We have previously shown that masked hypertension (MH) and sustained hypertension (SH) contribute to the progression of diabetic nephropathy. Although the risk of target organ damage and cardiovascular events in MH and SH is significantly higher than that in normotension and white coat hypertension, the role of MH or SH in cardiovascular events has never been reported in studies specific to diabetic patients. Therefore, in this study, we aimed to determine whether blood pressure control status contributes to the development of new cardiovascular events. A longitudinal study of 1082 patients with type 2 diabetes mellitus and no history of cardiovascular events was conducted. Patients were instructed to have their blood pressure measured three times, every morning and evening, for 14 consecutive days. Hypertension status was classified into four groups based on the systolic blood pressure measurements in the clinic and at home. The primary endpoint was the first cardiovascular event. After a median follow-up of 7.0 (interquartile range, 4.0-9.0) years, 119 patients developed cardiovascular events. The hazard ratio (95% confidence interval) for the risk of developing cardiovascular events was significantly higher in the SH group than in the controlled blood pressure group (1.63 [1.02-2.59]). SH is a useful predictor of cardiovascular events. Both at home and in the clinic, blood pressure monitoring should be assessed in routine clinical practice to predict future cardiovascular events in patients with type 2 diabetes.
Abstract Background: To investigate the acute effects of the coronavirus disease 2019 (COVID-19) on the lifestyle and metabolic parameters in patients with type 1 diabetes mellites (T1DM). Methods: This retrospective cohort study induced 34 patients who received our hospital from April 16 to May 1, 2020. Data regarding stress levels, sleep time, exercise, and total diet, snack, and prepared food intake were obtained from the questionnaires. To evaluate the pandemic effect on the changes in the body weight or HbA1c levels, we evaluated those differences of the values at the time the questionnaire was administered to those noted 3 months ago and those differences of 12 months ago and 15 months ago using paired t test. Results: Increased stress levels and decreased exercise levels were observed in approximately 60%, and 50% of the participants, during the COVID-19 pandemic. There was a negative correlation between stress and exercise ( r = -0.407, p = 0.021). Decreased sleep duration were associated with increased body weight ( r = -0.40, p = 0.042). Furthermore, compared with 1 years ago, HbA1c was become worse (this year 0.12 [0.33] % in this year vs.-0.09 [0.39] % in 1 years ago, p = 0.027). Conclusions: Many patients experienced stress and decreased exercise due to the COVID-19 pandemic. The glycemic control of patients with T1DM was worse than last year. Given that the pandemic is ongoing, we should pay more attention to the management of stress and lifestyle factors in patients with T1DM.
Diabetes is a common comorbidity in patients with coronavirus disease (COVID-19) and contributes significantly to COVID-19 severity. We aimed to investigate the association between diabetic status and severe COVID-19. This prospective study included all COVID-19 patients admitted to our hospital, who were divided into four groups according to their diabetic status: no diabetes, treated diabetes, untreated diabetes, and COVID-19-related diabetes. Severe COVID-19 was defined as a condition that required the use of a ventilator. Of the 114 patients included in this study, 26 had severe COVID-19. The adjusted odds ratio (OR; 95% confidence interval [CI]) for severe COVID-19 was significantly higher in the treated diabetes, untreated diabetes, and COVID-19-related diabetes groups than in the no diabetes group (OR: 7.5, 95% CI [1.7–32.9]; OR 13.1, 95% CI [2.3–76.4]; and OR: 17.6, 95% [2.3–133.4], respectively). Findings from this study showed that the risk of severe COVID-19 increased with treated diabetes, untreated diabetes, and COVID-19-related diabetes, in that order.Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: All procedures were approved by the local Research Ethics Committee of Kyoto Prefectural University of Medicine (ERB-C-1810-2) and were conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all the patients.
