scholarly journals Low prevalence of diabetic retinopathy in patients with long-term type 1 diabetes and current good glycemic control - one-center retrospective assessment

Endocrine ◽  
2021 ◽  
Author(s):  
Paulina Surowiec ◽  
Bartłomiej Matejko ◽  
Marianna Kopka ◽  
Agnieszka Filemonowicz-Skoczek ◽  
Tomasz Klupa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycemic Control ◽  
De Novo ◽  
University Hospital ◽  
Specialist Care ◽  
Good Glycemic Control ◽  
Independent Risk Factors

Abstract Purpose Despite progress in type 1 diabetes (T1DM) therapy, diabetic retinopathy (DR) is still a common complication. We analysed predictors and prevalence of DR in patients with T1DM lasting 10 years or more. All of the patients were considered to be currently in excellent glycemic control and treated using modern therapies. Methods Study included 384 (80.7% women) T1DM patients participating in the Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow between the years 2014 and 2020. A retrospective analysis of medical records was conducted. Results The patients were on average 34 ± 9.2 years old, had a BMI 25.0 ± 3.9 and a T1DM duration of 20.5 ± 7.9 years. The mean level of HbA1c throughout the follow-up (mean duration 4.9 ± 1.4 years) was 6.9 ± 1%. The group included 238 (62.0%) patients treated with insulin pumps and 99 (25.8%) on multiple daily injections, 47 (12.2%) used both methods; almost all patients were on insulin analogues. DR was confirmed in 150 (39.1%) patients, from which 109 (28.4%) were diagnosed de novo. Severe DR was occurred in just 31 cases (8.1%). In the multivariate logistic regression, independent risk factors for the presence of DR were T1DM duration (OR 1.13; 95% CI, 1.09–1.19), HbA1c level (OR 1.41; 95% CI, 1.08–1.84), LDL level (OR 1.79; 95% CI, 1.16–2.87), and the combined presence of non-DR micro- and macrovascular chronic complications (OR 1.86; 95% CI, 1.16–3.03). Conclusions In this highly-selected group of T1DM patients, mostly female, the prevalence of both DR at any stage and severe DR was lower than earlier reported results from other cohorts. Independent risk factors for the DR cohort did not differ from previously reported studies.

scholarly journals Influence of Age at Diagnosis and Time-Dependent Risk Factors on the Development of Diabetic Retinopathy in Patients with Type 1 Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Luis Forga ◽  
María José Goñi ◽  
Berta Ibáñez ◽  
Koldo Cambra ◽  
Marta García-Mouriz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycemic Control ◽  
Diastolic Blood Pressure ◽  
Hdl Cholesterol ◽  
Time Dependent

Aim. To determine the influence of age at onset of type 1 diabetes and of traditional vascular risk factors on the development of diabetic retinopathy, in a cohort of patients who have been followed up after onset.Methods. Observational, retrospective study. The cohort consists of 989 patients who were followed up after diagnosis for a mean of 10.1 (SD: 6.8) years. The influence of age at diagnosis, glycemic control, duration of diabetes, sex, blood pressure, lipids, BMI, and smoking is analyzed using Cox univariate and multivariate models with fixed and time-dependent variables.Results. 135 patients (13.7%) developed diabetic retinopathy. The cumulative incidence was 0.7, 5.9, and 21.8% at 5-, 10-, and 15-year follow-up, respectively. Compared to the group with onset at age <10 years, the risk of retinopathy increased 2.5-, 3-, 3.3-, and 3.7-fold in the groups with onset at 10–14, 15–29, 30–44, and >44 years, respectively. During follow-up we also observed an association between diabetic retinopathy and HbA1c levels, HDL-cholesterol, and diastolic blood pressure.Conclusion. The rate of diabetic retinopathy is higher in patients who were older at type 1 diabetes diagnosis. In addition, we confirmed the influence of glycemic control, HDL-cholesterol, and diastolic blood pressure on the occurrence of retinopathy.

scholarly journals Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2625
Author(s):  
Chiara Garonzi ◽  
Gun Forsander ◽  
Claudio Maffeis
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Cardiovascular Risk ◽  
Glycemic Control ◽  
Children And Adolescents ◽  
Cardiovascular Risk Factors ◽  
Specific Role ◽  
Fat Intake ◽  
High Fat

Nutrition therapy is a cornerstone of type 1 diabetes (T1D) management. Glycemic control is affected by diet composition, which can contribute to the development of diabetes complications. However, the specific role of macronutrients is still debated, particularly fat intake. This review aims at assessing the relationship between fat intake and glycemic control, cardiovascular risk factors, inflammation, and microbiota, in children and adolescents with T1D. High fat meals are followed by delayed and prolonged hyperglycemia and higher glycated hemoglobin A1c levels have been frequently reported in individuals with T1D consuming high amounts of fat. High fat intake has also been associated with increased cardiovascular risk, which is higher in people with diabetes than in healthy subjects. Finally, high fat meals lead to postprandial pro-inflammatory responses through different mechanisms, including gut microbiota modifications. Different fatty acids were proposed to have a specific role in metabolic regulation, however, further investigation is still necessary. In conclusion, available evidence suggests that a high fat intake should be avoided by children and adolescents with T1D, who should be encouraged to adhere to a healthy and balanced diet, as suggested by ISPAD and ADA recommendations. This nutritional choice might be beneficial for reducing cardiovascular risk and inflammation.

