Dislipidemia aterogénica en pacientes con diabetes mellitus tipo 1 / Atherogenic dyslipidemia in patients with type 1 diabetes mellitus

Fundamento y objetivo: Evaluar la prevalencia de alteraciones lipídicas, con especial énfasis en la dislipidemia aterogénica y su relación con las complicaciones crónicas en los pacientes con diabetes mellitus tipo 1 (DM1). Pacientes y método: Estudio transversal que incluyó a los pacientes con DM1 mayores de 18 años atendidos de forma consecutiva en la consulta externa del Hospital del Mar de Barcelona y del Hospital de Granollers durante 2008. Resultados: El 17,2 y 7,9% de los 291 pacientes incluidos tenía un colesterol unido a high density lipoproteins (HDL, «lipoproteínas de alta densidad») < 40 mg/dl (varones) o a 50 mg/dl (mujeres), y unos triglicéridos > 150 mg/dl, respectivamente. Los pacientes con hipoalfalipoproteinemia presentaron una mayor prevalencia de neuropatía periférica (28 frente a 7,1%, p < 0,001), macroalbuminuria (14 frente a 2,5%, p < 0,001) y concentraciones superiores de triglicéridos (media [DE] de 107,5 [55,8] frente a 82,7 [36] mg/dl, p < 0,0001) que aquellos con una concentración normal/alta de colesterol HDL. La hipertrigliceridemia se asoció con una mayor edad (media de 43,6 [2,11] frente a 37,6 [8,11] años, p < 0,02), una mayor prevalencia de hipertensión arterial (47,8 frente a 22,8%, p < 0,008), síndrome metabólico (82,6 frente a 22%, p < 0,001), complicaciones microangiopáticas y una menor sensibilidad a la insulina (media de 6,75 [1,2] frente a 8,54 [2,6] mg/kg−1 / min−1, p < 0,004) que aquellos con normotrigliceridemia. Conclusión: Uno de cada 5 pacientes con DM1 presenta bajas concentraciones de colesterol HDL y/o altas de triglicéridos, lo que se asocia con una prevalencia de microangiopatía 3 veces superior. Por tanto, en estos pacientes el control glucémico y de presión arterial, pero también del perfil lipídico, debe ser óptimo (AU)

Background and objective: To assess the prevalence of lipid abnormalities, with special emphasis on atherogenic dyslipidemia and its relationship with chronic complications in patients with type 1 diabetes mellitus (T1DM). Patients and method: Cross-sectional study including all patients aged 18 and over, diagnosed of T1DM attending the outpatient clinic at Hospital del Mar and Hospital de Granollers, in Barcelona, during 2008. Results: Of the 291 enrolled patients, 17.2 and 7.9% had high density lipoproteins (HDL) cholesterol < 40 mg/dL (men) or < 50 mg/dL (women) and triglycerides > 150 mg/dL, respectively. Hypoalphalipoproteinemic patients had a higher prevalence of peripheral neuropathy (28 vs. 7.1%, P < .001), macroalbuminuria (14 vs. 2.5%, P < .001) and higher concentrations of triglycerides (107.5 [55.8] vs. 82.7 [36] mg/dL, P < .0001) compared with those with normal/high HDL cholesterol levels. Hypertriglyceridemia was associated with increasing age (43.6 [11.2] vs. 37.6 [11.8] yr, P < .02), higher prevalence of hypertension (47.8 vs. 22.8%, P < .008), metabolic syndrome (82.6 vs. 22%, P < .001) and microangiopathic complications, lower insulin sensitivity (6.75 [2.1] vs. 8.54 [2.6] mg/Kg−1/min−1, P < .004) compared with the normotriglyceridemic group. Conclusion: One in 5 patients with T1DM has hypoalphalipoproteinemia or hypertriglyceridemia and these conditions are associated with 3 fold-increase microangiopathy. Thus, in these patients glycemic and blood pressure but also lipid profile control must be optimum (AU)

[Atherogenic dyslipidemia in patients with type 1 diabetes mellitus]. / Dislipidemia aterogénica en pacientes con diabetes mellitus tipo 1.

