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Trevor J Orchard - One of the best experts on this subject based on the ideXlab platform.
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cardiovascular health in early adulthood predicts the development of coronary heart disease in individuals with type 1 Diabetes 25 year follow up from the pittsburgh Epidemiology of Diabetes complications study
Diabetologia, 2021Co-Authors: Susan Devaraj, Trevor J Orchard, Rachel G. Miller, Andrea M. Kriska, Tina CostacouAbstract:AIMS/HYPOTHESIS Type 1 Diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA1c, BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 Diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD. METHODS Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6 years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 Diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25 years of follow-up was examined by metric scores. RESULTS Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA1c demonstrated the lowest. During 25 years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p < 0.01) of CHD, adjusting for Diabetes duration, estimated glomerular filtration rate, albumin excretion rate, triacylglycerols, depression and white blood cell count. CONCLUSIONS/INTERPRETATION Among individuals with type 1 Diabetes, higher cardiovascular health metric scores were associated with lower risk of incident CHD. The American Heart Association-defined cardiovascular health metrics provide straightforward goals for health promotion that may reduce CHD risk in the type 1 Diabetes population. Graphical abstract.
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Association of age at Diabetes complication diagnosis with age at natural menopause in women with type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study.
Journal of diabetes and its complications, 2021Co-Authors: Samar R. El Khoudary, Trevor J Orchard, Rachel G. Miller, Jeanine M. Buchanich, Debra Rubinstein, Tina CostacouAbstract:Abstract Objective Vascular damage is thought to have a role in premature ovarian aging. We thus assessed the association between the presence, and age at onset of, vascular Diabetes complications and age at natural menopause in women with type 1 Diabetes. Methods Female participants of the Epidemiology of Diabetes Complications study with type 1 Diabetes who experienced natural menopause and who never received hormone therapy during their menopausal transition were included in the analysis (n=105). Microalbuminuria (MA), overt nephropathy, proliferative retinopathy, confirmed distal symmetric polyneuropathy, and coronary artery disease, were assessed during biennial clinical exanimations for the first 10 years of follow-up and at year 18, 25 and 30. Menopausal status was determined via self-report and sex hormone data. For each complication, separate linear regression models were used to assess whether, compared with women without the complication of interest, an earlier age at complication development (i.e., Results Although results from multivariable linear regression models suggested a similar age at menopause between women with normo-albuminuria and those diagnosed with MA after 30 years of age, menopause occurred 2.06 years earlier (β±SE=−2.06±1.08) among women diagnosed with MA before age 30 (p=0.06). No significant association was observed for other complications. Conclusion Among women with type 1 Diabetes, menopause appears to occur earlier in those diagnosed with MA before age 30 compared to those with normo-albuminuria, suggesting that vascular dysfunction associated with early microvascular disease may affect ovarian aging.
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Cardiovascular health in early adulthood predicts the development of coronary heart disease in individuals with type 1 Diabetes: 25 year follow-up from the Pittsburgh Epidemiology of Diabetes Complications study.
Diabetologia, 2020Co-Authors: Susan Devaraj, Trevor J Orchard, Rachel G. Miller, Andrea M. Kriska, Tina CostacouAbstract:AIMS/HYPOTHESIS Type 1 Diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA1c, BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 Diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD. METHODS Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6 years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 Diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25 years of follow-up was examined by metric scores. RESULTS Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA1c demonstrated the lowest. During 25 years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p
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Skin intrinsic fluorescence scores are a predictor of all-cause mortality risk in type 1 Diabetes: The Epidemiology of Diabetes Complications study.
Journal of diabetes and its complications, 2020Co-Authors: Erin L. Tomaszewski, Trevor J Orchard, Thomas J. Songer, Hawkins, Baqiyyah Conway, Jeanine M. Buchanich, John D. Maynard, Tina CostacouAbstract:Abstract Aims We assessed the association of skin intrinsic fluorescence (SIF) scores, as a measure of advanced glycation end-products (AGE), with all-cause mortality in type 1 Diabetes (T1D). Methods This is an observational retrospective study of a convenience sample from the Epidemiology of Diabetes Complications (EDC) study. AGEs were measured with a SIF score between 2007 and 2014; vital status was assessed in 2020. Results Among 245 participants, mean age was 48.6 ± 7.4 years, median Diabetes duration was 39.5 years (IQR: 34.2, 44.9), and 53.5% were female. Compared to survivors, the deceased (n = 20) were older, with higher SIF scores, longer Diabetes duration, lower body mass index (BMI), and an adverse risk factor profile (all p≤0.05). Univariate Cox regression showed a marginal association between SIF score and mortality (HR: 1.1, 95% CI 0.9–1.2, p = 0.06), which persisted after adjustment for multiple daily insulin shots/pump (MDI) use (HR: 1.1, 95% CI 1.0–1.2, p = 0.04). This association was attenuated after adjustment for T1D duration, A1c months, or estimated glomerular filtration rate (eGFR). Conclusions In individuals with long duration T1D, SIF scores adjusted for MDI predicted all-cause mortality, although this association was attenuated after adjustments. Given the nature of sampling and small number of events, our findings require replication.
