Background and Aims. In diabetic patients, chronic kidney disease (CKD) requires special attention due to the multitude of factors that determine glycemic variability. We aimed to assess glycemic variability in patients with CKD and type 2 diabetes mellitus (T2DM) using a continuous glucose monitoring system (CGMS) and identify the predictive value of inter-day and intra-day glycemic variability indices for metabolic imbalance. Material and method. We included 20 diabetic patients (10 CKD patients/10 patients without CKD) and 10 healthy volunteers. Anthropometric parameters, glycated hemoglobin (HbA1c), and glycemic variability indices on CGMS readings were registered. Results. CKD diabetic patients presented significantly higher inter-day and intra-day glycemic variability compared to the diabetic patients without CKD. HbA1c was not significantly different between diabetic subjects with/without CKD. ROC curves indicated that just some CGMS parameters had higher predictive value for metabolic imbalance (HbA1c≥6.5%) but only the percentage of time with glucose values>180 mg/dl (p=0.024) was an independent predictor for HbA1c≥6.5%. Conclusions. Subjects with CKD and T2DM had poor glycemic control and significantly higher glycemic variability comparative to those without CKD, and especially to healthy volunteers. Assessment of glycemic variability indices is more accurate than HbA1c for the quantification of glycemic control in CKD diabetic patients
Background and Aims. Peritoneal dialysis (PD) is accompanied by a multitude of factors that influence glycemic variability, and HbA1c does not detect dynamic glucose changes. In this study we wanted to assess glycemic variability, using a 72-hour continuous glucose monitoring system (CGMS), in 31 patients stratified according to the presence of type 2 diabetes and PD. Materials and Methods. The study included 31 patients (11 type 2 diabetic PD patients, 9 non diabetic PD patients and 11 type 2 diabetic patients without PD). Glycemic variability was assessed on CGM readings by: Mean Amplitude of Glycemic Excursion (MAGE), Mean of Daily Differences (MODD), Fractal Dimensions (FD), Mean Interstitial Glucose (MIG), Area Under glycemia Curve (AUC), M100, % time with glucose >180/<70 mg/dl. Results. The PD diabetic patients presented AUC, MIG and inter-day glycemic variability (MODD) significantly higher than diabetic patients without PD. In PD patients, the type of dialysis fluid in the nocturnal exchange and peritoneal membrane status did not significantly influence glycemic variability. Conclusions. CGMS is more useful than HbA1c in quantifying the metabolic imbalance of PD patients. PD induces inter-day glycemic variability and poor glycemic control, thus being a potential risk factor for chronic complications progression in diabetic patients.
Accurate measurement of blood pressure (BP) and evaluation of global cardiovascular risk is crucial for diagnosis and treatment of hypertensive patients. When hypertension and diabetes mellitus are associated, the risk for cardiovascular events is bigger than the sum of the components. Beyond systolic and diastolic BP values as targets for antihypertensive treatment, recent guidelines recognize BP variability as an independent predictor for future cardiovascular events. 24 hours ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are two methods used in patient day to day life conditions for BP measurements. Increased variability of systolic and/or diastolic BP within one day (“short-term BP variability”) and also over longer periods (“long-term BP variability”) showed by ABPM and/or HBPM is associated with target-organ damage and cardiovascular events. This review is focused on the prognostic importance of BP variability in hypertensive patients with diabetes mellitus.
Diabetes mellitus represents a major public health problem in the world and glycemic control is very important in subjects with diabetes. Glycation of many proteins is increased in subjects with diabetes compared with persons without diabetes. Glycated albumin (GA) has emerged as a possible glycation index for intermediate-term diabetes control. There is evidence that GA can be considered a better parameter than glycated haemoglobin in many conditions including pregnancy, chronic kidney disease, liver diseases and anemia. Several reports indicate that GA plays a role in the pathogeny of diabetes complications, mainly in diabetic nephropathy and retinopathy. There are several limitations for using GA including the lack of standardization in the laboratories. Several studies are needed in order to understand the place of GA in the pathogeny of diabetes complications and the role in assessing the metabolic control
Background and aims. Hypertension and dyslipidemia (DLP) increase the risk of cardiovascular diseases (CVD), especially in patients with chronic kidney disease (CKD). A non dipping pattern is very common in CKD. The aim of the study was to determine whether there is a difference between dipping/non dipping hypertension in subjects with CKD and DLP with or without lipid-lowering therapy (LLT). Material and methods. We performed a retrospective study that included 129 subjects from the Nephrology- Hypertension Out-patient Department of the University Campus Bio-Medico, Rome from January 2011 to April 2013. Results. From a total of 129 CKD subjects, 73 (56.59%) subjects had a non dipping pattern and 56 (43.41%) had a dipper pattern. We found statistically significant differences between the dipping and non-dipping pattern in subjects with CKD stages 1-2 versus stages 3-4 (p=0.018). When we analyzed the association between non-dipping status with DLP and type 2 diabetes (T2D), we did not find a statistically significant result. Conclusions. Only CKD significantly influenced the dipping/non dipping pattern in the study group
Insulin resistance (IR) is a fundamental disorder of type 2 Diabetes Mellitus (DM), but it is also involved in the etiopathogenesis of type 1 DM, with important implications in the onset and progression of micro- and macrovascular complications in type 1 DM. Overweight plays the main role in the increased incidence of both types of DM, exacerbating IR. The epidemic increase of overweight and obesity makes it difficult to diagnose the exact phenotype of DM, as IR and autoimmunity often coexist. Many studies showed an increase in incidence of micro- and macrovascular complications in patients with type 1 DM with IR, compared to patients with type 1 DM without IR. The gold standard of IR evaluation is represented by the method of euglycemic-hyperinsulinemic clamp, applied on a reduced scale in research. Thus, it is necessary to identify early IR markers (clinical or biological markers), less laboured ones, that could be used on a large scale in current medical practice, for the IR determination in type 1 DM. Clinicians and health experts should prevent/ reduce the epidemic of overweight and obesity in young people, thus decreasing IR, and implicitly the chronic complications of DM.
