scholarly journals Fracture Patterns in Type 1 and Type 2 Diabetes Mellitus: A Narrative Review of Recent Literature

2021 ◽  
Author(s):  
V. Van Hulten ◽  
Nicklas Rasmussen ◽  
J.H.M. Driessen ◽  
A.M. Burden ◽  
A. Kvist ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Vascular Complications ◽  
Fracture Site ◽  
Narrative Review ◽  
Diabetes Duration ◽  
Macrovascular Complications ◽  
Special Focus ◽  
Glucose Lowering ◽  
Time Patterns

Abstract Purpose of Review In this narrative review, we have summarized the literature on fracture risk in T1DM and T2DM with a special focus on fracture site, time patterns, glucose-lowering drugs, and micro- and macrovascular complications. Recent Findings T1DM and T2DM were associated with an overall increased fracture risk, with preferent locations at the hip, vertebrae, humerus, and ankle in T1DM and at the hip, vertebrae, and likely humerus, distal forearm, and foot in T2DM. Fracture risk was higher with longer diabetes duration and the presence of micro- and macrovascular complications. In T2DM, fracture risk was higher with use of insulin, sulfonylurea, and thiazolidinediones and lower with metformin use. Summary The increased fracture risk in T1DM and T2DM concerns specific fracture sites, and is higher in subjects with longer diabetes duration, vascular complications, and in T2DM with the use of specific glucose-lowering medication.

scholarly journals Modification of the Association Between Severe Hypoglycemia and Ischemic Heart Disease by Surrogates of Vascular Damage Severity in Type 1 Diabetes During ∼30 Years of Follow-up in the DCCT/EDIC Study

2021 ◽  
Author(s):  
Elke R. Fahrmann ◽  
Laura Adkins ◽  
Henry K. Driscoll
Keyword(s):  
Type 1 Diabetes ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Severe Hypoglycemia ◽  
Vascular Damage ◽  
Diabetes Duration ◽  
Ischemic Heart

OBJECTIVE <p>Literature suggests that severe hypoglycemia (SH) may be linked to cardiovascular events only in older individuals with high cardiovascular risk score (CV-score). Whether a potential relationship between any-SH and cardiovascular disease exists and whether it is conditional on vascular damage severity in a young type 1 diabetes (T1D) cohort without apparent macro-vascular and no or mild-to-moderate micro-vascular complications at baseline is unknown.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>We evaluated data of 1441 Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) volunteers (diabetes duration 1-15 years) followed for ~30 years. Time-dependent associations between any-SH, interactions of any-SH with surrogates of baseline micro-/macro- vascular damage severity (diabetes duration, Early Treatment Diabetic Retinopathy Study scale (ETDRS), Diabetes Complications Severity Index (DCSI), or CV-scores) and ischemic heart disease (IHD: death, silent/nonfatal myocardial infarct, revascularization, or confirmed angina) were analyzed.</p> <p>RESULTS</p> <p>Without interactions, in the minimal adjusted model controlling for confounding bias by age and HbA1c, SH was a significant IHD factor (p~0.003). SH remained a significant factor for IHD in fully adjusted models (p<0.05). In models with interactions, interactions between SH and surrogates of microvascular complications severity, but not between SH and CV-score, were significant. Hazard ratios for IHD based on SH increased 1.19-fold, 1.32-fold, and 2.21-fold for each additional year of diabetes duration, ETDRS-unit, and DCSI-unit, respectively. At time of IHD event, ~15% of 110 participants with SH had high CV-scores.</p> <p> </p> <p>CONCLUSION</p> <p>In a young T1D cohort with no baseline macrovascular complications, surrogates of baseline microvascular damage severity impact the effect of SH on IHD. Older age with high CV-score per se is not mandatory for an association of SH with IHD. However, the association is multifactorial.</p>

scholarly journals Reduced expression of OXPHOS and DNA damage genes is linked to protection from microvascular complications in long-term type 1 diabetes: the PROLONG study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Türküler Özgümüş ◽  
Oksana Sulaieva ◽  
Leon Eyrich Jessen ◽  
Ruchi Jain ◽  
Henrik Falhammar ◽  
...  
Keyword(s):  
Dna Repair ◽  
Type 1 Diabetes ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Diabetes Duration ◽  
Chronic Hyperglycemia ◽  
Increased Risk ◽  
Term Type

