Abstract P147: Glycemic Control and Weight in a Pediatric Diabetes Clinic Over Time: Gender Differences in Children With Type 1 Diabetes Between the Ages of 9-17 Years

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Alexandra Bodan
Keyword(s):  
Gender Differences ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Critical Time ◽  
Cvd Risk ◽  
Pediatric Diabetes ◽  
Increased Risk

Research shows women with type 1 diabetes (T1D) face a disproportionately increased risk for development of cardiovascular disease (CVD) compared to men. We posit, adolescence may be a critical time period for CVD risk development. Our study examined the effects on gender differences in Hemoglobin A1c (HbA1c) and Body Mass Index z-score (BMIz) across puberty in children with T1D in a large pediatric diabetes specialty clinic. A total of 733 T1D children (M=355, F=378) aged 9-17 with a total of 21,534 visits from the Barbara Davis Center were suitable for this retrospective cohort study. To exam HbA1c and BMIz overtime by gender we used a linear mixed model with SAS version 9.4. HbA1c increased with age in both genders (p<0.0001), but there was a greater increase in girls across adolescence (sex by age interaction, p<0.0007). BMIz increased with age in girls only (sex by age interaction, p<0.0001). Teenagers had worse glycemic control than younger children, and girls had worse glycemic control with greater obesity rates than boys. This gender difference in glycemic control and obesity during puberty may explain the increased CVD risk seen in women with T1D compared to men.

scholarly journals Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach

2021 ◽  
Vol 9 ◽  
Author(s):  
Scott T. Chiesa ◽  
M. Loredana Marcovecchio
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Treatment Strategies ◽  
Critical Time ◽  
Cardiovascular Complications ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
Increased Risk

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in individuals with type 1 diabetes (T1D). Adolescence appears to be a critical time for the development of early subclinical manifestations of CVD, with these changes likely driven by a deterioration in glycemic control during the progression through puberty, combined with the emergence of numerous other traditional cardiometabolic risk factors (e.g., hypertension, dyslipidemia, smoking, alcohol use, obesity, etc.) which emerge at this age. Although hemoglobin A1C has long been the primary focus of screening and treatment strategies, glycemic control remains poor in youth with T1D. Furthermore, screening for cardiovascular risk factors—which are often elevated in youth with T1D—is suboptimal, and use of pharmacological interventions for hypertension and dyslipidemia remains low. As such, there is a clear need not only for better screening strategies for CVD risk factors in youth, but also early interventions to reduce these, if future CVD events have to be prevented. Accumulating evidence has recently suggested that early increases in urinary albumin excretion, even within the normal range, may identify adolescents with T1D who are at an increased risk of complications, and results from pharmacological intervention with statins and ACE inhibitors in these individuals have been encouraging. These data join a growing evidence highlighting the need for a whole-life approach to prevention starting from childhood if efforts to improve CVD outcomes and related mortality in T1D are to be maintained.

836-P: Cannabis Use in Adults with Type 1 Diabetes (T1D) Is Associated with Poor Glycemic Control and Increased Risk for Diabetic Ketoacidosis (DKA)

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 836-P ◽  
Author(s):  
VIRAL N. SHAH ◽  
DANIEL D. TAYLOR ◽  
NICOLE C. FOSTER ◽  
ROY BECK ◽  
HALIS K. AKTURK ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Diabetic Ketoacidosis ◽  
Cannabis Use ◽  
Poor Glycemic Control ◽  
Increased Risk

scholarly journals 30-Year Cardiovascular Disease in Type 1 Diabetes: Risk and Risk Factors Differ by Long-Term Patterns of Glycemic Control

2021 ◽  
Author(s):  
Rachel G. Miller ◽  
Trevor J. Orchard ◽  
Tina Costacou
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Latent Class ◽  
Diabetes Duration ◽  
Cvd Risk ◽  
High Hba1c

