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Steiman De Visser H, Fast I, Brunton N, Arevalo E, Askin N, Rabbani R, Abou-Setta AM, McGavock J. Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes: A Systemic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e240235. [PMID: 38393727 PMCID: PMC10891480 DOI: 10.1001/jamanetworkopen.2024.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/22/2023] [Indexed: 02/25/2024] Open
Abstract
Importance It is unclear whether cardiorespiratory fitness (CRF) and physical activity are lower among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with youths without diabetes. Objective To describe the magnitude, precision, and constancy of the differences in CRF and physical activity among youths with and without diabetes. Data Sources MEDLINE, Embase, CINAHL, and SPORTDiscus were searched from January 1, 2000, to May 1, 2022, for eligible studies. Study Selection Observational studies with measures of CRF and physical activity in children and adolescents aged 18 years or younger with T1D or T2D and a control group were included. Data Extraction and Synthesis Data extraction was completed by 2 independent reviewers. A random-effects meta-analysis model was used to estimate differences in main outcomes. The pooled effect estimate was measured as standardized mean differences (SMDs) with 95% CIs. The Preferred Reporting Items for Systematic Review and Meta-Analyses guideline was followed. Main Outcomes and Measures The main outcomes were objectively measured CRF obtained from a graded maximal exercise test and subjective or objective measures of physical activity. Subgroup analyses were performed for weight status and measurement type for outcome measures. Results Of 7857 unique citations retrieved, 9 studies (755 participants) with measures of CRF and 9 studies (1233 participants) with measures of physical activity for youths with T2D were included; for youths with T1D, 23 studies with measures of CRF (2082 participants) and 36 studies with measures of PA (12 196 participants) were included. Random-effects models revealed that directly measured CRF was lower in youths with T2D (SMD, -1.06; 95% CI, -1.57 to -0.56; I2 = 84%; 9 studies; 755 participants) and in youths with T1D (SMD, -0.39; 95% CI, -0.70 to -0.09; I2 = 89%; 22 studies; 2082 participants) compared with controls. Random-effects models revealed that daily physical activity was marginally lower in youths with T1D (SMD, -0.29; 95% CI, -0.46 to -0.11; I2 = 89%; 31 studies; 12 196 participants) but not different among youths with T2D (SMD, -0.56; 95% CI, -1.28 to 0.16; I2 = 91%; 9 studies; 1233 participants) compared with controls. When analyses were restricted to studies with objective measures, physical activity was significantly lower in youths with T2D (SMD, -0.71; 95% CI, -1.36 to -0.05; I2 = 23%; 3 studies; 332 participants) and T1D (SMD, -0.67; 95% CI, -1.17 to -0.17; I2 = 93%; 12 studies; 1357 participants) compared with controls. Conclusions and Relevance These findings suggest that deficits in CRF may be larger and more consistent in youths with T2D compared with youths with T1D, suggesting an increased risk for cardiovascular disease-related morbidity in adolescents with diabetes, particularly among those with T2D. The findings reinforce calls for novel interventions to empower youths living with diabetes to engage in regular physical activity and increase their CRF.
