Dose-Dependent association of cumulative tobacco consumption with the presence of carotid atherosclerosis in individuals with type 1 diabetes.

AIMS: Evaluate the association between cumulative tobacco consumption (CTC; packs-year) and atherosclerosis in type 1 diabetes (T1D), and study whether the inclusion of CTC in the Steno T1 Risk Engine (ST1RE) equation improves the identification of plaques. METHODS: Cross-sectional study in T1D patients without cardiovascular disease (CVD), with ≥ 1 of the following: ≥40 years-old, diabetic kidney disease, and/or T1D duration ≥ 10 years + cardiovascular risk factors.Preclinical atherosclerosis was evaluated by carotid ultrasonography. RESULTS: N = 584 patients were included (46.1 % women, age 48.7 ± 10.5 years, T1D duration 27.3 ± 10.8 years, 26.2 % active smokers). The overall plaque prevalence was 40.9 %. In models adjusted for age, sex, lipids, blood pressure, kidney function, statin use, microvascular complications and HbA1c, CTC was dose-dependently associated with the number of plaques (none, 1-2, ≥3) overall and in both active and former smokers (p < 0.001). This association remained after adjusting for ST1RE (OR 1.11 [1.02-1.19]). Although the inclusion of CTC in the ST1RE did not improve plaque identification overall (p = 0.180), it did so when analyzing active smokers separately (AUC 0.738 vs. 0.768; p < 0.01). CONCLUSIONS: In T1D patients, CTC is dose-dependently associated with atherosclerosis. Further prospective studies are needed to determine if CTC could identify T1D individuals more prone to accelerated atherosclerosis.

¿Por qué debemos preocuparnos de diagnosticar una diabetes monogénica? / Why should we be concerned about diagnosing a monogenic form of diabetes?

Se estima que las alteraciones monogénicas son una causa infrecuente (en torno al 1%) de diabetes. La mayoría de los casos están clínicamente mal etiquetados como diabetes mellitus tipo 1 o tipo 2. Aunque constituyen un grupo muy heterogéneo, sus formas más frecuentes, como la diabetes neonatal o las denominadas MODY (Maturity Onset Diabetes of the Young), comparten como características comunes la ausencia de signos de autoinmunidad e insulinorresistencia y la persistencia de una secreción de insulina con el paso del tiempo. Entre las razones que explican su baja tasa de diagnóstico podemos encontrar una escasa sensibilización de los profesionales sanitarios sobre la relevancia de su diagnóstico y la necesidad de que este se realice en unidades específicas de genética. En los últimos años se está produciendo un avance significativo en la descripción de nuevas formas clínicas y la validación de marcadores séricos que facilitan su diagnóstico

Monogenic forms represent a rare form (about 1%) of diabetes. Most cases are clinically mislabeled as type 1 or type 2 diabetes mellitus. Although they constitute a very heterogeneous group, their most common forms, such as neonatal diabetes or those called MODY (Maturity Onset Diabetes of the Young) share common characteristics as the absence of signs of autoimmunity or insulin resistance and the persistence of insulin secretion in over time. Reasons for the low rate of diagnosis may be a low awareness about the importance of diagnosis by health professionals and the need to perform tests in specific genetic units. In recent years there has been significant progress in the description of new forms and validation of clinical serum markers that facilitate their diagnosis

Réplica a «Te recuerdo Amanda (y Antonio J.)» / Reply to «I remember you Amanda (and Antonio J.)»

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¿Por qué volvería o por qué no volvería a elegir formarme como especialista en Endocrinología y Nutrición? / Why should I choose or not choose to be trained as a specialist in Endocrinology and Nutrition again?

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