Decreasing Incidence of Severe Diabetic Microangiopathy in Type 1 Diabetes (original) (raw)
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Cardiovascular Diabetology
Background Microvascular complications (MC) have been claimed to increase the risk for cardiovascular disease in diabetic subjects. However, the effect of MC burden on the risk of major vascular outcomes and all-cause mortality in type 1 diabetes is still poorly explored. We evaluated the relationship between microvascular complications burden and incidence of major cardiovascular events and all-cause mortality in subjects with type 1 diabetes. Methods We recruited 774 participants with type 1 diabetes in a single-center observational study over a follow-up of 10.8 ± 2.5 years. Hazard ratios (HR) for cardiovascular outcomes and all-cause death associated with microvascular complications were determined by unadjusted and adjusted Cox regression analysis. Results Out of 774 individuals, 54.9% had no-MC, 32.3% 1 MC, 9.7% 2 MC and 3.1% 3 MC. A total of 54 deaths (7.0%) occurred. Death rate increased from no-MC 2.1% (Ref) to 1 MC 7.2% (HR 3.54 [95% CI 1.59–7.87]), 2 MC 14.7% (HR 6.41 [95...
International Journal of Clinical Practice, 2007
The aim of this retrospective study was to elucidate the association between glucose profile using the continuous glucose monitoring system (CGMS) and microvascular complications in patients with type 2 diabetes mellitus (T2DM). The subjects were 160 inpatients with T2DM. The mean blood glucose (MBG) level, percentage of time in a 24-hour period spent with blood glucose level higher than 180 mg/dl (time at >180 mg/dl), standard deviation (SD), and mean amplitude of glycemic excursions (MAGE) were measured continuously over 48 hours using the CGMS. The primary outcome was the association between microvascular complications and glycemic variability. The secondary outcome was the association between microangiopathies and MBG. The SD and MAGE were not associated with presence of microangiopathies or number of complications. There were also no associations between abnormal vibratory sensation in the bilateral lower extremities, coefficient of variation of the R-R interval (CVRR), retinopathy stage, nephropathy stage, or microalbuminuria. MBG was associated, however, with retinopathy, retinopathy stage, and number of complications. Time at >180 mg/dl correlated with abnormal vibratory sensation in the bilateral lower extremities and presence or stage of retinopathy. MBG and time at >180 mg/ dl were not associated with presence or stage of nephropathy. Our findings suggest that broad glycemic variability was not associated with microvascular complications, the number of which increased in patients with a high mean glucose level and long time spent with hyperglycemia. It is important, therefore, to reduce the mean glucose level and time spent with hyperglycemia to prevent future microangiopathies.
International Journal of Chronic Diseases, 2014
The study was aimed at assessing the prevalence of microvascular complications and associated risk factors in newly diagnosed type 2 diabetes mellitus patients. A cross-sectional study was conducted in a public tertiary care hospital. All the recruited patients underwent extensive examination for the presence of microvascular complications like neuropathy, retinopathy, and nephropathy. Prevalence of any complication was 18.04%. Prevalence of neuropathy, retinopathy, and nephropathy was found to be 8.2%, 9.5%, and 2.8%, respectively. Triglycerides (OR, 1.01;P = 0.011) and old age (OR, 1.06;P ≤0.01) were significantly associated with any complication. Triglycerides were significantly associated with neuropathy (OR, 1.01;P = 0.05) and retinopathy (OR, 1.01;P =0.02). Being male posed high risk for nephropathy (OR, 0.06;P =0.01). These results are suggesting need of regular screening for microvascular complications.
The WHO multinational study of vascular disease in diabetes: 3. Microvascular disease
Diabetes Care, 1979
A preliminary comparison and analysis of microvascular disease was performed in 14 stratified samples of diabetic subjects. Microvascular disease was assessed by estimating visual disabilities, by standardized examination of the optic fundus by direct ophthalmoscopy, by estimating proteinuria, and by measuring the serum creatinine concentration. Visual impairment by questionnaire positive varied considerably between centers, probably due to cultural differences in interpretation of the questions. Physician-assessed visual disability also yielded considerable differences in frequency; however, the frequency differences were unrelated to those observed for macrovascular disease. Retinopathy—the sum of all components—was related to duration of diabetes in each participating center. The apparent frequency of proteinuria varied considerably between centers. In general, the frequency of retinopathy was related to the level of systolic blood pressure, but there was no systematic associatio...
