Novel glycoproteins identify preclinical atherosclerosis among women with previous preeclampsia regardless of type 1 diabetes status

Objective: Diabetes surveillance often requires manual medical chart reviews to confirm status and type. This project aimed to create an electronic health record (EHR)-based procedure for improving surveillance efficiency through automation of case identification. Research Design and Methods: Youth (< 20 years) with potential evidence of diabetes (N=8,682) were identified from EHRs at three children’s hospitals participating in the SEARCH for Diabetes in Youth Study. True diabetes status/type was determined by manual chart reviews. Multinomial regression was compared with an ICD-10 rule-based algorithm in the ability to correctly identify diabetes status and type. Subsequently, the investigators evaluated a scenario of combining the rule based algorithm with targeted chart reviews where the algorithm performed poorly. Results: The sample included 5308 true cases (89.2% type 1 diabetes). The rule-based algorithm outperformed regression for overall accuracy (0.955 vs 0.936). Type 1 diabetes was classified well by both methods: sensitivity (Se) (>0.95), specificity (Sp) (>0.96), and positive predictive value (PPV) (>0.97). In contrast, the PPVs for type 2 diabetes were 0.642 and 0.778 for the rule-based algorithm and the multinomial regression, respectively. Combining the rule-based method with chart reviews (n=695, 7.9%) of persons predicted to have non type 1 diabetes resulted in perfect PPV for the cases reviewed, while increasing overall accuracy (0.983). The sensitivity, specificity, and PPV for type 2 diabetes using the combined method were >=0.91. Conclusions: An ICD-10 algorithm combined with targeted chart reviews accurately identified diabetes status/type and could be an attractive option for diabetes surveillance in youth.

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Repeated Episodes of Hypoglycemia as a Potential Aggravating Factor for Preclinical Atherosclerosis in Subjects With Type 1 Diabetes

Diabetes Care ◽

10.2337/dc10-1371 ◽

2010 ◽

Vol 34 (1) ◽

pp. 198-203 ◽

Cited By ~ 55

Author(s):

M. Gimenez ◽

R. Gilabert ◽

J. Monteagudo ◽

A. Alonso ◽

R. Casamitjana ◽

...

Keyword(s):

Type 1 Diabetes ◽

Preclinical Atherosclerosis

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Steno type 1 risk engine and preclinical atherosclerosis in Mediterranean individuals with type 1 diabetes

Diabetes/Metabolism Research and Reviews ◽

10.1002/dmrr.3320 ◽

2020 ◽

Vol 36 (7) ◽

Cited By ~ 3

Author(s):

C. Viñals ◽

I. Conget ◽

A. Pané ◽

L. Boswell ◽

V. Perea ◽

...

Keyword(s):

Type 1 Diabetes ◽

Risk Engine ◽

Preclinical Atherosclerosis

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

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-1993 ◽

2010 ◽

Vol 95 (6) ◽

pp. 2868-2876 ◽

Cited By ~ 66

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.

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An Iterative Process for Identifying Pediatric Patients With Type 1 Diabetes: Retrospective Observational Study

JMIR Medical Informatics ◽

10.2196/18874 ◽

2020 ◽

Vol 8 (9) ◽

pp. e18874

Author(s):

Heather Lynne Morris ◽

William Troy Donahoo ◽

Brittany Bruggeman ◽

Chelsea Zimmerman ◽

Paul Hiers ◽

...

Keyword(s):

Type 1 Diabetes ◽

Predictive Value ◽

Pediatric Patients ◽

Current Approach ◽

Data Repository ◽

Data Set ◽

Diabetes Status ◽

Research Consortium ◽

The University

Background The incidence of both type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in children and youth is increasing. However, the current approach for identifying pediatric diabetes and separating by type is costly, because it requires substantial manual efforts. Objective The purpose of this study was to develop a computable phenotype for accurately and efficiently identifying diabetes and separating T1DM from T2DM in pediatric patients. Methods This retrospective study utilized a data set from the University of Florida Health Integrated Data Repository to identify 300 patients aged 18 or younger with T1DM, T2DM, or that were healthy based on a developed computable phenotype. Three endocrinology residents/fellows manually reviewed medical records of all probable cases to validate diabetes status and type. This refined computable phenotype was then used to identify all cases of T1DM and T2DM in the OneFlorida Clinical Research Consortium. Results A total of 295 electronic health records were manually reviewed; of these, 128 cases were found to have T1DM, 35 T2DM, and 132 no diagnosis. The positive predictive value was 94.7%, the sensitivity was 96.9%, specificity was 95.8%, and the negative predictive value was 97.6%. Overall, the computable phenotype was found to be an accurate and sensitive method to pinpoint pediatric patients with T1DM. Conclusions We developed a computable phenotype for identifying T1DM correctly and efficiently. The computable phenotype that was developed will enable researchers to identify a population accurately and cost-effectively. As such, this will vastly improve the ease of identifying patients for future intervention studies.

