Valsartan inhibited HIF-1α pathway and attenuated renal interstitial fibrosis in streptozotocin-diabetic rats

Aims

This study was carried out with the purpose of investigating the association between serum lactadherin, monocyte chemoattractant protein 1 (MCP-1), tumor necrosis factor alpha (TNFα) and carotid-femoral pulse wave velocity (PWV) in elderly patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 105 subjects including 27 T2DM patients without vascular complications (DM), 28 T2DM patients with vascular complications (DC), 25 elderly healthy volunteers (older) and 25 younger healthy volunteers (younger) were recruited into the study. Carotid-femoral PWV was measured using an automatic device. Serum lactadherin, MCP-1 and TNFα were determined by enzyme linked immunosorbent assay.

Results

PWV and lactadherin, MCP-1 and TNFα were significantly higher in DM and DC groups than those of older and younger groups. PWV and lactadherin were higher in older group than those of younger group. Moreover, lactadherin was significantly correlated with MCP-1, TNFα, PWV, HbA1c and 2 h postprandial blood glucose (P2hBG) (P < 0.05). In multivariate regression analysis, the independent determinants of lactadherin were HbA1c, P2hBG and age (P < 0.05).

Conclusions

These findings underscore that lactadherin is correlated with poor blood glucose control and diabetic vascular complications.     

Adequacy of Vitamin D Replacement in Severe Deficiency Is Dependent on Body Mass Index

Background

Obesity is associated with hypovitaminosis D. Whether body mass index (BMI) determines the replacement dose of vitamin D to achieve sufficiency is unclear.

Objective

To determine the relationship between BMI and serum 25-OH vitamin D concentrations and whether the increase in serum 25-OH vitamin D concentrations with vitamin D replacement is dependent on BMI.

Methods

Retrospective review of anthropometric data and serum 25-OH vitamin D concentrations in 95 patients attending an outpatient clinic in a tertiary hospital. In a second component of the study, 17 hospital inpatients with severe vitamin D deficiency (serum 25-OH D concentrations < 6 ng/mL [15 nmol/L]) were supplemented with 10,000 units vitamin D₃/day orally for 1 week. Biochemistry and anthropometric measurements were compared before and after vitamin D replacement.

Results

Serum 25-OH vitamin D concentrations correlated negatively with BMI in the 95 outpatients (r² = 0.11, P <.01). In the longitudinal study, BMI correlated positively with serum intact parathyroid hormone (r² = 0.84, P <.01) and negatively with 1.25-(OH)₂ vitamin D (r² = 0.19, P = .06) at baseline. Serum 25-OH D concentrations achieved following 1 week of vitamin D₃ replacement correlated negatively with BMI (r² = 0.63, P <.01).

Conclusion

Efficacy of vitamin D supplementation is dependent on BMI. Overweight and obese patients with hypovitaminosis D might require higher doses of vitamin D to achieve vitamin D repletion compared with individuals with normal body weight.     

Central and peripheral pulse wave velocities are associated with ankle-brachial pressure index

Background

Central Pulse Wave Velocity (PWV) is considered to be the gold standard measurement of arterial stiffness. In healthy subjects, cardiovascular risk factors such as age, hypertension, diabetes and end-stage renal disease are associated with increased central (Carotid-Femoral) and peripheral (Femoral-Ankle) PWV. However, little is known about PWV in patients with peripheral arterial disease and pathological Ankle-Brachial Index (ABI). The aim of this study was to study central and peripheral PWV in a population with various degree of peripheral arterial disease.

Methods

Central and peripheral PWV were measured in sixty-two hospitalized patients. Half were admitted for symptomatic peripheral vascular disease and the remainder for cardiac or carotid disease. The population was classified on basis of the Framingham-derived risk score for claudicants and on the ABI. For all patients, PWV was assessed on electrocardiogram-ultrasonographic images acquired at the four following sites: carotid, radial, femoral and tibial arteries.

Results

Carotid-Femoral PWV increased significantly with the Framingham-derived global risk score (p < 0.0001) but Femoral-Ankle PWV did not. With respect to the Ankle-Brachial Index, Carotid-Femoral and Femoral-Ankle PWV significantly increased (p = 0.05 and p = 0.02 respectively) with the severity of peripheral arterial scoring.

