Introduction: Obesity is increasing in T1D patients worldwide and is related to cardiovascular (CV) disease.
Objective: To identify the background characteristics linked to overweight/obesity and CV ...risk factors during insulin treatment in T1D patients.
Methods: We performed anthropometric, laboratory and genetic analysis - FTO rs9939609 and visfatin rs9770242 of young Brazilian T1D. This study was approved by the Ethic Committee.
Results: From 181 T1D patients (age 23.6±5.5 y, diabetes duration 12.1±7.2 y, A1c 8.9±1.9%), 87 were female - 64.4% normal weight (NW), 26.4% overweight (OW) and 9.2% obese (OB) - and 94 male (77.7% NW, 14.9% OW and 7.4% OB).
Male: OB were older (OB: 29.4±3.7 y vs. OW: 23.2±5.8 vs. NW: 22.5±5.3, p=0.01), had higher prevalence of blacks (57.1% vs. 7.1 vs. 7, p=0.01), higher triglycerides levels (180.3±140.2 mg/dL vs. 74.4±34.4 vs. 87±57.1, p=0.03), diastolic BP (85±8.4 mmHg vs. 78.9±9.2 vs. 73.4±9.6, p=0.009) and lower eGDR (5.4±1.9 mg/Kg/min vs. 6.8±1.9 vs. 7.9±1.7, p=0.003). Higher prevalence of AH (100% vs. 57.1 vs. 50.7, p=0.03) and early CV disease (28.6% vs. 7.1 vs. 2.7, p=0.02) in their first-degree relatives (FDR) were also found in OB. A1c, insulin dose (U/kg/day), diabetes duration, physical activity, high molecular weight (HMW) adiponectin, visfatin, FTO and visfatin genes polymorphisms were not different in NW and OW/OB.
Female: We found no difference between groups in A1c, insulin dose, diabetes duration, physical activity, HMW adiponectin, visfatin or FTO and visfatin genes polymorphisms. OW and OB had lower eGDR (5.4±2.4 mg/Kg/min vs. 6.1±2.1 vs. 8±2.1, p=0.0002). OB women had FDR with obesity more frequently (62.5% vs. 47.8 vs. 25.5, p=0.03).
Conclusion: FDR with obesity is a risk factor to OW/OB in female T1D as well as FDR with early CV disease or AH in male T1D. These specifics familiar background must be considered for early prevention of CV risk factors during natural history of T1D.
Disclosure
F. Valente: Consultant; Spouse/Partner; Sanofi Genzyme. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc. T. Valente: None. S.A. Dib: None.
Persistence of β cell-function in Type 1 diabetes (T1D) is associated with glycaemia stability and lower prevalence of microvascular complications. We aimed to assess the prevalence of residual C- ...peptide secretion in long-term Brazilian childhood onset T1D receiving usual diabetes care and its association to clinical, metabolic variables and microvascular complications.
A cross-sectional observational study with 138 T1D adults with ≥ 3 years from the diagnosis by routine diabetes care. Clinical, metabolic variables and microvascular complications were compared between positive ultra-sensitive fasting serum C-peptide (FCP +) and negative (FCP-) participants.
T1D studied had ≥ 3 yrs. of diagnosis and 60% had FCP > 1.15 pmol/L. FCP + T1D were older at diagnosis (10 vs 8 y.o; p = 0.03) and had less duration of diabetes (11 vs 15 y.o; p = 0.002). There was no association between the FCP + and other clinical and metabolic variable but there was inversely association with microalbuminuria (28.6% vs 13.4%, p = 0.03), regardless of HbA
. FCP > 47 pmol/L were associated with nephropathy protection but were not related to others microvascular complications.
Residual insulin secretion is present in 60% of T1D with ≥ 3 years of diagnosis in routine diabetes care. FCP + was positively associated with age of diagnosis and negatively with duration of disease and microalbuminuria, regardless of HbA
.
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•This study reviews the role of gut microbiota in pregnancies that evolved with GDM.•There are differences in the microbiota between healthy women and women with GDM.•Microbiota profile during ...pregnancy could predict progression to GDM.•Gut microbiota could be a biomarker for early detection of GDM.•Gut microbiota could be a potential target to reduce the risk of GDM.
Gestational Diabetes Mellitus (GDM) is one of the most prevalent complications of pregnancy and can cause adverse maternal and fetal outcomes. The maternal gut microbiota is involved in several metabolic functions, but it is not yet known its role in GDM physiopathology. This study aims to review the role of gut microbiota in pregnancies that evolved with GDM.
Systematic search of the PubMed, Embase, and Scopus databases was performed to identify articles published until 18th August 2021 involving the assessment of gut microbiota in pregnancy.
