scholarly journals Heart Failure in Type 1 Diabetes: A Complication of Concern? A Narrative Review

2021 ◽  
Vol 10 (19) ◽  
pp. 4497
Author(s):  
Ana María Gómez-Perez ◽  
Miguel Damas-Fuentes ◽  
Isabel Cornejo-Pareja ◽  
Francisco J. Tinahones
Keyword(s):  
Heart Failure ◽  
Type 1 Diabetes ◽  
Common Complication ◽  
Prevention Strategies ◽  
Sodium Glucose Cotransporter ◽  
Therapeutic Tools ◽  
Worse Prognosis

Heart failure (HF) has been a hot topic in diabetology in the last few years, mainly due to the central role of sodium-glucose cotransporter 2 inhibitors (iSGLT2) in the prevention and treatment of cardiovascular disease and heart failure. It is well known that HF is a common complication in diabetes. However, most of the knowledge about it and the evidence of cardiovascular safety trials with antidiabetic drugs refer to type 2 diabetes (T2D). The epidemiology, etiology, and pathophysiology of HF in type 1 diabetes (T1D) is still not well studied, though there are emerging data about it since life expectancy for T1D has increased in the last decades and there are more elderly patients with T1D. The association of T1D and HF confers a worse prognosis than in T2D, thus it is important to investigate the characteristics, risk factors, and pathophysiology of this disease in order to effectively design prevention strategies and therapeutic tools.

scholarly journals Sodium–Glucose Cotransporter-2 Inhibitors and Heart Failure Prevention in Type 2 Diabetes

2019 ◽  
Vol 5 (3) ◽  
pp. 169-172 ◽  
Author(s):  
Muhammad Shahzeb Khan ◽  
Javed Butler
Keyword(s):  
Heart Failure ◽  
Sglt2 Inhibitors ◽  
Current Evidence ◽  
Future Directions ◽  
Glucose Lowering ◽  
Sodium Glucose Cotransporter ◽  
Reduce Risk ◽  
Worse Prognosis

Diabetes and heart failure (HF) are closely linked, with one causing a worse prognosis in the other. The majority of anti-hyperglycaemic agents primarily reduce risk of ischaemic microvascular events without targeting the mechanisms involved for diabetes cardiomyopathy and HF. Sodium–glucose cotransporter-2 (SGLT2) inhibitors have emerged as a novel class of glucose-lowering agents that have consistently reduced HF hospitalisations, unlike other agents. The authors discuss the current evidence and highlight possible future directions for the role of SGLT2 inhibitors in HF prevention.

scholarly journals Lipid metabolism and its implications for type 1 diabetes-associated cardiomyopathy

2017 ◽  
Vol 58 (4) ◽  
pp. R225-R240 ◽  
Author(s):  
Rebecca H Ritchie ◽  
Eser J Zerenturk ◽  
Darnel Prakoso ◽  
Anna C Calkin
Keyword(s):  
Heart Failure ◽  
Type 1 Diabetes ◽  
Lipid Metabolism ◽  
Large Population ◽  
Diabetic Patients ◽  
Heart Study ◽  
Cardiac Lipotoxicity

Diabetic cardiomyopathy was first defined over four decades ago. It was observed in small post-mortem studies of diabetic patients who suffered from concomitant heart failure despite the absence of hypertension, coronary disease or other likely causal factors, as well as in large population studies such as the Framingham Heart Study. Subsequent studies continue to demonstrate an increased incidence of heart failure in the setting of diabetes independent of established risk factors, suggesting direct effects of diabetes on the myocardium. Impairments in glucose metabolism and handling receive the majority of the blame. The role of concomitant impairments in lipid handling, particularly at the level of the myocardium, has however received much less attention. Cardiac lipid accumulation commonly occurs in the setting of type 2 diabetes and has been suggested to play a direct causal role in the development of cardiomyopathy and heart failure in a process termed as cardiac lipotoxicity. Excess lipids promote numerous pathological processes linked to the development of cardiomyopathy, including mitochondrial dysfunction and inflammation. Although somewhat underappreciated, cardiac lipotoxicity also occurs in the setting of type 1 diabetes. This phenomenon is, however, largely understudied in comparison to hyperglycaemia, which has been widely studied in this context. The current review addresses the changes in lipid metabolism occurring in the type 1 diabetic heart and how they are implicated in disease progression. Furthermore, the pathological pathways linked to cardiac lipotoxicity are discussed. Finally, we consider novel approaches for modulating lipid metabolism as a cardioprotective mechanism against cardiomyopathy and heart failure.

