Glucose as a modifiable cause of atherosclerotic cardiovascular disease: Insights from type 1 diabetes and transplantation

被引:11
作者
Senior, Peter A. [1 ,2 ]
机构
[1] Univ Alberta, Div Endocrinol & Metab, 1-005 Li Ka Shing Ctr Hlth Res Innovat, Edmonton, AB T6G 2E1, Canada
[2] Univ Alberta, Alberta Diabet Inst, Charles A Allard Chair Diabet Res, 1-005 Li Ka Shing Ctr Hlth Res Innovat, Edmonton, AB T6G 2E1, Canada
关键词
Type; 1; diabetes; Glycemic variability; Cardiovascular disease; Hypoglycemia; CVOT; Pancreas transplant; Islet transplant; ALL-CAUSE MORTALITY; ISLET TRANSPLANTATION; GLYCEMIC CONTROL; KIDNEY-TRANSPLANTATION; FOLLOW-UP; MULTIFACTORIAL INTERVENTION; SIMULTANEOUS PANCREAS; NONDIABETIC SUBJECTS; SEVERE HYPOGLYCEMIA; INSULIN INJECTIONS;
D O I
10.1016/j.atherosclerosis.2021.09.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Diabetes is a major risk factor for cardiovascular (CV) disease. In contrast to the clear benefits from treatments which reduce blood pressure and lipids, clinical trials targeting blood glucose have not shown clear CV benefits. Interventions to intensify glycemic control early in the course of diabetes may have benefits in long term observational studies (DCCT-EDIC/UKPDS), but may not be helpful if introduced late in the course of type 2 diabetes (ACCORD, ADVANCE, VA-DT). More recent CVOT in high risk subjects suggest that the benefits of SGLT2 and GLP1-RA are glucose-independent. Type 1 diabetes provides a "cleaner" model to study the links between glucose and cardiovascular disease. Abnormalities of glucose regulation in type 1 diabetes is not restricted to hyperglycemia, but includes glycemic variability and hypoglycemia. Increasingly the mechanisms linking glycemic variability and hypoglycemia as key mediators of cardiovascular complications are being understood. Furthermore, data from pancreas and islet transplantation showing reduced cardiovascular mortality and regression of intima-media thickness supports a causal role for glucose in the pathogenesis of atherosclerosis, but suggests that restoration of normal glucose regulation may be required to demonstrate substantial impact on CV risk accrued over decades of type 1 diabetes. Considering the limited organ supply and risks of immunosuppression, advances in biology (stem cell derived beta cells) or technology (automated insulin delivery systems) will be required to provide a scalable solution to deliver optimal glucose control and reduce CV risk for people with type 1 diabetes.
引用
收藏
页码:16 / 22
页数:7
相关论文
共 95 条
[1]   The metabolic syndrome - a new worldwide definition [J].
Alberti, KGMM ;
Zimmet, P ;
Shaw, J .
LANCET, 2005, 366 (9491) :1059-1062
[2]   Limited impact of impaired awareness of hypoglycaemia and severe hypoglycaemia on the inflammatory profile of people with type 1 diabetes [J].
Ali, Namam ;
Janssen, Anna W. M. ;
Jaeger, Martin ;
Van de Wijer, Lisa ;
van Der Heijden, Wouter ;
ter Horst, Rob ;
Vart, Priya ;
van Gool, Alain ;
Joosten, Leo A. B. ;
Netea, Mihai G. ;
Stienstra, Rinke ;
De Galan, Bastiaan E. ;
Tack, Cees J. .
DIABETES OBESITY & METABOLISM, 2020, 22 (12) :2427-2436
[3]   Hypoglycaemia, cardiovascular disease, and mortality in diabetes: epidemiology, pathogenesis, and management [J].
Amiel, Stephanie A. ;
Frier, Brian M. ;
Heller, Simon R. ;
McCrimmon, Rory J. ;
Khunti, Kamlesh ;
Aschner, Pablo ;
Childs, Belinda ;
Cryer, Philip E. ;
Gonder-Frederick, Linda ;
Seaquist, Elizabeth R. ;
de Galan, Bastiaan E. ;
Jones, Timothy ;
Zoungas, Sophia ;
Leiter, Lawrence A. ;
Luo, Yingying ;
Pedersen-Bjergaard, Ulrik .
LANCET DIABETES & ENDOCRINOLOGY, 2019, 7 (05) :385-396
[4]   Improvement in Outcomes of Clinical Islet Transplantation: 1999-2010 [J].
