Serum AGEs and sRAGE levels are not related to vascular complications in patients with prediabetes

BackgroundWhile hyperglycemia has a key role in the pathogenesis of microvascular complications of diabetes, it is just one of the many factors contributing to macrovascular damage. The aim of the present study is to investigate the link between serum pentosidine and sRAGE levels and vascular complications in patients with prediabetes compared to normal glucose tolerance controls with obesity.MethodsIn this study were included 76 patients with mean age 50.7 ± 10.7 years, divided into two age and BMI-matched groups – group 1 with obesity without glycemic disturbances (n = 38) and group 2 with obesity and prediabetes (n = 38).ResultsThere was no significant difference in pentosidine and sRAGE levels between patients with obesity and prediabetes. Patients with hypertension had lower levels of sRAGE compared to nonhypertensive subjects. sRAGE showed a weak negative correlation to blood glucose on 60th min of OGTT and HOMA index. There was no correlation between sRAGE and pentosidine levels and the markers of micro- and macrovascular complications. There was no difference in sRAGE and pentosidine levels between patients with and without endothelial dysfunction.Conclusions: sRAGE and pentosidine levels are similar in patients with obesity with and without prediabetes and do not correlate to the markers of micro- and macrovascular complications.     

Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting

Aims/Introduction

The study was carried out to assess the prevalence of diabetic peripheral neuropathy (DPN), compare the prevalence between known diabetes mellitus (KDM) and newly detected diabetes mellitus (NDDM), identify risk factors associated, its prevalence pattern and to assess if any sex-specific differences are present.

Materials and Methods

A cross-sectional study was carried out in a tertiary care hospital. Patients with duration of diabetes ≤6 months were considered to be NDDM. DPN was diagnosed by the combination of more than one abnormal result of 10-g monofilament, pinprick sensations and ankle reflexes, and categorized according to the severity level using vibration perception threshold. The study included 1,637 KDM and 369 NDDM patients.

Results

A total of 586 participants were found to have DPN, accounting for 29.2% (95% confidence interval [CI] 27.2–31.2) prevalence. The higher prevalence was observed in KDM compared with NDDM 33.7% (95% CI 31.42–36.01) vs 9.2% (95% CI 6.3–12.2; P < 0.001). Prevalence of mild, moderate, and severe neuropathies was 8.06, 14.55 and 6.63%, respectively. Regression analysis showed age (P < 0.001), duration of diabetes (P < 0.001), dyslipidemia (P = 0.03), glycated hemoglobin (P < 0.001), the presence of other microvascular complications (P < 0.001), macrovascular complications (P = 0.003) and alcoholic status (P < 0.033) to be associated. No sex-specific differences were observed in the mean age at diagnosis of diabetes, mean age at the diagnosis of neuropathy, and duration taken for the DPN development among females and males.

Conclusions

The study showed a high prevalence (29.2%) of DPN among north Indian type 2 diabetes mellitus patients. Thus, timely screening with earlier detection and intervention would be useful in preventing the progression of neuropathy.     

Chronic stress,sense of coherence and risk of type 2 diabetes mellitus

AimsThe study was conducted to ascertain whether chronic stress and sense of coherence are associated with risk of type 2 diabetes mellitus.MethodsStress questionnaires - Presumptive Stressful Life Events Scale (PSLES), Perceived Stress Scale (PSS) and Sense of Coherence (SOC) - were administered to 500 Newly Detected Diabetes Mellitus (NDDM) cases and 500 Normal Glucose Tolerance (NGT) controls recruited following 75 g OGTT. Assessment of stress was completed before the diagnosis of diabetes was revealed to them.ResultsPSLES and PSS scores were significantly higher and SOC score was significantly lower in NDDM subjects compared to those with NGT. PSLES and PSS correlated positively with anthropometric parameters (waist circumference, BMI), glycemic parameters (FPG, 2 hPG, A1C) and HOMA-IR and inversely with HOMA-β whereas SOC correlated inversely with glycemic parameters (FPG, 2 hPG, A1C) and HOMA-IR and positively with HOMA-β. In stepwise logistic regression analysis, SOC emerged as the strongest independent predictor of diabetes (OR: 0.774) after HOMA-IR (OR: 1.621) and BMI (OR: 1.288). Other significant predictors included PSS (OR:1.153), PSLES-LT (OR: 1.005) and HOMA-β (OR: 0.894).ConclusionChronic stress and low sense of coherence are associated with a higher risk of type 2 diabetes mellitus.     

