Young patients with type 1 diabetes mellitus are characterised by high frequency of masked hypertension that is associated with increased arterial stiffness

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Troitskaya ◽  
Y Stavtseva ◽  
D Medvedev ◽  
A Petrosyan ◽  
A Safarova ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Arterial Stiffness ◽  
High Frequency ◽  
Young Patients ◽  
Public Institution ◽  
Laboratory Evaluation ◽  
Funding Source ◽  
Masked Hypertension ◽  
History Of

Abstract Background Hypertension (HTN) is a major risk factor for microvascular complications and cardiovascular disease (CVD) in individuals with type 1 diabetes (T1D). Masked and nocturnal HTN are associated with increased cardio-vascular (CV) risk and may be common in patients with T1D. Increased arterial stiffness (AS) is associated with elevated blood pressure (BP) and vascular complications. Very few studies have analyzed the association between masked HTN and markers of AS in T1D. Purpose To evaluate BP phenotypes and their associations with AS and to assess CV risk in young patients with T1D without history of HTN and other known CVD. Methods We included 81 patients with T1D without any history of known CVD. Routine clinical and laboratory evaluation was performed. Office BP was measured with a validated oscillometric device. 24-h ABPM was performed using BPLab Vasotens (“Petr Telegin”). Central BP and AS (carotid-femoral pulse wave velocity (cfPWV)) were measured with applanation tonometry. BP phenotypes were analyzed according to the criteria recommended in ESC/ESH 2018 HTN guidelines. CV risk categories were assessed with the global scale of 10-year risk (ESC 2019). P <0.05 was considered significant. Data are presented as median (interquartile range (IQR)). Results The study group included 39% males, age 27 (23; 34) years, 24.7 smokers, duration of T1D– 6 (2.8; 11) years, HbA1c – 6.9% (5.6; 7.9%). Brachial BP was 122 (110; 122)/80 (70; 80) mmHg; central BP was 109 (100; 118)/72 (67; 78) mmHg, cfPWV – 6.3 (5.3; 6.7) m/s. High and very high 10-year CV risk was observed in 87.7% of patients. True HTN was observed in 5 (6.2%) patients, masked – in 31 (38.3%), white-coat – in 1 (1.2%), true normotension in 44 (54.3%). Isolated nocturnal HTN was found in 30.7% of patients with office BP <140/90 mmHg. 41% of all patients with clinical normotension had masked HTN and isolated nocturnal HTN was present in 74.2% of them. The most common patterns of diurnal index were non-dipping (63,9%) and night-peaking (16.6%). Patients with masked HTN compared to patients with true normotension were older (31±8.6 vs 26.4±5.5 years, p=0.02), had longer duration of T1D (6 (3; 12.9) vs 4 (0.7; 8) years, p=0.009), higher urine albumin/creatinine ratio (18.5 (11; 29) vs 8 (3; 17) mg/g, p<0.001) and higher cfPWV (7.2 (6.2; 8.2) vs 6.3 (5.8; 6.8) m/s, p=0.002). Conclusions Young patients with T1D and clinical normotension are characterized by high frequency of masked HTN (41%) especially isolated nocturnal HTN (74.2%), and high rate of non-dipping. Masked HTN is associated with higher cfPWV and higher albuminuria. This may reflect early vascular changes and potentially lead to further CV risk elevation in this population. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The publication was prepared with the support of the “RUDN University Program 5-100”

scholarly journals Blood pressure phenotypes in young patients with type 1 diabetes

2020 ◽  
Vol 25 (3) ◽  
pp. 3729
Author(s):  
Zh. D. Kobalava ◽  
Yu. V. Stavtseva ◽  
E. A. Troitskaya ◽  
A. F. Safarova ◽  
A. E. Petrosyan
Keyword(s):  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Arterial Stiffness ◽  
Young Patients ◽  
Applanation Tonometry ◽  
Cross Sectional ◽  
High Prevalence ◽  
History Of ◽  
Very High

