Diabetes Care Disparities in Long-standing Type 1 Diabetes in Canada and the U.S.: A Cross-sectional Comparison

Weisman, Alanna; Lovblom, Leif E.; Keenan, Hillary A.; Tinsley, Liane J.; D’Eon, Stephanie; Boulet, Geneviève; Farooqi, Mohammed A.; Lovshin, Julie A.; Orszag, Andrej; Brent, Michael H.; Paul, Narinder; Bril, Vera; Cherney, David Z.I.; Perkins, Bruce A.

doi:10.2337/dc17-1074

Cited by 16 publications

(8 citation statements)

References 32 publications

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“…Between February 2015 and September 2016, a total of 75 participants with ≥50 years of T1D and 75 age- and sex-matched nondiabetic controls underwent extensive phenotyping procedures over the course of 2 clinical visits set 2 to 4 weeks apart. Participants with T1D were recruited from the nationwide registry of approximately 450 Canadians with ≥50 years of T1D established during the first phase of the study,29, 30, 31, 32, 33 and nondiabetic controls were friends or family members of T1D participants, or were recruited through community advertisement. Search criteria for the second phase included residence in the Greater Toronto Area (e.g., proximity to the University Health Network and Mount Sinai Hospital in Toronto, Ontario, Canada), or a willingness to travel for 2 requisite study days.…”

Section: Methodsmentioning

confidence: 99%

Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes

Scarr

Bjornstad²,

Lovblom

et al. 2019

Kidney International Reports

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Introduction Glomerular filtration rate (GFR) is routinely used for clinical assessment of kidney function. However, the accuracy of estimating equations in older adults is uncertain. Methods In 66 adults with ≥50 years type 1 diabetes (T1D) duration and 73 nondiabetic controls from age/sex-matched subgroups (65 ± 8 years old and 77[55%] were women) we evaluated the performance of estimated GFR (eGFR) by creatinine (Modification of Diet and Renal Disease [MDRD], Chronic Kidney Disease–Epidemiology [CKD-EPI] cr ), cystatin C (CKD-EPI cys , CKD-EPI cr-cys ), and β 2 -microglobulin (β2M) compared with measured GFR by inulin clearance (mGFR). Performance was evaluated using metrics of bias (mean difference), precision (SD), and accuracy (proportion of eGFR that differed by >20% of mGFR). Results Mean mGFR was 104 ± 18 ml/min per 1.73 m 2 (range: 70–154 ml/min per 1.73 m 2 ) and was not different between T1D and controls (103 ± 17 vs. 105 ± 19 ml/min per 1.73 m 2 , P = 0.39). All equations significantly underestimated mGFR (bias: −15 to −30 ml/min per 1.73 m 2 , P < 0.001 for all comparisons) except for β2M, which had bias of 1.9 ml/min per 1.73 m 2 ( P = 0.61). Bias was greatest in cystatin C–based equations. Precision was lowest for β2M (SD: 43.5 ml/min per 1.73 m 2 , P < 0.001 for each comparison). Accuracy was lowest for CKD-EPI cysC (69.1%, P < 0.001 for each comparison). Cystatin C–based equations demonstrated greater bias and lower accuracy in older age subgroups (<60, 60–69, ≥70 years). All equations demonstrated greater bias across higher ranges of mGFR (60–89, 90–119, ≥120 ml/min per 1.73 m 2 ). Results were similar between T1D and controls except that β2M had lower performance in T1D. Conclusion Better estimates of GFR in older adults are needed for research and clinical practice, as this subgroup of the population has an amplified risk for the development of chronic kidney disease (CKD) that requires accurate GFR estimation methods.

