scholarly journals Modification of the Association Between Severe Hypoglycemia and Ischemic Heart Disease by Surrogates of Vascular Damage Severity in Type 1 Diabetes During ∼30 Years of Follow-up in the DCCT/EDIC Study

2021 ◽  
Author(s):  
Elke R. Fahrmann ◽  
Laura Adkins ◽  
Henry K. Driscoll
Keyword(s):  
Type 1 Diabetes ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Severe Hypoglycemia ◽  
Vascular Damage ◽  
Diabetes Duration ◽  
Ischemic Heart

OBJECTIVE <p>Literature suggests that severe hypoglycemia (SH) may be linked to cardiovascular events only in older individuals with high cardiovascular risk score (CV-score). Whether a potential relationship between any-SH and cardiovascular disease exists and whether it is conditional on vascular damage severity in a young type 1 diabetes (T1D) cohort without apparent macro-vascular and no or mild-to-moderate micro-vascular complications at baseline is unknown.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>We evaluated data of 1441 Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) volunteers (diabetes duration 1-15 years) followed for ~30 years. Time-dependent associations between any-SH, interactions of any-SH with surrogates of baseline micro-/macro- vascular damage severity (diabetes duration, Early Treatment Diabetic Retinopathy Study scale (ETDRS), Diabetes Complications Severity Index (DCSI), or CV-scores) and ischemic heart disease (IHD: death, silent/nonfatal myocardial infarct, revascularization, or confirmed angina) were analyzed.</p> <p>RESULTS</p> <p>Without interactions, in the minimal adjusted model controlling for confounding bias by age and HbA1c, SH was a significant IHD factor (p~0.003). SH remained a significant factor for IHD in fully adjusted models (p<0.05). In models with interactions, interactions between SH and surrogates of microvascular complications severity, but not between SH and CV-score, were significant. Hazard ratios for IHD based on SH increased 1.19-fold, 1.32-fold, and 2.21-fold for each additional year of diabetes duration, ETDRS-unit, and DCSI-unit, respectively. At time of IHD event, ~15% of 110 participants with SH had high CV-scores.</p> <p> </p> <p>CONCLUSION</p> <p>In a young T1D cohort with no baseline macrovascular complications, surrogates of baseline microvascular damage severity impact the effect of SH on IHD. Older age with high CV-score per se is not mandatory for an association of SH with IHD. However, the association is multifactorial.</p>

scholarly journals Modification of the Association Between Severe Hypoglycemia and Ischemic Heart Disease by Surrogates of Vascular Damage Severity in Type 1 Diabetes During ∼30 Years of Follow-up in the DCCT/EDIC Study

2021 ◽  
Author(s):  
Elke R. Fahrmann ◽  
Laura Adkins ◽  
Henry K. Driscoll
Keyword(s):  
Type 1 Diabetes ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Severe Hypoglycemia ◽  
Vascular Damage ◽  
Diabetes Duration ◽  
Ischemic Heart

OBJECTIVE <p>Literature suggests that severe hypoglycemia (SH) may be linked to cardiovascular events only in older individuals with high cardiovascular risk score (CV-score). Whether a potential relationship between any-SH and cardiovascular disease exists and whether it is conditional on vascular damage severity in a young type 1 diabetes (T1D) cohort without apparent macro-vascular and no or mild-to-moderate micro-vascular complications at baseline is unknown.</p> <p>RESEARCH DESIGN AND METHODS</p> <p>We evaluated data of 1441 Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) volunteers (diabetes duration 1-15 years) followed for ~30 years. Time-dependent associations between any-SH, interactions of any-SH with surrogates of baseline micro-/macro- vascular damage severity (diabetes duration, Early Treatment Diabetic Retinopathy Study scale (ETDRS), Diabetes Complications Severity Index (DCSI), or CV-scores) and ischemic heart disease (IHD: death, silent/nonfatal myocardial infarct, revascularization, or confirmed angina) were analyzed.</p> <p>RESULTS</p> <p>Without interactions, in the minimal adjusted model controlling for confounding bias by age and HbA1c, SH was a significant IHD factor (p~0.003). SH remained a significant factor for IHD in fully adjusted models (p<0.05). In models with interactions, interactions between SH and surrogates of microvascular complications severity, but not between SH and CV-score, were significant. Hazard ratios for IHD based on SH increased 1.19-fold, 1.32-fold, and 2.21-fold for each additional year of diabetes duration, ETDRS-unit, and DCSI-unit, respectively. At time of IHD event, ~15% of 110 participants with SH had high CV-scores.</p> <p> </p> <p>CONCLUSION</p> <p>In a young T1D cohort with no baseline macrovascular complications, surrogates of baseline microvascular damage severity impact the effect of SH on IHD. Older age with high CV-score per se is not mandatory for an association of SH with IHD. However, the association is multifactorial.</p>