A total of 23 articles were selected for this review. Seventeen studies investigated differences in the gut microbiota of healthy and GDM pregnant women and showed differences in alfa and beta diversity. Six prospective studies found that microbiota changes during pregnancy and showed that some particularities in the microbiome in are associated with the risk of GDM.
This systematic review showed that there is a relationship between intestinal microbiota and GDM. Gut microbiota could be a biomarker for early detection of GDM and could be considered a potential target for modification to reduce the risk of GDM.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
AWARD-PEDS was a Phase 3 trial to assess the efficacy and safety of dulaglutide (DU) , a once-weekly GLP-1 receptor agonist, in youth (10 to <18 years old) with T2D treated with lifestyle alone or on ...stable metformin with or without basal insulin. Participants (mean age, 14.5 yrs; mean BMI, 34.1 kg/m2) were randomized to placebo (N=51) , DU 0.75 mg (N=51) , or DU 1.5 mg (N=52) . The primary aim was to demonstrate superiority of DU (pooled doses) vs. placebo for change in HbA1c at 26 weeks. Analyses included all patients with ≥1 dose of study drug, excluding data after initiation of rescue therapy. DU was superior to placebo (figure) in improving glycemic control measured by change in HbA1c, percent of patients with HbA1c <7%, and change in fasting glucose at Week 26. No effect of DU was observed on BMI change (p=0.776) . Fewer patients assigned to DU compared to placebo required rescue therapy (2.9% vs. 17.6% respectively, p=0.003) . Incidence of common GI adverse events was higher in DU group vs. placebo nausea (14.6% vs. 7.8%) , vomiting (15.5% vs. 3.9%) , diarrhea (18.4% vs. 13.7%) but comparable to that observed in adults.
In conclusion, in youth with inadequately controlled T2D treated with or without metformin and/or basal insulin, once weekly DU 0.75 mg or 1.5 mg was superior to placebo in improving glycemic control without an effect on BMI through 26 weeks, with a safety profile consistent with that established in adults.
Disclosure
S. A. Arslanian: Advisory Panel; Eli Lilly and Company, Novo Nordisk. Research Support; Eli Lilly and Company, Novo Nordisk. Other Relationship; AstraZeneca. J. Cho: None. T. S. Hannon: Advisory Panel; Eli Lilly and Company. P. Zeitler: Consultant; Boehringer Ingelheim International GmbH, Daiichi Sankyo, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Takeda Pharmaceutical Company Limited. L. Chao: None. M. Barrientos: Research Support; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Research & Development, LLC, Novo Nordisk. C. C. Boucher-Berry: None. E. Bismuth: None. S. A. Dib: None. D. Cox: Employee; Eli Lilly and Company.
Funding
Eli Lilly and Company
Background A main factor contributing to insufficient glycemic control, during basal/bolus insulin therapy, is poor self-management bolus. Insulin bolus administration frequency is strongly ...associated with glycated hemoglobin (A1c) in Type 1 Diabetes (T1D). In the present study, we analyzed the performance of two-bolus calculator's software that could be accessible to T1D patients from a Public Health Service to improve glycemic time in range (TIR) and A1c. Methods This prospective, controlled, randomized, parallel intervention clinical trial was carried out with 111 T1D participants on basal/bolus therapy multiple daily insulin injections (MDI) or subcutaneous infusion pump (CSII) with basal A1c greater than or equal to 8.5% for 24 weeks. Patients were divided into 3 groups: 2 interventions: COMBO.sup.R (bolus calculator) and GLIC (mobile application) and 1 control (CSII group). Anthropometrics and metabolic variables were assessed on basal, 3 and 6 months of follow-up. Results TIR was increased in 9.42% in COMBO group (29 + or - 12% to 38.9 + or - 12.7%; p < 0.001) in 8.39% in the GLICR group (28 + or - 15% to 36.6 + or - 15.1%; p < 0.001) while remained stable in CSII group (40 + or - 11% to 39.3 + or - 10.3%). A1c decrease in 1.08% (p < 0.001), 0.64% (p < 0.001) and 0.38% (p = 0.01) at 6 months in relation to basal in the COMBO, GLIC and CSII respectively. Daily basal insulin dose was reduced by 8.8% (p = 0.01) in the COMBO group. Conclusion The COMBO and a mobile applicative (GLIC) bolus calculator had a similar and a good performance to optimize the intensive insulin treatment of T1D in the public health system with increase in the TIR and reduction in A1C without increase hypoglycemia prevalence. Keywords: Insulin bolus calculator, Type 1 diabetes, Mobile applications, Glycemic control
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Objective: Evaluate the impact of recurrent episodes of diabetic ketoacidosis (DKAr) in T1DM. Methods: Electronic databases of hospitalized of 263 T1DM patients with the code for DKA (E10.1 and ...E14.1) were selected (from 2007 to 2018). Mortality curves were compared in 4 groups: a) new-onset T1DM b) single DKA episode after T1DM diagnosis c) 2 to 5 DKA and d)> 5 DKA during follow-up period. Results: We found a 16.02% mortality rate (37/231) during the follow-up. The age at the death was 38.7 yrs IQR 28.43-48.91 yrs. Comparing the deceased group vs. survivors was shown in Table. Conclusions: T1DM patients with more than 2 DKA episodes were associated with 5 times risk of mortality in the next 5 years. Psychosocial issues and microangiopathic complications were associated with this condition in this unique population.
