Does autoimmune hypothyroidism increase the risk of neurovascular complications in type 1 diabetes?

BACKGROUND: Type 1 diabetes (T1DM) often coexists with other autoimmune diseases, most commonly with hypothyroidism. To date, the influence of coexisting autoimmune hypothyroidism (AHT) on the course of chronic neurovascular complications of autoimmune diabetes has not been established. The aim of the study was to assess the relationship between AHT and the occurrence of chronic T1DM complications. METHODS: The study group comprised 332 European Caucasian participants with T1DM [165 (49.7%) men]. AHT was recognized in subclinical and overt hypothyroidism and confirmed by the presence of anti-thyroid autoantibodies: anti-peroxidase (ATPO) and/or anti-thyroglobulin (ATg) and ultrasonography (hypoechogenicity, parenchymal heterogeneity, lymph nodes assessment). RESULTS: In the analyzed group, 48.5% of patients were diagnosed with at least one neurovascular complication. At the time of enrollment, 16.3% of participants were diagnosed with AHT. Patients with AHT, compared to those without AHT, were characterized by a higher prevalence of neurovascular complications (64.8 vs. 45.3%; P = 0.009) and retinopathy (55.6 vs. 38.9%; P = 0.02). There were significant differences between groups with and without neurovascular complications, with regard to classic risk factors for chronic diabetes complications: age, T1DM duration, SBP, DBP, HbA1c, TG, eGFR and hypertension prevalence. In the multivariate logistic regression analysis, AHT was an independent predictor of neurovascular complications after adjusting for age, DBP, HbA1c and TG (odds ratio, 2.40; 95% confidence interval, 1.17-4.92; P = 0.02). CONCLUSIONS: AHT coexisting with T1DM was associated with a higher incidence of neurovascular complications.

Does glucagon stimulation test help to predict autoimmunity in newly diagnosed non obese adults with diabetes?

Classification of diabetes type in adults patients remains difficult. This study was undertaken to determine the relationship between presence of autoantibodies in the serum and the result of glucagon stimulation test in non obese patients at aged above 35 years with newly diagnosed diabetes.Study involved 52 non obese adults aged 42 years [interquartile range (IQR): 37-46], with body mass index (BMI) 23.7 kg/m2 (IQR: 21.4-26.2). Presence of autoantibodies to islet cells (ICA), antibodies to tyrosine phosphatase (IA-2), glutamic acid decarboxylase autoantibodies (anti-GAD) and plasma fasting and stimulating (6 min after intravenous injection of 1 mg glucagon) C-peptide level was assessed.73.1% subjects had at least 1 of 3 assessed autoantibodies, 26.9% patients were autoantibodies negative. According to serum C-peptide concentration after stimulation test with glucagon patients were divided into 2 groups. Receiver Operating Characteristic (ROC) Curve for determination of an optimal cut-point (C-peptide stimulation above and below 1.6) was used. In patients with negative stimulation test higher prevalence of 2 (33.3% vs. 66.7%; p=0.04) or 3 (12.5% vs. 87.5%, p=0.01) positive autoantibodies was noticed in comparison to patients with positive stimulation test. Multivariate logistic regression showed that presence of autoantibodies was independently associated with stimulated C-peptide level (OR 2.3; 95%CI: 1.07-5.28, p=0.03).Autoimmune diabetes should be suspected in subjects with lower response of ß- cell in glucagon stimulation test. If the C-peptide do not increase more than 1.6 after glucagon presence of autoanibodies is more probable.

Carotid intima-media thickness and arterial stiffness in type 1 diabetic patients are dependent on age and mean blood pressure.

AIM: The aim of the study was to assess the factors that influence carotid intima-media thickness (CIMT) and arterial stiffness in type 1 diabetic patients. MATERIAL AND METHODS: We included 87 type 1 diabetic patients (44 women, 43 men), median age 34 years, disease duration 10 years, HbA1c 8.2%. CIMT was measured using high resolution ultrasonography. Arterial stiffness was assessed with the use of digital volume pulse analysis and tonometric measurement of wave reflection and central haemodynamics. Serum C-reactive protein (hsCRP), matrix metalloproteinase-9 (MMP-9), soluble intracellular adhesion molecule-1 (sICAM-1) and myeloperoxidase (MPO) concentrations were also measured. RESULTS: CIMT and arterial stiffness correlated with age, duration of diabetes, systolic and diastolic blood pressure, GFR-glomerular filtration rate and sICAM-1. Multiple regression analysis identified only age as significant determinant of CIMT. Age, mean blood pressure and GFR, but not duration of diabetes were significant determinants of arterial stiffness. CONCLUSIONS: In type 1 diabetic patients both CIMT and arterial stiffness were related to age, blood pressure, kidney function and sICAM-1 serum concentration.