Relationship between onset age of type 2 diabetes mellitus and vascular complications based on propensity score matching analysis

Aims/IntroductionTo assess the relationship between type 2 diabetes mellitus onset age and vascular complications in China.Materials and MethodsA retrospective review of 3,568 patients with type 2 diabetes mellitus using a propensity score‐matched (PSM) cohort analysis was carried out in two different age of onset groups (age 40 and 60 years). These groups were then subdivided into two groups, early‐onset diabetes (EOD40 and EOD60; the onset age before 40 and 60 years, respectively) and late‐onset diabetes (LOD40 and LOD60: the onset age after 40 and 60 years, respectively). Macrovascular and microvascular complications were analyzed before and after PSM.ResultsPatients categorized in both the early‐onset disease (EOD) groups had a higher risk of developing macro‐ and microvascular complications before PSM. After PSM, no differences existed between the EOD and late‐onset disease groups in the risk of macrovascular complications. Compared with the late‐onset disease group, the odds ratio of having a microvascular complication of diabetic retinopathy, chronic kidney disease and diabetic peripheral neuropathy in the 40‐year‐old EOD group increased to 2.906, 1.967 and 1.672 (P < 0.05), respectively. The odds ratio of diabetic retinopathy and diabetic peripheral neuropathy in the 60‐year‐old EOD group was 1.763 and 1.675 (P < 0.05), respectively.ConclusionsThe earlier the onset of type 2 diabetes mellitus, the higher risk of microvascular, but not necessarily macrovascular, complications. It is not too late to prevent diabetes at any age. Pre‐emptive microvascular treatment or preventative measures in EOD patients who do not yet show symptoms, might be beneficial.     

Association of RAGE gene polymorphism with vascular complications in Indian type 2 diabetes mellitus patients

Aims

The study was designed to evaluate the association of −374T/A and −429T/C polymorphism in the promoter region and Gly82Ser polymorphism in exon 3 region of RAGE gene with diabetic vascular complications in Indian population.

Methods

We screened 603 subjects which includes 176 healthy controls, 140 type 2 diabetes mellitus (T2DM) subjects without any vascular complications (DM), 152 T2DM subjects with microvascular complications (DM-micro) and 135 T2DM subjects with macrovascular complications (DM-macro) for −374T/A, −429T/C and Gly82Ser polymorphisms of RAGE gene. DNA isolated from the enrolled subjects were genotyped by PCR-RFLP. Logistic regression analysis was used to evaluate the association of single nucleotide polymorphisms (SNPs).

Results

The −429 T/C and Gly82Ser RAGE polymorphisms were found to be significantly associated with the development of macrovascular and microvascular complications, respectively, in T2DM subjects while −374A allele showed reduced risk towards the development of macrovascular complications. Further, −429T/C, −374T/A and Gly82Ser haplotype analysis revealed association of CTG haplotype with development of macrovascular complications while haplotype TAG was observed to be significantly protective towards development of macrovascular complications in T2DM subjects (OR = 0.617, p = 0.0202).

Conclusions

Our data indicates significant association of RAGE SNPs and haplotypes with vascular complications in North Indian T2DM subjects.     

Soluble endothelial protein C receptor and high sensitivity C reactive protein levels as markers of endothelial dysfunction in patients with type 1 and type 2 diabetes mellitus: Their role in the prediction of vascular complications

Background and objectiveEndothelial dysfunction in diabetes mellitus (DM) is an important factor in the pathogenesis of micro and macrovascular complications. We aimed to measure soluble endothelial protein C receptor (sEPCR) and high sensitivity C reactive protein (hsCRP) levels as markers of endothelial damage in both types of diabetes mellitus and to determine if they can be used as predictors of vascular complications.MethodsFifty patients with DM, 20 with type 1 and 30 with type 2 as well as 30 healthy subjects were included. All were subjected to measurement of sEPCR and hsCRP by enzyme linked immunosorbent assay.ResultssEPCR and hsCRP were significantly increased when compared to the control group in both types of DM. sEPCR was a significant predictor of macrovascular complications and thrombosis in type 1 p = 0.02, and p = 0.015, respectively. hsCRP was a significant predictor of macrovascular complications in type 2 p = 0.04.ConclusionPatients with type 1 and type 2 DM exhibit higher sEPCR and hsCRP levels compared to healthy controls which suggesting endothelial damage. sEPCR could be used as a predictor of macrovascular complications and thrombosis in type 1 DM, whereas, hsCRP might be used as a predictor of macrovascular complications in type 2 DM.     