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Affiliation(s)
| | - Isaak Fast
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Brunton
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Arevalo
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John MacLean Library, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, Manitoba, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
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2
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Li Y, Fujii M, Ohno Y, Ikeda A, Godai K, Nakamura Y, Akagi Y, Yabe D, Tsushita K, Kashihara N, Kamide K, Kabayama M. Lifestyle factors associated with a rapid decline in the estimated glomerular filtration rate over two years in older adults with type 2 diabetes-Evidence from a large national database in Japan. PLoS One 2023; 18:e0295235. [PMID: 38091297 PMCID: PMC10718407 DOI: 10.1371/journal.pone.0295235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40-74 years with treated and untreated type 2 diabetes. METHODS AND RESULTS This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40-74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR >85 mL/min/1.73 m2 or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40-59 and 60-74 years) and baseline eGFR levels (60-85, 30-59, and <30 mL/min/1.73 m2). Covariates included sex, a history of heart disease, a history of stroke, a history of renal failure, anemia, low-density lipoprotein, systolic blood pressure, hemoglobin A1C, body mass index, antidiabetic medications, antihypertension drugs, lipid-lowering drugs, the oral adsorbent Kremezin, non-steroidal anti-inflammatory drugs, and drugs for the treatment of renal anemia. A rapid decline in eGFR was detected in approximately 1.3% of participants (7,683 cases). In the baseline eGFR >30 subgroups (60-85 or 30-59 mL/min/1.73 m2), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60-74 age group and non-refreshing sleep in the 40-59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60-74 age group regardless of baseline eGFR levels. In the baseline eGFR <30 mL/min/1.73 m2 subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR. CONCLUSIONS We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease.
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Affiliation(s)
- Yaya Li
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Makoto Fujii
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuko Ohno
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Asuka Ikeda
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kayo Godai
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuko Nakamura
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuya Akagi
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuyo Tsushita
- Graduate Schools of Nutrition Sciences, Kagawa Nutrition University, Saitama, Sakado, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Kei Kamide
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mai Kabayama
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
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3
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Huerta-Uribe N, Andrés Hormazábal-Aguayo I, Izquierdo M, García-Hermoso A. Youth with type 1 diabetes mellitus are more inactive and sedentary than apparently healthy peers: a systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 200:110697. [PMID: 37169308 DOI: 10.1016/j.diabres.2023.110697] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
AIMS To conduct a meta-analysis of differences in physical activity, sedentary behaviour, and physical fitness between children and adolescents with type 1 diabetes and their healthy peers. METHODS The databases EMBASE, PubMed and SportsDiscus were searched for studies. Pooled effects were calculated using random effects inverse-variance models with the Hartung-Knapp-Sidik-Jonkman adjustment. RESULTS Thirty-five studies were included, comprising a total of 4,751 youths (53% girls) of which 2,452 with type 1 diabetes. Youth with type 1 diabetes were less physically active (Coheńs d=-0.23, 95%CI -0.42 to -0.04), more sedentary (Coheńs d=0.33, 95%CI 0.06 to 0.61), and had lower cardiorespiratory fitness (Coheńs d=-0.52, 95%CI -0.73 to -0.31) than their healthy peers. This corresponds to -12.72 min/day of moderate-to-vigorous physical activity, 63.3 min/day of sedentary time (accelerometry) and -4.07 ml/kg/min of maximum/peak oxygen consumption. In addition, young people with type 1 diabetes were less likely to meet the international physical activity recommendations than their healthy peers (odds ratio=0.44, 95%CI 0.31 to 0.62). CONCLUSIONS Keeping in mind the heterogeneity between studies in the design, population and assessment, our findings show that children and adolescents with type 1 diabetes seem to be less active, more sedentary, and have lower cardiorespiratory fitness levels than their healthy peers.
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Affiliation(s)
- Nidia Huerta-Uribe
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA
| | | | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA.
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4
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Association of HbA1c with VO 2max in Individuals with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Metabolites 2022; 12:metabo12111017. [PMID: 36355100 PMCID: PMC9697838 DOI: 10.3390/metabo12111017] [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: 09/17/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to evaluate the association between glycemic control (HbA1c) and functional capacity (VO2max) in individuals with type 1 diabetes (T1DM). A systematic literature search was conducted in EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ISI Web of Knowledge for publications from January 1950 until July 2020. Randomized and observational controlled trials with a minimum number of three participants were included if cardio-pulmonary exercise tests to determine VO2max and HbA1c measurement has been performed. Pooled mean values were estimated for VO2max and HbA1c and weighted Pearson correlation and meta-regression were performed to assess the association between these parameters. We included 187 studies with a total of 3278 individuals with T1DM. The pooled mean HbA1c value was 8.1% (95%CI; 7.9−8.3%), and relative VO2max was 38.5 mL/min/kg (37.3−39.6). The pooled mean VO2max was significantly lower (36.9 vs. 40.7, p = 0.001) in studies reporting a mean HbA1c > 7.5% compared to studies with a mean HbA1c ≤ 7.5%. Weighted Pearson correlation coefficient was r = −0.19 (p < 0.001) between VO2max and HbA1c. Meta-regression adjusted for age and sex showed a significant decrease of −0.94 mL/min/kg in VO2max per HbA1c increase of 1% (p = 0.024). In conclusion, we were able to determine a statistically significant correlation between HbA1c and VO2max in individuals with T1DM. However, as the correlation was only weak, the association of HbA1c and VO2max might not be of clinical relevance in individuals with T1DM.
