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Verhulst CEM, van Heck JIP, Fabricius TW, Stienstra R, Teerenstra S, McCrimmon RJ, Tack CJ, Pedersen-Bjergaard U, de Galan BE. Hypoglycaemia induces a sustained pro-inflammatory response in people with type 1 diabetes and healthy controls. Diabetes Obes Metab 2023; 25:3114-3124. [PMID: 37485887 DOI: 10.1111/dom.15205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023]
Abstract
AIM To determine the duration and the extension of the pro-inflammatory response to hypoglycaemia both in people with type 1 diabetes and healthy controls. MATERIALS AND METHODS Adults with type 1 diabetes (n = 47) and matched controls (n = 16) underwent a hyperinsulinaemic-euglycaemic hypoglycaemic (2.8 ± 0.1 mmoL/L [49.9 ± 2.3 mg/dL]) glucose clamp. During euglycaemia, hypoglycaemia, and 1, 3 and 7 days later, blood was drawn to determine immune cell phenotype, monocyte function and circulating inflammatory markers. RESULTS Hypoglycaemia increased lymphocyte and monocyte counts, which remained elevated for 1 week. The proportion of CD16+ monocytes increased and the proportion of CD14+ monocytes decreased. During hypoglycaemia, monocytes released more tumour necrosis factor-α and interleukin-1β, and less interleukin-10, after ex vivo stimulation. Hypoglycaemia increased the levels of 19 circulating inflammatory proteins, including high sensitive C-reactive protein, most of which remained elevated for 1 week. The epinephrine peak in response to hypoglycaemia was positively correlated with immune cell number and phenotype, but not with the proteomic response. CONCLUSIONS Overall, despite differences in prior exposure to hypoglycaemia, the pattern of the inflammatory responses to hypoglycaemia did not differ between people with type 1 diabetes and healthy controls. In conclusion, hypoglycaemia induces a range of pro-inflammatory responses that are sustained for at least 1 week in people with type 1 diabetes and healthy controls.
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Affiliation(s)
- Clementine E M Verhulst
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Julia I P van Heck
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Therese W Fabricius
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Rinke Stienstra
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Steven Teerenstra
- Section Biostatistics, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, MUMC+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Ali N, El Hamdaoui S, Schouwenberg BJ, Tack CJ, de Galan BE. Fall in prevalence of impaired awareness of hypoglycaemia in individuals with type 1 diabetes. Diabet Med 2023; 40:e15042. [PMID: 36645139 DOI: 10.1111/dme.15042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
AIMS Impaired awareness of hypoglycaemia (IAH) has been reported to affect up to a third of people with type 1 diabetes. Whether the increased use of sensor technology has changed its prevalence remains unknown. The aim of this study was to investigate the current prevalence of IAH and its change over time in a cohort of individuals with type 1 diabetes. METHODS IAH was assessed using the modified Clarke questionnaire in adults with type 1 diabetes. Participants were recruited from the diabetes outpatient clinic from February 2020 through April 2021. The scores were compared to similar data collected during previous assessments in 2006, 2010 and 2016 respectively. RESULTS A total of 488 individuals (51.2% male) with a mean (±SD) age of 51.3 ± 15.9 years, median [Q1-Q3] diabetes duration of 30 [16-40] years and mean HbA1c of 60 ± 12 mmol/mol (7.7 ± 1.1%) were included. Sensors were used by 85% of the study population. IAH was present among 78 (16.0%) participants, whereas 86 (17.6%) participants had a history of severe hypoglycaemia. By comparison, the prevalence of IAH equalled 32.5% in 2006, 32.3% in 2010 and 30.1% in 2016 (p for trend <0.001), while the proportion of individuals reporting severe hypoglycaemia equalled 21.2%, 46.7% and 49.8% respectively (p for trend 0.010). Comparing sequential assessments over time, the proportion of individuals with persistent IAH decreased from 74.0% and 63.6% between 2006 and 2016 to 32.5% in 2020. CONCLUSIONS Among individuals with type 1 diabetes and high use of sensor technology, the current prevalence of IAH was 16%, about 50% lower as compared to previous years.