Aim To investigate the association between sarcopenia and blood pressure parameters in older patients with type 2 diabetes. Methods This was a cross‐sectional study of 146 older patients with diabetes. Body composition was evaluated by bioimpedance analysis. The skeletal muscle mass index (kg/m 2 ) was defined as appendicular muscle mass / the square of the height. Patients with both handgrip strength <26 kg for men and <18 kg for women, and skeletal muscle mass index <7.0 kg/m 2 for men and <5.7 kg/m 2 for women were diagnosed as sarcopenia. We measured systolic blood pressure (SBP) at every visit for 1 year and calculated the coefficient of variation of SBP. Results Among 146 patients (86 men and mean age 72.6 years [SD 5.9 years], 21 patients (14.4%) were sarcopenic. The coefficient of variation of SBP in patients with sarcopenia was higher than that in patients without sarcopenia (9.1 [SD 3.2] vs 7.1 [SD 2.9]%, P = 0.007), although the average SBP of patients with sarcopenia and that of patients without sarcopenia was not different (129.5 [SD 14.0] vs 130.5 [SD 12.9] mmHg, P = 0.558). Multiple regression analysis showed that sarcopenia was associated with the coefficient of variation of SBP (β = 0.20, P = 0.024), even after adjusting for covariates, whereas sarcopenia was not associated with the average SBP (β = 0.05, P = 0.558). Conclusions We showed that sarcopenia was associated with blood pressure variability, whereas not with the average SBP. It is necessary for clinicians to pay careful attention to blood pressure variability when examining patients with sarcopenia. Geriatr Gerontol Int 2018; 18: 1345–1349 .
Thrombopoietin (THPO) is a circulatory cytokine that plays an important role in platelet production. The presence of anti-THPO antibody relates to thrombocytopenia and is rarely seen in hematopoietic and autoimmune diseases. To date, there had been no reports that focused on the anti-THPO antibody in patients with type 2 diabetes mellitus (T2DM). To evaluate prevalence of the anti-THPO antibody in patients with T2DM and the relationship between anti-THPO antibody and platelet count, a cross-sectional study was performed on 82 patients with T2DM. The anti-THPO antibody was measured by ELISA using preserved sera and detected in 13 patients. The average platelet count was significantly lower in patients with the anti-THPO antibody than in those without the anti-THPO antibody. Multivariate linear regression analyses showed a significant relationship between the anti-THPO antibody and platelet count, after adjusting for other variables. To our best knowledge, this was the first report on the effect of the anti-THPO antibody on platelet count in patients with T2DM. Further investigation is needed to validate the prevalence and pathological significance of the anti-THPO antibody in patients with T2DM.
Background: This cross-sectional study was designed to examine the association between home blood pressure and cognitive impairment in elderly patients with type 2 diabetes. Methods: Home blood pressure was measured in the morning and evening for 14 consecutive days in 749 patients with type 2 diabetes. A total of 231 patients were included in the study population. Cognitive function was evaluated using the Mini-Cog test, which is used as a screening for cognitive impairment in elderly patients. We performed a logistic regression analysis and measured the area under the receiver operating characteristic curve and estimated home blood pressure as a marker of cognitive impairment. Results: The adjusted odds ratio (95% confidence interval) of evening systolic blood pressure for cognitive impairment was 1.24 (1.02–1.53). Evening systolic blood pressure showed the highest area under the receiver operating characteristic curve for cognitive impairment in both unadjusted and adjusted models. In all subgroup analyses except gender, home blood pressure showed higher area under the receiver operating characteristic curve than clinic blood pressure. Conclusion: Home blood pressure was associated with cognitive impairment in elderly patients with type 2 diabetes.
