1
|
Bulum T, Tomić M, Vrabec R, Brkljačić N, Ljubić S. Systolic and Diastolic Blood Pressure Are Independent Risk Factors for Diabetic Retinopathy in Patients with Type 2 Diabetes. Biomedicines 2023; 11:2242. [PMID: 37626738 PMCID: PMC10452473 DOI: 10.3390/biomedicines11082242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIMS Diabetic retinopathy (DR) is a microvascular complication of diabetes and represents the leading cause of blindness in working-age adults. The aim of this study was to investigate the risk factors for DR in patients with type 2 diabetes (T2DM) with and without diabetic nephropathy (DN). METHODS A total of 160 patients with T2DM were included in the study. Photodocumented retinopathy status was determined according to the EURODIAB protocol. Renal function was determined using creatinine-based estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Binary univariate and multiple logistic regression analyses were performed to determine the main predictors of DR. RESULTS The prevalence of DR in this studied sample was 46.3%. No significant correlation was observed between DR and age, body mass index, serum lipids, and renal function. Binary logistic regression analysis (no DR/DR) showed that longer diabetes duration (p = 0.008), poor glycemic control (HbA1c) (p = 0.008), higher systolic blood pressure (p = 0.001), and diastolic blood pressure (p = 0.003) were the main predictors of DR in patients with T2DM. However, the influence of systolic blood pressure (AOR = 1.06, p = 0.004) and diastolic blood pressure (AOR = 1.12, p = 0.007) on DR development remained significant even after adjustment for diabetes duration and HbA1c. CONCLUSIONS Our results suggest that systolic and diastolic blood pressure are independent risk factors for DR in patients with T2DM.
Collapse
Affiliation(s)
- Tomislav Bulum
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- Medical School, University of Zagreb,10000 Zagreb, Croatia
| | - Martina Tomić
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Romano Vrabec
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Neva Brkljačić
- Department of Cardiology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Spomenka Ljubić
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- Medical School, University of Zagreb,10000 Zagreb, Croatia
| |
Collapse
|
2
|
Xiaodong L, Xuejun X, Xiaojuan S, Yu H, Mingchao X. Characterization of peripheral blood inflammatory indicators and OCT imaging biological markers in diabetic retinopathy with or without nephropathy. Front Endocrinol (Lausanne) 2023; 14:1160615. [PMID: 37465123 PMCID: PMC10351984 DOI: 10.3389/fendo.2023.1160615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023] Open
Abstract
Objective To observe the distribution characteristics of peripheral blood inflammatory indexes and retinal macular area optical coherence tomography (OCT) imaging biomarkers in patients with diabetic retinopathy (DR) with or without diabetic nephropathy (DN), in order to seek clinical biomarkers that can predict the development of DR and DN. Methods A total of 169 inpatients with DR who visited the ophthalmology department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from October 2020 to June 2022 and had complete clinical data were collected, and the patients with DR were divided into two major groups, DR and DR/DN, according to whether they had DN, and then further divided into four subgroups, Non-proliferative DR(NPDR), proliferative DR(PDR), NPDR/DN and PDR/DN, according to the stage of DR. The distribution characteristics of peripheral blood inflammatory indexes [Neutrophil to lymphocyte ratio(NLR) and Platelet to neutrophil ratio(PLR)], renal function indexes [Cystatin-C(CYS-C), Creatinine(Crea), Uric acid(UA)and Urinary albumin to creatinine ratio(UACR)] and OCT imaging indexes [Hyperreflective foci(HRF), Disorgnization of retinal inner layers(DRIL), Outer retinal tubulations(ORTs), Central retinal thickness(CRT), Retinal nerve fiber layer(RNFL) and Ganglion cell layer(GCL)] were analyzed between the above subgroups. Results There was no difference between DR and DR/DN groups in terms of gender, family history of diabetes, duration of diabetes and Body mass index(BMI) (P>0.05), the mean age of the DR/DN group was significantly lower than that of the DR group (P<0.05), and the proportion of the DR/DN group with a history of hypertension was significantly higher than that of the DR group (P<0.05); there was no significant difference in hemoglobin A1C(HbA1c) between DR and DR/DN groups (P>0.05). (P>0.05), Hemoglobin(HGB) was significantly higher in the DR group than in the DR/DN group (P <0.05), NLR, PLR, Crea, UA and CYS-C were significantly higher in the DR/DN group than in the DR group (P<0.05); there was no significant difference in the comparison of HRF, DRIL, ORTs positive rate and CRT between the DR and DR/DN groups (P>0.05). RNFL and GCL thickness were significantly lower in the DR/DN group than in the DR group (P<0.05); history of hypertension (OR=2.759), NLR (OR=1.316), PLR (OR=1.009), Crea (OR=1.018), UA (OR=1.004), CYS-C (OR=3.742) were the independent (OR=0.951), age (OR=0.951), HGB (OR=0.976), RNFL (OR=0.909) and GCL (OR=0.945) were independent protective factors for DR/DN; RNFL (OR=0.899) and GCL (OR=0.935) were independent protective factors for NPDR/DN, RNFL (OR=0.852) and GCL (OR=0.928) were independent protective factors for PDR/DN. ROC curve analysis showed that the area under the curve (AUC) for CYS-C, PLR, Crea, UA and the combination of the four indicators to predict DR/DN were 0.717, 0.625, 0.647, 0.616 and 0.717, respectively. Conclusions (1) Low age combined with hypertension HGB, NLR, PLR, CYS-C, Crea and UA may be serum biological markers for predicting DN in DR; meanwhile, PLR, CYS-C, Crea, UA and the combination of the four indicators can be used for risk assessment and adjunctive diagnosis of DN in DR combined with hypertension. (2) The RNFL and GCL thickness in the temporal aspect of the central macular sulcus may be imaging biological markers for predicting DN in DR; meanwhile, GCL thickness may have important value for risk prediction and diagnosis of DN in combination with DR.
Collapse
Affiliation(s)
- Li Xiaodong
- Department of Ophthalmology, The First Affiliated Hospital of Guizhou University of Chinese Medicine, Chengdu, China
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xie Xuejun
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Su Xiaojuan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - He Yu
- Department of Ophthalmology, Chengdu First People’s Hospital, Chengdu, China
| | - Xu Mingchao
- Traditional Chinese Medicine Hospital of Meishan, Meishan, China
| |
Collapse
|
3
|
El-Tawab SS, Ibrahim IK, Megallaa MH, Mgeed RMA, Elemary WS. Neutrophil–lymphocyte ratio as a reliable marker to predict pre-clinical retinopathy among type 2 diabetic patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-023-00177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Abstract
Background
Diabetic retinopathy is now recognized as a neurovascular in lieu of a microvascular complication. Visual evoked potentials (VEPs) are greatly valuable in detecting early diabetic retinal functional changes before the occurrence of structural damage. Low-grade inflammation plays a fundamental part in the development and progression of retinopathy in diabetics. Detecting diabetic patients with early retinopathy before the occurrence of clinical symptoms provides a window of opportunity to ensure the best prognosis for these eyes. Neutrophil–lymphocyte ratio (NLR) has recently been introduced as a novel marker of inflammation in various diseases. Indeed, the presence of a cheap, available, and reliable marker of inflammation that is capable to detect pre-clinical diabetic retinopathy (P-DR) is crucial for early intervention to retard the progression of ocular damage. As far as we know no previous studies investigated the role of NLR in the detection of P-DR. The aim of this study was to investigate the quality of prediction of NLR in detecting pre-clinical retinopathy in type 2 diabetic patients.