Conclusions

These results confirm that central PWV is the best indicator of general atherosclerosis, even in the presence of peripheral arterial disease. Both central and peripheral PWV can be considered as indicators of the severity of peripheral vascular disease.     

Effects of 12 weeks high dose vitamin D3 treatment on insulin sensitivity,beta cell function,and metabolic markers in patients with type 2 diabetes and vitamin D insufficiency – a double-blind,randomized, placebo-controlled trial

Objectives

Vitamin D insufficiency is common in subjects with type 2 diabetes. Observational studies suggest that vitamin D plays a role in the pathogenesis of type 2 diabetes. However, results of intervention studies have been inconsistent. We investigated the effects of improving vitamin D status on insulin sensitivity, insulin secretion, and inflammatory markers in patients with type 2 diabetes.

Materials/methods

A double blind, randomized, placebo controlled trial was conducted. Sixteen patients with type 2 diabetes and hypovitaminosis D were recruited. Eight patients received colecalciferol and (280 μg daily for 2 weeks, 140 μg daily for 10 weeks) and 8 patients received identical placebo tablets for 12 weeks. Before and after intervention, patients underwent IVGTT, hyperinsulinemic euglycemic clamp, assessment of baseline high-frequency insulin pulsatility, glucose-entrained insulin pulsatility, DXA scans, 24-hour-ambulatory blood pressure monitorings, and fasting blood samples.

Results

Serum-25(OH) vitamin D and serum-1,25(OH)₂ vitamin D increased significantly after 12 weeks in the intervention group (p = 0.01, p = 0.004). Serum-25(OH) vitamin D was also significantly higher in the vitamin D group compared to the placebo group (p = 0.02) after intervention. Although no significant changes in insulin sensitivity, inflammation, blood pressure, lipid profile, or HbA1c were found, we observed borderline (p between 0.05 and 0.10) improvements of insulin secretion, in terms of c-peptide levels, first phase incremental AUC insulin and insulin secretory burst mass.

Conclusions

Improvement in vitamin D status does not improve insulin resistance, blood pressure, inflammation or HbA1c, but might increase insulin secretion in patients with established type 2 diabetes.     

Risk factor associations with clinical distal symmetrical polyneuropathy and various neuropathy screening instruments and protocols in type 1 diabetes

Objective

To determine whether DSP and neuropathy-assessment instruments used by non-physicians have similar risk factors.

Research design and methods

Analyses were cross-sectional (n = 176).

Results

Risk factors were similar for DSP and screening devices.

Conclusions

These data support the clinical utility of neuropathy screening devices used by non-physician personnel.     

Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women

Background

Hemoglobin A1c (HbA1c) is a marker of cumulative glycemic exposure over the preceding 2- to 3-month period. Whether mild elevations of this biomarker provide prognostic information for development of clinically evident type 2 diabetes and cardiovascular disease among individuals at usual risk for these disorders is uncertain.

Methods

We examined baseline HbA1c levels as a predictor of incident clinical diabetes and cardiovascular disease (nonfatal myocardial infarction, coronary revascularization procedure, ischemic stroke, or death from cardiovascular causes) in a prospective cohort study beginning in 1992 of 26,563 US female health professionals aged 45 years or more without diagnosed diabetes or vascular disease (median follow-up 10.1 years).

Results

During follow-up, 1238 cases of diabetes and 684 cardiovascular events occurred. In age-adjusted analyses using quintiles of HbA1c, a risk gradient was observed for both incident diabetes and cardiovascular disease. After multivariable adjustment, HbA1c remained a strong predictor of diabetes but was no longer significantly associated with incident cardiovascular disease. In analyses of threshold effects, adjusted relative risks for incident diabetes in HbA1c categories of less than 5.0%, 5.0% to 5.4%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 6.9%, and 7.0% or more were 1.0, 2.9, 12.1, 29.3, 28.2, and 81.2, respectively. Risk associations persisted after additional adjustment for C-reactive protein and after excluding individuals developing diabetes within 2 and 5 years of follow-up.

