Blood urea level and diabetes duration are independently associated with ankle-brachial index in type 2 diabetic patients

AimThe purpose of the study was to determine factors of ankle-brachial index (ABI) in a population of patients with type 2 diabetes and coronary artery disease.Material and methods370 patients (mean age 60.3 ± 8.3 years and diabetes duration 8.6 ± 6.2 years) with type 2 diabetes and coronary artery disease were enrolled in a cross sectional study during 2006–2007. Multivariable linear regression analysis was conducted to determine the factors of ABI, considering systolic and diastolic blood pressure, weight, body mass index, waist circumference, glycemia, urea, creatinin, triglycerides, total cholesterol, LDL- and HDL-cholesterol.ResultsPeripheral arterial disease was detected in 82.35% (280 pts). Mean ABI value of 0.97 ± 0.33, and its minimal value of 0.95 ± 0.38 was detected in this study population. Regression analysis demonstrated that mean and minimal values of ABI were independently associated with diabetes duration (β 0.120, 95% CI ?0.014, ?0.001) and blood urea level (β ?0.126, 95% CI ?0.020, ?0.002).ConclusionResults might have clinical implications for patients with type 2 diabetes and coronary artery disease in defining those with a long diabetes duration and a higher blood urea level to have greater probability of detecting pathological ankle-brachial index.     

Utilization of Frontal Assessment Battery and Executive Interview 25 in assessing for dysexecutive syndrome and its association with diabetes self-care in elderly patients with type 2 diabetes mellitus

AimsExecutive function (EF) comprises a set of cognitive skills that controls the execution of complex activities. In the context of diabetes, this may include patients’ self-monitoring and daily management of their condition. We compared two different measures of EF in a population of elderly patients with type 2 diabetes mellitus (T2DM) and studied its relationship with diabetes self-care.MethodsFifty patients (34 males) had EF assessed using Frontal Assessment Battery (FAB) and Executive Interview 25 (EXIT25). Diabetes self-care was assessed using the Summary of Diabetes Self-Care Activities (SDSCA) scale. Haemoglobin A1c (HbA1c), lipid levels, blood pressure and diabetes duration were recorded.ResultsThe mean age of the patients was 67.0 ± 7.5 years and mean duration of diabetes was 8.1 ± 6.4 years. Mean HbA1c was 7.0 ± 1.2%, and mean fasting plasma glucose, cholesterol and LDL-C were 7.0 ± 1.7 mM, 4.0 ± 0.9 mM and 2.1 ± 0.7 mM respectively. Mean EXIT25 score was 9.5 ± 4.6 in the range of normal EF (14% had EXIT25 score > 15, indicating impaired EF). Mean FAB score was 13.7 ± 3.3 (48% having scores < 15, indicating impaired EF), suggesting a degree of dysexecutive syndrome involving frontal lobe functions. EXIT25 score was inversely correlated with SDSCA (r = −0.3, p < 0.05) but no significant correlation between FAB and SDSCA or HbA1c, diabetes duration, lipid levels and blood pressure with EXIT25, FAB or SDCSA was found.ConclusionA substantial proportion of elderly patients with T2DM may have dysexecutive syndrome and impairment in EF may impact on self-care in this group.     

Analysis of arterial function in adults with a history of Kawasaki disease

Background and purposeIt remains controversial whether Kawasaki disease (KD) is a risk factor for the early onset of atherosclerosis.The purpose of the present study was to assess endothelial function and arterial stiffness as markers of the early onset of atherosclerosis in adult patients with a history of KD.Methods and subjectsWe compared 14 adult patients with a history of KD with 41 healthy controls. To assess arterial endothelial function, we measured the reactive hyperemia-peripheral arterial tonometry (RH-PAT) index and augmentation index adjusted to 75 bpm (AIx@75) using the Endo-PAT 2000 (Itamar Medical, Caesarea, Israel). In addition, we analyzed medical history, blood pressure, lifestyle habits, and atherosclerosis-related serum biochemical markers [asymmetric dimethylarginine, adiponectin, lipoprotein (a), cholesterols, atherogenic index of plasma].ResultsThere was no difference between the KD and control groups with regard to the RH-PAT index values (2.10 ± 0.43 and 1.84 ± 0.49, respectively; p = 0.19). However, in the KD group, the RH-PAT index values were negatively correlated with the febrile period in the acute phase of disease (r² = 0.458, p = 0.048). In addition, the AIx@75 values were higher in KD patients compared to healthy controls (?7.69 ± 11.86% and ?15.87 ± 8.72%, respectively; p = 0.01). No significant differences existed between the KD and control groups with regard to the serum biomarkers of atherosclerosis.ConclusionsWe speculate that endothelial dysfunction in former KD patients is affected by the febrile period of the acute phase, and antiplatelet drugs may improve endothelial function. The increased arterial stiffness of patients caused by post-inflammatory fibrotic changes in the arterial wall indicates that adults with a history of KD have an increased risk of developing atherosclerosis.     

