Aims To assess the effects of weight gain on metabolic control, plasma lipids and blood pressure in patients with Type 1 diabetes.
Methods Patients in the EURODIAB Prospective Complications Study ...(n = 3250) were examined at baseline and 1800 (55%) were re‐examined a mean of 7.3 years later. Patients had Type 1 diabetes, defined as a diagnosis made before age 36 years and with a need for continuous insulin therapy within a year of diagnosis. Patients were aged 15–60 years at baseline and were stratified for age, sex and duration of diabetes.
Results The change in HbA1c from baseline to follow‐up examination was significantly more favourable in those who gained 5 kg or more during follow‐up (‘marked weight gain’) than in patients who gained less or no weight or lost weight (‘less or no weight gain’). In those with marked weight gain, there was a significantly greater rise in plasma triglycerides and total cholesterol and significantly less favourable changes in low‐density lipoprotein and high‐density lipoprotein cholesterol compared with those with less or no weight gain, with or without adjustment for HbA1c. Systolic and diastolic blood pressure also rose significantly more in the group with marked weight gain.
Conclusion Weight gain in patients with Type 1 diabetes has adverse effects on plasma lipids and blood pressure, despite a small improvement in glycaemic control.
An integral-path self-calibration scheme is introduced as part of a 20.1 GHz to 26.7 GHz low-noise PLL in 32 nm CMOS SOI. A dual-loop architecture in combination with an integral path measurement and ...correction scheme desensitizes the loop transfer function to the VCO's small signal gain variations. The spread of gain peaking is reduced by self-calibration from 2.4 dB to 1 dB, when measured at 70 sites on a 300 mm wafer. The PLL has a measured phase noise @10 MHz offset of -126.5 dBc/Hz at 20.1 GHz and - 124.2 dBc/Hz at 24 GHz
Bivalve aquaculture is an expanding coastal industry with the potential to modify the habitat of fish and crab species, affecting their refuge, movement, and feeding. The habitat function of ...shellfish aquaculture is not yet well understood, in part due to difficulties in data collection using traditional methods. Underwater video was used to observe fish and crab species’ affiliations with cultured Pacific oyster
Crassostrea gigas
and Manila clam
Venerupis philippinarum
aquaculture sites in comparison to uncultured reference sediment and eelgrass habitats. Sites were monitored in 9 locations across 3 regions of Puget Sound, Washington, USA, in the summers of 2017 and 2018. Of the 3038 fish and crabs observed, 98% were represented by Embiotocidae (surfperch), crabs, three-spined stickleback
Gasterosteus aculeatus
, Cottidae (sculpins), and Pleuronectiformes (flatfish). Overall, the affiliations of fish and crabs with bivalve aquaculture varied by species groups, culture type, and regional environmental and habitat conditions. These interactions varied on a scale of approximately 150 km, highlighting variation of aquaculture-ecological interactions at a scale not previously recorded in Puget Sound. Species composition varied between aquaculture and non-aquaculture habitats in 2 of the 3 regions studied. Species diversity and richness in aquaculture habitats varied regionally, relative to reference habitats. Pelagic species were more abundant in aquaculture and reference sites that had vertical structure, but abundances of demersal and benthic species on aquaculture habitat relative to reference sites varied regionally. The availability of habitats within intertidal regions, including varying types of aquaculture, could determine community structure for marine organisms such as fish and crab.
We applied Qualitative Network Models (QNMs) to evaluate the potential community effects of ocean acidification (OA) in a major shellfish-producing estuary (Willapa Bay, Washington). QNMs are ...well-suited to data-limited systems and only require information on the sign (+, –, 0) of the interactions between species. We examined qualitative predictions of community responses to 13 different OA scenarios that corresponded to 3 broad categories of hypothesized OA effects: (1) increased primary productivity, (2) reductions in bivalve populations, and (3) enhanced predation interactions between bivalves and their crab and gastropod predators. The cultivated bivalve Manila clam tended to respond negatively across scenarios, while primary producers (phytoplankton and eelgrasses) and Chinook salmon tended to respond positively. Tradeoffs between species were also assessed: Manila clam and Pacific oyster were predicted to decrease and increase, respectively, when direct OA effects were limited to eelgrasses and the reverse occurred when phytoplankton alone was stimulated by OA. We analyzed the QNMs to identify key linkages that influenced the sign outcome of community members and might therefore warrant future quantitative study. QNMs may be particularly relevant to researchers as a simple method for identifying conditions under which the sign response of species to OA, as inferred from single-species OA experiments, will likely hold in the wild. Given data limitations in most systems, QNMs are a practical alternative or complement to data-intensive quantitative approaches and may help accelerate our understanding of the community-wide effects of OA in marine systems.
