OBJECTIVE: This study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: Adolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10-17 years, mean duration 6.9 years; mean HbA1c 8.4%, 68 mmol/mol) underwent a 10-min continuous electrocardiogram recording for heart rate variability analysis. Time-domain heart rate variability measures included baseline heart rate, SD of the R-R interval (SDNN), and root mean squared difference of successive R-R intervals (RMSSD). Spectral analysis included sympathetic (low-frequency) and parasympathetic (high-frequency) components. Standardized ACR were calculated from six early morning urine collections using an established algorithm, reflecting age, sex, and duration, and stratified into ACR tertiles, where the upper tertile reflects higher nephropathy risk. RESULTS: The upper-tertile ACR group had a faster heart rate (76 vs. 73 bpm; P < 0.01) and less heart rate variability (SDNN 68 vs. 76 ms, P = 0.02; RMSSD 63 vs. 71 ms, P = 0.04). HbA1c was 8.5% (69 mmol/mmol) in the upper tertile vs. 8.3% (67 mmol/mol) in the lower tertiles (P = 0.07). In multivariable analysis...
OBJECTIVE: The origins of cardiovascular and renal disease in type 1 diabetes begin during childhood. We aimed to evaluate carotid (cIMT) and aortic intima-media thickness (aIMT) and their relationship with cardiovascular risk factors and urinary albumin excretion in adolescents with type 1 diabetes in the Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT). RESEARCH DESIGN AND METHODS: A total of 406 adolescents with type 1 diabetes, who were 14.1 ± 1.9 years old with type 1 diabetes duration of 6.7 ± 3.7 years, and 57 age-matched control subjects provided clinical and biochemical data and ultrasound measurements of vascular structure (cIMT and aIMT). Vascular endothelial and smooth muscle function was also measured in 123 of 406 with type 1 diabetes and all control subjects. RESULTS: In type 1 diabetic subjects, mean/maximal aIMT (P < 0.006; <0.008), but not mean/maximal cIMT, was greater than in control subjects. Mean/maximal aIMT related to urinary albumin-to-creatinine ratio (multiple regression coefficient [SE], 0.013 [0.006], P = 0.03; 0.023 [0.007], P = 0.002), LDL cholesterol (0.019 [0.008], P = 0.02; 0.025 [0.011], P = 0.02), and age (0.010 [0.004], P = 0.004; 0.012 [0.005], P = 0.01), independent of other variables. Mean/maximal cIMT was greater in males (0.023 [0.006]...
Ademi, Z; Walls, Helen; Peeters, Anna; Liew, Danny; Hollingsworth, B; Stevenson, C; Steg, Ph-G; Bhatt, DL; Reid, Christopher M
Fonte: Nature Publishing GroupPublicador: Nature Publishing Group
Tipo: Artigo de Revista Científica
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Objective:The purpose of this study was to ascertain the impact of obesity on the cost of disease management in people with or at high risk of atherothrombotic disease from a governmental perspective using a bottom-up approach to cost estimation. In addit
Cho, Yoon Hi; Craig, Maria E.; Davis, Elizabeth A.; Cotterill, Andrew; Couper, Jennifer J.; Cameron, Fergus J.; Benitez-Aguirre, Paul Z.; Dalton, R. Neil
Fonte: American Diabetes AssociationPublicador: American Diabetes Association
Tipo: Article; accepted version
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This is the accepted manuscript. The final version is available at http://care.diabetesjournals.org/content/early/2015/01/01/dc14-1848.; Objective:
To examine the association between cardiac autonomic dysfunction and high albumin:creatinine ratio (ACR) in adolescents with type 1 diabetes.
Research Design and Methods:
Adolescents recruited as part of a multicentre screening study (n=445, 49% female, aged 10-17 years, mean duration 6.9 years, mean HbA1c 8.4%, 68mmol/mol) underwent a 10-minute continuous ECG-recording for heart rate variability analysis. Time domain heart rate variability measures included: baseline heart rate, SDNN (standard deviation of the R-R interval), RMSSD (root mean squared difference of successive RR intervals); and spectral analysis included: sympathetic (low frequency) and parasympathetic (high frequency) components. Standardised ACR were calculated from 6 early morning urine collections using an established algorithm, reflecting age, gender and duration, and stratified into ACR tertiles where the upper tertile reflects higher nephropathy risk.
The upper tertile ACR group had faster heart rate (76 vs 73bpm; p<0.01) and less heart rate variability (SDNN 68 vs 76ms, p=0.02; RMSSD 63 vs 71ms...
Adolescent type 1 Diabetes cardio-renal Intervention Trial Research Group
Fonte: Universidade de CambridgePublicador: Universidade de Cambridge
Tipo: Article; Published Version
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RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.; Abstract Background The prognosis for young people diagnosed with diabetes during childhood remains poor and this is mainly related to the long-term risk of developing vascular complications. Microalbuminuria identifies subjects at risk for diabetic nephropathy (DN) and cardiovascular disease (CVD). It is often detected in adolescence but is rarely treated before the age of 18 years, as at the end of puberty albumin excretion may decline and in some subjects will return into the normal range. However, evidence indicates that subjects with both transient and persistent microalbuminuria have experienced renal damage during puberty and thus reno-protection to prevent long-term complications is warranted. In adults with diabetes and microalbuminuria, the use of angiotensin converting enzyme inhibitors (ACEI) and Statins is increasing...