Barton, Franca B. ;
Rickels, Michael R. ;
Alejandro, Rodolfo ;
Hering, Bernhard J. ;
Wease, Stephen ;
Naziruddin, Bashoo ;
Oberholzer, Jose ;
Odorico, Jon S. ;
Garfinkel, Marc R. ;
Levy, Marlon ;
Pattou, Francois ;
Berney, Thierry ;
Secchi, Antonio ;
Messinger, Shari ;
Senior, Peter A. ;
Maffi, Paola ;
Posselt, Andrew ;
Stock, Peter G. ;
Kaufman, Dixon B. ;
Luo, Xunrong ;
Kandeel, Fouad ;
Cagliero, Enrico ;
Turgeon, Nicole A. ;
Witkowski, Piotr ;
Naji, Ali ;
O'Connell, Philip J. ;
Greenbaum, Carla ;
Kudva, Yogish C. ;
Brayman, Kenneth L. ;
Aull, Meredith J. ;
Larsen, Christian ;
Kay, Tom W. H. ;
Fernandez, Luis A. ;
Vantyghem, Marie-Christine ;
Bellin, Melena ;
Shapiro, A. M. James .
DIABETES CARE, 2012, 35 (07) :1436-1445
[5]   Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range [J].
Battelino, Tadej ;
Danne, Thomas ;
Bergenstal, Richard M. ;
Amiel, Stephanie A. ;
Beck, Roy ;
Biester, Torben ;
Bosi, Emanuele ;
Buckingham, Bruce A. ;
Cefalu, William T. ;
Close, Kelly L. ;
Cobelli, Claudio ;
Dassau, Eyal ;
DeVries, J. Hans ;
Donaghue, Kim C. ;
Dovc, Klemen ;
Doyle, Francis J. ;
Garg, Satish ;
Grunberger, George ;
Heller, Simon ;
Heinemann, Lutz ;
Hirsch, Irl B. ;
Hovorka, Roman ;
Jia, Weiping ;
Kordonouri, Olga ;
Kovatchev, Boris ;
Kowalski, Aaron ;
Laffel, Lori ;
Levine, Brian ;
Mayorov, Alexander ;
Mathieu, Chantal ;
Murphy, Helen R. ;
Nimri, Revital ;
Norgaard, Kirsten ;
Parkin, Christopher G. ;
Renard, Eric ;
Rodbard, David ;
Saboo, Banshi ;
Schatz, Desmond ;
Stoner, Keaton ;
Urakami, Tatsuiko ;
Weinzimer, Stuart A. ;
Phillip, Moshe .
DIABETES CARE, 2019, 42 (08) :1593-1603
[6]   Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections A Randomized Trial [J].
Beck, Roy W. ;
Riddlesworth, Tonya D. ;
Ruedy, Katrina ;
Ahmann, Andrew ;
Haller, Stacie ;
Kruger, Davida ;
McGill, Janet B. ;
Polonsky, William ;
Price, David ;
Aronoff, Stephen ;
Aronson, Ronnie ;
Toschi, Elena ;
Kollman, Craig ;
Bergenstal, Richard .
ANNALS OF INTERNAL MEDICINE, 2017, 167 (06) :365-+
[7]   Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections The DIAMOND Randomized Clinical Trial [J].
Beck, Roy W. ;
Riddlesworth, Tonya ;
Ruedy, Katrina ;
Ahmann, Andrew ;
Bergenstal, Richard ;
Haller, Stacie ;
Kollman, Craig ;
Kruger, Davida ;
McGill, Janet B. ;
Polonsky, William ;
Toschi, Elena ;
Wolpert, Howard ;
Price, David .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2017, 317 (04) :371-378
[8]   Long-Term (5 Years) Efficacy and Safety of Pancreas Transplantation Alone in Type 1 Diabetic Patients [J].
Boggi, Ugo ;
Vistoli, Fabio ;
Amorese, Gabriella ;
Giannarelli, Rosa ;
Coppelli, Alberto ;
Mariotti, Rita ;
Rondinini, Lorenzo ;
Barsotti, Massimiliamo ;
Signori, Stefano ;
De Lio, Nelide ;
Occhipinti, Margherita ;
Mangione, Emanuela ;
Cantarovich, Diego ;
Del Prato, Stefano ;
Mosca, Franco ;
Marchetti, Piero .
TRANSPLANTATION, 2012, 93 (08) :842-846
[9]   Biochemistry and molecular cell biology of diabetic complications [J].
Brownlee, M .
NATURE, 2001, 414 (6865) :813-820
[10]   The pathobiology of diabetic complications - A unifying mechanism [J].
Brownlee, M .
DIABETES, 2005, 54 (06) :1615-1625