P2489What are the main determinants of an increase in bnp level in asymptomatic diabetic patients without known cardiac disease?

Abstract Background Diabetes mellitus is associated with a high risk of heart failure. The predictors of futures heart failure events in diabetic patients are not clearly understood. BNP measurement can be used as a surrogate endpoint for the diagnosis of heart failure. We investigated the determinants of an increase in BNP level in a large cohort of asymptomatic diabetic patients without known cardiac disease Methods This prospective study included consecutive stable diabetic (type 1 or 2) patients coming for yearly check-up between March 2015 and July 2018 in the university center for the study of diabetes and its complications. Patients with an history of cardiac disease (coronary artery disease, atrial fibrillation, cardiomyopathy, previous heart failure ...) were excluded. All patients had a complete clinical exam, blood pressure measurement (3 consecutive times – mean of 2 lasts measurements), ECG, and blood sample including HbA1C, risk factors assessment, renal function (CKD-EPI) and BNP measurement. Data are presented as mean±SD or median - Spearman's rank and multivariate regression were used for analysis. Results 3743 patients (mean age 57±14 y.o. – 57% male – 78% / 18% / 4% of type 2, type 1 or other type of diabetes respectively – Mean duration of diabetes 17 [1–63] y. – 44% treated with insulin) were studied. Mean±SD / median [min-max] BNP level was 25±39 / 12 [4–737] ng/L. BNP was <20 / 21–35 / 36–50 / 51–100 / 101–400 / >400 ng/L in 69 / 15 / 6 / 7 / 3 / 0.1% of the population respectively. The parameters most correlated with BNP level in type 1 and type 2 diabetes were age, duration of diabetes, renal function, HbA1C, and pulsed pressure. For multivariate analysis, renal function was removed of the model as it was highly correlated with age (r=−0.68). Multivariate analysis demonstrated that in type 1 diabetes, high BNP level was linked to age (p<0.001), pulsed pressure (p<0.001), duration of diabetes (p=0.003) and HbA1C (p=0.02). In type 2 diabetes, high BNP level was linked to age (p<0.0001), pulsed pressure (p<0.0001), duration of diabetes (p=0.005) but not HbA1C (p=0.09). Interestingly the type of treatment (mainly insulin treatment) was not independently related to an increase in BNP level. Conclusion Age, pulsed pressure and duration of diabetes are the main determinants of an increased level of BNP in asymptomatic diabetic patients without any history of cardiac disease. This result could help to select a population who could benefit to a more extensive follow up concerning heart failure.

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Maternal history of type 2 diabetes is associated with diabetic nephropathy in type 1 diabetic patients

Diabetes & Metabolism ◽

10.1016/j.diabet.2006.09.003 ◽

2007 ◽

Vol 33 (1) ◽

pp. 37-43 ◽

Cited By ~ 8

Author(s):

S. Hadjadj ◽

F. Duengler ◽

F. Torremocha ◽

G. Faure-Gerard ◽

F. Bridoux ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Nephropathy ◽

Diabetic Patients ◽

Maternal History ◽

History Of ◽

Type 1 Diabetic Patients

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3269Impact of type 2 diabetes on incidence and phenotype of heart failure in patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0054 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Polovina ◽

I Milinkovic ◽

G Krljanac ◽

I Veljic ◽

I Petrovic-Djordjevic ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Type 2 Diabetes ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Diabetic Patients ◽

