Browsing by Author "Groop, Per-Henrik"

The fact that individuals with type 1 diabetes (T1D) are at greater risk for cardiovascular disease and premature death, can only partly be explained by traditional risk factors. Interestingly, T1D is accompanied by arterial stiffening that correlates with microvascular and macrovascular complications. The aim of this study was to find out whether arterial stiffness predicts all-cause mortality in individuals with T1D. Augmentation index (AIx), a measure of arterial pulse wave reflections, is used to estimate stiffness in the resistance arteries and can be determined non-invasively from pulse wave analysis by applanation tonometry. The data consisted of 906 individuals with T1D from the FinnDiane Study that have been examined for arterial stiffness, cardiovascular risk factors and diabetic complications at baseline between 2001 and 2015. After a median follow-up of 8.2 (5.7-9.7) years, 67 individuals had died according to mortality data from Statistics Finland. They had higher baseline AIx (28 [21-33] vs. 19 [9-27] %, P < 0.001) compared to those alive. This association was independent of related risk factors (age, sex, BMI, HbA1c, triglycerides, renal function and past cardiovascular events) in Cox regression analysis (hazard ratio 1.042 [1.007-1.078], P = 0.017). Arterial stiffness estimated by AIx independently predicted all-cause mortality in T1D. Promising pharmacological agents counteracting arterial stiffness include inhibitors of the renin-angiotensin-aldosterone system and sodium-glucose co-transporter 2, and research data on their effect in individuals with T1D is constantly growing. Our finding suggests that detecting early arterial stiffening individuals with T1D could be useful in targeting a more aggressive treatment for high-risk individuals.

Tidigare studier har visat en högre frekvens av bakterieinfektioner hos patienter med diabetes, men de specifika riskfaktorerna har varit oklara. Målet med vår studie var att underöka incidensen av bakterieinfektioner och deras koppling till kronisk hyperglykemi och diabetesnefropati hos patienter med typ 1 diabetes. Vi undersökte frekvensen av bakterieinfektioner hos patienter med typ 1 diabetes (n=4748) och deras kontrollpatienter som hade justerats för ålder och kön (n=12 954). Vi använde landsomfattande register ur vilka vi samlade information på årliga uppköp av antibiotika och epikrisdiagnoser mellan 1996 och 2009. Diabetesnefropati klassificerades enligt graden av albuminuri. Resultat: Frekvensen av bakterieinfektioner som krävde sjukhusvård och det årliga antalet uppköp av antibiotika var högre hos patienter med typ 1 diabetes, jämfört med kontrollpatienterna. Resultaten korrelerade även med svårighetsgraden av diabetesnefropati. Mängden årliga uppköp av antibiotika korrelerade med graden av kronisk hyperglykemi. Studien visar för första gången sambandet mellan bakterieinfektioner, kronisk hyperglykemi och diabetesnefropati.

Background Sedentary behavior, such as excessive sitting, is associated with an increased risk of cardiovascular disease and premature mortality in the general population, but this has not been assessed in type 1 diabetes. Occupational sitting is increasingly ubiquitous and often composes the largest portion of individuals´ daily sitting time. Our aim was, therefore, to identify clinical factors associated with excessive occupational sitting in individuals with type 1 diabetes, and additionally, in a prospective setting, to explore the association between excessive occupational sitting and cardiovascular events and all-cause mortality, independently of leisure-time physical activity. Methods Observational follow-up study, including 1,704 individuals (mean age 38.9 ± 10.1 years) from the Finnish Diabetic Nephropathy Study. Baseline assessments of occupational sitting and leisure-time physical activity were conducted using a validated self-report questionnaire. Excessive occupational sitting was defined as ≥ 6 hours of daily workplace sitting. Data on cardiovascular events and mortality were retrieved from national registries. Multivariable logistic regression analysis was applied to determine independently associated factors. Kaplan-Meier curves and Cox proportional hazard models were performed regarding prospective analyses. Results Factors independently and positively associated with excessive occupational sitting included a high educational level [OR 6.53, 95% CI (4.09‒10.40)] and older age [1.02 (1.00‒1.03)], whereas negatively associated factors included current smoking [0.68 (0.50‒0.92)], moderate albuminuria [0.55 (0.38‒ 0.80)], and high amounts of leisure-time physical activity [0.52 (0.36‒0.74)]. During a median followup of 12.5 (6.5-16.4) years, 163 (9.6%) individuals suffered a cardiovascular event. Respectively, during a median follow-up of 13.7 (9.4-16.6) years, 108 (6.3%) deaths occurred. Excessive occupational sitting increased the risk of cardiovascular events (hazard ratio [HR] 1.43 [95% CI 1.02‒2.01]) after adjustment for confounders. In a stratified multivariable analysis among current smokers, excessive occupational 5 sitting increased the risk of cardiovascular events (1.93 [1.03‒3.62]) and all-cause mortality (2.16 [1.10‒ 4.21]). Conclusions Excessive occupational sitting is associated with an increased risk of cardiovascular events and all-cause mortality in individuals with type 1 diabetes, especially among current smokers, regardless of leisuretime physical activity. These findings highlight the importance of recommendations for reducing sedentary time, as part of the physical activity guidelines for individuals with type 1 diabetes.