Lipid peroxidation,antioxidants, lipid profile,and HbA1c in diabetic patients

Diabetes mellitus is characterized by hyperglycemia together with biochemical changes in glucose, lipid profile, lipid peroxidation, and antioxidants status. This study aims to assess lipid profile, lipid peroxidation, antioxidants, and glycated hemoglobin (HbA1c) in type 1 and type 2 diabetic subjects. Type 1 and type 2 diabetic patients were selected from the subjects attending OPD in Nepalgunj Medical College, Nepal, for medical checkup. Fasting blood sugar (FBS), lipid profile, lipid peroxidation (malondialdehyde), and antioxidants status (reduced glutathione and vitamin E) were estimated in both groups and were compared with healthy controls. Low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratio was calculated to assess the cardiovascular risk factors. When type 1 diabetic patients were compared with type 2 diabetic patients, it showed statistically significant increase in the levels of HbA1c, triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C), whereas statistically significant decreased level was found in malondialdehyde (MDA). FBS, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), reduced glutathione (GSH), vitamin E, and HDL/LDL ratio were not significant. Early diagnosis of dyslipidemia and oxidative stress can be used as a preventive measure for the development of microvascular and macrovascular complications in type 1 and type 2 diabetes mellitus.     

Association of serum sialic acid with cardiovascular metabolic risk factors in Kuwaiti children and adolescents with type 1 diabetes

The aim of the present study was to investigate the relation of serum total sialic acid (TSA) concentrations with cardiovascular metabolic risk factors in Kuwaiti children and adolescents with uncomplicated type 1 diabetes. This case-control study included 150 (57 males and 93 females) type 1 diabetic children aged 6 to 18 years matched by age and sex to 150 nondiabetic children as controls. Measured variables included weight, height, systolic, diastolic blood pressure, and biochemical variables: blood glucose, glycated hemoglobin (HbA(1C)), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), apolipoproteins (apo) A1 and B, and urine microalbumin. There was no significant difference between mean serum TSA of the type 1 diabetic children (671.0 mg/L) and their controls (663.7 mg/L). In diabetic children, mean serum TSA was significantly higher in females (699.1 mg/L) than in males (625.2 mg/L) (P =.003). Significant correlations were found between serum TSA and the cardiovascular risk factors TC (P =.002), TG (P <.001), and apo B (P =.008). TSA mean level was significantly higher in diabetic children with poor glycemic control (HbA(1C) > 9.0%; P =.015), raised TC (P =.013), raised TG (P =.014), and in children with family history of cardiovascular disease (CVD; P =.02). In conclusion, the study suggests that serum TSA levels were not elevated in young type 1 diabetic children as compared with controls. The study also confirmed significant correlation of TSA concentrations with CVD risk factors TC, TG, and apo B, and as such serum TSA may be considered as a marker for CVD risk, especially in diabetic patients. A long-term prospective study is recommended to ascertain the longitudinal relationship of serum TSA with the adverse metabolic changes in type 1 diabetic children as complications prevail.     

High and low hemoglobin glycation phenotypes in type 1 diabetes: a challenge for interpretation of glycemic control

This study tested the hypothesis that there are consistent individual differences in the relationship between glycated hemoglobin (HbA1c) and mean blood glucose (MBG) levels in individuals with similar preceding blood glucose levels. Blood glucose data were collected for up to 2.3 years by 128 children and adolescents with type 1 diabetes. HbA1c values were date-matched with MBG levels calculated from an average of 85 self-monitored blood glucose measurements collected in the previous 30 days. There was significant linear correlation between MBG and HbA1c (HbA1c=0.027xMBG+5.8, n=682, r=.71, P<.0001) but also wide variability in the population HbA1c response to MBG. We calculated a hemoglobin glycation index (HGI=observed HbA1c-predicted HbA1c) to quantify the magnitude and direction of the difference between each patient's set of observed and predicted HbA1c results. Likelihood ratio tests and t statistics showed that mean HGI were significantly different among individuals, and that 29% of the patients had HbA1c levels that were statistically significantly higher or lower than predicted by the regression equation. The observed individual differences in the relationship between MBG and HbA1c were not related to erythrocyte age and there was no evidence of analytical artifact. We interpret these results as possible evidence of high and low hemoglobin glycation phenotypes within the population. We conclude that MBG and HbA1c are not necessarily interchangeable estimates of glycemic control and that hemoglobin glycation phenotype may be important for the clinical assessment of diabetic patients.     