scholarly journals Reduced expression of OXPHOS and DNA damage genes is linked to protection from microvascular complications in long-term type 1 diabetes: the PROLONG study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Türküler Özgümüş ◽  
Oksana Sulaieva ◽  
Leon Eyrich Jessen ◽  
Ruchi Jain ◽  
Henrik Falhammar ◽  
...  
Keyword(s):  
Dna Repair ◽  
Type 1 Diabetes ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Diabetes Duration ◽  
Chronic Hyperglycemia ◽  
Increased Risk ◽  
Term Type

AbstractType 1 diabetes is a chronic autoimmune disease requiring insulin treatment for survival. Prolonged duration of type 1 diabetes is associated with increased risk of microvascular complications. Although chronic hyperglycemia and diabetes duration have been considered as the major risk factors for vascular complications, this is not universally seen among all patients. Persons with long-term type 1 diabetes who have remained largely free from vascular complications constitute an ideal group for investigation of natural defense mechanisms against prolonged exposure of diabetes. Transcriptomic signatures obtained from RNA sequencing of the peripheral blood cells were analyzed in non-progressors with more than 30 years of diabetes duration and compared to the patients who progressed to microvascular complications within a shorter duration of diabetes. Analyses revealed that non-progressors demonstrated a reduction in expression of the oxidative phosphorylation (OXPHOS) genes, which were positively correlated with the expression of DNA repair enzymes, namely genes involved in base excision repair (BER) machinery. Reduced expression of OXPHOS and BER genes was linked to decrease in expression of inflammation-related genes, higher glucose disposal rate and reduced measures of hepatic fatty liver. Results from the present study indicate that at transcriptomic level reduction in OXPHOS, DNA repair and inflammation-related genes is linked to better insulin sensitivity and protection against microvascular complications in persons with long-term type 1 diabetes.

scholarly journals Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002288
Author(s):  
Martine J Wellens ◽  
Charlotte E Vollenbrock ◽  
Pim Dekker ◽  
Lianne S M Boesten ◽  
Petronella H Geelhoed-Duijvestijn ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Antihypertensive Drugs ◽  
Microvascular Complications ◽  
Severe Hypoglycemia ◽  
Diabetes Duration ◽  
Fasting Serum ◽  
C Peptide ◽  
Diabetes Onset ◽  
Peptide Secretion

IntroductionThis study aimed to assess the association between fasting serum C-peptide levels and the presence of impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes.Research design and methodsWe performed a cross-sectional study among 509 individuals with type 1 diabetes (diabetes duration 5–65 years). Extensive clinical data and fasting serum C-peptide concentrations were collected and related to the presence or absence of IAH, which was evaluated using the validated Dutch version of the Clarke questionnaire. A multivariable logistic regression model was constructed to investigate the association of C-peptide and other clinical variables with IAH.ResultsIn 129 (25%) individuals, residual C-peptide secretion was detected, while 75 (15%) individuals reported IAH. The median (IQR) C-peptide concentration among all participants was 0.0 (0.0–3.9) pmol/L. The prevalence of severe hypoglycemia was lower in people with demonstrable C-peptide versus those with absent C-peptide (30% vs 41%, p=0.025). Individuals with IAH were older, had longer diabetes duration, more frequently had macrovascular and microvascular complications, and more often used antihypertensive drugs, antiplatelet agents and cholesterol-lowering medication. There was a strong association between IAH and having a severe hypoglycemia in the preceding year. In multivariable regression analysis, residual C-peptide, either continuously or dichotomous, was associated with lower prevalence of IAH (p=0.040–0.042), while age at diabetes onset (p=0.001), presence of microvascular complications (p=0.003) and body mass index (BMI) (p=0.003) were also independently associated with the presence of IAH.ConclusionsHigher BMI, the presence of microvascular complications and higher age at diabetes onset were independent risk factors for IAH in people with type 1 diabetes, while residual C-peptide secretion was associated with lower risk of this complication.

scholarly journals Plasma Copeptin, Kidney Outcomes, Ischemic Heart Disease, and All-Cause Mortality in People With Long-standing Type 1 Diabetes

Diabetes Care ◽  
2016 ◽  
Vol 39 (12) ◽  
pp. 2288-2295 ◽  
Author(s):  
Gilberto Velho ◽  
Ray El Boustany ◽  
Guillaume Lefèvre ◽  
Kamel Mohammedi ◽  
Frédéric Fumeron ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Ischemic Heart ◽  
All Cause Mortality

