Zeljko Metelko

Different risk factors of microangiopathy in patients with Type I diabetes mellitus of short versus long duration. The EURODIAB IDDM Complications Study

Aims/hypothesis. To identify factors associated with early development of and late protection from microvascular complications in subjects with Type I (insulin-dependent) diabetes mellitus.¶Methods. The frequency of microvascular complications and their relation to risk factors were studied in 300 Type I diabetic subjects with short duration of disease ( ≤ 5 years) compared with 1062 subjects with long duration ( ≥ 14 years). Microvascular disease was defined as the presence of either retinopathy (assessed from centrally-graded retinal photographs) or urinary albumin excretion rate of more than 20 μg/min.¶Resu1ts. The prevalence of microvascular disease was 25 % in the short duration group. In the long duration group 18 % had no evidence of microvascular complications. In the short duration group factors associated with early development of complications were cigarette smoking and a family history of hypertension. Subjects free of microvascular complications in spite of long duration of diabetes had better glycaemic control, lower blood pressure, better lipid profile and lower von Willebrand factor levels.¶Conclusion/interpretation. At the early stages of Type I diabetes, cigarette smoking and genetic susceptibility to hypertension are important risk factors for microvascular complications. At a later stage, additional risk factors are poorer glycaemic control, higher blood pressure, and an unfavourable lipid profile possibly associated with endothelial dysfunction. Many of these factors are amenable to long-term intervention which should be started as soon as possible in the course of the disease. [Diabetologia (2000) 43: 348–355]

Psychoeducation versus treatment as usual in diabetic patients with subthreshold depression: preliminary results of a randomized controlled trial

BackgroundResearch on the effects of treating sub-threshold depression in persons with diabetes is scarce in spite of the findings indicating that this condition is highly prevalent in the diabetic population and may increase the risk of developing a subsequent major depression. This study was aimed at exploring the effects of a psycho-educational intervention on depression- and diabetes-related outcomes in patients with mild to moderate depressive symptoms.MethodsA randomized controlled study design with a one-year follow-up was used. Fifty patients with mild to moderate depressive symptoms (74% female, aged 57 ± 9 yrs, diabetes duration of 10 ± 8 yrs, BMI 31 ± 6 kg/m2, HbA1C 7.7% ± 1.4, 53% insulin treated) were randomly assigned to either an intervention or a control group. The intervention group underwent four psycho-educational sessions aimed at enabling self-management of depressive symptoms. The control group was informed about the screening results and depression treatment options while continuing diabetes treatment as usual. Both groups were contacted by phone in 2–3-month intervals, and re-assessed for depression after 6 and 12 months. Changes in depressive symptoms and glycaemic control were considered primary outcomes. Mann-Whitney U test and Friedman ANOVA were used to compare between- and within-group indicators at 6- and 12-month follow-ups.ResultsBoth the intervention and the control group reported a significant decrease in depressive symptoms as measured by the CES-D scale (Friedman ANOVA χ2 = 10.8 p = .004 and χ2 = 7.3 p = 0.03, respectively). The 6-month and 1-year indicators of glycaemic control as compared to baseline HbA1C values were also improved in both groups (χ2 = 11.6 p = 0.003 and χ2 = 17.1 p = 0.0002, respectively). Between-group differences in depressive symptoms and HbA1C values were not statistically significant either at 6- or at 12-month follow-up (all p > 0.05).ConclusionPsycho-educational treatment appears to be beneficial in diabetic patients with mild to moderate depressive symptoms, but its effects are comparable with the non-specific support given to the subjects in the control group.Trial registrationCurrent Controlled Trials ISRCTN58745372

Lipoprotein(a) predicts progression of carotid artery intima-media thickening in patients with type 2 diabetes: A four-year follow-up