WHO-5, a tool focusing on psychological needs in patients with diabetes: The French contribution to the DAWN study

AimIn 2001, the international Diabetes Attitudes, Wishes and Needs (DAWN) programme was launched to evaluate the psychosocial impact of diabetes. In France, DAWN experts carried out an observational study to further understand the impact of diabetes on the psychological well-being of people with diabetes, using the French version of the WHO-5 questionnaire.MethodsThe WHO-5, a unidimensional five-item questionnaire that measures positive psychological well-being, was completed by 2213 patients (1670 with diabetes). A total sum score was calculated, ranging on a scale from 0 to 25. A score less than 13 indicated impaired well-being and a score less than 8 reflected likely depression.ResultsThe mean total well-being score for the whole study population was 14.1 ± 5.5, and 14.3 ± 5.5 for patients with diabetes and 13.5 ± 5.4 for patients with other chronic diseases. The average score for patients with diabetes only (15.1 ± 5.2) was higher than those for the other subgroups (P = 0.005), whereas the average scores for those using insulin (14.8 ± 5.2) and women with diabetes (13.2 ± 5.6) were significantly lower compared with the whole diabetic group (15.6 ± 5.1 [P = 0.03] and 15 ± 5.2 [P < 0.001], respectively).ConclusionThe WHO-5 questionnaire showed satisfactory psychometric properties in a large sample of French diabetic patients. The scale is unidimensional and highlighted differences in well-being, which was lower in diabetic women, in patients with other chronic diseases and in those treated with insulin.     

Vascular responsiveness in patients with chronic obstructive pulmonary disease (COPD)

BackgroundIschemic heart disease and peripheral vascular diseases are prevalent in COPD and it is estimated that any 10% decrease in forced expiratory volume in 1 second (FEV1) is associated with 30% increased cardiovascular risk of death. Endothelial dysfunction may be one of the mechanistic pathways that link between COPD and cardiovascular mortality. Our aim was to study the vascular reactivity of patients with stable COPD and to try to correlate endothelial dysfunction, vascular reactivity and functional capacity of these patients that eventually may lead to cardiovascular mortality.MethodsThis was a prospective study. Twenty-three consecutive ambulatory COPD patients were enrolled. All were smoking men, aged 64.4 ± 8.4 years. Twenty-two healthy volunteers aged 44.7 ± 11.7 years, BMI of 25.2 ± 4.2, height of 172 ± 8 cm served as the control group. Vascular studies included endothelial function and ankle brachial index.ResultsBaseline diameter of the brachial artery was larger in COPD patients compared with controls. The absolute change in diameter post hyperemia was significantly less in patients (0.004 ± 0.02 cm vs. 0.05 ± 0.02 cm, p < 0.001) and COPD patients responded to hyperemia by constriction instead of dilatation (FMD% was − 0.6 ± 6.3% in patients vs. 15.6 ± 7.6% in controls, p < 0.001). There was no difference in ABI in patients and controls (0.95 ± 0.26 vs. 1.06 ± 0.16, p = 0.07).DiscussionWe found that patients with COPD have dilated arteries, have impaired ability to respond to high shear stress that triggers nitric oxide dependent flow mediated dilatation, and have also impaired ability to function — represented by the poor 6 minute walk test.     

