Introduction La rétinopathie diabétique est-elle plus fréquente chez les patients diabétiques de type 2 (DT2) qui ont un parent diabétique ? Patients et Méthodes Chez les patients DT2 hospitalisés ...pour déséquilibre et dont le statut rétinien était connu, nous avons recueilli systématiquement les antécédents familiaux de diabète : père, mère, les deux parents. Les associations entre rétinopathie et antécédents parentaux ont été analysées par régression logistique binaire, avec ajustement aux caractéristiques du diabète (durée de diabète, HbA1c ). Résultats Les 316 patients (57 % hommes) étaient âgés de 62 ± 10 ans, leur diabète était connu depuis l'âge de 47 ± 12 ans, leur HbA1c à 8,6 ± 2,0 %, et 72 % étaient traités par insuline. La rétinopathie était présente chez 28,2 % des patients : 12,2 % non proliférantes, 10,4 % proliférantes, et 5,5 % d'oedèmes maculaires. 49 % des patients avaient un antécédent parental de diabète : 15,1 % le père, 25,9 % la mère, et 7,9 % les deux parents. Ils étaient plus jeunes : 60 ± 10 ans vs 65 ± 10 ans en l'absence de parent diabétique ( p < 0,001), avec un diagnostic du diabète plus précoce : 44 ± 12 ans vs 50 ± 12 ( p < 0,001), les durées de diabète et les HbA1c ne différaient pas significativement. Les seuils de perception vibratoire (neuroesthésiométrie), les excrétions urinaires d'albumine, les créatininémies et les prévalences de macroangiopathies ne différaient pas selon l'existence d'un antécédent parental. Les rétinopathies étaient plus fréquentes en présence d'un antécédent parental de diabète : 36,8 % vs 21,7 % ( p = 0,004, et p < 0,05 après ajustement à : âge, sexe, HbA1c et âge au diagnostic ou durée de diabète), du fait de rétinopathies non proliférantes (16,1 % vs 9,3 %, p = 0,038) et proliférantes (14,8 % vs 6,8 %, p = 0,015) plus fréquentes, par contre l'œdème maculaire avait la même prévalence dans les deux groupes : 5,9 % vs 5,6 %. Les prévalences de rétinopathies étaient similaires selon le type d'antécédent parental : 35 % si père, 39 % si mère, 32 % si deux parents diabétiques. Conclusions Chez les patients DT2 dont un ou les deux parents sont diabétiques, le diabète débute 6 ans plus tôt et la rétinopathie est 1,7 fois plus fréquente. Ce surcroit de rétinopathies reste significatif après ajustement à l'HbA1c et à la durée du diabète.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Advanced glycation end-products play a role in diabetic vascular complications. Their optical properties allow to estimate their accumulation in tissues by measuring the skin autofluorescence (SAF). ...We searched for an association between SAF and major adverse cardiovascular events (MACE) incidence in subjects with Type 1 Diabetes (T1D) during a 7 year follow-up.
During year 2009, 232 subjects with T1D were included. SAF measurement, clinical age, sex, body mass index (BMI), comorbidities and biological data (HbA1C, blood lipids, renal parameters) were recorded. MACE (myocardial infarction, stroke, lower extremity amputation or a revascularization procedure) were registered at visits in the center or by phone call to general practitioners until 2016.
The participants were mainly men (59.5%), 51.5 ± 16.7 years old, with BMI 25.0 ± 4.1 kg/m
, diabetes duration 21.5 ± 13.6 years, HbA1C 7.6 ± 1.1%. LDL cholesterol was 1.04 ± 0.29 g/L, estimated Glomerular Filtration Rates (CKD-EPI): 86.3 ± 26.6 ml/min/1.73 m
. Among these subjects, 25.1% were smokers, 45.3% had arterial hypertension, 15.9% had elevated AER (≥ 30 mg/24 h), and 9.9% subjects had a history of previous MACE. From 2009 to 2016, 22 patients had at least one new MACE: 6 myocardial infarctions, 1 lower limb amputation, 15 revascularization procedures. Their SAF was 2.63 ± 0.73 arbitrary units (AU) vs 2.08 ± 0.54 for other patients (p = 0.002). Using Cox-model, after adjustment for age (as the scale time), sex, diabetes duration, BMI, hypertension, smoking status, albumin excretion rates, statin treatment and a previous history of MACE, higher baseline levels of SAF were significantly associated with an increased risk of MACE during follow-up (HR = 4.13 1.30-13.07; p = 0.02 for 1 AU of SAF) and Kaplan-Meier curve follow-up showed significantly more frequent MACE in group with SAF upper the median (p = 0.001).
A high SAF predicts MACE in patients with T1D.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
As diabetic retinopathy (DR) can occur even in well-controlled patients with type 2 diabetes (T2D), our study sought to determine whether it might be related to ‘glucose memory’ by evaluating ...patients’ HbA1c over previous years and their skin autofluorescence (SAF).