Results
In this case–control study, VEPs results showed a significant delay in P100 latencies of the patients’ group compared to the control group. According to the VEPs results, the patient group was further subdivided into two: diabetic with VEPs changes (a group with P-DR) and diabetic without VEPs changes. NLR was significantly elevated in patients with P-DR (p < 0.001). NLR cut-off point ≥ 1.97 is able to predict P-DR with 89.29% sensitivity and 84.37% specificity. Linear regression model revealed that NLR is the only independent factor that predicts P-DR. (odds ratio 3.312; 95% confidence interval 1.262–8.696, p = 0.015*.
Conclusions
Visual evoked potentials have an important role to evaluate the visual pathway in diabetics and to diagnose pre-clinical diabetic retinopathy before the occurrence of structural damage. Neutrophil–lymphocyte ratio is a reliable marker for the detection of pre-clinical diabetic retinopathy with good sensitivity (89.29%) and specificity (84.37%). Finding a reliable available laboratory test to predict P-DR could be of help to save diabetic patients from serious ocular complications.
Collapse
|
4
|
Liu Z, Shao M, Ren J, Qiu Y, Li S, Cao W. Association Between Increased Lipid Profiles and Risk of Diabetic Retinopathy in a Population-Based Case-Control Study. J Inflamm Res 2022; 15:3433-3446. [PMID: 35711238 PMCID: PMC9197172 DOI: 10.2147/jir.s361613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We aimed to investigate the association between lipid profiles and diabetic retinopathy (DR). Patients and Methods This case-control study, which was conducted between November 2019 and August 2021, comprised 309 patients with DR, 186 patients with diabetes mellitus, and 172 healthy controls. Serum cholesterol (CHOL), triglyceride (TRIG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (SDLDL-C), apolipoprotein A (APOA), APOB, APOE and lipoprotein (a)(LPA) levels were assessed. Patients were divided into two groups according to median age and glycated hemoglobin (HbA1c) level. Linear and logistic regression analyses were performed to assess the association between lipid levels and DR. Results CHOL, TRIG, HDL-C, APOB, APOE, and SDLDL-C levels were significantly higher in the DR group than in the healthy control group, and TRIG levels were lower in the DR group than in the DM group (P < 0.05), especially in the ≤57-year-old and the HbA1c ≤7.2% subgroups. Linear regression analyses showed that CHOL, TRIG, APOA, APOB, APOE, and SDLDL-C levels were associated with HbA1c levels. Multivariable logistic regression analyses indicated that CHOL (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.112–1.566), TRIG (OR = 1.269, 95% CI = 1.030–1.563), HDL-C (OR = 43.744, 95% CI = 17.12–111.769), APOB (OR = 7.037, 95% CI = 3.370–14.695), APOE (OR = 1.057, 95% CI = 1.038–1.077), and SDLDL-C (OR = 14.719, 95% CI = 8.304–26.088) levels were risk factors for DR (P < 0.05). Conclusion Increased lipid levels were risk factors for DR, and lipid level control should be strengthened, especially in younger adults or in patients with HbA1c ≤7.2%.
Collapse
Affiliation(s)
- Zhenzhen Liu
- Department of Clinical Laboratory, Eye and Ear Nose Throat (ENT) Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Mingxi Shao
- Department of Clinical Laboratory, Eye and Ear Nose Throat (ENT) Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jun Ren
- Department of Clinical Laboratory, Eye and Ear Nose Throat (ENT) Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yichao Qiu
- Department of Clinical Laboratory, Eye and Ear Nose Throat (ENT) Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Shengjie Li
- Department of Clinical Laboratory, Eye and Ear Nose Throat (ENT) Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Wenjun Cao
- Department of Clinical Laboratory, Eye and Ear Nose Throat (ENT) Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| |
Collapse
|
5
|
Tomić M, Vrabec R, Bulum T, Ljubić S. HDL cholesterol is a protective predictor in the development and progression of retinopathy in type 1 diabetes: A 15-year follow-up study. Diabetes Res Clin Pract 2022; 186:109814. [PMID: 35248652 DOI: 10.1016/j.diabres.2022.109814] [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: 08/14/2021] [Revised: 01/23/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the 15-year incidence of development and progression of diabetic retinopathy (DR) in type 1 diabetic patients (T1DM) and determine the associated risk factors. METHODS 123 T1DM were included in this prospective cohort study and followed for 15 years. Demographic, clinical, laboratory parameters, and retinal photographs were collected and analyzed. Risk factors for DR development and progression were identified using Cox regression analysis. RESULTS At baseline, 87 (71%) patients had no DR, and 36 (29%) had nonproliferative DR (NPDR). After 15 years, 54 patients (43.9%; 29.3/1000 person-years) developed NPDR or progressed to proliferative DR (PDR); 24 (27.6%) developed new NPDR, and 30 (83.3%) progressed to PDR. HbA1c (HR = 1.48, p = 0.008) and urinary albumin excretion rate (AER) (HR = 1.58, p = 0.045) were associated with the risk of DR development and progression, and a protective association was found for HDL cholesterol (HR = 0.17, p = 0.021). The presence of DR at baseline (HR = 2.95, p = 0.023) was associated with the risk of its progression to PDR. CONCLUSIONS The 15-year incidence of DR development and progression in T1DM is still very high, which points to the need for close monitoring of T1DM, especially those with higher HbA1c, higher AER, the initial presence of DR, and lower HDL cholesterol.