Lipoatrophic diabetes in familial partial lipodystrophy type 2: From insulin resistance to diabetes

AimSubjects with Familial Partial Lipodystrophy type 2 (FPLD2) are at high risk to develop diabetes. To better understand the natural history and variability of this disease, we studied glucose tolerance, insulin response to an oral glucose load, and metabolic markers in the largest cohort to date of subjects with FPLD2 due to the same LMNA variant.MethodsA total of 102 patients aged > 18 years, with FPLD2 due to the LMNA ‘Reunionese’ variant p.(Thr655Asnfs*49) and 22 unaffected adult relatives with normal glucose tolerance (NGT) were enrolled. Oral Glucose Tolerance Tests (OGTT) with calculation of derived insulin sensitivity and secretion markers, and measurements of HbA1c, C-reactive protein, leptin, adiponectin and lipid profile were performed.ResultsIn patients with FPLD2: 65% had either diabetes (41%) or prediabetes (24%) despite their young age (median: 39.5 years IQR 29.0-50.8) and close-to-normal BMI (median: 25.5 kg/m² IQR 23.1-29.4). Post-load OGTT values revealed insulin resistance and increased insulin secretion in patients with FPLD2 and NGT, whereas patients with diabetes were characterized by decreased insulin secretion. Impaired glucose tolerance with normal fasting glucose was present in 86% of patients with prediabetes. Adiponectin levels were decreased in all subjects with FPLD2 and correlated with insulin sensitivity markers.ConclusionsOGTT reveals early alterations of glucose and insulin metabolism in patients with FPLD2, and should be systematically performed before excluding a diagnosis of prediabetes or diabetes to adapt medical care. Decreased adiponectin is an early marker of the disease. Adiponectin replacement therapy warrants further study in FPLD2.     

The association between intensive glycemic control and vascular complications in type 2 diabetes mellitus: A meta-analysis

Background and AimIn patients with type 2 diabetes mellitus, the relationship between lowering glycated hemoglobin (HbA_1c) and macrovascular complications is not clear and therefore lowering the level of HbA_1c is controversial.Methods and ResultsWe searched for all randomized controlled trials comparing the effects of intensive and standard glycemic control on vascular events in patients with type 2 diabetes mellitus. The primary endpoint was combined macrovascular complications, including cardiac events, stroke and peripheral vascular disease. Fixed and random effect models were used to analyze the results.Eight studies were included according to selection criteria. The results showed no benefits of intensive glycemic control on macrovascular and microvascular complications (P > 0.1), but a higher rate of severe hypoglycemia (P < 0.00001) in the intensive control group when the target HbA_1c level was <7.0%. When the target HbA_1c level was lowered to 7.0–7.9%, intensive glycemic control showed benefits on the reduction of microvascular events (P < 0.05) without increasing the risk of severe hypoglycemia (P = 0.74), but no influence on macrovascular complications (P > 0.1).ConclusionThe results of this analysis suggest that a target HbA_1c level of 7.0–7.9% may be a better glycemic control target than that of <7.0% in patients with established type 2 diabetes mellitus.     

A comparative study of the clinical profile of fibrocalculous pancreatic diabetes and type 2 diabetes mellitus

AimsThe present study aimed to compare the clinical characteristics of patients with fibrocalculous pancreatic diabetes (FCPD) and those with type 2 diabetes mellitus (T2DM) to identify the characteristics distinctive of FCPD.MethodsA total of 133 patients with FCPD were compared with 665 patients with T2DM matched for duration of diabetes. Biochemical parameters and microvascular and macrovascular complications were assessed in all patients. Multivariate regression analyses were performed to study the determinants of microvascular and macrovascular complications in both groups.ResultsThe mean duration of diabetes was 4.42 ± 5.65 years in the FCPD group and 4.51 ± 3.88 years in the T2DM group. FCPD participants were significantly younger at diagnosis and leaner than patients with T2DM. The FCPD group had higher fasting and postprandial glucose and HbA1c levels than the T2DM group. The FCPD group had significantly lower triglyceride, total cholesterol, low-density lipoprotein cholesterol, serum total calcium, hemoglobin, and serum creatinine values than the T2DM group. The prevalence of coronary artery disease, stroke, and retinopathy was significantly higher in the T2DM patients while the prevalence of distal symmetric polyneuropathy was significantly lower. On multivariate logistic regression analysis, duration of diabetes and HbA1c (OR = 1.17, P = 0 0.04) in FCPD patients and age (OR = 1.04, P < 0 0.001), duration of diabetes (OR = 1.17, P < 0 0.001) and HbA1c (OR = 1.28, P < 0.001) in T2DM patients were associated with microvascular complications.ConclusionsThere are several differences in the phenotype, biochemical parameters, and prevalence of diabetic complications between patients with FCPD and T2DM. Timely diagnosis may have implications in the follow-up and management of patients.     

