Serum lipids and glucose control. The SEARCH for Diabetes in Youth Study

ArticleinArchives of Pediatrics and Adolescent Medicine 161(2):159-65 · February 2007with10 Reads
Impact Factor: 5.73 · DOI: 10.1001/archpedi.161.2.159 · Source: PubMed
Abstract

To assess the relationship of serum lipid concentrations with glucose control in youth with diabetes mellitus. Cross-sectional analyses of data from the SEARCH for Diabetes in Youth study. Multicenter study of youth with diabetes onset at younger than 20 years. PATIENTS/ PARTICIPANTS: Nineteen hundred seventy-three SEARCH participants aged 10 years or older with hemoglobin A(1c) and fasting total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride measured at the SEARCH study examination. Hemoglobin A(1c). Lipid concentrations. There were significant trends of higher levels of TC, LDL-C, triglyceride, and non-HDL-C (but not HDL-C) with higher hemoglobin A(1c) concentrations for both diabetes types. The slopes of TC increase were 7.8 mg/dL (0.20 mmol/L) per unit increase in hemoglobin A(1c) for type 1 and 8.1 mg/dL (0.21 mmol/L) for type 2. Levels of TC, LDL-C, triglyceride, and non-HDL-C were all significantly higher (all P values <.001) in type 2 than in type 1 diabetes (mean differences in milligrams per deciliter [millimoles per liter], +13.6 [+0.35] for TC; +8.3 [+0.22] for LDL-C; +66.3 [+0.75] for triglyceride; +25.5 [+0.66] for non-HDL-C). Levels of HDL-C were lower in youth with type 2 diabetes (mean difference, -11.9 mg/dL [-0.31 mmol/L]). Among those with type 1 diabetes in poor glycemic control, 35%, 27%, and 12% had high concentrations of TC (>or=200 mg/dL [5.17 mmol/L]), LDL-C (>or=130 mg/dL [3.36 mmol/L]), and triglyceride (>or=200 mg/dL [2.26 mmol/L]), respectively. In youth with type 2 diabetes in poor glycemic control, percentages with high levels of TC, LDL-C, and triglycerides were 65%, 43%, and 40%, respectively. Glycemic control and lipid levels are independently associated in youth with both type 1 and type 2 diabetes.

