scholarly journals Association of Cardiovascular Autonomic Neuropathy and Distal Symmetric Polyneuropathy with All-Cause Mortality: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Orsolya E. Vági ◽  
Márk M. Svébis ◽  
Beatrix A. Domján ◽  
Anna E. Körei ◽  
Ildikó Istenes ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Autonomic Neuropathy ◽  
Cardiovascular Autonomic Neuropathy ◽  
Secondary Diabetes ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Distal Symmetric Polyneuropathy

Background. People with diabetic cardiovascular autonomic neuropathy (CAN) have increased cardiovascular mortality. However, the association between distal symmetric polyneuropathy (DSPN) or CAN with all-cause mortality is much less investigated. Thus, we set out to examine the effect of CAN and DSPN on all-cause mortality in a well-phenotyped cohort. Methods. All diabetes cases ( n = 1,347 ) from the catchment area of a secondary diabetes care centre who had medical examination including neuropathy assessment between 1997 and 2016 were followed up for all-cause mortality in the NHS Hungary reimbursement database until 2018. We investigated the association of CAN (Ewing tests) and DSPN (Neurometer) with all-cause mortality using Cox models stratified by diabetes type. Results. Altogether, n = 131 / 1,011 persons with type 1/type 2 diabetes were included. Of the participants, 53%/43% were male, mean age was 46 ± 12 / 64 ± 10 years, diabetes duration was 13 ± 10 / 7 ± 8 years, 42%/29% had CAN, and 39%/37% had DSPN. During the 9 ± 5 / 8 ± 5 -year follow-up, n = 28 / 494 participants died. In fully adjusted models, participants with type 1 diabetes patients with versus without DSPN had an increased mortality (HR 2.99, 95% CI 1.4-8.63), while no association with CAN was observed. In type 2 diabetes, both DSPN and CAN independently increased mortality (HR 1.32, 95% CI: 1.07-1.64, and HR 1.44, 95% CI: 1.17-1.76). Conclusions. Our results are compatible with an increased risk of mortality in people with type 1 diabetes and DSPN. Furthermore, we report a similarly strong association between DSPN and CAN and all-cause mortality in type 2 diabetes mellitus.

HLA Class II Allele Analyses Implicate Common Genetic Components in Type 1 and Non–Insulin-Treated Type 2 Diabetes

2020 ◽  
Vol 105 (3) ◽  
pp. e245-e254 ◽  
Author(s):  
Thomas Jacobi ◽  
Lucas Massier ◽  
Nora Klöting ◽  
Katrin Horn ◽  
Alexander Schuch ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Class Ii ◽  
Hla Class Ii ◽  
Risk Haplotype ◽  
Genetic Components ◽  
Hla Genotypes ◽  
Increased Risk

Abstract Context Common genetic susceptibility may underlie the frequently observed co-occurrence of type 1 and type 2 diabetes in families. Given the role of HLA class II genes in the pathophysiology of type 1 diabetes, the aim of the present study was to test the association of high density imputed human leukocyte antigen (HLA) genotypes with type 2 diabetes. Objectives and Design Three cohorts (Ntotal = 10 413) from Leipzig, Germany were included in this study: LIFE-Adult (N = 4649), LIFE-Heart (N = 4815) and the Sorbs (N = 949) cohort. Detailed metabolic phenotyping and genome-wide single nucleotide polymorphism (SNP) data were available for all subjects. Using 1000 Genome imputation data, HLA genotypes were imputed on 4-digit level and association tests for type 2 diabetes, and related metabolic traits were conducted. Results In a meta-analysis including all 3 cohorts, the absence of HLA-DRB5 was associated with increased risk of type 2 diabetes (P = 0.001). In contrast, HLA-DQB*06:02 and HLA-DQA*01:02 had a protective effect on type 2 diabetes (P = 0.005 and 0.003, respectively). Both alleles are part of the well-established type 1 diabetes protective haplotype DRB1*15:01~DQA1*01:02~DQB1*06:02, which was also associated with reduced risk of type 2 diabetes (OR 0.84; P = 0.005). On the contrary, the DRB1*07:01~DQA1*02:01~DQB1*03:03 was identified as a risk haplotype in non–insulin-treated diabetes (OR 1.37; P = 0.002). Conclusions Genetic variation in the HLA class II locus exerts risk and protective effects on non–insulin-treated type 2 diabetes. Our data suggest that the genetic architecture of type 1 diabetes and type 2 diabetes might share common components on the HLA class II locus.

