Stanislaw Pilacinski

Carotid intima-media thickness and arterial stiffness in type 1 diabetic patients with and without microangiopathy

Introduction The aim of the study was to assess carotid intima-media thickness (CIMT) as a subclinical marker of atherosclerosis and arterial stiffness in type 1 diabetic patients in relation to microangiopathy. Material and methods We included 87 type 1 diabetic patients (44 women, 43 men), median age 34 years (interquartile range [IQR] 29-43), median disease duration 10 years (IQR: 9-14), mean ± standard deviation (SD) glycated haemoglobin (HbA1c) 8.4 ±1.4%. Fifty patients had at least one microangiopathic complication. Intima-media thickness (IMT) of the common carotid artery was measured using high resolution ultrasonography. Arterial stiffness was assessed using digital volume pulse analysis and tonometric measurement of wave reflection and central haemodynamics. Results Subjects with microangiopathy compared with those without had higher values of CIMT (median [IQR]: 0.53 mm [0.45-0.60 mm] vs 0.47 mm [0.34-0.52 mm], p = 0.002), higher central augmentation index (CAIx) (mean ± SD: 120.2 ±19.4% vs. 110.5 ±17.1%, p = 0.016) and higher peripheral augmentation index (PAIx) (65.7 ±18.1% vs. 57.2 ±14.9%, p = 0.023). In the logistic regression analysis, the duration of diabetes, systolic and diastolic blood pressure, postprandial glycaemia, HbA1c and triglycerides predicted the presence of diabetic microangiopathy independently of age and sex. The CIMT, CAIx and PAIx were associated with the presence of diabetic microangiopathy only in the univariate model. Conclusions In type 1 diabetic patients with microangiopathic complications, increased carotid IMT and arterial stiffness were observed. The study confirms the role of traditional risk factors for late diabetic complications, such as the duration of the disease and metabolic control in the development of microangiopathy.

Smoking and other factors associated with short-term partial remission of Type 1 diabetes in adults.

Diabet. Med. 29, 464–469 (2012)

Influence of lifestyle on the course of type 1 diabetes mellitus

Type 1 diabetes (T1DM) is an autoimmune disease that requires insulin treatment from the time of diagnosis. Its clinical course depends on both genetic and environmental factors, and the lifestyle of a patient modulates their interaction. The evidence about the influence of lifestyle on the course of T1DM is increasing. In this paper, we present evidence on the relationship between lifestyle parameters and diabetes-related outcomes. We discuss the most commonly addressed factors associated with lifestyle, such as physical activity, nutrition and smoking, and those with sparse evidence in T1DM, such as socioeconomic status, sleep duration, psychological stress and illicit drugs intake.

Influence of remission and its duration on development of early microvascular complications in young adults with type 1 diabetes

INTRODUCTION Prevalence of partial remission ranges between 20% and 80% in the initial course of type 1 diabetes. In this phase of the disease, a substantial insulin secretion contributes to good metabolic control. The aim of the study was to determine the association between presence of partial remission and occurrence of microangiopathy complications in type 1 diabetes. MATERIAL AND METHODS Ninety-eight consecutive patients with newly diagnosed type 1 diabetes were asked to participate in a cohort study. Partial remission was defined as the time in which all of the following criteria were met: HbA1c below 6.5% (48mmol/mol), daily insulin requirement below 0.3 U/kg body weight and serum Cpeptide concentration above 0.5ng/ml. Patients were divided into those who were in remission at any time during follow-up (remitters) and non-remitters. After 7years of follow-up, the occurrence of microangiopathy complications was analyzed. In statistical analysis, Mann-Whitney test, chi(2) test and Fisher test were used for analysis between groups. We applied a Coxs multivariate regression model and univariate regression method. P<0.05 was considered statistically significant. RESULTS In univariate logistic regression, a significant association was found between absence of remission and occurrence of at least one microvascular complication. In the Cox proportional hazards regression model that included clinically significant parameters at diagnosis (presence of ketoacidosis, cigarette smoking and HbA1c value) as covariates, absence of remission was associated with occurrence of chronic complications of diabetes at 7years [HR: 3.65 (95% CI 1.23-4.56), p=0.04]. In non-remitters, higher incidence of at least one microvascular complication (46.4% vs. 7.6%), higher incidence of retinopathy (42.8% vs. 5.7%), and neuropathy (21.4% vs. 1.9%) was found. CONCLUSIONS Occurrence of partial remission of diabetes is associated with a reduced risk of chronic microvascular complications at 7-year follow-up.