<b>Objective:</b> We hypothesized that there is heterogeneity in long-term patterns of glycemic control with respect to cardiovascular disease (CVD) development in type 1 diabetes and that risk factors for CVD differ by glycemic control pattern. Thus, we estimated associations between data-derived latent HbA1c trajectories and 30-year CVD risk in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (<17 years old) type 1 diabetes.<b> </b> <p><b>Research Design and Methods: </b>Participants (n=536 with ≥2 HbA1c measurements [median 6] and CVD-free at baseline; mean age 27 and diabetes duration 18 years) were followed from 1986-88 to 2016-18 to ascertain CVD incidence (CVD death, myocardial infarction, stroke, coronary revascularization or blockage ≥50%, ischemic ECG, or angina). Latent HbA1c trajectories and their association with time-to-CVD incidence were simultaneously assessed using Joint Latent Class Mixed Models.</p> <p><b>Results:</b> Two HbA1c trajectories with respect to differential CVD risk were identified: Low (HbA1c ~8% [64 mmol/mol] and improving over follow-up, 76% of cohort) and High (HbA1c ~10% [86 mmol/mol] and stable, 24%). Overall, 30-year CVD incidence was 47.4% (n=253); MACE incidence 31.0% (n=176). High HbA1c was associated with 3-fold increased CVD risk versus Low HbA1c. Both groups had similar age and diabetes duration. Non-HDLc and estimated glomerular filtration rate were associated with CVD risk only in Low HbA1c; albumin excretion rate was associated with CVD risk only in High HbA1c.<b> </b></p> <p><b>Conclusions: </b>These risk factor differences suggest that pathways to CVD may differ by glycemic control, potentially resulting in important implications for prognosis in type 1 diabetes.</p>

scholarly journals Smoking is Associated With Increased Risk of Not Achieving Glycemic Target, Increased Glycemic Variability, and Increased Risk of Hypoglycemia for People With Type 1 Diabetes

2020 ◽  
pp. 193229682092225
Author(s):  
Morten Hasselstrøm Jensen ◽  
Simon Lebech Cichosz ◽  
Irl B. Hirsch ◽  
Peter Vestergaard ◽  
Ole Hejlesen ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Linear Models ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Treatment Intensification ◽  
Increased Risk ◽  
Glycemic Target ◽  
Inadequate Glycemic Control

Background: The prevalence of smoking and diabetes is increasing in many developing countries. The aim of this study was to investigate the association of smoking with inadequate glycemic control and glycemic variability with continuous glucose monitoring (CGM) data in people with type 1 diabetes. Methods: Forty-nine smokers and 320 nonsmokers were obtained from the Novo Nordisk Onset 5 trial. After 16 weeks of treatment with continuous subcutaneous insulin infusion, risk of not achieving glycemic target and glycemic variability from six CGM measures was investigated. Analyzes were carried out with logistic regression models (glycemic target) and general linear models (glycemic variability). Finally, CGM median profiles were examined for the identification of daily glucose excursions. Results: A 4.7-fold (95% confidence interval: 1.5-15.4) increased risk of not achieving glycemic target was observed for smokers compared with nonsmokers. Increased time in hyperglycemia, decreased time in range, increased time in hypoglycemia (very low interstitial glucose), and increased fluctuation were observed for smokers compared with nonsmokers from CGM measures. CGM measures of coefficient of variation and time in hypoglycemia were not statistically significantly different. Examination of CGM median profiles revealed that risk of morning hypoglycemia is increased for smokers. Conclusions: In conclusion, smoking is associated with inadequate glycemic control and increased glycemic variability for people with type 1 diabetes with especially risk of morning hypoglycemia. It is important for clinicians to know that if the patient has type 1 diabetes and is smoking, a preemptive action to treat high glycated hemoglobin levels should not necessarily be treatment intensification due to the risk of hypoglycemia.

scholarly journals Metformin improves glycemic variability in adults with type 1 diabetes mellitus: an open-label randomized control trial

2021 ◽  
Author(s):  
Xiuzhen Zhang ◽  
Dan Xu ◽  
Ping Xu ◽  
Shufen Yang ◽  
Qingmei Zhang ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Glycemic Variability ◽  
Mean Amplitude ◽  
Insulin Requirement ◽  
Cvd Risk ◽  
Open Label ◽  
Metformin Therapy ◽  
Increased Risk

Introduction: Metformin has been demonstrated to enhance cardioprotective benefits in type 1 diabetes (T1DM). Although glycemic variability (GV) is associated with increased risk of CVD in diabetes, there is a scarcity of research evaluating the effect of metformin on GV in T1DM. Objectives: In the present study, the effects of adjuvant metformin therapy on GV and metabolic control in T1DM were explored. Patients and methods: A total of 65 adults with T1DM were enrolled and subjected to physical examination, fasting laboratory tests and continuous glucose monitoring, and subsequently randomized 1:1 to 3 months of 1000- 2000 mg metformin daily add-on insulin (MET group, n=34) or insulin (Non-MET group, n=31). After, baseline measurements were repeated. Results: The mean amplitude of glycemic excursions was substantially reduced in MET group, compared with Non-MET group [-1.58 (-3.35,0.31) mmol/L versus 1.36 (-1.12,2.24) mmol/L, P=0.004]. In parallel, the largest amplitude of glycemic excursions [-2.83 (-5.47,-0.06) mmol/L versus 0.45 (-1.29,4.48) mmol/L, P=0.004], the standard deviation of blood glucose [-0.85 (-1.51,0.01) mmol/L versus -0.14 (-0.68,1.21) mmol/L, P=0.015], and the coefficient of variation [-6.66 (-15.00,1.50) % versus -1.60 (-6.28,11.71) %, P=0.012] all demonstrated improvement in the MET group, compared with the Non-MET group. Significant reduction in insulin dose, body mass index and body weight were observed in patients in MET, not those in Non-MET group. Conclusion: Additional metformin therapy improved GV in adults with T1DM, as well as improving body composition and reducing insulin requirement. Hence, metformin as adjunctive therapy has potential prospects in reducing the CVD risk in patients with T1DM in the long term.