History Of ◽

New Onset

Abstract Background Type 2 diabetes (T2DM) portends adverse prognosis in patients with atrial fibrillation (AF). Whether T2DM independently increases the risk of incident heart failure (HF) in AF is uncertain. Also, HF phenotype developing in patients with vs. those without T2DM has not been characterised. Purpose In AF patients without a history of prior HF, we aimed to assess: 1) the impact of T2DM on the risk of new-onset HF; and 2) the association between T2DM and HF phenotype developing during the prospective follow-up. Methods We included diabetic and non-diabetic AF patients, without a history of HF. Baseline T2DM status was inferred from medical history, haemoglobin A1c levels and oral glucose tolerance test. Study outcome was the first hospital admission or emergency department treatment for new-onset HF during the prospective follow-up. The phenotype of new-onset HF was determined by echocardiographic exam performed following clinical stabilisation (at hospital discharge, or within a month after HF diagnosis). HF phenotype was defined as HFrEF (left ventricular ejection fraction [LVEF] <40%), HFmrEF (LVEF 40–49%) or HFpEF (LVEF≥50%). Cox regression analyses adjusted for age, sex, baseline LVEF, comorbidities, smoking status, alcohol intake, AF type (paroxysmal vs. non-paroxysmal) and T2DM treatment was used to analyse the association between T2DM and incident HF. Results Among 1,288 AF patients without prior HF (mean age: 62.1±12.7 years; 61% male), T2DM was present in 16.5%. Diabetic patients had higher mean baseline LVEF compared with nondiabetic patients (50.0±6.2% vs. 57.6±9.0%; P<0.001). During the median 5.5-year follow-up, new-onset HF occurred in 12.4% of patients (incidence rate, 2.9; 95% confidence interval [CI], 2.5–3.3 per 100 patient-years). Compared with non-diabetic patients, those with T2DM had a hazard ratio of 2.1 (95% CI, 1.6–2.8; P<0.001) for new-onset HF, independent of baseline LVEF or other factors. In addition, diabetic patients had a significantly greater decline in covariate-adjusted mean LVEF (−10.4%; 95% CI, −9.8% to −10.8%) at follow-up, compared with nondiabetic patients (−4.0%; 95% CI, −3.8% to −4.2%), P<0.001. The distribution of HF phenotypes at follow-up is presented in Figure. Among patients with T2DM, HFrEF (56.9%) was the most common phenotype of HF, whereas in patients without T2DM, HF mostly took the phenotype of HFpEF (75.0%). Conclusions T2DM is associated with an independent risk of new-onset HF in patients with AF and confers a greater decline in LVEF compared to individuals without T2DM. HFrEF was the most prevalent presenting phenotype of HF in AF patients with T2DM.

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Incidence of atrial fibrillation in patients with diabetes mellitus: effect of sex, age and type of diabetes in a nationwide analysis

EP Europace ◽

10.1093/europace/euab116.150 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

L Fauchier ◽

A Bisson ◽

G Fauchier ◽

A Bodin ◽

J Herbert ◽

...

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Incidence Rates ◽

Diabetic Patients ◽

History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background. There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age. Methods. All patients aged > =18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes). Results. In 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. During 13.5 million person-years of follow-up, 327,012 patients with new-onset AF were identified. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27-1.37) in women vs. 1.12(1.08-1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16-1.19) in women vs. 1.10(1.09-1.12) in men for type 2 diabetes. The adjusted HRs for women were significantly higher than the adjusted HRs for men as shown with the adjusted women-to-men ratios (adjusted WMR = adjusted HR women compared to adjusted HR men) = 1.18 (95%CI 1.12-1.24) for type 1 diabetes and 1.10 (95%CI 1.08-1.12) for type 2 diabetes. This phenomenon was seen across all ages in men and women with type 1 diabetes and progressively decreased with advancing age. In type 2 diabetes, this phenomenon was seen after 50 years, increased until 60-65 years and then progressively decreased with advancing age. Conclusion. Although men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.

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A study of thyroid dysfunction in patients with type 2 diabetes mellitus at new civil hospital, Surat, Gujarat, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20201122 ◽

2020 ◽

Vol 7 (4) ◽

pp. 678

Author(s):

Kunal D. Kumar ◽

Mahesh G. Solu ◽

Ankit P. Kakadiya ◽

Arpit V. Patel ◽

Sumer S. Ramawat ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Thyroid Dysfunction ◽