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risk factors for diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in the Diabetes control and complications trial Epidemiology of Diabetes interventions and complications dcct edic study
Diabetes, 2020Co-Authors: Barbara H Braffett, Rose Gubitosiklug, James W Albers, Eva L Feldman, Catherine L Martin, Neil H White, Trevor J Orchard, Maria F Lopesvirella, John M Lachin, Rodica PopbusuiAbstract:The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study demonstrated that intensive glucose control reduced the risk of developing diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN). We evaluated multiple risk factors and phenotypes associated with DPN and CAN in this large, well-characterized cohort of participants with type 1 Diabetes, followed for >23 years. DPN was defined by symptoms, signs, and nerve conduction study abnormalities in ≥2 nerves; CAN was assessed using standardized cardiovascular reflex tests. Generalized estimating equation models assessed the association of DPN and CAN with individual risk factors measured repeatedly. During DCCT/EDIC, 33% of participants developed DPN and 44% CAN. Higher mean HbA1c was the most significant risk factor for DPN, followed by older age, longer duration, greater height, macroalbuminuria, higher mean pulse rate, β-blocker use, and sustained albuminuria. The most significant risk factor for CAN was older age, followed by higher mean HbA1c, sustained albuminuria, longer duration of type 1 Diabetes, higher mean pulse rate, higher mean systolic blood pressure, β-blocker use, estimated glomerular filtration rate <60 mL/min/1.73 m2, higher most recent pulse rate, and cigarette smoking. These findings identify risk factors and phenotypes of participants with diabetic neuropathy that can be used in the design of new interventional trials and for personalized approaches to neuropathy prevention.
Tina Costacou - One of the best experts on this subject based on the ideXlab platform.
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cardiovascular health in early adulthood predicts the development of coronary heart disease in individuals with type 1 Diabetes 25 year follow up from the pittsburgh Epidemiology of Diabetes complications study
Diabetologia, 2021Co-Authors: Susan Devaraj, Trevor J Orchard, Rachel G. Miller, Andrea M. Kriska, Tina CostacouAbstract:AIMS/HYPOTHESIS Type 1 Diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA1c, BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 Diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD. METHODS Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6 years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 Diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25 years of follow-up was examined by metric scores. RESULTS Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA1c demonstrated the lowest. During 25 years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p < 0.01) of CHD, adjusting for Diabetes duration, estimated glomerular filtration rate, albumin excretion rate, triacylglycerols, depression and white blood cell count. CONCLUSIONS/INTERPRETATION Among individuals with type 1 Diabetes, higher cardiovascular health metric scores were associated with lower risk of incident CHD. The American Heart Association-defined cardiovascular health metrics provide straightforward goals for health promotion that may reduce CHD risk in the type 1 Diabetes population. Graphical abstract.
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Association of age at Diabetes complication diagnosis with age at natural menopause in women with type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study.
Journal of diabetes and its complications, 2021Co-Authors: Samar R. El Khoudary, Trevor J Orchard, Rachel G. Miller, Jeanine M. Buchanich, Debra Rubinstein, Tina CostacouAbstract:Abstract Objective Vascular damage is thought to have a role in premature ovarian aging. We thus assessed the association between the presence, and age at onset of, vascular Diabetes complications and age at natural menopause in women with type 1 Diabetes. Methods Female participants of the Epidemiology of Diabetes Complications study with type 1 Diabetes who experienced natural menopause and who never received hormone therapy during their menopausal transition were included in the analysis (n=105). Microalbuminuria (MA), overt nephropathy, proliferative retinopathy, confirmed distal symmetric polyneuropathy, and coronary artery disease, were assessed during biennial clinical exanimations for the first 10 years of follow-up and at year 18, 25 and 30. Menopausal status was determined via self-report and sex hormone data. For each complication, separate linear regression models were used to assess whether, compared with women without the complication of interest, an earlier age at complication development (i.e., Results Although results from multivariable linear regression models suggested a similar age at menopause between women with normo-albuminuria and those diagnosed with MA after 30 years of age, menopause occurred 2.06 years earlier (β±SE=−2.06±1.08) among women diagnosed with MA before age 30 (p=0.06). No significant association was observed for other complications. Conclusion Among women with type 1 Diabetes, menopause appears to occur earlier in those diagnosed with MA before age 30 compared to those with normo-albuminuria, suggesting that vascular dysfunction associated with early microvascular disease may affect ovarian aging.
