Anna Duda-Sobczak

Impaired olfactory function is related to the presence of neuropathy in adults with type 1 diabetes.

Introduction: Olfactory dysfunction is suggested to be a clinical manifestation of central diabetic neuropathy. The aim of the study was to assess olfactory function in adult patients with type 1 diabetes. Materials and methods: A total of 106 patients with type 1 diabetes and 30 healthy subjects were included in the study. We evaluated the metabolic control of diabetes and the presence of chronic complications. Olfactory function was assessed with Sniffin’ Sticks. Results: We found a negative correlation between olfactory identification scores and body mass index (Rs −0.2; p = 0.04) and triglycerides (Rs = −0.2; p = 0.04). We showed lower olfactory identification scores in neuropathy group versus non-neuropathy group [8 (interquartile range, 7–9) vs 10 (interquartile range, 9–11) points; p = 0.005]. In multivariate linear regression, impaired olfaction was independently associated with neuropathy (beta, −0.3; p = 0.005). In multivariate logistic regression, diabetes duration (odds ratio, 1.06; 95% confidence interval, 1.00–1.11; p = 0.04) and olfactory identification score (odds ratio, 0.61; 95% confidence interval, 0.43–0.85; p = 0.003) were independently associated with neuropathy. Conclusion: Olfactory dysfunction is observed in patients with type 1 diabetes and diabetic peripheral neuropathy.

Association Between Self-reported Physical Activity and Skin Autofluorescence, a Marker of Tissue Accumulation of Advanced Glycation End Products in Adults With Type 1 Diabetes: A Cross-sectional Study

PURPOSE The accumulation of advanced glycation end products (AGEs) in local tissue is an important cause of low-grade inflammation and oxidative stress and is linked to late diabetic complications. Physical activity has various beneficial cardiometabolic effects in type 1 diabetes (T1D) and is associated with lower frequency of chronic complications of diabetes, although the specific mechanisms still remain unclear. The present study determines the association between self-reported physical activity and skin autofluorescence (AF), a marker of tissue accumulation of AGEs in adults with T1D. METHODS We enrolled 119 patients (63 women), aged 34 years (interquartile range [IQR], 26-41 years), with T1D duration of 17 years (IQR, 12-25 years), glycosylated hemoglobin (HbA1c) of 7.9% (IQR, 7.1%-8.9%) referred to an outpatient diabetes clinic. Patients with diabetes duration of <5 years, age >65 years, concomitant diabetic ketoacidosis, and severe complications that restrict physical activity (eg, diabetic foot, diabetic proliferative retinopathy, blindness) were excluded. Physical activity was measured with the short version of the International Physical Activity Questionnaire (IPAQ-SF), and raw scores were then log-transformed because of non-normality. The accumulation of AGEs in the skin was assessed on the basis of skin AF. Correlations between AF and various laboratory and clinical findings were assessed, and multivariate linear regression analysis was used to examine factors that influenced AGEs. FINDINGS Skin AF correlated positively with age (Spearmans coefficient [Rs] = 0.47; P < 0.0001), HbA1c (Rs = 0.30; P = 0.001), waist-to-hip ratio (WHR; Rs = 0.23; P = 0.02), and negatively with logIPAQ-SF (Rs = -0.28; P = 0.002). A stepwise multivariable linear regression analysis indicated age (β = 0.46; P < 0.0001), HbA1c (β = 0.21; P = 0.01), and logIPAQ-SF score (β = -0.17; P = 0.04) as predictors of the skin AF after adjustment for sex and WHR (R2 = 0.36; P < 0.0001). IMPLICATIONS Higher physical activity is related to lower accumulation of AGEs in patients with T1D. Our study provides new insight into the beneficial effects of physical activity in T1D according to tissue accumulation of AGEs.

High-intensity Exercise in Men with Type 1 Diabetes and Mode of Insulin Therapy

The purpose of this study was to evaluate the impact of high intensity exercise on glucose levels and risk of metabolic decompensation in males with type 1 diabetes (T1D), depending on the method of insulin administration. The study comprised 29 males (aged 25.3±5.1 years; duration of diabetes 10.3±3.2 years) treated with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI). Treadmill exercise test was performed twice in each patient until subjective exhaustion as maximum according to the Borg scale. All the patients achieved ≥85% of the maximal heart rate. Distance during the test was 4 500±1 400 m and 4 473±1 559 m in the MDI and CSII groups, respectively, which was achieved in 31±8 min. During the test and in the 6 h after, no clinically significant episodes of hypoglycemia occurred. Mean glucose levels did not exceed 10 mmol/L in most patients. The risk of the composite endpoint (hypoglycemia<3.8 mmol/L, hyperglycemia≥16.6 mmol/L, ketones≥0.6 mmol/L, and lactate>2.2 mmol/L) was higher in patients treated with MDI than CSII (OR3.75, 95%CI:1.22-11.52, p=0.02). In conclusion, planned high intensity physical effort in men with well-controlled T1D is metabolically safe. CSII shows greater metabolic advantage over MDI during and after high intensity exercise in men with T1D.

Type 1 Diabetes and Periodontal Health

It is well established that hyperglycemia affects periodontal outcomes. A body of evidence, predominantly over the past 20 years supports significant independent associations between periodontal disease and glycemic control or complications of diabetes. Association between periodontal tissue and hyperglycemia is possible through altered cellular immunity, increased proliferation of bacteria, microangiopathy, and formation of the advanced glycation end products. However, most studies focus solely on patients with type 2 diabetes or diabetes in general. There is still the paucity of data concerning patients with type 1 diabetes (T1D). Here, the authors consider the possible mechanisms linking periodontal disease with diabetes, focusing mainly on T1D and discuss possible diagnostic and therapeutic approaches.