Evaluation of the Finnish Diabetes Risk Score as a screening tool for impaired fasting glucose, impaired glucose tolerance and undetected diabetes

Aim

To evaluate the performance of FINDRISC as a screening tool for prediabetes - impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and undetected diabetes (UDD) in subjects at risk of developing diabetes.

Subjects and methods

2169 subjects with at least one risk factor for diabetes completed the FINDRISC questionnaire and underwent an oral glucose tolerance test. FINDRISC performance was assessed using the area under the receiver operating characteristic curve (AUC-ROC).

Results

56.6% of subjects demonstrated normal glucose tolerance (NGT), 14.5% - IFG, 11.4% - IGT and 17.5% - UDD. NGT group demonstrated mean FINDRISC 10.1 ± 3.4, IFG group - 13.8 ± 4.3 (p < 0.0001 vs. NGT), IGT group - 14.4 ± 5.4 (p < 0.0001 vs. NGT) and UDD group - 15.5 ± 4.8 (p < 0.0001 vs. NGT and IFG, p < 0.01 vs. IGT). The AUC-ROC was 0.70 (95% CI 0.67-0.73) for UDD and 0.71 (95% CI 0.69-0.73) for undetected prediabetes and diabetes. The FINDRISC cut-off value of 10 to identify both prediabetes and diabetes had sensitivity of 84% and specificity of 61%.

Conclusions

FINDRISC is a feasible, non-invasive and useful tool for identifying subjects at risk for undetected diabetes and prediabetes. Laboratory screening should be performed in subjects with FINDRISC higher than 10.     

Newly diagnosed diabetes vs. pre-existing diabetes upon admission for COVID-19: Associated factors,short-term outcomes,and long-term glycemic phenotypes

AimsHigh rates of newly diagnosed diabetes mellitus (NDDM) have been reported in association with coronavirus disease-2019 (COVID-19). Factors associated with NDDM and long-term glycemic outcomes are not known.MethodsRetrospective review of individuals admitted with COVID-19 and diabetes mellitus (DM; based on labs, diagnoses, outpatient insulin use, or severe inpatient hyperglycemia) between March and September 2020, with follow-up through July 2021.ResultsOf 1902 individuals admitted with COVID-19, 594 (31.2%) had DM; 77 (13.0%) of these had NDDM. Compared to pre-existing DM, NDDM was more common in younger patients and less common in those of non-Hispanic White race/ethnicity. Glycemic parameters were lower and inflammatory markers higher in patients with NDDM. In adjusted models, NDDM was associated with lower insulin requirements, longer length of stay, and intensive care unit admission but not death. Of 64 survivors with NDDM, 36 (56.3%) continued to have DM, 26 (40.6%) regressed to normoglycemia or pre-diabetes, and 2 were unable to be classified at a median follow-up of 323 days.ConclusionsDiabetes diagnosed at COVID-19 presentation is associated with lower glucose but higher inflammatory markers and ICU admission, suggesting stress hyperglycemia as a major physiologic mechanism. Approximately half of such individuals experience regression of DM.     

Interactions between microvascular and macrovascular disease in diabetes: pathophysiology and therapeutic implications

Convention partitions the complications of diabetes into two main subtypes. First are the diabetes-specific microvascular complications of retinopathy, nephropathy and neuropathy; second are the atherothrombotic macrovascular complications that account for the majority of premature deaths. Pathological interactions between microvascular and macrovascular complications, for example, nephropathy and macrovascular disease, are common. Similar mechanisms and shared risk factors drive the development and progression of both small and large vessel disease. This concept has therapeutic implications. Mounting evidence points to the need for multifactorial strategies to prevent vascular complications in subjects with diabetes and/or the metabolic syndrome. We advocate a combined therapeutic approach that addresses small and large vessel disease. Preferential use should be made of drug regimens that (i) maximize vascular protection, (ii) reduce the risk of iatrogenic vascular damage and (iii) minimize the increasing problem of polypharmacy.     

