Young Type 1 Diabetes Mellitus Patients Research Articles

The right atrium in young patients with type 1 diabetes mellitus: Insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study.

IntroductionEarly onset of cardiomyopathy represented by myocardial volumetric and deformation properties is a major concern for patients with type 1 diabetes mellitus (T1DM). Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel methodology with capability of 3D assessment of the right atrium (RA) via virtual models. The present study was designed for detailed comparative analysis of T1DM-associated RA volumetric and functional abnormalities to those of matched healthy controls to be examined by 3DSTE.MethodsThe present study comprised of 17 patients with typical features of T1DM (mean age: 36.4 ± 13.0 years, 59% males). Their results were compared to those of 31 age- and gender-matched healthy controls (mean age: 35.0 ± 2.9 years, 61% males).Results3DSTE-derived RA volumes respecting the cardiac cycle and RA stroke volumes and emptying fractions did not show differences between young T1DM patients and matched controls. From peak RA strains representing RA reservoir function, mean segmental RA 3D strain proved to be significantly increased. Some regional basal/midatrial end-systolic peak RA strains were found to be significantly increased as well in T1DM patients as compared to controls. T1DM duration and HbA1c correlated with certain RA strains and RA volume-based functional properties.ConclusionsIn young patients with T1DM, preserved RA volumes respecting the cardiac cycle are accompanied with increase in certain regional end-systolic peak RA strains, which seems to be associated with T1DM duration and HbA1c.

Relationships between parameters of cardiorespiratory function and bioimpedance analysis in young patients with type 1 diabetes mellitus

Type 1 diabetes mellitus (T1DM) triggers disruption of oxygen transport system in patients. The maximum oxygen consumption (VO2 max) during spiroergometry depends on the functional capabilities and composition of the body. Moreover, VO2 max may be considered a predictor of pathological changes in cardiovascular system.Aim. The purpose of the study was to investigate the compositional body characteristics and functional cardiorespiratory parameters in T1DM patients.Material and Methods. The study comprised 30 patients with T1DM (average age of 25.5 ± 8.1 years) and 10 patients of control group (average age of 27 ± 9 years). Patients received spiroergometry examination according to B. Bruce protocol and bioimpedansometry using the Inbody 770 apparatus. The study showed that T1DM patients reached anaerobic threshold faster (p = 0.032) and had significantly lower VO2 max and carbon dioxide emission compared to patients without diabetes (p = 0.021; p = 0.034) whereas exercise tolerance did not significantly differ compared with the corresponding value in control group. Patients with higher muscle mass i.e. muscle tissue weight (kg) according to bioimpedance measurements had higher values of VO2 max (L) in control group (p = 0.017) and in group of T1DM patients (p = 0.028).Conclusions: Young T1DM patients without cardiovascular diseases had significantly less effective cardiorespiratory system compared with that in people without diabetes even in those with high exercise tolerance. Rapid achievement of anaerobic threshold with preserved performance efficiency was a sign of unfavorable prognosis. Body mass index and lean body mass did not significantly affect the performance parameters in young T1DM patients. Screening of spiroergometry parameters may be used for identification of young T1DM patients at high risk of unfavorable cardiovascular diseases including chronic heart failure.

Possibilities of predicting preclinical forms of cardiovascular diseases in young patients with type 1 diabetes mellitus using cardiac magnetic resonance imaging