Aim. To study phenotypes of clinic and 24-hour ambulatory blood pressure (BP), to determine their associations with arterial stiffness parameters, and to assess global cardiovascular risk (CVR) in young patients with type 1 diabetes (T1D).Material and methods. The presented cross-sectional single-center study included 81 T1D patients without a history of hypertension (HTN) and other cardiovascular diseases (CVD) (men — 39%; median age — 27 years; median duration of T1D — 6 years). All participants underwent a routine clinical and laboratory testing, measurement of clinic and 24-hour ambulatory BP (BPLab Vasotens), assessment of central BP and arterial stiffness parameters using applanation tonometry technique. BP phenotypes were analyzed with diagnostic criteria for HTN by ESC/ESH 2018 guidelines. CVR was assessed using the SCORE 10-year risk calculator (ESC 2019). The differences were considered significant at p<0,05.Results. The prevalence of true HTN was 6,2%, masked HTN — 38,3%. Isolated nocturnal HTN was revealed in 30,7% of patients with clinic BP <140/90 mm Hg. The subgroup with masked HTN was dominated by patients with normal clinic BP (58,1%) and in most cases was characterized by isolated diastolic BP increase (64,5%). Masked HTN was associated with a higher carotid-femoral pulse wave velocity (PWV) (median — 7,2 versus 6,3 m/s, p=0,002). The most common profiles of nocturnal BP decrease were non-dipper (63.9%) and night-picker (16.6%). High and very high CVR was recorded in 87,7% of patients. Conclusion. Hypertension occurs in 44,5% of young patients with type 1 diabetes and is characterized by a high prevalence of masked isolated nocturnal HTN and non-dipping. Masked HTN is associated with a higher carotid-femoral PWV. High and very high 10-year CVR was recorded in 87,7% of patients.

scholarly journals Acute hyperglycaemia rapidly increases arterial stiffness in young patients with type 1 diabetes

Diabetologia ◽  
2007 ◽  
Vol 50 (9) ◽  
pp. 1808-1814 ◽  
Author(s):  
D. Gordin ◽  
M. Rönnback ◽  
C. Forsblom ◽  
O. Heikkilä ◽  
M. Saraheimo ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Arterial Stiffness ◽  
Young Patients ◽  
Acute Hyperglycaemia

scholarly journals RISK FACTORS FOR HEARING IMPAIRMENT IN TYPE 1 DIABETES

2019 ◽  
Vol 25 (12) ◽  
pp. 1243-1254
Author(s):  
Barbara H. Braffett ◽  
Gayle M. Lorenzi ◽  
Catherine C. Cowie ◽  
Xiaoyu Gao ◽  
Kathleen E. Bainbridge ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Hearing Impairment ◽  
High Frequency ◽  
Noise Exposure ◽  
Glycated Hemoglobin ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
History Of ◽  
Male Sex

Objective: Studies have demonstrated that glycated hemoglobin (HbA1c) is a significant predictor of hearing impairment in type 1 diabetes. We identified additional factors associated with hearing impairment in participants with type 1 diabetes from the Diabetes Control and Complications Trial and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods: A total of 1,150 DCCT/EDIC participants were recruited for the Hearing Study. A medical history, physical measurements, and a self-administered hearing questionnaire were obtained. Audiometry was performed by study-certified personnel and assessed centrally. Logistic regression models assessed the association of risk factors and comorbidities with speech- and high-frequency hearing impairment. Results: Mean age was 55 ± 7 years, duration of diabetes 34 ± 5 years, and DCCT/EDIC HbA1c 7.9 ± 0.9% (63 mmol/mol). In multivariable models, higher odds of speech-frequency impairment were significantly associated with older age, higher HbA1c, history of noise exposure, male sex, and higher triglycerides. Higher odds of high-frequency impairment were associated with older age, male sex, history of noise exposure, higher skin intrinsic florescence (SIF) as a marker of tissue glycation, higher HbA1c, nonprofessional/nontechnical occupations, sedentary activity, and lower low-density-lipoprotein cholesterol. Among participants who previously completed computed tomography and carotid ultrasonography, coronary artery calcification (CAC) >0 and carotid intima-medial thickness were significantly associated with high-but not speech-frequency impairment. Conclusion: Consistent with previous reports, male sex, age, several metabolic factors, and noise exposure are independently associated with hearing impairment. The association with SIF further emphasizes the importance of glycemia—as a modifiable risk factor—over time. In addition, the macrovascular contribution of CAC is novel and important. Abbreviations: AER = albumin excretion rate; CAC = coronary artery calcification; CVD = cardiovascular disease; DCCT/EDIC = Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; eGFR = estimated glomerular filtration rate; ETDRS = Early Treatment Diabetic Retinopathy Study; HbA1c = glycated hemoglobin; HDL = high-density lipoprotein; IMT = intima-media thickness; LDL = low-density lipoprotein; NHANES = National Health and Nutrition Examination Survey; OR = odds ratio; SIF = skin intrinsic fluorescence; T1D = type 1 diabetes