scholarly journals Estimating the Effect of Liver and Pancreas Volume and Fat Content on Risk of Diabetes: A Mendelian Randomization Study

Diabetes Care ◽  
2021 ◽  
Author(s):  
Susan Martin ◽  
Elena P. Sorokin ◽  
E. Louise Thomas ◽  
Naveed Sattar ◽  
Madeleine Cule ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Mendelian Randomization ◽  
Fat Content ◽  
Liver Fat ◽  
Liver And Pancreas ◽  
Pancreas Volume

OBJECTIVE Fat content and volume of liver and pancreas are associated with risk of diabetes in observational studies; whether these associations are causal is unknown. We conducted a Mendelian randomization (MR) study to examine causality of such associations. RESEARCH DESIGN AND METHODS We used genetic variants associated (P < 5 × 10−8) with the exposures (liver and pancreas volume and fat content) using MRI scans of UK Biobank participants (n = 32,859). We obtained summary-level data for risk of type 1 (9,358 cases) and type 2 (55,005 cases) diabetes from the largest available genome-wide association studies. We performed inverse–variance weighted MR as main analysis and several sensitivity analyses to assess pleiotropy and to exclude variants with potential pleiotropic effects. RESULTS Observationally, liver fat and volume were associated with type 2 diabetes (odds ratio per 1 SD higher exposure 2.16 [2.02, 2.31] and 2.11 [1.96, 2.27], respectively). Pancreatic fat was associated with type 2 diabetes (1.42 [1.34, 1.51]) but not type 1 diabetes, and pancreas volume was negatively associated with type 1 diabetes (0.42 [0.36, 0.48]) and type 2 diabetes (0.73 [0.68, 0.78]). MR analysis provided evidence only for a causal role of liver fat and pancreas volume in risk of type 2 diabetes (1.27 [1.08, 1.49] or 27% increased risk and 0.76 [0.62, 0.94] or 24% decreased risk per 1SD, respectively) and no causal associations with type 1 diabetes. CONCLUSIONS Our findings assist in understanding the causal role of ectopic fat in the liver and pancreas and of organ volume in the pathophysiology of type 1 and 2 diabetes.

scholarly journals The role of glycemic self-control in diabetes management: based on the American Diabetes Association guidelines (2021)

2021 ◽  
pp. 286-292
Author(s):  
G. E. Runova
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
American Diabetes Association ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Self Monitoring ◽  
Diabetes Technology

Glycemic control represents an integral part of diabetes mellitus (DM) therapy. It is not surprising that diabetes technology is evolving to not only create new routes of insulin administration, but also to improve the measurement of glycemia. A significant number of new glucose monitoring systems have been launched to the market over the past 10 years. Nevertheless, only 30% of patients with type 1 diabetes and very few patients with type 2 diabetes use continuous or flash glucose monitoring. The reason for this is not only the cost and technical difficulties of continuous glucose monitoring, but also its clinical appropriateness. There is indisputable evidence that patients who receive intensified insulin therapy, especially those with type 1 diabetes, need frequent self-monitoring / continuous glucose monitoring. As for patients with type 2 diabetes receiving basal insulin and / or other antihyperglycemic therapy, the data received seem to be contradictory and uncertain. However, most of the recommendations simmer down to the need for self-monitoring of blood glucose levels in patients with type 2 diabetes. The diabetes technology section of the American Diabetes Association guidelines 2021 goes into details about the role of self-monitoring of blood glucose in diabetes management, including the need for continuous patient education on the principles and rules of self-monitoring, interpretation and practical use of the results of self-monitoring, various standards of glucometers, factors affecting the accuracy of the results. 