scholarly journals 30-Year Cardiovascular Disease in Type 1 Diabetes: Risk and Risk Factors Differ by Long-Term Patterns of Glycemic Control

2021 ◽  
Author(s):  
Rachel G. Miller ◽  
Trevor J. Orchard ◽  
Tina Costacou
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Latent Class ◽  
Diabetes Duration ◽  
Cvd Risk ◽  
High Hba1c

<b>Objective:</b> We hypothesized that there is heterogeneity in long-term patterns of glycemic control with respect to cardiovascular disease (CVD) development in type 1 diabetes and that risk factors for CVD differ by glycemic control pattern. Thus, we estimated associations between data-derived latent HbA1c trajectories and 30-year CVD risk in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (<17 years old) type 1 diabetes.<b> </b> <p><b>Research Design and Methods: </b>Participants (n=536 with ≥2 HbA1c measurements [median 6] and CVD-free at baseline; mean age 27 and diabetes duration 18 years) were followed from 1986-88 to 2016-18 to ascertain CVD incidence (CVD death, myocardial infarction, stroke, coronary revascularization or blockage ≥50%, ischemic ECG, or angina). Latent HbA1c trajectories and their association with time-to-CVD incidence were simultaneously assessed using Joint Latent Class Mixed Models.</p> <p><b>Results:</b> Two HbA1c trajectories with respect to differential CVD risk were identified: Low (HbA1c ~8% [64 mmol/mol] and improving over follow-up, 76% of cohort) and High (HbA1c ~10% [86 mmol/mol] and stable, 24%). Overall, 30-year CVD incidence was 47.4% (n=253); MACE incidence 31.0% (n=176). High HbA1c was associated with 3-fold increased CVD risk versus Low HbA1c. Both groups had similar age and diabetes duration. Non-HDLc and estimated glomerular filtration rate were associated with CVD risk only in Low HbA1c; albumin excretion rate was associated with CVD risk only in High HbA1c.<b> </b></p> <p><b>Conclusions: </b>These risk factor differences suggest that pathways to CVD may differ by glycemic control, potentially resulting in important implications for prognosis in type 1 diabetes.</p>

scholarly journals The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study

2020 ◽  
Vol 17 (14) ◽  
pp. 5132
Author(s):  
Li-Chen Hung ◽  
Chu-Yu Huang ◽  
Fu-Sung Lo ◽  
Su-Fen Cheng
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Phenomenological Study ◽  
Medical Center ◽  
Self Management ◽  
Good Glycemic Control ◽  
Descriptive Phenomenology ◽  
Parental Assistance ◽  
Colaizzi's Method

Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi’s method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents’ misconceptions regarding self-management of diabetes.

scholarly journals Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control

Endocrine ◽  
2016 ◽  
Vol 55 (2) ◽  
pp. 447-455 ◽  
Author(s):  
Katarzyna Cyganek ◽  
Jan Skupien ◽  
Barbara Katra ◽  
Alicja Hebda-Szydlo ◽  
Izabela Janas ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Good Glycemic Control

Prevention of Hypoglycemia While Achieving Good Glycemic Control in Type 1 Diabetes: The role of insulin analogs

Diabetes Care ◽  
2008 ◽  
Vol 31 (Supplement 2) ◽  
pp. S113-S120 ◽  
Author(s):  
P. Rossetti ◽  
F. Porcellati ◽  
G. B. Bolli ◽  
C. G. Fanelli
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Analogs ◽  
Good Glycemic Control

scholarly journals Inflammatory Markers Are Increased in Youth with Type 1 Diabetes: The SEARCH Case-Control Study

2010 ◽  
Vol 95 (6) ◽  
pp. 2868-2876 ◽  
Author(s):  
Janet K. Snell-Bergeon ◽  
Nancy A. West ◽  
Elizabeth J. Mayer-Davis ◽  
Angela D. Liese ◽  
Santica M. Marcovina ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
South Carolina ◽  
Glycemic Control ◽  
Apolipoprotein B ◽  
Inflammatory Markers ◽  
Glycated Hemoglobin ◽  
Case Control ◽  
Good Glycemic Control ◽  
Diabetes Status

