OBJECTIVES

To evaluate the relationship between long-term glycemia, traditional cardiovascular disease (CVD) risk factors, and ascending aortic stiffness in type 1 diabetes.

RESEARCH DESIGN AND METHODS

Eight hundred seventy-nine subjects in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study were evaluated. The stiffness/distensibility of the ascending thoracic aorta (AA) was measured with magnetic resonance imaging. Associations of AA distensibility and CVD risk factors, mean HbA_1c, and cardiovascular complications including macroalbuminuria were assessed using multivariate linear regression models.

RESULTS

The mean age of the subjects was 50 ± 7 years (47% women, mean diabetes duration of 28 years). Over 22 years of follow-up, 27% of participants had cardiovascular complications. After adjusting for gender and cohort, AA distensibility was lower with increasing age, mean systolic blood pressure, LDL, and HbA_1c measured over an average of 22 years (–26.3% per 10 years, –11.0% per 10 mmHg SBP, –1.8% per 10 mg/dL of LDL, and –9.3% per unit mean HbA_1c [%], respectively). Patients with macroalbuminuria had 25% lower AA distensibility compared with those without (P < 0.0001). Lower AA distensibility also was associated with greater ratio of left ventricular mass to volume (–3.4% per 0.1 g/mL; P < 0.0001).

CONCLUSIONS

Our findings indicate strong adverse effects of hypertension, chronic hyperglycemia and macroalbuminuria on AA stiffness in type 1 diabetes in the DCCT/EDIC cohort.

OBJECTIVES

To evaluate the relationship between long-term glycemia, traditional cardiovascular disease (CVD) risk factors, and ascending aortic stiffness in type 1 diabetes.

RESEARCH DESIGN AND METHODS

Eight hundred seventy-nine subjects in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study were evaluated. The stiffness/distensibility of the ascending thoracic aorta (AA) was measured with magnetic resonance imaging. Associations of AA distensibility and CVD risk factors, mean HbA_1c, and cardiovascular complications including macroalbuminuria were assessed using multivariate linear regression models.

RESULTS

The mean age of the subjects was 50 ± 7 years (47% women, mean diabetes duration of 28 years). Over 22 years of follow-up, 27% of participants had cardiovascular complications. After adjusting for gender and cohort, AA distensibility was lower with increasing age, mean systolic blood pressure, LDL, and HbA_1c measured over an average of 22 years (–26.3% per 10 years, –11.0% per 10 mmHg SBP, –1.8% per 10 mg/dL of LDL, and –9.3% per unit mean HbA_1c [%], respectively). Patients with macroalbuminuria had 25% lower AA distensibility compared with those without (P < 0.0001). Lower AA distensibility also was associated with greater ratio of left ventricular mass to volume (–3.4% per 0.1 g/mL; P < 0.0001).

CONCLUSIONS

Our findings indicate strong adverse effects of hypertension, chronic hyperglycemia and macroalbuminuria on AA stiffness in type 1 diabetes in the DCCT/EDIC cohort.

OBJECTIVE

To investigate changes in body composition after 12 months of high-intensity progressive resistance training (PRT) in relation to changes in insulin resistance (IR) or glucose homeostasis in older adults with type 2 diabetes.

RESEARCH DESIGN AND METHODS

One-hundred three participants were randomized to receive either PRT or sham exercise 3 days per week for 12 months. Homeostatic model of assessment 2 (HOMA2-IR) and glycosylated hemoglobin (HbA_1c) were used as indices of IR and glucose homeostasis. Skeletal muscle mass (SkMM) and total fat mass were assessed using bioelectrical impedance. Visceral adipose tissue, mid-thigh cross-sectional area, and mid-thigh muscle attenuation were quantified using computed tomography.