Microvascular and macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and Europe: The RODAM study

AimsTo compare microvascular and macrovascular complication rates among Ghanaians with type 2 diabetes (T2D) living in Ghana and in three European cities (Amsterdam, London and Berlin).MethodsData from the multicenter Research on Obesity and Diabetes among African Migrants (RODAM) study were analyzed. 650 Ghanaian participants with T2D (206 non-migrant and 444 migrants) were included. Logistic regression analyses were used to determine the association between migrant status and microvascular (nephropathy and retinopathy) and macrovascular (coronary artery disease (CAD), peripheral artery disease (PAD) and stroke) complications with adjustment for age, gender, socioeconomic status, alcohol, smoking, physical activity, hypertension, BMI, total-cholesterol, and HbA1c.ResultsMicrovascular and macrovascular complications rates were higher in non-migrant Ghanaians than in migrant Ghanaians (nephropathy 32.0% vs. 19.8%; PAD 11.2% vs. 3.4%; CAD 18.4% vs. 8.3%; and stroke 14.5% vs. 5.6%), except for self-reported retinopathy (11.0% vs. 21.6%). Except nephropathy and stroke, the differences persisted after adjustment for the above-mentioned covariates: PAD (OR 7.48; 95% CI, 2.16–25.90); CAD (2.32; 1.09–4.93); and retinopathy (0.23; 0.07–0.75).ConclusionsExcept retinopathy, the rates of microvascular and macrovascular complications were higher in non-migrant than in migrant Ghanaians with T2D. Conventional cardiovascular risk factors did not explain the differences except for nephropathy and stroke.     

Prediabetes: diagnosis, evaluation of chronic complications, and treatment

Type 2 diabetes mellitus accounts for 90% of diabetes cases and is associated with macro- and microvascular complications of high morbidity and mortality. Individuals with increased risk for type 2 diabetes include those with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and especially those with combined IFG and IGT. These individuals are part of a group known as prediabetes patients. Approximately 25% of individuals with prediabetes will develop type 2 diabetes in three to five years. Hyperglycemia, in the absence of diabetes, is also associated with increased risk of cardiovascular disease. Studies have shown that changes in lifestyle and drug interventions are effective in delaying or preventing type 2 diabetes in patients with prediabetes. Metformin is the drug of choice when medical treatment is warranted. IGT and IFG are associated with type 2 diabetes and, despite controversy, most studies reinforce the importance of these conditions in the development of micro- and macrovascular disease. Thus, therapeutic interventions in patients with prediabetes are important in primary prevention of type 2 diabetes and its chronic complications.     

Microvascular and macrovascular complications in type 2 diabetes in a multi-ethnic population based in Amsterdam. The HELIUS study

ObjectiveTo assess ethnic differences in diabetes-related microvascular and macrovascular complication rates in a multi-ethnic population in the Netherlands.Study, design and settingData from the HELIUS study comprising of 165 Dutch, 591 South-Asian Surinamese, 494 African Surinamese, 272 Ghanaian, 368 Turkish, and 444 Moroccan participants with diabetes were analyzed. Logistic regression was used to assess ethnic differences in microvascular (nephropathy) and macrovascular (coronary heart disease (CHD), peripheral artery disease (PAD) and stroke) complications, with adjustments for age, sex, education, and the conventional risk factors.ResultsIn an age-sex adjusted model, ethnic minorities had higher odds of nephropathy than Dutch except for Ghanaians and African Surinamese. The difference remained statistically significant in South-Asian Surinamese (odds ratio: 2.29; 95% CI, 1.09–4.80), but not in the Turkish (1.01; 0.43–2.38) and Moroccan (1.56; 0.68–3.53) participants. The odds of CHD was higher in all ethnic minorities than in Dutch, with the odds ratios ranging from 2.73 (1.09–6.84) in Ghanaians to 6.65 (2.77–15.90) in Turkish in the fully-adjusted model. There were no ethnic differences in the odds of PAD and stroke.ConclusionsThe findings suggest ethnic inequalities in macrovascular and microvascular complications in diabetes, with nephropathy and CHD being the most common complications affecting ethnic minorities.     

