Effect of acute variations of insulin and glucose on plasma concentrations of asymmetric dimethylarginine in young people with Type 1 diabetes

2008 ◽  
Vol 115 (12) ◽  
pp. 361-369 ◽  
Author(s):  
M. Loredana Marcovecchio ◽  
Barry Widmer ◽  
David B. Dunger ◽  
R. Neil Dalton
Keyword(s):  
Type 1 Diabetes ◽  
Risk Factor ◽  
Young People ◽  
Asymmetric Dimethylarginine ◽  
Plasma Concentrations ◽  
Young Patients ◽  
Glucose Levels ◽  
Significant Fall ◽  
Plasma Adma

ADMA (asymmetric dimethylarginine), an endogenous inhibitor of nitric oxide synthase, is considered a major risk factor for cardiovascular disease and progression of renal disease. In the present study we aim to investigate the effect of acute variations in plasma glucose and insulin on plasma ADMA levels in young people with T1D (Type 1 diabetes). Fifteen young patients (ten males) with T1D, median age 18.3 (13.2–24.4) years, HbA1c (glycated haemoglobin) 9% (6.4–13.6%), underwent an overnight (18:00–08:00 hours) variable insulin infusion for euglycaemia, followed by a hyperinsulinaemic–euglycaemic clamp (08:00–12:00 hours). Blood samples were collected every 15 min for determination of ADMA, SDMA (symmetric dimethylarginine), valine, phenylalanine, arginine, creatinine and glucose. Insulin levels were assessed every 30 min. During the overnight period, glucose levels increased following the evening meal. In response to the protein intake there was a significant increase in ADMA, arginine, valine, phenylalanine and creatinine. For the remaining part of the night, glucose levels progressively decreased reaching 5 mmol/l by 04:00 hours. ADMA and SDMA did not change significantly. During the hyperinsulinaemic clamp, a significant fall in ADMA was observed, from 0.468±0.056 to 0.364±0.050 μmol/l (P<0.001). A significant fall was also found in SDMA, valine, phenylalanine, arginine and the ADMA/SDMA ratio (all P<0.001), but not in creatinine levels. No correlation was found between insulin sensitivity and ADMA. We conclude that acute changes in glycaemia do not significantly affect plasma ADMA levels whereas infusion of insulin significantly reduces ADMA, suggesting an important role for insulin in the regulation of this cardiovascular risk factor.

scholarly journals Plasma concentrations of soluble IL-2 receptor α (CD25) are increased in type 1 diabetes and associated with reduced C-peptide levels in young patients

Diabetologia ◽  
2013 ◽  
Vol 57 (2) ◽  
pp. 366-372 ◽  
Author(s):  
Kate Downes ◽  
M. Loredana Marcovecchio ◽  
Pamela Clarke ◽  
Jason D. Cooper ◽  
Ricardo C. Ferreira ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Plasma Concentrations ◽  
Young Patients ◽  
C Peptide

scholarly journals Magnetic resonance imaging can diagnostic early morphofunctional changes in the myocardium in young people with type 1 diabetes

2019 ◽  
Vol 10 (1) ◽  
pp. 29-35
Author(s):  
Kirill A. Popov ◽  
Irina Z. Bondarenko ◽  
Elena V. Biryukova ◽  
Elena V. Averkieva ◽  
Alexander V. Vorontsov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Type 1 Diabetes ◽  
Magnetic Resonance ◽  
Young People ◽  
Left Ventricle ◽  
Contrast Agent ◽  
Young Patients ◽  
Resonance Imaging ◽  
Functional Changes

Aim. To study the morphofunctional state of the myocardium in young people with diabetes mellitus 1 using magnetic resonance imaging (MRI) technology. Materials and methods. 38 patients (14 men, 24 women), aged 18 to 36 years old, with an experience of type 1 diabetes from 5 to 16 years old were underwent contrastive MRI of the heart. The exclusion criteria were: pronounced electrolyte disorders in the blood, dysproteinemia, chronic liver and kidney failure - glomerular filtration rate (EPI)≤60 ml/min/1.73 m2, thyroid dysfunction, obesity (body mass index ≥30 kg/m2), diagnosed cardiovascular diseases, contraindications for MRI. The indicators of functional changes in the left ventricle (circular strain, strain relaxation index - SRI), peak early diastolic strain (PSRDS) were obtained and the accumulation of the contrast agent in the delayed period were assessed. Results. The obtained results of strain, SRI, PSRDS do not allow to exclude the presence of functional changes in the myocardium of the left ventricle. In 42.11%, zones of accumulation of the contrast agent were visualized in the delayed period (insignificant - 28.95% and moderate accumulation - 13.16%), mainly by the endocardium of the cardiac apparatus (mitral and tricuspid), and in one observation (2.9%) - in combination with unexpressed diffuse heterogeneity of the myocardium of the left ventricle. Conclusion. MRI of the heart is a promising direction in the assessment of early morphofunctional changes in the structure of the myocardium, which will probably make it possible to predict life-threatening changes in the heart muscle in young patients with type 1 diabetes.