AbstractType 1 diabetes is a chronic autoimmune disease requiring insulin treatment for survival. Prolonged duration of type 1 diabetes is associated with increased risk of microvascular complications. Although chronic hyperglycemia and diabetes duration have been considered as the major risk factors for vascular complications, this is not universally seen among all patients. Persons with long-term type 1 diabetes who have remained largely free from vascular complications constitute an ideal group for investigation of natural defense mechanisms against prolonged exposure of diabetes. Transcriptomic signatures obtained from RNA sequencing of the peripheral blood cells were analyzed in non-progressors with more than 30 years of diabetes duration and compared to the patients who progressed to microvascular complications within a shorter duration of diabetes. Analyses revealed that non-progressors demonstrated a reduction in expression of the oxidative phosphorylation (OXPHOS) genes, which were positively correlated with the expression of DNA repair enzymes, namely genes involved in base excision repair (BER) machinery. Reduced expression of OXPHOS and BER genes was linked to decrease in expression of inflammation-related genes, higher glucose disposal rate and reduced measures of hepatic fatty liver. Results from the present study indicate that at transcriptomic level reduction in OXPHOS, DNA repair and inflammation-related genes is linked to better insulin sensitivity and protection against microvascular complications in persons with long-term type 1 diabetes.

Relationship between time in range, glycemic variability, HbA1c and complications in adults with type 1 diabetes mellitus

2021 ◽  
Author(s):  
Anass El Malahi ◽  
Michiel Van Elsen ◽  
Sara Charleer ◽  
Eveline Dirinck ◽  
Kristien Ledeganck ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Microvascular Complications ◽  
Diabetes Duration ◽  
Macrovascular Complications ◽  
Glycaemic Variability ◽  
Pump Therapy ◽  
Time In Range

Abstract Purpose Real-time continuous glucose monitoring (RT-CGM) provides information on glycaemic variability (GV), time in range (TIR) and guidance to avoid hypoglycemia, thereby complimenting HbA1c for diabetes management. We investigated whether GV and TIR were independently associated with chronic and acute diabetes complications. Methods Between September 2014 and January 2017 515 subjects with type 1 diabetes using sensor-augmented pump therapy were followed for 24 months. The link between baseline HbA1c and CGM-derived glucometrics (TIR [70-180 mg/dL], coefficient of variation [CV] and standard deviation [SD]) obtained from the first 2 weeks of RT-CGM use and the presence of complications was investigated. Complications were defined as: composite microvascular complications (presence of neuropathy, retinopathy or nephropathy), macrovascular complications, and hospitalization for hypoglycemia and/or ketoacidosis. Results Individuals with microvascular complications were older (P&lt;0.001), had a longer diabetes duration (P&lt;0.001), a higher HbA1c (7.8±0.9 vs 7.5±0.9%, P&lt;0.001) and spent less time in range (60.4±12.2 vs 63.9±13.8%, P=0.022) compared to those without microvascular complication. Diabetes duration (OR=1.12 [1.09-1.15],P&lt;0.001) and TIR (OR=0.97 [0.95-0.99], P=0.005) were independent risk factors for composite microvascular complications, while SD and CV were not. Age (OR=1.08 [1.03-1.14],P=0.003) and HbA1c (OR=1.80 [1.02-3.14], P=0.044) were risk factors for macrovascular complications. TIR (OR=0.97 [0.95-0.99], P=0.021) was the only independent risk factor for hospitalizations for hypoglycaemia or ketoacidosis. Conclusions Lower TIR was associated with the presence of composite microvascular complications and with hospitalization for hypoglycemia or ketoacidosis. TIR, SD and CV were not associated with macrovascular complications.