Background and Aims: Studies have shown an increased incidence of chronic complications in people with type 1 diabetes mellitus (T1DM) with insulin resistance (IR) compared to people with T1DM without IR. Estimated glucose disposal rate (eGDR) is an important indicator of IR in patients with T1DM, lower eGDR levels indicating greater IR. It was shown that T1DM patients with chronic complications (diabetic retinopathy - DR, diabetic peripheral neuropathy - DPN or diabetic kidney disease - DKD) exhibit higher IR compared to patients without chronic complications. The aim of our study was to evaluate eGDR as a marker for the assessment of IR in T1DM patients.
Materials and Methods: The study was observational, cross-sectional and included 140 T1DM patients with diabetes duration>10 years. The collected data were analyzed using the Statistic Package for Social Sciences (SPSS) version 22 software (IBM Corporation, Armonk, NY, USA).
Results: eGDR presented statistically significant correlations (p<0.05) with the presence of metabolic syndrome (MS), obesity, chronic complications of T1DM, cardiovascular risk (CVR) and smoking status in patients with T1DM duration >10 years.
Conclusions: eGDR represents a reliable marker for assessing the IR in T1DM.
Background and aims. Dyslipidemia (DLP) is a common complication of chronic kidney disease (CKD) and may accelerate its progression. Circulating lipoproteins and their constituent proteins, apolipoproteins, are risk factors for CKD and cardiovascular diseases (CVD). The aim of the study was to determine whether there is a correlation between apolipoproteins and estimated glomerular filtration rate (eGFR) or between apolipoproteins and anthropometrical and laboratory parameters or between evaluated cardiovascular risk (CV) and dyslipidemia/CKD. Material and methods. We performed a study on 51 subjects from the Nephrology Department of Emergency Clinical County Hospital of Craiova, from November 2011 to July 2013. Results. We found statistically significant correlations between eGFR and Apo A1. Also we found a linear correlation between C-reactive protein (CRP) and Apo B. When we evaluated the CV risk using CRP, we found statistically significant differences between the groups (CKD and DLP, only CKD, only DLP and control group), patients with CKD and DLP showing the highest levels of CRP. Conclusions. Elevated levels of Apo A1 are associated with a low rate of CKD. DLP and chronic inflammation play an important role in the progression of CKD. Patients with CKD and DLP had a high cardiovascular risk.
Chronic Kidney Disease-Mineral Bone Disorder in Diabetes Mellitus Patients
Diabetes mellitus (DM) and chronic kidney disease (CKD) are two diseases with increasing prevalence and adverse outcomes that represent an international health problem. Chronic kidney disease- mineral and bone disorder (CKD-MBD) is defined as a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism; abnormalities in bone turnover, mineralization, volume, linear growth, or strength and vascular or other soft-tissue calcification. Disturbances in mineral and bone metabolism are prevalent in CKD and are an important cause of decreased quality of life, cardiovascular morbidity and mortality; these disturbances settle in earlier and have a more severe evolution in DM patients.
Cardiac failure (CHF), renal disease and anemia are interconnected in the Cardio-Renal Anemia syndrome. Diabetes mellitus remains the most common cause of endstagerenal disease (ESRD) in the developed world and when it is associated withthese three conditions it worsens the outcomes of these patients. Aim:to evaluaterenal anemia and cardiac dysfunction in patients with chronic kidney disease withand without diabetes mellitus (DM). Materials and methods - we assessed 100patients (40 women and 60 men), 41 patients with DM and 59 patients without DM.All patients had Chronic Kidney Disease (CKD) - estimated glomerular filtrationrate (eGFR) under 60 ml/min/1,73 mp. We considered anemia when the value ofhaemoglobin (Hb) was under 11 g/dl. Results - Mean age of the studied patients was60.38±11.79 years old in women and 59.28±13.89 years old in men. The prevalenceof anemia was high in diabetic and non-diabetic patients, too. Anemia was moresevere in patients with cardiac dysfunction than in those with normal cardiacfunction. The higher prevalence of cardiac dysfunction was in patients which hadboth anemia and DM. There were no significant differences about prevalence ofdiastolic or systolic cardiac dysfunction in non-diabetic versus diabetic patients.Conclusions - Anemia was an independent predictor for the development of cardiacdysfunction in patients with CKD and the prevalence of cardiac dysfunction washigher in patients who had both anemia and DM than in those without anemia andDM.