Abnormalities of the renin-angiotensin system have been reported in patients with diabetes mellitus and with diabetic complications. In this study, plasma concentrations of prorenin, renin, and ...aldosterone were measured in a stratified random sample of 110 insulin-dependent (Type 1) diabetic patients attending our outpatient clinic. Fifty-four age- and sex-matched control subjects were also examined. Plasma prorenin concentration was higher in patients without complications than in control subjects when upright (geometric mean (95% confidence intervals (CI): 75.9 (55.0-105.6) vs 45.1 (31.6-64.3) mU I-1, p < 0.05). There was no difference in plasma prorenin concentration between patients without and with microalbuminuria and between patients without and with background retinopathy. Plasma renin concentration, both when supine and upright, was similar in control subjects, in patients without complications, and in patients with varying degrees of diabetic microangiopathy. Plasma aldosterone was suppressed in patients without complications in comparison to control subjects (74 (58-95) vs 167 (140-199) ng I-1, p < 0.001) and was also suppressed in patients with microvascular disease. Plasma potassium was significantly higher in patients than in control subjects (mean +/- standard deviation: 4.10 +/- 0.36 vs 3.89 +/- 0.26 mmol I-1; p < 0.001) and plasma sodium was significantly lower (138 +/- 4 vs 140 +/- 2 mmol I-1; p < 0.001). We conclude that plasma prorenin is not a useful early marker for diabetic microvascular disease. Despite apparently normal plasma renin concentrations, plasma aldosterone is suppressed in insulin-dependent diabetic patients.
The objective of this study was to examine total exchangeable sodium, plasma-blood volume, and the status of the renin-angiotensin system in hypertensive diabetic patients with established ...nephropathy. We also evaluated hypertensive patients with diabetes who were free of clinically apparent nephropathy or other diabetic complications. Total exchangeable sodium (by 24Na dilution) was expressed as percentage predicted. Subjects were studied as inpatients receiving unrestricted sodium intake and in stable metabolic control. Total exchangeable sodium was 100 +/- 2% in controls (n = 42), higher (p less than 0.01) at 108 +/- 2% in normotensive patients with diabetes (n = 30), and higher still (p less than 0.005) in hypertensive patients with diabetic nephropathy (n = 16) 118 +/- 4% (p less than 0.05 vs normotensive diabetics). The value correlated with blood pressure only in diabetics with nephropathy (r = 0.61, p less than 0.01). Plasma renin activity, and blood and plasma volumes were similar in nephropathic diabetics and controls. Hypertensive patients with maturity-onset (type II) diabetes free of nephropathy (n = 18) were compared with nondiabetic controls (n = 16) and normotensive patients with type II diabetes (n = 18) of similar age. Total exchangeable sodium in the controls was 100 +/- 3%, higher (p less than 0.01) in normotensive diabetics at 109 +/- 2%, but not significantly elevated in hypertensive diabetics at 106 +/- 2%. Again, blood and plasma volumes did not differ among the groups. Plasma renin activity was suppressed (p less than 0.01) to a comparable degree in both normotensive and hypertensive patients with type II diabetes.
The goal of the study was to examine risk factors in the prediction of coronary heart disease (CHD) and differences in men and women in the EURODIAB Prospective Complications Study.
Baseline risk ...factors and CHD at follow-up were assessed in 2,329 type 1 diabetic patients without prior CHD. CHD was defined as physician-diagnosed myocardial infarction, angina pectoris, coronary artery bypass graft surgery, and/or Minnesota-coded ischemic electrocardiograms or fatal CHD.
There were 151 patients who developed CHD, and the 7-year incidence rate was 8.0 (per 1,000 person-years) in men and 10.2 in women. After adjustment for age and/or duration of diabetes, the following risk factors were related to CHD in men: age, GHb, waist-to-hip ratio (WHR), HDL cholesterol, smoking, albumin excretion rate (AER), and autonomic neuropathy. The following risk factors were related to CHD in women: age, systolic blood pressure (BP), fasting triglycerides, AER, and retinopathy. Multivariate standardized Cox proportional hazards models showed that age (hazard ratio 1.5), AER (1.3 in men and 1.6 in women), WHR (1.3 in men), smoking (1.5 in men), fasting triglycerides (1.3 in women) or HDL cholesterol (0.74 in women), and systolic BP (1.3 in women) were predictors of CHD.
This study supports the evidence for a strong predictive role of baseline albuminuria in the pathogenesis of CHD in type 1 diabetes. Furthermore, sex-specific risk factors such as systolic BP, fasting triglycerides (or HDL cholesterol), and WHR were found to be important in the development of CHD.
Dietary intake was assessed, using a 3-day recorded food diary, in 122 patients with insulin-dependent diabetes. Subjects were selected randomly from patients attending a diabetic clinic and ...stratified for age, sex, and duration of diabetes. The findings were compared to the dietary recommendations of the European Association for the Study of Diabetes (EASD) and to the findings in a recent Irish National Nutrition Survey. The average daily protein intake among diabetic patients was 18% of the total calories, significantly higher than recommended by EASD and significantly higher than in the age-matched general population. Dietary fat intake was on average 37% of total calorie intake, again significantly higher than recommended and greater than in the general population among older patients. Saturated fat intake was higher than recommended and polyunsaturated fat intake was low. The average carbohydrate intake was 42% of total calories, significantly lower than recommended and similar to that in the general population. Sugar intake was lower and starch intake was higher among patients than in the general population, however. Fibre intake was also lower than recommended, but was higher than in the general population. We conclude that the present dietary targets for diabetic patients are not being fully achieved.
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