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Sridhar VS, Limonte CP, Groop PH, Heerspink HJL, Pratley RE, Rossing P, Skyler JS, Cherney DZI. Chronic kidney disease in type 1 diabetes: translation of novel type 2 diabetes therapeutics to individuals with type 1 diabetes. Diabetologia 2024; 67:3-18. [PMID: 37801140 DOI: 10.1007/s00125-023-06015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/21/2023] [Indexed: 10/07/2023]
Abstract
Current management of chronic kidney disease (CKD) in type 1 diabetes centres on glycaemic control, renin-angiotensin system inhibition and optimisation of risk factors including blood pressure, lipids and body weight. While these therapeutic approaches have significantly improved outcomes among people with type 1 diabetes and CKD, this population remains at substantial elevated risk for adverse kidney and cardiovascular events, with limited improvements over the last few decades. The significant burden of CKD and CVD in type 1 diabetes populations highlights the need to identify novel therapies with the potential for heart and kidney protection. Over the last decade, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists have emerged as potent kidney-protective and/or cardioprotective agents in type 2 diabetes. The consistent, substantial kidney and cardiovascular benefits of these agents has led to their incorporation into professional guidelines as foundational care for type 2 diabetes. Furthermore, introduction of these agents into clinical practice has been accompanied by a shift in the focus of diabetes care from a 'glucose-centric' to a 'cardiorenal risk-centric' approach. In this review, we evaluate the potential translation of novel type 2 diabetes therapeutics to individuals with type 1 diabetes with the lens of preventing the development and progression of CKD.
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Affiliation(s)
- Vikas S Sridhar
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Christine P Limonte
- Division of Nephrology, University of Washington, Seattle, WA, USA
- Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- The George Institute for Global Health, Sydney, Australia
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jay S Skyler
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David Z I Cherney
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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Pappa A, Haeusler MG, Tittel SR, Boettcher C, Hilgard D, Knauer-Fischer S, Pavel M, Woelfle J, Holl RW. Neuropathy in paediatric type 1 diabetes mellitus - clinical characterization and analysis of risk factors in the diabetes prospective follow-up registry DPV (Diabetes-Patienten-Verlaufsdokumentation)-registry. J Pediatr Endocrinol Metab 2023; 0:jpem-2023-0074. [PMID: 37307302 DOI: 10.1515/jpem-2023-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Data on the prevalence, clinical features and risk factors associated with paediatric diabetic neuropathy (DN) are scarce. METHODS We retrospectively analysed data from the DPV registry, including patients under 20 years of age, treated for type 1 diabetes mellitus (T1D) between 2005 and 2021. Patients with non-diabetic neuropathy were excluded. Data came from centres in Austria, Germany, Luxembourg and Switzerland. RESULTS 1,121 of the 84,390 patients included had been diagnosed with DN. Univariate analysis showed patients with DN to be older and predominantly female, with a longer duration of T1D, higher insulin dosages per kg and day, lower rates of insulin pump therapy, higher postprandial glucose-, higher HbA1c-and higher cholesterol levels, and higher diastolic and systolic blood pressure values. There was also a larger proportion of smokers and higher prevalence of diabetic retinopathy. Median duration of diabetes at diagnosis of DN was 8.3 years. Multivariable analysis, adjusted for demographics revealed an increased risk for DN among female patients and those who were older, underweight (BMI-SDS), smoked cigarettes or had a longer duration of T1D or higher levels of HbA1c and postprandial blood glucose. The presence of retinopathy and higher cholesterol levels were also linked to increased risk while not-using insulin pump therapy was not. CONCLUSIONS DN can develop after just a short duration of T1D. Prevention may be achieved by a lowering of HbA1c-and postprandial glucose levels through improved glycaemic control. This warrants further investigation. The slight female predominance suggests further hormonal and genetic etiological factors.