BACKGROUND AND OBJECTIVE: To assess the prevalence of lipid abnormalities, with special emphasis on atherogenic dyslipidemia and its relationship with chronic complications in patients with type 1 diabetes mellitus (T1DM). PATIENTS AND METHOD: Cross-sectional study including all patients aged 18 and over, diagnosed of T1DM attending the outpatient clinic at Hospital del Mar and Hospital de Granollers, in Barcelona, during 2008. RESULTS: Of the 291 enrolled patients, 17.2 and 7.9% had high density lipoproteins (HDL) cholesterol<40 mg/dL (men) or<50mg/dL (women) and triglycerides>150 mg/dL, respectively. Hypoalphalipoproteinemic patients had a higher prevalence of peripheral neuropathy (28 vs. 7.1%, P<.001), macroalbuminuria (14 vs. 2.5%, P<.001) and higher concentrations of triglycerides (107.5 [55.8] vs. 82.7 [36] mg/dL, P<.0001) compared with those with normal/high HDL cholesterol levels. Hypertriglyceridemia was associated with increasing age (43.6 [11.2] vs. 37.6 [11.8] yr, P<.02), higher prevalence of hypertension (47.8 vs. 22.8%, P<.008), metabolic syndrome (82.6 vs. 22%, P<.001) and microangiopathic complications, lower insulin sensitivity (6.75 [2.1] vs. 8.54 [2.6] mg/Kg(-1)/min(-1), P<.004) compared with the normotriglyceridemic group. CONCLUSION: One in 5 patients with T1DM has hypoalphalipoproteinemia or hypertriglyceridemia and these conditions are associated with 3 fold-increase microangiopathy. Thus, in these patients glycemic and blood pressure but also lipid profile control must be optimum.

Prevalencia y factores asociados con la presencia de albuminuria y sus estadios en los pacientes con diabetes mellitus tipo 1 / Prevalence and related factors with the presence of albuminuria and its stages in patients with type 1 diabetes mellitus

Antecedentes y objetivos: A pesar de los beneficios del tratamiento insulínico intensivo, la nefropatía continúa siendo un problema importante en la diabetes mellitus tipo 1 (DM1). Dada la escasez de datos en nuestro medio, hemos realizado un estudio observacional con el objetivo de analizar la prevalencia de albuminuria y sus estadios en una serie pacientes con DM1 y evaluar los factores relacionados. Pacientes y métodos: Estudio transversal que incluyó a todos los pacientes mayores de 18 años con un tiempo de evolución de la DM1 superior a 6 meses, que fueron atendidos de manera consecutiva durante el año 2008 en el Hospital del Mar de Barcelona y el Hospital de Granollers. Resultados: De los 291 pacientes analizados, 46 (20,2 %) presentaban microalbuminuria o proteinuria. Los pacientes albuminúricos presentaron, en comparación con aquellos sin enfermedad renal, mayor edad (42,0 ± 12,3 años vs. 37,1 ± 11,5 años), tiempo de evolución de la diabetes (22,5 ± 11,5 años vs. 14,1 ± 10,1 años), índice de masa corporal (26,3 ± 3,7 kg/m2 vs. 25,2 ± 3,4 kg/m2), hemoglobina glucosilada (8,15 ± 1,5 % vs. 7,59 ± 1,4 %) y de presión arterial sistólica (139,7 ± 21,7 mmHg vs. 122,2 ± 20,3 mmHg). El análisis multivariado mostró una asociación independiente de la presencia de albuminuria con la duración de la diabetes (odds ratio [OR] 1,081; intervalo de confianza [IC] del 95 % 1,038-1,126), la trigliceridemia (OR 1,011; IC del 95 %: 1,002-1,018), el tabaquismo (OR 3,279; IC del 95 %: 1,114-9,654) y la hipertensión arterial (OR 3,495; IC del 95 %: 1,074-11,368). Conclusión: En la presente serie, uno de cada cinco pacientes con DM1 tenía microalbuminuria o proteinuria, y su presencia se relacionó con el tiempo de evolución de la diabetes, la trigliceridemia, el tabaquismo y la hipertensión arterial (AU)