Aim. To identify the indicators of cardiac magnetic resonance (CMR), which have diagnostic value in the individual assessment of the cardiovascular prognosis in young patients with type 1 diabetes mellitus (T1DM).Material and Methods. The study included a total of 60 patients (29 men and 31 women) aged 18 to 36 years with a history of T1DM from 5 to 16 years, who underwent contrast-enhanced CMR. Circular strain, strain relaxation index (SRI), peak early diastolic strain rate (SRe), epicardial fat thickness (EFT), ejection fraction (EF), stroke volume (SV), end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular mass (LVM) were assessed. Echocardiography, 24-h electrocardiography (ECG), treadmill test, and NT-proBNP blood test were performed to exclude heart pathology. Statistical data processing was used to identify the relationships of changes in CMR parameters of the left ventricle and epicardial adipose tissue with disease duration, carbohydrate metabolism compensation (HbA1c), total cholesterol, and low-density lipoprotein (LDL).Results. Using the nonparametric Mann – Whitney U-test, the study showed the presence of significant differences in the values of SV, EDV, end-diastolic volume index (EDVI), and LVM in the groups of 5–10and 11–16-year duration of disease, respectively. The assessment of Spearman’s rank correlation coefficients revealed negative correlations between the values of SV, ESV, ESV index (ESVI), EDV, and LVM and T1DM duration; between the index of circular strain and blood level of HbA1c; between the values of SV, EDVI, ESVI, EDV, ESV, and LVM and blood levels of total cholesterol and LDL; between SV, EDVI, ESVI, EDV, ESV, and LVM and mean EFT in the left ventricular projection.Conclusion. The CMR-based evaluation of strain parameters may become a key in personalized identification of young T1DM patients with a high risk of adverse cardiovascular events. The thickness and distribution of epicardial adipose tissue in young patients with T1DM may have predictive value for risk stratification of developing diseases associated with atherosclerosis and chronic heart failure, which will affect the primary prevention strategy in this population.

Peripheral and Autonomic Neuropathy Status of Young Patients With Type 1 Diabetes Mellitus at the Time of Transition From Pediatric Care to Adult-Oriented Diabetes Care

IntroductionThe prevalence of neuropathic lesions in young patients with type 1 diabetes mellitus (T1DM) at the time of transition from pediatric care to adult-oriented diabetes care is poorly studied. A comparative study with healthy volunteers to assess the possible neuropathic condition of this special population and to identify the potential early screening needs has not been performed yet. The results may provide important feedback to pediatric diabetes care and a remarkable baseline reference point for further follow up in adult diabetes care.Patients and MethodsTwenty-nine young patients with T1DM [age: 22.4 ± 2.9 years; HbA1c: 8.5 ± 2.1%, diabetes duration: 12.2 ± 5.8 years; (mean ± SD)] and 30 healthy volunteers (age: 21.5 ± 1.6 years; HbA1c: 5.3 ± 0.3%) were involved in the study. Autonomic function was assessed by standard cardiovascular reflex tests. Complex peripheral neuropathic testing was performed by Neurometer®, Neuropad®-test, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests.ResultsT1DM patients had significantly higher diastolic blood pressure than controls (80 ± 9 vs. 74 ± 8 mmHg, p < 0.01), but there was no significant difference in systolic blood pressure (127 ± 26 vs. 121 ± 13 mmHg). Cardiovascular reflex tests had not revealed any significant differences between the T1DM patients and controls. No significant differences with Neurometer®, Neuropad®-test, and Monofilament® were detected between the two groups. The vibrational sensing on the radius on both sides was significantly impaired in the T1DM group compared to the controls with Rydel-Seiffer tuning fork test (right: 7.5 ± 1.0 vs. 7.9 ± 0.3; left: 7.5 ± 0.9 vs. 7.9 ± 0.3, p < 0.05). The Tiptherm®-test also identified a significant impairment in T1DM patients (11 sensing failures vs. 1, p < 0.001). In addition, the neuropathic complaints were significantly more frequently present in the T1DM patient group than in the controls (9 vs. 0, p < 0.01).ConclusionIn this young T1DM population, cardiovascular autonomic neuropathy and cardiac morphological alterations could not be found. However, Rydel-Seiffer tuning fork and Tiptherm®-tests revealed peripheral sensory neurological impairments in young T1DM patients at the time of their transition to adult diabetes care.

Cardiovascular Disease in Type 1 Diabetes Mellitus: Epidemiology and Management of Cardiovascular Risk.

Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1DM) patients, and cardiovascular risk (CVR) remains high even in T1DM patients with good metabolic control. The underlying mechanisms remain poorly understood and known risk factors seem to operate differently in T1DM and type 2 diabetes mellitus (T2DM) patients. However, evidence of cardiovascular risk assessment and management in T1DM patients often is extrapolated from studies on T2DM patients or the general population. In this review, we examine the existing literature about the prevalence of clinical and subclinical CVD, as well as current knowledge about potential risk factors involved in the development and progression of atherosclerosis in T1DM patients. We also discuss current approaches to the stratification and therapeutic management of CVR in T1DM patients. Chronic hyperglycemia plays an important role, but it is likely that other potential factors are involved in increased atherosclerosis and CVD in T1DM patients. Evidence on the estimation of 10-year and lifetime risk of CVD, as well as the efficiency and age at which current cardiovascular medications should be initiated in young T1DM patients, is very limited and clearly insufficient to establish evidence-based therapeutic approaches to CVD management.

Acute hyperglycaemia can impair driving skill in young type 1 diabetes mellitus patients

AimDrivers with diabetes are at increased risk of being involved in road accidents. Therefore, this study aimed to evaluate the effects of acute hyperglycaemia (AH) compared with euglycaemia on driving ability in patients with type 1 diabetes mellitus (T1DM). MethodsEighteen drivers with T1DM were asked to navigate twice through nine hazardous scenarios, using a driving simulator, during euglycaemia and then again during AH (mean blood glucose: 138 ± 34 mg/dL and 321 ± 29 mg/dL, respectively) in a counterbalanced crossover study. Driving performance was continually monitored for driving speed, steering wheel angle, acceleration, and location and velocity of other vehicles and obstacles, with drivers wearing a mobile head-mounted eye-tracking system. ResultsThe main findings were that, during AH, participants were less likely to identify a hazard [probability of identification (POI): 0.5725 ± 0.5], glanced fewer times at the hazard (3.24 ± 5.9), maintained shorter headway (between-vehicle) distance (mean: 40.87 ± 20.15 m) and had an increased number of braking events per km driven (6.69 ± 5.20) compared with driving during euglycaemia (POI: 0.733 ± 0.4; number of glances: 3.69 ± 6.99; headway distance: 50.46 ± 26.2 m; number of braking events per km driven: 4.31 ± 3.87; P < 0.05 for all parameters). ConclusionThis study provides evidence that AH impairs driving performance in young T1DM patients by demonstrating the negative effects of AH on both hazard perception and speed management.

757-P: Financial Strain and Relationship Quality in Young Married Couples Managing Type 1 Diabetes

Over the last 5 years, individual diabetes management costs have increased 26%, with the average diabetes patient spending $16,752 per year and those with type 1 diabetes mellitus (T1DM) paying a disproportionately higher amount than their type 2 counterparts. With T1DM diagnoses increasing by around 40,000 each year and the majority of diagnoses among adolescents and emerging adults approaching financial independence with limited funds, young T1DM patients and their partners may experience relational strain that often accompanies financial stress. Using data from a nationally representative sample of over 2,000 young married couples involved in the CREATE study, we identified 16 couples wherein one partner had T1DM. Among these, 8 wives had T1DM and 8 husbands had T1DM. For comparisons, we matched these couples with others in the CREATE study based on household income, husband and wife education, and husband and wife approximate number of weekly hours worked. A total of 116 matches were found, for a total of 132 couples in the analytic sample. Among the 16 couples with T1DM, half earned less than $50,000 annually (mean = $50,000-60,000/year). Mean comparisons indicated that both partners in couples with T1DM reported higher levels of financial distress and worry compared to matched couples, albeit not at a statistically significant level. Financial distress and worry were both significant predictors of relationship quality a year later for all couples in the study. However, associations between financial distress and relationship quality did not differ for couples with T1DM. Additional research is needed to explore specific diabetes supplies costs and how these may relate to relationship quality. Disclosure J.B. Yorgason: None. J. Saylor: None. S. Rellaford: None. M.S. Porter: None. Funding Brigham Young University

Trabecular bone score and transilial bone trabecular histomorphometry in type 1 diabetes and healthy controls.