Macro- and micro-vascular complications and their determinants among people with type 2 diabetes in Bangladesh

ObjectivesTo identify the prevalence of micro- and macro-vascular complications and their associated factors for type 2 diabetes mellitus in Bangladesh.MethodsThis retrospective and cross-sectional study was conducted in six diabetes hospitals, covered urban and rural population. From April to September in 2017, a total of 1253 type 2 diabetes patients aged ≥18 years were recruited. Participants answered a pre-tested electronic questionnaire, and their medical records were reviewed for documented diabetes complications.ResultsMean age was 55.1 (±12.6) years. Among macrovascular complications, the prevalence of coronary artery disease was found to be 30.5%, 10.1% for stroke and 12.0% for diabetic foot. Among microvascular complications, nephropathy was prevalent among 34.2%, retinopathy among 25.1% and neuropathy among 5.8% of patients. Risk factors found to be associated with one or more of the complications were female gender, higher age, lower education level, an urban area of residence, higher household income, smoking, physical inactivity, hypertension, poor glycaemic control, poor adherence to treatment, longer duration of diabetes, and insulin use.ConclusionDiabetes complications are highly prevalent among type 2 diabetes population in Bangladesh. Prevention strategies should focus on increasing physical activity, weight loss, smoking cessation, and more strict control of hypertension and glycaemic level.     

Age,age at diagnosis and diabetes duration are all associated with vascular complications in type 2 diabetes

Background

Type 2 diabetes (T2DM) is increasingly diagnosed in younger patients. The trajectory of complications in patients diagnosed at a younger or older age is not well understood. We examine the associations between age, age at diagnosis and diabetes duration and vascular complications in patients with T2DM.

Effective treatment of hypertension in patients with diabetes mellitus.

Atherosclerosis, presenting as macrovascular complications of diabetes mellitus, produces approximately 80% of all diabetic mortality, whether the patient has Type I insulin-dependent diabetes (IDDM) or Type II non-insulin dependent diabetes mellitus (NIDDM). Specifically, 75% of this atherosclerotic macrovascular mortality flows as the outcome of coronary atherosclerosis, which is increased approximately two-fold in men and four-fold in women with diabetes as compared with otherwise matched populations with entirely normal carbohydrate tolerance. The remaining 25% of this atherosclerotic mortality in patients with diabetes mellitus is the result either of accelerated cerebrovascular or of peripheral vascular complications of diabetes, both of which are increased four-fold and five-fold, respectively, in patients with diabetes mellitus, regardless of type. Furthermore, atherosclerosis is the principal cause of hospitalizations for patients with diabetes mellitus. Admissions for this complication account for approximately 77% of total hospitalizations for diabetes owing to complications. Aside from mortality data alone, atherosclerosis is obviously a leading cause of diabetic disability, since it produces patients who are chronic cardiovascular, peripheral or cerebrovascular cripples, perhaps for many years before their ultimate demise. Small blood vessel or microvascular complications of diabetes mellitus, while formerly thought to be the end-stage in the unfolding of the diabetic process, do not appear to have the potential for mortality as do the atherosclerotic large blood vessel complications.(ABSTRACT TRUNCATED AT 250 WORDS)     

The role of lipoprotein(a) in the vascular complications of diabetes mellitus

Abstract. Lipoprotein(a) has been identified as an independent risk factor for atherosclerotic vascular disease in non-diabetic populations. Because of its potential role in the pathogenesis of both microvascular and macrovascular complications in diabetes, there have recently been many reports on lipoprotein(a) in diabetic populations. Some studies indicate an association between elevated lipoprotein(a) and macro-vascular disease in non-insulin-dependent diabetes mellitus (NIDDM), but this link has not been found with insulin-dependent diabetes mellitus (IDDM). In IDDM, elevated lipoprotein(a) has been found in groups with diabetic nephropathy and retinopathy, raising the possibility that it plays a causative role. The relationship between glycaemic control and the lipoprotein(a) level has not been fully resolved. Most studies have not found any connection in NIDDM, but some found higher lipoprotein(a) levels in hyper-glycaemic IDDM patients. Potentially, lipoprotein(a) is an important factor linking the microvascular and macrovascular complications of diabetes.