Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

Relationship of nonalcoholic hepatic steatosis to cortisol secretion in diet-controlled type 2 diabetic patients.

AimsTo examine the association of non-alcoholic hepatic steatosis (HS) withthe activity of the hypothalamo-pituitary-adrenal (HPA) axis in Type 2 diabeticindividuals.MethodsThe activity of the HPA axis, as measured by 24-h urinary free cortisol(UFC) excretion and serum cortisol levels after 1.0 mg dexamethasone, wasmeasured in 40 diet-controlled, predominantly overweight, Type 2 diabeticpatients with non-alcoholic HS and in 40 diabetic patients without HS whowere comparable for age, sex and body mass index (BMI).ResultsSubjects with non-alcoholic HS had significantly higher 24-h UFCexcretion (191\ub14 vs. 102\ub13 nmol/24 h;P< 0.001) and post-dexamethasonecortisol concentrations (29.1\ub12 vs. 14.4\ub11 nmol/ l;P< 0.001) than thosewithout HS. Patients with HS had significantly higher values for HOMA insulinresistance score, plasma triglycerides and liver enzymes. Age, sex, BMI, waist\u2013hip ratio (WHR), diabetes duration, HbA1c, LDL-cholesterol and blood pressurevalues were not different between the groups. The differences in urinaryand serum cortisol concentrations between the groups remained significant afteradjustment for age, sex, BMI, WHR, HOMA insulin resistance score, plasmatriglycerides, HbA1cand liver enzymes. In multiple logistic regression analyses,24-h UFC or serum cortisol concentrations (P <0.05 andP= 0.02, respectively),along with age and HOMA insulin resistance, predicted the presence of HS,independently of potential confounders.ConclusionsThese results demonstrate that non-alcoholic HS is closely associatedwith a subtle, chronic overactivity of the HPA axis in diet-controlled Type 2diabetic individuals

Increased plasma markers of inflammation and endothelial dysfunction and their association with microvascular complications in type 1 diabetic patients without clinically manifest macroangiopathy.

Aims To evaluate whether plasma biomarkers of inflammation and endothelial dysfunction differed in Type 1 diabetic patients as compared with those in non-diabetic subjects, and to examine the association of these biomarkers with early stages of microvascular complications. Methods Plasma biomarkers of inflammation [fibrinogen, hs-C-reactive protein (hs-CRP)] and endothelial dysfunction [von Willebrand factor (v-WF), intercellular adhesion molecule-1, plasminogen activator inhibitor-1 (PAI-1) activity] were measured in 88 non-smoking young patients with Type 1 diabetes without clinical macrovascular disease and in 40 healthy controls. Results Plasma levels of hs-CRP, fibrinogen, v-WF, soluble intracellular adhesion molecule-1 (sICAM-1) and PAI-1 activity were markedly higher (P < 0.01 or less) in Type 1 diabetic patients than in healthy controls; these results were essentially unchanged when healthy controls were compared with patients without complications. After stratification by microvascular complication status, plasma biomarkers of inflammation and endothelial dysfunction were significantly increased in those with more advanced disease compared with those with early complications or without complications, respectively. However, while the significant differences in these biomarkers were little affected by adjustment for sex, age, BMI and blood pressure values, they were totally abolished after additional adjustment for diabetes duration and glycaemic control. Conclusions These results indicate that in Type 1 diabetes there is a subclinical, chronic inflammation which is, at least partly, independent of clinically manifest macro- and microvascular complications, smoking or other traditional cardiovascular risk factors; this subclinical inflammation is closely correlated to the magnitude and duration of hyperglycaemia

Elevated levels of interleukin-6 in young adults with type 1 diabetes without clinical evidence of microvascular and macrovascular complications

Elevated levels of interleukin-6 in young adults with type 1 diabetes without clinical evidence of microvascular and macrovascular complication