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Affiliation(s)
- Angeliki Pappa
- Department of Paediatrics, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin G Haeusler
- Department of Paediatrics, Division of Neuropediatrics and Social Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Claudia Boettcher
- Paediatric Endocrinology & Diabetology, University Children's Hospital, University of Berne, Berne, Switzerland
| | - Doerte Hilgard
- Kinder-und Jugenddiabetologische Praxis Witten, Herdecke, Germany
| | - Sabine Knauer-Fischer
- Klinik für Kinder-und Jugendmedizin, Universitätsmedizin Mannheim, Mannheim, Baden-Württemberg
| | - Marianne Pavel
- Medizinische Klinik 1, UK Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Kinderklinik Universitätsklinikum Erlangen, Erlangen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
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Gurbuz P, Duzova H, Taslidere AC, Gul CC. Effects of noopept on ocular, pancreatic and renal histopathology in streptozotocin induced prepubertal diabetic rats. Biotech Histochem 2023:1-12. [PMID: 36946173 DOI: 10.1080/10520295.2023.2187460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic disease at all ages including childhood and puberty. Failure to treat DM can cause retinopathy, nephropathy and neuropathy. Endocrine and metabolic changes during the pubertal period complicate management of DM. Noopept is a cognitive enhancer that exhibits antidiabetic properties. We investigated the effect of noopept on the histopathology of the cornea, retina, kidney and pancreas in pubertal diabetic rats. We allocated 60 prepubertal male rats randomly into six groups of 10: untreated control (C), DM control (DC), noopept control (NC), DM + noopept (D + N), DM + insulin (D + I) and DM + insulin + noopept (D + I + N). DM was induced by streptozotocin in the DC, D + N, D + I and D + I + N groups. Noopept was administered to the NC, D + N and D + I + N groups; insulin was administered to the D + I and D + I + N groups for 14 days. On day 18 of the experiment, animals were sacrificed and eyes, kidneys and pancreata were excised for histological investigation. Renal tubule diameter and corneal and retinal thickness were increased significantly in DC groups compared to the control group. The D + I, D + N and D + I + N groups exhibited fewer DM induced pathological changes than the DC group. The D + I + N group exhibited no significant differences in renal tubule diameter and corneal and retinal thickness compared to the DC group. Our findings suggest that noopept is protective against DM end organ complications in streptozotocin induced diabetic pubertal rats.
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Affiliation(s)
- Perihan Gurbuz
- Vocational School of Health Services, Inonu University, Malatya, Turkey
| | - Halil Duzova
- Physiology Department, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Asli Cetin Taslidere
- Histology and Embryology Department, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemile Ceren Gul
- Histology and Embryology Department, Inonu University Faculty of Medicine, Malatya, Turkey
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Dahl AR, M. SJ, Pittock SJ, Pittock ST. Clinical Utility and Outcome Prediction of Early ZnT8-IgG Testing and Titer in Type 1 Diabetes. J Clin Res Pediatr Endocrinol 2023; 15:35-41. [PMID: 35984226 PMCID: PMC9976167 DOI: 10.4274/jcrpe.galenos.2022.2022-4-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Type 1 diabetes autoantibodies are directed against multiple antigens including: glutamic acid decarboxylase, protein tyrosine phosphatase-like islet antigen 2 (IA2), insulin (IAA), and Zinc transporter 8 protein (ZnT8). The aim of our study was to determine if the presence or titer of ZnT8 antibodies (Ab) was predictive for clinical presentation at diagnosis or for the subsequent disease course. METHODS Between January, 2003 and May, 2019, 105 patients aged ≤21 years with a clinical diagnosis of type 1 diabetes mellitus had at least 1 autoantibody measured. A retrospective chart review was completed. At diagnosis, we evaluated the body mass index z-score, hemoglobin (HbA1c), and the presence of diabetic ketoacidosis (DKA). Complications analyzed post-diagnosis included episodes of DKA, the diagnosis of autoimmune disease, and the presence of vascular complications. We evaluated cumulative lifetime excess glucose as HbA1c area under the curve (AUC) >6%. RESULTS Seventy-one patients were ZnT8-Ab(+) (68%), with 19 having low titer ZnT8-Ab and 52 with high titer ZnT8-Ab. Follow-up ranged from 10 days to 15.7 years (median 2.08 years). There were no differences in the characteristics at disease onset or in the subsequent follow-up between those with and those without ZnT8-Ab or those with high or low titers of ZnT8 Ab, except for a small but statistically significant difference in cumulative excess glucose (HbA1c AUC >6%) between those with low and high titers (p=0.0095). CONCLUSION Our study adds to the limited literature on the effect of the presence and titer of ZnT8-Ab in pediatric diabetes. The small effect of ZnT8-Ab titer on glucose excess as measured by HbA1c AUC warrants further study.
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Affiliation(s)
- Amanda R. Dahl
- Mayo Clinic, Department of Pediatric Endocrinology, Minnesota, USA
| | | | | | - Siobhan T. Pittock
- Mayo Clinic, Department of Pediatric Endocrinology, Minnesota, USA,* Address for Correspondence: Mayo Clinic, Department of Pediatric Endocrinology, Minnesota, USA E-mail:
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Yang H, Hu Y, Yin X, Huang J, Qiao C, Hu Z, He C, Huo D, Hou C. A disposable and sensitive non-enzymatic glucose sensor based on a 3D-Mn-doped NiO nanoflower-modified flexible electrode. Analyst 2023; 148:153-162. [DOI: 10.1039/d2an01495e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Herein, Mn-doped NiO nano-enzyme composites with high catalytic performance and excellent conductivity were grown on 3D CFC via hydrothermal and calcination methods to construct an efficient flexible glucose sensor.