Presence of retinopathy in type 1 diabetic patients is associated with subclinical macroangiopathy

Abstract Purpose. The aim of the study was to assess the relationships between diabetic retinopathy, subclinical atherosclerosis and wave reflection in type 1 diabetic patients. Methods. The investigation involved 87 type 1 diabetic patients aged 34 years (interquartile range [IQR]: 29–43), with a disease duration of 10 years (IQR: 9–14). Of these 39 (45%) had diabetic retinopathy. Carotid intima-media thickness (CIMT) was measured using high resolution ultrasonography. Wave reflection and central hemodynamics [central (CAIx) and peripheral augmentation index (PAIx)] were determined with the use of tonometry. Results. Patients with retinopathy compared to those without had increased CIMT (530 vs 480 μm, p = 0.017) and wave reflection (CAIx [118.90 vs 110.96 %, p = 0.03] and PAIx [64.95 vs 57.44 %, p = 0.029]). In logistic regression analysis, patients age, duration of diabetes, systolic and diastolic blood pressure, postprandial glycemia, HbA1c value, CIMT (p = 0.017), CAIx (p = 0.03) and PAIx (p = 0.016) were associated with the presence of diabetic retinopathy. However, in the multivariate model, CIMT and CAIx did not remain predictors of retinopathy. Conclusions. We have shown that the presence of retinopathy in type 1 diabetic patients is associated with subclinical atherosclerosis and wave reflection.

Association between serum adiponectin and HbA1c is independent of the severity of clinical presentation in young adults with new onset type 1 diabetes.

hospitalized with newly diagnosed autoimmune type 1 diabetes. The diagnosis was confirmed by positive assay for at least one islet autoantibody: to glutamic acid decarboxylase 65 (anti-GAD) or to insulinoma-associated antigen (IA2Ab) or islet cell antibodies (ICA). Among these, 23 patients (19 %) presented with diabetic ketoacidosis (DKA), defined according to the ADA 2009 criteria. Informed consent was obtained from all individual participants included in the study. Clinical and biochemical characteristics of the study group are shown in Table 1. At diagnosis of diabetes, anthropometric measurements were taken and data on the duration of clinical symptoms, body weight before onset of symptoms and smoking status were collected using a questionnaire. Serum adiponectin was measured using ELISA kit (Quantikine, R&D). HbA1c was measured using high-performance liquid chromatography (normal reference range 4.1–6.4 %). Serum C-peptide concentration was determined using immunoenzymatical method (IMMULITE, DPC), normal range: 1.1–5.0 ng/ml. In statistical analysis (Statistica 10, StatSoft Inc., Tulsa, USA) Student’s t test or Mann–Whitney U test, as appropriate, were used to compare serum adiponectin concentration between subgroups. Pearson or Spearman correlation coefficients between continuous variables and serum adiponectin concentration was calculated. In the multivariate linear regression model we determined the association between serum adiponectin concentration and HbA1c, with adjustment for sex and variables that reflect catabolism and inflammation.

C-Reactive protein and soluble intracellular adhesion molecule-1 are related to pulse wave reflection in type 1 diabetes 在1型糖尿病中C-反应蛋白以及可溶性细胞间黏附分子在1与脉冲波反射有关

The association of inflammation with cardiovascular (CV) complications in diabetes remains a matter of considerable debate. Arterial stiffness and enhanced wave reflection play an important role in CV complications. Therefore, in the present study we investigated whether markers of inflammation are correlated with parameters of wave reflection in type 1 diabetes (T1D).