Erciyes Medical Journal , 2020
Objective: The aim of this study was to determine the relationship between microvascular Type 2 diabetes mellitus (T2DM) complications and the severity and duration of diabetes in the light of sociodemographic and lifestyle variables. Materials and Methods: This is a prospective cohort study based on 899 (527 females, 372 males) patients with T2DM aged 25-70 years. Patient information including socio-demographic variables; body mass index (BMI); lifestyle habits and duration of diabetes; treatment of diabetes; values for hemoglobin A1c (HbA1c); development of diabetes complications; and the presence of neuropathy, nephropathy, and retinopathy were recorded. A univariate and multivariate statistical analysis were performed. Results: Significant differences were found between diabetics with HbA1c ≤7 and >7 in terms of the education level, occupation , household income, duration of diabetes, the number of children, smoking, physical exercise, eating fast food, control regularity, and diabetes education. A total of 17.1% of patients had diabetic retinopathy, 17.0% had neuropathy, and 13.7% had nephropathy. Among diabetics, 2.3% had three microvascular complications, whereas 66.6% had none of them. The prevalence of diabetes complications was lower in patients who had good glycemic control than those who had poor glycemic control. Furthermore, the highest reduction in the level of HbA1c was for sulfonylurea usage. Conclusion: A high prevalence of diabetes complications is a burden for both the patients and the health care system. Screening, early diagnosis, management of the glucose level, and the follow-up may result in delayed diabetes complications .
Microvascular complications and their associated risk factors in type 2 diabetes mellitus
Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 2017
The aim of this study was to determine the prevalence of microvascular complications and to identify the various risk factors related to these complications in subjects with diabetes. Materials and Methods: The study was cross-sectional and conducted in Outdoor of BIRDEM, from July 2014 to December 2014. Subjects were considered at age 30 to 60 years and duration of diabetes was 2-10 years. Investigations included socio-demographic, anthropometry and blood pressure. Blood samples were collected for HbA1c, fasting plasma glucose (FBG), 2-h after breakfast (2-hBG), total cholesterol (chol), triglyceride (TG), LDL, HDL, Hb% and serum creatinine. All the complications were taken from the medical record books which was diagnosed by physician. Results: A total of 400 type 2 diabetes mellitus patients were investigated in this study. The mean and SD of age was 50.05 ± 7.54. The male and female subjects were 41.5% and 58.5% respectively. The prevalence of diabetic retinopathy, nephropathy, neuropathy was 12.3%, 21.3% and 16.8% respectively. Logistic regression model estimated that increasing age (age>50y; OR=3.04;p=<0.001), female participants (OR=1.35; p=<0.04), rural patients (OR=3.75; p=<0.001), housewife (OR=1.89; p=<0.01) and retired patients (2.50; p=<0.03), lack of physical exercise, increasing HbA1c (p=<0.001), FBG (p=<0.001), 2-hBG (<0.001) and blood pressure (p=0.000) had independent significant risk factors for any of three microvascular complications. Conclusion: This study observed that about all the microvascular complications were developed from first three years after registration at BIRDEM. Increasing age, HbA1c, FBG, 2-hBG and blood pressure had significant risk factors for any type of microvascular complications.
T1DMicro: A Clinical Risk Calculator for Type 1 Diabetes Related Microvascular Complications
Development of complications in type 1 diabetes patients can be reduced by modifying risk factors. We used a cross-sectional cohort of 1646 patients diagnosed with type 1 diabetes (T1D) to develop a clinical risk score for diabetic peripheral neuropathy (DPN), autonomic neuropathy (AN), retinopathy (DR), and nephropathy (DN). Of these patients, 199 (12.1%) had DPN, 63 (3.8%) had AN, 244 (14.9%) had DR, and 88 (5.4%) had DN. We selected five variables to include in each of the four microvascular complications risk models: age, age of T1D diagnosis, duration of T1D, and average systolic blood pressure and HbA1C over the last three clinic visits. These variables were selected for their strong evidence of association with diabetic complications in the literature and because they are modifiable risk factors. We found the optimism-corrected R2 and Harrells C statistic were 0.39 and 0.87 for DPN, 0.24 and 0.86 for AN, 0.49 and 0.91 for DR, and 0.22 and 0.83 for DN respectively. This tool (...