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Affiliation(s)
- Huisi Yang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Yian Hu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Xinxue Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Jiaqing Huang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Cailin Qiao
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Zhikun Hu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Congjuan He
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Danqun Huo
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
- Chongqing Key Laboratory of Bio-perception & Intelligent Information Processing, School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, 400044, PR China
| | - Changjun Hou
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
- Liquor Making Biology Technology and Application of Key Laboratory of Sichuan Province, College of Bioengineering, Sichuan University of Science and Engineering, Zigong, 643000, PR China
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Temmen CD, Lu R, Gee BT, Chen Z, Nansel TR. Latent classifications of parental involvement in diabetes management for youth with type 1 diabetes: A randomized clinical trial. Pediatr Diabetes 2022; 23:1133-1142. [PMID: 36250647 PMCID: PMC11090373 DOI: 10.1111/pedi.13397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Understanding how parent-child relationships influence diabetes management in youth with type 1 diabetes is critical for minimizing the risk of short- and long-term complications. We examined how classes of diabetes-specific parenting behaviors are associated with disease management and well-being for youth with type 1 diabetes. RESEARCH DESIGN AND METHODS The Family Management of Diabetes clinical trial tested the efficacy of a 2-year behavioral intervention for families of youth with type 1 diabetes. Three hundred and ninety youth diagnosed with type 1 diabetes and their primary caregiver were recruited from four pediatric endocrinology centers in the US Classifications of parental involvement utilized baseline parent and youth reports of task involvement, collaborative involvement, and parent-youth conflict. Class differences in baseline glycemic control (HbA1c), regimen adherence, general and diabetes quality of life, and depressive symptoms, and 2-year change in HbA1c were examined. RESULTS Latent profile analysis identified three classes: (1) high in task and collaborative involvement, low in conflict (Harmonious), (2) low in task involvement, collaborative involvement, and conflict (Indifferent), (3) high in task involvement and conflict, low in collaborative involvement (Inharmonious). The Harmonious group demonstrated the best adherence, glycemic control, and psychosocial well-being. The Inharmonious and Indifferent groups had similar diabetes management, but youth from Inharmonious families showed poorer psychosocial well-being. The intervention effect on glycemic control did not differ across the classes. CONCLUSIONS The interplay of parental involvement and conflict resulted in distinct parenting classes that differed in disease management and well-being. However, the classes benefitted similarly from the behavioral intervention.
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Affiliation(s)
- Chelsie D. Temmen
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
- Department of Counseling and Human Development, University of Louisville, Louisville, Kentucky, USA
| | - Ruijin Lu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Benjamin T. Gee
- Kaiser Permanente, SCPMG Riverside, Riverside, California, USA
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Tonja R. Nansel
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Mihoubi E, Amroun H, Bouldjennet F, Azzouz M, Touil-Boukoffa C, Raache R, Attal N. Polymorphismes 869C> T et 915 G>C du TGF-β dans la rétinopathie du diabète de type 1 chez la population algérienne. J Fr Ophtalmol 2022; 45:908-914. [DOI: 10.1016/j.jfo.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
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Shao Y, Wang M, Zhu Y, Li X, Liu J. Association of metformin treatment with enhanced effect of anti-VEGF agents in diabetic macular edema patients. Acta Diabetol 2022; 59:553-559. [PMID: 35034186 DOI: 10.1007/s00592-021-01833-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/25/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To investigate the effect of metformin combined with anti-VEGF agents in patients with diabetic macular edema (DME). METHODS This study was a prospective, nonrandomized case-control study. Patients were included in with a diagnosis of DME who received anti-VEGF agents injection. Basic information, medical history, best-corrected visual acuity (BCVA), central macular thickness (CMT), the number of intravitreal injections, panretinal photocoagulation (PRP), and macular grid photocoagulation treatment during the 6-month follow-up, were recorded for each patient. RESULTS A total of 50 DME patients were collected (24 patients with a history of oral metformin ≥ 6 months and 26 patients who had not taken metformin). The BCVA and the CMT were significantly improved after anti-VEGF treatment in two groups (F1 = 19.35, F2 = 26.78; F1 = 65.45, F2 = 76.23; P < 0.05). The BCVA in the metformin group was better than that in non-metformin group at every point after treatment (F = 34.45, P < 0.05). The CMT in metformin group decreased much more than that in non-metformin group during the follow-up period (F = 87.05, P < 0.05). The injection numbers decreased in the metformin group compared with the non-metformin group (t = 5.14, P < 0.05). However, there was no difference in PRP and macular grid photocoagulation therapy between the two groups during the 6-month follow-up. CONCLUSION Metformin can enhance the therapeutic effect of anti-VEGF agents on DME patients to improve their visual acuity, improve the structure of the macular area, and reduce the number of intravitreal injections 90.