Abstract P059: Association Of Uric Acid With Change In Arterial Stiffness And Blood Pressure Over Time In Type 1 Diabetes Mellitus: The SEARCH For Diabetes In Youth Study

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Andrew M South ◽  
Joseph Rigdon ◽  
Jeanette M Stafford ◽  
Dana Dabelea ◽  
Jean Lawrence ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Uric Acid ◽  
Arterial Stiffness ◽  
Cvd Risk ◽  
History Of ◽  
Youth Study ◽  
Multivariable Regression Models ◽  
Diabetes In Youth ◽  
Over Time

Background: Type 1 diabetes (T1D) increases CVD risk, and early detection of CV changes could mitigate CVD risk. Increased arterial stiffness is an early marker of adverse CV health and precedes hypertension. Uric acid has been associated with arterial stiffness, hypertension, and CVD in select conditions such as obesity, but its relationship to T1D is undefined. We hypothesized that uric acid predicts increased arterial stiffness and BP over time in youth with T1D, especially those with overweight/obesity. Methods: Prospective cohort of 451 participants with T1D from the SEARCH for Diabetes in Youth Study. We measured uric acid, BP, and arterial stiffness assessed by pulse wave velocity (PWV) in the arm (PWV-R), trunk (PWV-T), and lower extremity (PWV-LE). BP and PWV were repeated a mean of 4.5 years later (±1.1). We defined high BP as ≥90 th %ile for age/sex/height (<13 years) and ≥120/80 mmHg (≥13 years). We applied multivariable regression models to estimate the association of uric acid with annualized changes in each outcome. Directed acyclic graph-informed models were adjusted for age, sex, race/ethnicity, health insurance, family history of CVD, A1c, antihypertensive use, T1D duration, dyslipidemia, and study site. We assessed for effect modification by overweight/obesity. Results: Mean age was 18.1 years (±4.5), 50.8% (229/451) were female, 66.1% (298/451) were White, and 42.4% (191/451) had overweight/obesity. A 1 mg/dl increase in uric acid was associated with increased PWV-R (adjusted β : 0.02 m/s/year, 95% CI -0.01 to 0.06), decreased SBP (-0.45 mmHg/year, -0.73 to -0.18), and sustained high BP (referenced to normal BP, adjusted OR 1.28, 0.91 to 1.79), but not PWV-T or PWV-LE. Compared to normal BMI, those with overweight/obesity demonstrated somewhat stronger associations between uric acid and PWV-R (0.05 m/s/year, 0.0 to 0.1 vs. 0.0 m/s/year, -0.05 to 0.05, interaction p =0.17) and sustained high BP (1.58, 0.99 to 2.51 vs. 0.79, 0.44 to 1.4, interaction p =0.06). Discussion: Among participants with T1D, uric acid was modestly associated with changes in PWV-R and BP over time, particularly in those with overweight/obesity. Further investigations are warranted to determine uric acid’s role in hypertension and arterial stiffness in T1D.

scholarly journals Association between uric acid, renal haemodynamics and arterial stiffness over the natural history of type 1 diabetes