RESULTS

Within the PRT group, changes in HOMA2-IR were associated with changes in SkMM (r = –0.38; P = 0.04) and fat mass (r = 0.42; P = 0.02). Changes in visceral adipose tissue tended to be related to changes in HOMA2-IR (r = 0.35; P = 0.07). Changes in HbA_1c were related to changes in mid-thigh muscle attenuation (r = 0.52; P = 0.001). None of these relationships were present in the sham group (P > 0.05). Using ANCOVA models, participants in the PRT group who had increased SkMM had decreased HOMA2-IR (P = 0.05) and HbA_1c (P = 0.09) compared with those in the PRT group who lost SkMM. Increases in SkMM in the PRT group decreased HOMA2-IR (P = 0.07) and HbA_1c (P < 0.05) compared with those who had increased SkMM in the sham group.

CONCLUSIONS

Improvements in metabolic health in older adults with type 2 diabetes were mediated through improvements in body composition only if they were achieved through high-intensity PRT.

OBJECTIVES

To evaluate the relationship between long-term glycemia, traditional cardiovascular disease (CVD) risk factors, and ascending aortic stiffness in type 1 diabetes.

RESEARCH DESIGN AND METHODS

Eight hundred seventy-nine subjects in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study were evaluated. The stiffness/distensibility of the ascending thoracic aorta (AA) was measured with magnetic resonance imaging. Associations of AA distensibility and CVD risk factors, mean HbA_1c, and cardiovascular complications including macroalbuminuria were assessed using multivariate linear regression models.

RESULTS

The mean age of the subjects was 50 ± 7 years (47% women, mean diabetes duration of 28 years). Over 22 years of follow-up, 27% of participants had cardiovascular complications. After adjusting for gender and cohort, AA distensibility was lower with increasing age, mean systolic blood pressure, LDL, and HbA_1c measured over an average of 22 years (–26.3% per 10 years, –11.0% per 10 mmHg SBP, –1.8% per 10 mg/dL of LDL, and –9.3% per unit mean HbA_1c [%], respectively). Patients with macroalbuminuria had 25% lower AA distensibility compared with those without (P < 0.0001). Lower AA distensibility also was associated with greater ratio of left ventricular mass to volume (–3.4% per 0.1 g/mL; P < 0.0001).

CONCLUSIONS

Our findings indicate strong adverse effects of hypertension, chronic hyperglycemia and macroalbuminuria on AA stiffness in type 1 diabetes in the DCCT/EDIC cohort.

As media coverage of the new research on sugar exposure and diabetes has expanded , a few readers have asked me why our coverage did not specify that the findings apply only to Type 2 diabetes.

OBJECTIVE

To evaluate the effects of two bariatric procedures versus intensive medical therapy (IMT) on β-cell function and body composition.

RESEARCH DESIGN AND METHODS

A prospective, randomized, controlled trial of 60 subjects with uncontrolled type 2 diabetes (HbA_1c 9.7 ± 1%) and moderate obesity (BMI 36 ± 2 kg/m²) randomized to IMT alone, IMT plus Roux-en-Y gastric bypass, or IMT plus sleeve gastrectomy. Assessment of β-cell function (mixed meal tolerance testing) and body composition were performed at baseline and 12 and 24 months.

RESULTS

Glycemic control improved in all three groups at 24 months (N = 54), with a mean HbA_1c of 6.7 ± 1.2% for gastric bypass, 7.1 ± 0.8% for sleeve gastrectomy, and 8.4 ± 2.3% for IMT (P < 0.05 for each surgical group versus IMT). Reduction in body fat was similar for both surgery groups, with greater absolute reduction in truncal fat in gastric bypass versus sleeve gastrectomy (–16 vs. –10%; P = 0.04). Insulin sensitivity increased significantly from baseline in gastric bypass (2.7-fold; P = 0.004) and did not change in sleeve gastrectomy or IMT. β-cell function (oral disposition index) increased 5.8-fold in gastric bypass from baseline, was markedly greater than IMT (P = 0.001), and was not different between sleeve gastrectomy versus IMT (P = 0.30). At 24 months, β-cell function inversely correlated with truncal fat and prandial free fatty acid levels.

CONCLUSIONS

Bariatric surgery provides durable glycemic control compared with intensive medical therapy at 2 years. Despite similar weight loss as sleeve gastrectomy, gastric bypass uniquely restores pancreatic β-cell function and reduces truncal fat, thus reversing the core defects in diabetes.

