Abdominal obesity in type 1 diabetes associated with gender, cardiovascular risk factors and complications, and difficulties achieving treatment targets: a cross sectional study at a secondary care diabetes clinic

Abstract

BackgroundAbdominal obesity is linked to cardiovascular diseases in type 1 diabetes (T1D). The primary aim was to explore associations between abdominal obesity and cardiovascular complications, metabolic and inflammatory factors. The secondary aim was to explore whether achieved recommended treatment targets differed between the obese and non-obese participants.MethodsCross sectional study of 284 T1D patients (age 18–59 years, men 56%), consecutively recruited from one secondary care specialist diabetes clinic in Sweden. Anthropometrics, blood pressure, serum-lipids and high-sensitivity C-reactive protein (hs-CRP) were collected and supplemented with data from the patients’ medical records and from the Swedish National Diabetes Registry. Abdominal obesity was defined as waist circumference men/women (meters): ≥1.02/≥0.88. Hs-CRP was divided into low-, moderate-, and high-risk groups for future cardiovascular events (< 1, 1 to 3, and > 3 to ≤8.9 mg/l). Treatment targets were blood pressure ≤ 130/≤ 80, total cholesterol ≤4.5 mmol/l, LDL: ≤ 2.5 mmol/l, and HbA1c: ≤5 2 mmol/mol (≤ 6.9%). Different explanatory linear, logistic and ordinal regression models were elaborated for the associations, and calibrated and validated for goodness of fit with the data variables.ResultsThe prevalence of abdominal obesity was 49/284 (17%), men/women: 8%/29% (P < 0.001). Women (adjusted odds ratio (AOR) 6.5), cardiovascular complications (AOR 5.7), HbA1c > 70 mmol/mol (> 8.6%) (AOR 2.7), systolic blood pressure (per mm Hg) (AOR 1.05), and triglycerides (per mmol/l) (AOR 1.7), were associated with abdominal obesity. Sub analyses (n = 171), showed that abdominal obesity (AOR 5.3) and triglycerides (per mmol/l) (AOR 2.8) were associated with increasing risk levels of hs-CRP. Treatment targets were obtained for fewer patients with abdominal obesity for HbA1c (8% vs 21%, P = 0.044) and systolic blood pressure (51% vs 68%, P = 0.033). No patients with abdominal obesity reached all treatment targets compared to 8% in patients without abdominal obesity.ConclusionsSignificant associations between abdominal obesity and gender, cardiovascular disease, and the cardiovascular risk factors low-grade inflammation, systolic blood pressure, high HbA1c, and triglycerides, were found in 284 T1D patients. Fewer patients with abdominal obesity reached the treatment targets for HbA1c and systolic blood pressure compared to the non-obese.

Soluble CD163 was linked to galectin-3, diabetic retinopathy and antidepressants in type 1 diabetes

“…This study has a cross-sectional design and is one of seven baseline analyses ( 7 , 11 , 23 , 27 , 28 , 29 ) for a randomized controlled trial (ClinicalTrials.gov: Nbib1714986) where ‘Affect School with Script Analysis’ was tried against ‘Basic Body Awareness Therapy’ for persons with diabetes, inadequate glycemic control and psychological symptoms ( 30 ). Patients who attend the clinic every 6 months for regular follow-up visits were consecutively recruited by specialist diabetes physicians or diabetes nurses during a nine-month period, 03/25/2009 to 12/28/2009, from one hospital diabetes outpatient clinic.…”

“…Lipid-lowering drugs (LLD) were hydroxy-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) (C10AA). Indications for LLD were TC >4.5 mmol/L (>1.74 mg/dL) and/or LDL >2.5 mmol/L (>97 mg/dL) according to local and Swedish National Guidelines in 2009 ( 29 ).…”

“…Antihypertensive drugs (AHD) were calcium antagonists (ATC codes bib8CA01-02); angiotensin-converting enzyme inhibitors (ATC codes bib9AA-BA); angiotensin II antagonists (ATC codes bib9CA-DA); diuretics (ATC code bib3A) and/or selective beta-adrenoreceptor antagonists (ATC code bib7AB). Indications for AHD were systolic BP (SBP) >130 mmHg and/or diastolic BP (DBP) >80 mmHg according to local and the Swedish National Guidelines in 2009 ( 29 ).…”

Role of Changes in Some Adipokines with Obesity in Relation to Thyroid Function in Early Diagnosed Patients with Subclinical Hypothyroidism

“…The level of lipocalin 2 is significantly increased in obese group as compared to normal control group. Obesity is a pro-inflammatory state with elevation of multiple markers of inflammation and different cytokines [44] . This proinflammatory cytokines stimulate Lcn2 expression in the active adipocyte [45] , as well as by the activated hepatocyte [46] .…”

Higher levels of the soluble receptor for advanced glycation end products and lower levels of the extracellular newly identified receptor for advanced glycation end products were associated with lipid-lowering drugs in patients with type 1 diabetes: a comparative cross-sectional study

“…The study has a cross sectional design, and is one of several studies addressing metabolic and inflammatory disturbances in a cohort of patients with T1D [24][25][26][27][28][29][30]. For inclusion and exclusion criteria, number of included and excluded patients, and missing variables, see Fig.…”