Autoimmune comorbidity and microvascular complications in childhood-onset type 1 diabetes after 20 years of diabetes duration. A questionnaire study

2012 ◽  
Vol 153 (6) ◽  
pp. 222-226
Author(s):  
Katalin H. Nagy ◽  
Barnabás Rózsai ◽  
Kálmán Kürti ◽  
Ilona Rippl ◽  
Éva Erhardt ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Microvascular Complications ◽  
Thyroid Autoimmunity ◽  
Vascular Complications ◽  
Population Based ◽  
Diabetes Duration ◽  
Childhood Onset ◽  
Onset Type

There are no population-based data on the autoimmune morbidity and vascular complications of young adults with childhood-onset type 1 diabetes in Hungary. Aims: To assess the prevalence of these morbidities after 20 years of diabetes duration. Method: Postal questionnaire. Results: 6.2% of the patients had celiac disease. Diabetes was diagnosed at a significantly earlier age in patients with diabetes and celiac disease as compared to those without celiac diasease. Thyroid autoimmunity was reported in 7.6% of cases. They were significantly older with longer duration of diabetes. Every fifth patients reported retinopathy, one sixth of patients was treated for hypertension. Neuropathy was found in 3.4% and kidney disease in 4.8% of the cases. Conclusions: Apart from retinopathy and hypertension, the prevalence of microvascular complications was relatively low. Considering the limitations of questionnaire studies, laboratory screening is warranted to assess the true prevalence of comorbidities and complications. Orv. Hetil., 2012, 153, 222–226.

scholarly journals Impact of Sex and Age at Onset of Diabetes on Mortality From Ischemic Heart Disease in Patients With Type 1 Diabetes

Diabetes Care ◽  
2013 ◽  
Vol 37 (1) ◽  
pp. 144-148 ◽  
Author(s):  
Valma Harjutsalo ◽  
Christine Maric-Bilkan ◽  
Carol Forsblom ◽  
Per-Henrik Groop
Keyword(s):  
Type 1 Diabetes ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Age At Onset ◽  
Ischemic Heart ◽  
Onset Of Diabetes

Risk factors for mortality and ischemic heart disease in patients with long-term type 1 diabetes

2010 ◽  
Vol 24 (4) ◽  
pp. 223-228 ◽  
Author(s):  
Jakob Grauslund ◽  
Trine M.M. Jørgensen ◽  
Mads Nybo ◽  
Anders Green ◽  
Lars M. Rasmussen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Ischemic Heart ◽  
Term Type

scholarly journals Diabetes Complications and their Relation to Glycemic Control among Patients Attending Diabetic Clinic at King Khalid National Guard Hospital in Jeddah, Saudi Arabia

2011 ◽  
Vol 1 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Abdullah M. Krawagh ◽  
Abdullah M. Alzahrani ◽  
Tariq A. Naser
Keyword(s):  
Diabetes Mellitus ◽  
Saudi Arabia ◽  
Heart Disease ◽  
Glycemic Control ◽  
Ischemic Heart Disease ◽  
National Guard ◽  
Microvascular Complications ◽  
Ischemic Heart ◽  
Diabetic Clinic

This study addresses the prevalence of ischemic heart disease, hypertension and long-term complications of diabetes mellitus among patients attending the diabetic clinic and their relation to glycemic control. Methods: A study was conducted on a cross-section on all consecutive patients attending the diabetic clinic at King Khalid National Guard Hospital in Jeddah, Saudi Arabia, from January 2007 to January 2008. The degree of glycemic control was gauged using blood level of glycosylated hemoglobin (HbA1C) and classified into good (less 7%), fair (7.1-8%), poor (8.1-9%) and very poor (greater than 9%). All patients were screened for hypertension, ischemic heart disease and microvascular complications. Results: Two hundred and ten patients were recruited in the study. Glycemic control was good in 17 (8.1%), fair in 49 (23.2%), poor in 56 (26.6%) and very poor in 88 (41.9%). There was high prevalence of retinopathy (76; 36%), microalbuminuria (80; 37.9%), neuropathy (108; 51.2%) and ischemic heart disease (51; 24.2%), especially among patients with poor and very poor control. Although the presence of hypertension, frank nephropathy and peripheral vascular disease was also disturbingly high among diabetic patients, their frequency was the same among good, fair, poor and very poor glycemic control groups. Conclusion: The prevalence of long-term complications of diabetes mellitus was alarmingly high among Saudi nationals. Microvascular complications and ischemic heart disease were also noticed to be more common in diabetics with poor and very poor glycemic control. This emphasizes the need of national awareness program about the gravity of the problem.

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