OBJECTIVE

To evaluate the effects of two bariatric procedures versus intensive medical therapy (IMT) on β-cell function and body composition.

RESEARCH DESIGN AND METHODS

A prospective, randomized, controlled trial of 60 subjects with uncontrolled type 2 diabetes (HbA_1c 9.7 ± 1%) and moderate obesity (BMI 36 ± 2 kg/m²) randomized to IMT alone, IMT plus Roux-en-Y gastric bypass, or IMT plus sleeve gastrectomy. Assessment of β-cell function (mixed meal tolerance testing) and body composition were performed at baseline and 12 and 24 months.

RESULTS

Glycemic control improved in all three groups at 24 months (N = 54), with a mean HbA_1c of 6.7 ± 1.2% for gastric bypass, 7.1 ± 0.8% for sleeve gastrectomy, and 8.4 ± 2.3% for IMT (P < 0.05 for each surgical group versus IMT). Reduction in body fat was similar for both surgery groups, with greater absolute reduction in truncal fat in gastric bypass versus sleeve gastrectomy (–16 vs. –10%; P = 0.04). Insulin sensitivity increased significantly from baseline in gastric bypass (2.7-fold; P = 0.004) and did not change in sleeve gastrectomy or IMT. β-cell function (oral disposition index) increased 5.8-fold in gastric bypass from baseline, was markedly greater than IMT (P = 0.001), and was not different between sleeve gastrectomy versus IMT (P = 0.30). At 24 months, β-cell function inversely correlated with truncal fat and prandial free fatty acid levels.

CONCLUSIONS

Bariatric surgery provides durable glycemic control compared with intensive medical therapy at 2 years. Despite similar weight loss as sleeve gastrectomy, gastric bypass uniquely restores pancreatic β-cell function and reduces truncal fat, thus reversing the core defects in diabetes.

OBJECTIVE

To evaluate the effects of two bariatric procedures versus intensive medical therapy (IMT) on β-cell function and body composition.

RESEARCH DESIGN AND METHODS

A prospective, randomized, controlled trial of 60 subjects with uncontrolled type 2 diabetes (HbA_1c 9.7 ± 1%) and moderate obesity (BMI 36 ± 2 kg/m²) randomized to IMT alone, IMT plus Roux-en-Y gastric bypass, or IMT plus sleeve gastrectomy. Assessment of β-cell function (mixed meal tolerance testing) and body composition were performed at baseline and 12 and 24 months.

RESULTS

Glycemic control improved in all three groups at 24 months (N = 54), with a mean HbA_1c of 6.7 ± 1.2% for gastric bypass, 7.1 ± 0.8% for sleeve gastrectomy, and 8.4 ± 2.3% for IMT (P < 0.05 for each surgical group versus IMT). Reduction in body fat was similar for both surgery groups, with greater absolute reduction in truncal fat in gastric bypass versus sleeve gastrectomy (–16 vs. –10%; P = 0.04). Insulin sensitivity increased significantly from baseline in gastric bypass (2.7-fold; P = 0.004) and did not change in sleeve gastrectomy or IMT. β-cell function (oral disposition index) increased 5.8-fold in gastric bypass from baseline, was markedly greater than IMT (P = 0.001), and was not different between sleeve gastrectomy versus IMT (P = 0.30). At 24 months, β-cell function inversely correlated with truncal fat and prandial free fatty acid levels.

CONCLUSIONS

Bariatric surgery provides durable glycemic control compared with intensive medical therapy at 2 years. Despite similar weight loss as sleeve gastrectomy, gastric bypass uniquely restores pancreatic β-cell function and reduces truncal fat, thus reversing the core defects in diabetes.

Rather than trying to reactivate the insulin-producing beta cells, researchers say that reprogramming the alpha cells into beta cells may be a better route to take in order to treat type 2 diabetes.

More than 25 million Americans are now living with diabetes. That is roughly 8 percent of the total population of the United States.