    • "As has been observed by others (Park et al. 1998; Forbes et al. 2004; Lassila et al. 2004), we found that induction of diabetes in Apoe À/À mice with STZ resulted in an approximately two-fold increase in apolipoprotein B-associated plasma cholesterol. In human type 1 diabetic subjects, poor glycemic control is also associated with increased total and LDL cholesterol levels (The DCCT Research Group 1992; Petitti et al. et al. 2009) although this is not as exaggerated as that which is seen in the diabetic Apoe À/À mice. The hypercholesterolemia that occurs in the Apoe À/À mice following STZ administration has been considered a shortcoming in this mouse model of human diabetic cardiovascular disease (Renard and Van Obberghen 2006; Hsueh et al. 2007; Kanter et al. 2007; Ramasamy and Goldberg 2010 ) and, in our case, may mask any macrovascular protective effects that are due to reducing dicarbonyl stress through overexpression of GLO1. "
    [Show abstract] [Hide abstract] ABSTRACT: The reactive dicarbonyls, glyoxal and methylglyoxal (MG), increase in diabetes and may participate in the development of diabetic complications. Glyoxal and MG are detoxified by the sequential activities of glyoxalase 1 (GLO1) and glyoxalase 2. To determine the contribution of these dicarbonyls to the etiology of complications, we have genetically manipulated GLO1 levels in apolipoprotein E-null (Apoe(-/-)) mice. Male Apoe(-/-) mice, hemizygous for a human GLO1 transgene (GLO1TGApoe(-/-) mice) or male nontransgenic Apoe(-/-) litter mates were injected with streptozotocin or vehicle and 6 or 20 weeks later, aortic atherosclerosis was quantified. The GLO1 transgene lessened streptozotocin (STZ)-induced increases in immunoreactive hydroimidazolone (MG-H1). Compared to nondiabetic mice, STZ-treated GLO1TGApoe(-/-) and Apoe(-/-) mice had increased serum cholesterol and triglycerides and increased atherosclerosis at both times after diabetes induction. While the increased GLO1 activity in the GLO1TGApoe(-/-) mice failed to protect against diabetic atherosclerosis, it lessened glomerular mesangial expansion, prevented albuminuria and lowered renal levels of dicarbonyls and protein glycation adducts. Aortic atherosclerosis was also quantified in 22-week-old, male normoglycemic Glo1 knockdown mice on an Apoe(-/-) background (Glo1KDApoe(-/-) mice), an age at which Glo1KD mice exhibit albuminuria and renal pathology similar to that of diabetic mice. In spite of ~75% decrease in GLO1 activity and increased aortic MG-H1, the Glo1KDApoe(-/-) mice did not show increased atherosclerosis compared to age-matched Apoe(-/-) mice. Thus, manipulation of GLO1 activity does not affect the development of early aortic atherosclerosis in Apoe(-/-) mice but can dictate the onset of kidney disease independently of blood glucose levels.
    Full-text · Article · Jun 2014
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    • "Patients with raised serum TG than the upper limit of normal were two times more liable to be uncontrolled than patients with lower levels (aOR, 2.2; P = 0.020). Pettiti et al.[33] found significant association between poor glycemic control and higher concentrations of TC, LDL-C, and TG even in children and youth aged, 10 to 22 years, in all major ethnic/racial groups in the United States. Poor glycemic control and increased serum lipids are risk factors for micro-and macro-vascular complication of T1DM. "
    [Show abstract] [Hide abstract] ABSTRACT: Type 1 diabetes mellitus (T1DM) may lead to severe long-term health consequences, such as renal failure, blindness, as well as heart and cerebrovascular disease. Although a direct relationship between blood glucose control and diabetes complications remains to be established beyond doubt, most diabetologists aim to achieve the best possible glucose control in their patients with T1DM. The aim of this study was to detect the predictors of glycemic control among children with T1DM in Assiut Governorate-Egypt. We enrolled 415 children aged 2 to 18 years with type 1 diabetes of >1-year duration. They were subjected to full history including demographic factors and disease-related factors. Examination was done with determination of the body mass index, and assessment of stage of maturity. Investigations included hemoglobin A1c (HbA1c) and lipid profile. Patients with HbA1c above the recommended values for age by the American Diabetes Association were considered as poor glycemic control group. Of the studied cases, 190 cases (45.8%) were of poor glycemic control. Patients with poor control had significantly higher mean age (16.83 ± 3.3 vs 9.77 ± 3.7, P<0.000). Girls aged 15 years or more had significantly higher prevalence of poor glycemic control than males of the same age group. As regard the disease-related factors, patients with poor control had significantly longer duration of disease (7.94 ± 2.6 vs 2.40 ± 2.0, P<0.000) and were older in age at onset of disease. Insulin regimen which consists of basal bolus insulin plus three injections of regular insulin was associated with more frequency of good glycemic control than other regimens. Patients with poor control had significantly higher mean of cholesterol, triglyceride (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol than patients with good control. Adjusting for other variables, age of the patients, duration of disease, and serum TG level were significant independent risk factors of poor glycemic control. This study concluded that children more than 15 years, duration of disease more than 5 years, and high serum TG level are the predictors of poor glycemic control of children with T1DM in Assiut - Egypt. Pediatricians need to be aware of factors associated with poor glycemic control in children with T1DM, so that more effective measures can be implemented to prevent deterioration in diabetes control .
    No preview · Article · Sep 2012
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    • "These metabolic perturbations result in depressed ATP production, generation of oxygen free radicals, increased myocardial oxygen consumption, and myocardial contractile dysfunction. It is not surprising that additional myocardial damage results in heart failure out of proportion to infarct size in patients with diabetes [7]. Hemoglobin A1c (HbA1c), also known as glycosylated hemoglobin, is a measure of the average sugar level in the blood over an extended period of time. "
    [Show abstract] [Hide abstract] ABSTRACT: Type 2 diabetes is associated with multiple abnormalities, all of which can contribute to vascular disease. The most notable of these abnormalities include obesity, insulin resistance, hyperglycemia, dyslipidemia, hypertension, and renal disease. Although a number of these disorders are often grouped together in an entity termed "metabolic syndrome,” the increased risk for atherosclerotic disease in insulin-resistant patients correlates best with these abnormalities when each is considered individually. These abnormalities promote heart disease by inducing atherosclerosis, endothelial cell dysfunction, oxidative stress, inflammation, and vascular remodeling. This review article is focused on the prevalence of diabetes mellitus in patients with acute myocardial infarction and to determine whether cardiac markers along with routine biochemical markers measured at admission could be used to diagnose the interrelation between Myocardial infarction and diabetes mellitus.
    Full-text · Article · Jan 2011
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