C-Reactive protein and soluble intracellular adhesion molecule-1 are related to pulse wave reflection in type 1 diabetes 1C-1.

The association of inflammation with cardiovascular (CV) complications in diabetes remains a matter of considerable debate. Arterial stiffness and enhanced wave reflection play an important role in CV complications. Therefore, in the present study we investigated whether markers of inflammation are correlated with parameters of wave reflection in type 1 diabetes (T1D).

Baseline diabetic knowledge after 5-day teaching program is an independent predictor of subclinical macroangiopathy in patients with type 1 diabetes (Poznan Prospective Study).

PURPOSE The cardiovascular diseases (CVD) are the leading cause of mortality in type 1 diabetes (DM1). Carotid intima-media thickness (IMT) has been approved as a marker of subclinical atherosclerosis. The aim of this prospective study was to evaluate the relationship between baseline diabetic knowledge after five-day teaching program and IMT in patients with (DM1) treated with intensive functional insulin therapy (IFIT) from the onset of the disease. MATERIAL/METHODS The analysis included 79 subjects aged 23.4 ± 5.1 years with newly diagnosed DM1, participating in Poznan Prospective Study (PoProStu). The patients attended a five-day structured training program in IFIT at diagnosis, followed by a test consisting of 20 questions. After follow-up period of 11 years we evaluated the presence of microangiopathy and subclinical macroangiopathy. IMT of the right common carotid artery was determined using high resolution ultrasonography and calculated automatically with the Carotid Analyzer for Research program. RESULTS After 11-year follow-up median intima-media thickness was 560 (IQR: 520-630) μm. We found a negative correlation between diabetes knowledge at baseline and IMT at the end of follow-up (r=-0.27, p=0.017). In multivariate linear regression model baseline diabetic knowledge test result was associated with IMT at follow-up, independently from sex, age, smoking status, presence of hypertension and diabetic kidney disease (all at follow-up) and from mean follow-up LDL-cholesterol concentrations and HbA1c results (β=-8, 95% CI -16, -1, p=0.037). CONCLUSIONS Baseline diabetic knowledge after 5-day teaching program is an independent predictor of subclinical macroangiopathy in patients with DM1.

Insulin resistance is associated with larger thyroid volume in adults with type 1 diabetes independently from presence of thyroid autoimmunity

Abstract To investigate the effect of insulin resistance (IR) on thyroid function, thyroid autoimmunity (AIT) and thyroid volume in type 1 diabetes (T1DM). 100 consecutive patients with T1DM aged 29 (±6) years with diabetes duration 13 (±6) years were included. Exclusion criteria were: history of thyroid disease, current treatment with L-thyroxin or anti-thyroid drugs. Evaluation of thyroid stimulating hormone (TSH), free thyroid hormones and anti-thyroid antibodies was performed. Thyroid volume was measured by ultrasonography. IR was assessed using the estimated glucose disposal rate (eGDR) formula. In the study group 22% of subjects had insulin resistance defined as eGDR lower or equal to 7.5 mg/kg/min. The prevalence of thyroid autoimmunity (positivity for ATPO or ATg or TRAb) in the study group was 37%. There were no significant differences in the concentration of TSH, FT3, FT4, the prevalence of AIT and hypothyroidism between IR and insulin sensitive (IS) group. Mean (±SD) thyroid volume was 15.6 (±6.2) mL in patients with IR and 11.7 (±4.7) mL in IS subjects (p = .002). Thyroid volume correlated inversely with eGDR (r = –0.35, p < .001). In a multivariate linear regression model the association between thyroid volume and eGDR was independent of sex, age, duration of diabetes, daily insulin dose, BMI, cigarette smoking, TSH value and presence of thyroid autoimmunity (beta: –0.29, p = .012). Insulin resisance is associated with larger thyroid volume in patients with type 1 diabetes independently of sex, body mass index, TSH value and presence of autoimmune thyroid disease.