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J Clin Endocrinol Metab. 2019 Jan 11. doi: 10.1210/jc.2018-00946. [Epub ahead of print]

Apnea hypopnea index during rapid eye movement sleep with diabetic retinopathy in patients with type 2 diabetes.

Author information

1
Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
2
Sleep Center, Toranomon Hospital, Tokyo, Japan.
3
Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Abstract

Context:

Recent studies based on home sleep apnea testing (HSAT) reported the potential association of sleep disordered breathing (SDB), such as obstructive sleep apnea (OSA), with diabetic retinopathy (DR). A few studies showed that the apnea hypopnea index during rapid eye movement sleep (REM-AHI) is associated with glycated hemoglobin and hypertension, two known risk factors for DR. However, there are no studies that have evaluated the association of REM-AHI with DR because previous studies were based on HSAT.

Objective:

To determine the association of REM-AHI with DR.

Design, Setting, and Patients:

The study subjects were 131 patients with type 2 diabetes mellitus who underwent all-night polysomnography with ≥30 minutes of REM sleep and were free of heart failure or active lung disease and had not yet been treated for OSA. Logistic regression analysis was performed to determine the effect of REM-AHI on the prevalence of DR adjusted by several known risk factors for DR.

Results:

Quartile of REM-AHI was independently associated with DR [p=0.024, odds ratio (OR) and 95% confidence interval (95%CI) for Q2, 3.887 (0.737-20.495); Q3, 9.467 (1.883-47.588); Q4, 12.898 (2.008-82.823), relative to Q1] whereas quartile of NREM-AHI was not (p=0.119). Similarly, continuous REM-AHI (OR, 2.875; 95%CI, 1.224-6.752; p=0.015) was independently associated with DR whereas NREM-AHI was not (p=0.107). In addition, AHI was independently associated with DR when controlling for several known risk factors for DR (p=0.043).

Conclusion:

REM-AHI was independently associated with DR. REM-AHI could be a potential risk factor for DR.

5.
J Clin Endocrinol Metab. 2018 Jul 1;103(7):2651-2659. doi: 10.1210/jc.2018-00306.

Changes Over Time in Hepatic Markers Predict Changes in Insulin Sensitivity, β-Cell Function, and Glycemia.

Author information

1
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada.
2
Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada.
3
Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
4
Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada.
5
Division of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
6
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.

Abstract

Context:

Serum concentrations of liver enzymes and the hepatokine fetuin-A have been linked to the risk of type 2 diabetes, but their longitudinal impact on insulin resistance and β-cell dysfunction is unclear.

Objective:

To evaluate the impact of changes over 2 years in fetuin-A and the liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyltransferase (GGT) on changes in insulin sensitivity, β-cell function, and glycemia in women with varying degrees of previous gestational dysglycemia, reflecting a range of future diabetic risk.

Design/Setting/Participants:

In total, 336 women underwent glucose challenge test (GCT) and oral glucose tolerance test (OGTT) in pregnancy, followed by repeat OGTT and measurement of ALT/AST/GGT/fetuin-A at both 1 year and 3 years postpartum. The antepartum GCT/OGTT identified four gestational glucose tolerance groups: gestational diabetes (n = 104), gestational impaired glucose tolerance (n = 59), abnormal GCT with normal OGTT (n = 98), and normal GCT/OGTT (n = 75).

Results:

At 1 and 3 years postpartum, ALT, AST, GGT, and fetuin-A did not differ across the four groups, but the intervening change in ALT/AST ratio was greater in the gestational dysglycemia groups (P = 0.05). Higher baseline ALT/AST (t = -1.99, P = 0.05) and fetuin-A (t = -3.17, P = 0.002) predicted lower insulin sensitivity (Matsuda) at 3 years, as did their respective changes from 1 to 3 years (ALT/AST: t = -5.47, P < 0.0001; fetuin-A: t = -3.56, P = 0.0004). Change in ALT/AST predicted lower β-cell function (t = -2.33, P = 0.02) and higher fasting glucose at 3 years (t = 2.55, P = 0.01). Moreover, baseline fetuin-A predicted prediabetes/diabetes at 3 years (OR, 1.38; 95% CI, 1.01 to 1.88).

Conclusion:

Circulating hepatic markers, particularly ALT/AST ratio and fetuin-A, track with changes in insulin sensitivity and β-cell function, supporting a pathophysiologic basis in their prediction of diabetic risk.

PMID:
29897453
DOI:
10.1210/jc.2018-00306
[Indexed for MEDLINE]
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6.
Lancet. 2018 Nov 17;392(10160):2142-2144. doi: 10.1016/S0140-6736(18)32466-8. Epub 2018 Oct 4.

Twice the benefits with twincretins?

Author information

1
Universitätsklinikum Leipzig and Helmholtz Institut für Metabolismus, Adipositas und Gefäßforschung (HI-MAG), Leipzig, Germany.
2
Helmholtz Zentrum München, Neuherberg, Germany; Technische Universität München, Munich 80333, Germany. Electronic address: matthias.tschoep@helmholtz-muenchen.de.
PMID:
30293768
DOI:
10.1016/S0140-6736(18)32466-8
[Indexed for MEDLINE]
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