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Affiliation(s)
- Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Manqiao Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yimeng Zhu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China.
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China.
- Eye Institute and School of Optometry, Tianjin, China.
- Tianjin Medical University Eye Hospital, Tianjin, China.
| | - Juping Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China.
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China.
- Eye Institute and School of Optometry, Tianjin, China.
- Tianjin Medical University Eye Hospital, Tianjin, China.
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Franceschi R, Mozzillo E, Di Candia F, Rosanio FM, Leonardi L, Liguori A, Micheli F, Cauvin V, Franzese A, Piona CA, Marcovecchio ML. A systematic review of the prevalence, risk factors and screening tools for autonomic and diabetic peripheral neuropathy in children, adolescents and young adults with type 1 diabetes. Acta Diabetol 2022; 59:293-308. [PMID: 35089443 DOI: 10.1007/s00592-022-01850-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/09/2022] [Indexed: 01/09/2023]
Abstract
AIMS We aimed to estimate the prevalence of Diabetic peripheral neuropathy (DPN) and Cardiac autonomic neuropathy (CAN) in youth with type 1 diabetes; identify key risk factors; identify the most useful tests for the diagnostic evaluation of DPN and CAN; identify key treatment options for DPN and CAN. METHODS A systematic search was performed including studies published in the last 15 years. PICO framework was used in the selection process and evidence was assessed using the GRADE system. RESULTS A total of 758 studies were identified and a final number of 49 studies were included in this systematic review. According to moderate-high level quality studies, the prevalence of probable DPN, ranged between 13.5 and 62%; subclinical DPN between 22 and 88%; confirmed DPN between 2.6 and 11%. The Michigan Neuropathy Screening Instrument was the tool with higher sensitivity and specificity for detecting DPN, which needs to be confirmed by nerve conduction velocity. The prevalence of CAN was 4-39%. Specific treatment options for DPN or CAN in patients younger than 25 years are not available. Key risk factors for DPN and CAN are hyperglycemia/HbA1c, age, diabetes duration, the presence of other microvascular complications, waist/height ratio, lipid profile and blood pressure. For CAN, additional risk factors were cigarette smoking, BMI and total daily insulin. CONCLUSIONS Prevalence of neuropathy in youth with type 1 diabetes varies depending on different screening methods and characteristics of the study populations. However, the assessed studies confirmed a relatively high prevalence of subclinical neuropathy, reiterating the importance of early identification of risk factors to prevent this complication.
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Affiliation(s)
- Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Francesca Di Candia
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Francesco Maria Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Letizia Leonardi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Alice Liguori
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Francesca Micheli
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Vittoria Cauvin
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Claudia Anita Piona
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Gynecology and Pediatrics, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Nadeem S, Siddiqi U, Martins RS, Badini K. Perceptions and Understanding of Diabetes Mellitus Technology in Adults with Type 1 or Type 2 DM: A Pilot Survey from Pakistan. J Diabetes Sci Technol 2021; 15:1052-1058. [PMID: 33957791 PMCID: PMC8442186 DOI: 10.1177/19322968211011199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Diabetes mellitus technology (DMT) is increasingly used for routine management in developed countries, yet its uptake in developing countries is not as consistent. Multiple factors may influence this, including country specific patient perception regarding DMT. We conducted a pilot study in Pakistan to understand this important question which has not been studied yet. METHODS A cross-sectional pilot study was conducted in Pakistan. An anonymous survey exploring perceptions of diabetes technology was circulated on social media platforms, collecting responses over 2 weeks. Target population included adults (≥18 years) living in Pakistan, with DM1 or 2. RESULTS A total of 40 responses were received. The majority (36/40) reported using conventional glucometers. Nine used continuous glucose monitoring (CGM). Thirty-two of 40 patients believed DMT improved diabetes care, 22 felt it helped decreased risk of Diabetes-related complications. 15/40 stated that DMT results in increased cost of care. Sixteen reported their diabetes care teams had never discussed wearable DMT options whereas 11 disliked them because they did not want a device on their self. CONCLUSION In our pilot study we have identified broad themes of opportunity and challenges to DMT use in Pakistan. Patients' perceptions regarding DMT were generally positive but significant barriers to its acceptance included high cost, lack of discussion between doctor and patient about available technology and personal hesitation. Limitations of our study include sampling bias (online survey) and small sample size, but this data can help inform larger studies, to look at this important topic in greater detail.