Urinary mevalonate excretion rate in type 2 diabetes: role of metabolic control

An increased cholesterogenesis has been described in obese dyslipidemic type 2 diabetic patients and in a small number of patients with poor glucose control. So far, it is not clear if increased cholesterogenesis in type 2 diabetes is related to the degree of glycemic control or depends on the commonly associated dyslipidemia or both. Therefore, the aim of the present study was to investigate the relationships among cholesterogenesis and degree of metabolic control in a group of non-obese normolipidemic type 2 diabetic patients. Fifty four (25 men and 29 postmenopausal women) non-obese type 2 diabetic patients with cholesterol and triglyceride plasma levels, respectively, below 6.40 and 2.85 mmol/l and 20 normal subjects matched for age and sex were studied. Endogenous cholesterol synthesis was evaluated by the determination of 24-h urinary mevalonate excretion (MVA). In the diabetic group the mean glycated hemoglobin was 8.47+/-2.2% (range 4.6-14.6%), the mean total cholesterol, triglycerides, HDL and LDL cholesterol were, respectively, 4.86+/-0.7, 1.64+/-0.5, 1.19+/-0.3 and 2.87+/-0.7 mmol/l. The mean 24-h MVA urine excretion rates were 1.41+/-0.3 micromol/24 h in control subjects and 1.66+/-0.7 micromol/24 h in diabetics (P=0.05). In diabetics, urinary mevalonate excretion was significantly correlated with glycated hemoglobin concentrations (HbA(1c)) (r=0.65; P=0.0001) and body mass index (BMI) (r=0.33; P=0.009). In the multivariate analysis both HbA(1c) and BMI were independent predictors of urinary mevalonate. These data demonstrate that lower the degree of blood glucose control, higher is the whole body cholesterol production even in the absence of overt dyslipidemia. In conclusion, the relationship between mevalonate excretion rate and glycated hemoglobin gives further weight to the importance of intensive blood-glucose control in diabetic disease and adds a new element to the list of potentially atherogenic factors strictly related to hyperglycemia in type 2 diabetic patients.     

Microvascular Complications in Adolescents with Type 1 Diabetes Mellitus

Objective: Screening of complications is an important part of diabetes care. The aim of this study was to investigate diabetic complications and related risk factors in adolescents with type 1 diabetes mellitus (T1DM).Methods: This cross-sectional study was conducted on type 1 diabetics who were over 11 years of age or had a diabetes duration of 2 years and included 155 adolescents with T1DM (67 male, 88 female). The mean age of the patients was 14.4±2.1 years. Mean diabetes duration was 6.3±2.9 years. The patients were screened for diabetic nephropathy, retinopathy and peripheral neuropathy.Results: Mean glycosylated hemoglobin (HbA1c) level of the study group was 8.4%. The frequency of microalbuminuria and peripheral neuropathy were 16.1% and 0.6%, respectively. None of the patients had diabetic retinopathy. Dyslipidemia and hypertension rates were 30.3% and 12.3%, respectively. Risk factors associated with microalbuminuria were hypertension, higher HbA1c levels, longer diabetes duration and dyslipidemia.Conclusion: Early diagnosis and treatment of hypertension and dyslipidemia as well as achieving a better metabolic control are important in prevention or postponement of complications in patients with T1DM. Yearly screening for diabetic nephropathy should be started 2 years after the onset of the diabetes. Conflict of interest:None declared.     

