Diabetic Medicine
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Physical activity level and body composition among adults with Type 1 diabetes Abstract Aims Physical activity is part of a healthy lifestyle and contributes to prevent weight gain and cardiometabolic disorders. Adults with Type 1 diabetes are at risk of weight gain attributable to various factors, including a high prevalence of sedentary lifestyle related to fear of exercise‐induced hypoglycaemia. This project aims to observe the association between physical activity level and body composition in adults with Type 1 diabetes.Methods Cross‐sectional study; 75 adults with and 75 adults without diabetes (52% men; 41.8 ± 11.8 years old) wore a motion sensor for 1 week and performed a cardiorespiratory fitness test on an ergocycle (VO2 peak ). Body composition was assessed by dual energy X‐ray absorptiometry and circumferences measures.Results Mean body composition was not different between the two groups. VO2 peak was lower among the group with diabetes than the control subjects (29.3 ± 9.2 vs. 33.5 ± 9.0 ml kg−1 min−1 ; P = 0.005), but their physical activity level (ratio total/resting energy expenditure) was similar (1.68 ± 0.37 vs. 1.65 ± 0.26; P = 0.572). In both groups, having an active lifestyle (physical activity level ≥ 1.7) compared with a more sedentary lifestyle (physical activity level < 1.7) was associated with lower BMI and percentage of total and truncal fat mass (P ≤ 0.030 to P ≤ 0.001). Among adults with diabetes, physical activity level was not associated with diabetes treatment (insulin doses) and control (HbA1c and hypoglycaemia) or cardiovascular risk factors (blood pressure and lipid profile).Conclusion As in the population without diabetes, an active lifestyle is associated with a better body composition profile in adults with Type 1 diabetes.
Diabetic Medicine - Tập 29 Số 11 - 2012
Diabetic neuropathy is closely associated with arterial stiffening and thickness in Type 2 diabetes Abstract Aims Interaction of vascular and metabolic factors appears to contribute to the pathogenesis of diabetic neuropathy. The aim of the study was to assess the impact of arterial stiffening and thickness on diabetic neuropathy in Type 2 diabetes.Methods In 294 patients with Type 2 diabetes, neuropathy was assessed by four components: the presence of neuropathic symptoms, the absence of ankle tendon reflexes, perception of vibration scores and heart rate variation. We measured intima‐media thickness (IMT) of carotid arteries to assess arterial thickening, and brachial–ankle pulse‐wave velocity (PWV) and brachial pulse pressure (PP) which reflect arterial stiffening.Results Diabetic neuropathy, defined as ≥ two of the four components, was significantly associated with age, duration, glycated haemoglobin (HbA1c ), systolic blood pressure, diastolic blood pressure, PP, hypertension, retinopathy, urinary albumin excretion rate, nephropathy stages, PWV and IMT. PWV and PP were significantly associated with neuropathy independent of conventional cardiovascular risk factors. Multiple logistic regression analysis revealed that PWV, retinopathy, age, and HbA1c , were significant independent determinants of neuropathy.Conclusions The present cross‐sectional study indicates that markers for vascular wall properties such as PWV, IMT and PP are significantly associated with diabetic neuropathy. PWV and PP are significant determinants of neuropathy independent of conventional cardiovascular risk factors. Multifactorial intervention to inhibit progression of the atherosclerotic process may slow progression of neuropathy.
Diabetic Medicine - Tập 24 Số 12 - Trang 1329-1335 - 2007
Diabetic retinopathy is associated with an increased incidence of cardiovascular events in Type 2 diabetic patients Abstract Aims We investigated the association of diabetic retinopathy with the risk of incident cardiovascular disease (CVD) events in a large cohort of Type 2 diabetic adults.Methods Our study cohort comprised 2103 Type 2 diabetic outpatients who were free of diagnosed CVD at baseline. Retinal findings were classified based on fundoscopy (by a single ophthalmologist) to categories of no retinopathy, non‐proliferative retinopathy and proliferative/laser‐treated retinopathy. Outcomes measures were incident CVD events (i.e. non‐fatal myocardial infarction, non‐fatal ischaemic stroke, coronary revascularization procedures or cardiovascular death).Results During approximately 7 years of follow‐up, 406 participants subsequently developed incident CVD events, whereas 1697 participants remained free of diagnosed CVD. After adjustment for age, body mass index, waist circumference, smoking, lipids, glycated haemoglobin, diabetes duration and medications use, patients with non‐proliferative or proliferative/laser‐treated retinopathy had a greater risk (P < 0.001 for all) of incident CVD events than those without retinopathy [hazard ratio 1.61 (95% confidence interval 1.2–2.6) and 3.75 (2.0–7.4) for men, and 1.67 (1.3–2.8) and 3.81 (2.2–7.3) for women, respectively]. After additional adjustment for hypertension and advanced nephropathy (defined as overt proteinuria and/or estimated glomerular filtration rate ≤ 60 ml/min/1.73 m2 ), the risk of incident CVD remained markedly increased in those with proliferative/laser‐treated retinopathy [hazard ratio 2.08 (1.02–3.7) for men and 2.41 (1.05–3.9) for women], but not in those with non‐proliferative retinopathy.Conclusions Diabetic retinopathy (especially in its more advanced stages) is associated with an increased CVD incidence independent of other known cardiovascular risk factors.
