Sex Disparities in the Treatment and Control of Cardiovascular Risk Factors in Type 2 Diabetes

OBJECTIVE: To assess whether sex differences exist in the effective control and medication treatment intensity of cardiovascular disease (CVD) risk factors.

RESEARCH DESIGN AND METHODS: We performed a cross-sectional analysis including 44,893 patients with type 2 diabetes (51% women). End points included uncontrolled CVD risk factors (LDL cholesterol >=130 mg/dl, systolic blood pressure [SBP] >=140 mmHg, and A1C >=8%) and the intensity of medical management in patients with uncontrolled CVD risk factors. Multiple-adjusted odds ratios were calculated after stratification for the presence of CVD (present in 39% of the patients).

RESULTS: Women with CVD were less likely to have SBP, LDL cholesterol, and A1C controlled and less likely to receive intensive lipid-lowering treatment. Women without CVD were less likely than men to have LDL cholesterol controlled with no differences in SBP or A1C control.

CONCLUSIONS: Women with diabetes and CVD have poorer control of important modifiable risk factors than men and receive less intensified lipid-lowering treatment.

(C) 2008 by the American Diabetes Association, Inc.

Trends in High-Risk HLA Susceptibility Genes Among Colorado Youth With Type 1 Diabetes

OBJECTIVE: Type 1 diabetes is associated with a wide spectrum of susceptibility and protective genotypes within the HLA class II system. It has been reported that adults diagnosed with youth-onset type 1 diabetes more recently have been found to have fewer classical high-risk HLA class II genotypes than those diagnosed several decades ago. We hypothesized that such temporal trends in the distribution of HLA-DR, DQ genotypes would be evident, and perhaps even stronger, among 5- to 17-year-old Hispanic and non-Hispanic white (NHW) youth diagnosed with type 1 diabetes in Colorado between 1978 and 2004.

RESEARCH DESIGN AND METHODS: HLA-DR, DQ was typed using PCR and sequence-specific oligonucleotide hybridization in 100 youth diagnosed during the period of 1978-1988 and 264 diagnosed during 2002-2004. Logistic regression was used to adjust for confounders and assess temporal trends.

RESULTS: The frequency of the highest-risk genotype (DRB1*03-DQB1*02/DRB1*04-DQB1*03) was higher (39%) in children diagnosed during the period 1978-1988 than in those diagnosed during 2002-2004 (28%). A similar pattern was observed in NHWs and Hispanics.

CONCLUSIONS: We found that high-risk HLA genotypes are becoming less frequent over time in youth with type 1 diabetes of NHW and Hispanic origin. This temporal trend may suggest that increasing environmental exposure is now able to trigger type 1 diabetes in subjects who are less genetically susceptible.

(C) 2008 by the American Diabetes Association, Inc.

Increased Shear Rate Resistance and Fastest Kinetics of Erythrocyte Aggregation in Diabetes Measured With Ultrasound

OBJECTIVE: To measure with ultrasound the increased erythrocyte aggregation (EA) kinetics and adhesion energy between erythrocytes in patients with type 2 diabetes and poor metabolic control.

RESEARCH DESIGN AND METHODS: Blood samples were analyzed in a Couette rheometer at 32 MHz following shear rate reductions from 500 s-1 to residual shears of 0 (stasis), 1, 2, 10, 50, 100, and 200 s-1. The increase in EA was determined with the integrated backscatter coefficient as a function of time and shear rate.

RESULTS: The time required to form aggregates was shorter in diabetic patients at shear rates below 200 s-1 (P <>

CONCLUSIONS: Ultrasound can potentially noninvasively demonstrate, in vivo and in situ, the impact of local abnormal EA on arteriovenous flow disorders in diabetes.

(C) 2008 by the American Diabetes Association, Inc.

Too Much Glucagon, Too Little Insulin: Time course of pancreatic islet dysfunction in new-onset type 1 diabetes

OBJECTIVE: To determine the time course of changes in glucagon and insulin secretion in children with recently diagnosed type 1 diabetes.

RESEARCH DESIGN AND METHODS: Glucagon and C-peptide concentrations were determined in response to standard mixed meals in 23 patients with type 1 diabetes aged 9.4 +/- 4.6 years, beginning within 6 weeks of diagnosis, and every 3 months thereafter for 1 year.

RESULTS: Glucagon secretion in response to a physiologic stimulus (mixed meal) increased by 37% over 12 months, while C-peptide secretion declined by 45%. Fasting glucagon concentrations remained within the normal (nondiabetic) reference range.

CONCLUSIONS: Postprandial hyperglucagonemia worsens significantly during the first year after diagnosis of type 1 diabetes and may represent a distinct therapeutic target. Fasting glucagon values may underestimate the severity of hyperglucagonemia. The opposing directions of abnormal glucagon and C-peptide secretion over time support the link between dysregulated glucagon secretion and declining [beta]-cell function.

(C) 2008 by the American Diabetes Association, Inc.