Diabetic nephropathy, a major complication of diabetes, is the primary risk factor for dialysis, cardiovascular diseases, and mortality. Dietary fatty acids (FAs) have been revealed to be related with cardiovascular diseases in the general populations. The aim of this study was to investigate the association of circulating FAs with diabetic nephropathy.In this cross-sectional study, 190 Japanese patients with type 2 diabetes were included. Circulating FAs were measured by gas chromatography-mass spectrometry. Spearman rank correlation coefficients were used to investigate the association between the logarithm of FAs and the logarithm of urinary albumin excretion (UAE). We have performed logistic regression analysis to determine the effect of FAs on the presence of macroalbuminuria, defined as UAE value ≥300 mg/g creatinine.Mean age, body mass index, and duration of diabetes were 62.7 ± 12.1 years, 25.0 ± 4.5 kg/m2, and 9.8 ± 8.7 years, respectively. In total, 26 patients were diagnosed with macroalbuminuria. The logarithm of circulating arachidonic acid (AA) was negatively associated with the logarithm of UAE (r = - 0.221, p = 0.002). Additionally, circulating AA in patients with macroalbuminuria was lower than that in patients without macroalbuminuria (112.3 ± 75.3 mg/day vs. 164.8 ± 66.0 mg/day, p < 0.001). The logarithm of circulating AA was associated with the presence of macroalbuminuria after adjusting for covariates (odds ratio of Δ1 incremental: 0.32, 95% confidence interval: 0.10-0.99, p = 0.042).Circulating AA was negatively associated with UAE and the presence of macroalbuminuria.
Maintenance of muscle mass is important for sarcopenia prevention. However, the effect of eating speed, especially fast, normal, or slow speed, on muscle mass changes remains unclear. Therefore, the purpose of this prospective study was to investigate the effect of eating speed on muscle mass changes in patients with type 2 diabetes (T2DM).This study included 284 patients with T2DM. Based on a self-reported questionnaire, participants were classified into three groups: fast-, normal-, and slow-speed eating. Muscle mass was assessed using a multifrequency impedance body composition analyzer, and skeletal muscle mass (SMI) decrease (kg/m2/year) was defined as [baseline SMI (kg/m2)-follow-up SMI (kg/m2)] ÷ follow-up duration (year). The rate of SMI decrease (%) was defined as [SMI decrease (kg/m2/year) ÷ baseline SMI (kg/m2)] × 100.The proportions of patients with fast-, normal-, and slow-speed eating were, respectively, 50.5%, 42.9%, and 6.6% among those aged <65 years and 40.4%, 38.3%, and 21.3% among those aged ≥65 years. In patients aged ≥65 years, the rate of SMI decrease in the normal (0.85 [95% confidence interval, CI: -0.66 to 2.35]) and slow (0.93 [95% CI -0.61 to 2.46]) speed eating groups was higher than that in the fast speed eating group (-1.08 [95% CI -2.52 to 0.36]). On the contrary, there was no difference in the rate of SMI decrease among the groups in patients aged <65 years. Compared with slow speed eating, the adjusted odds ratios of incident muscle loss [defined as rate of SMI decrease (%) ≥0.5%] due to fast- and normal-speed eating were 0.42 (95% CI 0.18 to 0.98) and 0.82 (95% CI 0.36 to 2.03), respectively.Slow-speed eating is associated with a higher risk of muscle mass loss in older patients with T2DM.
Non-alcoholic fatty liver disease (NAFLD), which has a close relationship with type 2 diabetes (T2D), is related to salt intake in the general population. In contrast, the relationship between salt intake and the presence of NAFLD in patients with T2D has not been clarified.Salt intake (g/day) was assessed using urinary sodium excretion, and a high salt intake was defined as an intake greater than the median amount of 9.5 g/day. Hepatic steatosis index (HSI) ≥ 36 points was used to diagnosed NAFLD. Odds ratios of high salt intake to the presence of NAFLD were evaluated by logistic regression analysis.The frequency of NAFLD was 36.5% in 310 patients with T2D (66.7 ± 10.7 years old and 148 men). The patients with high salt intake had a higher body mass index (25.0 ± 4.0 vs. 23.4 ± 3.8 kg/m2, p < 0.001) than those with low salt intake. HSI in patients with high salt intake was higher than that in patients with low salt intake (36.2 ± 6.2 vs. 34.3 ± 5.5 points, p = 0.005). In addition, the presence of NALFD in patients with high salt intake was higher than that in patients with low salt intake (44.5% vs. 28.4%, p = 0.005). High salt intake was associated with the prevalence of NAFLD [adjusted odds ratio, 1.76 (95% confidence interval: 1.02-3.03), p = 0.043].This cross-sectional study revealed that salt intake is related to the prevalence of NAFLD in patients with T2D.