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Cardiovascular health in early adulthood predicts the development of coronary heart disease in individuals with type 1 Diabetes: 25 year follow-up from the Pittsburgh Epidemiology of Diabetes Complications study.
Diabetologia, 2020Co-Authors: Susan Devaraj, Trevor J Orchard, Rachel G. Miller, Andrea M. Kriska, Tina CostacouAbstract:AIMS/HYPOTHESIS Type 1 Diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA1c, BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 Diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD. METHODS Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6 years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 Diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25 years of follow-up was examined by metric scores. RESULTS Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA1c demonstrated the lowest. During 25 years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p
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Skin intrinsic fluorescence scores are a predictor of all-cause mortality risk in type 1 Diabetes: The Epidemiology of Diabetes Complications study.
Journal of diabetes and its complications, 2020Co-Authors: Erin L. Tomaszewski, Trevor J Orchard, Thomas J. Songer, Hawkins, Baqiyyah Conway, Jeanine M. Buchanich, John D. Maynard, Tina CostacouAbstract:Abstract Aims We assessed the association of skin intrinsic fluorescence (SIF) scores, as a measure of advanced glycation end-products (AGE), with all-cause mortality in type 1 Diabetes (T1D). Methods This is an observational retrospective study of a convenience sample from the Epidemiology of Diabetes Complications (EDC) study. AGEs were measured with a SIF score between 2007 and 2014; vital status was assessed in 2020. Results Among 245 participants, mean age was 48.6 ± 7.4 years, median Diabetes duration was 39.5 years (IQR: 34.2, 44.9), and 53.5% were female. Compared to survivors, the deceased (n = 20) were older, with higher SIF scores, longer Diabetes duration, lower body mass index (BMI), and an adverse risk factor profile (all p≤0.05). Univariate Cox regression showed a marginal association between SIF score and mortality (HR: 1.1, 95% CI 0.9–1.2, p = 0.06), which persisted after adjustment for multiple daily insulin shots/pump (MDI) use (HR: 1.1, 95% CI 1.0–1.2, p = 0.04). This association was attenuated after adjustment for T1D duration, A1c months, or estimated glomerular filtration rate (eGFR). Conclusions In individuals with long duration T1D, SIF scores adjusted for MDI predicted all-cause mortality, although this association was attenuated after adjustments. Given the nature of sampling and small number of events, our findings require replication.
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risk factor modeling for cardiovascular disease in type 1 Diabetes in the pittsburgh Epidemiology of Diabetes complications edc study a comparison with the Diabetes control and complications trial Epidemiology of Diabetes interventions and complicati
Diabetes, 2019Co-Authors: Rachel G. Miller, Tina Costacou, Trevor J OrchardAbstract:In a recent Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study report, mean HbA1c was the strongest predictor of cardiovascular disease (CVD) after age. In DCCT/EDIC, mean Diabetes duration was 6 years (median 4) at baseline and those with high blood pressure or cholesterol were excluded. We now replicate these analyses in the Pittsburgh Epidemiology of Diabetes Complications (EDC) prospective cohort study of childhood-onset (at <17 years of age) type 1 Diabetes, with similar age (mean 27 years in both studies) but longer Diabetes duration (mean 19 years and median 18 years) and no CVD risk factor exclusion at baseline. CVD incidence (CVD death, myocardial infarction (MI), stroke, revascularization, angina, or ischemic electrocardiogram) was associated with Diabetes duration, most recent albumin excretion rate (AER), updated mean triglycerides, baseline hypertension, baseline LDL cholesterol, and most recent HbA1c Major atherosclerotic cardiovascular events (CVD death, MI, or stroke) were associated with Diabetes duration, most recent AER, baseline systolic blood pressure, baseline smoking, and updated mean HbA1c Compared with findings in DCCT/EDIC, traditional risk factors similarly predicted CVD; however AER predominates in EDC and HbA1c in DCCT/EDIC. Thus, the relative impact of HbA1c and kidney disease in type 1 Diabetes varies according to Diabetes duration.