Previous History ◽

Comorbid Condition ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

History Of

Background: Thyroid diseases and diabetes mellitus, as comorbid condition these together throw a great burden to medicine and humanity. Considering the ever increasing population of diabetics in our country and the significant causal relationship established by current literature, this study was undertaken.Methods: A thorough clinical history regarding diabetes mellitus (onset, duration), any history of long-term illness, any previous thyroid dysfunction, previous history of any kind of drug therapy, whether the patient was on insulin or oral hypoglycaemic drugs was sought. All diabetic patients were evaluated for thyroid dysfunction by testing thyroid profile (T3, T4 and TSH).Results: In the present study, out of the 100 diabetic patients, 18 (18%) patients had thyroid dysfunction and 82 (82%) patients were found to be euthyroid. The prevalence of thyroid dysfunction more in females as compared to males (68.75% vs 31.25%) and highest in the age group of >60 years. The prevalence of thyroid dysfunction found to be more in patients with HbA1C >7 as compared to patients with HbA1C <7. Out of 18 diabetic patients who had thyroid dysfunction, 05 (27.78%) had duration of diabetes >1 - 5 years and 08 (44.44%) had duration of diabetes 6 - 10 years. The prevalence of thyroid dysfunction found to be more in patients who had BMI >30 and patients who were on both oral hypoglycaemic agents and insulin.Conclusions: There is a high prevalence of thyroid disorders in patients of type 2 diabetes mellitus which found to be more in Females, Elderly patients, Patients with uncontrolled diabetes and BMI > 30.

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Sex, age, type of diabetes and incidence of atrial fibrillation in patients with diabetes mellitus: a nationwide analysis

Cardiovascular Diabetology ◽

10.1186/s12933-021-01216-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Arnaud Bisson ◽

Alexandre Bodin ◽

Grégoire Fauchier ◽

Julien Herbert ◽

Denis Angoulvant ◽

...

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Incidence Rates ◽

Diabetic Patients ◽

Diabetes Status ◽

History Of

Abstract Background There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age. Methods All patients aged ≥ 18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes). Results In 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27–1.37) in women vs. 1.12(1.08–1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16–1.19) in women vs. 1.10(1.09–1.12) in men for type 2 diabetes. Conclusion Although men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.

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Guidelines adherence in the prevention and management of chronic kidney disease in patients with diabetes mellitus on the background of recent European recommendations – a registry-based analysis

BMC Nephrology ◽

10.1186/s12882-021-02394-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Peter Bramlage ◽

Stefanie Lanzinger ◽

Sascha R. Tittel ◽

Eva Hess ◽

Simon Fahrner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Clinical Practice ◽

Kidney Disease ◽

Analysis Data ◽

Disease Diagnosis ◽

Diabetic Patients ◽

European Society Of Cardiology

Abstract Background Recent European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) guidelines provide recommendations for detecting and treating chronic kidney disease (CKD) in diabetic patients. We compared clinical practice with guidelines to determine areas for improvement. Methods German database analysis of 675,628 patients with type 1 or type 2 diabetes, with 134,395 included in this analysis. Data were compared with ESC/EASD recommendations. Results This analysis included 17,649 and 116,747 patients with type 1 and type 2 diabetes, respectively. The analysis showed that 44.1 and 49.1 % patients with type 1 and type 2 diabetes, respectively, were annually screened for CKD. Despite anti-diabetic treatment, only 27.2 % patients with type 1 and 43.5 % patients with type 2 achieved a target HbA1c of < 7.0 %. Use of sodium-glucose transport protein 2 inhibitors (1.5 % type 1/8.7 % type 2 diabetes) and glucagon-like peptide-1 receptor agonists (0.6 % type 1/5.2 % type 2 diabetes) was limited. Hypertension was controlled according to guidelines in 41.1 and 67.7 % patients aged 18–65 years with type 1 and 2 diabetes, respectively, (62.4 vs. 68.4 % in patients > 65 years). Renin angiotensin aldosterone inhibitors were used in 24.0 and 40.9 % patients with type 1 diabetes (micro- vs. macroalbuminuria) and 39.9 and 47.7 %, respectively, in type 2 diabetes. Conclusions Data indicate there is room for improvement in caring for diabetic patients with respect to renal disease diagnosis and treatment. While specific and potentially clinically justified reasons for non-compliance exist, the data may serve well for a critical appraisal of clinical practice decisions.