Diabetic Medicine - Tập 25 Số 1 - Trang 45-50 - 2008
Vascular dysfunction and autonomic neuropathy in Type 2 diabetes Abstract Aims To test the hypothesis that arterial dysfunction in Type 2 diabetes is related to autonomic neuropathy.Methods Arterial function and autonomic neuropathy were assessed over two consecutive days in 45 Type 2 diabetic and control subjects. Systemic arterial compliance (SAC), arterial stiffness (pulse‐wave velocity, PWV) and carotid intima thickness (IMT) were assessed; these markers reflect early vascular disease and predict clinical vascular events. Autonomic neuropathy was assessed using heart rate variability with continuous ECG recording during various breathing and postural manoeuvres and an overall autonomic score was generated. Fasting metabolic parameters including glucose, insulin, HbA1c and lipid profile were measured.Results Autonomic neuropathy tests were all repeatable in diabetic subjects. Compared with controls, diabetic subjects had arterial dysfunction with increased PWV (P = 0.009), IMT (P < 0.001) and reduced SAC (P = 0.053). After adjustment for age, central PWV correlated with fasting insulin (r 2 = 0.45, P < 0.05) and autonomic score (r 2 = 0.44, P < 0.05), peripheral PWV correlated with autonomic score (r 2 = 0.51, P < 0.005) and IMT correlated with fasting insulin (r 2 = 0.5, P < 0.005). The presence of autonomic neuropathy correlated with fasting insulin (P = 0.015), but not age, duration diabetes, lipids or blood pressure.Conclusion Using repeatable measures of autonomic neuropathy and vascular function in Type 2 diabetic subjects, we have demonstrated associations between autonomic neuropathy, vascular dysfunction and hyperinsulinaemia. This may help to explain the excess cardiovascular mortality seen in diabetic subjects with autonomic neuropathy.
Diabetic Medicine - Tập 21 Số 7 - Trang 746-751 - 2004
Association between changes in oestradiol and follicle‐stimulating hormone levels during the menopausal transition and risk of diabetes Abstract Aim To investigate the association between changes in oestradiol and follicle‐stimulating hormone levels during the menopausal transition and incident diabetes. Methods We followed 1407 pre‐menopausal women, aged 42–52 years at baseline, who experienced natural menopause, from baseline to the 12th annual follow‐up visit in the Study of Women's Health Across the Nation (SWAN ). Diabetes was defined based on fasting glucose level, medication use and self‐report of physician diagnosis. Cox proportional hazards regression was used to evaluate the associations of incident diabetes with three components of the rate of change in hormones: the intercept (pre‐menopausal levels) and two piece‐wise slopes representing change during the early and late transition, respectively. Results During 15 years of follow‐up, 132 women developed diabetes. After adjusting for potential confounders, a higher oestradiol intercept, but not its rate of change, was borderline significantly associated with lower risk of diabetes [hazard ratio for an interquartile range increase (75.2 pmol/L) 0.53, 95% CI 0.27–1.06]. For follicle‐stimulating hormone, a greater rate of increase in the early transition, but not the intercept or late transition, was significantly associated with lower risk of diabetes [hazard ratio for an interquartile range increase (5.9 IU/L/year) 0.31, 95% CI 0.10–0.94]. Conclusions Lower pre‐menopausal oestradiol levels and a slower rate of follicle‐stimulating hormone change during the early transition were associated with higher risk of developing diabetes. Given that obesity plays an important role in diabetes risk and in the levels and changes in oestradiol and follicle‐stimulating hormone over the menopausal transition, weight control in earlier mid‐life is important to prevent future diabetes development.