2型糖尿病患者血清糖化白蛋白水平与冠脉侧支循环的关系研究

目的：探讨2型糖尿病患者血清糖化白蛋白水平与冠脉侧支循环的关系,并与非糖尿病患者作比较。方法：入选连续434例稳定型心绞痛伴1支或以上冠脉完全阻塞的患者,其中糖尿病组317例,非糖尿病组117例。检测空腹血清糖化白蛋白（GA）和糖化血红蛋白（HbA1c）水平,并用Rentrop计分法评估阻塞远端来自对侧冠脉提供的侧支循环情况（Rentrop 0或1分为侧支循环不佳,2或3分为侧支循环良好）。结果：在总的437例患者中,侧支循环不佳患者的GA[（20.9±6.3）%对（18.6±5.5）%,P〈0.001]和HbA1c[（6.9±1.0）%对（6.7±1.1）%,P〈0.05]显著高于侧支循环良好患者。糖尿病组中,侧支循环不佳患者（118例）较侧支循环良好者（199例）血清GA水平明显增高,为（21.2±6.5）%对（18.7±5.6）%,P〈0.001;但HbA1c水平相似,为（7.0±1.1）%对（6.8±1.3）%,P=0.27。GA与Rentrop计分呈显著负相关（r=-0.28,P〈0.001）,但HbA1c与其无关（r=-0.10,P=0.09）。在预测冠脉侧支循环不佳方面,GA的曲线下面积较HbA1c明显增大（0.64对0.58）。在非糖尿病组,GA和HbA1c水平与冠脉侧支循环状态无关。多因素分析发现,年龄〉65岁、女性、非高血压、高脂血症和肾功能减退是预测糖尿病和非糖尿病患者冠脉侧支循环不佳的独立危险因素。经校正混杂因素后,GA〉18.3%仍然较HbA1c〉7%更为敏感地预测糖尿病患者冠脉侧支循环不佳。结论：血清GA水平增高是2型糖尿病患者冠脉侧支循环形成不佳的重要原因之一。     

急性心肌梗死并发糖尿病患者糖脂代谢特点分析

目的:探讨并发糖尿病的急性心肌梗死(AMI)患者糖化血红蛋白（HbA1c）和血脂异常的临床特点。方法:将临床确诊为AMI的132例患者按是否患有糖尿病分为糖尿病组（91例）和非糖尿病组（41例）,同期住院的非糖尿病非冠心病患者32例为对照组,分析对比各组冠心病危险因素、HbA1c和血脂异常的特点。结果:对照组、糖尿病组和非糖尿病组在吸烟史、早发冠心病家族史、并发血脂异常、并发高血压比例上均无统计学意义。非糖尿病组患者的空腹血糖(FPG)显著高于对照组,但HbA1c(%)与对照组比较无差异。糖尿病组患者的FPG和HbA1c显著高于非糖尿病组。糖尿病组和非糖尿病组的总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A-Ⅰ(ApoA-Ⅰ)、载脂蛋白B(ApoB)水平均无显著差异,但糖尿病组患者TG和LDL C水平显著高于对照组。低HDL-C是二组患者检出率最高的血脂异常。结论:并发糖尿病的AMI患者血糖控制不佳,存在更明显的脂代谢异常,应重视冠心病患者糖化血红蛋白和血脂的检测和降糖、调脂治疗。     

Impact of low-density lipoprotein particle size on carotid intima-media thickness in patients with type 2 diabetes mellitus

Small low-density lipoprotein (LDL) particles and modifications to LDL such as glycation and oxidation have been linked to the pathogenesis of atherosclerosis in patients with diabetes. We investigated whether LDL particle size, or the levels of glycated LDL or malondialdehyde-modified LDL (MDA-LDL) are associated with carotid intima-media thickness (IMT) in patients with type 2 diabetes mellitus. One hundred seventy-two patients with type 2 diabetes mellitus were enrolled. Carotid IMT was measured by high-resolution ultrasound, and LDL particle size and serum glycated LDL and MDA-LDL levels were determined. The 3 variables were significantly correlated with one another. Univariate analyses defined statistically significant correlations of carotid IMT with LDL size, hemoglobin A(1c), glycated LDL, MDA-LDL, high-density lipoprotein (HDL) cholesterol, and age. The strongest association of IMT was with LDL size (r = -0.406, P < .0001), followed by that with HDL cholesterol (r = -0.225, P = .004). A stepwise multiple regression analysis revealed that LDL size and HDL cholesterol are independent predictors of carotid IMT. Neither glycated LDL nor MDA-LDL had a significant independent contribution to the severity of carotid IMT in the multivariate model. Low-density lipoprotein particle size, but not the glycated LDL or MDA-LDL level, was independently associated with carotid IMT in patients with type 2 diabetes mellitus regardless of antidiabetic and lipid-lowering medications. These results suggest that the measurement of LDL size may be more useful than quantification of modified LDLs for assessing atherosclerosis in patients with type 2 diabetes mellitus. Small LDL particles may be the most important predictor for the risk of cardiovascular disease in diabetic patients.     

