1 型糖尿病患者 10 年生酮饮食后的高级心血管生理学。

IF 5 2区 生物学 Q2 CELL BIOLOGY American journal of physiology. Cell physiology Pub Date : 2024-08-01 Epub Date: 2024-06-24 DOI:10.1152/ajpcell.00694.2023
Joseph C Watso, Austin T Robinson, Saiful Anuar Bin Singar, Jens N Cuba, Andrew P Koutnik
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引用次数: 0

摘要

与普通人群相比,1 型糖尿病(T1D)患者罹患心血管疾病(CVD)的风险较高。HbA1c 是 T1D 患者罹患心血管疾病的主要可改变风险因素。只有不到1%的患者能达到优生血糖(所有患者的第10百分位数);胰岛素需求量低,为0.38±0.03IU/kg/天(T1D标准:第8百分位数)。坐位收缩压(SBP)为 113mmHg(T1D 标准:第 18 百分位数),而卧位清醒 SBP 为 132±15mmHg(T1D 目标:第 th 百分位数),低密度脂蛋白为 129mg/dL(T1D 标准:第 60 百分位数),心率为 56bpm(T1D 标准:低于平均值 >1SD),颈动脉-股动脉脉搏波速度为 7.17m/s(T1D 常模:风险最低四分位数),血流介导的扩张率为 12.8%(T1D 常模:高于平均值 1SD),心脏迷走神经条反射增益为 23.5ms/mmHg(T1D 常模:高于平均值 1SD)。最后,超声心动图没有显示左心室舒张功能障碍。总体而言,这些数据表明,尽管人们担心 KD 对心血管疾病风险的长期影响,但相对于 T1D 常模而言,心血管疾病风险低于平均水平。
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Advanced cardiovascular physiology in an individual with type 1 diabetes after 10-year ketogenic diet.

Adults with type 1 diabetes (T1D) have an elevated risk for cardiovascular disease (CVD) compared with the general population. HbA1c is the primary modifiable risk factor for CVD in T1D. Fewer than 1% of patients achieve euglycemia (<5.7% HbA1c). Ketogenic diets (KD; ≤50 g carbohydrate/day) may improve glycemia and downstream vascular dysfunction in T1D by reducing HbA1c and insulin load. However, there are concerns regarding the long-term CVD risk from a KD. Therefore, we compared data collected in a 60-day window in an adult with T1D on exogenous insulin who consumed a KD for 10 years versus normative values in those with T1D (T1D norms). The participant achieved euglycemia with an HbA1c of 5.5%, mean glucose of 98 [5] mg/dL (median [interquartile range]), 90 [11]% time-in-range 70-180 mg/dL (T1D norms: 1st percentile for all), and low insulin requirements of 0.38 ± 0.03 IU/kg/day (T1D norms: 8th percentile). Seated systolic blood pressure (SBP) was 113 mmHg (T1D norms: 18th percentile), while ambulatory awake SBP was 132 ± 15 mmHg (T1D target: <130 mmHg), blood triglycerides were 69 mg/dL (T1D norms: 34th percentile), low-density lipoprotein was 129 mg/dL (T1D norms: 60th percentile), heart rate was 56 beats/min (T1D norms: >1SD below the mean), carotid-femoral pulse wave velocity was 7.17 m/s (T1D norms: lowest quartile of risk), flow-mediated dilation was 12.8% (T1D norms: >1SD above mean), and cardiac vagal baroreflex gain was 23.5 ms/mmHg (T1D norms: >1SD above mean). Finally, there was no indication of left ventricular diastolic dysfunction from echocardiography. Overall, these data demonstrate below-average CVD risk relative to T1D norms despite concerns regarding the long-term impact of a KD on CVD risk.NEW & NOTEWORTHY Adults with type 1 diabetes (T1D) have a 10-fold higher risk for cardiovascular disease (CVD) compared with the general population. We assessed cardiovascular health metrics in an adult with T1D who presented with a euglycemic HbA1c after following a ketogenic diet for the past 10 years. Despite concerns about the ketogenic diet increasing CVD risk, the participant exhibited below-average CVD risk relative to others with T1D when considering all outcomes together.

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来源期刊
CiteScore
9.10
自引率
1.80%
发文量
252
审稿时长
1 months
期刊介绍: The American Journal of Physiology-Cell Physiology is dedicated to innovative approaches to the study of cell and molecular physiology. Contributions that use cellular and molecular approaches to shed light on mechanisms of physiological control at higher levels of organization also appear regularly. Manuscripts dealing with the structure and function of cell membranes, contractile systems, cellular organelles, and membrane channels, transporters, and pumps are encouraged. Studies dealing with integrated regulation of cellular function, including mechanisms of signal transduction, development, gene expression, cell-to-cell interactions, and the cell physiology of pathophysiological states, are also eagerly sought. Interdisciplinary studies that apply the approaches of biochemistry, biophysics, molecular biology, morphology, and immunology to the determination of new principles in cell physiology are especially welcome.
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