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Redel JM, DiFrancesco M, Lee GR, Ziv A, Dolan LM, Brady CC, Shah AS. Cerebral blood flow is lower in youth with type 2 diabetes compared to obese controls: A pilot study. Pediatr Diabetes 2022; 23:291-300. [PMID: 35001473 DOI: 10.1111/pedi.13313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
AIM The cerebral vasculature may be susceptible to the adverse effects of type 2 diabetes. In this pilot study, we compared cerebral blood flow (CBF) in youth with type 2 diabetes to obese, euglycemic controls, and explored the association between CBF and a non-invasive measure of atherosclerosis, carotid intima-medial thickness (IMT). METHODS Global and regional CBF were compared between youth with type 2 diabetes (mean age 16.7 ± 2.0 years, n = 20) and age, race, and sex similar obese youth without diabetes (17.4 ± 1.9 years, n = 19) using arterial spin labeling magnetic resonance imaging. Mean CBF values were compared between groups. Voxel-wise results were evaluated for statistical significance (p < 0.05) after adjustment for multiple comparisons. Carotid IMT in the type 2 diabetes group was correlated with CBF. RESULTS Compared to obese controls, the type 2 diabetes group had significantly lower global CBF (49.7 ± 7.2 vs. 63.8 ± 11.5 ml/gm/min, p < 0.001). Significantly lower CBF was observed in multiple brain regions for the type 2 diabetes group, while no regions with higher CBF were identified. In the type 2 diabetes group, carotid IMT was inversely correlated with CBF, both globally (r = -0.70, p = 0.002) and in regional clusters. CONCLUSIONS In this pilot study, lower CBF was seen in youth with type 2 diabetes compared to youth with obesity and IMT was inversely correlated with CBF. Cerebrovascular impairment may be present in youth with type 2 diabetes. These findings could represent a mechanistic link to explain previously reported brain volume and neurocognitive differences.
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Affiliation(s)
- Jacob M Redel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Endocrinology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Mark DiFrancesco
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gregory R Lee
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adi Ziv
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Adolescent Medicine Unit, Department of Day Care Hospitalization, Schneider Children's Hospital Medical Center of Israel, Petah Tikva, Israel
| | - Lawrence M Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cassandra C Brady
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Division of Endocrinology and Diabetes, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Amy S Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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6
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Elbarbary NS, Ismail EAR, Ghallab MA. Effect of metformin as an add-on therapy on neuregulin-4 levels and vascular-related complications in adolescents with type 1 diabetes: A randomized controlled trial. Diabetes Res Clin Pract 2022; 186:109857. [PMID: 35351535 DOI: 10.1016/j.diabres.2022.109857] [Citation(s) in RCA: 1] [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: 01/06/2022] [Revised: 03/06/2022] [Accepted: 03/24/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inflammation is closely associated with atherosclerosis and plays a crucial role in the development of cardiovascular disease. Metformin sensitizes body cells to insulin, which may cause a reduction of atherogenic lipid fractions. Low neuregulin-4 (Nrg-4) levels, an adipokine, are linked to obesity, insulin resistance, impaired glucose tolerance and type 2 diabetes. OBJECTIVES We assessed the effect of oral supplementation with metformin on glycemic control, neuregulin-4 levels and carotid intima media thickness (CIMT) as a marker for subclinical atherosclerosis in adolescents with type 1 diabetes mellitus (T1DM) and microvascular complications. METHODS This randomized placebo-controlled trial included 80 type 1 diabetic patients with microvascular complications who were randomly divided to receive either 24 weeks of metformin 500 mg/day or matching placebo. Fasting blood glucose (FBG), HbA1c, C-reactive protein (CRP), urinary albumin creatinine ratio (UACR), lipid profile, Nrg-4 and CIMT were assessed at baseline and study end. RESULTS Both groups were well-matched as regards baseline clinical and laboratory data (p greater than 0.05). After 24-weeks, metformin therapy for the intervention group resulted in a significant decrease of HbA1c, CRP, UACR, total cholesterol and CIMT while Nrg-4 levels were increased compared with baseline levels (p < 0.001) and with placebo group(p < 0.001). Baseline Nrg-4 levels were negatively correlated to FBG, HbA1c, total cholesterol, CRP and CIMT. Metformin was well-tolerated. CONCLUSIONS Oral metformin supplementation once daily for 24 weeks as an adjuvant therapy to intensive insulin in pediatric T1DM was safe and effective in improving glycemic control, dyslipidemia and Nrg-4 levels; hence, it decreased inflammation, microvascular complications and subclinical atherosclerosis.
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Smigoc Schweiger D, Battelino T, Groselj U. Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes. Int J Mol Sci 2021; 22:ijms221910192. [PMID: 34638531 PMCID: PMC8508122 DOI: 10.3390/ijms221910192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.
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Affiliation(s)
- Darja Smigoc Schweiger
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Urh Groselj
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
- Department of Cardiovascular Medicine, School of Medicine, Stanford University, 870 Quarry Road, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +386-1-522-9235; Fax: +386-1-232-0190
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8
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Shah AS, Jaiswal M, Dabelea D, Divers J, Isom S, Liese AD, Lawrence JM, Kim G, Urbina EM. Cardiovascular risk and heart rate variability in young adults with type 2 diabetes and arterial stiffness: The SEARCH for Diabetes in Youth Study. J Diabetes Complications 2020; 34:107676. [PMID: 32713707 PMCID: PMC7502460 DOI: 10.1016/j.jdiacomp.2020.107676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate cardiovascular risk factors and heart rate variability (HRV) in young adults with type 2 diabetes and arterial stiffness and to explore the relationship between HRV and arterial stiffness. METHODS We studied 185 young adults with youth-onset T2D enrolled in the SEARCH for Diabetes in Youth Study. Cardiovascular risk factors and HRV were compared between individuals with and without type 2 diabetes and arterial stiffness (defined as a pulse wave velocity greater than the 90th percentile of healthy controls, >6.767 m/s). Semiparametric regression evaluated the independent relationship between HRV and PWV. RESULTS Participants with T2D and arterial stiffness were more likely to be older, non-Hispanic Black, have higher systolic and diastolic blood pressure, greater adiposity and obesity-related dyslipidemia (higher triglycerides and lower HDLC). Participants with T2D and arterial stiffness also had lower overall HRV (lower SDNN) with parasympathetic loss (lower RMSSD and PNN50), p < 0.05. Lower HRV tended to be but was not significantly associated with arterial stiffness after adjustment for age, race/ethnicity, sex and cardiovascular risk factors (beta coefficient = -1.11, p = 0.08). CONCLUSIONS Youth with T2D and arterial stiffness have a worse cardiovascular risk profile, specifically risk factors related to the metabolic syndrome and lower HRV.