ZusammenfassungHINTERGRUND: Ziel dieser Studie war es, herauszufinden ob erhöhtes Serum Lipoprotein(a) (Lpa) bei Patienten mit Diabetes mellitus Typ 2 signifikant zu einem Anstieg der Intima-Media-Dicke und der Zahl der Plaques der Carotiden beiträgt und so das kardiovaskuläre Risiko dieser Patienten erhöht. METHODEN: Bei 146 Patienten mit Diabetes mellitus Typ 2 wurden die Lipoprotein(a)-Spiegel, die Intima-Media-Dicke und die Zahl der Plaques in den Carotiden erhoben. Die Intima-Media-Dicke und die Anzahl der Plaques wurde nach 4 Jahren Follow-up kontrolliert. Die Patienten wurden entsprechend ihrem Serum-Lipoprotein(a)-Spiegel in 2 Gruppen (> oder ≤30 mg/dl) eingeteilt. Die Intima-Media-Dicke wurde mit hochauflösendem B-Mode Ultraschall erhoben. ERGEBNISSE: Anfangs bestand kein signifikanter Unterschied in der Intima-Media Dicke der Carotiden der beiden Gruppen. Bei der Kontrolle waren die Intima-Media-Dicken der Gruppe mit höherem Lipoprotein(a)-Spiegel signifkant höher als jene der Gruppe mit niedrigem Lipoprotein(a) Spiegel (1,24 + 0,22 vs. 1,15 + 0,17 mm; p = 0.005), Die mittlere Zunahme der Intima-Media Dicke betrug in der Gruppe mit niedrigem Lipoprotein(a) Spiegel nach 4 Jahren 0,12 mm (0,030 mm/Jahr) und in der Gruppe mit höherem Lipoprotein(a) Spiegel 0,17 mm (0,043 mm/Jahr). Die Multivarianzanalyse ergab, dass die Intima-Media Dicke nur vom Lipoprotein(a)- und nicht vom Triglyzerid- beziehungsweise vom HDL-Cholesterin-Spiegel oder dem Taille-Hüfte Quotienten abhing. Die Anzahl der Plaques unterschied sich weder bei der Erstuntersuchung noch bei der Kontrolle zwischen den beiden Gruppen signifikant (p = 0,276 respektive p = 0,355). In der Gruppe mit höherem Lipoprotein(a)-Spiegel traten mehr kardiovaskuläre Ereignisse ein als in der anderen Gruppe – der Unterschied war allerdings statistisch nicht signifikant. SCHLUSSFOLGERUNGEN: Unsere Ergebnisse weisen daraufhin, dass Lipoprotein(a) ein unabhängiger, genetisch determinierter Risikofaktor ist, der eng mit der Zunahme der Intima-Media-Dicke bei Diabetes mellitus Typ 2 assoziiert ist.SummaryBACKGROUND: The aim of the study was to establish whether increased levels of serum lipoprotein(a) significantly contribute to an increase in intima-media thickness and the number of carotid artery plaques, and consequently to cardiovascular risk in patients with type 2 diabetes mellitus. METHODS: Lipoprotein(a) levels, intima-media thickness and the number of carotid artery plaques were determined at the beginning of the study in 146 patients with type 2 diabetes. Patients were divided into two groups according to serum lipoprotein(a) levels (> or ≤30 mg/dl). Intima-media thickness and the number of plaques were again determined after four years of follow-up. Intima-media thickness was assessed using high-resolution B-mode ultrasound. RESULTS: The two groups of patients revealed no significant differences in baseline intima-media thickness (P = 0.112) in relation to lipoprotein(a) level. After follow-up, intima-media thickness was significantly greater in patients with higher lipoprotein(a) levels (1.24 + 0.22 vs. 1.15 + 0.17 mm, respectively; P = 0.005). The mean increase in thickness over four years was 0.12 mm (0.030 mm/year) in the group with low lipoprotein(a) levels and 0.17 mm (0.043 mm/year) in the group with high lipoprotein(a). Multivariate analysis indicated that intima-media thickness depended on lipoprotein(a), and not on triglyceride, HDL-cholesterol levels or waist-to-hip ratio. No significant difference in baseline and follow-up number of plaques was observed between the study groups (P = 0.276 vs. P = 0.355, respectively). Although the group with lipoprotein(a) >30 mg/dl had more cardiovascular events, the difference was not statistically significant. CONCLUSIONS: These results indicate that lipoprotein(a) is an independent, genetically determined risk factor closely associated with progression of intima-media thickness in type 2 diabetes.