scholarly journals Use of continuous glucose monitoring trend arrows in the younger population with type 1 diabetes

2021 ◽  
Vol 18 (6) ◽  
pp. 147916412110621
Author(s):  
Nancy Elbarbary ◽  
Othmar Moser ◽  
Saif Al yaarubi ◽  
Hussain Alsaffar ◽  
Adnan Al Shaikh ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Young People ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Vascular Complications ◽  
Rate Of Change ◽  
Rapid Expansion ◽  
Nocturnal Hypoglycaemia ◽  
Glucose Levels

Early control of glycaemia is key to reduce vascular complications in individuals with Type 1 diabetes. Therefore, encouraging children and adolescents with T1DM to take responsibility for controlling glucose levels is an important yet a challenging task. The rapid expansion of continuous glucose monitoring (CGM) systems has allowed for more comprehensive analysis of glycaemia in T1D. Moreover, CGM devices have the ability to calculate rate of change in glucose levels and display the information as trend arrows. In turn, this can help to take evasive actions to return glucose levels to near physiological glycaemia, which can be highly motivating for young people with T1DM. In the absence of standardised, evidence-based guidance, this consensus document, generated by experts from the Arab Society of Paediatric Endocrinology and Diabetes and international advisors, summarises recent literature on the use of trend arrows in young people with T1DM. The use of trend arrows in different CGM systems is reviewed and their clinical significance is highlighted. Adjusting insulin doses according to trend arrows is discussed while also addressing special situations, such as exercise, fasting, nocturnal hypoglycaemia and menstruation. Adequate understanding of trend arrows should facilitate optimisation of glycaemic control in the T1D population.

scholarly journals Acceptability of the FreeStyle Libre Flash Glucose Monitoring System: The Experience of Young Patients With Type 1 Diabetes

2020 ◽  
Vol 13 ◽  
pp. 117955142091012 ◽  
Author(s):  
Ayman A Al Hayek ◽  
Asirvatham A Robert ◽  
Mohamed A Al Dawish
Keyword(s):  
Type 1 Diabetes ◽  
Young Patients ◽  
Glucose Monitoring ◽  
Daily Activities ◽  
Smart Devices ◽  
Flash Glucose Monitoring ◽  
Sensor Application ◽  
Glucose Levels ◽  
Study Population

Background: In the current era of modern technology, the development of smart devices such as the flash glucose monitoring (FGM) systems helps patients with diabetes to effortlessly monitor their glucose levels more frequently. In this study, we determine the user acceptability of FGM among young patients with type 1 diabetes (T1D). Methods: A cross-sectional study was performed among 67 young patients with T1D in the age group of 13 to 19 years and who were managed on the FGM method for self-testing the glucose levels for a minimum of 6 months. The participants acceptability measures that were collected with a standard questionnaire and where they rated their experience with the system on a scale of 1 (strongly agree/painless) to 5 (strongly disagree/severe pain). In addition to the demographic and clinical parameters, a closed/structured questionnaire was administered, in order to record the prior and present skin issues, over a 6-month period. Results: From the patient statements regarding sensor application, 95.5% of the study population strongly agreed that the sensor application caused less pain than the routine finger-stick. Similarly, 85% of the users strongly agreed that using the sensor was comfortable, while 94% strongly agreed that they found the small size of the FGM made it easy to wear, 47.8% strongly agreed that wearing the sensor did not attract attention, 70.1% reported no discomfort under the skin, 80.6% stated that the sensor could be scanned without anyone noticing it, 89.6% felt that the sensor did not affect their daily activities, 91% strongly agreed that the sensor was very compatible with their lifestyle, 79.1% reported ease with taking a glucose reading with the scan, 89.6% reported that taking glucose readings with this system would not disrupt their daily activities, and 76.1% participants were excited to share with other individuals their experiences with this system. A comparison of the self-monitoring of blood glucose and freestyle techniques demonstrated that 83.6% participants strongly agreed that it was less painful to get glucose readings from the freestyle sensor, and that it was a more discreet (83.6%), more comfortable (85.1%), easier (95.5%), faster (82.1%), simpler (79.1%), more private (88.1%), and less stressful (77.6%) method, with minimal hassle (74.6%). It is notable here that 86.6% of the participants reported absolutely no pain when the freestyle sensor was applied; also, the majority of the participants (91%) reported no pain symptoms when scanning the sensor. Conclusion: The findings of this study clearly showed that the study population had a high level of acceptability of the FGM.

scholarly journals A1C Variability as an Independent Risk Factor for Microalbuminuria in Young People With Type 1 Diabetes

