Context Despite a high prevalence of hypertension in diabetes and close relationship between primary aldosteronism (PA) and glucose metabolism, few study concerns the prevalence of PA in diabetes with hypertension. Objective This study aimed to detect the prevalence of PA in patients with new-onset type 2 diabetes (T2D) and hypertension and to explore the association between PA and diabetes. Methods A total of 256 outpatients with new-onset T2D and hypertension were screened for PA. Plasma aldosterone concentration (PAC), plasma renin activity (PRA) were measured. Patients with an aldosterone renin activity ratio (ARR) ≥ 30 ng/dL/ng/mL/h and PAC ≥ 15 ng/dL underwent confirmatory captopril challenge test (CCT) for PA. The diagnostic criteria for PA were, after CCT, (1) PAC decreased < 30%, (2) ARR maintained ≥ 30 ng/dL/ng/mL/h, and (3) PAC was ≥ 11 ng/dL. Results Of 256 consecutive patients, 99 (39%) were positive for the screening test, and 49 (19%) were diagnosed with PA. Compared with those in groups A (screening test −) and B (screening test +, CCT −), patients in group C (diagnosed with PA) had a higher percentage of systolic blood pressure of ≥ 160 mmHg, less family history of hypertension, and lower serum potassium. Patients in group B and C had higher PAC and ARR levels, but lower PRA than those in group A. Homeostatic model assessment for insulin resistance (HOMA-IR) was positively associated with PAC level among the diabetic patients. Conclusion The prevalence of PA in new-onset T2D patients with hypertension is at least 19%. Higher aldosterone may be related with insulin resistance in patients with diabetes.
Disease modifying therapies aiming to preserve β-cell function in patients with adult-onset autoimmune type 1 diabetes are lacking. Here, we conducted a multi-centre, randomized, controlled trial to assess the β-cell preservation effects of saxagliptin alone and saxagliptin combined with vitamin D as adjunctive therapies in adult-onset autoimmune type 1 diabetes. In this 3-arm trial, 301 participants were randomly assigned to a 24-month course of the conventional therapy (metformin with or without insulin) or adjunctive saxagliptin or adjunctive saxagliptin plus vitamin D to the conventional therapy. The primary endpoint was the change from baseline to 24 months in the fasting C-peptide. The secondary endpoints included the area under the concentration-time curve (AUC) for C-peptide level in a 2-h mixed-meal tolerance test, glycemic control, total daily insulin use and safety, respectively. The primary endpoint was not achieved in saxagliptin plus vitamin D group (P = 0.18) and saxagliptin group (P = 0.26). However, compared with the conventional therapy, 2-h C-peptide AUC from 24 months to baseline decreased less with saxagliptin plus vitamin D (-276 pmol/L vs. -419 pmol/L; P = 0.01), and not to the same degree with saxagliptin alone (-314 pmol/L; P = 0.14). Notably, for participants with higher glutamic acid decarboxylase antibody (GADA) levels, the decline of β-cell function was much lower in saxagliptin plus vitamin D group than in the conventional therapy group (P = 0.001). Insulin dose was significantly reduced in both active treatment groups than in the conventional therapy group despite all groups having similar glycemic control. In conclusion, the combination of saxagliptin and vitamin D preserves pancreatic β-cell function in adult-onset autoimmune type 1 diabetes, an effect especially efficacious in individuals with higher GADA levels. Our results provide evidence for a novel adjunct to insulin and metformin as potential initial treatment for adult-onset type 1 diabetes. (ClinicalTrials.gov identifier: NCT02407899).
Objective To assess bone mineral density (BMD) and associated clinical factors in patients with type 1 diabetes (T1D), latent autoimmune diabetes in adults (LADA), and type 2 diabetes (T2D) and in non‐diabetic subjects. Methods Total 108 age‐, sex‐, disease duration‐, and postmenopausal ratio‐matched patients with T1D, LADA, and T2D each and 216 age‐, sex‐, and postmenopausal ratio‐matched non‐diabetic controls. Anthropometric, biochemical, and BMD data were collected and analysed. Results BMD of total hip and lumbar spine of individuals in the LADA group was lower than those in the T2D and control groups but higher than those in the T1D group. After adjusting for body mass index (BMI), a significant difference in BMD in the lumbar spine was seen between groups. After adjustment for smoking, BMI, 25‐(OH) vitamin D, calcium, haemoglobin A1c, and diabetic complication scores, BMD values of patients in LADA group were not significantly different from those of patients in T1D and T2D groups. Multiple stepwise regression analysis showed that BMD was (a) positively associated with weight and C‐peptide, and negatively associated with age in patients with diabetes, (b) positively associated with C‐peptide in the T1D and LADA groups. The proportion of patients with osteoporosis in the T1D, LADA, T2D, and control groups was 55.6%, 45.4%, 34.3%, and 26.9%, respectively. Conclusions BMD values in T1D, LADA, and T2D were in an increasing order of mention. Patients with autoimmune diabetes were more susceptible to osteoporosis. A lower C‐peptide level may be responsible for decreased BMD in individuals with autoimmune diabetes.
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