Patricia A. Cleary - One of the best experts on this subject based on the ideXlab platform.
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Haptoglobin 2–2 genotype and the risk of coronary artery disease in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC)
Journal of diabetes and its complications, 2016Co-Authors: Trevor J Orchard, Tina Costacou, Patricia A. Cleary, Andrew P. Levy, Jye-yu C. Backlund, Maria F. Lopes-virella, John M LachinAbstract:Abstract Aims/hypothesis Haptoglobin(Hp) 2–2 genotype has been shown to increase coronary artery disease (CAD) risk in numerous type 2 Diabetes studies but in only one type 1 Diabetes cohort. We assessed the association of Hp2–2 with incident CAD over 26 years of follow-up in 1303 Caucasian participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods DCCT randomized volunteers with type 1 Diabetes to intensive versus conventional therapy within two cohorts: ‘primary prevention’ with 1–5 years Diabetes duration and ‘secondary intervention’ with 1–15 years Diabetes duration and early retinopathy, with or without albuminuria, but no advanced complications. CAD was defined as myocardial infarction (MI) or death judged to be from CAD, silent MI, angina, coronary revascularization, or congestive heart failure due to CAD. Results In the entire DCCTcohort, Hp2–2 was not significantly associated with incident CAD or MI. However, in pre-specified exploratory subgroup analyses, an increased MI risk was suggested in the secondary cohort for those with Hp2–2. Conclusions/interpretation The analysis does not statistically confirm an overall association between Hp 2–2 and incident CAD, however, some suggestions of associations were observed in secondary analyses.
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Ovarian reserve in women with Type 1 Diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study.
Diabetic medicine : a journal of the British Diabetic Association, 2016Co-Authors: Catherine Kim, Barbara H Braffett, Patricia A. Cleary, Rodney L. Dunn, Valerie L. Arends, Michael W. Steffes, M. S. M. Lanham, John F. Randolph, Hunter Wessells, Melissa WellonsAbstract:Markers of ovarian reserve such as anti-Mullerian hormone (AMH) are used in the management of fertility and prediction of menopause. Although women with type 1 Diabetes have a high prevalence of reproductive disorders, no studies have examined whether markers of ovarian reserve are associated with randomization to intensive insulin therapy and subsequent markers of glycemic control. Using data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study, we found that the strongest predictor of AMH was chronologic age, and that Diabetes-specific variables such as randomization to intensive therapy, insulin dose, and glycemic control were not associated with AMH concentrations.
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Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow‐up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study
Journal of the American Heart Association, 2016Co-Authors: Elsayed Z Soliman, Patricia A. Cleary, Jye-yu C. Backlund, Ionut Bebu, Zhu-ming Zhang, John M LachinAbstract:Background The electrocardiogram (ECG) is an objective tool for cardiovascular disease (CVD) risk assessment. Methods and Results We evaluated distribution of ECG abnormalities and risk factors for developing new abnormalities in 1314 patients with type 1 Diabetes (T1D) from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Annual ECGs were centrally read. ECG abnormalities were classified as major and minor according to the Minnesota ECG Classification. At EDIC year 1 (baseline), 356 (27.1%) of the participants had at least 1 ECG abnormality (major or minor) whereas 26 (2%) had at least one major abnormality. During 16 years of follow‐up, 1016 (77.3%) participants developed at least 1 new ECG abnormality (major or minor), whereas 172 (13.1%) developed at least 1 new major abnormality. Independent risk factors for developing new major ECG abnormalities were: age, current smoking, increased systolic blood pressure, and higher glycosylated hemoglobin (hazard ratio \[HR\] \[95% CI\]: 1.04 [1.02–1.06] per 1‐year increase, 1.75 [1.22–2.53], 1.03 [1.01–1.05] per 1 mm Hg increase, and 1.16 [1.04–1.29] per 10% increase, respectively). Independent risk factors for developing any new ECG abnormalities (major or minor) were age and systolic blood pressure (HR [95% CI]: 1.02 [1.01–1.03] per 1‐year increase and 1.01 [1.00–1.02] per 1 mm Hg increase, respectively). Conclusions New ECG abnormalities commonly occur in the course of T1D, consistent with the recognized increasing risk for CVD as patients age. Advanced age, increased systolic blood pressure, smoking, and higher HbA1c are independent risk factor for developing major ECG abnormalities, which underscores the importance of tight glucose control in T1D in addition to management of common CVD risk factors.