Diabetic Medicine - Tập 34 Số 4 - Trang 531-538 - 2017
Lack of effect of simvastatin on insulin sensitivity in Type 2 diabetic patients with hypercholesterolaemia: results from a double-blind, randomized, placebo-controlled crossover study
Diabetic Medicine - Tập 16 Số 9 - Trang 749-754 - 1999
Oxidized Low Density Lipoproteins: a Role in the Pathogenesis of Atherosclerosis in Diabetes?
Diabetic Medicine - Tập 8 Số 5 - Trang 411-419 - 1991
Comparison of autoantibodies to IA‐2 and GAD<sub>65</sub> in the rapid‐ and the slow‐onset, adult Type 1 diabetes in Thailand
Diabetic Medicine - Tập 18 Số 9 - Trang 770-772 - 2001
Latent Autoimmune Diabetes Mellitus in Adults (LADA): the Role of Antibodies to Glutamic Acid Decarboxylase in Diagnosis and Prediction of Insulin Dependency Type 1 diabetes mellitus in adults may present in a manner similar to that of Type 2 diabetes but with a late development of insulin dependency. We studied 65 patients who presented with ‘adult‐onset’ diabetes after the age of 30 years. Of these patients, 19 required insulin therapy. The insulin‐treated patients were significantly younger, their onset of diabetes was at an earlier age, and their postprandial serum C‐peptide levels were lower than those of the non‐insulin‐treated group. Moreover, the insulin‐treated subjects had a higher mean concentration of antibodies to glutamic acid decarboxylase (GAD) (66.8 ± 10.2 units) than the patients who did not require insulin (9.9 ± 1.9 units) (p < 0.001) and their frequency of anti‐GAD positivity was 73.7% versus 4.3% (p < 0.001). Thus, among patients attending a diabetes clinic, the majority (73.7%) of subjects who presented with diabetes after 30 years of age and who subsequently required therapy with insulin, actually have the islet cell lesion of Type 1 diabetes which progresses at a slower tempo than in children. We conclude that testing for anti‐GAD in adult‐onset non‐obese diabetic patients should be a routine procedure in order to detect latent insulin‐dependency at the earliest possible stage, since this assay can assist in the correct classification of diabetes, and more appropriate therapy.
Diabetic Medicine - Tập 11 Số 3 - Trang 299-303 - 1994
Urine and plasma metabolites predict the development of diabetic nephropathy in individuals with Type 2 diabetes mellitus Abstract Aims Early detection of individuals with Type 2 diabetes mellitus or hypertension at risk for micro‐ or macroalbuminuria may facilitate prevention and treatment of renal disease. We aimed to discover plasma and urine metabolites that predict the development of micro‐ or macroalbuminuria. Methods Patients with Type 2 diabetes (n = 90) and hypertension (n = 150) were selected from the community‐cohort ‘Prevention of RE nal and Vascular End‐stage Disease’ (PREVEND ) and the Steno Diabetes Center for this case–control study. Cases transitioned in albuminuria stage (from normo‐ to microalbuminuria or micro‐ to macroalbuminuria). Controls, matched for age, gender, and baseline albuminuria stage, remained in normo‐ or microalbuminuria stage during follow‐up. Median follow‐up was 2.9 years. Metabolomics were performed on plasma and urine. The predictive performance of a metabolite for albuminuria transition was assessed by the integrated discrimination index. Results In patients with Type 2 diabetes with normoalbuminuria, no metabolites discriminated cases from controls. In patients with Type 2 diabetes with microalbuminuria, plasma histidine was lower (fold change = 0.87, P = 0.02) and butenoylcarnitine was higher (fold change = 1.17, P = 0.007) in cases vs. controls. In urine, hexose, glutamine and tyrosine were lower in cases vs. controls (fold change = 0.20, P < 0.001; 0.32, P < 0.001; 0.51, P = 0.006, respectively). Adding the metabolites to a model of baseline albuminuria and estimated glomerular filtration rate metabolites improved risk prediction for macroalbuminuria transition (plasma integrated discrimination index = 0.28, P < 0.001; urine integrated discrimination index = 0.43, P < 0.001). These metabolites did not differ between hypertensive cases and controls without Type 2 diabetes. Conclusions Type 2 diabetes‐specific plasma and urine metabolites were discovered that predict the development of macroalbuminuria beyond established renal risk markers. These results should be confirmed in a large, prospective cohort.
Diabetic Medicine - Tập 31 Số 9 - Trang 1138-1147 - 2014
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