Collapse
Affiliation(s)
- Martina Tomić
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, Zagreb, Croatia.
| | - Romano Vrabec
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, Zagreb, Croatia
| | - Tomislav Bulum
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, Zagreb, Croatia; Medical School, University of Zagreb, Šalata 3, Zagreb, Croatia
| | - Spomenka Ljubić
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, Zagreb, Croatia; Medical School, University of Zagreb, Šalata 3, Zagreb, Croatia
| |
Collapse
|
6
|
Jansson Sigfrids F, Dahlström EH, Forsblom C, Sandholm N, Harjutsalo V, Taskinen MR, Groop PH. Remnant cholesterol predicts progression of diabetic nephropathy and retinopathy in type 1 diabetes. J Intern Med 2021; 290:632-645. [PMID: 33964025 DOI: 10.1111/joim.13298] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND We aimed to assess whether remnant cholesterol concentration and variability predict the progression of diabetic nephropathy (DN) and severe diabetic retinopathy (SDR) in type 1 diabetes. METHODS This observational prospective study covered 5150 FinnDiane Study participants. Remnant cholesterol was calculated as total cholesterol - LDL cholesterol - HDL cholesterol and variability as the coefficient of variation. DN category was based on consensus albuminuria reference limits and the progression status was confirmed from medical files. SDR was defined as retinal laser treatment. For 1338 individuals, the severity of diabetic retinopathy (DR) was graded using the ETDRS classification protocol. Median (IQR) follow-up time was 8.0 (4.9-13.7) years for DN and 14.3 (10.4-16.3) for SDR. RESULTS Remnant cholesterol (mmol L-1 ) was higher with increasing baseline DN category (P < 0.001). A difference was also seen comparing non-progressors (0.41 [0.32-0.55]) with progressors (0.55 [0.40-0.85]), P < 0.001. In a Cox regression analysis, remnant cholesterol predicted DN progression, independently of diabetes duration, sex, HbA1c , systolic blood pressure, smoking, BMI, estimated glucose disposal rate and estimated glomerular filtration rate (HR: 1.51 [1.27-1.79]). Remnant cholesterol was also higher in those who developed SDR (0.47 [0.36-0.66]) than those who did not (0.40 [0.32-0.53]), P < 0.001, and the concentration increased stepwise with increasing DR severity (P < 0.001). Regarding SDR, the HR for remnant cholesterol was 1.52 (1.26-1.83) with the most stringent adjustment. However, remnant cholesterol variability was not independently associated with the outcomes. CONCLUSIONS Remnant cholesterol concentration, but not variability, predicts DN progression and development of SDR. However, it remains to be elucidated whether the associations are causal or not.
Collapse
Affiliation(s)
- F Jansson Sigfrids
- From the, Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - E H Dahlström
- From the, Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - C Forsblom
- From the, Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - N Sandholm
- From the, Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - V Harjutsalo
- From the, Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - M-R Taskinen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - P-H Groop
- From the, Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| |
Collapse
|
7
|
Rathsman B, Haas J, Persson M, Ludvigsson J, Svensson AM, Lind M, Andersson Franko M, Nyström T. LDL cholesterol level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes mellitus: A nationwide cohort study. J Intern Med 2021; 289:873-886. [PMID: 33283333 PMCID: PMC8247303 DOI: 10.1111/joim.13212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Microvascular complications are common in people with diabetes, where poor glycaemic control is the major contributor. The aim of this study was to explore the association between elevated LDL cholesterol levels and the risk of retinopathy or nephropathy in young individuals with type 1 diabetes. METHODS This was a nationwide observational population-based cohort study, including all children and adults with a duration of type 1 diabetes of ≤ 10 years, identified in the Swedish National Diabetes Register between 1998 and 2017. We calculated the crude incidence rates with 95% confidence intervals (CIs) and used multivariable Cox regression to estimate crude and adjusted hazard ratios (HRs) of retinopathy or nephropathy in four LDL cholesterol categories: <2.6 (Reference), 2.6-3.4, 3.4-4.1 and > 4.1 mmol L-1 . RESULTS In total, 11 024/12 350 (retinopathy/nephropathy, both cohorts, respectively) children and adults (median age 21 years, female 42%) were followed up to 28 years from diagnosis until end of study. Median duration of diabetes when entering the study was 6 and 7 years in the retinopathy and nephropathy cohort, respectively. Median LDL cholesterol was 2.4 mmol L-1 , and median HbA1c level was 61 mmol mol-1 (7.7 %). After multivariable adjustment, the HRs (95% CI) for retinopathy in individuals with LDL cholesterol levels of 2.6-3.4, 3.4-4.1 or > 4.1 mmol L-1 were as follows: 1.13 (1.03-1.23), 1.16 (1.02-1.32) and 1.18 (0.99-1.41), compared with the reference. The corresponding numbers for nephropathy were as follows: 1.15 (0.96-1.32), 1.30 (1.03-1.65) and 1.41 (1.06-1.89). CONCLUSIONS Young individuals with type 1 diabetes exposed to high LDL cholesterol levels have an increased risk of retinopathy and nephropathy independent of glycaemia and other identified risk factors for vascular complications.
Collapse
Affiliation(s)
- B Rathsman
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - J Haas
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - M Persson
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet, Stockholm, Sweden
| | - J Ludvigsson
- Division of Paediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Crown Princess Victoria Children's Hospital, Linköping, Sweden
| | - A-M Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - M Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - M Andersson Franko
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - T Nyström
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
8
|
Pramanik S, Chowdhury S, Ganguly U, Banerjee A, Bhattacharya B, Mondal LK. Visual contrast sensitivity could be an early marker of diabetic retinopathy. Heliyon 2020; 6:e05336. [PMID: 33145449 PMCID: PMC7591734 DOI: 10.1016/j.heliyon.2020.e05336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 07/11/2020] [Accepted: 10/21/2020] [Indexed: 12/28/2022] Open
Abstract
The present study aimed to explore the early predictive marker of diabetic retinopathy (DR) and to elucidate the associated demographic, metabolic, and ocular factors. We enrolled 43 type 2 diabetic subjects with mild non-proliferative retinopathy (MNPDR), 30 diabetic subjects with no retinopathy (DNR), and 35 healthy controls (HC). The study groups showed no significant alteration in central macular thickness (CMT) and visual acuity (VA). The contrast sensitivity (CS) score was found to be significantly lower among DNR and MNPDR subjects compared to HCs (p < 0.0001). Between MNPDR and DNR subjects, the CS score was significantly lower in the former (p = 0.0036). CS score discriminated DNR subjects from HC, with 74% accuracy for the optimal threshold 0.71. The associated area under the ROC curve (AUC) is 0.82 (p < 0.0001) while the discrimination rule has 66% sensitivity and 80% specificity. The CS score also discriminated MNPDR subjects from DNR with 64% accuracy for the optimal threshold 0.53. The associated AUC is 0.65 (p < 0.023) and the rule has 86% sensitivity and 33% specificity. According to best subset regression analysis, not only glycaemic parameters but also lipid parameters [low-density lipoprotein cholesterol (LDL-C) (p = 0.045) and triglycerides (TG) (p = 0.0005)] were found to be significant predictors of CS. CMT (p = 0.058) was another marginally significant predictor of CS. CS may be used as an early predictive marker for DR. So, not only hyperglycemia, but also hyperlipidemia seems to significantly affect retinal CS function in diabetes.
