Introduction. Little is known about the relationship between insulin resistance and proliferative diabetic retinopathy in type 1 diabetes. The aim of this article is to explore the relationship between sight-threatening proliferative diabetic retinopathy and insulin resistance.
Methods. This was a cross-sectional study that included 167 type 1 diabetes patients. Insulin resistance was assessed using eGDR (estimated glucose disposal rate) formula. Diabetic retinopathy was assessed by ophthalmoscopy using Early Treatment Diabetic Retinopathy classification. The association between eGDR and proliferative diabetic retinopathy was assessed in uni- and multivariate models using stepwise logistic regression of covariates. The contribution of individual predictors in the final regresion model was examined using Wald statistic.
Results. Significantly lower eGDR’s values were observed in patients with proliferative diabetic retinopathy: 5.5 vs. 7 (p = 0.002). The results remained significant (p < 0.001) after adjusting for multiple covariates (sex, diabetes duration, body mass index, HDL cholesterol, LDL cholesterol, triglycerides, smoking). eGDR variable was retained in the final model of stepwise logistic regression (p < 0.001) and showed the strongest association with proliferative diabetic retinopathy (Wald = 12.73).
Conclusions. In type 1 diabetes patients insulin resistance was the most important independent risk factor associated with diabetic proliferative retinopathy.
Olivia Georgescu, Cătălin Nica, Silvia Crăciun, Cristina Toader, Sorin Ioacără and Simona Fica
Background and aims: Cardio-Ankle Vascular Index (CAVI) was developed as an index of arterial stiffness independently of blood pressure and other markers of early atherosclerosis. The aim of the study was to assess the correlations between CAVI and renal disease in type 2 diabetic patients compared with those without diabetes. Material
and methods: We evaluated anthropometric, biochemical and vascular parameters (through CAVI) in 133 patients with and 80 without type 2 diabetes mellitus (T2DM) mean aged 59.34 ± 11.94 years. Results: We found that 52.04 % of subjects with T2DM and 22.22 % of patients without T2DM had pathological arterial stiffness. Mean CAVI value was significantly higher in T2DM (p = 0.04), positively correlated with age and negatively with glomerular filtration rate. The prevalence of chronic kidney disease in patients with pathological vascular stiffness was 5.28 times higher in T2DM compared with the control group. Conclusion: The prevalence of pathological vascular stiffness, mean CAVI and prevalence of chronic kidney disease (CKD) were also higher in patients with T2DM than in the control group. Arterial stiffness plays an important role in renal impairment both in normoglycemic subjects and patients with T2DM, so preventive measures to optimize lifestyle and treatment must target the decrease of CAVI
Olivia Georgescu, Gabriel Clătici, Cătălin Nica and Simona Fica
In patients with type 2 diabetes mellitus it might be helpful to use, for risk stratification, non-invasive techniques as markers of early atherosclerosis. Arterial stiffness shows the functional vascular properties and can be estimated by pulse wave velocity (PWV) and augmentation index (AIX). Typical for type 2 diabetes is premature arterial stiffening which appears before the onset of clinically micro or macrovascular disease and is increased in the presence of microvascular complications. Further studies are needed to determine whether therapeutic interventions for reducing vascular stiffness may decrease the cardiovascular mortality in patients with type 2 diabetes.
Letiția Elena Leuștean, Cristina Dimitriu, Simona Fica, Maria-Christina Ungureanu, Cristina Preda, Voichița Mogoș, Didona Ungureanu and Carmen Vulpoi
Background: Women with polycystic ovary syndrome (PCOS) are at high risk for the development of diabetes mellitus, hypertension and coronary heart disease. Due to the inverse correlation between serum uric acid and insulin sensitivity, the measurement of uric acid may provide a marker of insulin resistance. Objective: To establish the relationship between uric acid and markers of insulin resistance in obese and overweight women with PCOS. Methods: Serum uric acid levels were measured in 38 PCOS obese and overweight patients and 30 controls matched for age and body mass index (BMI). Anthropometric variables, plasma glucose and insulin levels were measured. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR). Results: No statistically significant differences in uric acid levels between PCOS and non-PCOS women were found. Serum uric acid levels were positively correlated with BMI, waist circumference, insulin and HOMA. Following the use of stepwise linear regression analysis, BMI was the only parameter retained by the regression model, responsible for 42.1% of the variability of serum uric acid levels. Conclusions: In PCOS women obesity seems to be the main determinant of plasma uric acid levels. Insulin and HOMA are also involved to a lesser extent, but their role remains to be clarified by further studies.