Conclusions

These prospective findings suggest that HbA1c levels are elevated well in advance of the clinical development of type 2 diabetes, supporting recent recommendations for lowering of diagnostic thresholds for glucose metabolic disorders. In contrast, the association of HbA1c with incident cardiovascular events is modest and largely attributable to coexistent traditional risk factors.     

Serum transforming growth factor-beta levels in patients with vitamin D deficiency

Background

Transforming growth factor-beta 1 (TGF-β1) contributes to tissue repair by promoting tissue fibrosis, and elevations have been reported in patients with bone marrow fibrosis. The aim of this study was to evaluate the relationship between TGF-β1 levels and vitamin D deficiency.

Methods

All patients presenting to the outpatient Endocrinology and Metabolic Diseases clinic between June and September of 2008 were approached, and consenting patients who were deemed suitable candidates were enrolled. Hematological parameters were measured, along with serum levels of total and ionized calcium, phosphorus, parathyroid hormone, iron, folic acid vitamin B12 levels, 25 OH vitamin D3 (25OHD₃) and TGF-β1.

Results

A total of 132 patients were included in the study. Patients were divided into 4 groups based on levels of 25OHD₃ [group 1 (< 5 ng/ml), 20 patients; group 2 (5-15 ng/ml), 38 patients; group 3 (16-30 ng/ml); and group 4 (> 30 ng/ml), 28 patients]. TGF-β1 levels were higher in patients in group 1 compared to the other groups. Transforming growth factor-beta levels correlated negatively with vitamin D3 and positively with leukocyte count, platelet count, of MCV and MCH. Multiple regression analyses revealed TGF-β1 levels to be associated with 25OHD₃ as well as with platelet count.

Conclusions

Results of this study are suggestive of the presence of a significant relationship between TGF-β and vitamin D deficiency. Increased TGF-β1 and platelet count may be an early indicator of bone marrow fibrosis in patients with vitamin D deficiency.     

The utility of hemoglobin A1c at diagnosis for prediction of future glycemic control in children with type 1 diabetes

Introduction

We evaluated the relationships of hemoglobin A1c (A1c) at diagnosis of type 1 diabetes (T1DM) to future glycemic control and to a series of clinical variables in children with T1DM.

Materials and methods

Patients <18 years old diagnosed with T1DM during a one year period who had an A1c at diagnosis and at least one follow-up visit at our center were eligible for inclusion. Baseline variables examined included age, race, gender, symptom duration, admission acuity, anthropometrics, bicarbonate, and A1c. Annual anthropometric and A1c data were also obtained from clinic visits through 4 years after diagnosis.

Results

We identified 120 children (53 males). Mean age at diagnosis was 7.6 ± 3.9 years. Mean A1c at diagnosis was 10.9 ± 1.9%. A1c at diagnosis correlated with age at diagnosis, symptom duration, and A1c at 3-years, with trends towards correlations at 6 weeks and 4 years. A1c at 1 year correlated highly with A1c at subsequent visits. No other baseline variables correlated with subsequent glycemic control.

Conclusions

In children with newly diagnosed diabetes, A1cs at diagnosis and one year post diagnosis are related to subsequent glycemic control. Children with high A1cs particularly at one year post diagnosis may benefit from targeted intensification of resources.     

The foot in type 2 diabetes: is there a link between vascular calcification and bone mineral density?

Aims

To examine the relationship between vascular calcification in the foot (FVC) and bone mineral density (BMD) in the heel of type 2 diabetes mellitus (DM) subjects.

Methods

65 subjects with type 2 DM and serum creatinine < 125 μmol/l underwent CT scanning of the foot to assess FVC and dual energy X ray absorptiometry (DEXA) scan to assess heel BMD. Routine biochemistry including osteoprotegerin (OPG) and Receptor activator of nuclear factor kappa-B ligand (RANKL) was also carried out.

Results

The proportion of subjects with FVC was 43%, whilst 40% had low BMD (T score < −1.0). Age, neuropathy and 25 hydroxyvitamin D were independent predictors of FVC. Body-weight, eGFR, 25 hydroxyvitamin D, OPG, and total cholesterol were independent predictors of low heel BMD. There was no correlation between albuminuria and BMD or FVC. There was no difference in heel BMD between those with FVC and those without, but those with frank osteoporosis were significantly more likely to have FVC than those with higher BMD.

