Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications

Dost, Axel; Pozza, Susanne Bechtold‐Dalla; Bollow, Esther; Kovacic, Rosemary; Vogel, Paul A.; Feldhahn, Lutz; Schwab, Karl Otfried; Holl, Reinhard W.; Dpv, Initiative

doi:10.1111/pedi.12502

Cited by 29 publications

(30 citation statements)

References 37 publications

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“…Statistically significant and clinical important explanatory variables were included in multivariate analysis models. Covariates examined were HbA1c, diabetes duration, and BMI, which are routinely available and widely accepted to influence the clinical outcome of diabetes …”

Section: Methodsmentioning

confidence: 75%

Associations between circulating inflammatory markers, diabetes type and complications in youth

et al. 2019

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Background Inflammation is implicated in the pathogenesis of diabetes and its complications in adults. Little is known about the relative contribution of inflammation in common types of diabetes in youth: type 1 diabetes (T1D), type 2 diabetes (T2D), and cystic fibrosis‐related diabetes (CFRD). This study investigates inflammatory markers by diabetes type and complication status, and assesses indicators of inflammation and complications. Methods A cross‐sectional study of 134 T1D, 32 T2D, 32 CFRD and 48 subjects without diabetes (including 11 with CF and normal glucose tolerance) was undertaken. Inflammation was assessed by sE‐selectin by ELISA, hsCRP by turbidimetry, WCC and ESR. Nephropathy was defined by albuminuria, autonomic neuropathy by heart rate variability, and peripheral neuropathy by vibration and thermal threshold testing and retinopathy by seven‐field stereoscopic fundus photography. Descriptive statistics, parametric and non‐parametric ANOVA and regression analyses were performed, with significance at P < .05. Results Of 198 diabetic participants; 49% female, mean (SD) age, median diabetes duration and median HbA1c were 16 (2.5) and 6 (3–9) years, and 8.1 (6.9‐9.3)%, respectively. All inflammatory markers were lower in T1D than in other diabetes groups (P < .05) but higher than in non‐diabetic controls. T2D (n = 32) and CFRD (n = 32) subjects had comparable elevated levels of inflammation. Body mass index (BMI) was a strong independent explanatory variable of inflammation. In multivariate analysis, hsCRP and ESR were associated with complications in addition to HbA1c, BMI, and diastolic BP. Conclusions Circulating inflammatory markers are elevated in adolescents with diabetes, being higher and comparable in T2D and CFRD than in T1D. Inflammation is independently associated with diabetes complications, consistent with inflammation driving vascular pathology in diabetes.

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Section: Methodsmentioning

confidence: 75%

Associations between circulating inflammatory markers, diabetes type and complications in youth

et al. 2019

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“…Full‐text versions of the remaining 73 articles were retrieved and singularly examined. Ultimately, 47 studies were excluded and, of the remaining 26 papers that were included, 22 were selected for quantitative analysis . Secondary endpoints (i.e.…”

Section: Resultsmentioning

confidence: 99%

Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis

Chiriacò

Pateras

Virdis

et al. 2019

Diabetes Obesity Metabolism

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Aim To investigate the associations of blood pressure variability (BPV), expressed as long‐term (visit‐to‐visit) and short‐term (ambulatory blood pressure monitoring [ABPM] and home blood pressure monitoring [HBPM]) and all‐cause mortality, major adverse cardiovascular events (MACEs), extended MACEs, microvascular complications (MiCs) and hypertension‐mediated organ damage (HMOD) in adult patients with type 2 diabetes. Materials and methods PubMed, Medline, Embase, Cinahl, Web of Science, http://clinicaltrials.gov and grey literature databases were searched for studies including patients with type 2 diabetes, at least one variable of BPV (visit‐to‐visit, HBPM, ABPM) and evaluation of the incidence of at least one of the following outcomes: all‐cause mortality, MACEs, extended MACEs and/or MiCs and/or HMOD. The extracted information was analyzed using random effects meta‐analysis and meta‐regression. Results Data from a total of 377 305 patients were analyzed. Systolic blood pressure (SBP) variability was associated with a significantly increased risk of all‐cause mortality (HR 1.12, 95% CI 1.04–1.21), MACEs (HR 1.01, 95% CI 1.04–1.17), extended MACEs (HR 1.07, 95% CI 1.03–1.11) and MiCs (HR 1. 12, 95% CI 1.01–1.24), while diastolic blood pressure was not. Associations were mainly driven from studies on long‐term SBP variability. Qualitative analysis showed that BPV was associated with the presence of HMOD expressed as carotid intima‐media thickness, pulse wave velocity and left ventricular hypertrophy. Results were independent of mean blood pressure, glycaemic control and serum creatinine levels. Conclusions Our results suggest that BPV might provide additional information rather than mean blood pressure on the risk of cardiovascular disease in patients with type 2 diabetes.