Hypoglycemia symptoms are reduced in hospitalized patients with diabetes

AimsHospitalized patients with diabetes are have an impaired ability to detect hypoglycemia events. The purpose of this study was to compare hypoglycemia symptom scores (HSS) in hospitalized patients with diabetes after a documented blood glucose (BG) <70 mg/dl with recalled HSS with outpatient hypoglycemia events.MethodsNon-critically ill hospitalized patients with diabetes grouped as symptomatic (n = 23) or asymptomatic (n = 32) at time of index hypoglycemia completed a standardized HSS-Questionnaires (HSS-Q) related to the inpatient event and to recall of symptoms with outpatient hypoglycemia.ResultsAfter controlling for BG at time of index hypoglycemia (49.8 ± 11.4 vs. 57.4 ± 6.8 mg/dl, p = 0.02), symptomatic patients reported higher HSS than asymptomatic patients with the inpatient event (11.6 ± 7.3 vs. 1.5 ± 3.4, p < 0.001) and in the outpatient setting (13.9 ± 8.6 vs. 10.1 ± 10.6, p < 0.01). Recurrent hypoglycemia was more frequent in asymptomatic patients (13% vs. 44%, p = 0.015) during the hospitalization.ConclusionsCompared to symptomatic patients, asymptomatic patients had lower inpatient and outpatient HSS and more frequent recurrent hypoglycemia events. These results suggest modification of glycemic management strategies in high risk patients to reduce risk for hypoglycemia events.     

Assessment of right ventricular function by myocardial performance index in diabetic patients

BackgroundAssessment of right ventricular (RV) function remains difficult because of the RV complex shape. Data regarding RV performance in patients with diabetes are incomplete The aim of this study was to assess the feasibility of pulsed wave tissue Doppler imaging and myocardial performance index (MPI) for the assessment of right ventricular function in diabetic patients without coronary artery disease.MethodsThe study included 20 diabetic patients, 20 diabetic hypertensive and 20 gender and age matched healthy subjects underwent standard echocardiography with tissue Doppler imaging (TDI) to assess RV function. Patients with myocardial ischemia, impaired left ventricular systolic function, valvular heart disease or other diseases which could alter the right ventricular performance were excluded.ResultsMyocardial performance index was significantly higher in diabetes compared to control group (0.41 ± 0.05 versus 0.27 ± 0.04, p = 0.001). Peak myocardial systolic velocity (Sa), early diastolic myocardial velocity (Ea), and late diastolic myocardial velocity (Aa) were significantly lower in patients with diabetes mellitus (DM) compared to the control group (p = 0.0001). Isovolumetric relaxation time (IVRT) was significantly higher in DM group compared to control group (p = 0.003). MPI was significantly higher in diabetic hypertensive group versus DM alone group (0.46 ± 0.050 versus 0.41 ± 0.05, p = 0.01). There was no correlation between MPI and blood glucose level and duration of diabetes.ConclusionMyocardial performance index is a useful noninvasive tool for the detection of early right ventricular systolic and diastolic dysfunction in diabetic patients, regardless of coexisting hypertension.     

Prevalence,predictors and evolution of echocardiographically defined cardiac abnormalities in adults with type 1 diabetes: an observational cohort study

Aims/hypothesisThe aims of this observational study were to determine the prevalence and predictors of an abnormal echocardiogram in adults with type 1 diabetes, and to assess the evolution of changes in a subset of subjects.MethodsCardiac function and structure were prospectively investigated by comprehensive transthoracic echocardiographic techniques in asymptomatic adults with type 1 diabetes seen in the ambulatory care setting.ResultsWe recruited 136 subjects (mean age 39 years, SD 14 years) with a median diabetes duration of 21 years [25^th, 75^th interquartile range; 11, 29]. An abnormal echocardiogram was present in 29% of subjects; diastolic dysfunction in 69%, left ventricular hypertrophy in 38% and systolic dysfunction in 10%. The independent predictors of an abnormal echocardiogram were age, with a 9-fold increase in those ≥ 40 years (OR 9.40 [95% CI 2.68–33.04], P < 0.0001), and increased body mass index (BMI), with a 17% increase in risk (P = 0.04). A second echocardiogram was available in 65 subjects (3.8 ± 1.7 years later). The results showed that one in five with a normal first study had developed an abnormal second study, mainly diastolic dysfunction, with age being the only independent predictor of progression (P = 0.006).Conclusions/interpretationSubclinical echocardiographic abnormalities are common in asymptomatic type 1 diabetes adults, and changes are progressive. The addition of an echocardiogram to complication surveillance programs in those with type 1 diabetes aged ≥ 40 years may represent a cost-effective way to screen for, and aggressively treat, occult cardiac disease.     