scholarly journals Incidence and associates of diabetic ketoacidosis in a community-based cohort: the Fremantle Diabetes Study Phase II

2020 ◽  
Vol 8 (1) ◽  
pp. e000983
Author(s):  
Timothy M E Davis ◽  
Wendy Davis
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Phase Ii ◽  
Negative Binomial ◽  
Study Phase ◽  
Community Based ◽  
Secondary Diabetes

ObjectiveTo assess the incidence and associates of diabetic ketoacidosis (DKA) in a representative community-based cohort.MethodsAll hospitalizations of 1724 participants in the Fremantle Diabetes Study Phase II for/with DKA (plasma glucose >13.8 mmol/L, urinary/serum ketones, serum bicarbonate <18 mmol/L and/or arterial/venous pH <7.30) were identified between study entry from 2008 to 2011 and end-2013. Details of each episode were categorized by chart review as confirmed/probable DKA, possible DKA or not DKA. Incidence rates by diabetes type were calculated. Cox proportional hazards modeling determined predictors of first episode, and negative binomial regression identified predictors of frequency.ResultsThere were 53 coded DKA episodes (41 first episodes, 12 recurrences), of which 19 (35.8%) were incorrectly coded, 9 (17.0%) had possible DKA and 25 (47.2%) had confirmed/probable DKA. Of this latter group, 44% had type 1 diabetes, 32% had type 2 diabetes, 12% had latent autoimmune diabetes of adults (LADA) and 12% had secondary diabetes. The overall incidence of confirmed/probable DKA (95% CI) was 35.6 (23.0 to 52.6)/10 000 person-years (178.6 (85.7 to 328.5)/10 000 person-years for type 1 diabetes, 13.3 (5.7 to 26.1)/10 000 person-years for type 2 diabetes, 121.5 (33.1 to 311.0)/10 000 person-years for LADA and 446.5 (92.1 to 1304.9)/10 000 person-years for secondary diabetes). Baseline ln(fasting serum C-peptide) (inversely), glycated hemoglobin and secondary diabetes predicted both incident first confirmed/probable DKA episode and the frequency of DKA (p<0.001).ConclusionsThese data highlight the contribution of poor glycemic control and limited pancreatic beta cell function to incident DKA, and show that people with types of diabetes other than type 1, especially secondary diabetes, are at risk.

scholarly journals Glucose-Lowering Therapy in Patients With Postpancreatitis Diabetes Mellitus: A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Rikke Viggers ◽  
Morten Hasselstrøm Jensen ◽  
Henrik Vitus Bering Laursen ◽  
Asbjørn Mohr Drewes ◽  
Peter Vestergaard ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetes Incidence ◽  
Secondary Diabetes ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

<p><i>Objective</i>: Postpancreatitis diabetes mellitus (PPDM) is a type of secondary diabetes that requires special considerations for management. The main objective was to examine prescription patterns of glucose-lowering therapy among adults with PPDM compared to type 1 and type 2 diabetes.</p> <p><i>Research Design and Methods:</i> In a Danish nation-wide population-based cohort study we identified all individuals with adult-onset diabetes mellitus in the period 2000-2018 and categorized them as type 1 diabetes, type 2 diabetes or PPDM. We ascertained diabetes incidence rates, clinical and demographic characteristics, classifications and prescription patterns of glucose-lowering therapy and compared these parameters across diabetes subgroups. </p> <p><i>Results</i><i>:</i> Among 398,456 adults with new-onset diabetes mellitus, 5,879 (1.5%) had PPDM, 9,252 (2.3%) type 1 diabetes and the remaining type 2 diabetes (96.2%). The incidence rate of PPDM was 7.9 (95% CI 7.7-8.1) per 100,000 person-years vs. 12.5 (95% CI 12.2-12.7) for type 1 diabetes (incidence-rate-ratio 0.6; 95% CI 0.6-0.7, p<0.001). A sizeable proportion of PPDM patients were classified as type 2 diabetes (44.9%) and were prescribed sulfonylureas (25.2%) and incretin-based therapies (18.0%) that can potentially be harmful in PPDM. In contrast, 35.0% of patients never received biguanides, which are associated with a survival benefit in PPDM. Increased insulin requirements were observed for patients with PPDM compared to type 2 diabetes (hazard ratio 3.10; 95% CI 2.96-3.23, p<0.001) in particular for PPDM associated with chronic pancreatitis (hazard ratio 4.30; 95% CI 4.01-4.56, p<0.001).</p> <p><i>Conclusions</i><i>:</i> PPDM is a common type of secondary diabetes in adults but is often misclassified and treated as type 2 diabetes, although PPDM requires special considerations for management.</p>