Glycaemic control, markers of endothelial cell activation and oxidative stress in children with type 1 diabetes mellitus

BACKGROUND: The aim of this study was to compare the effect of glycaemic control on oxidative stress and biochemical markers of endothelial activation in type 1 diabetic children. METHODS: Serum total cholesterol, HDL cholesterol, VLDL cholesterol, apolipoprotein A1, apolipoprotein B, HbA(1c), MDA, VEGF, NO, ICAM levels were assessed in 100 children with type 1 DM aged 2-17 years. Study cases were evaluated in three groups in view of their mean HbA(1c) values, as metabolically well-controlled (HbA(1c)< or =8%) and poorly controlled (HbA(1c)>8%) patients with DM and 40 healthy children were included as normal controls. RESULTS: Levels of MDA, NO, VEGF, ICAM, apolipoprotein A1 and apolipoprotein B in metabolically poorly controlled diabetic patients were significantly higher than control group (P<0.05). In correlation analysis of HbA(1c) to VEGF, no significant correlations were detected in metabolically well-controlled DM, but there were significant correlations between HbA(1c) and NO, MDA, ICAM levels. In correlation analysis of HbA(1c) to VEGF, NO, MDA and ICAM levels, significant correlations were detected in poorly controlled diabetics (P<0.05). CONCLUSIONS: In the present study, increased levels of MDA, NO, ICAM-1 and VEGF levels showed that especially metabolically poorly controlled DM children are at high risk of atherosclerosis and vascular complications of DM and that there is a significant relationship between HbA(1c) and oxidative stress. It may be appropriate to evaluate levels of VEGF and sICAM-1 as well as markers of oxidative stress in addition to routine laboratory assessments in evaluation of type 1 DM pediatric patients.     

Glycated hemoglobin A1C level and the risk of diabetic retinopathy in Africa: A systematic review and meta-analysis

Background and aimsDiabetic retinopathy is a frequent cause of acquired blindness worldwide. Various studies have reported the effects of glycemic control on the risk of diabetic retinopathy, but the results remain inconclusive. Therefore, this meta-analysis was performed to determine the association between glycated hemoglobin A1C levels and diabetic retinopathy in Africa.MethodsA systematic search was performed using the PubMed, African Journals Online, Google Scholar, Scopus, and Wiley Online Library from inception to June 11, 2020, for observational studies addressing the association of hemoglobin A1c levels with diabetic retinopathy. The I² statistic was used to check heterogeneity across the included studies. A random-effects model was applied to estimate the pooled effect size (OR) and respective 95% confidence interval across studies. A funnel plot and Egger’s regression test were used to determine the presence of publication bias. Sensitivity analysis was used to determine the effect of a single study on the overall estimation. All statistical analyses were performed using STATA™ Version 14 software.ResultA total of 23 articles with 18,099 study participants were included in this meta-analysis. In the present review, when HbA1c was analyzed as a categorical variable, poor glycemic control (HbA1c >7%) was associated with an increased risk of diabetic retinopathy when compared with good glycemic control (OR = 1.25; 95% CI; 1.14, 1.38). Similarly, when HbA1c was analyzed as a continuous variable, a higher HbA1c was associated with an increased risk of diabetic retinopathy (MD: 0.42, 95% CI; 0.11, 0.98).ConclusionOur meta-analysis indicated evidence for poor glycemic control as an independent risk factor for the development of diabetic retinopathy in patients with diabetes mellitus. Therefore, the authors suggest that clinicians should advise their patients with diabetes to maintain their HbA1c levels within the normal range.     

Lipoprotein (a) in type 2 diabetes mellitus: Relation to LDL:HDL ratio and glycemic control

BACKGROUND:

Increased lipoprotein (a) [Lp (a)] concentrations are predictive of coronary artery disease (CAD). Type 2 diabetes mellitus also leads to dyslipidemia, like elevated triglyceride levels and low HDL levels, which are known risk factors for CAD. This study was designed to investigate the levels of Lp (a) in type 2 diabetic patients and their association with LDL: HDL ratio and glycemic control.

MATERIALS AND METHODS:

The study included 60 patients of type 2 diabetes and 50 age and sex matched controls. The Lp(a) levels in the diabetic group were compared with the control group and the relationship between the Lp(a) levels and LDL: HDL ratio was evaluated. Diabetic group was further divided into three subgroups according to levels of glycated hemoglobin. Lp(a) levels and glycated hemoglobin in controlled and uncontrolled diabetes mellitus were also compared to find out any correlation between them. Statistical analysis was done using the students ‘t’ test and Chi square test.