2019 ◽  
Vol 21 (6) ◽  
pp. 1388-1398 ◽  
Author(s):  
Yuliya Lytvyn ◽  
Petter Bjornstad ◽  
Julie A. Lovshin ◽  
Sunita K. Singh ◽  
Genevieve Boulet ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Uric Acid ◽  
Natural History ◽  
Arterial Stiffness ◽  
Renal Haemodynamics ◽  
History Of

scholarly journals Masked Hypertension in Adolescents with Type 1 Diabetes Mellitus: An Exploratory Study

2021 ◽  
pp. 1-5
Author(s):  
Bachar Afandi ◽  
Bassam Bernieh ◽  
Sana Roubi ◽  
Juma Al Kaabi
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Large Scale ◽  
Masked Hypertension ◽  
Diabetes Clinic ◽  
Early Evaluation ◽  
Retinal Examination ◽  
History Of

<b><i>Introduction:</i></b> Masked hypertension (MHTN) is the finding of elevated out-of-office blood pressure (BP) measurement. This is a pilot study to evaluate the prevalence of MHTN in adolescents with type 1 diabetes mellitus (T1DM). <b><i>Patients and Methods:</i></b> Normotensive, adolescents with T1DM were recruited from Tawam Adolescents Diabetes Clinic at Tawam hospital, Al Ain, UAE. They consented to wear the ambulatory BP monitoring (ABPM) device. The heart rate and ambulatory BP were recorded at 15-min intervals for 24 h. Abnormal systolic BP (SBP) and diastolic BP (DBP) were defined as readings above 135 and 85 mm Hg; respectively. <b><i>Results:</i></b> Thirteen patients (10 females) were recruited from “Tawam Adolescents Diabetes Clinic.” The median age was 17 (15–19) years, median BMI 21.4 (14.8–29), and median diabetes duration 9 (3–12) years. All patients had normal retinal examination within the past 12 months. Family history of hypertension (HTN) was present in 6/13 (46%) patients. Office BP measurements revealed a mean DBP ± SD of 72 ± 6.9 mm Hg and mean SBP ± SD116 ± 5.5 mm Hg. The median HbA1c was 8.4% (5.6–13.7) and median GFR 125 mL/min/m<sup>2</sup> (87–134). Two patients had microalbuminuria. Twenty-four hour ABPM revealed elevated SBP and DBP in 12.2 and 5.8% of the values; respectively. Further analysis confirmed MHTN in 4 (30%) patients, nondipping pattern of BP in 5 (38%) patients, and elevated pulse pressure in 8 (61.5%) patients. Only 4 (30%) patients had normal studies. <b><i>Conclusions:</i></b> ABPM uncovered a very high prevalence of MHTN in our patients. Whenever available, ABPM provides an excellent tool for diagnosis and hence early evaluation and management of HTN in adolescents with T1DM. Well-designed large-scale studies are needed to examine the magnitude of MHTN among adolescents with T1DM.

Diabetic nephropathy and arterial stiffness in patients with type 1 diabetes mellitus

2019 ◽  
Author(s):  
Karina Sarkisova ◽  
Iwona-Renata Jarek-Martynowa ◽  
Marina Shestakova ◽  
Minara Shamkhalova ◽  
Alexander Parfenov
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
Arterial Stiffness ◽  
Type 1 Diabetes Mellitus

Venular oxygen saturation is increased in young patients with type 1 diabetes and mild nonproliferative diabetic retinopathy

2020 ◽  
Vol 98 (8) ◽  
pp. 800-807 ◽  
Author(s):  
Nina C.B.B. Veiby ◽  
Aida Simeunovic ◽  
Martin Heier ◽  
Cathrine Brunborg ◽  
Naila Saddique ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Oxygen Saturation ◽  
Young Patients ◽  
Nonproliferative Diabetic Retinopathy

scholarly journals Prevalence of bone fracture and its association with severe hypoglycemia in Japanese patients with type 1 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002099
Author(s):  
Yuji Komorita ◽  
Masae Minami ◽  
Yasutaka Maeda ◽  
Rie Yoshioka ◽  
Toshiaki Ohkuma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Fracture Risk ◽  
Bone Fracture ◽  
Severe Hypoglycemia ◽  
Japanese Patients ◽  
Anatomic Site ◽  
Cross Sectional ◽  
History Of

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.

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