Current Issue : January - March Volume : 2014 Issue Number : 1 Articles : 8 Articles
Objective: To evaluate possible associations between cardiovascular autonomic dysfunction and peripheral artery\r\ndisease (PAD) in patients with type 2 diabetes mellitus.\r\nResearch design and methods: In this cross-sectional study, 67 patients with type 2 diabetes were included. PAD\r\nwas identified by Doppler ultrasonography: systolic ankle-brachial pressure index <0.9. Cardiovascular autonomic\r\nfunction, besides five conventional cardiovascular autonomic function tests, was assessed by heart rate variability\r\n(HRV; 24-h ambulatory ECG recording) in time and frequency domains (spectral analyses) and three dimensional\r\nreturn maps. Power spectral analyses (PSA) were quantified in low frequency (LF), high frequency (HF), and very\r\nlow frequency.\r\nResults: Patients with PAD (n = 30) had longer diabetes duration, higher systolic blood pressure (BP), waist-to-hip\r\nratio, HbA1C test, and urinary albumin excretion (UAE) than patients without PAD. Most HRV indices in time\r\ndomain were lower in patients with than without PAD. These patients also had lower PSA indices (LF=0.19�±0.07\r\nvs. 0.29�±0.11 n.u.; LF/HF ratio=1.98�±0.9 vs. 3.35�±1.83; P<0.001) and indices of sympathetic (three-dimensional\r\nreturn map: P1-night 61.7�±9.4 vs. 66.8�±9.7; P=0.04) and vagal (24-h P2 54.5�±15.2 vs. 62.7�±2.9; P< 0.02) activities\r\n(arbitrary units) than patients without PAD. Multivariate logistic regression analyses, adjusted for systolic BP, DM\r\nduration, HbA1C test, and UAE, confirmed the associations between impaired autonomic modulation and PAD,\r\nexcept for P1 index.\r\nConclusion: In conclusion, patients with type 2 diabetes with PAD had lower HRV indices than patients without\r\nPAD, reflecting a dysfunction of cardiovascular autonomic modulation....
Hypertension in diabetes is the most widespread, substantial and treatable cardiovascular risk factors of importance in clinical practice. It is an increasingly important medical and public health issue. The prevalence of hypertension increases with advancing age to the point where more than half of people aged 60 to 69 years old and approximately three-fourths of those aged 70 years and older are affected. There is an intimate relationship between diabetes mellitus and hypertension. It was estimated that if diabetic patients live long enough, approximately 75% would develop hypertension. Both diabetes and high blood pressure tend to share many predisposing factors. High fat diets rich in salt and processed sugars put stress on both enzyme production and the cardiovascular systems. Hypertension is a common comorbidity in patients with diabetes, and adequate control of blood pressure significantly reduces the risk of macro vascular and micro vascular complications. Based on the weight of all evidence, angiotensin converting enzyme inhibitors or angiotensin receptor blockers is preferred first-line agents for treating patients with hypertension and diabetes. The need for combination therapy should be anticipated, and thiazide-type diuretics should be the second agent added. Based on scientific evidence, β-blockers and calcium channel blockers are useful evidence-based agents in this population, but consider add-on therapies to the aforementioned agents....
Current gold standard therapeutic strategies for T2DM target insulin resistance or �Ÿ cell dysfunction as their core\r\nmechanisms of action. However, the use of traditional anti-diabetic drugs, in most cases, does not significantly\r\nreduce macrovascular morbidity and mortality. Among emerging anti-diabetic candidates, glucagon like peptide-1\r\n(GLP-1) based therapies carry special cardiovascular implications, exerting both direct as well as indirect effects.\r\nThe direct cardiovascular effects of GLP-1 and its analogs remain the focus of this review....
