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Prediction of severe hypoglycaemia by angiotensin-converting enzyme activity and genotype in type 1 diabetes

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@article{b1abf4b3626f41ba8bd6addf435e0ed8,
title = "Prediction of severe hypoglycaemia by angiotensin-converting enzyme activity and genotype in type 1 diabetes",
abstract = "AIMS/HYPOTHESIS: We have previously shown a strong relationship between high angiotensin-converting enzyme (ACE) activity, presence of the deletion (D) allele of the ACEgene and recall of severe hypoglycaemic events in patients with Type 1 diabetes. This study was carried out to assess this relationship prospectively.METHODS: We followed 171 adult outpatients with Type 1 diabetes in a one-year observational study with the recording of severe hypoglycaemia. Participants were characterised by serum ACE activity and ACE genotype and not treated with ACE inhibitors or angiotensin II receptor antagonists.RESULTS: There was a positive relationship between serum ACE activity and rate of severe hypoglycaemia with a 2.7 times higher rate in the fourth quartile of ACE activity compared to the first quartile (p=0.0007). A similar relationship was observed for the subset of episodes with coma (2.9 times higher rate in fourth quartile compared to first quartile; p=0.048). The impact of serum ACE activity was most pronounced in C-peptide negative subjects (4.2 times higher rate in fourth quartile compared to first quartile; p=0.003), and in this subgroup carriers of the D allele of the ACEgene had higher rates of severe hypoglycaemia compared to the group homozygous for the insertion (I) allele. In a multiple regression analysis high serum ACE activity and impaired awareness of hypoglycaemia were identified as the only significant predictors of severe hypoglycemia.CONCLUSION: High ACE activity and the presence of the D allele of the ACE gene predict a high rate of severe hypoglycaemia in Type 1 diabetes.",
keywords = "Adult, Alleles, Awareness, C-Peptide, Diabetes Mellitus, Type 1, Female, Genotype, Humans, Hypoglycemia, Male, Middle Aged, Multivariate Analysis, Peptidyl-Dipeptidase A, Prognosis, Retrospective Studies, Risk Factors, Severity of Illness Index, Journal Article, Research Support, Non-U.S. Gov't",
author = "U Pedersen-Bjergaard and Birgit Agerholm-Larsen and S Pramming and P Hougaard and B Thorsteinsson",
year = "2003",
month = jan,
doi = "10.1007/s00125-002-0969-4",
language = "English",
volume = "46",
pages = "89--96",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer",
number = "1",

}

RIS

TY - JOUR

T1 - Prediction of severe hypoglycaemia by angiotensin-converting enzyme activity and genotype in type 1 diabetes

AU - Pedersen-Bjergaard, U

AU - Agerholm-Larsen, Birgit

AU - Pramming, S

AU - Hougaard, P

AU - Thorsteinsson, B

PY - 2003/1

Y1 - 2003/1

N2 - AIMS/HYPOTHESIS: We have previously shown a strong relationship between high angiotensin-converting enzyme (ACE) activity, presence of the deletion (D) allele of the ACEgene and recall of severe hypoglycaemic events in patients with Type 1 diabetes. This study was carried out to assess this relationship prospectively.METHODS: We followed 171 adult outpatients with Type 1 diabetes in a one-year observational study with the recording of severe hypoglycaemia. Participants were characterised by serum ACE activity and ACE genotype and not treated with ACE inhibitors or angiotensin II receptor antagonists.RESULTS: There was a positive relationship between serum ACE activity and rate of severe hypoglycaemia with a 2.7 times higher rate in the fourth quartile of ACE activity compared to the first quartile (p=0.0007). A similar relationship was observed for the subset of episodes with coma (2.9 times higher rate in fourth quartile compared to first quartile; p=0.048). The impact of serum ACE activity was most pronounced in C-peptide negative subjects (4.2 times higher rate in fourth quartile compared to first quartile; p=0.003), and in this subgroup carriers of the D allele of the ACEgene had higher rates of severe hypoglycaemia compared to the group homozygous for the insertion (I) allele. In a multiple regression analysis high serum ACE activity and impaired awareness of hypoglycaemia were identified as the only significant predictors of severe hypoglycemia.CONCLUSION: High ACE activity and the presence of the D allele of the ACE gene predict a high rate of severe hypoglycaemia in Type 1 diabetes.

AB - AIMS/HYPOTHESIS: We have previously shown a strong relationship between high angiotensin-converting enzyme (ACE) activity, presence of the deletion (D) allele of the ACEgene and recall of severe hypoglycaemic events in patients with Type 1 diabetes. This study was carried out to assess this relationship prospectively.METHODS: We followed 171 adult outpatients with Type 1 diabetes in a one-year observational study with the recording of severe hypoglycaemia. Participants were characterised by serum ACE activity and ACE genotype and not treated with ACE inhibitors or angiotensin II receptor antagonists.RESULTS: There was a positive relationship between serum ACE activity and rate of severe hypoglycaemia with a 2.7 times higher rate in the fourth quartile of ACE activity compared to the first quartile (p=0.0007). A similar relationship was observed for the subset of episodes with coma (2.9 times higher rate in fourth quartile compared to first quartile; p=0.048). The impact of serum ACE activity was most pronounced in C-peptide negative subjects (4.2 times higher rate in fourth quartile compared to first quartile; p=0.003), and in this subgroup carriers of the D allele of the ACEgene had higher rates of severe hypoglycaemia compared to the group homozygous for the insertion (I) allele. In a multiple regression analysis high serum ACE activity and impaired awareness of hypoglycaemia were identified as the only significant predictors of severe hypoglycemia.CONCLUSION: High ACE activity and the presence of the D allele of the ACE gene predict a high rate of severe hypoglycaemia in Type 1 diabetes.

KW - Adult

KW - Alleles

KW - Awareness

KW - C-Peptide

KW - Diabetes Mellitus, Type 1

KW - Female

KW - Genotype

KW - Humans

KW - Hypoglycemia

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Peptidyl-Dipeptidase A

KW - Prognosis

KW - Retrospective Studies

KW - Risk Factors

KW - Severity of Illness Index

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1007/s00125-002-0969-4

DO - 10.1007/s00125-002-0969-4

M3 - Journal article

C2 - 12637987

VL - 46

SP - 89

EP - 96

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - 1

ER -

ID: 51548475