Abstract Context: Increased inflammation may contribute to type 1 diabetes (T1D) complications. Objective: The objective of the study was to investigate the association of inflammation with obesity, hyperglycemia and dyslipidemia in youth with T1D. Design: This was a cross-sectional study of youth with and without T1D. Setting: The study was conducted in Colorado and South Carolina. Patients: SEARCH Case-Control participants with T1D [n = 553, mean age 15 yr (range 10–22), median duration 2.7 yr] and without diabetes [n = 215, mean age 15 yr (range 10–22)]. Intervention: This was an observational study. Main Outcome Measures: IL-6, high-sensitivity C-reactive protein (hsCRP), fibrinogen, and leptin were measured. Results: Inflammatory markers were evaluated by diabetes status, quartiles of glycated hemoglobin, and obesity using multiple linear regression analyses, adjusted for age, sex, study site, race/ethnicity, T1D duration, body mass index, and pubertal status. Compared with controls, youth with T1D had higher IL-6 and fibrinogen levels at all levels of glycemia and obesity, and hsCRP levels were significantly higher in youth with T1D in the top three quartiles of glycated hemoglobin (≥7.2%) and among normal-weight subjects. Leptin was lower in youth with poor glycemic control. Higher hsCRP and fibrinogen were correlated with higher total and LDL cholesterol, and apolipoprotein B in youth with T1D, whereas higher fibrinogen was correlated with higher LDL and apolipoprotein B in controls. Conclusions: T1D is characterized by excess inflammation, independent of adiposity and glycemic control. Even T1D youth in good glycemic control had higher levels of IL-6 and fibrinogen than controls. Elevated inflammatory markers were associated with an atherogenic lipid profile, which may contribute to accelerated atherosclerosis in youth with T1D.

scholarly journals Association Between Serum Magnesium and Glycemic Control, Lipid Profile and Diabetic Retinopathy in Type 1 Diabetes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A457-A457
Author(s):  
Isabel Inácio ◽  
Teresa Azevedo ◽  
Sara Ferreira ◽  
Patrícia Rosinha ◽  
Márcia Alves ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycemic Control ◽  
Lipid Profile ◽  
Diabetes Complications ◽  
Serum Magnesium ◽  
Multivariate Logistic Regression Analysis ◽  
Hydroxyvitamin D ◽  
Significant Difference

Abstract Background: Many studies have shown an association between decreased serum magnesium (Mg) levels and poor glycemic control and dyslipidemia in patients with type 1 diabetes (T1DM). However, few studies have evaluated the association between reduced Mg levels and the diabetes complications in these patients and, in particular with diabetic retinopathy (DR), found divergent results. Aims: To evaluate the status of serum Mg levels in adults with T1DM and to assess the association between Mg levels and glycemic control, lipid profile and prevalence of DR. Methods: Retrospective study of adults with T1DM, with an ophthalmological evaluation and a serum Mg level determination. According to Mg levels, the patients were stratified into two groups: normomagnesemic (1.81–2.60 mg/dl) and hypomagnesemic (≤1.80 mg/dl) patients. Exclusion criteria were: patients on diuretics or proton-pump inhibitors, malabsorption or diarrhea, oral magnesium supplementation in recent past, pregnancy or sepsis. Results: Included 105 patients (56.2% male) with median age of 36.0 (interquartile range 16.0) years and median T1DM duration of 16.0 (12.0) years. Median HbA1c was 7.6 (1.5)% and median Mg levels was 1.96 (0.23) mg/dl. Hypomagnesemia (≤1.80 mg/dl) was detected in 20.0% (n=21) patients and 26.7% (n=28) had DR. Hypomagnesemic patients had higher HbA1c [8.2 (1.6) vs 7.5 (1.3)%, p=0.014]. There was no statistical difference in age, sex, T1DM duration or DR between the groups stratified by Mg levels. Mg levels was negatively and weakly correlated with systolic blood pressure (r=-0.200, p=0.041), HbA1c (r=-0.281, p=0.004) and BMI (r=-0.197, p=0.041). There was no correlation between Mg levels and total cholesterol, LDL-C, HDL-C or triglycerides. In multivariate logistic regression analysis, HbA1c was the only predictor of hypomagnesemia [OR=1.541 (1.027–2.312), p=0.037], after the adjustments for age, T1DM duration and BMI. There was no significant difference between patients with or without DR in relation to Mg levels [1.96 (0.28) vs 1.96 (0.19) mg/dL, p=0.986]. Also, there was no statistically significant association between Mg levels and the severity of DR or T1DM duration. In multivariate analysis, T1DM duration, male and estimated glomerular filtration rate &gt;60mL/min/1.73m2 had independently significant association with DR after adjusting for age, glycemic control, hypertension, dyslipidemia, 25-hydroxyvitamin D and Mg levels [OR=1.194 (1.088–1.310), p=&lt;0.001; OR=6.980 (1.654–29.450), p=0.008, and OR=0.780 (0.008–0.751), p=0.028, respectively]. Discussion: Hypomagnesemia is a common problem in adults with T1DM and it was correlated with glycemic control, although we did not find significant association between Mg levels and lipid profile or prevalence of DR. Future longitudinal studies may elucidate the causality between reduced Mg levels and the prevalence of diabetes complications.

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