Background: Hypertension frequently coexists with type 2 diabetes (DM), and increases the risk of cardiovascular\r\noutcomes. The aim of the study was to obtain/maintain blood pressure (BP) goals (ADA/JNC 7) according to a\r\nstepwise algorithm using the medication supplied by the Brazilian government.\r\nMethods: A one-year, single-arm interventional study conducted with type 2 diabetes patients. Intervention\r\nconsisted of intensification of lifestyle changes and sequential prescription of drugs: diuretic; ACE inhibitors;\r\n�Ÿ-adrenergic blocking agent and calcium channel blocking agent if BP >130/80 mmHg.\r\nResults: Seventy-eight patients completed the trial. During intervention, the number of antihypertensive tablets\r\nrose (3.6 �± 3.5 vs. 5.9 �± 3.5 pills/patient; p <0.001), as the number of antihypertensive classes increased (1.8 �± 1.0 vs.\r\n2.70 �± 1.2; p < 0.01) and the overall drop of BP was 11 mmHg for SBP (145.0 �± 22.8 vs. 133.7 �± 20.9 mmHg;\r\np < 0.01) and 5 mmHg for DBP (78.7 �± 11.5 vs. 73.7 �± 10.5 mmHg; p = 0.001). Although the number of patients with\r\nBP in target almost doubled [14 (18.7%) vs. 30 (38.5%) p = 0.008], less than 40% of the patients achieved the proposed\r\ngoals.\r\nConclusions: A BP algorithm applied to type 2 diabetic and hypertensive patients is able to lower BP, however more\r\nthan half of the patients did not achieve the ADA/JNC 7 targets demonstrating the complexity of BP control in this\r\npopulation....
To determine the effect of patient counselling on quality of life and knowledge, attitude and practice of the diabetes patients. Prospective observational study was conducted in the department of general medicine, Rajiv Gandhi Institute of medical sciences, Kadapa for the period of 6 months. Both men and women were included to participate if they had uncontrolled type-2 diabetes mellitus, obese lower weight, FBS level > 129 mg/dl and RBS > 200 mg/dl, age group(>30 yrs). Patients were excluded, if they were unable to comply with protocol requirements, the patients having end stage complications like renal failure, hepatic failure and cardiac failure and history of drug (or) alcohol abuse. The study proposal was approved by the Institutional Ethical Committee of RIMS, Kadapa. Diabetes mellitus was more prevalent in females 65% than in males 35%. We found that 39% had alcoholism. 48.5% responded to physical components, followed by 36% people responded to mental components and considerable patients 15.5% responded to both physical and mental components. We observed both statistical and clinical improvement in quality of life of the patients at baseline and after counselling. The present study revealed that the patients were un-aware about the basic concept related to diabetes. The present study concluded that chronic diseases like diabetes affect the quality of life of patients and the education has a major role in improving the health care outcomes like glycemic control and quality of life....
Background: The aim of this study is to compare the efficacy of intensification of insulin treatment with insulin\r\nglargine and biphasic human insulin in patients with type 2 diabetes on concomitant therapy with oral antidiabetic\r\ndrugs (OAD) in daily clinical practice.\r\nMethods: A retrospective multicentre parallel two-arm study included 301 patients with type 2 diabetes already on\r\ntreatment with biphasic human insulin twice daily (bd) in combination with OAD. Data were collected\r\nretrospectively from 142 patients who had been switched from biphasic human insulin to insulin glargine in a\r\nperiod of 6ââ?¬â??12 months prior to their inclusion (active group) and compared to data collected retrospectively from\r\n159 patients who continued treatment with biphasic human insulin bd for the same time period (control group). Our\r\nprimary objective was to examine the efficacy of the two treatments, assessed as change in HbA1c. Secondary objectives\r\nwere to examine for changes in fasting blood glucose (FBG), body weight, treatment with OAD or fast-acting insulin and\r\nsafety, by assessing the frequency and severity of hypoglycaemic episodes.\r\nResults: At the end of the study there was a significant reduction in HbA1c in both arms. The least squares (LS) mean\r\n[(95% confidence intervals (CI)] reduction in HbA1c was -1.13 (-0.96 to -1.30)% in the active and -0.59 (-0.41to -0.77)%\r\nin the control group [LS mean treatment difference 0.53 (0.31-0.76)%, p < 0.001]. Similarly, fasting blood glucose declined\r\nsignificantly in both arms. The LSmean decline in FBG was -47.02 (-37.89 to -56.14) mg/dl in the active and -19.73\r\n(-11.57 to -27.89) mg/dl in the control group [LS mean treatment difference 27.85 (15.74-39.95) mg/dl, p < 0.001]. No\r\nsignificant difference in hypoglycaemic episodes and in body weight was found. In the active group, more patients\r\nreceived rapid-acting pre-meal insulin and used insulin secretagogues drugs.\r\nConclusions: Glargine alone or in combination with fast acting insulin is more effective in reducing glycaemia than\r\nbiphasic human insulin alone or in combination with fast acting insulin in patients with type 2 diabetes without increase\r\nin hypoglycaemic episodes or body weight....