scholarly journals A Comprehensive System for Identifying Patients With Type 1 Diabetes at Increased Risk for Diabetic Ketoacidosis at Texas Children's Hospital

2021 ◽  
Author(s):  
David D. Schwartz ◽  
Mili Vakharia ◽  
Serife Uysal ◽  
Kristen R. Hendrix ◽  
Kelly Fegan-Bohm ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Care ◽  
Care Center ◽  
The United States ◽  
Pediatric Endocrinology ◽  
Children's Hospital ◽  
Pediatric Diabetes ◽  
Increased Risk ◽  
Children’S Hospital

Texas Children’s Hospital, located in Houston, TX, is the largest pediatric hospital in the United States, with 973 inpatient beds and extensive outpatient clinics and services. It is the primary pediatric teaching hospital of Baylor College of Medicine. The Texas Children’s Endocrine and Diabetes Care Center is one of the largest pediatric endocrinology and diabetes centers in the country, with three inpatient facilities and seven ambulatory clinics. The service is staffed by a multidisciplinary team that includes endocrinologists, endocrine fellows, advanced practice providers, certified diabetes care and education specialists (CDCES), dietitians, social workers, and consulting psychologists. Almost 500 youth with newly diagnosed type 1 diabetes are admitted to the hospital each year, with a total pediatric diabetes population of >3,400 patients.

Abstract P137: Women Experience A Greater Decline In Brachial Artery Distensibility With Age Than Men

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Martin Cech ◽  
Amena Keshawarz ◽  
Janet Snell-bergeon
Keyword(s):  
Type 1 Diabetes ◽  
Cardiovascular Risk ◽  
Brachial Artery ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Age Group ◽  
Rapid Reduction ◽  
Arterial Distensibility ◽  
Diabetes Status

Introduction: Brachial artery distensibility is reduced in type 1 diabetes and can predict future coronary artery disease (CAD). Although women generally have reduced cardiovascular risk as compared with men, type 1 diabetes increases cardiovascular risk to a greater degree in women such that their cardiovascular risk matches that in men. Sex differences in arterial distensibility may contribute to the increased cardiovascular risk in women with type 1 diabetes. Hypothesis: We tested the hypothesis that brachial distensibility differed by sex and by diabetes status in a cohort of adults with and without type 1 diabetes. Methods: We measured brachial distensibility via DynaPulse instrument (PulseMetric, San Diego, CA) in 268 adults with type 1 diabetes (mean age 44±9 years) and 373 adults without diabetes (mean age 47 ±8 years) who completed clinical study visits 8±0.89 years apart. A linear mixed model was used to calculate mean brachial distensibility by age at the study visits in men and women by diabetes status. This model was adjusted for age, sex, diabetes status, and visit number. An age group*sex*diabetes interaction was used to calculate least squares means (LSmeans) brachial distensibility and examine trends in each stratum of interest. Results: Brachial distensibility decreases with increasing age (Figure 1). This reduction is greatest for women with type 1 diabetes and smallest for men without diabetes, with decreases from the oldest to youngest age group of 2.6 %/mmHg and 0.98 %/mmHg, respectively. Prior to the age of 40 years, women have better brachial distensibility than men regardless of diabetes status, while men have better brachial distensibility than women beginning in the 40-45 years age group. Conclusions: Women experience a steeper decline in their brachial distensibility than men regardless of diabetes status. Rapid reduction in brachial distensibility may contribute to the increases in cardiovascular risk in women with type 1 diabetes.

scholarly journals Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes

2019 ◽  
Vol 7 (1) ◽  
pp. e000602 ◽  
Author(s):  
Arndís Finna Ólafsdóttir ◽  
Ann-Marie Svensson ◽  
Aldina Pivodic ◽  
Soffia Gudbjörnsdottir ◽  
Thomas Nyström ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
General Population ◽  
Lower Extremity ◽  
Excess Risk ◽  
Diabetes Duration ◽  
Renal Complications ◽  
Increased Risk ◽  
Type 1 Dm