PREVALENCE OF DIABETIC NEPHROPATHY IN CHILDREN AND ADOLESCENTS IN THE KYRGYZ REPUBLIC

2019 ◽  
pp. 50-56
Author(s):  
O.I. Terekhova
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Nephropathy ◽  
Children And Adolescents ◽  
Vascular Complications ◽  
Premature Death ◽  
Diabetes Mellitus Type 1 ◽  
Diabetes Duration ◽  
Kyrgyz Republic ◽  
Critical Age

Nowadays diabetes mellitus is one of the global problems. Due to insufficiently effective treatment, diabetes can significantly worsen the life of patients, which leads to early disability and premature death caused by vascular complications. Today, it is clear that diabetic complications not only develop more often in patients who fell ill in their childhood, but also are widespread among adolescents. The purpose of the paper is to study the prevalence of diabetic nephropathy among children and adolescents in the Kyrgyz Republic. Materials and Methods. The authors examined 131 children, hospitalized to the Department of Endocrinology, the National Center for Maternity and Childhood Protection between January 2017 and December 2018 and diagnosed with diabetes mellitus, type 1. The results were processed by variation statistics technique using the statistical analysis software package (Statistica for Windows v. 6.0). Results. Diabetic nephropathy was detected in 60 patients (46 %). Complications were observed more often in children from Bishkek (28 %). Data analysis showed that boys prevailed (62 % boys and 38 % girls). The frequency of diabetic nephropathy directly depended on the age of the patient during examination. The critical age for patients was 15–17 years old, since at thats age the transition of diabetic nephropathy from its latent form to clinically expressed stages III and IV was observed. Conclusions. Diabetic nephropathy is rarely diagnosed in children under 10 years of age and in case of diabetes duration up to 3 years; puberty is one of the leading risk factors in its development; the transition from functional to clinical stages occurs at the age of 12–17 and in case of diabetes duration for 12–15 years. Keywords: children and adolescents, diabetic nephropathy, diabetes mellitus. Сахарный диабет представляет собой одну из глобальных проблем современности. Часто при недостаточно эффективном лечении диабет может значительно ухудшить жизнь пациентов, что приводит к ранней инвалидизации и преждевременной смерти из-за развития сосудистых осложнений. На сегодняшний день достоверно установлено, что диабетические осложнения не только чаще развиваются у пациентов, заболевших в детстве, но и имеют широкую распространенность среди детей подросткового возраста. Цель исследования – изучить распространенность диабетической нефропатии среди детей и подростков в Кыргызской Республике. Материалы и методы. Был обследован 131 ребенок, госпитализированный в отделение эндокринологии Национального центра охраны материнства и детства (НЦОМиД) в период с января 2017 г. по декабрь 2018 г. с диагнозом «сахарный диабет 1 типа». Материалы и методы. Результаты обработаны методом вариационной статистики с использованием стандартного пакета программ прикладного статистического анализа (Statistica for Windows v. 6.0). Результаты. Диабетическая нефропатия выявлена у 60 больных, что составляет 46 % от общего числа обследованных. Чаще дети с осложнениями в отделение поступали из г. Бишкека (28 %). Анализ данных показал, что мальчиков было 62 %, а девочек – 38 %. Частота выявления диабетической нефропатии находилась в прямой зависимости от возраста больного в момент обследования. Возраст 15–17 лет является критическим для больного, так как в это время происходит переход диабетической нефропатии из ее скрытой формы в клинически выраженные III и IV стадии. Выводы. Диабетическая нефропатия редко диагностируется у детей до 10-летнего возраста и при длительности течения диабета до трех лет; пубертатный период является одним из ведущих факторов риска ее развития; переход от функциональных к клиническим стадиям происходит в возрасте 12–17 лет и при длительности течения диабета 12–15 лет. Ключевые слова: дети и подростки, диабетическая нефропатия, сахарный диабет.