Background: CD36, a class B scavenger receptor, participates in the pathogenesis of metabolic dysregulation such\r\nas insulin resistance, hepatic steatosis, and atherosclerosis. Persistent hepatitis C virus (HCV) infection often evokes\r\nthese metabolic abnormalities. The primary purpose of this study was to investigate the role of CD36 in the\r\npathogenesis of insulin resistance and hepatic steatosis caused by chronic HCV infection.\r\nMethods: Forty-five patients with HCV-related chronic liver disease (CLD-C) were enrolled in this study. CD36\r\nexpression in the liver specimen was examined by an immunohistochemical procedure. The concentrations of\r\ncirculating soluble form of CD36 (sCD36) and oxLDL were determined by the enzyme-linked innunosorbent assay.\r\nInsulin resistance was estimated by the values of HOMA-IR.\r\nResults: Moderate to extensive hepatic CD36 expression was observed in the sinusoids of all enrolled CLD-C\r\npatients. CD36-positive sinusoids appeared to be identical to Kupffer cells. The severity of CD36 expression in the\r\nhepatic sinusoids was significantly correlated with the sCD36 level in sera of patients with CLD-C. The serum sCD36\r\nlevels were significantly correlated with body mass index and serum oxLDL levels in those patients. However, the\r\nserum sCD36 concentrations were independent of the values of HOMA-IR and the severity of hepatic steatosis.\r\nConclusions: These data suggest that the serum sCD36 levels reflect the severity of CD36 expression on the\r\nKupffer cells in patients with CLD-C, and that the serum sCD36 levels were associated with obesity, although the\r\nlevels were independent of insulin resistance and hepatic steatosis in those patients....
During our phylogenetic evolution we have selected genes, the so called thrifty genes, that can help to maximize\r\nthe amount of energy stored from every consumed calorie. An imbalance in the amount of stored calories can lead\r\nto many diseases. In the early 80�s the distinguished English epidemiologist David Barker, formulated a hypothesis\r\nsuggesting that many events that occur during the intrauterine life and early in infancy can influence the\r\noccurrence of many diseases that will develop in adulthood. This theory proposes that under-nutrition and other\r\ninsult or adverse stimulus in utero and during infancy can permanently change the body�s structure, physiology and\r\nmetabolism. The lasting or lifelong effects of under-nutrition will depend on the period in the development at\r\nwhich it occurs. The clues that led Barker to his conclusions started to be discovered when he was studying the\r\ntemporal trends in the incidence of ischemic heart disease in England and Wales. Examining data found in The\r\nHertfordshire records, collected in the beginning of the last century, he found that the rates of mortality by\r\nischemic heart disease was much higher in children born in less affluent counties and mostly in those with low\r\nbirth weight. After his initial findings a myriad of diseases have been found to be linked to low birth weight and\r\nunder-nutrition in utero and in the neonatal period. These diseases were then nominated adult diseases with fetal\r\norigin. Epidemiological studies that led to these findings suggest that in utero and early postnatal life have critical\r\nimportance for long-term programming of health and disease, opening unique chances for primary prevention of\r\nchronic diseases....
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