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Affiliation(s)
- Namam Ali
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Soumia El Hamdaoui
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bas J Schouwenberg
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
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Vos WAJW, Groenendijk AL, Blaauw MJT, van Eekeren LE, Navas A, Cleophas MCP, Vadaq N, Matzaraki V, dos Santos JC, Meeder EMG, Fröberg J, Weijers G, Zhang Y, Fu J, ter Horst R, Bock C, Knoll R, Aschenbrenner AC, Schultze J, Vanderkerckhove L, Hwandih T, Wonderlich ER, Vemula SV, van der Kolk M, de Vet SCP, Blok WL, Brinkman K, Rokx C, Schellekens AFA, de Mast Q, Joosten LAB, Berrevoets MAH, Stalenhoef JE, Verbon A, van Lunzen J, Netea MG, van der Ven AJAM. The 2000HIV study: Design, multi-omics methods and participant characteristics. Front Immunol 2022; 13:982746. [PMID: 36605197 PMCID: PMC9809279 DOI: 10.3389/fimmu.2022.982746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/25/2022] [Indexed: 01/07/2023] Open
Abstract
Background Even during long-term combination antiretroviral therapy (cART), people living with HIV (PLHIV) have a dysregulated immune system, characterized by persistent immune activation, accelerated immune ageing and increased risk of non-AIDS comorbidities. A multi-omics approach is applied to a large cohort of PLHIV to understand pathways underlying these dysregulations in order to identify new biomarkers and novel genetically validated therapeutic drugs targets. Methods The 2000HIV study is a prospective longitudinal cohort study of PLHIV on cART. In addition, untreated HIV spontaneous controllers were recruited. In-depth multi-omics characterization will be performed, including genomics, epigenomics, transcriptomics, proteomics, metabolomics and metagenomics, functional immunological assays and extensive immunophenotyping. Furthermore, the latent viral reservoir will be assessed through cell associated HIV-1 RNA and DNA, and full-length individual proviral sequencing on a subset. Clinical measurements include an ECG, carotid intima-media thickness and plaque measurement, hepatic steatosis and fibrosis measurement as well as psychological symptoms and recreational drug questionnaires. Additionally, considering the developing pandemic, COVID-19 history and vaccination was recorded. Participants return for a two-year follow-up visit. The 2000HIV study consists of a discovery and validation cohort collected at separate sites to immediately validate any finding in an independent cohort. Results Overall, 1895 PLHIV from four sites were included for analysis, 1559 in the discovery and 336 in the validation cohort. The study population was representative of a Western European HIV population, including 288 (15.2%) cis-women, 463 (24.4%) non-whites, and 1360 (71.8%) MSM (Men who have Sex with Men). Extreme phenotypes included 114 spontaneous controllers, 81 rapid progressors and 162 immunological non-responders. According to the Framingham score 321 (16.9%) had a cardiovascular risk of >20% in the next 10 years. COVID-19 infection was documented in 234 (12.3%) participants and 474 (25.0%) individuals had received a COVID-19 vaccine. Conclusion The 2000HIV study established a cohort of 1895 PLHIV that employs multi-omics to discover new biological pathways and biomarkers to unravel non-AIDS comorbidities, extreme phenotypes and the latent viral reservoir that impact the health of PLHIV. The ultimate goal is to contribute to a more personalized approach to the best standard of care and a potential cure for PLHIV.
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Affiliation(s)
- Wilhelm A. J. W. Vos
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands,Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands,*Correspondence: Wilhelm A. J. W. Vos,
| | - Albert L. Groenendijk
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands,Department of Internal Medicine and Department of Medical Microbiology and Infectious diseases, Erasmus Medical Center (MC), Erasmus University, Rotterdam, Netherlands
| | - Marc J. T. Blaauw
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands,Department of Internal Medicine and Infectious Diseases, Elizabeth-Tweesteden Ziekenhuis, Tilburg, Netherlands
| | - Louise E. van Eekeren
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Adriana Navas
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Maartje C. P. Cleophas
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Nadira Vadaq
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Vasiliki Matzaraki
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Jéssica C. dos Santos
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Elise M. G. Meeder
- Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, Netherlands,Donders Institute for Brain, Radboud University, Cognition and Behavior, Nijmegen, Netherlands,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, Netherlands
| | - Janeri Fröberg
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Gert Weijers
- Medical UltraSound Imaging Center (MUSIC) Department of Medical Imaging, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Yue Zhang
- Universitair Medisch Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Jingyuan Fu
- Universitair Medisch Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Rob ter Horst
- Center for Molecular Medicine (CeMM) Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Christoph Bock
- Center for Molecular Medicine (CeMM) Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria,Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Institute of Artificial Intelligence, Vienna, Austria
| | - Rainer Knoll
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) eingetragener Verein (e.V.), Bonn, Germany,Genomics & Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany
| | - Anna C. Aschenbrenner
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands,Platform for Single Cell Genomics and Epigenomics (PRECISE), DZNE and University of Bonn, Bonn, Germany
| | - Joachim Schultze
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) eingetragener Verein (e.V.), Bonn, Germany,Genomics & Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany,Platform for Single Cell Genomics and Epigenomics (PRECISE), DZNE and University of Bonn, Bonn, Germany
| | - Linos Vanderkerckhove
- HIV Cure Research Center, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Talent Hwandih
- Medical Science Department, Sysmex Europe Societas Europaea (SE), Norderstedt, Germany
| | | | - Sai V. Vemula
- Clinical Development, ViiV Healthcare, Durham, NC, United States
| | - Mike van der Kolk
- Translational Medical Research, ViiV Healthcare, Brentford, United Kingdom
| | - Sterre C. P. de Vet
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands
| | - Willem L. Blok
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands
| | - Kees Brinkman
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands
| | - Casper Rokx
- Department of Internal Medicine and Department of Medical Microbiology and Infectious diseases, Erasmus Medical Center (MC), Erasmus University, Rotterdam, Netherlands
| | - Arnt F. A. Schellekens
- Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, Netherlands,Donders Institute for Brain, Radboud University, Cognition and Behavior, Nijmegen, Netherlands,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
| | - Leo A. B. Joosten
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands,Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marvin A. H. Berrevoets
- Department of Internal Medicine and Infectious Diseases, Elizabeth-Tweesteden Ziekenhuis, Tilburg, Netherlands
| | - Janneke E. Stalenhoef
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, Netherlands
| | - Annelies Verbon
- Department of Internal Medicine and Department of Medical Microbiology and Infectious diseases, Erasmus Medical Center (MC), Erasmus University, Rotterdam, Netherlands
| | - Jan van Lunzen
- Translational Medical Research, ViiV Healthcare, Brentford, United Kingdom
| | - Mihai G. Netea
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands,Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Andre J. A. M. van der Ven
- Department of Internal Medicine and Infectious Diseases, Radboudumc, Radboud University, Nijmegen, Netherlands
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