Association between new markers of cardiovascular risk and hepatic insulin resistance in those at high risk of developing type 2 diabetes

Abstract Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.

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Abdominal obesity, insulin resistance, and cardiovascular risk in pre-diabetes and type 2 diabetes

European Heart Journal Supplements ◽

10.1093/eurheartj/sul004 ◽

2006 ◽

Vol 8 (suppl_B) ◽

pp. B20-B25 ◽

Cited By ~ 21

Author(s):

Steven M. Haffner

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Abdominal Obesity

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Insulin Resistance (IR) in Patients with Type 2 Diabetes Mellitus. Identifying Predictors of Insulin Resistance and Establishing a Correlation Between Insulin Resistance and Cardiovascular Risk

Internal Medicine ◽

10.2478/inmed-2018-0009 ◽

2018 ◽

Vol 15 (2) ◽

pp. 7-15

Author(s):

Vesa Cosmin Mihai ◽

Popa Loredana ◽

Daina Lucia ◽

Moisi Mădălina ◽

Popescu Mircea ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cardiovascular Risk ◽

Biochemical Parameters ◽

Diabetes Development ◽

Effect Of Age ◽

Determinant Factor

AbstractInsulin resistance is a determinant factor for the increased prevalence of hypertension and dyslipidemia in type 2 diabetes patients. In this study we determined those modifications of clinical and biochemical parameters associated with insulin resistance in the diabetic patient, these alterations can offer us indications concerning the pathophysiological mechanisms that lead to the diabetes development in the case of most patients. Also we determined a correlation between insulin resistance and cardiovascular risk, through the combined effect of age and insulin resistance on this risk.

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An integrative transcriptional logic model of hepatic insulin resistance

10.1101/2021.03.15.435438 ◽

2021 ◽

Author(s):

TAKUMI KITAMOTO ◽

Taiyi Kuo ◽

Atsushi Okabe ◽

Atsushi Kaneda ◽

Domenico Accili

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Regulatory Elements ◽

Hepatic Insulin Resistance ◽

Dependent Manner ◽

Metabolic Genes ◽

Target Sites ◽

Common Pathogenesis ◽

Glucose Abnormalities

Abnormalities of lipid/lipoprotein and glucose metabolism are hallmarks of hepatic insulin resistance in type 2 diabetes. The former antedate the latter, but the latter become progressively refractory to treatment and contribute to therapeutic failures. It's unclear whether the two processes share a common pathogenesis and what underlies their progressive nature. In this study, we investigated the hypothesis that genes in the lipid/lipoprotein pathway and those in the glucose metabolic pathway are governed by different transcriptional logics that affect their response to physiologic (fasting/refeeding) as well as pathophysiologic cues (insulin resistance and hyperglycemia). To this end, we obtained genomic and transcriptomic maps of the key insulin-regulated transcription factor, FoxO1, and integrated them with those of CREB, PPARα, and glucocorticoid receptor. We found an enrichment of glucose metabolic genes among those regulated by intergenic and promoter enhancers in a fasting-dependent manner, while lipid genes were enriched among fasting-dependent intron enhancers and fasting-independent enhancer-less introns. Glucose genes also showed a remarkable transcriptional resiliency, i.e., an enrichment of active marks at shared PPARα/FoxO1 regulatory elements when FoxO1 was inactivated. Surprisingly, the main features associated with insulin resistance and hyperglycemia were a ″spreading″ of FoxO1 binding to enhancers, and the emergence of target sites unique to this condition. We surmise that this unusual pattern correlates with the progressively intractable nature of hepatic insulin resistance. This transcriptional logic provides an integrated model to interpret the combined lipid and glucose abnormalities of type 2 diabetes.

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