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Affiliation(s)
- Sarah Nadeem
- Department of Medicine, Section of
Endocrinology, Aga Khan University, Karachi, Pakistan
- Sarah Nadeem, MD, FACE, Internal Medicine
and Endocrinology, Department of Medicine, Aga Khan University, Stadium Rd,
Faculty Office Building, Karachi, 74800, Pakistan.
| | - Uswah Siddiqi
- Medical College, Aga Khan University,
Karachi, Pakistan
| | | | - Kaleemullah Badini
- Department of Medicine, Section of
Endocrinology, Aga Khan University, Karachi, Pakistan
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Noras K, Rusak E, Jarosz-Chobot P. The Problem of Abnormal Body Weight and Dyslipidemia as Risk Factors for Cardiovascular Diseases in Children and Adolescents with Type 1 Diabetes. J Diabetes Res 2021; 2021:5555149. [PMID: 34395631 PMCID: PMC8355997 DOI: 10.1155/2021/5555149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022] Open
Abstract
Diabetes is a disease that affects many people around the world. Its complications are the cause of cardiovascular diseases (CVD) and increased mortality. That is why the search for predictive biomarkers is so important. The aim of the study was to show the prevalence of the problem and risk factors in children and adolescents with type 1 diabetes. These patients are often overweight and obese, and the percentage of lipid disorders is particularly high. The discussed markers of CVD risk in type 1 diabetes include apolipoproteins (apo-B and apo-C3), modified forms of LDL, and the role of high-density lipoprotein (HDL). Recently, a new look at the vasoprotective effect of HDL has appeared, which due to its dysfunctional form in type 1 diabetes may not protect against cardiovascular risk. The HDL proteome in type 1 diabetes has an altered protein composition compared to the healthy population. Another direction of research is determining the importance of trace elements (mainly Mg) in the development of diabetes complications.
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Affiliation(s)
- Katarzyna Noras
- Department of Children's Diabetology, Upper Silesian Child Health Centre, Katowice, Poland
| | - Ewa Rusak
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
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Zhang Y, Zheng L, Xu H, Ling L. Circ_0084043 Facilitates High Glucose-Induced Retinal Pigment Epithelial Cell Injury by Activating miR-128-3p/TXNIP-Mediated Wnt/β-Catenin Signaling Pathway. J Cardiovasc Pharmacol 2021; 78:e112-21. [PMID: 34173806 DOI: 10.1097/FJC.0000000000001039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/10/2021] [Indexed: 12/29/2022]
Abstract
ABSTRACT Diabetic retinopathy is a frequent complication of diabetes mellitus and one of the common causes of blindness. Circular RNAs (circRNAs) can modulate various biological behaviors of human diseases. Circ_0084043 is a novel circRNA, and its function in diabetic retinopathy progression is unclear. Adult retinal pigment epithelial cells (ARPE-19) were treated with high glucose (HG). RNA levels of circ_0084043, microRNA-128-3p (miR-128-3p), and thioredoxin-interacting protein (TXNIP) were detected by quantitative real-time polymerase chain reaction. 3-(4, 5-dimethylthiazole-2-y1)-2, 5-diphenyl tetrazolium bromide and flow cytometry were, respectively, used to examine cell viability and apoptosis. Apoptotic and TNXIP relative protein levels were measured by Western blot. The combination between targets was analyzed through dual-luciferase reporter assay or RNA immunoprecipitation assay. Results showed that HG induced the upregulation of circ_0084043 and the downregulation of miR-128-3p in ARPE-19 cells. Circ_0084043 knockdown or miR-128-3p overexpression mitigated the HG-mediated cell viability inhibition, apoptosis promotion, and inflammatory response. Circ_0084043 targeted miR-128-3p and miR-128-3p inhibitor returned the regulation of si-circ_0084043 in HG-treated cells. TXNIP was the target gene of miR-128-3p and TXNIP overexpression abolished the miR-128-3p-mediated effects after HG treatment. Circ_0084043 regulated the TXNIP expression to activate Wnt/β-catenin signal pathway by targeting miR-128-3p. Our findings unraveled that circ_0084043 promoted the HG-induced retinal pigment epithelial cell injury through activating the Wnt/β-catenin signal pathway by the miR-128-3p/TXNIP axis. Circ_0084043 might be an available biomarker in diabetic retinopathy diagnosis and therapy.