Impaired glucose metabolism is a risk factor for increased thyroid volume and nodule prevalence in a mild-to-moderate iodine deficient area

ObjectiveInsulin resistance (IR) is a key factor involved in the pathogenesis of impaired glucose metabolism. IR is associated with increased thyroid volume and nodule prevalence in patients with metabolic syndrome. Data on the association of thyroid morphology and abnormal glucose metabolism are limited. This prospective study was carried out to evaluate thyroid volume and nodule prevalence in patients with pre-diabetes and type 2 diabetes mellitus (DM) in a mild-to-moderate iodine deficient area.Materials and MethodsData were gathered on all newly diagnosed patients with pre-diabetes and type 2 diabetes mellitus between May 2008 and February 2010. 156 patients with pre-diabetes and 123 patients with type 2 DM were randomly matched for age, gender, and smoking habits with 114 subjects with normal glucose metabolism. Serum thyroid-stimulating hormone (TSH) and thyroid ultrasonography was performed in all participants.ResultsMean TSH level in the diabetes group (1.9 ± 0.9 mIU/L) was higher than in the control group (1.4 ± 0.8 mIU/L) and the pre-diabetes group (1.5 ± 0.8 mIU/L) (P < 0.0001 for both). Mean thyroid volume was higher in the pre-diabetes (18.2 ± 9.2 mL) and diabetes (20.0 ± 8.2 mL) groups than in controls (11.4 ± 3.8 mL) (P < 0.0001 for both). Percentage of patients with thyroid nodules was also higher in the pre-diabetes (51.3%) and diabetes groups (61.8%) than in controls (23.7%) (P < 0.0001 for both).ConclusionsThe results suggest that patients with impaired glucose metabolism have significantly increased thyroid volume and nodule prevalence.     

Detection of cardiovascular autonomic neuropathy using exercise testing in patients with type 2 diabetes mellitus

AimsThis study investigated autonomic nervous system function in subjects with diabetes during exercise and recovery.MethodsEighteen type 2 diabetics (age 55 ± 2 years) and twenty healthy controls (age 51 ± 1 years) underwent two 16-min bicycle submaximal ECG stress tests followed by 45 min of recovery. During session #2, atropine (0.04 mg/kg) was administered at peak exercise, and the final two minutes of exercise and entire recovery occurred under parasympathetic blockade. Plasma catecholamines were measured throughout. Parasympathetic effect was defined as the difference between a measured parameter at baseline and after parasympathetic blockade.ResultsThe parasympathetic effect on the RR interval was blunted (P = .004) in diabetic subjects during recovery. Parasympathetic effect on QT–RR slope during early recovery was diminished in the diabetes group (diabetes 0.13 ± 0.02, control 0.21 ± 0.02, P = .03). Subjects with diabetes had a lower heart rate recovery at 1 min (diabetes 18.5 ± 1.9 bpm, control 27.6 ± 1.5 bpm, P < .001).ConclusionsIn subjects with well-controlled type 2 diabetes, even with minimal evidence of CAN using current methodology, altered cardiac autonomic balance is present and can be detected through an exercise-based assessment for CAN. The early post-exercise recovery period in diabetes was characterized by enhanced sympathoexcitation, diminished parasympathetic reactivation and delay in heart rate recovery.     

Diabetic state as a crucial factor for impaired arterial elastic properties in patients with peripheral arterial disease

BackgroundIncreased arterial stiffness is associated with greater risk of cardiovascular events and mortality. However, in patients with peripheral arterial disease (PAD) who have severe atherosclerotic disorder or risk clustering, the major determinants of increased stiffness have been not clarified.MethodsThis study investigated the associations between elastic properties of the carotid artery as measured by ultrasonography and atherosclerotic risk factors, with particular focus on diabetes mellitus (DM), in PAD patients (n = 481; mean age, 69.6 years). DM was defined as hemoglobin A1c ≥6.5%, administration of anti-diabetic agents, or DM pattern on 75-g oral glucose tolerance test. Stiffness β index was calculated from luminal diameter changes measured by the M-mode method using a linear array imaging probe.ResultsStiffness parameter β was significantly increased in diabetic patients compared with non-diabetic patients (9.56 ± 0.35 vs. 8.31 ± 0.32; p = 0.009) in an age- and gender-adjusted model. This significant difference was maintained in a multivariate-adjusted model including age, gender, hypertension, hyperlipidemia, obesity and smoking history (9.43 ± 0.36 vs. 8.39 ± 0.33; p = 0.037). No significant differences in mean intima-media complex thickness or plaque score of the carotid artery were seen between diabetic and non-diabetic patients.ConclusionDiabetic condition impairs the elastic properties of arteries, independent of other known atherosclerotic risk factors or excessive intimal diseases in PAD patients. This may support the notion that diabetic condition can worsen prognosis for PAD patients.     