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Insulin secretion measured by stimulated C-peptide in long-established Type 1 Diabetes in the Diabetes Control and Complications Trial (DCCT)/ Epidemiology of Diabetes Interventions and Complications (EDIC) cohort: A pilot study
Diabetic medicine : a journal of the British Diabetic Association, 2014Co-Authors: Paula Mcgee, John M Lachin, Patricia A. Cleary, Michael W. Steffes, Maren Nowicki, M. Bayless, Rose Gubitosi-klug, J. PalmerAbstract:Aims To evaluate whether clinically relevant concentrations of stimulated C-peptide in response to a mixed-meal tolerance test can be detected after almost 30 years of Diabetes in people included in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort. Methods Mixed-meal tolerance tests were performed in a sample of 58 people. C-peptide levels were measured using a chemiluminescent immunoassay. This sample size assured a high probability of detecting C-peptide response if the true prevalence was at least 5%, a level that would justify the subsequent assessment of C-peptide in the entire cohort. Results of the 58 participants, 17% showed a definite response, defined as one or more post-stimulus concentrations of C-peptide > 0.03 nmol/l, and measurable concentrations were found in all participants. Conclusions These results show that a stimulated C-peptide response can be measured in some people with long-term Type 1 Diabetes. Further investigation of all participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study will help relate long-term residual C-peptide response to glycaemia over time and provide insight into the relevance of this response in terms of insulin dose, severe hypoglycaemia, retinopathy, nephropathy and macrovascular disease. Establishing the clinical relevance of long-term C-peptide responses is important in understanding the impact that therapy to preserve or improve β-cell function may have in patients with long-term Type 1 Diabetes.
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self reported autoimmune disease by sex in the Diabetes control and complications trial Epidemiology of Diabetes interventions and complications dcct edic study
Diabetes Care, 2014Co-Authors: Elizabeth Buschur, Barbara H Braffett, Aruna V. Sarma, Patricia A. Cleary, Rodney L. Dunn, Hunter Wessells, Massimo Pietropaolo, Catherine C. Cowie, Mary E. Larkin, David M. NathanAbstract:People with type 1 Diabetes have an increased risk for autoimmune thyroid disease, which is more common in women than in men according to at least one (1) but not all (2) studies. Exposures unique to women, such as pregnancy, exogenous estrogen, and menopause, have been linked to other autoimmune diseases, including rheumatoid arthritis and systemic lupus erythematosus (3). However, studies examining such exposures in women with type 1 Diabetes are unavailable. Because the incidence of type 1 Diabetes is increasing worldwide, it is important to determine the factors associated with comorbid conditions (4). We analyzed participants ( n = 1,324) in the Diabetes Control and Complications Trial (DCCT), a randomized trial of intensive insulin therapy, and its follow-up, Epidemiology of Diabetes Interventions and Complications (EDIC). With the use of Cox regression models, we estimated hypothyroid risk associated with sex, age, DCCT treatment group, Diabetes duration, microvascular complications, and hemoglobin A1c (HbA1c). Among women, we further examined parity, menopause, and estrogen use. We also report the cumulative …
Rachel G. Miller - One of the best experts on this subject based on the ideXlab platform.
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cardiovascular health in early adulthood predicts the development of coronary heart disease in individuals with type 1 Diabetes 25 year follow up from the pittsburgh Epidemiology of Diabetes complications study
Diabetologia, 2021Co-Authors: Susan Devaraj, Trevor J Orchard, Rachel G. Miller, Andrea M. Kriska, Tina CostacouAbstract:AIMS/HYPOTHESIS Type 1 Diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA1c, BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 Diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD. METHODS Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6 years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 Diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25 years of follow-up was examined by metric scores. RESULTS Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA1c demonstrated the lowest. During 25 years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p < 0.01) of CHD, adjusting for Diabetes duration, estimated glomerular filtration rate, albumin excretion rate, triacylglycerols, depression and white blood cell count. CONCLUSIONS/INTERPRETATION Among individuals with type 1 Diabetes, higher cardiovascular health metric scores were associated with lower risk of incident CHD. The American Heart Association-defined cardiovascular health metrics provide straightforward goals for health promotion that may reduce CHD risk in the type 1 Diabetes population. Graphical abstract.