Conclusions

There is no clear-cut association between FVC and low BMD in type 2 DM with relatively well-preserved renal function. Age, neuropathy, eGFR, hyperlipidemia, body-weight, 25 hydroxyvitamin D and OPG play a complex role in their pathogenesis.     

Renal outcomes in patients with type 2 diabetes with or without coexisting non-diabetic renal disease

Aims

We sought not only to determine the independent predictors of non-diabetic renal disease (NDRD) but also to investigate the impact of NDRD on renal outcomes in patients with type 2 diabetes who underwent renal biopsy and were followed-up longitudinally.

Methods

The present study was conducted by reviewing the medical records of 119 type 2 diabetic patients who underwent renal biopsy at Yonsei University Health System from January 1988 to December 2008.

Results

Renal biopsy findings declared that 43 patients (36.1%) had diabetic nephropathy alone, 12 (10.1%) had NDRD superimposed on diabetic nephropathy, and 64 (53.8%) had only NDRD. On multivariate analysis, the absence of diabetic retinopathy, higher hemoglobin levels, and shorter duration of diabetes were independent predictors of NDRD in these patients. During the follow-up period, end-stage renal disease (ESRD) developed in 33 patients (27.7%). On multivariate Cox regression, higher serum creatinine levels, higher systolic blood pressure, longer duration of diabetes, and the presence of diabetic nephropathy were identified as significant independent predictors of ESRD. When the presence of diabetic retinopathy was included in the multivariate model, higher serum creatinine levels, higher systolic blood pressure, and the presence of retinopathy were shown to be independent predictors of ESRD.

Conclusions

Since diabetic patients with NDRD have significantly better renal outcomes compared to patients with biopsy-proven diabetic nephropathy, it is important to suspect, identify, and manage NDRD as early as possible, especially in type 2 diabetic patients with short duration of diabetes and those without diabetic retinopathy or anemia.     

Do patients with diabetes and low socioeconomic status receive less care and have worse outcomes? A national study

Purpose

The objective of the study was to assess the influence of socioeconomic status (SES) on the care of patients with diabetes.

Methods

Quality indicators for patients who were taking medication for diabetes were established. Overall compliance with the quality indicators, as well as prevalence of diabetes by age, were obtained from a national database. Patients with national tax exemptions (used as a marker for low SES) were compared to those without.

Results

Of 4,110,852 citizens aged 18-74, 210,988 (5.1%) were receiving medication for diabetes. The prevalence of diabetes reached 19.9% in people aged 65-74. 495,392 citizens had an exemption, and they had a higher prevalence of diabetes that those who did not (15.4% vs. 3.7%). Patients with an exemption had a higher rate of having a yearly HbA1c done, a yearly LDL level done, a yearly eye exam, a yearly urinary protein exam, of being treated with insulin for an elevated HbA1c than those without an exemption. In patients with an exemption there was a lower percentage with an HbA1c less than 7%, a higher percentage with an HbA1c greater than 9%, and a lower percentage with an LDL less than 130. Multivariate analysis showed that exemption status was a predictor of better performance on process measures (LDL test done, OR-1.03, 95% CI 1.01-1.06, HbA1c test done, OR 1.03, 95% CI- 1.01-1.05) and of worse outcomes (high LDL, OR 0.92, 95% CI, 0.90-0.95 and high HbA1c, OR, 0.85, 95% CI, 0.83-0.87).

Conclusions

In a country with universal healthcare, patients from a lower SES had an increased prevalence of diabetes and had greater adherence to preventive healthcare measures However, they were less successful in meeting target treatment goals.     

Vitamin D and cognitive functioning in the elderly population in Germany

Objectives

To examine the relationship of serum 25-hydroxy vitamin D3 with cognitive functioning in higher age, using an instrument covering multiple cognitive domains in a population-based study.

Design

Follow-up study with measurement of vitamin D levels at baseline and assessment of cognitive functioning at year 5 follow-up.