Patients with type 1 Diabetes Mellitus (T1DM) have an increased risk of fracture. Little is known about the microarchitecture of trabecular bone in T1DM, which may account for some of the increased risk. We report here a secondary analysis comparing Trabecular Bone Score (TBS) derived from DXA to 2-D histomorphometric and 3-D micro-computerized tomography (CT) variables obtained from iliac biopsies in 83 subjects (29 T1DM and 54 controls). The transilial bone biopsy specimens were fixed, embedded and scanned using a desktop micro-CT at 16 μm resolution. They were then sectioned and quantitative histomorphometry was performed. TBS of the anterior/posterior (AP) spine was obtained by re-analysis of AP lumbar spine DXA images. Overall, there were no differences in TBS, histomorphometry or micro-CT measurements between T1DM and controls. There was a significant association between TBS and 2-D BV/TV using multivariable linear regression after adjusting for group, age and gender. For every 1 unit increase in 2-D BV/TV, TBS increases by 0.0036 units after adjusting for group, gender and age. In conclusion, T1DM does not result in abnormal TBS, histomorphometric or micro-CT variables in young T1DM patients in the absence of diabetic complications. TBS is a good surrogate measure for trabecular microarchitecture.

Subclinical Auditory Neural Deficits in Patients With Type 1 Diabetes Mellitus

Diabetes mellitus (DM) is associated with a variety of sensory complications. Very little attention has been given to auditory neuropathic complications in DM. The aim of this study was to determine whether type 1 DM (T1DM) affects neural coding of the rapid temporal fluctuations of sounds, and how any deficits may impact on behavioral performance. Participants were 30 young normal-hearing T1DM patients, and 30 age-, sex-, and audiogram-matched healthy controls. Measurements included electrophysiological measures of auditory nerve and brainstem function using the click-evoked auditory brainstem response, and of brainstem neural temporal coding using the sustained frequency-following response (FFR); behavioral tests of temporal coding (interaural phase difference discrimination and the frequency difference limen); tests of speech perception in noise; and self-report measures of auditory disability using the Speech, Spatial and Qualities of Hearing Scale. There were no significant differences between T1DM patients and controls in the auditory brainstem response. However, the T1DM group showed significantly reduced FFRs to both temporal envelope and temporal fine structure. The T1DM group also showed significantly higher interaural phase difference and frequency difference limen thresholds, worse speech-in-noise performance, as well as lower overall Speech, Spatial and Qualities scores than the control group. These findings suggest that T1DM is associated with degraded neural temporal coding in the brainstem in the absence of an elevation in audiometric threshold, and that the FFR may provide an early indicator of neural damage in T1DM, before any abnormalities can be identified using standard clinical tests. However, the relation between the neural deficits and the behavioral deficits is uncertain.

Effects of Continuous Subcutaneous Insulin Infusion on Glycaemic Control and Acute Complications in Young People with Type 1 Diabetes in Bangladesh

Objective: The objective of this study was to assess the effects of continuous subcutaneous insulin infusion (CSII) therapy on glycaemic control and acute complications in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM). Methods: The prospective observational study was done in patients on multiple daily injection (MDI) switching to pump system. All patients were followed at the Paediatric Diabetes Clinic at BIRDEM Hospital. They were trained on carbohydrates counting and started on continuous basal insulin infusion in addition to meal and high blood glucose correction insulin boluses. They were followed on insulin pump therapy for a 6-month period. Results: Twenty patients were analysed, from baseline to visit 2 after 6 months. The patients included in the study had T1DM for a mean duration of 4.7 ± 3.1 years. The age ranged from 3 to 25 years (mean 13.7 ± 6.1). There was 1% reduction in haemoglobin A1c (HbA1c) after 6 months, though it did not reach the statistical significance (p = 0.084). There was significant reduction of mean fasting blood glucose level 13.4 ± 7.0 versus 6.9 ± 1.6 mmol/L (p = 0.001), total insulin requirement (p = 0.043), frequency of hypoglycaemic episodes (p = 0.006), and diabetic ketoacidosis (p = 0.002) events during CSII therapy. Conclusion: In our study, we found that switching young T1DM patients from MDI to insulin pump had been effective with achievement of a reduction in fasting blood glucose, HbA1c, and acute complications.