Collapse
Affiliation(s)
- Subhasish Pramanik
- Institute of Post Graduate Medical Education and Research (IPGMER), 244 Acharya Jagadish Chandra Bose Road, Kolkata, 700020, India
| | - Subhankar Chowdhury
- Institute of Post Graduate Medical Education and Research (IPGMER), 244 Acharya Jagadish Chandra Bose Road, Kolkata, 700020, India
| | - Upasana Ganguly
- Institute of Post Graduate Medical Education and Research (IPGMER), 244 Acharya Jagadish Chandra Bose Road, Kolkata, 700020, India
| | - Anindita Banerjee
- Institute of Post Graduate Medical Education and Research (IPGMER), 244 Acharya Jagadish Chandra Bose Road, Kolkata, 700020, India.,ICARE Institute of Medical Sciences and Research, Haldia, 721645, India
| | - Basudev Bhattacharya
- Institute of Post Graduate Medical Education and Research (IPGMER), 244 Acharya Jagadish Chandra Bose Road, Kolkata, 700020, India
| | - Lakshmi Kanta Mondal
- Regional Institute of Ophthalmology (RIO), Medical College and Hospital, Kolkata, 700073, India
| |
Collapse
|
9
|
Vergès B. Dyslipidemia in Type 1 Diabetes: AMaskedDanger. Trends Endocrinol Metab 2020; 31:422-434. [PMID: 32217073 DOI: 10.1016/j.tem.2020.01.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 12/28/2022]
Abstract
Type 1 diabetes (T1D) patients show lipid disorders which are likely to play a role in their increased cardiovascular (CV) disease risk. Quantitative abnormalities of lipoproteins are noted in T1D with poor glycemic control. In T1D with optimal glycemic control, triglycerides and LDL-cholesterol are normal or slightly decreased whereas HDL-cholesterol is normal or slightly increased. T1D patients, even with good glycemic control, show several qualitative and functional abnormalities of lipoproteins that are potentially atherogenic. An association between these abnormalities and CV disease risk has been reported in recent studies. Although the mechanisms underlying T1D dyslipidemia remain unclear, the subcutaneous route of insulin administration, that is responsible for peripheral hyperinsulinemia, is likely to be an important factor.
Collapse
Affiliation(s)
- Bruno Vergès
- Service Endocrinologie, Diabétologie, et Maladies Métaboliques, Centre Hospitalier Universitaire (CHU), Institut National de la Santé et de la Recherche Médicale (INSERM) Lipides, Nutrition, Cancer (LNC)-Unité Mixte de Recherche (UMR) 1231, University of Burgundy, 21000 Dijon, France.
| |
Collapse
|
10
|
Shi R, Niu Z, Wu B, Zhang T, Cai D, Sun H, Hu Y, Mo R, Hu F. Nomogram for the Risk of Diabetic Nephropathy or Diabetic Retinopathy Among Patients with Type 2 Diabetes Mellitus Based on Questionnaire and Biochemical Indicators: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2020; 13:1215-1229. [PMID: 32368114 PMCID: PMC7182465 DOI: 10.2147/dmso.s244061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/08/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aimed to develop a diabetic nephropathy (DN) or diabetic retinopathy (DR) incidence risk nomogram in China's population with type 2 diabetes mellitus (T2DM) based on a community-based sample. METHODS We carried out questionnaire evaluations, physical examinations and biochemical tests among 4219 T2DM patients in Shanghai. According to the incidence of DN and DR, 4219 patients in our study were divided into groups of T2DM patients with DN or DR, patients with both, and patients without any complications. We successively used least absolute shrinkage and selection operator regression analysis and logistic regression analysis to optimize the feature selection for DN and DR. To ensure the accuracy of the results, we carried out multivariable logistic regression analysis of the above significant risk factors on the sample data for both DN and DR. The selected features were included to establish a prediction model. The C-index, calibration plot, curve analysis and internal validation were used to validate the distinction, calibration, and clinical practicality of the model. RESULTS The predictors in the prediction model included disease course, body mass index (BMI), total triglycerides (TGs), systolic blood pressure (SBP), postprandial blood glucose (PBG), haemoglobin A1C (HbA1c) and blood urea nitrogen (BUN). The model displayed moderate predictive power with a C-index of 0.807 and an area under the receiver operating characteristic curve of 0.807. In internal verification, the C-index reached 0.804. The risk threshold was 16-75% according to the analysis of the decision curve, and the nomogram could be applied in clinical practice. CONCLUSION This DN or DR incidence risk nomogram incorporating disease course, BMI, TGs, SBP, PBG, HbA1c and BUN can be used to predict DN or DR incidence risk in T2DM patients. The research team has developed an online app based on a clinical prediction model incorporating risk factors for rapid and simple prediction.
Collapse
Affiliation(s)
- Rong Shi
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Zheyun Niu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Birong Wu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Taotao Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Dujie Cai
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Hui Sun
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yuhong Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Ruohui Mo
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Fan Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Correspondence: Fan Hu School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of ChinaTel +8613585828140Fax +862151322466 Email
| |
Collapse
|
11
|
Life Style Intervention Improves Retinopathy Status-The Finnish Diabetes Prevention Study. Nutrients 2019; 11:nu11071691. [PMID: 31340493 PMCID: PMC6683279 DOI: 10.3390/nu11071691] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to find out whether participation in earlier intervention had an effect on the occurrence of retinopathy in study participants. We also examined risk factors (age, sex, weight, fasting and 2 h glucose, fasting insulin, blood pressure, serum lipids) for early retinal changes. The study included 522 individuals (mean 55 years old, range 40-64 years) with impaired glucose tolerance who were randomized into intervention (weight loss, healthy diet, and physical activity, N = 265) and control groups (N = 257). Intervention lasted for median of four years in 1993-2000, after which annual follow-up visits at study clinics were conducted. In the years 2002-2006 (at least five years after stopping intervention), fundus photography was offered for all study participants in four of five study clinics. Photographs were assessed by two experienced ophthalmologists (A.A. and K.K.), masked for the group assignment. After exclusion of poor quality photographs, the data of 211 individuals (N = 113 for intervention and N = 98 for control group) were included in the present study. The occurrence of microaneurysms was significantly higher in the control (37/98, 38%) than in the intervention group (27/113, 24%; p = 0.029). In the model, including age, sex, diabetes diagnosis before the retinal assessment, body mass index (BMI), and treatment group, the odds ratio for microaneurysms was markedly lower in intervention group (OR 0.52; 0.28-0.97, p = 0.039). The only risk factor that predicted the occurrence of microaneurysms was serum triglycerides at baseline (mean ± SD 1.9 ± 0.9 vs. 1.6 ± 0.7, mmol/L, with and without microaneurysms, respectively, p = 0.003). Triglycerides associated with decreased microaneurysms in regression analysis for age, sex, fasting glucose, and intervention group (OR 1.92, p = 0.018). Lifestyle intervention in overweight and obese individuals with impaired glucose tolerance showed decreased occurrence of retinal microaneurysms. Elevated serum triglycerides were associated to the development of early diabetic microangiopathy.