Setting and participants

A subgroup of 1639 participants of the ongoing epidemiological ESTHER study of the elderly general population in Saarland State, Germany, aged 65 + years at baseline (2000-2002).

Intervention

Observational study.

Measurements

Cognitive functioning was assessed by the COGTEL phone interview developed by Kliegel et al., which was administered 5 years after ESTHER baseline. Vitamin D in baseline samples was measured by chemiluminescence methods. Additional information was obtained by standardised questionnaires.

Results

In multiple linear regression adjusted for important confounders, women in the lowest sex-specific quintile of vitamin D showed an on average 2.1 (95% confidence interval: 0.4 to 3.9) units lower COGTEL score than women in the highest quintile. A similar, albeit slightly weaker, association was seen in males (difference of 1.7 [− 0.4 to 3.8] units). Spline regression suggested non-linearity with a distinct decline in cognitive performance in the lower range of vitamin D levels.

Conclusions

Our findings support suggestions that low levels of vitamin D may be associated with reduced cognitive functioning in the elderly.     

Glycated human DNA is a preferred antigen for anti-DNA antibodies in diabetic patients

Aims

Glycation of proteins and DNA, results in the generation of free radicals causing structural modification of biomacromolecule. This leads to the generation of neo-antigenic epitopes having implication in diabetes mellitus. In this study, human placental DNA was glycated with fructose and its binding was probed with the serum antibodies from type 1 and 2 diabetes patients.

Methods

Glycation was carried out by incubating DNA (10 μg/ml) with fructose (25 mM) for 5 days at 37 °C. The induced structural changes in DNA were studied by spectroscopic techniques, thermal denaturation studies and agarose gel electrophoresis. Furthermore, binding characteristics of autoantibodies in diabetes (type 1 and 2) patients were assessed by direct binding and competitive ELISA.

Results

DNA glycation with fructose resulted in single strand breaks, hyperchromicity in UV spectrum and increased fluorescence intensity. Thermal denaturation studies demonstrated the unstacking of bases and early onset of duplex unwinding. Type 1 diabetes patients exhibited enhanced binding with glycated DNA as compared to native form, while for type 2 diabetes only those with secondary complications (Nephropathy) showed higher binding.

Conclusions

Glycation of DNA has resulted in structural perturbation causing generation of neo-antigenic epitopes that are better antigens for antibodies in diabetes patients.     

Central haemodynamics reveal significant potential for prevention in Black hypertensive patients born and living in sub-Saharan Africa

Background

Few studies assessed arterial stiffness in Black hypertensive patients born and living in sub-Saharan Africa, where cardiovascular disease reaches epidemic proportions.

Methods

The Newer versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial is currently recruiting native African patients to compare the efficacy of various antihypertensive drugs given once daily as single-pill combinations. Two centres engaged in pulse wave analysis and measured carotid-femoral pulse wave velocity (PWV). Statistical methods included single and multiple linear regressions.

Results

Of 172 patients screened, 116 entered the ancillary study on central haemodynamics (51.3% women; mean age 52.7 years; untreated blood pressure 147.6/87.1 mm Hg). The augmentation indexes were higher (p < 0.0001) in women than men, both peripherally (pAI, 11.1 vs. −10.6%) and centrally (cAI, 39.0 vs. 28.0%). PWV (8.91 m/s) and central pulse pressure (cPP, 48.7 mm Hg) were similar (p > 0.844) in both sexes. pAI and cAI increased with female sex and mean arterial pressure, but decreased with heart rate and body mass index. cPP increased with age and mean arterial pressure. PWV increased with age and mean arterial pressure. Patients with measurements above the age-specific thresholds determined in healthy Black South Africans amounted to 0 for cAI, 1 (1.2%) for cPP, and 11 (18.3%) for PWV.

Conclusion

NOAAH patients have measures of arterial stiffness similar to those of a healthy Black reference population with determinants as reported in the literature. Our observations highlight the potential for the prevention of irreversible arterial damage by timely treating sub-Saharan hypertensive patients to target blood pressure levels.     