Stress Induced Diabetes

2021 ◽  
Vol 11 (2) ◽  
pp. 145-150
Author(s):  
Vaishnav Priti Baludas ◽  
Kadam Kavita Shivaji ◽  
Kalunkhe Amruta Dadasaheb ◽  
Pagar Swati Aappasaheb ◽  
Musmade Deepak Sitaram
Keyword(s):  
Type 1 Diabetes ◽  
Animal Studies ◽  
Physiological Mechanism ◽  
Human Studies ◽  
Control Of Diabetes ◽  
Natural Element ◽  
Stressful Experience

Many evidences suggested that stressful experience might affect diabetes. The estimate of the actual number of diabetes in India is around 40 million. This means India actually has the highest number of diabetic’s patient of any one country in entire world. No doubt, one of the natural element of life i.e. Stress is a major contributor to the diabetes. Stress can bring many unexpected changes in the blood sugar level; this could trigger symptoms associated with diabetes. Some retrospective human studies have suggested that the stress can participate in Type-1 diabetes, animal studies have shown that stress can cause Type-1 diabetes. impaired glucose tolerance and metabolic disease, however human studies have shown that stress can stimulate hyperglycaemia, insulin resistance. In contrast more consistentevidence support the role of stress in Type-2 diabetes. In recent year the complexities of the relationship between stress and diabetes have become well known but have been less well researched. Some studies have suggested that stressful experience may affect the onset and the metabolic control of diabetes, but finding have often been inconclusive. In this article we reviewed some of this research going on to consider how stress might affect the diabetes and physiological mechanism through which this may occurs and their preventions and management.

6. Appetite, fat, and obesity

2014 ◽  
pp. 74-87
Author(s):  
Martin Luck
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
The Body ◽  
Storage Process ◽  
Lifestyle Disease ◽  
Energy Shortage

‘Appetite, fat, and obesity’ considers the role of insulin in the body’s fat storage process. In the condition diabetes mellitus, the sugar level in the blood rises uncontrollably so the kidneys cannot stop it leaking into the urine. Type 1 diabetes is an autoimmune disease in which a person’s immune system attacks the insulin-secreting β-cells of the pancreas. The only effective treatment is to inject the missing insulin. Type 2 diabetes is considered more of a lifestyle disease. But what exactly is the connection between obesity and poorly regulated blood glucose? The body has more hormones capable of responding to energy shortage than to energy abundance, which may be why keeping control of body weight can be difficult. The hormones affecting appetite are also discussed.

The preventive role of type 2 NKT cells in the development of type 1 diabetes

Apmis ◽  
2013 ◽  
Vol 122 (3) ◽  
pp. 167-182 ◽  
Author(s):  
Jakob Ørskov Sørensen ◽  
Karsten Buschard ◽  
Carl-Henrik Brogren
Keyword(s):  
Type 1 Diabetes ◽  
Nkt Cells ◽  
Preventive Role

scholarly journals Type 1 diabetes mellitus: most recent advances in its pathogenesis and treatment

2012 ◽  
Vol 153 (27) ◽  
pp. 1047-1056 ◽  
Author(s):  
András Zóka ◽  
Anikó Somogyi ◽  
Gábor Firneisz
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Protective Role ◽  
Therapeutic Approaches ◽  
Β Cell ◽  
Mhc Genes ◽  
Prevalence Of Diabetes Mellitus

The incidence and prevalence of diabetes mellitus is globally increasing. The causes of this trend are relatively obvious in the case of type 2 diabetes. In contrast, in case of type 1 diabetes the amount of available data is continuously growing, but the causes are not so well defined. The genetic risk, especially related to the MHC genes is well known, and the increasing amount of data underlines the role of additional risks due to non-MHC genetic polimorphisms. Hopefully, they will provide the basis for future diagnostic and therapeutic approaches. There is increasing knowledge about the pathophysiological aspects including the role of immunological disregulation (balance of autotolerance, role of regulatory T-cells) and environmental triggers (nutrients, viruses). Information on the entero-insular axis and the β-cell protective role of incretin hormones might offer an opportunity for new therapeutic strategies. In this paper, the authors try to summarize some current aspects of the pathomechanism and related therapeutic approaches. Orv. Hetil., 2012, 153, 1047–1056.

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