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Prevalence and risk of appearence of skin lesions considered to be cutaneous markers of diabetes in a population group in bihor county

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/v10255-012-0034-0 ◽

2012 ◽

Vol 19 (3) ◽

pp. 285-290

Author(s):

Denisa Kovacs ◽

Luiza Demian ◽

Aurel Babeş

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Skin Lesion ◽

Skin Diseases ◽

Population Group ◽

Skin Lesions ◽

Diabetic Patients ◽

Cutaneous Lesions

Abstract Objectives: The aim of the study was to calculate the prevalence rates and risk ofappearance of cutaneous lesions in diabetic patients with both type-1 and type-2diabetes. Material and Method: 384 patients were analysed, of which 47 had type-1diabetes (T1DM), 140 had type-2 diabetes (T2DM) and 197 were non-diabeticcontrols. Results: The prevalence of the skin lesions considered markers of diabeteswas 57.75% in diabetics, in comparison to 8.12% in non-diabetics (p<0.01). The riskof skin lesion appearance is over 7 times higher in diabetic patients than in nondiabetics.In type-1 diabetes the prevalence of skin lesions was significantly higherthan in type-2 diabetes, and the risk of skin lesion appearance is almost 1.5 timeshigher in type-1 diabetes than type-2 diabetes compared to non-diabetic controls.Conclusions: The diabetic patients are more susceptible than non-diabetics todevelop specific skin diseases. Patients with type-1 diabetes are more affected.

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Clinical significance of intramammary arterial calcifications in diabetic women

Vojnosanitetski pregled ◽

10.2298/vsp0402163m ◽

2004 ◽

Vol 61 (2) ◽

pp. 163-167 ◽

Cited By ~ 2

Author(s):

Zorica Milosevic ◽

Jelica Bjekic ◽

Stanko Radulovic ◽

Branislav Goldner

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Control Group ◽

Duration Of Diabetes ◽

Diabetic Macroangiopathy ◽

Indirect Sign ◽

Significant Difference

Background. It is well known that intramammary arterial calcifications diagnosed by mammography as a part of generalized diabetic macroangiopathy may be an indirect sign of diabetes mellitus. Hence, the aim of this study was to determine the incidence of intramammary arterial calcifications, the patient?s age when the calcifications occur, as well as to observe the influence of diabetic polineuropathy, type, and the duration of diabetes on the onset of calcifications, in comparison with nondiabetic women. Methods. Mammographic findings of 113 diabetic female patients (21 with type 1 diabetes and 92 with type 2), as well as of 208 nondiabetic women (the control group) were analyzed in the prospective study. The data about the type of diabetes, its duration, and polineuropathy were obtained using the questionnaire. Statistical differences were determined by Mann-Whitney test. Results. Intramammary arterial calcifications were identified in 33.3% of the women with type 1 diabetes, in 40.2% with type 2, and in 8.2% of the women from the control group, respectively. The differences comparing the women with type 1, as well as type 2 diabetes and the controls were statistically significant (p=0.0001). Women with intramammary arterial calcifications and type 1 diabetes were younger comparing to the control group (median age 52 years, comparing to 67 years of age, p=0.001), while there was no statistically significant difference in age between the women with calcifications and type 2 diabetes (61 years of age) in relation to the control group (p=0.176). The incidence of polineuropathy in diabetic women was higher in the group with intramammary arterial calcifications (52.3%) in comparison to the group without calcifications (26.1%), (p=0.005). The association between intramammary arterial calcifications and the duration of diabetes was not found. Conclusion. The obtained results supported the theory that intramammary arterial calcifications, detected by mammography could serve as markers of co-existing diabetes mellitus and therefore should be specified in radiologic report in case of their early development.