scholarly journals Leptin mediate central obesity on the severity of cardiovascular autonomic neuropathy in well-controlled type 2 diabetes and prediabetes

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Yun-Ru Lai ◽  
Meng Hsiang Chen ◽  
Wei Che Lin ◽  
Wen-Chan Chiu ◽  
Ben-Chung Cheng ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Autonomic Neuropathy ◽  
Central Obesity ◽  
Cardiovascular Autonomic Neuropathy ◽  
Mediation Model ◽  
Cardiovascular Risks ◽  
Cardiovascular Reflex ◽  
The Relationship

Abstract Background Evidences support the view that central obesity is an independently cardiovascular risk. It is thought that leptin contributes to autonomic dysfunction and cardiovascular risks in type 1 and type 2 diabetes mellitus (T1DM and T2DM). This raises the possibility that leptin might mediate the relationship between central obesity and the severity of cardiovascular autonomic neuropathy (CAN) in patients with well-controlled T2DM and prediabetes. Methods The complete cardiovascular reflex tests and biomarkers were assessed for each patient. The severity of CAN was assessed using composite autonomic scoring scale (CASS). A single-level three-variable mediation model was used to investigate the possible relationships among central obesity [as indicated by waist circumference (WC)], leptin level, and severity of CAN (as indicated by CASS value). Results A total of 107 patients were included in this study: 90 with diabetes and 17 with prediabetes. The results demonstrate that increased WC is associated with increased severity of CAN (r = 0.242, P = 0.017). We further discovered that leptin level is positively correlated with WC (r = 0.504, P < 0.0001) and the CASS value (r = 0.36, P < 0.0001). Further mediation analysis shows that leptin level serves as mediators between higher WC and higher CASS. Conclusions Our results highlighted the relationship among leptin, central obesity, and severity of CAN. As the leptin level serves as mediator between central obesity and severity of CAN, a longitudinal study is needed to confirm that control of WC can decrease leptin levels and can be effective in reducing CAN progression.

High and low vitamin D level is associated with cardiovascular autonomic neuropathy in people with Type 1 and Type 2 diabetes

2016 ◽  
Vol 34 (3) ◽  
pp. 364-371 ◽  
Author(s):  
C. S. Hansen ◽  
J. Fleischer ◽  
D. Vistisen ◽  
M. Ridderstråle ◽  
J. S. Jensen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Autonomic Neuropathy ◽  
Cardiovascular Autonomic Neuropathy

scholarly journals Glucose-Lowering Therapy in Patients With Postpancreatitis Diabetes Mellitus: A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Rikke Viggers ◽  
Morten Hasselstrøm Jensen ◽  
Henrik Vitus Bering Laursen ◽  
Asbjørn Mohr Drewes ◽  
Peter Vestergaard ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetes Incidence ◽  
Secondary Diabetes ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy

<p><i>Objective</i>: Postpancreatitis diabetes mellitus (PPDM) is a type of secondary diabetes that requires special considerations for management. The main objective was to examine prescription patterns of glucose-lowering therapy among adults with PPDM compared to type 1 and type 2 diabetes.</p> <p><i>Research Design and Methods:</i> In a Danish nation-wide population-based cohort study we identified all individuals with adult-onset diabetes mellitus in the period 2000-2018 and categorized them as type 1 diabetes, type 2 diabetes or PPDM. We ascertained diabetes incidence rates, clinical and demographic characteristics, classifications and prescription patterns of glucose-lowering therapy and compared these parameters across diabetes subgroups. </p> <p><i>Results</i><i>:</i> Among 398,456 adults with new-onset diabetes mellitus, 5,879 (1.5%) had PPDM, 9,252 (2.3%) type 1 diabetes and the remaining type 2 diabetes (96.2%). The incidence rate of PPDM was 7.9 (95% CI 7.7-8.1) per 100,000 person-years vs. 12.5 (95% CI 12.2-12.7) for type 1 diabetes (incidence-rate-ratio 0.6; 95% CI 0.6-0.7, p<0.001). A sizeable proportion of PPDM patients were classified as type 2 diabetes (44.9%) and were prescribed sulfonylureas (25.2%) and incretin-based therapies (18.0%) that can potentially be harmful in PPDM. In contrast, 35.0% of patients never received biguanides, which are associated with a survival benefit in PPDM. Increased insulin requirements were observed for patients with PPDM compared to type 2 diabetes (hazard ratio 3.10; 95% CI 2.96-3.23, p<0.001) in particular for PPDM associated with chronic pancreatitis (hazard ratio 4.30; 95% CI 4.01-4.56, p<0.001).</p> <p><i>Conclusions</i><i>:</i> PPDM is a common type of secondary diabetes in adults but is often misclassified and treated as type 2 diabetes, although PPDM requires special considerations for management.</p>

scholarly journals Vitamin D and diabetes mellitus: an update 2013

2014 ◽  
Vol 58 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Luiz Henrique Maciel Griz ◽  
Francisco Bandeira ◽  
Mônica Andrade Lima Gabbay ◽  
Sergio Atala Dib ◽  
Eduardo Freese de Carvalho
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Vitamin D ◽  
Type 1 Diabetes ◽  
Vitamin D Deficiency ◽  
Pancreatic Beta Cells ◽  
Increased Risk ◽  
Geographical Regions

Vitamin D deficiency and diabetes mellitus are two common conditions and they are widely prevalent across all ages, races, geographical regions, and socioeconomic conditions. Epidemiologic studies have shown association of vitamin D deficiency and increased risk of chronic diseases, such as cancer, cardiovascular disease, type 2 diabetes, and autoimmune diseases, such as multiple sclerosis and type 1 diabetes mellitus. The identification of 1,25(OH)2D receptors and 1-α-hydroxilase expression in pancreatic beta cells, in cells of the immune system, and in various others tissues, besides the bone system support the role of vitamin D in the pathogenesis of type 2 diabetes. Observational studies have revealed an association between 25(OH) D deficiency and the prevalence of type 1 diabetes in children and adolescents. This review will focus on the concept of vitamin D deficiency, its prevalence, and its role in the pathogenesis and risk of diabetes mellitus and cardiovascular diseases.

scholarly journals Cardiovascular autonomic neuropathy in people with type 2 diabetes mellitus; investigation of its association with classical cardiovascular risk factors using cardiovascular autonomic reflex tests: a cross-sectional study

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Ahmad Osailan
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Autonomic Neuropathy ◽  
Cardiovascular Autonomic Neuropathy ◽  
Factors Associated ◽  
Increased Risk ◽  
Autonomic Reflex

Abstract Background People with type 2 diabetes mellitus (DM) are at increased risk of cardiovascular disease (CVD). Cardiovascular autonomic neuropathy (CAN) is an underdiagnosed risk factor for CVD, which is prevalent among people with 2DM and can lead to CVD and CVD-related mortality. Little is known about the risk factors associated with CAN in type 2DM. Thus, the study was aimed to assess CAN using five cardiovascular autonomic reflex tests (represented by Ewing’s score) and explore the factors associated with CAN in people with type 2DM. The studied factors include traditional and serological CVD risk factors obtained from a fasting blood sample and cardiorespiratory fitness (CRF) obtained via attainment of the highest peak of volumes of O2 (VO2Peak). Results Univariate analysis revealed a significant positive correlation between resting systolic blood pressure (SBP) and Ewing’s score (r=0.47, p=.02) and an inverse correlation between VO2Peak and Ewing’s score (r=−0.64, p=.001). Multivariate linear regression revealed that a significant model that included resting SBP and VO2Peak explained 93.8% of Ewing’s score variance. Conclusion CAN was associated with two CVD parameters, including resting SBP and CRF, which may indicate the importance of controlling these two factors to prevent or reduce CAN in people with type 2DM.

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