Relationship between short and long-term glycemic variability and oxidative stress in type 1 diabetes mellitus under daily life insulin treatment

Valente, Tatiana; Valente, Fernando; Lucchesi, Maria Beatriz Bastos; Punaro, Giovana Rita; Mouro, Margaret Gori; Gabbay, Mônica Andrade Lima; Higa, Elisa Mieko Suemitsu; Dib, Sérgio Atala

doi:10.20945/2359-3997000000338

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…These studies were, however, conducted in individuals with type 2 diabetes. Studies on the association between short-term GV and oxidative stress in type 1 diabetes have shown heterogeneous results [ 36 ]. Some associations between long-term GV and oxidative stress markers have also been shown [ 37 , 38 ], but most mechanistic studies have focused on short-term GV, and the true factors behind the ability of HbA 1c variability to capture cardiovascular risk are still unknown.…”

Section: Discussionmentioning

confidence: 99%

Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes

Tynjälä

Harjutsalo²,

Sigfrids³

et al. 2023

Cardiovasc Diabetol

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Background Both long-term glycaemic variability and arterial stiffness have been recognized as cardiovascular risk factors. This study aims to investigate whether an association between these phenomena exists in individuals with type 1 diabetes. Methods This cross-sectional study included 673 adults (305 men, 368 women) with type 1 diabetes and combined available retrospective laboratory data on HbA1c from the preceding 10 years with outcome data on arterial stiffness and clinical variables from a comprehensive study visit. HbA1c variability was calculated as adjusted standard deviation (adj-HbA1c-SD), coefficient of variation (HbA1c-CV) and average real variability (HbA1c-ARV). As measures of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV; n = 335) and augmentation index (AIx; n = 653) were assessed using applanation tonometry. Results The study population had a mean age of 47.1 (± 12.0) years and a median duration of diabetes of 31.2 (21.2–41.3) years. The median number of HbA1c assessments per individual was 17 (12–26). All three indices of HbA1c variability were significantly correlated with both cfPWV and AIx after adjustment for sex and age (p < 0.001). In separate multivariable linear regression models, adj-HbA1c-SD and HbA1c-CV were significantly associated with cfPWV (p = 0.032 and p = 0.046, respectively) and AIx (p = 0.028 and p = 0.049, respectively), even after adjustment for HbA1c-mean. HbA1c-ARV was not associated with cfPWV or AIx in the fully adjusted models. Conclusions An association independent of HbA1c-mean was found between HbA1c variability and arterial stiffness, suggesting a need to consider multiple HbA1c metrics in studies assessing cardiovascular risk in type 1 diabetes. Longitudinal and interventional studies are needed to confirm any causal relationship and to find strategies for reducing long-term glycaemic variability.

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Section: Discussionmentioning

confidence: 99%

Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes

Tynjälä

Harjutsalo²,

Sigfrids³

et al. 2023

Cardiovasc Diabetol

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“…Given no significant association was observed between albumin and cardiovascular events, the correlation between albumin and LBGI found in our study may only suggest that both albumin and LBGI are indicators of malnutrition status. Moreover, a most recent study found that albuminuria was positively correlated with plasmatic nitric oxide level which is one of the oxidative stress markers positively correlated with the average level of HbA1c [36]. This correlation suggested that albumin might be associated with glycemic variability via oxidative stress pathway.…”

Section: Discussionmentioning

confidence: 99%

Low Blood Glucose Index Associated with Cardiovascular Events in Diabetic Hemodialysis Patients

He,

Xuan,

Zhu

et al. 2023

Blood Purif

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Introduction: Blood glucose monitoring was vitally important in diabetic kidney disease (DKD) patients for preventing complications and improving survival rates. The associations between glycemic variability and blood biochemical indicators were underestimated in patients with DKD undergoing hemodialysis. Therefore, we primarily aimed to investigate the glycemic variability and 1-year risk of cardiovascular disease events in diabetic hemodialysis patients. And we secondarily aimed to explore the association between glycemic variability and blood biochemical indicators. Methods: In total, 27 patients were included in the final analysis. Continuous glucose monitoring (CGM) was used to evaluate glucose variability for 14 days. Patients were divided into two groups by the cutoff level of time in range (TIR; >70% or ≤70%). The three-point major adverse cardiovascular event (3P MACE) was recorded within 1 year. Results: After 1 year of follow-up, 4 patients in the high-TIR group and 3 patients in the low-TIR group had 3p MACE. Higher low blood glucose index (LBGI) level in diabetic hemodialysis patients increased the risk of 3p MACE outcomes (HR = 2.37, p = 0.018). And the level of albumin was positively associated with LBGI (β = 0.51, p = 0.036). The plasma levels of albumin, glycosylated hemoglobin, and hemoglobin were positively associated with other CGM parameters. Conclusion: LBGI during 14 days was positively associated with the risk of cardiovascular events in diabetic hemodialysis patients.

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“…On the other hand, some studies showed conflicting results. Cheprasova et al [ 50 ] found a strong positive correlation between glucose concentration and the levels of OS markers and a negative correlation between the activity of antioxidant enzymes and glucose concentration, while Valente et al [ 51 ] reported that the correlations between glycemic variability and OS markers were heterogeneous. The difference in patients’ characteristics or medications might have caused inconsistent results among these studies.…”

Section: Discussionmentioning

confidence: 99%

Salivary oxidative stress biomarkers in thai adolescents and young adults with type 1 diabetes mellitus: A cross-sectional study

Aroonrangsee,

Chairatnathrongporn,

Surarit

et al. 2023

JISPCD

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Aims and Objectives: The primary objectives of this study were to compare salivary oxidative stress (OS) biomarker levels in patients with type 1 diabetes mellitus (T1DM) and without T1DM (non-T1DM) and evaluate the relationships between diabetes, periodontal status, and OS biomarker levels. Materials and Methods: Twenty patients with T1DM and 20 age-matched patients without T1DM were enrolled. All participants were 15–23 years of age and had permanent dentition. Unstimulated whole saliva was collected in a sterile test tube before examination of clinical periodontal parameters, including bleeding on probing (BOP). Salivary levels of OS biomarkers—malondialdehyde, protein carbonyl, total oxidant status (TOS), and total antioxidant capacity—were determined using oxidative and antioxidative assays followed by spectrophotometric measurement at 375–532 nm. The relationships between diabetes, periodontal status, and OS biomarkers were analyzed using multiple linear regression. Results: TOS was significantly lower in the T1DM group compared with the non-T1DM group (5.06 ± 0.39 vs. 6.44 ± 0.51 µmol H2O2 Eq/l, P = 0.035). After adjusting for confounding factors (age, gender, BMI, clinical periodontal parameters, BOP, or diabetes status accordingly), the multiple linear regression showed that T1DM was significantly associated with a reduction of TOS level (P = 0.008). The BOP > 30% group showed a significant correlation with increased TOS levels compared with the BOP ≤ 30% group (P = 0.002). No relationship was found between OS biomarkers and HbA1c levels. Conclusion: Salivary TOS levels were related to both diabetes status and the extent of gingival inflammation. Further studies to elucidate the role of OS in relation of periodontal disease and T1DM are required.

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Relationship between short and long-term glycemic variability and oxidative stress in type 1 diabetes mellitus under daily life insulin treatment

Cited by 7 publications

References 36 publications

Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes

Higher HbA1c variability is associated with increased arterial stiffness in individuals with type 1 diabetes

Low Blood Glucose Index Associated with Cardiovascular Events in Diabetic Hemodialysis Patients

Salivary oxidative stress biomarkers in thai adolescents and young adults with type 1 diabetes mellitus: A cross-sectional study

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