Abstract Objective: To evaluate the association between diabetic retinopathy, diabetic kidney disease, and the 10-year risk of atherosclerotic cardiovascular disease in patients with diabetes. Subjects and methods: A cross-sectional study was performed involving patients diagnosed with either type 1 or type 2 diabetes mellitus. Participants were classified into four groups: DM (patients without diabetes-related complications), DR (patients with diabetic retinopathy only), DKD (patients with diabetic kidney disease only), and DR + DKD (patients with both diabetic retinopathy and diabetic kidney disease). The primary outcome was the 10-year risk assessment for cardiovascular events, calculated using the American Heart Association’s atherosclerotic cardiovascular disease score. Results: A total of 571 patients were selected including 128 with type 1 diabetes (average age of 39.4 ± 15.1 years; 48.4% female) and 443 with type 2 diabetes (average age of 59.5 ± 11.9 years; 66.4% female). Among the participants with type 2 diabetes, the cardiovascular risk was 15.2 ± 14.6% for the DM group, 15.7 ± 10.7% for the DR group, 22.5 ± 16.7% for the DKD group, and 21.5 ± 15.1% for the DR + DKD group, reflecting a significantly higher cardiovascular risk in the groups with renal involvement (P <0.001). For those with type 1 diabetes, the DM group had a risk of 6.1 ± 8.9%, the DR group 8.9 ±11.8%, the DKD group 5.4 ± 8.8%, and the DR + DKD group 6.1 ± 9.5%. The mean difference in risk between the groups was not statistically significant. Conclusion: In patients with type 2 diabetes, those with diabetic kidney disease appeared to have a higher theoretical risk of cardiovascular disease compared to those with only diabetic retinopathy.

ABSTRACT Objective: To determine circulating endothelial progenitor cells (EPC) counts and levels of inflammatory markers in individuals with and without type 1 diabetes mellitus (T1DM) in response to an intense aerobic exercise session. Subjects and methods: In total, 15 adult men with T1DM and 15 healthy individuals underwent a 30-minute aerobic exercise session on a cycle ergometer at 60% of the peak heart rate. The EPC count (CD45dim/CD34+/KDR+), tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) levels were measured before and 60 minutes after the session. Results: We found no difference within or between groups regarding EPC counts before and after the aerobic exercise: healthy individuals, 0.02% change (95% confidence interval [CI] −0.04%-0.08%); individuals with T1DM, 0.00% (95%CI −0.01%-0.01%). We also found no difference in TNF-α levels before and after exercise in healthy individuals (210.2, interquartile range [IQR] 142.1-401.2 pg/mL and 191.3, IQR 136.4-350.5 pg/mL, respectively) and in patients with T1DM (463.8, IQR 201.4-4306.0 pg/mL and 482.7, IQR 143.8-4304.3 pg/mL, respectively). Similarly, no difference in IL-6 levels was observed before and after exercise in healthy individuals (148.2, IQR 147.5-148.6 pg/mL and 148.2, IQR 147.7-148.6 pg/mL, respectively) and individuals with T1DM (147.2, IQR 145.9-147.7 pg/mL and 147.2, IQR 146.8-147.8 pg/mL, respectively). Conclusions: Patients with T1DM and healthy controls had comparable EPC responses to aerobic exercise, most likely due to the absence of a chronic inflammatory state.

ABSTRACT Objective To evaluate the profile of patients with diabetic kidney disease (DKD) with and without concomitant diabetic retinopathy (DR) to identify clinical predictors of the development of both complications together. Subjects and methods Cross-sectional study including patients with type 1 and type 2 diabetes and DKD followed at the endocrinology division of a public hospital in Southern Brazil and referred for retinography assessment. The definition of DR was the occurrence of any diabetes-related damage identified in color fundus photographs under mydriasis. Urinary albumin excretion ≥ 14 mg/L and/or glomerular filtration rate < 60 mL/min/1.73 m2 (CKD-EPI equation) were used to define DKD. Factors evaluated included the clinical differences of the participants according to the presence or absence of DR. Multiple regression models were used to identify predictors of DR presence according to the clinical characteristics evaluated. Results The study included 517 patients with DKD, 433 (83.7%) of whom had type 2 diabetes (median age 64.7 years [interquartile range 59-73 years] years, 59.8% women, 83.4% white) and 84 (16.3%) had type 1 diabetes (median age 46.6 years [interquartile range 33.5-54.2 years], 46.4% women, 91.7% white). Patients with type 2 diabetes and DR (versus those without DR) were more often on insulin (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.89-7.00), had diabetes for longer (OR 1.04, 95% CI 1.02-1.07), and had higher systolic blood pressure (OR 1.01, 95% CI 1.00-1.02). No predictors of DR presence were identified in participants with type 1 diabetes. Conclusion Among patients with DKD and type 2 diabetes, insulin use, longer diabetes duration, and higher systolic blood pressure level were associated with the presence of DR.