No association of dietary fiber intake with inflammation or arterial stiffness in youth with type 1 diabetes

AimTo examine the association of dietary fiber intake with inflammation and arterial stiffness among youth with type 1 diabetes (T1D) in the US.MethodsData are from youth ≥ 10 years old with clinically diagnosed T1D for ≥ 3 months and ≥ 1 positive diabetes autoantibody in the SEARCH for Diabetes in Youth Study. Fiber intake was assessed by food frequency questionnaire with measurement error (ME) accounted for by structural sub-models derived using additional 24-h dietary recall data in a calibration sample and the respective exposure-disease model covariates. Markers of inflammation, measured at baseline, included IL-6 (n = 1405), CRP (n = 1387), and fibrinogen (n = 1340); markers of arterial stiffness, measured approximately 19 months post-baseline, were available in a subset of participants and included augmentation index (n = 180), pulse wave velocity (n = 184), and brachial distensibility (n = 177).ResultsMean (SD) T1D duration was 47.9 (43.2) months; 12.5% of participants were obese. Mean (SD) ME-adjusted fiber intake was 15 (2.8) g/day. In multivariable analyses, fiber intake was not associated with inflammation or arterial stiffness.ConclusionAmong youth with T1D, fiber intake does not meet recommendations and is not associated with measures of systemic inflammation or vascular stiffness. Further research is needed to evaluate whether fiber is associated with these outcomes in older individuals with T1D or among individuals with higher intakes than those observed in the present study.     

Hypoadiponectinaemia enhances waist circumference as a predictor of glucose intolerance and clustering of risk factors in Chinese men

AimThis study aimed to confirm the hypothesis that adiponectin levels can enhance the discriminative value of waist circumference (WC) in predicting impaired glycaemic status and clustering of risk factors.MethodsWe used receiver operating characteristic (ROC) curve analysis to define the optimal cut-off value of adiponectin to predict diabetes in Chinese men with no relevant past medical history. This value was combined with WC to increase its discriminative power in ascertaining impaired glycaemic status and various cardiovascular risk factors.ResultsIn 360 men (mean ± S.D.; age: 41.3 ± 9.2 years), the mean ± S.D. adiponectin level was 5.2 ± 2.7 μg/mL. Based on oral glucose tolerance tests (OGTTs), 84 men (23.3%) had undiagnosed diabetes, 52 (14.4%) had impaired glucose tolerance (IGT) and 224 (62.3%) had normal glucose tolerance. On ROC analysis, 5.7 μg/mL was the optimal cut-off value of adiponectin in this population to predict diabetes. Compared with subjects who had normal WC (defined as less than 90 cm) and high adiponectin levels (≥ 5.7 μg/mL), the likelihood ratio of diabetes was 2.54 in those with central obesity and hypoadiponectinaemia.ConclusionThe combined use of low adiponectin levels and large WC measures has greater discriminative power than using either index alone to identify subjects at particular risk of glucose intolerance and clustering of risk factors.     

Awareness of risk factors for type 2 diabetes in women with current and former gestational diabetes mellitus (GDM): Implications for future primary diabetes prevention

AimsTo assess the awareness of risk factors for type 2 diabetes and lifestyle changes that can decrease such risks in women with GDM.MethodsThe study comprised responses to health questionnaires by 319 women: 31 pregnant women with current GDM (CGDM), 88 women with previous GDM (PGDM), 100 pregnant women without DM (PWDM) and 100 non-pregnant women without DM (NPWDM). The CGDM group answered the questionnaires at the initiation and 4 weeks after participating in formal education on GDM. Two types of awareness scores (AS) were established. One AS was about the risks associated with GDM (GDMR), and the other was related to the awareness of lifestyle changes that can decrease the risks of type 2 diabetes (DM2R).ResultsThe PGDM group had the highest GDMR and DM2R scores (9.55 ± 2.66) (13.2 ± 2.26) compared with the other groups (CGDM 7.48 ± 3.14, NPWDM 6.10 ± 3.17, PWDM 2.89 ± 2.48) (p < 0.05) and (NPWDM 12.05 ± 2.73, CGDM 11.29 ± 2.45, PWDM 8.27 ± 4.14) (p < 0.05). The CGDM group increased the GDMR score from 7.48 ± 3.14 to 10.54 ± 2.57 (p < 0.0001) and the DM2R score from 11.29 ± 2.45 to 14.04 ± 1.26 (p < 0.001).ConclusionsWomen had limited awareness of risk factors for type 2 diabetes and lifestyle modifications that can decrease such risk of diabetes. AS were higher in women with current and previous GDM after receiving formal education.     