Peroxisome proliferator-activated receptor-γ agonist rosiglitazone reduces circulating platelet activity in patients without diabetes mellitus who have coronary artery disease

Background

Rosiglitazone, a peroxisome proliferator-activated receptor-γ (PPAR-γ) agonist, is used in the treatment of type 2 diabetes mellitus, and in vitro data has shown that it may have anti-platelet effects independent of its hypoglycemic effects. The aim of this study was to assess the effect of rosiglitazone on circulating platelet activity in patients without diabetes mellitus who had coronary artery disease.

Methods

Ninety-two patients with stable, documented coronary artery disease without diabetes mellitus were studied. Patients were randomized (double-blind) to receive placebo or rosiglitazone for 12 weeks. Circulating platelet activity was measured at baseline and after 12 weeks of therapy with whole blood flow cytometry to quantify platelet P-selectin expression.

Results

The percentage of P-selectin positive platelets was significantly reduced by rosiglitazone treatment compared with placebo (P = .04). In the rosiglitazone group, the percentage of P-selectin positive platelets (median with interquartile range) decreased from 0.1 % (0.05-0.24) to 0.05 % (0.01-0.15). Rosiglitazone treatment significantly reduced the insulin resistance index (HOMA-R) compared with placebo (P = .02). No significant correlation was observed between change in platelet activity and change in HOMA-R.

Conclusions

Rosiglitazone significantly reduces circulating platelet activity in patients without diabetes mellitus who have coronary artery disease. This effect appears to be independent of any insulin-sensitising effect.     

Revisiting the efficacy of long-acting insulin analogues on adults with type 1 diabetes using mixed-treatment comparisons

Aim

To perform a network meta-analysis between long-acting insulin analogues (glargine and detemir) and Neutral Protamine Hagedorn (NPH) insulin on adults with type 1 diabetes.

Methods

A systematic review of the literature was conducted according to the Cochrane Collaboration guidelines. The search for randomized controlled trials was performed in process databases, conferences and “gray literature” by 1995.

Results

We found 1051 citations comparing glargine or detemir with human insulin and 187 comparing long-acting insulin analogues. Data on Glycated Hemoglobin (HbA1c), hypoglycemia episodes, nocturnal hypoglycemia and withdrawal were meta-analyzed. After review, 8 studies comparing glargine and 9 comparing detemir with NPH and 2 comparing glargine with detemir were considered relevant. Were included 1508 patients that received glargine, 2698 detemir and 2654 NPH insulin. Efficacy data showed no significant differences in HbA1c change between glargine or detemir (once daily) and NPH insulin. Twice-daily regimen of detemir caused a difference in HbA1c that favored detemir (−0.14% [95% CI −0.21 to −0.08]). Direct comparisons showed no significant differences between glargine and detemir in safety or HbA1c mean change.

Conclusion

The long-acting insulin analogues offer little to no clinical advantages over NPH insulin, and there is no significant difference in the efficacy and safety.     

The association between low 25-hydroxyvitamin D and increased aortic stiffness

There is accumulating evidence that vitamin D exerts important pathophysiological effects on cardiovascular system. Low vitamin D was associated with increased cardiovascular risk in several reports. We studied the association between vitamin D and arterial stiffness in a random sample of 560 subjects selected from general population. Arterial stiffness was measured as aortic pulse-wave velocity (PWV) using Sphygmocor device. Serum 25-hydroxyvitamin D (25(OH)D) was measured using commercial kits. We found a clear negative trend in aortic PWV among 25(OH)D quartiles. Subjects in the bottom 25(OH)D quartile (<20?ng?ml(-1)) showed the highest aortic PWV (9.04?m?s(-1)), compared with 2nd-4th quartile (8.07?m?s(-1), 7.93?m?s(-1) and 7.70?m?s(-1), respectively; P for trend <0.0001). The association between 25(OH)D and aortic PWV remained significant after adjustment for age, gender and other potential confounders; subjects in the first 25(OH)D quartile had adjusted odds ratio 2.04 (1.26-3.30) for having aortic PWV 9?m?s(-1) (top quartile) in multiple regression. In conclusion, we found a clear significant and independent negative association between 25(OH)D and aortic PWV. Subjects with lowest vitamin D status showed the highest arterial stiffness.     