Collapse
|
12
|
Wang Y, Jiang L, Wang XY, Chen W, Shao Y, Chen QK, Lv JL. Evidence of altered brain network centrality in patients with diabetic nephropathy and retinopathy: an fMRI study using a voxel-wise degree centrality approach. Ther Adv Endocrinol Metab 2019; 10:2042018819865723. [PMID: 31384421 PMCID: PMC6661786 DOI: 10.1177/2042018819865723] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/03/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Over recent years, some researchers believe that diabetic nephropathy (DN) and diabetic retinopathy (DR) both independently increase the incidence of brain diseases, such as stroke, cerebral infarction, and cerebral hemorrhage. In the present study, we used the voxel-wise degree centrality (DC) method to investigate potential changes of functional network brain activity in patients with DN and retinopathy (DNR). METHODS Twenty DNR patients (9 men, 11 women) and 20 healthy controls (HCs; 9 men, 11 women) were recruited; the controls were matched for age, sex, and educational background. All subjects underwent resting-state functional magnetic resonance imaging. Ophthalmoscopy, renal biopsy and single-photon emission computed tomography were used to evaluate microvascular lesions in the eye and kidney. Data were categorized using receiver operating characteristic curves, and correlation analysis was performed using Pearson's correlation analysis. RESULTS Compared with HCs, DNR patients showed reduced mean DC values in the right inferior temporal gyrus (RITG) and left subcallosal gyrus regions (LSG) and increased mean DC values in the bilateral precuneus (BP). Moreover, mean DC in the BP was correlated with renal estimated glomerular filtration rate (eGFR; r = 0.762). The area under the curve (AUC) value was 0.829 for BP and 0.839 for RITG and LSG. CONCLUSION DNR patients showed dysfunction in three different brain regions. The linear correlation between eGFR and mean brain DC values indicates the presence of common diabetic microangiopathy in the brain and kidney, which may provide new ideas for multiorgan microvascular lesions of diabetics.
Collapse
Affiliation(s)
- Yu Wang
- Department of Nephrology, The First Affiliated
Hospital of Nanchang University, Jiangxi, China
| | - Lei Jiang
- Department of Nephrology, The First Affiliated
Hospital of Nanchang University, Jiangxi, China
| | - Xiao-yu Wang
- Department of Nephrology, The First Affiliated
Hospital of Nanchang University, Jiangxi, China
| | - Weizhe Chen
- Department of Nephrology, The First Affiliated
Hospital of Nanchang University, Jiangxi, China
| | - Yi Shao
- Department of Ophthalmology, The First
Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Qin-kai Chen
- Department of Nephrology, The First Affiliated
Hospital of Nanchang University, Jiangxi, China
| | | |
Collapse
|
13
|
Nomogram for prediction of non-proliferative diabetic retinopathy in juvenile-onset type 1 diabetes: a cohort study in an Asian population. Sci Rep 2018; 8:12164. [PMID: 30111889 PMCID: PMC6093915 DOI: 10.1038/s41598-018-30521-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/01/2018] [Indexed: 12/18/2022] Open
Abstract
The need for screening for retinopathy in patients with type 1 diabetes mellitus (T1DM) has been emphasised, but diagnostic delays were reported when screening was done at fixed intervals. To establish an individualised risk-prediction model to assist screening non-proliferative diabetic retinopathy (NPDR) in T1DM, we performed a retrospective cohort study enrolling participants in the Chang Gung Juvenile Diabetes Eye Study. There were 413 patients with 12 381 records analysed from 2005 to 2015. A time-dependent Cox proportional hazard analysis was used to evaluate the risks of NPDR development and a nomogram with risk-stratification indicators was established based on the results. During 97 months of follow-up, 43 of 413 patients (10.4%) developed NPDR. Male sex (HR: 0.4, 95% CI: 0.19–0.85), age 5–14 years at onset of T1DM (6.38, 2.41–16.87), duration of diabetes (1.57, 1.41–1.75), and hemoglobin A1c level (1.56, 1.35–1.80) were independently associated with NPDR. Using the nomogram offers a quick method in the clinical setting to interpret the risk of NPDR development. Based on its weighting, each of the independent factors is allocated a score, and the total points indicate the probabilities of NPDR occurring within 6 months, 1 year, and 3 years.
Collapse
|
14
|
Ding Y, Ge Q, Qu H, Feng Z, Long J, Wei Q, Zhou Q, Wu R, Yao L, Deng H. Increased serum periostin concentrations are associated with the presence of diabetic retinopathy in patients with type 2 diabetes mellitus. J Endocrinol Invest 2018; 41:937-945. [PMID: 29349642 DOI: 10.1007/s40618-017-0820-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/27/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the association between serum periostin and the presence of diabetic retinopathy (DR). METHODS Serum periostin was detected in 114 healthy subjects, 122 patients with type 2 diabetes mellitus (T2DM) and 159 patients with DR and compared among groups. Clinical data and other laboratory measurements such as glycated hemoglobin (HbA1c), lipid profiles, serum creatinine (Cr) and high-sensitivity CRP (hsCRP) were also collected and compared among groups. For subgroup analysis, patients with DR were divided into a non-proliferated diabetic retinopathy (NPDR) group and a proliferated diabetic retinopathy (PDR) group. Multivariate analysis was performed using logistic regression models. RESULTS The serum periostin level was significantly higher in patients with diabetic retinopathy compared with healthy subjects and patients with T2DM (both P < 0.001, respectively). Also, the periostin level was significantly higher in the PDR group compared to the NPDR group (P = 0.044). Multivariate logistic regression revealed that serum periostin was independently associated with the presence of DR in patients with T2DM (P < 0.001). The receiver operating characteristic (ROC) curves for DR development using serum periostin showed that the area under the receiver operating characteristic curves (AUC) was 0.838 (P < 0.001). CONCLUSIONS The current study demonstrated that serum periostin is significantly associated with the presence of DR in patients with T2DM and is an independent risk factor of DR.