Serum uric acid and insulin sensitivity in adolescents and adults with and without type 1 diabetes

HypothesisDecreased insulin sensitivity (IS) exists in type 1 diabetes. Serum uric acid (SUA), whose concentration is related to renal clearance, predicts vascular complications in type 1 diabetes. SUA is also inversely associated with IS in non-diabetics, but has not been examined in type 1 diabetes. We hypothesized SUA would be associated with reduced IS in adolescents and adults with type 1 diabetes.MethodsThe cross-sectional and longitudinal associations of SUA with IS were investigated in 254 adolescents with type 1 diabetes and 70 without in the Determinants of Macrovascular Disease in Adolescents with Type 1 Diabetes Study, and in 471 adults with type 1 diabetes and 571 without in the Coronary Artery Calcification in Type 1 diabetes (CACTI) study.ResultsSUA was lower in subjects with type 1 diabetes (p < 0.0001), but still remained inversely associated with IS after multivariable adjustments in adolescents (β ± SE: − 1.99 ± 0.62, p = 0.001, R² = 2%) and adults (β ± SE: − 0.91 ± 0.33, p = 0.006, R² = 6%) with type 1 diabetes, though less strongly than in non-diabetic controls (adolescents: β ± SE: − 2.70 ± 1.19, p = 0.03, R² = 15%, adults: β ± SE: − 5.99 ± 0.75, p < 0.0001, R² = 39%).ConclusionWe demonstrated a significantly weaker relationship between SUA and reduced IS in subjects with type 1 diabetes than non-diabetic controls.     

Diabetes,peripheral neuropathy,and lower-extremity function

ObjectiveDiabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes–physical function relationship.Research Design and MethodsThis study included 983 participants, age 65 years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations.Results and ConclusionOne hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β = − 0.99; p < 0.01), decreased walking speed (β = − 0.1 m/s; p < 0.01), decreased nerve conduction velocity (β = − 1.7 m/s; p < 0.01), and increased neuropathy (β = 0.25; p < 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF.     

Baseline osteocalcin levels and incident diabetes in a 3-year prospective study of high-risk individuals

AimExperimental evidence suggests that osteocalcin is a key messenger that affects both adipocytes and insulin-producing β cells. Epidemiological cross-sectional studies have shown a negative association between plasma levels of osteocalcin and glucose. For this reason, the hypothesis that lower baseline osteocalcin plasma levels are associated with diabetes was prospectively tested.MethodsThe study population consisted of individuals at high risk for type 2 diabetes who were screened for participation in the Greek arm of a European type 2 diabetes prevention study (the DE-PLAN study). All participants were free of diabetes at baseline and underwent a second evaluation 3 years later. Diabetes status was defined according to an oral glucose tolerance test.ResultsA total of 307 subjects were included in the present analysis. The population, including 154 men (50.3%), was middle-aged (54.4 ± 10.2 years) and overweight (BMI: 29.5 ± 4.9 kg/m²). At baseline, mean total plasma osteocalcin was lower in those with impaired fasting glucose and/or impaired glucose tolerance compared with those with normal glucose tolerance (6.0 ± 3.1 ng/mL vs. 7.3 ± 4.0 ng/mL, respectively; P = 0.01). After 3 years, 36 subjects had developed diabetes. In the prospective evaluation, there was no association between baseline osteocalcin levels and diabetes (OR: 1.04 per 1 ng/mL, 95% CI: 0.93–1.15; P = 0.49) on multivariable logistic regression analysis, nor was there any correlation with changes in plasma glucose after 3 years (r = 0.09, P = 0.38).ConclusionOur prospective results show that lower levels of circulating osteocalcin do not predict future diabetes development and, in contrast to most cross-sectional published data so far, suggest that this molecule may not be playing a major role in glucose homoeostasis in humans.     