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Akinci G, Savelieff MG, Gallagher G, Callaghan BC, Feldman EL. Diabetic neuropathy in children and youth: New and emerging risk factors. Pediatr Diabetes 2021; 22:132-147. [PMID: 33205601 DOI: 10.1111/pedi.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022] Open
Abstract
Pediatric neuropathy attributed to metabolic dysfunction is a well-known complication in children and youth with type 1 diabetes. Moreover, the rise of obesity and in particular of type 2 diabetes may cause an uptick in pediatric neuropathy incidence. However, despite the anticipated increase in neuropathy incidence, pathogenic insights and strategies to prevent or manage neuropathy in the setting of diabetes and obesity in children and youth remain unknown. Data from adult studies and available youth cohort studies are providing an initial understanding of potential diagnostic, management, and preventative measures in early life. This review discusses the current state of knowledge emanating from these efforts, with particular emphasis on the prevalence, clinical presentation, diagnostic approaches and considerations, and risk factors of neuropathy in type 1 and type 2 diabetes in children and youth. Also highlighted are current management strategies and recommendations for neuropathy in children and youth with diabetes. This knowledge, along with continued and sustained emphasis on identifying and eliminating modifiable risk factors, completing randomized controlled trials to assess effectiveness of strategies like weight loss and exercise, and enhancing awareness to support early detection and prevention, are pertinent to addressing the rising incidence of neuropathy associated with diabetes and obesity in children and youth.
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Affiliation(s)
- Gulcin Akinci
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Masha G Savelieff
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Gary Gallagher
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brian C Callaghan
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan Medicine, Ann Arbor, Michigan, USA
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De Groot J, Wu D, Flynn D, Robertson D, Grant G, Sun J. Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes: A meta-analysis. World J Diabetes 2021; 12:170-197. [PMID: 33594336 PMCID: PMC7839169 DOI: 10.4239/wjd.v12.i2.170] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemedicine is defined as the delivery of health services via remote communication and technology. It is a convenient and cost-effective method of intervention, which has shown to be successful in improving glyceamic control for type 2 diabetes patients. The utility of a successful diabetes intervention is vital to reduce disease complications, hospital admissions and associated economic costs.
AIM To evaluate the effects of telemedicine interventions on hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), post-prandial glucose (PPG), fasting plasma glucose (FPG), weight, cholesterol, mental and physical quality of life (QoL) in patients with type 2 diabetes. The secondary aim of this study is to determine the effect of the following subgroups on HbA1c post-telemedicine intervention; telemedicine characteristics, patient characteristics and self-care outcomes.
METHODS PubMed Central, Cochrane Library, Embase and Scopus databases were searched from inception until 18th of June 2020. The quality of the 43 included studies were assessed using the PEDro scale, and the random effects model was used to estimate outcomes and I2 for heterogeneity testing. The mean difference and standard deviation data were extracted for analysis.
RESULTS We found a significant reduction in HbA1c [-0.486%; 95% confidence interval (CI) -0.561 to -0.410, P < 0.001], DBP (-0.875 mmHg; 95%CI -1.429 to -0.321, P < 0.01), PPG (-1.458 mmol/L; 95%CI -2.648 to -0.268, P < 0.01), FPG (-0.577 mmol/L; 95%CI -0.710 to -0.443, P < 0.001), weight (-0.243 kg; 95%CI -0.442 to -0.045, P < 0.05), BMI (-0.304; 95%CI -0.563 to -0.045, P < 0.05), mental QoL (2.210; 95%CI 0.053 to 4.367, P < 0.05) and physical QoL (-1.312; 95%CI 0.545 to 2.080, P < 0.001) for patients following telemedicine interventions in comparison to control groups. The results of the meta-analysis did not show any significant reductions in SBP and cholesterol in the telemedicine interventions compared to the control groups. The telemedicine characteristic subgroup analysis revealed that clinical treatment models of intervention, as well as those involving telemonitoring, and those provided via modes of videoconference or interactive telephone had the greatest effect on HbA1c reduction. In addition, interventions delivered at a less than weekly frequency, as well as those given for a duration of 6 mo, and those lead by allied health resulted in better HbA1c outcomes. Furthermore, interventions with a focus on biomedical parameters, as well as those with an engagement level > 70% and those with a drop-out rate of 10%-19.9% showed greatest HbA1c reduction. The patient characteristics investigation reported that Hispanic patients with T2DM had a greater HbA1c reduction post telemedicine intervention. For self-care outcomes, telemedicine interventions that resulted in higher post-intervention glucose monitoring and self-efficacy were shown to have better HbA1c reduction.
CONCLUSION The findings indicate that telemedicine is effective for improving HbA1c and thus, glycemic control in patients with type 2 diabetes. In addition, telemedicine interventions were also found to significantly improved other health outcomes as well as QoL scores. The results of the subgroup analysis emphasized that interventions in the form of telemonitoring, via a clinical treatment model and with a focus on biomedical parameters, delivered at a less than weekly frequency and 6 mo duration would have the largest effect on HbA1c reduction. This is in addition to being led by allied health, through modes such as video conference and interactive telephone, with an intervention engagement level > 70% and a drop-out rate between 10%-19.9%. Due to the high heterogeneity of included studies and limitations, further studies with a larger sample size is needed to confirm our findings.
