the most important microvascular complications in patients with diabetes occur at the same time and that the severity of retinopathy parallels the presence and severity of nephropathy in diabetes mellitus. The aim of this study was to evaluate the prevalence of retinopathy in patients with type 1 diabetes mellitus (T1DM) and normal renal function. A total of 333 T1DM patients with normal renal function (estimated glomerular filtration rate (eGFR) >60 mLmin-11.73 m2 and normoalbuminuria) were included in the study (age 38±7 years, 160 M/173 F, body mass index 23±5 kg/m2, hemoglobin A1c (HbA1c) 7.5±1.5%, duration of diabetes 16±8 years, serum creatinine 70±12 μmol/L, eGFR 108±15 mLmin-11.73 m2, urinary albumin excretion rate 10.8 (1.7-29.8 mg/24 h). The majority of patients (60%) were without retinopathy (the majority of those with retinopathy (84%) had nonproliferative retinopathy). Patients with proliferative and nonproliferative retinopathy compared to patients without retinopathy were older, had longer duration of diabetes, had higher HbA1c, higher total cholesterol, higher LDL- cholesterol, higher resting heart rate, and lower eGFR. The results of our study suggested a high prevalence of retinopathy in T1DM with normal renal function, especially in older patients with longer duration of diabetes, higher HbA1c, total and LDL cholesterol, resting heart rate and lower eGFR.
It has been documented that markers of nonalcoholic fatty liver disease (NAFLD), γ- glutamyltransferase (GGT) and alkaline phosphatase (ALP), are associated with hypertension in patients with chronic kidney disease. The aim of this study was to explore the relationship of NAFLD markers, i.e. concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), ALP, GGT and bilirubin with blood pressure in type 1 diabetic patients with normal renal function. The study included 313 normoalbuminuric type 1 diabetic patients (estimated glomerular filtration rate (eGFR) >60 mL min-1 1.73m-2) with no medical history of liver, renal and cardiovascular diseases and before any interventions with statins, angiotensin- converting enzyme inhibitors or angiotensin II receptor blockers. GGT and ALP significantly correlated with systolic (r=0.13 and 0.12 ; p<0.05) and diastolic (r=0.11 and 0.16 ; p<0.05) blood pressure. Correlations of AST, ALT and bilirubin with systolic (r=0.06, 0.09 and 0.08) and diastolic (r=-0.05, 0.02 and 0.03) blood pressure were not statistically significant. Higher ALP and GGT can be an additional marker of hypertension in type 1 diabetic patients, indicating that these subjects are not only at a risk of hepatic disease, but also at a risk of coronary artery disease and progression of renal disease.
New insulin glargine 300 units/mL (Gla-300) is a basal insulin that provides the same number of units as Gla-100 in a third of the volume. Compared with Gla-100, Gla-300 has shown more constant and prolonged pharmacokinetic (PK)/pharmacodynamic (PD) profiles. Gla-300 has been shown to achieve similar glycemic control with less nocturnal hypoglycemia compared with Gla-100, and lower hypoglycemia at any time of day. The EDITION clinical program also provides evidence for less weight gain with Gla-300 than with Gla-100. The PK/PD profiles of Gla-300 may allow more flexibility in the timing of doses. Based on these findings, Gla-300 could be optimal treatment option for a range of people with type 1 and type 2 diabetes mellitus.
Elevated LDL-cholesterol level is a major risk factor for cardiovascular disease (CVD) and atherosclerosis. LDL-cholesterol is cleared from circulation by the LDL receptor (LDL-R). Proprotein convertase subtilisin kexin 9 (PCSK9), an enzyme secreted into the plasma by the liver, binds the LDL-R in complex which is then subject to endocytosis and degradation in lysosomes. PCSK9 inhibitors prevent LDL-R degradation, the LDL-R recycling is preserved, with a consequent increase in receptor density on the hepatocyte surface and LDL-cholesterol clearance. In recent years, human monoclonal antibodies against PCSK9 have been identified as an innovative lipidlowering strategy. Clinical trials confirmed that treatment with PCSK9 antibodies combined with statins, as well as in monotherapy produces profoundreductions in total, LDL-cholesterol and lipoprotein(a), with a similar level of safety and survival benefit compared with no anti-PCSK9 treatment. Confirmation of these findings in ongoing, long-term trials will establish the role of these novel agents in reducing the risk of CVD.
The aim of the study was to investigate the association between adiponectin (ADPN) and glucagon-like peptide 1 (GLP-1) with diabetic retinopathy (DR) and correlation of ADPN with GLP- 1 in C-peptide negative type 1 diabetic mellitus (T1DM) patients. ADPN and GLP-1 concentrations were measured by ELISA in a cross-sectional study that included 76 patients, age 45 (19-65) and disease duration 22 (1-47) years. The severity of DR was evaluated according to the EURODIAB classification. Data were statistically analyzed by SPSS with a significance level P<0.05. Patients with proliferative DR had higher ADPN (24.4±6.8 μg/mL) in comparison to nonproliferative DR patients (16.8±7.2 μg/mL) and without DR (12.3±4.7 μg/mL) adjusted for age, disease duration and renal function (P for trend 0.035). Binary logistic regression showed that ADPN remained independently associated with DR prevalence (OR 1.129, 95%CI 1.001-1.273). GLP-1 was not associated with DR or ADPN. ADPN correlated with the severity of DR in T1DM patients, whereas such relationship was not observed for GLP-1.
Nonalcoholic fatty liver disease (NAFLD), previously also named diabetes hepatitis, is characterized by accumulation of fat in the liver and refers to a spectrum of disorders ranging from simple hepatic steatosis to more severe manifestations including nonalcoholic steatohepatitis. Although the etiology is still unclear, NAFLD is strongly associated with hepatic and adipose tissue insulin resistance. Glucagon-like peptide 1 (GLP-1) receptor agonists represent a novel class of therapies for the treatment of type 2 diabetes with a potent blood glucose-lowering action mediated via its ability to induce insulin secretion and reduce glucagon secretion in a glucosedependent manner. In addition, GLP-1-based therapy has direct effects on decreasing hepatic steatosis invitro by modulating elements of the insulin signaling pathway via functional GLP-1 receptor, resulting in the regulation of gene expression associated with insulin resistance and lipid metabolism, and the suppression of oxidative stress in liver cells.
