smoked in the last 30 days. Most patients incorrectly perceived low level smoking safe for diabetics (mean of 3.6 cigarettes). The median range of cigarettes smoked per day was in excess of this 'safe' amount (4-10 cigarettes). Most respondents did not associate smoking with diabetes and its complications. Only 35% of all patients recalled being asked whether they smoked by their doctors, and there were no differences between smokers and non-smokers. Quit messages received by patients were seen as general health advice and not diabetes specific. Many diabetic patients continue to smoke despite the hazard of smoking on diabetes complications and mortality. Smoking cessation is not commonly encouraged by health-care providers in Indonesia, and is not a routine part of diabetes counselling despite the risk of smoking to those with diabetes. Project Quit Tobacco International is currently developing cessation services for patients with diabetes and encouraging medical and nursing schools to incorporate disease specific tobacco education in its curriculum and skill based classes in tobacco cessation counselling.

Transient high glucose causes persistent epigenetic changes and altered gene expression during subsequent normoglycemia

The current goal of diabetes therapy is to reduce time-averaged mean levels of glycemia, measured as HbA1c, to prevent diabetic complications. However, HbA1c only explains <25% of the variation in risk of developing complications. Because HbA1c does not correlate with glycemic variability when adjusted for mean blood glucose, we hypothesized that transient spikes of hyperglycemia may be an HbA1c–independent risk factor for diabetic complications. We show that transient hyperglycemia induces long-lasting activating epigenetic changes in the promoter of the nuclear factor κB (NF-κB) subunit p65 in aortic endothelial cells both in vitro and in nondiabetic mice, which cause increased p65 gene expression. Both the epigenetic changes and the gene expression changes persist for at least 6 d of subsequent normal glycemia, as do NF-κB–induced increases in monocyte chemoattractant protein 1 and vascular cell adhesion molecule 1 expression. Hyperglycemia-induced epigenetic changes and increased p65 expression are prevented by reducing mitochondrial superoxide production or superoxide-induced α-oxoaldehydes. These results highlight the dramatic and long-lasting effects that short-term hyperglycemic spikes can have on vascular cells and suggest that transient spikes of hyperglycemia may be an HbA1c–independent risk factor for diabetic complications.

A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

BackgroundMost patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids – three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is practice facilitation (PF). PF creates time for learning and reflection by members of the team in each clinic, improves their communication, and promotes an individualized approach to implement a strategy to improve patient outcomes.Specific objectivesThe specific objectives of this protocol are to: evaluate the effectiveness and sustainability of PF to improve risk factor control in patients with type 2 diabetes across a variety of primary care settings; assess the implementation of the CCM in response to the intervention; examine the relationship between communication within the practice team and the implementation of the CCM; and determine the cost of the intervention both from the perspective of the organization conducting the PF intervention and from the perspective of the primary care practice.InterventionThe study will be a group randomized trial conducted in 40 primary care clinics. Data will be collected on all clinics, with 60 patients in each clinic, using a multi-method assessment process at baseline, 12, and 24 months. The intervention, PF, will consist of a series of practice improvement team meetings led by trained facilitators over 12 months. Primary hypotheses will be tested with 12-month outcome data. Sustainability of the intervention will be tested using 24 month data. Insights gained will be included in a delayed intervention conducted in control practices and evaluated in a pre-post design.Primary and secondary outcomesTo test hypotheses, the unit of randomization will be the clinic. The unit of analysis will be the repeated measure of each risk factor for each patient, nested within the clinic. The repeated measure of glycosylated hemoglobin A1c will be the primary outcome, with BP and Low Density Lipoprotein (LDL) cholesterol as secondary outcomes. To study change in risk factor level, a hierarchical or random effect model will be used to account for the nesting of repeated measurement of risk factor within patients and patients within clinics.This protocol follows the CONSORT guidelines and is registered per ICMJE guidelines:Clinical Trial Registration NumberNCT00482768

Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus

Diabetes mellitus is a known risk factor for frozen shoulder. This study was performed to quantify this association and test any relationship with other risk factors for diabetic complications. Patients attending diabetic (n = 865) and general medical (n = 202) clinics were interviewed and examined. External rotation was measured in both shoulders. Glycated hemoglobin A(1c) was measured in all diabetic patients. Frozen shoulder was defined as pain for more than 3 months and external rotation of less than 50% of the unaffected shoulder. Bilateral frozen shoulder was defined as external rotation of less than 30 degrees in both shoulders. Shoulder pain was present in 25.7% of diabetic patients compared with 5.0% of general medical patients. The criteria for frozen shoulder were fulfilled in 4.3% of diabetic patients and in 0.5% of the general medical patients. Only duration of diabetes had a positive association. The prevalence of painful or stiff shoulder was greater in diabetic patients than general medical patients. The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients.

Acute Glucose Fluctuations and Chronic Sustained Hyperglycemia as Risk Factors for Cardiovascular Diseases in Patients with Type 2 Diabetes

Chronic hyperglycemia, usually assessed from HbA1c determinations, results in excessive glycation and generation of oxidative stress. As a consequence, chronic hyperglycemia has been identified as a risk factor for diabetes complications leading to accelerated atherosclerosis. Both fasting and postprandial hyperglycemia contribute to this process. However the acute glucose fluctuations that occur in diabetes have been recently described as an additional factor that activates the oxidative stress. As a consequence, acute glucose swings, including upward (postprandial) and downward (interprandial) fluctuations can be considered as risk factors for cardiovascular events and should be included in the "dysglycemia" of diabetes in combination with fasting and postprandial hyperglycemia. As postprandial glucose is a contributor of both acute glucose fluctuations and chronic sustained hyperglycemia, it remains difficult to know whether these 2 mechanisms are equivalent or not equivalent risk factors for cardiovascular disease.