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Association of age at Diabetes complication diagnosis with age at natural menopause in women with type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study.
Journal of diabetes and its complications, 2021Co-Authors: Samar R. El Khoudary, Trevor J Orchard, Rachel G. Miller, Jeanine M. Buchanich, Debra Rubinstein, Tina CostacouAbstract:Abstract Objective Vascular damage is thought to have a role in premature ovarian aging. We thus assessed the association between the presence, and age at onset of, vascular Diabetes complications and age at natural menopause in women with type 1 Diabetes. Methods Female participants of the Epidemiology of Diabetes Complications study with type 1 Diabetes who experienced natural menopause and who never received hormone therapy during their menopausal transition were included in the analysis (n=105). Microalbuminuria (MA), overt nephropathy, proliferative retinopathy, confirmed distal symmetric polyneuropathy, and coronary artery disease, were assessed during biennial clinical exanimations for the first 10 years of follow-up and at year 18, 25 and 30. Menopausal status was determined via self-report and sex hormone data. For each complication, separate linear regression models were used to assess whether, compared with women without the complication of interest, an earlier age at complication development (i.e., Results Although results from multivariable linear regression models suggested a similar age at menopause between women with normo-albuminuria and those diagnosed with MA after 30 years of age, menopause occurred 2.06 years earlier (β±SE=−2.06±1.08) among women diagnosed with MA before age 30 (p=0.06). No significant association was observed for other complications. Conclusion Among women with type 1 Diabetes, menopause appears to occur earlier in those diagnosed with MA before age 30 compared to those with normo-albuminuria, suggesting that vascular dysfunction associated with early microvascular disease may affect ovarian aging.
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Cardiovascular health in early adulthood predicts the development of coronary heart disease in individuals with type 1 Diabetes: 25 year follow-up from the Pittsburgh Epidemiology of Diabetes Complications study.
Diabetologia, 2020Co-Authors: Susan Devaraj, Trevor J Orchard, Rachel G. Miller, Andrea M. Kriska, Tina CostacouAbstract:AIMS/HYPOTHESIS Type 1 Diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA1c, BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 Diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD. METHODS Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6 years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 Diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25 years of follow-up was examined by metric scores. RESULTS Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA1c demonstrated the lowest. During 25 years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p
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risk factor modeling for cardiovascular disease in type 1 Diabetes in the pittsburgh Epidemiology of Diabetes complications edc study a comparison with the Diabetes control and complications trial Epidemiology of Diabetes interventions and complicati
Diabetes, 2019Co-Authors: Rachel G. Miller, Tina Costacou, Trevor J OrchardAbstract:In a recent Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study report, mean HbA1c was the strongest predictor of cardiovascular disease (CVD) after age. In DCCT/EDIC, mean Diabetes duration was 6 years (median 4) at baseline and those with high blood pressure or cholesterol were excluded. We now replicate these analyses in the Pittsburgh Epidemiology of Diabetes Complications (EDC) prospective cohort study of childhood-onset (at <17 years of age) type 1 Diabetes, with similar age (mean 27 years in both studies) but longer Diabetes duration (mean 19 years and median 18 years) and no CVD risk factor exclusion at baseline. CVD incidence (CVD death, myocardial infarction (MI), stroke, revascularization, angina, or ischemic electrocardiogram) was associated with Diabetes duration, most recent albumin excretion rate (AER), updated mean triglycerides, baseline hypertension, baseline LDL cholesterol, and most recent HbA1c Major atherosclerotic cardiovascular events (CVD death, MI, or stroke) were associated with Diabetes duration, most recent AER, baseline systolic blood pressure, baseline smoking, and updated mean HbA1c Compared with findings in DCCT/EDIC, traditional risk factors similarly predicted CVD; however AER predominates in EDC and HbA1c in DCCT/EDIC. Thus, the relative impact of HbA1c and kidney disease in type 1 Diabetes varies according to Diabetes duration.