RESULTS:

Lp(a) levels were found to be significantly increased in the diabetic group as compared to the control group (P< 0.001). LDL: HDL ratio was also increased in the diabetic group as compared to the control group. Lp(a) levels showed no association with LDL: HDL ratio and degree of glycemic control in these patients.

CONCLUSIONS:

The results of the present study suggest that Lp(a) levels are increased in type 2 diabetic patients. The elevated Lp(a) levels do not reflect the glycemic status and are also independent of increase in LDL:HDL ratio suggesting different metabolic pathways and the genetic connection for LDL and Lp(a).     

Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period

BackgroundThis study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period.MethodsA total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3–12 months.ResultsPatients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c <7%) was achieved by 13.8% of patients. Multivariate analysis revealed <55 years of age, female gender, >3 years duration of diabetes, HbA1c >10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI <25 kg/m² and presence of hypertension were associated with a decreased risk of poor glycemic control.ConclusionUsing data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.     

Plasma lipoproteins,apoproteins and cardiovascular disease in type 2 diabetic patients. A nine-year follow-up study

BACKGROUND AND AIM: To evaluate the role of lipoprotein abnormalities as risk factors for macroangiopathy in Type 2 diabetes. METHODS AND RESULTS: This prospective nine-year follow-up study involved 113 Type 2 diabetic patients (50 men and 63 women, mean age 66.9 +/- 9.9 years), 37 of whom had clinical signs of coronary heart disease (CHD) and cerebrovascular disease (CVD) at baseline. During the follow-up, 32 patients died: 17 of CHD, five of CVD, and 10 of non-vascular causes. The patients who died because of vascular disease were more frequently smokers, and had baseline symptoms of vascular disease; they were also significantly different from the other patients insofar as they were older, and had higher fasting plasma glucose levels, lower fasting C-peptide levels, and lower apoprotein (apo) AII, apo CII, apo CIII and apo E levels. Univariate analysis showed that baseline symptoms of vascular disease, current smoking, age, high fasting plasma glucose levels, low fasting C-peptide levels, and low apo AII, apo CII, apo CIII and apo E levels [but not cholesterol, triglyceride, high-density lipoprotein (HDL)-cholesterol or qualitative low-density lipoprotein or HDL abnormalities] were associated with cardiovascular mortality. Multivariate analysis showed that only age, smoking, glycated hemoglobin (HbA1c) and fasting C-peptide levels were significant independent determinants of macrovascular death. CONCLUSIONS: In Type 2 normolipidemic diabetic patients, only age, smoking, HbA1c and fasting C-peptide levels are independent vascular risk factors. The differences in apo concentrations between patients with and without vascular disease may reflect qualitative abnormalities in plasma lipoproteins related to vascular disease.     

A comparative analysis of fructosamine with other risk factors for kidney dysfunction in diabetic patients with or without chronic kidney disease

BackgroundHyperglycemia is the driving force for the development of diabetic nephropathy leading to the end stage renal disease. It is well known that in hyperglycaemic condition, serum proteins become glycated through non-enzymatic glycation. With the other risk factors, serum fructosamine may be an important risk factor for kidney impairment. To assess coexistence of frequently documented risk factors of kidney dysfunction with serum fructosamine in diabetic patients with chronic kidney disease (CKD).MethodsIn this study, total 150 individuals, as control, type2 diabetic patients without complication and with CKD were included. Blood samples were collected from all the samples to estimate blood glucose, HbA1c, serum creatinine, fructosamine levels and lipid profile. Statistical analysis i.e. regression and correlation between serum fructosamine and other documented risk factors for diabetic CKD has been done. P < 0.001 was considered significant.ResultsSerum fructosamine, HbA1c, creatinine levels, cholesterol and LDL were increased significantly (P < 0.001) in diabetic patients with CKD compared to without complications. Systolic and diastolic blood pressure and BMI were also significantly higher in diabetic patients compared to control. Serum creatinine, total cholesterol and LDL showed a significant positive correlation but HDL showed a negative correlation with fructosamine in CKD diabetic patients. No significant correlation was found with any risk factors in diabetic patients without complications expect HbA1c.ConclusionIt is concluded that elevated serum fructosamine level is strongly associated with kidney dysfunction in diabetic patients. As there is a significant link between serum fructosamine and other risk factors for CKD diabetic patients.     

