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Diabetes & Metabolic Syndrome

Landmark Articles

Abdominal adiposity in rheumatoid arthritis: Association with cardiometabolic risk factors and disease characteristics.
By: Giles JT, Allison M, Blumenthal RS, Post W, Gelber AC, Petri M, Tracy R, Szklo M, Bathon JM.
The distribution of abdominal fat differs significantly by rheumatoid arthritis (RA) status. Higher visceral fat area (VFA) in men with RA, and the more potent association of VFA with cardiometabolic risk factors in men and women with RA, may contribute to cardiovascular risk in RA populations.
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Statins and risk of incident diabetes.
By: McEvoy JW.

Reported limitations of a meta-analysis of whether statin therapy affects incident diabetes (13 statin trials with 91,140 participants) include the loss of statistical significance on exclusion of two trials in which incident diabetes was by physician report only. Post-hoc and subgroup analyses introduce analytical errors that can lead to misleading conclusions. Therefore, these capricious findings should be regarded as a hypothesis generating statistical anomaly, lest we fall foul of the logical fallacy, “Post hoc ergo propter hoc.”

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Association between increasing levels of hemoglobin A1c and coronary atherosclerosis in asymptomatic individuals without diabetes mellitus.
By: Rivera JJ, Choi EK, Yoon YE, Chun EJ, Choi SI, Nasir K, Brancati FL, Blumenthal RS, Chang HdeveolpedJ.
Increasing levels of HbA1c in asymptomatic individuals without DM are associated with the presence of coronary atherosclerosis, but more specifically with the presence and burden of mixed coronary plaques. Elements of plaque instability have been associated with mixed coronary plaques.
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Update on obstructive sleep apnea and its associated metabolic abnormalities: Insulin resistance, The Metabolic Syndrome, and type 2 diabetes mellitus.
By: Tota-Maharaj R, Blumenthal RS, Blaha MJ.

Obstructive sleep apnea is characterized by repeated episodes of upper airway collapse during sleep, leading to apneic and hypopneic episodes, oxygen desaturation, and sleep fragmentation. This condition is closely associated with features of “metabolic syndrome” as well as overt diabetes. Although the association of metabolic abnormalities clearly portend increased cardiovascular risk, it remains unclear to what extent obesity confounds these associations. Attempts to demonstrate a causal relationship between obstructive sleep apnea and insulin resistance have yielded conflicting results. Although several recent studies have demonstrated a relationship between obstructive sleep apnea and diabetes mellitus independent of obesity, there are currently limited data demonstrating a strong causative link. The currently proposed pathophysiology involves intermittent hypoxia, sleep fragmentation, sympathetic activation, oxidative stress, an increase in proinflammatory adipocytokines, and hyperleptinemia and leptin resistance. Although continuous positive airway pressure has shown promise in treating obstructive sleep apnea and its associated metabolic derangements, two recent large, randomized controlled trials have redoubled the emphasis on weight loss in treating the triad of metabolic syndrome, diabetes, and obstructive sleep apnea. Weight loss and aggressive lifestyle intervention remain a common treatment modality for all of these conditions and should always be considered first-line treatment for this clinical construct.

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NOS1AP variant associated with incidence of type 2 diabetes in calcium channel blocker users in the Atherosclerosis Risk in Communities (ARIC) study.
By: Chu AY, Coresh J, Arking DE, Pankow JS, Tomaselli GF, Chakravarti A, Post WS, Spooner PH, Boerwinkle E, Kao WH.

We have independently replicated the association between rs10494366 in NOS1AP (the gene encoding nitric oxide synthase-1 adaptor protein) and incident diabetes among white calcium channel blocker users. Further exploration of NOS1AP variants and type 2 diabetes and functional studies of NOS1AP in type 2 diabetes pathology is warrranted.

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Life course socioeconomic conditions and metabolic syndrome in adults: the Atherosclerosis Risk in Communities (ARIC) Study.
By: Chichlowska KL, Rose KM, Diez-Roux AV, Golden SH, McNeill AM, Heiss G.
Black and white women with low childhood socioeconomic status (SES), early adult SES, mature adult SES or cumulative SES were more likely to have the metabolic syndrome (MetS) than those with high SES. These associations remained after adjustment for physical activity, smoking status, and drinking status. In contrast, there was no association of SES with MetS in men. Our findings suggest that socioeconomic disadvantage early in life and across the life course influences risk of the MetS in black and white women.
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Assessment of subclinical coronary atherosclerosis in asymptomatic patients with type 2 diabetes mellitus with single photon emission computed tomography and coronary computed tomography angiography.
By: Choi EK, Chun EJ, Choi SI, Chang SA, Choi SH, Lim S, Rivera JJ, Nasir K, Blumenthal RS, Jang HC, Chang HJ.
We evaluated the characteristics of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus (DM) using single photon emission computed tomography (SPECT) and coronary computed tomographic angiography (CCTA). In conclusion, a significant percentage of patients with DM and normal eletrocardiographic findings, no peripheral arterial disease, and normal findings on SPECT have evidence of occult CAD on CCTA. Furthermore, a small percentage had had a cardiac event by mid-term follow-up.
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