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Risk Factor Modeling for Cardiovascular Disease in Type 1 Diabetes in the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study: A Comparison With the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complic
Diabetes, 2018Co-Authors: Rachel G. Miller, Tina Costacou, Trevor J OrchardAbstract:In a recent Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study report, mean HbA1c was the strongest predictor of cardiovascular disease (CVD) after age. In DCCT/EDIC, mean Diabetes duration was 6 years (median 4) at baseline and those with high blood pressure or cholesterol were excluded. We now replicate these analyses in the Pittsburgh Epidemiology of Diabetes Complications (EDC) prospective cohort study of childhood-onset (at
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risk factors for diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in the Diabetes control and complications trial Epidemiology of Diabetes interventions and complications dcct edic study
Diabetes, 2020Co-Authors: Barbara H Braffett, Rose Gubitosiklug, James W Albers, Eva L Feldman, Catherine L Martin, Neil H White, Trevor J Orchard, Maria F Lopesvirella, John M Lachin, Rodica PopbusuiAbstract:The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study demonstrated that intensive glucose control reduced the risk of developing diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN). We evaluated multiple risk factors and phenotypes associated with DPN and CAN in this large, well-characterized cohort of participants with type 1 Diabetes, followed for >23 years. DPN was defined by symptoms, signs, and nerve conduction study abnormalities in ≥2 nerves; CAN was assessed using standardized cardiovascular reflex tests. Generalized estimating equation models assessed the association of DPN and CAN with individual risk factors measured repeatedly. During DCCT/EDIC, 33% of participants developed DPN and 44% CAN. Higher mean HbA1c was the most significant risk factor for DPN, followed by older age, longer duration, greater height, macroalbuminuria, higher mean pulse rate, β-blocker use, and sustained albuminuria. The most significant risk factor for CAN was older age, followed by higher mean HbA1c, sustained albuminuria, longer duration of type 1 Diabetes, higher mean pulse rate, higher mean systolic blood pressure, β-blocker use, estimated glomerular filtration rate <60 mL/min/1.73 m2, higher most recent pulse rate, and cigarette smoking. These findings identify risk factors and phenotypes of participants with diabetic neuropathy that can be used in the design of new interventional trials and for personalized approaches to neuropathy prevention.
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risk factors for diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in the Diabetes control and complications trial Epidemiology of Diabetes interventions and complications dcct edic study
Diabetes, 2020Co-Authors: Barbara H Braffett, Rose Gubitosiklug, James W Albers, Eva L Feldman, Catherine L Martin, Neil H White, Trevor J Orchard, Maria F Lopesvirella, John M Lachin, Rodica PopbusuiAbstract:The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study demonstrated that intensive glucose control reduced the risk of developing diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN). We evaluated multiple risk factors and phenotypes associated with DPN and CAN in this large, well-characterized cohort of participants with type 1 Diabetes, followed for >23 years. DPN was defined by symptoms, signs, and nerve conduction study abnormalities in ≥2 nerves; CAN was assessed using standardized cardiovascular reflex tests. Generalized estimating equation models assessed the association of DPN and CAN with individual risk factors measured repeatedly. During DCCT/EDIC, 33% of participants developed DPN and 44% CAN. Higher mean HbA1c was the most significant risk factor for DPN, followed by older age, longer duration, greater height, macroalbuminuria, higher mean pulse rate, β-blocker use, and sustained albuminuria. The most significant risk factor for CAN was older age, followed by higher mean HbA1c, sustained albuminuria, longer duration of type 1 Diabetes, higher mean pulse rate, higher mean systolic blood pressure, β-blocker use, estimated glomerular filtration rate
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electrocardiographic abnormalities and cardiovascular disease risk in type 1 Diabetes the Epidemiology of Diabetes interventions and complications edic study
Diabetes Care, 2017Co-Authors: Elsayed Z Soliman, Trevor J Orchard, Bernard Zinman, Jye-yu C. Backlund, Ionut Bebu, John M LachinAbstract:OBJECTIVE We examined the association between the prevalence and incidence of electrocardiographic (ECG) abnormalities and the development of cardiovascular disease (CVD) in patients with type 1 Diabetes, among whom these ECG abnormalities are common. RESEARCH DESIGN AND METHODS We conducted a longitudinal cohort study involving 1,306 patients with type 1 Diabetes (mean age 35.5 ± 6.9 years; 47.7% female) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. ECG abnormalities were defined by the Minnesota Code ECG classification as major, minor, or no abnormality. CVD events were defined as the first occurrence of myocardial infarction, stroke, confirmed angina, coronary artery revascularization, congestive heart failure, or death from any CVD. RESULTS During a median follow-up of 19 years, 155 participants (11.9%) developed CVD events. In multivariable Cox proportional hazard models adjusted for demographics and potential confounders, the presence of any major ECG abnormalities as a time-varying covariate was associated with a more than twofold increased risk of CVD events (hazard ratio [HR] 2.10 [95% CI 1.26, 3.48] vs. no abnormality/normal ECG, and 2.19 [1.46, 3.29] vs. no major abnormality). Also, each visit (year) at which the diagnosis of major ECG abnormality was retained was associated with a 30% increased risk of CVD (HR 1.30 [95% CI 1.14, 1.48]). The presence of minor ECG abnormalities was not associated with a significant increase in CVD risk. CONCLUSIONS The presence of major ECG abnormalities is associated with an increased risk of CVD in patients with type 1 Diabetes. This suggests a potential role for ECG screening in patients with type 1 Diabetes to identify individuals at risk for CVD.