Collapse
Affiliation(s)
- Y Ding
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Q Ge
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - H Qu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Z Feng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - J Long
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Q Wei
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Q Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - R Wu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - L Yao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - H Deng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| |
Collapse
|
15
|
Sarrafan-Chaharsoughi Z, Manaviat MR, Namiranian N, Yazdian-Anari P, Rahmanian M. Is there a relationship between body mass index and diabetic retinopathy in type II diabetic patients? A cross sectional study. J Diabetes Metab Disord 2018; 17:63-69. [PMID: 30288386 PMCID: PMC6154516 DOI: 10.1007/s40200-018-0339-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is one of the most important leading causes of disability, premature mortality and Diabetic Retinopathy (DR) that is one of the diabetes-related complications in diabetic patients and the most common cause of vision loss in diabetic patients. The aim of the study was to evaluate the association between DR and body mass index (BMI) in those patients with T2DM. METHODS This was a central-based, cross-sectional study on 518 diabetic patients. Their medical history and the laboratory data were collected. All the patients received examination of diabetic retinopathy by professional ophthalmologist. Based on their optic fundi findings, they were classified into five groups: No retinopathy, Mild Non-proliferative Diabetic Retinopathy (NPDR), Moderate NPDR, Severe NPDR, Proliferative diabetic retinopathy (PDR). To analysis data SPSS v18 software used. Frequency, percent, mean and standard deviation were used for population description. t test, spearman correlation, partial correlation, analysis of variance (ANOVA) and Chi-square test (χ2) were used for analytic analysis. Multivariate logistic regression was used to estimate the odds ratio. RESULTS 518 patients with T2DM 198 male (38%), 320 female (62%) included in this study. The mean age of patients was 61.02 ± 10.18 years. The mean age at onset was 49.06 + 10.52 years and the mean duration of diabetes was 12.09 ± 7.81 years. There was a strong relationship between duration of diabetes and DR (P = 0.001). There were strong significant association between the development of DR and Insulin therapy (OR = 5.975). Correlation analysis between Retinopathy and BMI showed that BMI had inverse relationship with DR when BMI considered as a continuous variable (p-value = 0.009 and correlation coefficient = -0.467). CONCLUSION BMI in diabetic patient is one of the most important clinical parameter for their health and disease progression. We conclude that BMI had inverse relationship with DR when BMI considered as a continuous variable.
Collapse
Affiliation(s)
| | - Masoud Reza Manaviat
- 2Geriatric Ophthalmology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- 3Yazd diabetes research center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Pouria Yazdian-Anari
- 4Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Rahmanian
- 5Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
16
|
Bulum T, Tomić M, Duvnjak L. Total Serum Cholesterol Increases Risk for Development and Progression of Nonproliferative Retinopathy in Patients with Type 1 Diabetes Without Therapeutic Intervention: Prospective, Observational Study. Arch Med Res 2017; 48:467-471. [PMID: 29089151 DOI: 10.1016/j.arcmed.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/17/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Results from studies investigating relationship between serum lipids and risk of development and progression of diabetic retinopathy (DR) in patients with type 1 diabetes (T1DM) are not consistent. The objective of this study was to explore the relationship between serum lipids and risk of development and progression of nonproliferative diabetic retinopathy (NPDR) in T1DM with normal renal function and with no therapeutic intervention that might influence on retinopathy and serum lipids status. METHODS A total of 103 T1DM with normal renal function (urinary albumin excretion rate <30 mg/24 h, estimated glomerular filtration rate (eGFR) >60 mL min‒11.73m‒2), and before any interventions with lipid-lowering therapy, ACE inhibitors or angiotensin II receptor blockers were included in this study and followed for 41 months. Photodocumented retinopathy status was made according to the EURODIAB protocol. RESULTS Patients who developed NPDR or progressed to proliferative retinopathy were older (44 vs. 33 years, p <0.001), had longer duration of diabetes (21.1 vs. 13.3 years, p <0.001), and higher serum total cholesterol level (5.1 vs. 4.5 mM/L, p = 0.02) compared to patients without retinopathy. In a backward stepwise Cox's multiple regression analysis serum total cholesterol was significantly associated with risk of development or progression of NPDR in our subjects (p = 0.04), with odds ratios of 1.27-1.91. CONCLUSION These data suggest that serum total cholesterol levels are associated with risk of development and progression of NPDR in T1DM and normal renal function. The study was conducted in patients with no therapeutic interventions.
Collapse
Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia; Medical School, University of Zagreb, Zagreb, Croatia.
| | - Martina Tomić
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia
| | - Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia; Medical School, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
17
|
Aryan Z, Afarideh M, Ghajar A, Esteghamati S, Esteghamati A, Nakhjavani M. Conflicting interactions of apolipoprotein A and high density lipoprotein cholesterol with microvascular complications of type 2 diabetes. Diabetes Res Clin Pract 2017; 133:131-141. [PMID: 28934670 DOI: 10.1016/j.diabres.2017.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 04/26/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022]
Abstract
AIMS This study is amid at investigating the associations, and interactions of serum lipid biomarkers with microvascular complications of type 2 diabetes (T2D). METHODS A nested case-control study was conducted within an ongoing prospective study on patients with T2D. Microvascular complications of T2D including diabetic neuropathy, diabetic retinopathy and diabetic nephropathy were investigated. A total of 444 cases with at least one of the microvascular complications of T2D and 439 age- and gender-matched controls free of any of the chronic microvascular complications of T2D were included. The associations and interactions of a panel of serum lipid biomarkers with the microvascular complications of T2D were investigated. RESULTS Serum triglyceride had the strongest association with microvascular complications of T2D (crude model: β=0.632, P value=0.045). Each standard deviation increment in serum TG was associated with 3.7 times increased frequency of microvascular complications. Despite high density lipoprotein cholesterol (HDL-C), serum apolipoprotein A1 (Apo A1) was positively associated with the presence of diabetic neuropathy. Each standard deviation increment in serum ApoA1 was associated with increased frequency of diabetic neuropathy (OR, 1.2, 95% CI, (1.1-1.3), P value=0.006). The frequency of diabetic neuropathy was higher in 2nd and 3rd quartiles of serum Lp(a) compared to diabetic patients in the first quartile (OR, 5.52, 95% (1.17-25.8), P value=0.047). CONCLUSIONS ApoA1 but not HDL-C is straightly associated with diabetic neuropathy. Even Slight rise in serum Lp(a) is associated with increased frequency of diabetic retinopathLipid variables could serve as specific predictors of vascular complications in diabetes.