Autoimmune comorbidity and microvascular complications in childhood-onset type 1 diabetes after 20 years of diabetes duration. A questionnaire study

2012 ◽  
Vol 153 (6) ◽  
pp. 222-226
Author(s):  
Katalin H. Nagy ◽  
Barnabás Rózsai ◽  
Kálmán Kürti ◽  
Ilona Rippl ◽  
Éva Erhardt ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Microvascular Complications ◽  
Thyroid Autoimmunity ◽  
Vascular Complications ◽  
Population Based ◽  
Diabetes Duration ◽  
Childhood Onset ◽  
Onset Type

There are no population-based data on the autoimmune morbidity and vascular complications of young adults with childhood-onset type 1 diabetes in Hungary. Aims: To assess the prevalence of these morbidities after 20 years of diabetes duration. Method: Postal questionnaire. Results: 6.2% of the patients had celiac disease. Diabetes was diagnosed at a significantly earlier age in patients with diabetes and celiac disease as compared to those without celiac diasease. Thyroid autoimmunity was reported in 7.6% of cases. They were significantly older with longer duration of diabetes. Every fifth patients reported retinopathy, one sixth of patients was treated for hypertension. Neuropathy was found in 3.4% and kidney disease in 4.8% of the cases. Conclusions: Apart from retinopathy and hypertension, the prevalence of microvascular complications was relatively low. Considering the limitations of questionnaire studies, laboratory screening is warranted to assess the true prevalence of comorbidities and complications. Orv. Hetil., 2012, 153, 222–226.

scholarly journals Modification of the Association Between Severe Hypoglycemia and Ischemic Heart Disease by Surrogates of Vascular Damage Severity in Type 1 Diabetes During ∼30 Years of Follow-up in the DCCT/EDIC Study

2021 ◽  
Author(s):  
Elke R. Fahrmann ◽  
Laura Adkins ◽  
Henry K. Driscoll
Keyword(s):  
Type 1 Diabetes ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Severe Hypoglycemia ◽  
Vascular Damage ◽  
Diabetes Duration ◽  
Ischemic Heart

OBJECTIVE <p>Literature suggests that severe hypoglycemia (SH) may be linked to cardiovascular events only in older individuals with high cardiovascular risk score (CV-score). Whether a potential relationship between any-SH and cardiovascular disease exists and whether it is conditional on vascular damage severity in a young type 1 diabetes (T1D) cohort without apparent macro-vascular and no or mild-to-moderate micro-vascular complications at baseline is unknown.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>We evaluated data of 1441 Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) volunteers (diabetes duration 1-15 years) followed for ~30 years. Time-dependent associations between any-SH, interactions of any-SH with surrogates of baseline micro-/macro- vascular damage severity (diabetes duration, Early Treatment Diabetic Retinopathy Study scale (ETDRS), Diabetes Complications Severity Index (DCSI), or CV-scores) and ischemic heart disease (IHD: death, silent/nonfatal myocardial infarct, revascularization, or confirmed angina) were analyzed.</p> <p>RESULTS</p> <p>Without interactions, in the minimal adjusted model controlling for confounding bias by age and HbA1c, SH was a significant IHD factor (p~0.003). SH remained a significant factor for IHD in fully adjusted models (p<0.05). In models with interactions, interactions between SH and surrogates of microvascular complications severity, but not between SH and CV-score, were significant. Hazard ratios for IHD based on SH increased 1.19-fold, 1.32-fold, and 2.21-fold for each additional year of diabetes duration, ETDRS-unit, and DCSI-unit, respectively. At time of IHD event, ~15% of 110 participants with SH had high CV-scores.</p> <p> </p> <p>CONCLUSION</p> <p>In a young T1D cohort with no baseline macrovascular complications, surrogates of baseline microvascular damage severity impact the effect of SH on IHD. Older age with high CV-score per se is not mandatory for an association of SH with IHD. However, the association is multifactorial.</p>

Type 1 Diabetes Mellitus - Risk Factor for Cardiovascular Disease Morbidity and Mortality

2020 ◽  
Vol 17 (1) ◽  
pp. 37-54
Author(s):  
Tatyana Chalakova ◽  
Yoto Yotov ◽  
Kaloyan Tzotchev ◽  
Sonya Galcheva ◽  
Boyan Balev ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Diabetic Control ◽  
Macrovascular Complications ◽  
Morbidity And Mortality ◽  
Diabetes Mellitus Risk

