Intensive treatment for type 1 diabetes is associated with lower risk of death

Objective: To identify determinants associated with insulin resistance and to assess the association between insulin resistance and cardiovascular events, vascular interventions and mortality in people with type 1 diabetes at high risk of cardiovascular disease . Design: Prospective cohort study. Methods: 195 people with type 1 diabetes from the Secondary Manifestations of ARTerial disease (SMART) cohort were included. Insulin resistance was quantified by the estimated glucose disposal rate (eGDR) with higher eGDR levels indicating higher insulin sensitivity (i.e. lower eGDR levels indicating higher insulin resistance). Linear regression models were used to evaluate determinants associated with eGDR. The effect of eGDR on cardiovascular events, cardiovascular events or vascular interventions (combined endpoint) and on all-cause mortality was analysed using Cox proportional hazards models adjusted for confounders. Results: In 195 individuals (median follow-up 12.9 years, IQR 6.7-17.0), a total of 25 cardiovascular events, 26 vascular interventions and 27 deaths were observed. High eGDR as a marker for preserved insulin sensitivity was independently associated with a lower risk of cardiovascular events (HR 0.75; 95%CI 0.61-0.91), a lower risk of cardiovascular events and vascular interventions (HR 0.74; 95%CI 0.63-0.87), and a lower risk of all-cause mortality (HR 0.81; 95%CI 0.67-0.98). Conclusions: Insulin resistance as measured by eGDR is an additional risk factor for cardiovascular disease in individuals with type 1 diabetes. Modification of insulin resistance by lifestyle interventions or pharmacological treatment could be a viable therapeutic target to lower the risk of cardiovascular disease.

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Type 1 diabetes in people hospitalized for COVID-19: new insights from the CORONADO study

10.2337/figshare.12728246.v1 ◽

2020 ◽

Author(s):

Matthieu Wargny ◽

Pierre Gourdy ◽

Lisa Ludwig ◽

Dominique Seret-Bégué ◽

Olivier Bourron ◽

...

Keyword(s):

New York ◽

New York City ◽

Type 1 Diabetes ◽

Severe Disease ◽

High Risk Population ◽

Risk Of Death ◽

High Prevalence ◽

Patients With Diabetes ◽

Outcomes Study

Since the start of the COVID-19 pandemic, patients with diabetes were rapidly recognized as a high-risk population for severe disease. Indeed, a high prevalence of diabetes among patients with COVID-19 who required hospitalization has been consistently reported, reaching 33.8% in 5,700 people hospitalized for COVID-19 in New York City area (1). In addition, diabetes was associated with more than a double risk of intensive care unit (ICU) admission and more than a triple risk of death (2). However, precise data regarding the type of diabetes are scarce. We report here the clinical characteristics and early prognosis of patients with type 1 diabetes (T1D) hospitalized for COVID-19 in the nationwide multicenter observational CORONADO (CORONAvirus-SARS-CoV-2 and Diabetes Outcomes) study (3).

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Persistent C‐peptide is associated with reduced hypoglycaemia but not HbA 1c in adults with longstanding Type 1 diabetes: evidence for lack of intensive treatment in UK clinical practice?

Diabetic Medicine ◽

10.1111/dme.13960 ◽

2019 ◽

Vol 36 (9) ◽

pp. 1092-1099 ◽

Cited By ~ 4

Author(s):

S. M. Marren ◽

S. Hammersley ◽

T. J. McDonald ◽

B. M. Shields ◽

B. A. Knight ◽

...

Keyword(s):

Type 1 Diabetes ◽

Clinical Practice ◽

Intensive Treatment ◽

C Peptide

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Author response for "Lower Risk for Severe Hypoglycaemia with Insulin Glargine 300 U/ mL vs Glargine 100 U/ mL in Participants with Type 1 Diabetes: a Meta‐Analysis of 6‐Month Phase 3 Clinical Trials"

10.1111/dom.14109/v2/response1 ◽

2020 ◽

Author(s):

Thomas Danne ◽

Munehide Matsuhisa ◽

Christian Sussebach ◽

Harmonie Goyeau ◽

Felipe Lauand ◽

...

Keyword(s):

Clinical Trials ◽

Type 1 Diabetes ◽

Insulin Glargine ◽

Lower Risk ◽

Severe Hypoglycaemia ◽

Meta Analysis ◽

Author Response ◽

Phase 3

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Lower risk of severe hypoglycaemia with insulin glargine 300 U/ mL versus glargine 100 U/ mL in participants with type 1 diabetes: A meta‐analysis of 6‐month phase 3 clinical trials

Diabetes Obesity and Metabolism ◽

10.1111/dom.14109 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1880-1885 ◽

Cited By ~ 2

Author(s):

Thomas Danne ◽

Munehide Matsuhisa ◽

Christian Sussebach ◽

Harmonie Goyeau ◽

Felipe Lauand ◽

...

Keyword(s):

Clinical Trials ◽

Type 1 Diabetes ◽

Insulin Glargine ◽

Lower Risk ◽

Severe Hypoglycaemia ◽

Meta Analysis ◽

Phase 3

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Traumatic brain injury associated with dementia risk among people with type 1 diabetes

Neurology ◽

10.1212/wnl.0000000000006391 ◽

2018 ◽

Vol 91 (17) ◽

pp. e1611-e1618 ◽

Cited By ~ 3

Author(s):

Paola Gilsanz ◽

Kathleen Albers ◽

Michal Schnaider Beeri ◽

Andrew J. Karter ◽

Charles P. Quesenberry ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Type 1 Diabetes ◽

Brain Injury ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Competing Risk ◽

Middle Aged ◽

Risk Of Death ◽

Dementia Risk

ObjectiveTo examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D).MethodsWe evaluated 4,049 members of an integrated health care system with T1D ≥50 years old between January 1, 1996, and September 30, 2015. Dementia and TBI diagnoses throughout the study period were abstracted from medical records. Cox proportional hazards models estimated associations between time-dependent TBI and dementia adjusting for demographics, HbA1c, nephropathy, neuropathy, stroke, peripheral artery disease, depression, and dysglycemic events. Fine and Gray regression models evaluated the association between baseline TBI and dementia risk accounting for competing risk of death.ResultsA total of 178 individuals (4.4%) experienced a TBI and 212 (5.2%) developed dementia. In fully adjusted models, TBI was associated with 3.6 times the dementia risk (hazard ratio [HR] 3.64; 95% confidence interval [CI] 2.34, 5.68). When accounting for the competing risk of death, TBI was associated with almost 3 times the risk of dementia (HR 2.91; 95% CI 1.29, 5.68).ConclusionThis study demonstrates a marked increase in risk of dementia associated with TBI among middle-aged and elderly people with T1D. Given the complexity of self-care for individuals with T1D, and the comorbidities that predispose them to trauma and falls, future work is needed on interventions protecting brain health in this vulnerable population, which is now living to old age.

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