Collapse
Affiliation(s)
- Zahra Aryan
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Mohsen Afarideh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Alireza Ghajar
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Sadaf Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| |
Collapse
|
18
|
Penman A, Hancock H, Papavasileiou E, James M, Idowu O, Riche DM, Fernandez M, Brauner S, Smith SO, Hoadley S, Richardson C, Vazquez V, Chi C, Andreoli C, Husain D, Chen CJ, Sobrin L. Risk Factors for Proliferative Diabetic Retinopathy in African Americans with Type 2 Diabetes. Ophthalmic Epidemiol 2016; 23:88-93. [PMID: 26950197 DOI: 10.3109/09286586.2015.1119287] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To assess personal and demographic risk factors for proliferative diabetic retinopathy in African Americans with type 2 diabetes. METHODS In this prospective, non-interventional, cross-sectional case-control study, 380 African Americans with type 2 diabetes were enrolled. Participants were recruited prospectively and had to have either: (1) absence of diabetic retinopathy after ≥10 years of type 2 diabetes, or (2) presence of proliferative diabetic retinopathy when enrolled. Dilated, 7-field fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study scale. Covariates including hemoglobin A1C (HbA1C), blood pressure, height, weight and waist circumference were collected prospectively. Multivariate regression models adjusted for age, sex and site were constructed to assess associations between risk factors and proliferative diabetic retinopathy. RESULTS Proliferative diabetic retinopathy was associated with longer duration of diabetes (odds ratio, OR, 1.62, p < 0.001), higher systolic blood pressure (OR 1.65, p < 0.001) and insulin use (OR 6.65, p < 0.001) in the multivariate regression analysis. HbA1C was associated with proliferative diabetic retinopathy in the univariate analysis (OR 1.31, p = 0.002) but was no longer significant in the multivariate analysis. CONCLUSIONS In this case-control study of African Americans with type 2 diabetes, duration of diabetes, systolic hypertension and insulin use were strong risk factors for the development of proliferative diabetic retinopathy. Interestingly, HbA1C did not confer additional risk in this cohort.
Collapse
Affiliation(s)
- Alan Penman
- a Department of Medicine , University of Mississippi Medical Center , Jackson , MS , USA.,b Center of Biostatistics and Bioinformatics , University of Mississippi Medical Center , Jackson , MS , USA
| | - Heather Hancock
- c Department of Ophthalmology , University of Mississippi Medical Center , Jackson , MS , USA
| | - Evangelia Papavasileiou
- d Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Maurice James
- e Department of Ophthalmology , St Dominic's Hospital , Jackson , MS , USA
| | - Omolola Idowu
- c Department of Ophthalmology , University of Mississippi Medical Center , Jackson , MS , USA
| | - Daniel M Riche
- a Department of Medicine , University of Mississippi Medical Center , Jackson , MS , USA
| | - Marlene Fernandez
- f Center for Human Genetic Research , Massachusetts General Hospital , Boston , MA , USA
| | - Stacey Brauner
- d Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Sataria O Smith
- c Department of Ophthalmology , University of Mississippi Medical Center , Jackson , MS , USA
| | - Suzanne Hoadley
- c Department of Ophthalmology , University of Mississippi Medical Center , Jackson , MS , USA
| | - Cole Richardson
- c Department of Ophthalmology , University of Mississippi Medical Center , Jackson , MS , USA
| | - Vanessa Vazquez
- g Department of Ophthalmology , Boston Medical Center , Boston , MA , USA
| | - Cheryl Chi
- g Department of Ophthalmology , Boston Medical Center , Boston , MA , USA
| | - Christopher Andreoli
- h Visual Services Department , Harvard Vanguard Medical Associates , Boston , MA , USA
| | - Deeba Husain
- d Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Ching J Chen
- c Department of Ophthalmology , University of Mississippi Medical Center , Jackson , MS , USA
| | - Lucia Sobrin
- i Harvard Medical School , Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| |
Collapse
|
19
|
Forga L, Goñi MJ, Ibáñez B, Cambra K, García-Mouriz M, Iriarte A. Influence of Age at Diagnosis and Time-Dependent Risk Factors on the Development of Diabetic Retinopathy in Patients with Type 1 Diabetes. J Diabetes Res 2016; 2016:9898309. [PMID: 27213158 PMCID: PMC4861784 DOI: 10.1155/2016/9898309] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 02/07/2023] Open
Abstract
Aim. To determine the influence of age at onset of type 1 diabetes and of traditional vascular risk factors on the development of diabetic retinopathy, in a cohort of patients who have been followed up after onset. Methods. Observational, retrospective study. The cohort consists of 989 patients who were followed up after diagnosis for a mean of 10.1 (SD: 6.8) years. The influence of age at diagnosis, glycemic control, duration of diabetes, sex, blood pressure, lipids, BMI, and smoking is analyzed using Cox univariate and multivariate models with fixed and time-dependent variables. Results. 135 patients (13.7%) developed diabetic retinopathy. The cumulative incidence was 0.7, 5.9, and 21.8% at 5-, 10-, and 15-year follow-up, respectively. Compared to the group with onset at age <10 years, the risk of retinopathy increased 2.5-, 3-, 3.3-, and 3.7-fold in the groups with onset at 10-14, 15-29, 30-44, and >44 years, respectively. During follow-up we also observed an association between diabetic retinopathy and HbA1c levels, HDL-cholesterol, and diastolic blood pressure. Conclusion. The rate of diabetic retinopathy is higher in patients who were older at type 1 diabetes diagnosis. In addition, we confirmed the influence of glycemic control, HDL-cholesterol, and diastolic blood pressure on the occurrence of retinopathy.
Collapse
Affiliation(s)
- Luis Forga
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
- *Luis Forga:
| | - María José Goñi
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| | - Berta Ibáñez
- Navarrabiomed, Fundación Miguel Servet, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| | - Koldo Cambra
- Navarrabiomed, Fundación Miguel Servet, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| | - Marta García-Mouriz
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| | - Ana Iriarte
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, Pamplona, 31008 Navarra, Spain
| |
Collapse
|
20
|
Lu J, Hou X, Zhang L, Jiang F, Hu C, Bao Y, Jia W. Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes. Acta Diabetol 2015; 52:701-8. [PMID: 25604042 DOI: 10.1007/s00592-014-0711-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/30/2014] [Indexed: 12/19/2022]
Abstract
AIMS To explore the factors mediating the relationship between body mass index (BMI) and diabetic retinopathy (DR) in Chinese type 2 diabetes patients. METHODS This is a cross-sectional study. Data of 2,533 patients with type 2 diabetes were studied from the Shanghai Diabetes Registry Database. DR was assessed using non-mydriatic fundus photography and graded as non-DR, mild-moderate (DR I-II), and sight-threatening (DR III-IV). BMI (kg/m(2)) was classified as normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). β cell function was evaluated by fasting C-peptide (FCP). RESULTS DR was present in 701 (27.7 %) patients. Patients with DR had lower BMI (24.3 vs. 24.9 kg/m(2), P = 0.001) and fasting C-peptide (1.46 vs. 1.86 ng/ml, P < 0.001) than those without DR. The association between BMI (2 kg/m(2) interval) and DR was U-shaped; patients with BMI 28-29.9 kg/m(2) had the lowest DR rate. Compared with normal weight, overweight was associated with reduced risk of any DR [odds ratio (OR) 0.73], DR I-II (OR 0.76), and DR III-IV (OR 0.64) after adjustment for sex, age at diabetes diagnosis, and duration of diabetes. This negative association attenuated after adjustment for other confounders and became nonsignificant after further adjustment for FCP. Patients with different BMI categories had similar DR risk when stratified by FCP tertiles. CONCLUSION Overweight patients have lower DR prevalence than normal weight individuals, which may be attributable to better β cell function in overweight patients.