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Section: Methodsmentioning

confidence: 99%

Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes

Scarr

Bjornstad²,

Lovblom

et al. 2019

Kidney International Reports

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“…In addition, recent studies have linked the incidence of CRC to certain metabolic syndrome components, especially elevated plasma glucose (type 2 diabetes mellitus) 12 . Several enzymes are reported to be involved in glucose homeostasis, among them α-amylase, α-glucosidase 13 , and xanthine oxidase 14 . Hence, targeting these enzymes has high potential in preventing CRC.…”

Section: Introductionmentioning

confidence: 99%

Synthesis and evaluation of anticancer, antiphospholipases, antiproteases, and antimetabolic syndrome activities of some 3H-quinazolin-4-one derivatives

El-Sayed

Almaneai

Bacha

et al. 2019

Journal of Enzyme Inhibition and Medicinal Chemistry

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Some new 3 H -quinazolin-4-one derivatives were synthesised and screened for anticancer, antiphospholipases, antiproteases, and antimetabolic syndrome activities. Compound 15d was more potent in reducing the cell viabilities of HT-29 and SW620 cells lines to 38%, 36.7%, compared to 5-FU which demonstrated cell viabilities of 65.9 and 42.7% respectively. The IC 50 values of 15d were ∼20 µg/ml. Assessment of apoptotic activity revealed that 15d decreased the cell viability by down regulating Bcl2 and BclxL. Moreover, compounds, 8j , 8d / 15a / 15e , 5b, and 8f displayed lowered IC 50 values than oleanolic acid against proinflammatory isoforms of hGV, hG-X, NmPLA 2, and AmPLA 2 . In addition, 8d , 8h , 8j , 15a , 15b , 15e , and 15f showed better anti-α-amylase than quercetin, whereas 8g , 8h , and 8i showed higher anti-α-glucosidase activity than allopurinol. Thus, these compounds can be considered as potential antidiabetic agents. Finally, none of the compounds showed higher antiproteases or xanthine oxidase activities than the used reference drugs.

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“…Similar results have also been identified in other longstanding T1DM cohorts, such as the Golden Years study in UK and the Canadian study of the longevity of T1DM patients. (8,9) These findings suggest that individuals with an extremely long duration of T1DM are either protected from or show slower progression of diabetic microvascular complications. This survival bias inherent in studying patients with a long duration of T1DM permits the evaluation of protective factors.…”

Section: Introductionmentioning

confidence: 94%

Factors associated with resistance to complications in long-standing type 1 diabetes in China

Liu¹,

Wang²,

Han³

et al. 2020

Endocrine Connections

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Objective Type 1 diabetes (T1DM) is associated with a higher risk of premature death, but there are factors in certain patients with T1DM that protect them from complications and premature death. These factors had not been identified in non-Caucasian populations, so we aimed to identify factors that protect against the development of diabetic nephropathy (DN) and diabetic retinopathy (DR) in long-standing T1DM in China. Methods Ninety-five T1DM patients with >30 years’ duration of diabetes were enrolled in this nationwide study. Differences between groups of patients with and without complications were compared, and multivariable regression analysis was used to evaluate the relationships between candidate protective factors and the development of DN or DR. Results Thirty of the participants did not have DN and the same amount did not have DR. 6/52 of participants without DN were from a rural area, whereas 11/28 of participants with DN had been born in a rural area (P = 0.005). Systolic blood pressure (SBP) was higher in participants with DN (135 ± 26 mmHg vs 121 ± 13 mmHg; P = 0.002). In participants without DR, 27/30 were married or cohabitating, and only 3/30 were single, never married, or widowed, but for those with proliferative DR (PDR), 13/26 had been married (P = 0.003). A rural or urban origin and SBP were associated with DN in the multivariable analysis. Conclusion we have shown that higher socioeconomic status, indicated by birth in an urban area, and being married or cohabitating, are accompanied by better blood pressure control and a lower risk of microvascular complications in Chinese patients with long-standing T1DM. These findings illustrate the importance of improving care for patients with T1DM in China.

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Diabetes Care Disparities in Long-standing Type 1 Diabetes in Canada and the U.S.: A Cross-sectional Comparison

Abstract: Although Canadians and Americans have similar rates of complications other than CAD, further research is required to understand why Canadians have higher HbA levels, lower QOL, and less insulin pump use.

Cited by 16 publications

References 32 publications

Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes

Estimating GFR by Serum Creatinine, Cystatin C, and β2-Microglobulin in Older Adults: Results From the Canadian Study of Longevity in Type 1 Diabetes

Synthesis and evaluation of anticancer, antiphospholipases, antiproteases, and antimetabolic syndrome activities of some 3H-quinazolin-4-one derivatives

Factors associated with resistance to complications in long-standing type 1 diabetes in China

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