Acute Hyperglycemia may impair driving skills of young T1DM patients

Diabetic drivers are at increased risk to be involved in road crashes. While there is a large body of evidence regarding the effects of hypoglycemia on driving, very little is known about the effects of hyperglycemia on driving. The goal of this study was, therefore, to evaluate the effects of acute hyperglycemia (AH) on type 1 diabetes mellitus (T1DM) drivers in comparison to euglycemic state. Eighteen T1DM drivers were asked to navigate twice through nine hazardous scenarios in a driving simulator during euglycemia and AH (mean glucose level 138±34 and 321±29 mg\dL respectively) in a counterbalanced crossover design. Driving performance was continually monitored for driving data and eye tracking data. During euglycemia, participants maintained a longer headway distance (Mean=50.46+26.2m) compared to AH (40.87+20.15m P&lt;0.005). Under a state of euglycemia, participants had a fewer number of brakes per kilometers driven (4.31+3.867) compared to AH (6.69+5.192 P&lt;0.05). This study provides evidence to the negative effects of acute hyperglycemia on driving performance.

Cardiac autonomic neuropathy in nonobese young adults with type 1 diabetes.

PurposeThe aim of this study was to evaluate the prevalence and risk factors for cardiac autonomic neuropathy (CAN) in nonobese nonobese young type 1 diabetes mellitus (T1DM) patients without micro- or macrovascular complications.MethodsCAN was assessed in 95 patients with T1DM, aged 18–29 years, using standard cardiovascular reflex tests – heart rate response to deep breathing, standing, and the Valsalva maneuver and blood pressure response to standing. Furthermore, power spectral analyses of overall heart rate variability (HRV), standard deviation of NN intervals (SDNN), and total power (TP) were tested with DiCAN. CAN was defined as abnormal results for at least 1 of the 4 cardiovascular reflex tests.ResultsThe prevalence of CAN was 12.6%. The frequency of one and 2 abnormal reflex tests was 10.5% and 2.1%, respectively. No significant differences were observed in age, sex, mean hemoglobin A1c (HbA1c) level, and duration of diabetes with respect to presence of CAN. Patients with CAN exhibited lower overall HRV parameters (SDNN and TP) compared with those without CAN even though there was no statistical significance. In multivariable analyses, higher mean HbA1c level was significantly associated with lower overall HRV (β=-44.42, P=0.002 for SDNN and β=-2.82, P<0.001 for TP).ConclusionsCAN can be detected in 12.6% of young adult T1DM patients even without other micro- or macrovascular complications. Glycemic control is the main determinant to maintain overall HRV and prevent CAN.

Using insulin pump with a remote-control system in young patients with diabetes improves glycemic control and enhances patient satisfaction