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Affiliation(s)
- Amy Sanghavi Shah
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati, United States of America.
| | - Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Jasmin Divers
- Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY, United States of America
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Grace Kim
- Seattle Children's Hospital, Seattle, WA, United States of America
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati, United States of America
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9
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Abstract
The purpose of this review is to provide an update on the changing face of paediatric type 1 diabetes and type 2 diabetes. Paediatric diabetes is on the rise, with extensive research dedicated to understanding its pathophysiology, comorbidities and complications. As obesity continues to increase among all youth, differentiating between type 1 diabetes and type 2 diabetes has become increasingly difficult but remains important for optimising treatment, anticipating complications and predicting disease risk. Novel treatments are emerging, with the ultimate goal being to achieve glycaemic control, limit weight gain, improve quality of life and reduce comorbidities. In this review, we focus on updates regarding the epidemiology, clinical presentation, comorbidities and complications of paediatric type 1 diabetes and type 2 diabetes and conclude with current and emerging treatments.
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Affiliation(s)
- Amy S Shah
- University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA.
- Cincinnati Children's Hospital Medical Center, Division of Endocrinology, 3333 Burnet Ave, ML 7012, Cincinnati, OH, 45229, USA.
| | - Kristen J Nadeau
- University of Denver, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Division of Endocrinology, Aurora, CO, USA
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10
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A Quality Initiative Reducing Adverse Outcomes in Pediatric Patients with DKA During Intrafacility Transit. Pediatr Qual Saf 2019; 4:e194. [PMID: 31572895 PMCID: PMC6708647 DOI: 10.1097/pq9.0000000000000194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 06/18/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Treatment of diabetic ketoacidosis (DKA) requires close and timely monitoring to prevent serious adverse events. This quality improvement project details how our institution improved blood glucose monitoring around hospital admission. The project aimed to increase the blood glucose assessments for children with DKA receiving insulin in the emergency department (ED) within 30 minutes before transitioning to an inpatient unit. Methods We implemented a series of Plan-Do-Survey-Act (PDSA) cycles established by a multidisciplinary team for this project, with the primary outcome of obtaining the blood glucose level within 30 minutes before leaving the ED and secondarily preventing episodes of hypoglycemia. These PDSAs harnessed the electronic health record, to prompt and direct the medical staff, to improve blood glucose monitoring. Results From March 2015 to November 2017, we saw 640 patients in our ED for DKA. Of these, we admitted 629 to the inpatient unit with treatment that included continuous infusion of insulin. Over this period, we increased blood glucose monitoring for these patients within 30 minutes before the transition from 56% to >90%. Following the final PDSA cycle, we observed no reported episodes of hypoglycemia. Conclusion Using the functionality of the electronic health record, we showed significant, rapid, and sustained increases in compliance with the International Society for Pediatric and Adolescent Diabetes guideline by alerting ED staff caring for patients receiving continuous insulin around the time of care-team transitions. We believe that this program is easily replicable, cost-effective, and safety enhancing.
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11
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Bjornstad P, Donaghue KC, Maahs DM. Macrovascular disease and risk factors in youth with type 1 diabetes: time to be more attentive to treatment? Lancet Diabetes Endocrinol 2018; 6:809-820. [PMID: 29475800 PMCID: PMC6102087 DOI: 10.1016/s2213-8587(18)30035-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 02/08/2023]
Abstract
Cardiovascular disease remains the leading cause of mortality in patients with type 1 diabetes. Although cardiovascular disease complications are rare until adulthood, pathology and early markers can manifest in adolescence. Whereas advances have been made in the management of microvascular complications of type 1 diabetes, similar progress in reducing macrovascular complications has not been made. The reasons for the absence of progress remain incompletely understood, but most likely relate to the long time needed for cardiovascular disease to manifest clinically and hence for risk factor management to show a clinical benefit, thus allowing inertia to prevail for diagnosis and particularly for targeting risk factors. In this Review, we summarise paediatric data on traditional and novel risk factors of cardiovascular disease, provide an overview of data from previous and current clinical trials, discuss future directions in cardiovascular disease research for paediatric patients with type 1 diabetes, and advocate for the early identification and treatment of cardiovascular disease risk factors as recommended in multiple guidelines.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO, USA.