Lipodystrophies are characterized by complete or selective loss of adipose tissue and can be acquired or inherited. Familial partial lipodystrophy (FPLD) is a hereditary lipodystrophy commonly caused ...by mutations in the LMNA gene. Herein, we report two cases of FPLD associated with podocytopathies. Patient 1 was diagnosed with FPLD associated with the heterozygous p.Arg482Trp variant in LMNA and had normal glucose tolerance and hyperinsulinemia. During follow-up, she developed nephroticrange proteinuria. Renal biopsy was consistent with minimal change disease. Patient 2 was diagnosed with FPLD associated with a de novo heterozygous p.Arg349Trp variant in LMNA. Microalbuminuria progressed to macroalbuminuria within 6 years and tonephrotic range proteinuria in the last year. He remained without diabetes and with hyperinsulinemia. Renal biopsy revealed focal segmental glomerulosclerosis not otherwise specified. This report provides further evidence of variable features of lipodystrophy associated with LMNA variants and the importance of long-term follow-up with evaluation of kidney dysfunction.
Aim
Periodontitis is correlated with type 2 diabetes mellitus (T2DM), but little is known about glycaemic status effect on subgingival microbiota associated with periodontitis. This study evaluated ...if periodontal microbiome of T2DM patients is affected by glycaemic status.
Materials and methods
Twenty‐one T2DM non‐smoking patients with chronic periodontitis and body mass index ≤40 kg/m2 were allocated into two groups according to systemic glycaemic status: inadequate (DMI‐ HbA1c ≥ 8%) and adequate (DMA‐ HbA1c <7.8%). Subgingival biofilm was collected from sites with moderate (PD = 4–6 mm) and severe disease (PD ≥ 7 mm) in two quadrants. The V5–V6 hypervariable region of the 16SrRNA was sequenced using the GS‐FLX‐454 Titanium platform. Sequences were compared with HOMD database using QIIME and PhyloToAST pipelines. Statistical comparisons were made using two‐sample t‐tests.
Results
DMA microbiome presented higher diversity than DMI. Inadequate glycaemic control favoured fermenting species, especially those associated with propionate/succinate production, whereas those forming butyrate/pyruvate was decreased in DMI. Higher abundances of anginosus group and Streptococcus agalactiae in DMI may indicate that subgingival sites can be reservoir of potentially invasive pathogens. Altered subgingival microbiome in DMI may represent an additional challenge in the periodontal treatment of these patients and in the prevention of more invasive infections.
Conclusion
Glycaemic status in T2DM patients seems to modulate subgingival biofilm composition.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Recurrent DKA (rDKA) remains an acute type 1 diabetes complication even in post-insulin era. This study aimed to analyze the predictors and effects of rDKA on the mortality of patients with type 1 ...diabetes.
Patients hospitalized (n = 231) wih diabetic ketoacidosis (between 2007 and 2018) were included. Laboratorial and clinical variables were collected. Mortality curves were compared in four groups: diabetic ketoacidosis as a new-onset type 1 diabetes (group A), single diabetic ketoacidosis episode after diagnosis of type 1 diabetes (group B), 2-5 diabetic ketoacidosis events (group C), and > 5 diabetic ketoacidosis events during follow-up period (group D).
During the follow-up period (approximately 1823 days), the mortality rate was 16.02% (37/231). The median age at death was 38.7 years. In the survival curve analysis, at 1926 days (5 years), the probabilities of death were indicated by ratios of 7.78%, 4.58%, 24.40%, and 26.63% in groups A, B, C, and D, respectively. One diabetic ketoacidosis episode compared with ≥ 2 events had a relative risk of 4.49 (p = 0.004) of death and > 5 events had 5.81 (p = 0.04). Neuropathy (RR 10.04; p < 0.001), retinopathy (relative risk 7.94; p < 0.01), nephropathy (RR 7.10; p < 0.001), mood disorders (RR 3.57; p = 0.002), antidepressant use (RR 3.09; p = 0.004), and statin use (RR 2.81; p = 0.0024) increased the risk of death.
Patients with type 1 diabetes with > 2 diabetic ketoacidosis episodes have four times greater risk of death in 5 years. Microangiopathies, mood disorders, and use of antidepressants and statins were important risk factors for short-term mortality.
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