A Lifetime Modelled Economic Evaluation Comparing Pioglitazone and Rosiglitazone for the Treatment of Type 2 Diabetes Mellitus in the UK

Adding pioglitazone or rosiglitazone to existing therapy are alternative treatment options for patients with type 2 diabetes mellitus who have insufficient glycaemic control while receiving the maximal tolerated dose of metformin monotherapy. Our objective was to develop a lifetime model of type 2 diabetes mellitus and its sequelae in order to compare the costs and benefits of pioglitazone versus rosiglitazone in combination with metformin. A decision-analytic model employing a first order Monte Carlo simulation of a Markov process was constructed. The model incorporated surrogate outcome measures from a large randomised controlled trial (RCT) [n = 802] that compared the glycaemic and lipid control of pioglitazone and rosiglitazone monotherapy. These efficacy data were used with a recently validated and peer-reviewed UKPDS (UK Prospective Diabetes Study) algorithm to simulate the progression of these surrogate outcomes to final health outcomes, including quality of life (QOL) and mortality, and to calculate the risks of diabetic complications and death. The model perspective was of the UK NHS and included direct healthcare costs only (pounds, 2004/5 values). Patient outcomes measured in the model included life-expectancy (LE) and QALYs. The base-case analysis was run for 56-year-old male Caucasions with a haemoglobin A(1c) (HbA(1c)) of 7.57% and a body mass index of 33.14 kg/m(2). Patients treated with pioglitazone experienced a reduction in the total cholesterol to high-density lipoprotein-cholesterol (TC : HDL-C) ratio of 0.34, whereas the TC : HDL-C ratio increased by 0.65 in those receiving rosiglitazone (p < 0.001). The HbA(1c) profile was similar between the treatment groups (p = 0.13), as were other known risk factors for diabetes complications. The lifetime healthcare costs per patient estimated by the model were 9585 pounds for pioglitazone and 10,299 pounds for rosiglitazone. Patients treated with pioglitazone had a discounted LE of 8.83 years versus 8.79 years for those treated with rosiglitazone. Patients treated with pioglitazone also gained additional QALYs (6.8070 vs 6.7686). With improved health outcomes and lower costs, treatment with pioglitazone dominated rosiglitazone treatment. Evidence from the only large head-to-head RCT comparing rosiglitazone and pioglitazone suggests that more favourable changes in serum lipid profiles in patients treated with pioglitazone translate into improved health outcomes in terms of reduced morbidity and mortality and greater gains in QOL. In addition, this analysis indicates that treatment with pioglitazone is associated with lower costs than rosiglitazone. Therefore, in the UK, adjunctive pioglitazone may represent a cost-effective treatment choice for patients with type 2 diabetes who have insufficient glycaemic control while receiving the maximal tolerated dose of metformin monotherapy.

ASSOCIATION OF MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN −493G/T POLYMORPHISM WITH LIPID METABOLISM AND MICROVASCULAR COMPLICATIONS IN TYPE 2 DIABETIC PATIENTS.

Background Type 2 diabetes (T2D) affects over 15 million Americans, and the prevalence is rising precipitously. T2D patients are at risk for atherosclerosis and microvascular complications; identifying those at risk can lead to improved outcomes. Risk for complications due to dyslipidemia is modulated by genetic factors. Common variations in the microsomal triglyceride transfer protein (MTP −493G/T) and apolipoprotein B (apoB insertion/deletion [In/Del]) genes may modulate the risk for diabetic complications through their impact on lipid metabolism. Methods As part of a longitudinal case-control study of T2D in a French population (401 cases, 113 controls, mean age 59.5 years at baseline, and 4.2-year mean follow-up) we examined the relationship between MTP −493G/T, apoB In/Del, lipoprotein parameters, and the prevalence of diabetic complications. Results After adjusting for relevant covariates, MTP −493G/T was associated with T2D (p = .032), lower apoB concentrations (p = .024), triglycerides (p = .047), total cholesterol (p = .049), body mass index (p = .006), and creatinine levels (p = .007). Given the biochemical interaction of apoB and MTP proteins in the assembly of triglyceride-rich lipoproteins, we tested for their genetic interaction as a predictor of apoB concentration; T2D individuals with MTP T/T and apoB In/In had the highest apoB concentrations (p = .05). MTP −493G/T was associated with nephropathy at follow-up (p = .048), with G-allele homozygotes more likely to have nephropathy than T-allele carriers (odds ratio = 1.621, 95% confidence interval 1.004, 2.616). Conclusion MTP −493G/T is associated with T2D and impacts lipoprotein parameters associated with complications in T2D. Importantly, we contribute novel evidence that lipoprotein metabolism genes are risk factors for diabetic complications.

A National Progress Report on Diabetes: Successes and Challenges

Over the last few decades, numerous public health agencies and other private and public organizations have sought to prevent and delay the disabling complications of diabetes by increasing the use of preventive care practices and reducing risk factors for complications among people with diabetes. Now, federal diabetes surveillance activities are yielding encouraging reports that progress is being made in increasing the use of preventive care practices, reducing risk factors for complications, and preventing or delaying diabetes complications. However, although several gains have been noted, levels of preventive care practices remain suboptimal, risk factors for diabetes complications are too prevalent, and diabetes complications are too pervasive. Furthermore, with compelling evidence that the onset of diabetes can be prevented or delayed among adults at high risk, prevention of diabetes has become a major new challenge. Additional efforts are needed to address the growing problems of obesity and physical inactivity, to identify the most efficacious and cost-effective prevention strategies and interventions, and to implement surveillance activities that allow us to gauge our success. Although progress has been made against diabetes complications, the current epidemic of diabetes increases the urgency of primary prevention efforts.