Greater hand-grip strength predicts a lower risk of developing type 2 diabetes over 10 years in leaner Japanese Americans

Aims

Much is known about body composition and type 2 diabetes risk but less about body function such as strength. We assessed whether hand-grip strength predicted incident diabetes.

Methods

We followed 394 nondiabetic Japanese-American subjects (mean age 51.9) for the development of diabetes. We fit a logistic regression model to examine the association between hand-grip strength at baseline and type 2 diabetes risk over 10 years, adjusted for age, sex, and family history.

Results

A statistically significant (p = 0.008) and negative (coefficient −0.208) association was observed between hand-grip strength and diabetes risk that diminished at higher BMI levels. Adjusted ORs for a 10-pound hand-grip strength increase with BMI set at the 25th, 50th or 75th percentiles were 0.68, 0.79, and 0.98, respectively.

Conclusions

Among leaner individuals, greater hand-grip strength was associated with lower risk of type 2 diabetes, suggesting it may be a useful marker of risk in this population.     

Investigation of early change of endothelial function and related factors in individuals with hyperglycemia

Objective

To evaluate early change of endothelial function by color Doppler ultrasound and pulse wave velocity in hyperglycemia people, and probe the effect of related factors.

Methods

From March to December 2009, 115 subjects (40 subjects with type 2 diabetes, 45 subjects with impaired glucose tolerance and 30 healthy individuals) aged 35-45 without cardio-cerebral-vascular disease and other disease were recruited into the study. Height, weight, blood pressure were measured, and fasting blood glucose, postprandial blood glucose, adiponectin, endothelin and lipid profile were tested. Then, pulse wave velocity and color Doppler ultrasound test was processed in all subjects.

Results

The abnormality of pulse wave velocity and endothelium-dependent dilatation was found both in impaired glucose tolerance stage and early stage of type 2 diabetes. Systolic blood pressure, pulse pressure, endothelin, fasting blood glucose and postprandial blood glucose were positively correlated with pulse wave velocity and endothelium-dependent dilatation. Whereas, adiponetin was negatively correlated with pulse wave velocity and endothelium-dependent dilatation.

Conclusion

Endothelial dysfunction exits in individuals with impaired glucose tolerance as well as in type 2 diabetes. Pulse wave velocity and endothelium-dependent dilatation are associated with adiponectin and endothelin.     

Impact of Vitamin D Status on Cardiometabolic Complications among Children and Adolescents with Type 1 Diabetes Mellitus

Objective:

There is an ongoing interest in the relationship between vitamin D status and diabetes control and complications. However, data from Saudi Arabia are limited. To determine the impact of vitamin D status on glycemic control and cardiometabolic complications of children and adolescents with type 1 diabetes mellitus (T1DM) attending a tertiary care diabetes clinic in Saudi Arabia.

Methods:

Demographic, clinical, and laboratory data of 301 children and adolescent subjects with T1DM (53.5% females) of a mean age of 13.9 years attending King Abdulaziz Medical City-Jeddah during 2010-2013 were retrospectively collected. Relationships between vitamin D status and frequency of hypoglycemia, hemoglobin A1c (HbA1c) level, body mass index (BMI), blood pressure, and lipid profile were evaluated.

Results:

The mean duration of diabetes was 7.7±3.7 years. Mean BMI value was 21.1±4.5 kg/m2 and HbA1c was 9.6±1.9% in both genders. Only 26.2% of the patients had a satisfactory HbA1c level. The mean level of 25-hydroxyvitamin D [25(OH)D] was 35.15 and that of cholesterol was 4.75. Vitamin D deficiency [25(OH)D≤37.5 nmol/L] was detected in 63.6% of the male and 67.7% of the female subjects. In males, it was inversely associated with frequency of hypoglycemia (p<0.01), BMI (p<0.05), diastolic blood pressure (p<0.05), and triglyceride levels (p<0.01), while in females, it was inversely associated with current age (p<0.05), age at diagnosis (p<0.01), and triglyceride levels (p<0.01). No significant correlation between HbA1c and vitamin D deficiency was observed.

Conclusion:

Vitamin D deficiency was highly prevalent in our study sample and was found to be associated with frequency of hypoglycemic episodes and with adverse cardiometabolic control.