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Abstract 19690: Association of Pericardial Fat Density With Progression of Coronary Artery Calcification Differs by Diabetes Status in the CACTI Study

Circulation ◽

10.1161/circ.132.suppl_3.19690 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Amy C Alman ◽

Steven R Smith ◽

Preethi R Sudini ◽

Robert H Eckel ◽

John E Hokanson ◽

...

Keyword(s):

Type 1 Diabetes ◽

Coronary Artery ◽

Coronary Artery Calcification ◽

Subclinical Atherosclerosis ◽

Pericardial Fat ◽

Progression Model ◽

Interaction Terms ◽

Diabetes Status

Density of adipose tissue can be measured by CT attenuation in Hounsfield Units (HU). Increased visceral fat density has been associated with coronary artery calcification (CAC). However, the relationship between pericardial fat density and CAC is unknown. We examined the association of pericardial fat density (PAT HU) with the presence (CAC > 0) and progression of CAC in the Coronary Artery Calcification in Type 1 Diabetes study (CACTI). CACTI is a prospective cohort study of adults with and without type 1 diabetes (T1D) with a mean age of 38 years (±9) at baseline. Participants were free of CVD at the time of enrollment in the study. PAT volume was measured from baseline EBCT scans within a range of HU from -190 to -30. CAC was measured at baseline and at the follow-up exam with a mean follow-up of 6 years (±0.5). Logistic regression was used to examine the association between PAT HU and CAC. Prevalence of CAC was defined as any CAC (>0) at baseline. Progression of CAC was defined as a change in volume of ≥2.5 square-root transformed units between the baseline and followup exams. PAT volume and triglycerides were log transformed. Interaction terms for diabetes and PAT HU were tested in the models. PAT data were available on 1319 subjects for the prevalence model, and 952 for the progression model. PAT HU was significantly higher (less-negative) in those with T1D compared to those without (-75.7 ±3.7 vs -77.8 ±4.2; p<0.001). Results from the regression models are shown in table 1. Increasing PAT HU was significantly associated with the prevalence of CAC in both those with T1D and without. However, increasing PAT HU was significantly associated with progression of CAC only in those with T1D. These results suggest that higher PAT fat density may be an important factor in subclinical atherosclerosis, particularly for those with T1D.

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Abstract P155: Weight Gain and Insulin Sensitivity in Adults With and Without Type 1 Diabetes

Circulation ◽

10.1161/circ.131.suppl_1.p155 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Lindsey M Duca ◽

Irene E Schauer ◽

Janet K Snell-Bergeon

Keyword(s):