Collapse
Affiliation(s)
- Jun Lu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | | | | | | | | | | | | |
Collapse
|
21
|
Bulum T, Blaslov K, Duvnjak L. Risk factors for development and progression of nonproliferative retinopathy in normoalbuminuric patients with type 1 diabetes. Diabetes Res Clin Pract 2014; 106:555-9. [PMID: 25451889 DOI: 10.1016/j.diabres.2014.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/19/2014] [Accepted: 09/14/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate risk factors for development and progression of nonproliferative retinopathy (NPR) in normoalbuminuric patients with type 1 diabetes mellitus (T1DM). METHODS A total of 223 T1DM with normal renal function and normoalbuminuria were included in this study and followed for 48 months. Photodocumented retinopathy status was made according to the EURODIAB protocol. Urinary albumin excretion rate (UAE) was measured from at least two 24-h urine samples. Possible risk factors for development or progression of NPR were examined in backward stepwise Cox's multiple regression analysis. RESULTS The majority of patients (70%) had no retinopathy while 67 (30%) had NPR at baseline. Patients with NPR were older, had longer duration of diabetes, higher systolic blood pressure, BMI, resting heart rate, UAE and lower estimated glomerular filtration rate (p ≤ 0.04 for all). After 48 months 24 patients (10.7%) developed NPR or progressed to proliferative retinopathy. Systolic blood pressure (HR 1.03, CI 1.01-1.05, p=0.02), UAE (HR 1.14, CI 1.07-1.21, p<0.001), and resting heart rate (HR 1.05, CI 1.01-1.09, p=0.006) were significantly associated with development or progression of NPR. CONCLUSIONS Our results suggest that retinopathy is present and may progress in T1DM even when coexisting renal disease is excluded. Normoalbuminuric T1DM requires close monitoring for the early detection of retinopathy, especially if they have a higher UAE, systolic blood pressure and resting heart rate.
Collapse
Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia.
| | - Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia
| | - Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
22
|
Tolonen N, Forsblom C, Mäkinen VP, Harjutsalo V, Gordin D, Feodoroff M, Sandholm N, Thorn LM, Wadén J, Taskinen MR, Groop PH. Different lipid variables predict incident coronary artery disease in patients with type 1 diabetes with or without diabetic nephropathy: the FinnDiane study. Diabetes Care 2014; 37:2374-82. [PMID: 24879842 DOI: 10.2337/dc13-2873] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study the ability of lipid variables to predict incident coronary artery disease (CAD) events in patients with type 1 diabetes at different stages of nephropathy. RESEARCH DESIGN AND METHODS Patients (n = 3,520) with type 1 diabetes and available lipid profiles participating in the Finnish Diabetic Nephropathy Study (FinnDiane) were included in the study. During a follow-up period of 10.2 years (8.6-12.0), 310 patients suffered an incident CAD event. RESULTS Apolipoprotein B (ApoB)/ApoA-I ratio was the strongest predictor of CAD in normoalbuminuric patients (hazard ratio 1.43 [95% CI 1.17-1.76] per one SD increase), and ApoB was the strongest in macroalbuminuric patients (1.47 [1.19-1.81]). Similar results were seen when patients were stratified by sex or glycemic control. LDL cholesterol was a poor predictor of CAD in women, normoalbuminuric patients, and patients with HbA1c below the median (8.3%, 67 mmol/L). The current recommended triglyceride cutoff of 1.7 mmol/L failed to predict CAD in normoalbuminuric patients, whereas the cohort median 0.94 mmol/L predicted incident CAD events. CONCLUSIONS In patients with type 1 diabetes, the predictive ability of the lipid variables differed substantially depending on the patient's sex, renal status, and glycemic control. In normoalbuminuric patients, the ratios of atherogenic and antiatherogenic lipoproteins and lipids were the strongest predictors of an incident CAD event, whereas in macroalbuminuric patients, no added benefit was gained from the ratios. Current treatment recommendations may need to be revised to capture residual CAD risk in patients with type 1 diabetes.
Collapse
Affiliation(s)
- Nina Tolonen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Ville-Petteri Mäkinen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandDepartment of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CASouth Australian Health and Medical Research Institute, Adelaide, Australia
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandDiabetes Prevention Unit, Institute for Health and Welfare, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Maija Feodoroff
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Niina Sandholm
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandAalto University, Espoo, Finland
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Johan Wadén
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Marja-Riitta Taskinen
- Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | |
Collapse
|
23
|
Renoprotective effect of atorvastatin on STZ-diabetic rats through attenuating kidney-associated dysmetabolism. Eur J Pharmacol 2014; 740:9-14. [PMID: 25008071 DOI: 10.1016/j.ejphar.2014.06.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 06/21/2014] [Accepted: 06/23/2014] [Indexed: 11/20/2022]
Abstract
Atorvastatin (AT) has been alternatively used for managing diabetic complications in clinic. However, AT-related therapeutic potentiality remains relatively unexplored, especially in diabetic nephropathy. This study aimed to investigate the underlying potentiality that AT exerted on anti-diabetic nephropathy role against streptozotocin (STZ)-induced kidney injury in rats. STZ-diabetic rats were intragastrically administered with AT (10, 20 mg/kg/d) for consecutive 8 weeks. The effects of AT on body weight, levels of blood glucose, lipometabolism, redox state, cellular metabolism, regulator factor and kidney morphological changes were monitored by routine measurement, biochemistry assay, PT-PCR analysis, ultrastructural and pathological observations, respectively. Compared with the diabetic nephropathy rats, AT elevated the body weight of diabetic nephropathy rats (P<0.01), effectively reduced the blood glucose level (P<0.01), increased the levels of insulin and high-density lipoprotein cholesterol (HDL-C) in plasma (P<0.01), and decreased the 24 h urine protein content and serum concentrations of low-density lipoprotein cholesterol (LDL-C) (P<0.01). Meanwhile, increase in kidney tissue, the intrarenal activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were enhanced, while the malonaldehyde (MDA) content was reduced (P<0.01). In addition, the expression of transforming growth factor beta 1 (TGF-β1) mRNA in kidney tissue was notably down-regulated (P<0.01). Furthermore, AT contributed to alleviating STZ-induced nephritic damages in rats. These results demonstrate that atorvastatin exerts the effective protective role against kidney injuries of STZ-induced diabetic nephropathy rat, which the underlying mechanisms are associated with ameliorating glyco, lipometabolism, enhancing antioxidant ability, and mitigating renal damage.
Collapse
|