BackgroundInsulin delivery triggered by a remote control is an advanced feature offered by newer insulin pump systems. These remote-integrated pump systems might further improve glycemic control and patient satisfaction. This study aims at assessing the effects of advanced insulin pump system on patients with type 1 diabetes mellitus (T1DM).MethodsThe prospective, observational study in two centers addressed patients on multiple daily injection (MDI) switching to an integrated pump system (primary: adolescents and young adults, secondary: school-children). Treatment and patient satisfaction parameters were recorded at baseline and at two visits at 12 and 24 weeks.ResultsThirty-eight patients were analyzed; primary n = 24 (mean-age 16) and secondary n = 14 (mean-age 9). From baseline to visit2, the mean decrease of HbA1c was 1.09% (p = 0.00009) and 0.79% (p = 0.09) for the primary and secondary group, respectively. Patient satisfaction rate was favorable. Exploratory analyses revealed patients favoring the use of the remote control achieved best reductions in HbA1c (p = 0.0174). Safety was encouraging with no adverse events in the period from visit1 to visit2.ConclusionsSwitching young T1DM patients from MDI to a remote control-integrated pump system achieved a reductions in HbA1c and insulin dose. Positive attitude towards remote operating enhanced these effects. Patient satisfaction has markedly improved.

Evaluating the Effect of Using Mobile Phone Reminders on the Adherence to Children and Young Adults With Type 1 Diabetes Attending Outreach Appointments

Effective management of Type 1 Diabetes Mellitus (T1DM) requires that people living with the condition attend regular clinical visits. The Rwanda Diabetes Association (RDA) asks young T1DM patients to attend quarterly outreach visits, and prior to the visits, RDA issues reminders via local radio stations. However, adherence in attending clinical appointments has remained low.Since Rwanda has a high mobile phone penetration rate, a pilot intervention study was conducted exploring the use of mobile phone call reminders and Short Message Service (SMS) messages to increase T1DM patients’ attendance of RDA’s quarterly outreach visits. The control group was exposed to only the regular radio broadcast, while the intervention group received reminder phone calls or SMS messages 72 hours prior to their appointments in addition to the regular radio broadcast.The attendance rate was significantly different between the 14 control patients and 35 intervention patients, with 23.3% (3/14) and 76.7% (27/35) attending visits, respectively (P=0.048). The results suggest that using mHealth methods (phone call/SMS reminders) can be effective in improving health outcomes, improving the adherence of T1DM patients to follow-up visits with minimal added cost. The total cost was 0.37 USD per person, compared to potential 672.40 USD for each lost treatment, indicating the intervention is cost-effective in that it minimizes loss to follow up in resource-limited settings. Further research is needed to evaluate the feasibility of scaling up the pilot project and to understand whether improved attendance is sustained long-term.

Association between proprotein convertase subtilisin/kexin 9 (PCSK9) and lipoprotein subclasses in children with type 1 diabetes mellitus: Effects of glycemic control

Background and aimsDyslipidemia in type 1 diabetes mellitus (T1DM) is characterised by altered distributions of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses. Recent studies suggested that proprotein convertase subtilisin/kexin 9 (PCSK9) may contribute to the development of dyslipidemia in T1DM. In this cross-sectional study, we investigated the association between PCSK9 and lipoprotein subclasses in young T1DM patients, with respect to glycemic control. MethodsPlasma PCSK9 and lipoprotein subclasses were determined in 207 patients with T1DM (106 boys and 101 girls), aged 13.9 ± 3.0 years and treated by intensive insulin therapy. ResultsPlasma PCSK9 levels significantly increased with worsening of glycemic control (p < 0.001). T1DM patients with poor glucoregulation had the highest proportion of small, dense LDL (sdLDL) and smaller HDL particles, as well. PCSK9 was positively associated with markers of glucose homeostasis and serum lipid parameters only in patients with suboptimal/poor glucoregulation. In well-controlled T1DM, plasma PCSK9 level was inversely associated with a relative proportion of sdLDL particles (p < 0.01) and this association remained significant in multivariate analysis. In T1DM patients with suboptimal/poor glycemic control, PCSK9 was positively associated with the proportion of the smallest HDL3c particles (p < 0.001), but negatively with HDL size (p < 0.05). ConclusionsThe extent of achieved metabolic control modifies the association between PCSK9 and lipoprotein subclasses in T1DM. Further investigations are needed to reveal whether the observed effects of glycemic control on PCSK9 and sdLDL levels have causal consequences on CVD risk in young patients with T1DM.