Cardiovascular Disease ◽

Weight Loss ◽

Type 1 Diabetes ◽

Weight Gain ◽

Coronary Artery ◽

Insulin Sensitivity ◽

Weight Change ◽

Diabetes Status ◽

Adjusted Least Squares

People with type 1 diabetes mellitus (T1D) have reduced insulin sensitivity (IS), which partially explains their increased risk of cardiovascular disease. However, there is limited data on how weight gain alters IS in T1D, and so this study aimed to analyze the effect of weight change on IS components in T1D and non-diabetic (non-DM) adults. This study included 1133 adults (T1D=528 and non-DM n=605) with a mean ± SD age of 38 ± 9 years from the Coronary Artery Calcification in Type 1 Diabetes cohort, examined at baseline and after 6.2±0.6 years. Weight change was categorized as follows: weight loss (WL), lost > 2%), weight stable (WS), within 2% of baseline, and weight gain (WG), > 2%. Estimated IS (eIS) was calculated by a model derived from a clamp study (Table) at each visit. Multiple age and sex adjusted least squares means were calculated by weight change group and diabetes status, and progression of coronary artery calcium (CAC) was examined by logistic regression. There was a significant improvement in eIS in the T1D WL group, along with a greater reduction in triglycerides and insulin dose and increase in adiponectin compared to the other weight change groups (Table). There was significant increase in eIS among the non-DM WL group, along with a reduction in triglycerides, fasting glucose, HbA1c and DBP and an increase in adiponectin. For each 2% increase in weight, the odds ratio (OR) for progression of CAC was 1.23 (95% CI 1.1-1.4, p=0.002), after adjusting for age, sex, diabetes status, and baseline BMI and CAC. The odds of CAC progression were decreased by 40% (OR 0.6, 95% CI 0.5-0.8, p=0.0007) for each SD increase in eIS, adjusting for the same variables. In conclusion, over 6 years of follow-up, weight loss increased eIS and related factors in both people with and without T1D, but was not associated with improved Hba1c in T1D. Additionally, weight gain was associated with a greater risk and eIS with a lower risk for CAC progression, demonstrating the importance of avoiding weight gain in prevention of subclinical cardiovascular disease.

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Abstract P445: Pulmonary Function is Associated With the Subendocardial Viability Ratio

Circulation ◽

10.1161/circ.141.suppl_1.p445 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Amena Keshawarz ◽

Martin Cech ◽

Elizabeth Westfeldt ◽

Gregory L Kinney ◽

Janet Snell-bergeon

Keyword(s):

Type 1 Diabetes ◽

Pulmonary Function ◽

Smoking Status ◽

Model Testing ◽

Future Research ◽

Diabetes Status ◽

Significant Difference ◽

Subendocardial Viability Ratio ◽

Function Measure

Introduction: Pulmonary function is reduced and arterial stiffening is increased in type 1 diabetes. While increased arterial stiffness is associated with greater risk of cardiovascular disease in type 1 diabetes, the association between reduced pulmonary function and health outcomes in this population is less understood. The subendocardial viability ratio (SEVR), a ratio comparing myocardial perfusion to cardiac workload, may provide useful information pulmonary function and myocardial hypoxemia in the context of pulmonary function in type 1 diabetes. Hypothesis: We tested the hypothesis that impaired pulmonary function (i.e., percent predicted forced vital capacity [FVCpp], forced expiratory volume at 1 second [FEV 1 pp], and FEV 1 /FVC), is associated with reduced SEVR in adults with and without type 1 diabetes. Methods: We conducted pulse wave analysis on 208 adults with type 1 diabetes (mean age 52±9 years) and 285 adults without diabetes (mean age 55±8 years) to obtain the outcome measure of SEVR. All participants underwent non-bronchodilated spirometry testing to obtain FVCpp, FEV 1 pp, and FEV 1 /FVC. Independent t-tests were used to test the difference by diabetes status in each pulmonary function measure and the SEVR. Linear regression models were used to test the association between each pulmonary function measure and SEVR after adjustment for age, sex, diabetes status, smoking status, and heart rate. Results: FVCpp and FEV 1 pp were both significantly lower in type 1 diabetes (87.5% and 85.6%, respectively) compared to controls without diabetes (95.6% and 94.9%, respectively; p<0.001 for both). There was no significant difference by diabetes status in FEV 1 /FVC (97.5% vs. 99.0%, p=0.07). SEVR was also significantly lower in type 1 diabetes (137.5 vs. 159.6, p<0.001). In an adjusted linear model, both FVCpp and FEV 1 pp were associated with SEVR. FVCpp was associated with 0.086 greater SEVR per SD (p=0.002), and FEV 1 pp was associated with 0.058 greater SEVR per SD (p=0.04). FEV 1 /FVC was not significantly associated with SEVR (p=0.37). In the model testing FVCpp, type 1 diabetes was associated with 0.18 lower SEVR (p<0.001). Similarly, in the model testing FEV 1 pp, type 1 diabetes was associated with 0.19 lower SEVR (p<0.001). After accounting for FEV 1 /FVC, type 1 diabetes was still associated with 0.20 lower SEVR (p<0.001). Conclusions: In conclusion, reduced pulmonary function was associated with reduced SEVR in cross-sectional analysis, but type 1 diabetes remained independently associated with reduced SEVR after accounting for reduced pulmonary function. The mechanism between pulmonary function and SEVR is unclear, but future research may reveal pathways or shared etiologies in type 1 diabetes.

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