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“…Using recent national reference values, SDS were computed applying the least mean squares method (LMS) . Microalbuminuria was defined according to the ISPAD guidelines, as described previously . Further variables of interest were total daily insulin dose per body weight, number of blood sugar measurements per day, use of continuous glucose monitoring (CGM) (either real‐time or intermittent “flash” CGM) and insulin therapy modality (percentage of insulin pump use) …”

Section: Methodsmentioning

confidence: 99%

“…26 Microalbuminuria was defined according to the ISPAD guidelines, as described previously. 27 Further variables of interest were total daily insulin dose per body weight, number of blood sugar measurements per day, use of continuous glucose monitoring (CGM) (either real-time or intermittent "flash" CGM) and insulin therapy modality (percentage of insulin pump use). 28 Elevated total cholesterol (>200 mg/dL), LDL-cholesterol (>130 mg/dL), triglycerides (>130 mg/dL) and/or low levels of HDLcholesterol (<35 mg/dL) were reported as dyslipidemia.…”

Section: Anthropometric Data (Weight Height and Body-mass-index [Bmi])mentioning

confidence: 99%

Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

et al. 2019

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Objectives To study celiac‐specific antibody status over 3 years in patients with type 1 diabetes and biopsy‐proven celiac disease (T1D + CD). Furthermore, to determine clinical differences after diagnosis between patients reaching constant antibody‐negativity (Ab‐neg) and staying antibody‐positive (Ab‐pos). Methods A total of 608 pediatric T1D + CD patients from the multicenter DPV registry were studied longitudinally regarding their CD specific antibody‐status. Differences between Ab‐neg (n = 218) and Ab‐pos (n = 158) patients 3 years after biopsy were assessed and compared with 26 833 T1D patients without CD by linear and logistic regression adjusted for age, gender, diabetes duration and migration background. Results Thirty‐six percent of T1D + CD patients reached and sustained antibody‐negativity 3 years after CD diagnosis. The median time until patients returned to Ab‐neg was 0.86 (0.51;1.16) years. Three years after diagnosis, HbA1c was lowest in Ab‐neg and highest in Ab‐pos patients compared to T1D‐only patients (adjusted mean (95%CI): 7.72 (7.51‐7.92) % vs 8.44 (8.20‐8.68) % vs 8.19 (8.17‐8.21) %, adjusted P < 0.001, respectively). Total cholesterol, LDL‐cholesterol and frequency of dyslipidemia were significantly lower in Ab‐neg compared to T1D‐only patients (167 (161‐173) mg/dl vs 179 (178‐179) mg/dl, P < .001; 90 (84‐96) mg/dl vs 99 (98‐99) mg/dl, P = .005; 15.7 (10.5‐22.9) % vs 25.9 (25.2‐26.6) %, P = .017). In longitudinal analyses over 6 years after diagnosis, a constantly higher HbA1c (P < .001) and a lower height‐SDS (P = .044) was observed in Ab‐pos compared to Ab‐neg patients. Conclusion Only one third of T1D + CD patients reached constant Ab‐negativity after CD diagnosis. Achieving Ab‐negativity after diagnosis seems to be associated with better metabolic control and growth, supposedly due to a higher adherence to therapy in general.

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Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications

Abstract: There is an early and close link between 24-hour blood pressure regulation and the development of diabetic complications not only for systolic, diastolic, and mean arterial BP but also for the derived BP parameter PP and BPV in our selected patients.

Cited by 29 publications

References 37 publications

Associations between circulating inflammatory markers, diabetes type and complications in youth

Associations between circulating inflammatory markers, diabetes type and complications in youth

Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis

Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

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