: Type 1 diabetes mellitus (T1DM) is a chronic disease that starts early in life and often leads to micro- and macrovascular complications. The incidence of the disease is lower than that of type 2 DM and varies in different countries and ethnic groups, and the etiological and pathogenetic factors are different from T2DM. The aim of this overview is to investigate the effect of T1DM on all-cause mortality and CVD morbidity and mortality. During the last decades, the treatment of T1DM has improved the prognosis of the patients. Still, the mortality rates are higher than those of the age- and sex-matched general population. With the prolonged survival, the macrovascular complications and cardiovascular diseases (CVD) appear as major health problems in the management of patients with T1DM. The studies on the CVD morbidity and mortality in this disease group are sparse, but they reveal that T1DM is associated with at least 30% higher mortality. In comparison to healthy people, CVDs are more common in T1DM patients and they occur earlier in life. : Furthermore, they are a major cause for death and impaired quality of life in T1DM patients. The correlation between diabetic control and the duration of T1DM is not always present or is insignificant. Nevertheless, the early detection of the preclinical stages of the diseases and the risk factors for their development is important; similarly, the efforts to improve glycemic and metabolic control are of paramount importance.

scholarly journals A Narrative Review on Sarcopenia in Type 2 Diabetes Mellitus: Prevalence and Associated Factors

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 183
Author(s):  
Anna Izzo ◽  
Elena Massimino ◽  
Gabriele Riccardi ◽  
Giuseppe Della Pepa
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Elderly Population ◽  
The Elderly ◽  
Narrative Review ◽  
Macrovascular Complications ◽  
Diabetic Patients ◽  
Age Related

Type 2 diabetes mellitus (T2DM) represents a major health burden for the elderly population, affecting approximately 25% of people over the age of 65 years. This percentage is expected to increase dramatically in the next decades in relation to the increased longevity of the population observed in recent years. Beyond microvascular and macrovascular complications, sarcopenia has been described as a new diabetes complication in the elderly population. Increasing attention has been paid by researchers and clinicians to this age-related condition—characterized by loss of skeletal muscle mass together with the loss of muscle power and function—in individuals with T2DM; this is due to the heavy impact that sarcopenia may have on physical and psychosocial health of diabetic patients, thus affecting their quality of life. The aim of this narrative review is to provide an update on: (1) the risk of sarcopenia in individuals with T2DM, and (2) its association with relevant features of patients with T2DM such as age, gender, body mass index, disease duration, glycemic control, presence of microvascular or macrovascular complications, nutritional status, and glucose-lowering drugs. From a clinical point of view, it is necessary to improve the ability of physicians and dietitians to recognize early sarcopenia and its risk factors in patients with T2DM in order to make appropriate therapeutic approaches able to prevent and treat this condition.

scholarly journals C-Peptide as a Therapy for Type 1 Diabetes Mellitus

Biomedicines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 270
Author(s):  
Rachel L. Washburn ◽  
Karl Mueller ◽  
Gurvinder Kaur ◽  
Tanir Moreno ◽  
Naima Moustaid-Moussa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Complications ◽  
The United States ◽  
Genetically Engineered ◽  
Therapeutic Effects ◽  
Pancreatic Islet Transplantation ◽  
C Peptide ◽  
Increased Risk

Diabetes mellitus (DM) is a complex metabolic disease affecting one-third of the United States population. It is characterized by hyperglycemia, where the hormone insulin is either not produced sufficiently or where there is a resistance to insulin. Patients with Type 1 DM (T1DM), in which the insulin-producing beta cells are destroyed by autoimmune mechanisms, have a significantly increased risk of developing life-threatening cardiovascular complications, even when exogenous insulin is administered. In fact, due to various factors such as limited blood glucose measurements and timing of insulin administration, only 37% of T1DM adults achieve normoglycemia. Furthermore, T1DM patients do not produce C-peptide, a cleavage product from insulin processing. C-peptide has potential therapeutic effects in vitro and in vivo on many complications of T1DM, such as peripheral neuropathy, atherosclerosis, and inflammation. Thus, delivery of C-peptide in conjunction with insulin through a pump, pancreatic islet transplantation, or genetically engineered Sertoli cells (an immune privileged cell type) may ameliorate many of the cardiovascular and vascular complications afflicting T1DM patients.

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