Background and objectives: Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major concern in type 1 diabetes mellitus (DM). Given the scarce data on this subject in our population, we performed an observational study in order to analyse the prevalence of albuminuria and its stages in a series of patients with type 1 DM and to evaluate the related factors. Patients and methods: Cross-sectional study that included all patients aged 18 and over, diagnosed of type 1 DM for at least 6 months, consecutively attended during 2008 at the Hospital del Mar de Barcelona and Hospital Granollers. Results: 291 patients were analysed and 46 (20.2%) had micro- or macroalbuminuria. Albuminuric patients, compared to those without were older (42.0±12.3 years vs. 37.1±11.5 years), had longer duration of diabetes (22.5±11.5 years vs. 14.1±10.1 years), and higher body mass index (26.3±3.7kg/m2 vs. 25.2±3.4kg/m2), glycosylated haemoglobin (8.15±1.5% vs. 7.59±1.4%) and systolic blood pressure (139.7±21.7 mmHg vs. 122.2±20.3mmHg). Multivariate analysis showed an independent association of albuminuria with diabetes duration (OR 1.081, 95% CI 1.038-1.126), triglyceride levels (OR 1.011, 95% CI: 1.002-1.018), smoking habit (OR 3.279, CI 95%: 1.114-9.654) and hypertension (OR 3.495, 95% CI: 1.074-11.368). Conclusion: In our series, one out of five patients with type 1 DM had micro- or macroalbuminuria, and its presence is associated with diabetes duration, triglyceride concentration, smoking and hypertension (AU)

Prevalence and related factors with the presence of albuminuria and its stages in patients with type 1 diabetes mellitus.

BACKGROUND AND OBJECTIVES: Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major concern in type 1 diabetes mellitus (DM). Given the scarce data on this subject in our population, we performed an observational study in order to analyse the prevalence of albuminuria and its stages in a series of patients with type 1 DM and to evaluate the related factors. PATIENTS AND METHODS: Cross-sectional study that included all patients aged 18 and over, diagnosed of type 1 DM for at least 6 months, consecutively attended during 2008 at the Hospital del Mar de Barcelona and Hospital Granollers. RESULTS: 291 patients were analysed and 46 (20.2%) had micro- or macroalbuminuria. Albuminuric patients, compared to those without were older (42.0±12.3 years vs. 37.1±11.5 years), had longer duration of diabetes (22.5±11.5 years vs. 14.1±10.1 years), and higher body mass index (26.3±3.7kg/m2 vs. 25.2±3.4kg/m2), glycosylated haemoglobin (8.15±1.5% vs. 7.59±1.4%) and systolic blood pressure (139.7±21.7 mmHg vs. 122.2±20.3mmHg). Multivariate analysis showed an independent association of albuminuria with diabetes duration (OR 1.081, 95% CI 1.038-1.126), triglyceride levels (OR 1.011, 95% CI: 1.002-1.018), smoking habit (OR 3.279, CI 95%: 1.114-9.654) and hypertension (OR 3.495, 95% CI: 1.074-11.368). CONCLUSION: In our series, one out of five patients with type 1 DM had micro- or macroalbuminuria, and its presence is associated with diabetes duration, triglyceride concentration, smoking and hypertension.

Insulin resistance and hypertension in patients with type 1 diabetes.

AIM: The aims of this study were to determine the prevalence of hypertension in type 1 diabetes patients and to analyze its relationship with insulin resistance and other associated factors. DESIGN AND METHODS: A cross-sectional study on 291 patients with type 1 immune-mediated diabetes managed at two outpatient endocrinology clinics was performed. All participants were Caucasian, 18 years or older with type 1 diabetes duration of more than 6 months, who had completed the study protocol. Hypertension was defined as blood pressure ≥130/80 mmHg or use of antihypertensive medication, excluding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers when used as treatment for micro- or macroalbuminuria. RESULTS: Hypertension was found in 87 [29.9% (95% confidence interval, or CI): 24.6%-35.2%] patients with type 1 diabetes. Hypertensive patients presented older age, male predominance, higher body mass index and overweight/obesity prevalence, and longer diabetes duration compared with normotensive patients. Insulin sensitivity quantified by estimated glucose disposal rate (eGDR) was lower in patients with hypertension compared with normotensives (5.2±1.4 vs. 9.1±1.2 mg kg(-1) min(-1), P<.001) and showed a negative correlation with systolic blood pressure level (r=-0.612, P<.01). In multivariate logistic regression analysis, eGDR, besides nephropathy, emerged significantly and independently associated with hypertension. An increment of 1 unit in insulin sensitivity assessed by eGDR was associated with a 5.7% decrease in hypertension prevalence (95% CI: 0.018-0.175) and the absence of nephropathy with an 88.2% decrease (95% CI: 0.15-0.92). CONCLUSIONS: Hypertension was present in approximately one third of patients with type 1 diabetes, especially in men, those with microangiopathy, overweight or obesity, older age and longer diabetes duration. Hypertension prevalence increased in parallel to the degree of renal impairment and was inversely related to insulin sensitivity.