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, NSW, Australia
| | - David M Maahs
- Department of Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, CA, USA
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Cummings LA, Clarke A, Sochett E, Daneman D, Cherney DZ, Reich HN, Scholey JW, Dunger DB, Mahmud FH. Social Determinants of Health Are Associated with Markers of Renal Injury in Adolescents with Type 1 Diabetes. J Pediatr 2018; 198:247-253.e1. [PMID: 29752172 PMCID: PMC6016557 DOI: 10.1016/j.jpeds.2018.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/26/2018] [Accepted: 03/14/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes (T1D). STUDY DESIGN Renal outcomes included estimated glomerular filtration rate (eGFR) and albumin-creatinine excretion ratio (ACR). Differences in urinary and serum inflammatory markers also were assessed in relation to social determinants of health. Regression analysis was used to evaluate the association between the Ontario Marginalization Index (ON-Marg) as a measure of the social determinants of health, patient characteristics, ACR, eGFR, and renal filtration status (hyperfiltration vs normofiltration). RESULTS Participants with T1D (n = 199) with a mean age of 14.4 ± 1.7 years and diabetes duration of 7.2 ± 3.1 years were studied. Mean eGFR was 122.0 ± 19.4 mL/min/1.73 m2. Increasing marginalization was positively associated with eGFR (P < .0001) but not with ACR (P = .605). Greater marginalization was associated with greater median levels of urinary interleukin (IL)-2, IL-12 (p40), macrophage-derived chemokine, monocyte chemoattractant protein-3, and tumor necrosis factor-β and serum IL-2. ON-Marg was significantly associated with eGFR after we controlled for age, sex, body mass index z score, ethnicity, serum glucose, and hemoglobin A1c in linear regression. A similar association between hyperfiltration and ON-Marg score was observed in multivariable logistic regression. CONCLUSION Increasing marginalization is significantly associated with both eGFR and hyperfiltration in adolescents with T1D and is associated with significant changes in urinary inflammatory biomarkers. These findings highlight a potentially important interaction between social and biological determinants of health in adolescents with T1D.
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Affiliation(s)
- Laura A.M. Cummings
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Clarke
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Etienne Sochett
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Z. Cherney
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Heather N. Reich
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - James W. Scholey
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David B. Dunger
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Farid H. Mahmud
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada,Reprint requests: Farid H. Mahmud, MD, Division of Pediatric Endocrinology, Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
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Bjornstad P, Cree-Green M, Baumgartner A, Coe G, Reyes YG, Schäfer M, Pyle L, Regensteiner JG, Reusch JE, Nadeau KJ. Achieving ADA/ISPAD clinical guideline goals is associated with higher insulin sensitivity and cardiopulmonary fitness in adolescents with type 1 diabetes: Results from RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) and Effects of MEtformin on CardiovasculaR Function in AdoLescents with Type 1 Diabetes (EMERALD) Studies. Pediatr Diabetes 2018; 19:436-442. [PMID: 29082640 PMCID: PMC5918223 DOI: 10.1111/pedi.12598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/23/2017] [Accepted: 09/22/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Most youth with type 1 diabetes do not meet the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) targets for hemoglobin A1c (HbA1c), blood pressure (BP), lipids, and body mass index (BMI). We hypothesized that ISPAD/ADA goal achievement would be associated with better insulin sensitivity (IS) and cardiopulmonary fitness. METHODS IS was quantified as glucose infusion rate (GIR) from a hyperinsulinemic-euglycemic clamp in youth with type 1 diabetes from the RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) (n = 86) and Effects of MEtformin on CardiovasculaR Function in AdoLescents with Type 1 Diabetes (EMERALD) (n = 41) cohorts (n = 127; age 15.7 ± 2.2 years, 52% girls). Cardiopulmonary fitness was measured as peak oxygen consumption (VO2 peak/kg) during upright (RESISTANT) or supine (EMERALD) cycle ergometry and were stratified by cycle type. Goal achievement was defined