Carotid intima media thickness and associations with serum osteoprotegerin and s-RANKL in children and adolescents with type 1 diabetes mellitus with increased risk for endothelial dysfunction

Background Although carotid intima media thickness (CIMT) is an established marker of endothelial dysfunction, limited data exist on relative laboratory biomarkers in youngsters with type 1 diabetes mellitus (T1DM). Our aim was to study CIMT and the biomarkers of the osteoprotegerin (OPG)/RANKL system in young T1DM patients and controls, and also in subgroups of patients with increased risk for endothelial dysfunction, such as those with overweight/obesity, poor metabolic control or the presence of microalbuminuria. Methods CIMT and OPG/RANKL of 56 T1DM children and adolescents were compared to 28 healthy controls. Results Anthropometric, laboratory, CIMT and OPG/RANKL measurements were similar between patients and controls. Overweight/obese patients had greater CIMT than the normal weight ones (0.50 vs. 0.44 mm, p=0.001). Microalbuminuric patients had greater CIMT (0.49 vs. 0.44 mm, p=0.035) than the normoalbuminuric ones, with no difference in terms of OPG/RANKL. In the microalbuminuric group, OPG (r=-0.90, p=0.036) and RANKL (r=-0.92, p=0.024) were significantly negatively associated with CIMT. Following linear regression analysis, in the total patients group, microalbuminuria was the only factor significantly associated with CIMT (beta±SE: 0.050±0.021, p=0.035), body mass index (BMI)-z-scores were negatively associated with OPG (beta±SE: -0.25±0.12, p=0.05), while in the microalbuminuric group, CIMT was negatively associated with OPG (beta±SE: -0.070±0.019, p=0.036). During the forward stepwise procedure, microalbuminuria and age were the only variables negatively associated with RANKL (b=-0.334, p=0.034, b=-35.95, p=0.013, respectively). Conclusions In T1DM pediatric patients, overweight/obesity and microalbuminuria were associated with greater CIMT and with impaired OPG/RANKL levels, as biochemical indices of calcification of the atherosclerotic plaque.

Decreased percentage of NKG2D+NK cells in patients withincident onset of Type 1 Diabetes.

Type 1 diabetes mellitus (T1DM) is characterized by absolute insulin deficiency owing to autoimmune destruction of the pancreatic β cells. A significant decrease in natural killer (NK) cells in peripheral blood has been observed in patients with untreated T1DM. In the present study, we aimed to explore the role of NK cells and their subsets in young T1DM patients. A total of 30 children and adolescents with untreated T1DM and 27 healthy controls (HC) were recruited in this study. Flow cytometry analysis indicated that the percentage of peripheral blood CD3-CD56+ NK cells and NK cells subsets (CD56bright, CD56dim and CD56neg), were significantly decreased in the T1DM patients compared to healthy controls. In addition, the percentage of inducible CD107a+ and IFN-γ-secreting NK cells was significantly decreased compared to HC. Interestingly, the percentage of NKG2D+ NK cells negatively correlated with the level of serum TCHOL and TG in T1DM patients. Our data indicate that decreased number and impaired function of NK cells may have a role in the pathogenesis of T1DM.

Assessment of left ventricular function in young type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography: Relation to duration and control of diabetes

