Menopause and diabetes : EMAS clinical guide

Introduction: Whether menopause increases the risk of type 2 diabetes mellitus (T2DM) independently of ageing has been a matter of debate. Controversy also exists about the benefits and risks of menopausal hormone therapy (MHT) in women with T2DM. Aims: To summarise the evidence on 1) the effect of menopause on metabolic parameters and the risk of T2DM, 2) the effect of T2DM on age at menopause, 3) the effect of MHT on the risk of T2DM, and 4) the management of postmenopausal women with T2DM. Materials and methods: Literature review and consensus of experts' opinions. Results and conclusion: Metabolic changes during the menopausal transition include an increase in and the central redistribution of adipose tissue, as well as a decrease in energy expenditure. In addition, there is impairment of insulin secretion and insulin sensitivity and an increase in the risk of T2DM. MHT has a favourable effect on glucose metabolism, both in women with and in women without T2DM, while it may delay the onset of T2DM. MHT in women with T2DM should be administered according to their risk of cardiovascular disease (CVD). In women with T2DM and low CVD risk, oral oestrogens may be preferred, while transdermal 17 beta-oestradiol is preferred for women with T2DM and coexistent CVD risk factors, such as obesity. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as progesterone, dydrogesterone or transdermal norethisterone. Postmenopausal women with T2DM should be managed primarily with lifestyle intervention, including diet and exercise. Most of them will eventually require pharmacological therapy. The selection of antidiabetic medications should be based on the patient's specific characteristics and comorbidities, as well on the metabolic, cardiovascular and bone effects of the medications.Peer reviewe

Brain-Derived Neurotrophic Factor and Diabetes

Diabetes and its chronic complications still represent a great clinical problem, despite improvements made in the diagnosis and treatment of the disease. People with diabetes have a much higher risk of impaired brain function and psychiatric disorders. Neurotrophins are factors that protect neuronal tissue and improve the function of the central nervous system, and among them is brain-derived neurotrophic factor (BDNF). The level and function of BDNF in diabetes seems to be disturbed by and connected with the presence of insulin resistance. On the other hand, there is evidence for the highly beneficial impact of physical activity on brain function and BDNF level. However, it is not clear if this protective phenomenon works in the presence of diabetes. In this review, we summarize the current available research on this topic and find that the results of published studies are ambiguous

Can We Prevent Mitochondrial Dysfunction and Diabetic Cardiomyopathy in Type 1 Diabetes Mellitus? Pathophysiology and Treatment Options

Type 1 diabetes mellitus is a disease involving changes to energy metabolism. Chronic hyperglycemia is a major cause of diabetes complications. Hyperglycemia induces mechanisms that generate the excessive production of reactive oxygen species, leading to the development of oxidative stress. Studies with animal models have indicated the involvement of mitochondrial dysfunction in the pathogenesis of diabetic cardiomyopathy. In the current review, we aimed to collect scientific reports linking disorders in mitochondrial functioning with the development of diabetic cardiomyopathy in type 1 diabetes mellitus. We also aimed to present therapeutic approaches counteracting the development of mitochondrial dysfunction and diabetic cardiomyopathy in type 1 diabetes mellitus

Better Gingival Status in Patients with Comorbidity of Type 1 Diabetes and Thyroiditis in Comparison with Patients with Type 1 Diabetes and No Thyroid Disease—A Preliminary Study

Periodontal disease has been postulated as one of the chronic complications of diabetes. The prevalence of autoimmune thyroiditis in type 1 diabetes (T1D) is higher. The aim of the study was to determine the association between the presence of thyroiditis and gingival status in adults with T1D. A total of 264 patients, 119 men aged 18–45, diagnosed with T1D were included. For further analysis, the study group was divided into two subgroups, with or without autoimmune thyroiditis. Gingival status was assessed with the use of gingival indices. Patients diagnosed with T1D and thyroiditis presented lower plaque accumulation (p = 0.01) and lower-grade gingivitis (p = 0.02). Approximal Plaque Index (API) in all study groups correlated positively with age (Rs = 0.24; p = 0.0001), body mass index (BMI) (Rs = 0.22; p = 0.0008), hemoglobin A1c (HbA1c) (Rs = 0.18; p = 0.006), high-sensitivity C-Reactive Protein (hsCRP) (Rs = 0.17; p = 0.009), total cholesterol (T-Chol) (Rs = 0.17; p = 0.01) and negatively with thyroid-stimulating hormone (TSH) (Rs = −0.2; p = 0.02). Stepwise multivariate linear regression analysis indicated TSH, BMI and gender as independent predictors of dental plaque accumulation in patients with T1D. Autoimmune thyroiditis was associated with a lower accumulation of dental plaque and better gingival status in patients with T1D

Better Gingival Status in Patients with Comorbidity of Type 1 Diabetes and Thyroiditis in Comparison with Patients with Type 1 Diabetes and No Thyroid Disease—A Preliminary Study