Diabetes Care ◽  
2011 ◽  
Vol 34 (4) ◽  
pp. 1011-1013 ◽  
Author(s):  
M. L. Marcovecchio ◽  
R. N. Dalton ◽  
F. Chiarelli ◽  
D. B. Dunger
Keyword(s):  
Type 1 Diabetes ◽  
Risk Factor ◽  
Young People ◽  
Independent Risk Factor

scholarly journals Uncomplicated Type 1 Diabetes Is Associated with Increased Asymmetric Dimethylarginine Concentrations

2007 ◽  
Vol 92 (5) ◽  
pp. 1881-1885 ◽  
Author(s):  
Alev E. Altinova ◽  
Metin Arslan ◽  
Aylin Sepici-Dincel ◽  
Mujde Akturk ◽  
Nilgun Altan ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Asymmetric Dimethylarginine ◽  
Fasting Blood Glucose ◽  
Vascular Complications ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Diabetic Patients ◽  
Plasma Adma ◽  
Type 1 Dm

Abstract Context: Asymmetric dimethylarginine (ADMA) has recently emerged as an independent risk marker for cardiovascular disease, but studies investigating the ADMA levels in type 1 diabetes mellitus (DM) are scarce. Objective: We aimed to evaluate plasma ADMA, l-arginine concentrations, and l-arginine to ADMA ratio in uncomplicated type 1 diabetic patients and controls. Design and Subjects: Forty patients with type 1 DM who did not have clinical evidence of vascular complications and 35 healthy controls were included in the study. Results: Plasma ADMA concentrations were higher (2.6 ± 1.9 vs. 1.7 ± 0.7 μmol/liter, P &lt; 0.01), and l-arginine levels were lower (79.3 ± 22.6 vs. 89.6 ± 19.4 μmol/liter, P &lt; 0.05) in the diabetic group, compared with controls. The l-arginine to ADMA ratio was also lower in the diabetic group (38.7 ± 17.1 vs. 62.0 ± 27.9, P &lt; 0.0001). In diabetic patients, logADMA correlated positively with body mass index (BMI) (P = 0.01), fasting blood glucose (P = 0.006), and low-density lipoprotein cholesterol (LDL-c) (P = 0.01) and negatively with high-density lipoprotein cholesterol (P = 0.03). l-Arginine to ADMA ratio correlated negatively with BMI (P = 0.004), fasting blood glucose (P = 0.02), and LDL-c (P = 0.01) and positively with high-density lipoprotein cholesterol (P = 0.04). In controls, logADMA and l-arginine to ADMA ratio correlated with BMI and LDL-c (P &lt; 0.05). In regression analysis, BMI predicted 15% variance of ADMA levels (P = 0.02). Conclusions: We demonstrated that ADMA increases and l-arginine to ADMA ratio decreases, even before the development of vascular complications in type 1 DM.

scholarly journals A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study

JMIR Diabetes ◽  
10.2196/29739 ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. e29739
Author(s):  
Vinutha B Shetty ◽  
Wayne H K Soon ◽  
Alison G Roberts ◽  
Leanne Fried ◽  
Heather C Roby ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Young People ◽  
Mobile Health ◽  
Quality Score ◽  
Total Quality ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Perceived Impact

Background Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. Objective Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. Methods A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. Results The main themes arising from the interview analysis were “increased knowledge,” “increased confidence to exercise,” and “suitability” for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). Conclusions The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373

Modulation by blood glucose levels of activity and concentration of paraoxonase in young patients with type 1 diabetes mellitus

Metabolism ◽  
2001 ◽  
Vol 50 (6) ◽  
pp. 657-660 ◽  
Author(s):  
O. Kordonouri ◽  
R.W. James ◽  
B. Bennetts ◽  
A. Chan ◽  
Y.L. Kao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Type 1 Diabetes Mellitus ◽  
Young Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels

scholarly journals A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study (Preprint)

2021 ◽  
Author(s):  
Vinutha B Shetty ◽  
Wayne H K Soon ◽  
Alison G Roberts ◽  
Leanne Fried ◽  
Heather C Roby ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Young People ◽  
Mobile Health ◽  
Quality Score ◽  
Total Quality ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Perceived Impact

BACKGROUND Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. OBJECTIVE Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. METHODS A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA<sub>1c</sub>, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. RESULTS The main themes arising from the interview analysis were “increased knowledge,” “increased confidence to exercise,” and “suitability” for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). CONCLUSIONS The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373

Asymmetric dimethylarginine in young people with Type 1 diabetes: a paradoxical association with HbA1c

2011 ◽  
Vol 28 (6) ◽  
pp. 685-691 ◽  
Author(s):  
M. L. Marcovecchio ◽  
B. Widmer ◽  
C. Turner ◽  
D. B. Dunger ◽  
R. N. Dalton
Keyword(s):  
Type 1 Diabetes ◽  
Young People ◽  
Asymmetric Dimethylarginine
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