by IDS Director of Patient Care and Education, Alicia Downs
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Updating The Diabetes Community on the Ups and Downs of Diabetes Related Complication Risks and Indicators, Making News:
NPAR: What Neutrophil Percentage to Albumin Ratio could mean for you
In a recent retrospective study, an association was found between Neutrophil Percentage to Albumin Ratio (NPAR) in patients with Type 2 diabetes and Diabetes Related Kidney Disease (DRKD).
NPAR is a blood biochemical level that assesses a patient’s chronic inflammatory state. Causes of chronic inflammation may include infection, nutritional status issues, or chronic organ damage. In a study of NPAR levels of 2,263 participants, it was found that elevated NPAR levels were a good predictive indicator for whether the patient would have DRKD. At this time, there is insufficient data to directly correlate specific NPAR levels with the time of onset of DKRD, or the severity of DKRD as these were retrospective studies, and further study is necessary. However, this can be helpful now as other recent studies have highlighted the high frequency of misdiagnosis of DRKD in persons with diabetes based only on their diagnosis of Diabetes. Advocating that clinicians further examine NPAR levels to corroborate a diagnosis of Diabetes being the causal factor in kidney disease can help specify whether there is an alternative underlying cause that needs to be addressed beyond Diabetes.
While this study was only in the Type 2 population, this information may also help open the field of vision for physicians working with patients with Type 1 diabetes, particularly with the expanding of dual diagnosis in the adult diabetes population, and until more advanced research in the Type 1 population and NPAR correlations becomes available.
NPAR levels also remain a strong indicator for predicting the risk of Diabetes related Retinopathy. Annual dilated retinal exams are the standard of care for screening for retinopathy, but adding NPAR screening to annual blood work every 5 years as studies have shown monitoring NPAR can alert clinicians to increased risks for Retinopathy as well as early warning of potential increase in risks for Cardiovascular disease, stroke, or other related complications.
Speaking of Stroke risks:
Does Type 1 or Type 2 Diabetes Have A Higher Stroke Risk?
A Recent study out of Sweden presents some startling data on stroke risks for people with Type 1 diabetes.
A 47,720 cohort of patients with Type 1 diabetes and 686,158 with Type 2 from the Swedish National Diabetes register from the years 2005-2019 were matched with control groups of 143,160 and 2,058,474 persons not diagnosed with diabetes respectively. Data was reviewed from time of first stroke onset through moretality as of end of 2022. The findings were remarkable.
As predicted in both groups, higher A1C levels were directly correlated with a higher risk of ischemic stroke (Blockage in arteries causing loss of partial or all brain function). We have known for a long time that improving glycemic management reduces stroke risk.
What was particularly eye-opening was the wide risk difference between Type 1 and Type 2 Diabetes.
Type 1 Diabetes was associated with double the risk of ischemic stroke and a staggering 88% increase in risk of hemorrhagic stroke (Arterial brain bleed resulting in loss of partial or total brain function) over the control group.
While the Type 2 population saw no statistically significant increase in hemorrhagic stroke risk, but a 37% higher risk for ischemic stroke.
The distinctly different findings in the types of stroke seem to indicate that glucose levels alone are not the primary cause of stroke risk. In fact, when one looks at the demographics of the two groups, the Type 1 group was significantly younger, with a mean age of 34.4 years, while the mean age of the Type 2 group was 34.4 years (Controls were adjusted to match).
A1C appears to be more closely tied to Ischemic stroke than hemorrhagic stroke risk. However, even with this stroke risk for people with Type 1 Diabetes took a major increase at A1C levels 50% lower than the same increase was seen in the Type 2 study group. All of this data indicates that a second cause of increased risk is at work. Considering the major differences in the two subtypes of diabetes are autoimmune causal factors, age of onset, DKA, and hypoglycemia (Frequency, duration and severity) we are likely to see future research into these factors as risk factors for stroke risks specific to the Type 1 diabetes population.
What can we take away from this study?
Clearly, the importance of steady blood sugar management remains a priority for all people with diabetes. Avoidance of DKA throughout the lifetime, beginning at pre-diagnosis, and reduction of hypoglycemic episodes remain central focuses of not only safety and quality of life for people with Type 1 Diabetes but will become important biomarkers for risk stratification as well.
For the Type 1 population, maintaining stroke risk screenings, such as blood pressure and cardiovascular risk screenings and healthy lifestyles remains at heightened importance at younger ages. We will continue to see lower A1C recommendations for people with Type 1 diabetes than the Type 2 population, with consideration toward the impacts of chronic and severe hypoglycemia on long-term risks.
*Original article: Which Diabetes Type Has Higher Stroke Risk?
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