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Haptoglobin 2–2 genotype and the risk of coronary artery disease in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study (DCCT/EDIC)
Journal of diabetes and its complications, 2016Co-Authors: Trevor J Orchard, Tina Costacou, Patricia A. Cleary, Andrew P. Levy, Jye-yu C. Backlund, Maria F. Lopes-virella, John M LachinAbstract:Abstract Aims/hypothesis Haptoglobin(Hp) 2–2 genotype has been shown to increase coronary artery disease (CAD) risk in numerous type 2 Diabetes studies but in only one type 1 Diabetes cohort. We assessed the association of Hp2–2 with incident CAD over 26 years of follow-up in 1303 Caucasian participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods DCCT randomized volunteers with type 1 Diabetes to intensive versus conventional therapy within two cohorts: ‘primary prevention’ with 1–5 years Diabetes duration and ‘secondary intervention’ with 1–15 years Diabetes duration and early retinopathy, with or without albuminuria, but no advanced complications. CAD was defined as myocardial infarction (MI) or death judged to be from CAD, silent MI, angina, coronary revascularization, or congestive heart failure due to CAD. Results In the entire DCCTcohort, Hp2–2 was not significantly associated with incident CAD or MI. However, in pre-specified exploratory subgroup analyses, an increased MI risk was suggested in the secondary cohort for those with Hp2–2. Conclusions/interpretation The analysis does not statistically confirm an overall association between Hp 2–2 and incident CAD, however, some suggestions of associations were observed in secondary analyses.
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Progression of Electrocardiographic Abnormalities in Type 1 Diabetes During 16 Years of Follow‐up: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study
Journal of the American Heart Association, 2016Co-Authors: Elsayed Z Soliman, Patricia A. Cleary, Jye-yu C. Backlund, Ionut Bebu, Zhu-ming Zhang, John M LachinAbstract:Background The electrocardiogram (ECG) is an objective tool for cardiovascular disease (CVD) risk assessment. Methods and Results We evaluated distribution of ECG abnormalities and risk factors for developing new abnormalities in 1314 patients with type 1 Diabetes (T1D) from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Annual ECGs were centrally read. ECG abnormalities were classified as major and minor according to the Minnesota ECG Classification. At EDIC year 1 (baseline), 356 (27.1%) of the participants had at least 1 ECG abnormality (major or minor) whereas 26 (2%) had at least one major abnormality. During 16 years of follow‐up, 1016 (77.3%) participants developed at least 1 new ECG abnormality (major or minor), whereas 172 (13.1%) developed at least 1 new major abnormality. Independent risk factors for developing new major ECG abnormalities were: age, current smoking, increased systolic blood pressure, and higher glycosylated hemoglobin (hazard ratio \[HR\] \[95% CI\]: 1.04 [1.02–1.06] per 1‐year increase, 1.75 [1.22–2.53], 1.03 [1.01–1.05] per 1 mm Hg increase, and 1.16 [1.04–1.29] per 10% increase, respectively). Independent risk factors for developing any new ECG abnormalities (major or minor) were age and systolic blood pressure (HR [95% CI]: 1.02 [1.01–1.03] per 1‐year increase and 1.01 [1.00–1.02] per 1 mm Hg increase, respectively). Conclusions New ECG abnormalities commonly occur in the course of T1D, consistent with the recognized increasing risk for CVD as patients age. Advanced age, increased systolic blood pressure, smoking, and higher HbA1c are independent risk factor for developing major ECG abnormalities, which underscores the importance of tight glucose control in T1D in addition to management of common CVD risk factors.