Utilization of lipid lowering medications among adults in the United States 1999–2006

ObjectiveWe examined the use of lipid lowering medications and control of dyslipidemia among US adults in 1999–2006.MethodsData were extracted from the National Health and Nutrition Examination Survey 1999–2006.ResultsThe mean low-density lipoprotein-cholesterol (LDL-C) level significantly decreased from 3.25 ± 0.03 mmol/L in 1999–2002 to 3.02 ± 0.02 mmol/L in 2003–2006 in men, and from 3.11 ± 0.03 to 2.98 ± 0.03 mmol/L in women (p < 0.001). Statins and fibrates were the most commonly used medications. Among those diagnosed with hypercholesterolemia, the proportion on treatment increased from 32.4% to 38.9% (p = 0.001) in the 8-year period. The proportion of participants with a history of diabetes treated with a statin increased from 20.9 ± 2.2% in 1999–2002 to 37.6 ± 2.5% in 2003–2006 (p < 0.001). However, only 39.9% of people with diabetes and 45.4% of people with ischemic heart disease (IHD) achieved LDL-C target levels.ConclusionsBetween 1999 and 2006, LDL-C level decreased in US adults and use of lipid lowering medications increased. More effort is still needed to detect and treat dyslipidemia in the community, particularly in people at high cardiovascular risk.     

Baseline renal functions predict the effect of canakinumab on regression of proteinuria in patients with familial Mediterranean fever

Introduction and objectivesCanakinumab, an IL-1 blocking drug, decreases the frequency and severity of the attacks and decreases the proteinuria level in colchicine resistant/intolerant familial Mediterranean fever (FMF) patients. However, it is not known whether patients with impaired or preserved renal functions respond differently to IL-1 blocking therapies in terms of proteinuria reduction and progression of kidney dysfunction which was the aim of this study.Materials and methodsAdult FMF subjects with biopsy proven amyloidosis who had 24-h urine protein excretion > 150 mg/day before initiation of canakinumab were divided into two groups as patients with preserved renal function (GFR ≥ 60 mL/min) and patients with impaired renal function (GFR < 60 mL/min). The response in proteinuria and renal functions are compared between two groups in this cross-sectional study.ResultsA total of 18 patients (11 with preserved and 7 with impaired renal function) were included in this study. Although proteinuria levels of both groups were similar at the baseline and at six months after initiation of canakinumab, proteinuria at 12 months was significantly lower for patients with preserved renal function compared to patients with impaired renal function (2462 ± 1760 mg/day vs. 7065 ± 3035 mg/day respectively, p = 0.02). All of the patients with preserved renal function had more than 50% decrease in proteinuria at 12 months compared to baseline values, while none of the patients with impaired renal function had more than 50% decrease in proteinuria.ConclusionsCanakinumab, an IL-1 blocking agent, is not effective in decreasing proteinuria in FMF patients with already impaired renal functions and should be started early in the course of disease to prevent renal impairment.     

Impaired endothelial function is not associated with arterial stiffness in adults with type 1 diabetes

AimThis study investigated the relationship between endothelial dysfunction (ED) and arterial stiffness (AS) in adults with type 1 diabetes and no clinical cardiovascular (CV) disease.MethodsA total of 68 patients with type 1 diabetes and 68 age- and gender-matched healthy (non-diabetic) subjects were evaluated. ED was assessed by reactive hyperaemia peripheral arterial tonometry (RH-PAT) and by serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and E-selectin. AS was assessed by aortic pulse wave velocity (aPWV). All statistical analyses were stratified by gender.ResultsAdults with type 1 diabetes had RH-PAT index scores similar to those of their matching controls [men: 1.55 (1.38–1.98)% versus 1.61 (1.40–2.17)%, P = 0.556; women: 2.07 (1.55–2.31)% versus 2.08 (1.79–2.49)%; P = 0.215]. However, after adjusting for potential confounders, type 1 diabetes emerged as the main determinant of the RH-PAT index in women. Also, differences between genders in both the controls and type 1 diabetes patients disappeared. Men with diabetes had higher serum concentrations of E-selectin, and women had higher serum concentrations of sICAM-1, sVCAM-1 and E-selectin than their respective controls. However, after adjusting for potential confounders, only the differences in sICAM-1 (women) and E-selectin (both genders) remained significant. No association was found between aPWV and the RH-PAT index and ED markers after adjusting for CV risk factors.ConclusionED was increased in adults with type 1 diabetes compared with age-matched non-diabetic subjects. Also, gender differences in ED were lost in type 1 diabetes. However, ED was not associated with AS after adjusting for potential confounders. These findings suggest that ED occurs earlier than AS in type 1 diabetes.