Abstract Background The effect of type 1 diabetes mellitus (T1DM) on myocardial function is still controversial. Aim To examine the usefulness of speckle tracking echocardiography (STE) in detecting subclinical left ventricular (LV) dysfunction in asymptomatic T1DM patients and detect whether any LV abnormalities are related to duration or control of DM. Methods Sixty young T1DM patients and 30 controls were subjected to conventional echocardiography and STE. The left ventricular (LV) peak systolic (PS) global longitudinal strain (GLS)/strain rate (GLSR) and diastolic global strain rate during the isovolumic relaxation period (GSRivr), early diastole (GSRe) and late diastole (GSRa) were calculated as the average of the 12 myocardial segments of the four and two-chamber views while the mid circumferential strain (MCS) was calculated as the average of strains of the 6 LV segments of the mid LV cavity. Results In diabetic patients, the LV end diastolic dimension (LVEDD) was significantly lower ( p = 0.000) while the LV myocardial performance index (LVMPI) and E/lateral E′ ratio were significantly higher ( p = 0.000 and p = 0.02 respectively) compared to controls. By STE, only the GLS was significantly lower in diabetic patients compared to controls ( p = 0.000). A significant negative correlation was detected between LDL-C and GLS ( r = −0.4; p = 0.002). Multivariate logistic regression analysis identified HbA1c as the only independent predictor of GLS in patients (beta = −0.34, 95% CI: −0.67 to −0.19; p = 0.001). Conclusion STE is useful to detect subclinical LV dysfunction in asymptomatic patients with T1DM. Control of DM but not duration of disease was an independent predictor of LV systolic dysfunction.

Vitamin D deficiency and its correlation to hemoglobin A1C in adolescent and young adult type 1 diabetes mellitus patients

Background Some studies have described the relationship between autoimmune diabetes or type 1 diabetes mellitus (T1DM) and vitamin D deficiency. Few studies correlate between vitamin D deficiency and glycemic control. Purpose This study was conducted to appraise the status of vitamin D in adolescent and young adult T1DM patients and to correlate its deficiency to glycated hemoglobin (HbA1c). Patients and methods Around 63 Kuwaiti patients with T1DM were recruited in a descriptive cross-sectional study in April 2015. Serum level of vitamin D [25(OH)D] was measured using enzyme-linked immunosorbent assay, and glycemic control was measured by HbA1c using autoanalyzer. The relationship between vitamin D levels and HbA1c was analyzed by Spearman’s correlation. Among the participants, 21 (33.3%) were male and 42 (66.7%) were female. The mean age was 18.41±6.19, and the mean diabetes duration was 6.98±4.99. The mean vitamin D concentration was 47.29±2.91 nmol/l, with 38.1% of participants identified to have vitamin D deficiency and 19% identified to have vitamin D insufficiency. There were high levels of HbA1c (10.08±2.28), with a significant inverse correlation between HbA1c and vitamin D (r=−0.374 and P=0.003). Conclusion Low vitamin D in T1DM is extremely highly and closely correlated to HbA1c. We recommend that evaluation of the level of vitamin D in type 1 diabetic patients is very critical, and vitamin D supplementation may improve glycemic control.

Cardiovascular autonomic neuropathy contributes to sleep apnea in young and lean type 1 diabetes mellitus patients.

Knowledge about association between sleep apnea and cardiovascular autonomic neuropathy (CAN) in type 1 diabetes mellitus (T1DM) might give some insight into the pathogenesis of this condition in these patients. In obese patients, excessive central adiposity, including a large neck circumference, can contribute to obstructive sleep apnea (OSA). Its presence in non-obese patients, however, indicates that it could be correlated with autonomic neuropathy. The aim of this study was to compare the prevalence of OSA in young and lean T1DM patients with and without CAN. We studied 20 adult, non-obese, T1DM patients who were divided into two groups according to the results of the cardiovascular autonomic reflex tests (CARTs). These two groups (9 with CAN and 11 without CAN) were compared to a control group of 22 healthy individuals, who were matched by age and BMI. A polysomnography was performed and sleep was analyzed. The CAN+ group had a significantly higher prevalence of sleep apnea compared to the other groups (67% CAN+; 23% CAN−; 4.5% controls: CAN+ vs. Control; p = 0.006 and CAN+ vs. CAN−; p = 0.02). The CAN− group had higher sleep efficiency compared to the CAN+ group, demonstrating impaired sleep architecture in diabetics with this chronic complication. In conclusion, OSA may be related to the presence of CAN in young and lean T1DM patients. It could contribute to worse the prognosis and reducing the quality of life of these patients without specific treatment of these conditions.