ObjectiveThis study investigates how the excess risk of lower extremity amputations (amputations) in people with type 1 diabetes mellitus (DM) differs from the general population by diabetes duration, glycemic control, and renal complications.Research design and methodsWe analyzed data from people with type 1 DM from the Swedish National Diabetes Register without prior amputation from January 1998 to December 2013. Each person (n=36 872) was randomly matched with five controls by sex, age, and county (n=184 360) from the population without diabetes. All were followed until first amputation, death or end of follow-up.ResultsThe overall adjusted HR for all amputation was 40.1 (95% CI 32.8 to 49.1) for type 1 DM versus controls. HR increased with longer diabetes duration. The incidence of amputation/1000 patient-years was 3.18 (95% CI 2.99 to 3.38) for type 1 DM and 0.07 (95% CI 0.05 to 0.08) for controls. The incidence decreased from 1998–2001 (3.09, 95% CI 2.56 to 3.62) to 2011–2013 (2.64, 95% CI 2.31 to 2.98). The HR for major amputations was lower than for minor amputations and decreased over the time period (p=0.0045). Worsening in glycemic control among patients with diabetes led to increased risk for amputation with an HR of 1.80 (95% CI 1.72 to 1.88) per 10 mmol/mol (1%) increase in hemoglobin A1c.ConclusionsAlthough the absolute risk of amputation is relatively low, the overall excess risk was 40 times that of controls. Excess risk was substantially lower for those with good glycemic control and without renal complications, but excess risk still existed and is greatest for minor amputations.

scholarly journals A Comprehensive System for Identifying Patients With Type 1 Diabetes at Increased Risk for Diabetic Ketoacidosis at Texas Children's Hospital

2021 ◽  
Author(s):  
David D. Schwartz ◽  
Mili Vakharia ◽  
Serife Uysal ◽  
Kristen R. Hendrix ◽  
Kelly Fegan-Bohm ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Care ◽  
Care Center ◽  
The United States ◽  
Pediatric Endocrinology ◽  
Children's Hospital ◽  
Pediatric Diabetes ◽  
Increased Risk ◽  
Children’S Hospital

Texas Children’s Hospital, located in Houston, TX, is the largest pediatric hospital in the United States, with 973 inpatient beds and extensive outpatient clinics and services. It is the primary pediatric teaching hospital of Baylor College of Medicine. The Texas Children’s Endocrine and Diabetes Care Center is one of the largest pediatric endocrinology and diabetes centers in the country, with three inpatient facilities and seven ambulatory clinics. The service is staffed by a multidisciplinary team that includes endocrinologists, endocrine fellows, advanced practice providers, certified diabetes care and education specialists (CDCES), dietitians, social workers, and consulting psychologists. Almost 500 youth with newly diagnosed type 1 diabetes are admitted to the hospital each year, with a total pediatric diabetes population of >3,400 patients.

scholarly journals Cardiovascular disease in type 1 diabetes mellitus

2008 ◽  
Vol 52 (2) ◽  
pp. 387-397 ◽  
Author(s):  
Bernardo Léo Wajchenberg ◽  
Nelson Rassi ◽  
Alina Coutinho R. Feitosa ◽  
Antonio Carlos Lerário ◽  
Roberto Tadeu Barcelos Betti
Keyword(s):  
Coronary Artery Disease ◽  
Type 1 Diabetes ◽  
Coronary Artery ◽  
Glycemic Control ◽  
Microvascular Disease ◽  
Epidemiologic Studies ◽  
Risk Factor Modification ◽  
Increased Risk ◽  
Artery Disease

The association between type 1 diabetes and coronary heart disease has become very clear since the late 1970. It has been demonstrated that there is an important increased risk in morbidity and mortality caused by coronary artery disease in young adults with type 1 diabetes compared with the non diabetic population. The underlying pathogeneses is still poorly understood. While the role of glycemic control in the development of microvascular disease complication is well established its role in CVD in patients with DM1 remains unclear with epidemiologic studies reporting conflicting data. Recent findings from the DCCT/EDIC showed that prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced level of HbA1c during the DCCT. The improvement of glycemic control itself appeared to be particularly effective in younger patients with shorter duration of the disease. Other analyses suggested the glycemia may have a stronger effect on CAD in patients without than in those with albuminúria. Other major determinants of coronary artery disease are the components of metabolic syndrome and the surrogate measure of insulin resistence: eGDR. It is proposed that patients with DM1 should have aggressive medical therapy, risk factor modification and careful monitoring not only of his blood sugar but also of the other processes involved in the atherosclerotic process, mostly the ones with family history of type 2 diabetes.

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