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Affiliation(s)
- Julia De Groot
- School of Medicine, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Dongjun Wu
- School of Medicine, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Declan Flynn
- School of Medicine, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Dylan Robertson
- School of Medicine, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Gary Grant
- School of Pharmacy and Pharmacology, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Jing Sun
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Brisbane 4222, Queensland, Australia
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Bersch-Ferreira ÂC, Weber B, da Silva JGST, Pagano R, Figueiro MF, da Silva LR, de Souza Mota LG, Suzumura EA, Torreglosa CR, de Sousa Lara E, Quinhoneiro D, da Silva Gherardi-Donato EC, Bueno PRT, Marcadenti A. Mindfulness Practice for Glycemic Control: Could it be a New Strategy for an Old Problem? A Systematic Review and Meta-Analysis. Curr Diabetes Rev 2021; 17:e081020184730. [PMID: 32778032 DOI: 10.2174/1573399816666200810131055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The management of type 2 diabetes mellitus (T2DM) requires a complex and organized care that includes patient's lifestyle change. Additionally, emotional well-being is an important part of self-management, and it may impair the individual's adherence. Therefore, equipping the patients with the necessary coping and self-care techniques may be an important step in managing diabetes. OBJECTIVE To evaluate the effect of interventions using established mindfulness-based protocols on glycemic control of individuals with T2DM. METHODS Data sources: Two electronic databases (PubMed and EMBASE) were searched from inception to December 2019. We limited our search to published studies in English, Spanish and Portuguese languages. STUDY SELECTION Randomized clinical trials that assessed the effects of mindfulness in individuals with T2DM were selected. DATA EXTRACTION Two authors independently assessed the risk of bias and extracted data from the included trials. Data were pooled using inverse-variance random-effects meta-analyses. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Four randomized trials were included. There were no differences in blood glucose change (mean difference between groups (MD) -0.73mg/dl; 95% CI, -10.49; 9.02; I2 =0%; very low quality of evidence) or glycated hemoglobin (MD 0.05%; 95%CI -0.22 to 0.32; I2 =29%; very low quality of evidence). CONCLUSION Although the quality of current evidence is very low, our findings suggest that established protocols involving mindfulness have no effect on blood glucose or glycated hemoglobin in individuals with T2DM. Indeed, large-scale trials are needed to evaluate the contribution of mindfulness to glycemic control in clinical practice. PROSPERO Registration ID: RD42020161940.
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Affiliation(s)
| | - Bernardete Weber
- HCor Research Institute (IP-HCor), Hospital do Coração (HCor), São Paulo, Brazil
| | | | - Raira Pagano
- Health Knowledge Implementation Laboratory (LICS), Hospital do Coração (HCor), São Paulo, Brazil
| | - Mabel Fernandes Figueiro
- Health Knowledge Implementation Laboratory (LICS), Hospital do Coração (HCor), São Paulo, Brazil
| | | | | | - Erica Aranha Suzumura
- Preventive Medicine Department, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | | | - Enilda de Sousa Lara
- Health Knowledge Implementation Laboratory (LICS), Hospital do Coração (HCor), São Paulo, Brazil
| | - Driele Quinhoneiro
- Department of Psychiatric Nursing and Human Science, Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Aline Marcadenti
- HCor Research Institute (IP-HCor), Hospital do Coração (HCor), São Paulo, Brazil
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Kara O, Can ME. Evaluation of microvascular changes in retinal zones and optic disc in pediatric patients with type 1 diabetes mellitus. Graefes Arch Clin Exp Ophthalmol 2021; 259:323-34. [PMID: 32960323 DOI: 10.1007/s00417-020-04935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/01/2020] [Accepted: 09/10/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the vascular parameters of the retinal zones and the optic disc (OD) with the use of optical coherence tomography angiography (OCTA) in pediatric patients with type 1 diabetes mellitus (T1DM). METHODS This study enrolled 60 patients with T1DM without clinically detectable diabetic retinopathy (DR), along with 59 age-, gender-, and pubertal stage-matched controls. The ages of the participants in both groups were < 18 years. Retinal and OD measurements were carried out with OCTA. Foveal avascular zone (FAZ) area, non-flow area (NFA), FAZ perimeter (PERIM), acircularity index of FAZ (AI, the rate of the perimeter of FAZ and the perimeter of a circle with equal area), foveal density (FD), superficial (SCP), and the deep capillary plexus (DCP) were analyzed in the macular region. SCP and DCP were also scanned centered on the OD. Correlations between the OCTA parameters with duration of DM, glycated hemoglobin (HbA1c) levels, and microalbuminuria were evaluated among patients with T1DM. RESULTS The mean values for NFA were significantly higher and mean FD were significantly lower in the diabetic group compared with the controls (p = 0.02 and p = 0.01, respectively). The mean values for SCP and DCP were significantly lower in diabetic group (p < 0.05). The mean values for capillary density in the OD were also significantly lower in diabetic group (p < 0.05). There were correlations between the duration of T1DM, HbA1c levels and microalbuminuria, and the investigated parameters of OCTA. CONCLUSIONS The presence of microvascular changes in both retinal zones and the OD in children with T1DM without retinopathy is an important data. OCTA can be used for the early detection of DR in children.