as HbA1c < 7.5%, BP < 90th percentile, LDL-cholesterol < 100 mg/dL, HDL-cholesterol > 35 mg/dL, triglycerides < 150 mg/dL and BMI < 85th percentile. Participants were stratified into 3 groups: achieving 0-3 goals (n = 52), 4 goals (n = 48), and 5-6 goals (n = 27). Differences between groups were examined with generalized linear models. RESULTS IS was lower in youth who met 0-3 goals (5.2 ± 3.4 mg/kg/min) vs those who met 4 goals (7.4 ± 4.1 mg/kg/min, P = .04) and those who met 5-6 goals (8.5 ± 4.3 mg/kg/min, P = .003), and remained significant after adjustments for sex and diabetes duration. Upright VO2 peak was lower in youth who met 0-3 goals (25.8 ± 4.6 mL/kg/min) vs those who met 4 goals (33.0 ± 7.8 mL/kg/min, P = .01) and those who met 5-6 goals (33.2 ± 4.4 mL/kg/min, P = .004). Similar and significant relationships were observed in EMERALD participants for supine VO2 peak. CONCLUSIONS ADA/ISPAD goal achievement was associated with greater IS and cardiopulmonary fitness.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States,Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
| | - Melanie Cree-Green
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Amy Baumgartner
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Gregory Coe
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Yesenia Garcia Reyes
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Michal Schäfer
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Laura Pyle
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, United States
| | - Judith G. Regensteiner
- Center for Women’s Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States,Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Jane E.B. Reusch
- Center for Women’s Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States,Division of Endocrinology, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Kristen J. Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, United States,Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
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Predictors of improvements in exercise capacity during cardiac rehabilitation in the recovery phase after coronary artery bypass graft surgery versus acute myocardial infarction. Heart Vessels 2017; 33:358-366. [DOI: 10.1007/s00380-017-1076-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
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Suh JS, Kim SH, Cho KS, Jung IA, Cho WK, Jeon YJ, Jung MH, Suh BK. Urinary markers in the early stage of nephropathy in patients with childhood-onset type 1 diabetes. Pediatr Nephrol 2016; 31:623-31. [PMID: 26525196 DOI: 10.1007/s00467-015-3253-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the association of a urinary tubular marker, liver-type fatty acid binding protein (L-FABP) and an inflammatory marker, serum/urinary YKL-40, with albuminuria in patients with childhood-onset type 1 diabetes (T1D). METHODS Twenty-nine patients with childhood-onset T1D and 32 controls were enrolled. Serum and urinary concentrations of YKL-40 and urinary concentrations of L-FABP were measured. RESULTS The serum levels of YKL-40 were not significantly different between the control group and the patient groups. However, the levels of urinary YKL-40/creatinine (Cr) were higher in the patients, even those with normoalbuminuria than in the controls (p < 0.001). The levels of urinary L-FABP/Cr were not different between the control group and the patient groups. However, the level of urinary L-FABP/Cr in the microalbuminuria group was higher than that in the normoalbuminuria group (p = 0.03). There were no associations between the levels of urinary albumin-to-creatinine ratio and urinary L-FABP/Cr or YKL-40/Cr. However, the urinary L-FABP/Cr level was significantly correlated with the hemoglobin A1C level (p = 0.005) and the urinary YKL-40/Cr level (p = 0.043). CONCLUSIONS Urinary L-FABP/Cr and YKL-40/Cr may reflect renal injury in early stages of nephropathy in patients with childhood-onset T1D, even in the normoalbuminuric state.
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Affiliation(s)
- Jin-Soon Suh
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Shin-Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyoung Soon Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In-Ah Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Won Kyoung Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon Jin Jeon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Min Ho Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Byoung Kyu Suh
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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