Periodontal disease has been postulated as one of the chronic complications of diabetes. The prevalence of autoimmune thyroiditis in type 1 diabetes (T1D) is higher. The aim of the study was to determine the association between the presence of thyroiditis and gingival status in adults with T1D. A total of 264 patients, 119 men aged 18–45, diagnosed with T1D were included. For further analysis, the study group was divided into two subgroups, with or without autoimmune thyroiditis. Gingival status was assessed with the use of gingival indices. Patients diagnosed with T1D and thyroiditis presented lower plaque accumulation (p = 0.01) and lower-grade gingivitis (p = 0.02). Approximal Plaque Index (API) in all study groups correlated positively with age (Rs = 0.24; p = 0.0001), body mass index (BMI) (Rs = 0.22; p = 0.0008), hemoglobin A1c (HbA1c) (Rs = 0.18; p = 0.006), high-sensitivity C-Reactive Protein (hsCRP) (Rs = 0.17; p = 0.009), total cholesterol (T-Chol) (Rs = 0.17; p = 0.01) and negatively with thyroid-stimulating hormone (TSH) (Rs = −0.2; p = 0.02). Stepwise multivariate linear regression analysis indicated TSH, BMI and gender as independent predictors of dental plaque accumulation in patients with T1D. Autoimmune thyroiditis was associated with a lower accumulation of dental plaque and better gingival status in patients with T1D

Palacze z cukrzycą typu 1 są bardziej oporni na insulinę. Wyniki z Poznań Prospective Study (PoProStu).

  Aim. The aim of the study was to evaluate the rela­tionship between smoking and insulin resistance in patients with type 1 diabetes (DM1). Material and methods. The study group consisted of 81 patients with DM1 (51 men, 30 women) from the Poznan Prospective Study (PoProStu), aged 34 ± 6 years, and with diabetes duration 10 ± 1.5 years. Patients were divided into two groups depending on the smoking status: smokers and non-smokers. Insulin resistance was assessed on the basis of indirect param­eters such as: estimated glucose disposal rate (eGDR), anthropometric data and liver function. Results. Smokers (n = 36) in comparison with non-smokers (n = 45) had: higher weight (80.4 ± 14.4 vs. 72.9 ± 15 kg, p = 0.02), larger waist circumference (89.6 ± 10.5 vs. 83.1 ± 10.9 cm, p = 0.003), higher waist-to-hip ratio (0.9 ± 0.08 vs. 0.86 ± 0.09, p = 0.006), higher level of gamma-glutamyl transferase [23 (15–36) vs. 15 (11–21) U/l, p = 0.003] and lower eGDR (7.11 ± 2.47 vs. 8.82 ± 1.79 mg/kg/min, p = 0.001). A significant relationship, adjusted for age, duration of diabetes, triglycerids (TG) and high density lipoproteins (HDL) cholesterol level between smoking and eGDR < 7.5 mg/kg/min was revealed [odds ratio OR 4.39 (95% confidence interval CI 1.52–12.66); p = 0.005]. Conclusions. The results of this study confirm the healthy dimension of not smoking among people with type 1 diabetes. Smoking in patients with type 1 dia­betes, treated from the initial diagnosis with intensive insulin therapy, is associated with insulin resistance. (Clin Diabetol 2018; 7, 2: 122–127)  Cel Celem pracy była ocena związku między paleniem tytoniu a insulinoopornością u pacjentów z cukrzycą typu 1 (DM1). Materiał i metody Grupa badana składała się z 81 pacjentów z DM1 (51 mężczyzn, 30 kobiet) z Poznan Prospective Study (PoProStu), w wieku 34±6.4 roku, z cukrzycą trwającą 10.5 roku. Pacjenci zostali podzieleni na dwie grupy w zależności od statusu palenia: palacze i osoby niepalące. Insulinooporność oceniano na podstawie parametrów pośrednich, takich jak: szacowany wskaźnik dystrybucji glukozy (eGDR), dane antropometryczne i czynność wątroby. Wyniki Palacze (n=36) w porównaniu z niepalącymi (n=45) mieli: wyższą masę ciała (80.4±14.4 vs 72.9±15 kg, p=0.02), większy obwód talii (89.6±10.5 vs 83.1±10.9 cm, p=0.003), wyższy WHR (0.9±0.08 vs. 0.86±0.09, p=0.006), wyższy poziom transferazy gamma-glutamylowej (23 [15-36] vs 15 [11-21] U/l, p=0.003) i niższy eGDR (7.11±2.47 vs 8.82±1.79 mg/kg/min, p=0.001). Wykazano istotny związek, skorygowany pod względem wieku, czasu trwania cukrzycy, triglicerydów (TG) i poziomu cholesterolu HDL (high density lipoproteins) między paleniem tytoniu a eGD