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Effects of sodium-glucose co-transporter 2 (SGLT2) inhibition on renal function and albuminuria in patients with type 2 diabetes: a systematic review and meta-analysis

PeerJ ◽

10.7717/peerj.3405 ◽

2017 ◽

Vol 5 ◽

pp. e3405 ◽

Cited By ~ 11

Author(s):

Lubin Xu ◽

Yang Li ◽

Jiaxin Lang ◽

Peng Xia ◽

Xinyu Zhao ◽

...

Keyword(s):

Type 2 Diabetes ◽

Renal Function ◽

Diabetic Patients ◽

Controlled Trials ◽

Cochrane Central Register ◽

Type 2 Diabetic Patients ◽

Sglt2 Inhibition ◽

Type 2 Diabetic

Aim To evaluate the effects of sodium-glucose co-transporter 2 (SGLT2) inhibition on renal function and albuminuria in patients with type 2 diabetes. Methods We conducted systematic searches of PubMed, Embase and Cochrane Central Register of Controlled Trials up to June 2016 and included randomized controlled trials of SGLT2 inhibitors in adult type 2 diabetic patients reporting estimated glomerular filtration rate (eGFR) and/or urine albumin/creatinine ratio (ACR) changes. Data were synthesized using the random-effects model. Results Forty-seven studies with 22,843 participants were included. SGLT2 inhibition was not associated with a significant change in eGFR in general (weighted mean difference (WMD), −0.33 ml/min per 1.73 m2, 95% CI [−0.90 to 0.23]) or in patients with chronic kidney disease (CKD) (WMD −0.78 ml/min per 1.73 m2, 95% CI [−2.52 to 0.97]). SGLT2 inhibition was associated with eGFR reduction in short-term trials (WMD −0.98 ml/min per 1.73 m2, 95% CI [−1.42 to −0.54]), and with eGFR preservation in long-term trials (WMD 2.01 ml/min per 1.73 m2, 95% CI [0.86 to 3.16]). Urine ACR reduction after SGLT2 inhibition was not statistically significant in type 2 diabetic patients in general (WMD −7.24 mg/g, 95% CI [−15.54 to 1.06]), but was significant in patients with CKD (WMD −107.35 mg/g, 95% CI [−192.53 to −22.18]). Conclusions SGLT2 inhibition was not associated with significant changes in eGFR in patients with type 2 diabetes, likely resulting from a mixture of an initial reduction of eGFR and long-term renal function preservation. SGLT2 inhibition was associated with statistically significant albuminuria reduction in type 2 diabetic patients with CKD.

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The result of treadmill test in asymptomatic type 2 diabetes mellitus

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20172508 ◽

2017 ◽

Vol 3 (6) ◽

pp. 166 ◽

Cited By ~ 2

Author(s):

Anil Shrinivasrao Joshi ◽

Chandrakant Gunaji Lahane ◽

Akshay Arvind Kashid

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Early Detection ◽

Diabetic Patients ◽

Cross Sectional ◽

Duration Of Diabetes ◽

Asymptomatic Patients ◽

Cardiovascular Morbidity And Mortality

Background: To study the prevalence of silent myocardial ischaemia in asymptomatic patients with type 2 DM.Methods: The present study was conducted in the Govt. Medical College and Hospital Aurangabad. During December 2012 to November 2014 with 50 patients. It was two year cross sectional study with the patients of asymptomatic type 2 diabetes mellitus without clinical and electrocardiographic evidence of coronary artery disease. Results: 12 (24%) out of 50 subjects had positive TMT. It correlated with years of duration of diabetes (9 positive TMT cases with duration of diabetes more than 10 years). 5 (25%) out of 20 had serum cholesterol levels >240, Number of positive TMT were higher in patients with LDL >160 [5 (25%) out of 20].Conclusions: Diabetic patients are at very high risk for cardiovascular morbidity and mortality. Early detection of IHD is very important so that pharmacological therapy, which may improve outcome, can be established. Tread mill exercise TMT being a non-invasive test with high safety, has an important role in early detection of IHD. It is recommended that TMT should be a part of routine management in asymptomatic patients with type II DM.

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