Fatty acid binding protein 1 (FABP1) and fatty acid binding protein 2 (FABP2) as a link between diabetic nephropathy and subclinical atherosclerosis in children and adolescents with type 1 diabetes

BackgroundDiabetic nephropathy is a major cause of morbidity and mortality in type 1 diabetes mellitus (T1DM). Fatty acid binding proteins (FABP1 and FABP2) play a role in the development and progression of chronic kidney disease including type 2 diabetes mellitus.AimWe assessed serum FABP1 and FABP2 levels in children and adolescents with T1DM as potential markers for diabetic nephropathy and their relation to carotid intima media thickness (CIMT).MethodsSixty patients with T1DM were divided into 2 groups according to the presence of nephropathy and compared with 30 healthy controls. CIMT, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), urinary albumin creatinine ratio (UACR), fasting lipid profile and serum FABP1 and FABP2 levels were assessed.ResultsFABP1 and FABP2 levels were significantly higher among type 1 diabetic patient with and without nephropathy compared with healthy controls with the highest levels among patients with nephropathy (p < 0.001). There were significant positive correlations between FABP1 and FABP2 and each of systolic blood pressure, CIMT, FBG, HbA1c and total cholesterol among T1DM patients. FABP1 was negatively correlated to glomerular filtration rate. Multivariable linear regression analysis showed that systolic blood pressure, CIMT, FBG and HbA1c were the significant independent variables related to FABP1 levels in type 1 diabetic patients with nephropathy. ROC curve analysis was performed to determine the cutoff value of FABP1 and FABP2 that could detect nephropathy.ConclusionFABP1 and FABP2 levels are elevated in children and adolescents with T1DM and could represent a link between diabetic nephropathy and subclinical atherosclerosis.     

Effect of CGM in the HbA1c and Coefficient of Variation of glucose in a pediatric sample

Aim of the studyPrevious studies have found no significant improvements in glycated hemoglobin (HbA1c), while using Continuous Glucose Monitoring (CGM), with children and adolescents. The aim of this paper is to measure the change in HbA1c, and the Coefficient of Variation in glucose levels, when using CGM, once the effect of other relevant variables, such as gender, actual age, the years the patient has had diabetes, use of an insulin pump, the presence of autoimmune disease, other associated pathologies, and weekly hours of exercise, are controlled for.MethodsThis is a retrospective study that uses a linear regression model. Data was collected from Type 1 Diabetes Mellitus (T1DM), children diagnosed between 2003 and 2017 in the Pediatric Unit for Diabetes in Zaragoza, Spain. We used a linear regression and the method of estimation is Ordinary Least Squares.ResultsResults show that the use of CGM decreased the HbA1c value by 3.5% and the Coefficient of Variation by 14%.ConclusionsThe implication of these results is that this device helped in the management of diabetes, although more research is needed to distinguish between different devices in terms of their efficacy.     

Extreme Values of Hemoglobin A1c Are Associated With Increased Risks of Chronic Obstructive Pulmonary Disease in Patients With Type 2 Diabetes: A Competing Risk Analysis in National Cohort of Taiwan Diabetes Study

The purpose of this study was to evaluate the relationship between glycated hemoglobin (HbA1c) and chronic obstructive pulmonary disease (COPD) in patients with type 2 diabetes.We conducted a retrospective cohort study involving 45,753 patients with type 2 diabetes, who participated in the National Diabetes Case Management Program in Taiwan. HbA1c at baseline and COPD events over the subsequent years were analyzed.After multivariate adjustment, the COPD risk increased among patients with HbA1c levels <6.0%, compared with that in patients with HbA1c levels ranging from 6.0% to 7.0% (hazard ratio: 1.19, 95% confidence interval (CI): 1.06–1.34). Similarly, high HbA1c levels (≥10%) were independently associated with COPD (1.19, 95% CI: 1.06–1.32). A U-shaped relationship was observed between HbA1c levels and COPD incidence.HbA1c levels lower than 6.0% and higher than 10% are associated with an increased risk of COPD in patients with type 2 diabetes. These findings suggest that meeting the recommended HbA1c targets might reduce the risk of COPD, but care should be taken not to pose risks to this population.     