In 334 patients with T2D and HbA1c levels≤8%, their available values of HbA1c from previous years were collected, and their SAF measured by an advanced glycation end-product (AGE) reader. Binary logistic regression analysis was then used to correlate DR with previously recorded HbA1c levels and to SAF, with adjustment for DR risk factors age, gender, BMI, duration of diabetes, arterial hypertension, diabetic kidney disease (DKD), blood lipid levels and statin treatment.
Our patients were mostly men (58.4%) aged 63±10years, with a duration of diabetes of 13±10years and HbA1c=7.1±0.7%. Of these patients, 84 (25.1%) had DR, which was associated with longer duration of diabetes and greater prevalence of DKD. A total of 605 HbA1c values from previous years were collected for time periods −4±3 months (n=255), −16±4months (n=152), −30±4months (n=93) and −62±26 months (n=105). After adjustment, the association between DR and having an HbA1c higher than the median was significant only for the oldest previous HbA1c values: OR=6.75, 95% CI: 1.90–23.90. Moreover, SAF values were higher in those with DR 2.95±0.67 arbitrary units (AU) vs 2.65±0.65 AU with no DR (P<0.01) and were also associated with the oldest previous HbA1c values (P<0.01).
Our study found that 25.1% of our well-controlled T2D patients had DR, which was related to both their HbA1c levels from 5years prior to study admission and their SAF values, a marker of glucose memory.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
While serum fructosamine may be a good marker of glucose control in pregnant women with diabetes, its relationship with macrosomia is still uncertain.
In 130 hyperglycaemic women with singleton ...pregnancies (117 gestational diabetes mellitus, 13 pregestational diabetes), serum fructosamine and HbA1c levels were measured at 25±7 weeks of gestation. Levels in mothers of infants with and without macrosomic newborns (birth weight>4000g and/or large-for-gestational-age birth weight>90th percentile) were compared using logistic regression analysis adjusted for macrosomia risk factors.
These 130 pregnant women were 33±5 years old; their BMI before pregnancy was 27.7±6.9kg/m2, and they gained 7.5±5.1kg during the first 6 months of gestation. Glucose control was good according to HbA1c levels (5.3±0.3%; 34±2mmol/mol), yet 17/130 (13%) newborns had macrosomia: 3900±227g vs 3057±512g (P<0.001) in the others. These mothers were older and had higher parity, whereas their BMI scores before pregnancy and gestational weight gains did not differ. Fructosamine levels were also higher at 221±40μmol/L vs 192±22μmol/l (P<0.001), respectively, and remained significant even after adjusting for maternal age, BMI, parity, type of diabetes, antecedents of macrosomia and excessive gestational weight gain. By contrast, HbA1c did not differ between the two groups. In fact, nearly two-thirds (64.7%) of the mothers of macrosomic newborns had fructosamine levels>200μmol/l vs 31.9% of mothers with non-macrosomic newborns (P<0.05).
High fructosamine levels are associated with macrosomia in the newborns of well-controlled hyperglycaemic pregnant women.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Aims
Several reports have suggested a relationship between male sex and albuminuria in Type 2 diabetes, but impact on renal function decline has not been established. Our aim was to describe the ...influence of sex on renal function decline in Type 2 diabetes.
Methods
SURDIAGENE, an inception cohort, consisted in 1470 people with Type 2 diabetes. Patients without renal replacement therapy and with ≥ 3 serum creatinine determinations during follow‐up prior to end‐stage renal disease were included in the study. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Primary outcome was steep estimated glomerular filtration rate (eGFR) decline, defined as a yearly slope value lower than –3.5 ml min−1 1.73 m−2. Secondary outcomes were estimated glomerular filtration rate trajectories according to sex and occurrence of end‐stage renal disease.
Results
A total of 22 914 serum creatinine determinations were considered in 1146 participants (60% men), aged 65 ± 11 years, with a median follow‐up duration of 5.7 years (range 0.1–10.2). Median yearly estimated glomerular filtration rate slope was –1.31 ml min−1 1.73 m−2 in women and –1.77 ml min−1 1.73 m−2 in men (P < 0.001). Men were more likely than women to develop end‐stage renal disease (22 men vs. 7 women; Plog‐rank = 0.03). Male sex was an independent risk factor of steep estimated glomerular filtration rate decline adjusted odds ratio = 1.33 (1.02–1.76), P = 0.04 after adjustment for age, time from diagnosis of Type 2 diabetes, glycated haemoglobin, systolic blood pressure and urinary albumin:creatinine ratio. A multivariable linear mixed‐effects model showed a significant difference of estimated glomerular filtration rate trajectories between men and women (P < 0.001).
Conclusion
Male sex is an important independent factor associated with renal function decline in Type 2 diabetes.
What's new?
Male sex was an independent risk factor of steep eGFR decline.
Estimated glomerular filtration rate trajectories were significantly different according to sex.
Survival without end‐stage renal disease was higher in women than in men.
Male sex is suggested as an important independent factor associated with renal function decline in Type 2 diabetes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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