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Neubauer‐Geryk J, Wielicka M, Kozera G, Myśliwiec M, Zorena K, Bieniaszewski L. Common carotid pulsatility is deteriorated by autoimmune thyroiditis in children with type 1 diabetes mellitus - A pilot study. Physiol Rep 2020; 8:e14518. [PMID: 32748565 PMCID: PMC7399375 DOI: 10.14814/phy2.14518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 01/19/2023] Open
Abstract
Autoimmune thyroiditis (AIT) frequently coexists with type 1 diabetes (DM1) and additionally increases the extent of microcirculatory complications due to DM1. We hypothesized that in pediatric patients with DM1, impairment of macrocirculation could be further augmented by a coexisting autoimmune process. Therefore, we investigated the influence of AIT on large arteries in DM1 pediatric patients. Our group consisted of 19 DM1, 19 DM1 + AIT patients and 29 control subjects. The groups were comparable regarding age and gender. The DM1 and DM1 + AIT patients were matched for age at onset of DM1 and diabetes duration. Macrocirculation was described using pulsatility indices (PIs) determined for common carotid (CCA) and peripheral arteries of upper and lower limbs. CCA resistance index (RI) and ABI were also assessed. Children with DM1 + AIT had only significantly lower CCA_PI and CCA_RI in comparison with controls whereas in the absence of AIT such difference was not found. The diabetes duration and age of onset did not correlate with carotid indices. Total cholesterol level was higher both in DM1 + AIT and DM1 groups than in the control group. For low density lipoproteins cholesterol, a significant difference was found between DM1 + AIT and control groups. Age-independent impact of AIT on CCA_PI was confirmed by multivariate analysis. Common carotid pulsatility is deteriorated by autoimmune thyroiditis independently of age in children with type 1 diabetes mellitus.
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Affiliation(s)
- Jolanta Neubauer‐Geryk
- Clinical Physiology UnitMedical Simulation CentreMedical University of GdańskGdanskPoland
| | - Melanie Wielicka
- Clinical Physiology UnitMedical Simulation CentreMedical University of GdańskGdanskPoland
| | - Grzegorz Kozera
- Clinical Physiology UnitMedical Simulation CentreMedical University of GdańskGdanskPoland
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and EndocrinologyMedical University of GdańskGdanskPoland
| | - Katarzyna Zorena
- Department of Immunobiology and Environmental MicrobiologyMedical University of GdańskGdanskPoland
| | - Leszek Bieniaszewski
- Clinical Physiology UnitMedical Simulation CentreMedical University of GdańskGdanskPoland
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Abstract
PURPOSE OF REVIEW To summarize recent advancements in our understanding of the impact of dyslipidemia on microvascular complications in type 2 diabetes (T2D), with an emphasis on peripheral neuropathy and nephropathy. RECENT FINDINGS Mounting evidence suggests that rigorous glycemic control only mitigates certain microvascular complications in T2D patients. Particularly, well regulated blood glucose levels only marginally improve peripheral neuropathy in the T2D setting. Dyslipidemia, an abnormal lipid profile, is emerging as a key factor in peripheral neuropathy. Furthermore, although glycemic control may prevent or slow nephropathy, recent developments demonstrate that dyslipidemia can also affect kidney outcomes in normoglycemic patients. Transcriptomic, epigenomic, and lipidomic investigations, as well as integrative approaches, are shedding light on potential pathomechanisms. These molecular studies are identifying possible targets for therapeutic intervention. Complementing molecular research, lifestyle interventions are on-going to assess whether dietary choices and/or exercise, weight-loss, or surgical interventions, such as bariatric surgery, can ameliorate peripheral neuropathy and nephropathy in T2D patients. SUMMARY Dyslipidemia is an emerging mechanism in microvascular complications in T2D. Elucidating the molecular pathomechanisms may pinpoint potential lipid-centric treatments. Interventional studies of dietary changes, exercise, or weight-loss surgery may also positively impact these highly prevalent and morbid complications.
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Affiliation(s)
- Masha G Savelieff
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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