Risk factors for asymptomatic atherosclerosis in Japanese type 2 diabetic patients without diabetic microvascular complications

Atherosclerotic vascular diseases are frequently associated with diabetes mellitus. There has been increasing evidence showing that the atherosclerotic diseases in diabetic patients are distinct from diabetic microvascular complications as to their pathophysiology and epidemiology. However, we have no information on the prevalence of asymptomatic atherosclerosis in diabetic patients before the onset of microvascular diseases. In the present investigation, we aimed to evaluate risk factors for the atherosclerosis in type 2 diabetic patients without the microvascular diseases. For this purpose, we evaluated atherosclerotic change of carotid arteries in 125 Japanese type 2 diabetic patients who had neither atherosclerotic vascular diseases nor diabetic microvascular complications. When atherosclerotic change was defined as the mean intima-media thickness (IMT) of >/= 1.1 mm and/or the presence of plaque lesion, 50% of patients had atherosclerosis of the carotid arteries. Risk factors for the carotid atherosclerosis were age, low-density lipoprotein (LDL)-cholesterol, hypertension, and diabetes treatment. Age and LDL-cholesterol were associated with mean IMT. Age, diabetes treatment, LDL-cholesterol, and hypertension were positively associated with plaque lesion, while high-density lipoprotein (HDL)-cholesterol was negatively associated with it. Fasting plasma glucose, glycosylated hemoglobin (HbA(1c)), and known diabetes duration remained unassociated with any parameters of asymptomatic atherosclerosis of the carotid arteries. These results indicate that glycemic control is unrelated with asymptomatic atherosclerosis in type 2 diabetic patients without diabetic microvascular complications. Conventional risk factors and diabetes treatment are independently associated with atherosclerosis of the carotid arteries in these patients.     

Insulin regimens and insulin adjustments in diabetic children, adolescents and young adults: personal experience

Because recent multicenter studies, even those performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of glycated hemoglobin (HbA1c) are very different, diabetes treatment teams should individually explore the reasons for failure, without any prejudice or bias. The "good" treatment is signed by good HbA1c associated with good quality of life, and is not necessarily exportable without adjustment to the local way of life. HbA1c must be under 7%, if the upper normal limit is about 6%, which is possible, in our experience, even in diabetic children and adolescents. Our "recipes" are summarized. The number of daily insulin injections, 2 or 4, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycemic control in young patients depends mainly on the quality and intensity of diabetes education. Any dogmatism must be avoided; only the objective result is important.     

Characterization of lipid parameters in diabetic and non-diabetic atherosclerotic patients

Background & Objective The relationship between lipid profile perturbation and diabetes associated complications has long been an area of interest. Dyslipidemia is a potent predictor of cardiovascular morbidity and mortality in diabetic patients. The aim of present study was to investigate relationship between aging and lipid profiles in diabetic and non-diabetic atherosclerotic patients. Methods Five hundred and seventy six individuals (45–75 year age) participated in this study. Among these, 192 were having history of diabetes mellitus and atherosclerosis. Individuals are categorized on the base of health (normal, non-diabetic atherosclerosis, diabetic atherosclerosis) and age (45–55 years, 56–65 years, and 66–75 years). All the participants were subjected to the procedures like a detailed history, biochemical analysis for fasting blood sugar, hemoglobin A1c, total cholesterol (TC), triglycerides (TG), low-density lipoprotein-(LDL), very low-density lipoprotein (VLDL) and high-density lipoprotein (HDL). All these parameters were compared between diabetic and non-diabetic atherosclerotic patients of all three age groups. TC/HDL and LDL/HDL were also calculated. Results Diabetic atherosclerotic individuals (both males and females) had high level of TC, TG, LDL, VLDL and low level of HDL in comparison to non-diabetic atherosclerotic and normal control individuals. Among all three age groups, lipoprotein abnormality was observed to be more frequent in females than males. There was a significant increase in TC/HDL and LDL/HDL ratio in diabetic atherosclerotic subjects compared to age and sex matched non-diabetic atherosclerotic and normal control. Conclusions Degree of dyslipidemia increases with increase in age in both genders. Female are more prone to diabetic dyslipidemia and hence have more risk of developing atherosclerosis with increasing age.