Severe hypoglycemia and hypoglycemia awareness are associated with preclinical atherosclerosis in patients with type 1 diabetes without an estimated high cardiovascular risk.

Autor: Mesa A; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain., Giménez M; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain.; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain., Perea V; Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain., Serés-Noriega T; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain., Boswell L; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain.; Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain., Blanco J; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain., Milad C; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain., Pané A; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain., Esmatjes E; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain.; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain., Vinagre I; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain., Conget I; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain.; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain., Viñals C; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain., Amor AJ; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Diabetes/metabolism research and reviews [Diabetes Metab Res Rev] 2024 Mar; Vol. 40 (3), pp. e3785.
DOI: 10.1002/dmrr.3785
Abstrakt: Aims: To explore the relationship between severe hypoglycemia (SH) and hypoglycemia awareness with preclinical atherosclerosis in type 1 diabetes (T1D).
Materials and Methods: Cross-sectional study in patients with T1D without cardiovascular disease (CVD), and with ≥1 of the following: ≥40 years, diabetic kidney disease, or ≥10 years of T1D duration with another risk factor. CVD risk was estimated with the Steno T1 Risk Engine (Steno-Risk). Carotid plaque was evaluated using standardised ultrasonography protocol. Logistic regression models adjusted for CVD risk factors were constructed to test the independent associations with SH or hypoglycemia awareness assessed by the Clarke questionnaire (Clarke). The inclusion of SH and Clarke in Steno-Risk was further evaluated.
Results: We included 634 patients (52.4% men, age 48.3 ± 10.8 years, T1D duration 27.4 ± 11.1 years, 39.9% harbouring plaque). A stepped increase in the presence of plaque according to Steno-Risk was observed (13.5%, 37.7%, and 68.7%, for low, moderate, and high risk, respectively; p < 0.001). SH history (OR 4.4 [1.3-14.6]) and Clarke score (OR 1.7 [1.2-2.2]) were associated with plaque in low-risk patients (n = 192). Clarke score was also associated with plaque burden in low-moderate-risk participants (n = 436; ≥2 plaques: OR 1.2 [1.0-1.5], p = 0.031; ≥3 plaques: OR 1.4 [1.1-2.0], p = 0.025). The inclusion of SH and Clarke scores in Steno-Risk significantly improved the identification of low-risk individuals with atherosclerosis (area under the curve: 0.658 vs. 0.576; p = 0.036).
Conclusions: In patients with T1D without an estimated high CVD risk, SH and hypoglycemia awareness assessment score were independently associated with preclinical atherosclerosis and improved identification of patients who would benefit from an intensive approach.
(© 2024 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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