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Diabetes AND macrovascular

Judy W M Cheng, Vincent J Colucci, James S Kalus, Sarah A Spinler
OBJECTIVE: While improving glycemic control with antihyperglycemics has been demonstrated to reduce microvascular complications, the benefits of reduction in cardiovascular diseases (CVDs) have not been demonstrated with older agents. This article reviews current evidence of the CV outcomes of newer antihyperglycemics approved since 2008. DATA SOURCES: Peer-reviewed articles were identified from MEDLINE (1966 to October 31, 2018) using search terms exenatide, liraglutide, lixisenatide, dulaglutide, semaglutide, alogliptin, linagliptin, saxagliptin, sitagliptin, canagliflozin, dapagliflozin, empagliflozin, mortality, myocardial infarction (MI), heart failure (HF), and stroke...
December 5, 2018: Annals of Pharmacotherapy
Violetta Ptushkina, Esther Jacobs, Sabine Schipf, Henry Völzke, Marcello Ricardo Paulista Markus, Matthias Nauck, Christa Meisinger, Annette Peters, Werner Maier, Christian Herder, Michael Roden, Wolfgang Rathmann
BACKGROUND: Previous studies found regional differences in the prevalence and incidence of type 2 diabetes between Northeast and South of Germany. The aim of this study was to investigate if regional variations are also present for macrovascular disease in people with type 2 diabetes and in the general population. A further aim was to investigate if traditional risk factors of macrovascular complications can explain these regional variations. METHODS: Data of persons aged 30-79 from two regional population-based studies, SHIP-TREND (Northeast Germany, 2008-2012, n = 2539) and KORA-F4 (South Germany, 2006-2008, n = 2932), were analysed...
December 3, 2018: BMC Public Health
Vishal Gupta, Michael Willis, Pierre Johansen, Andreas Nilsson, Manan Shah, Amey Mane, Cheryl Neslusan
OBJECTIVES: To simulate the long-term health outcomes of canagliflozin 100 mg versus glimepiride over 20 years in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin from the perspective of the Indian health care system. METHODS: Health outcomes were simulated using the validated Economic and Health Outcomes Model of T2DM. Patient demographic characteristics, biomarker values, and treatment effects were sourced from a subgroup of Indian patients enrolled in a 52-week, head-to-head study of canagliflozin versus glimepiride (mean maximum dose of 5...
November 28, 2018: Value in Health Regional Issues
Anne-Catherine Schwarz, Adrian T Billeter, Katharina M Scheurlen, Matthias Blüher, Beat P Müller-Stich
Metabolic diseases, comprising type 2 diabetes mellitus (T2DM), dyslipidemia, and non-alcoholic steatohepatitis (NASH), are rapidly increasing worldwide. Conservative medical therapy, including the newly available drugs, has only limited effects and does neither influence survival or the development of micro- or macrovascular complications, nor the progression of NASH to liver cirrhosis, nor the development of hepatocellular carcinomas in the NASH liver. In contrast, metabolic surgery is very effective independent of the preoperative body mass index (BMI) in reducing overall and cardiovascular mortality in patients with T2DM...
October 2018: Visceral Medicine
Jasmin Khateeb, Eyal Fuchs, Mogher Khamaisi
BACKGROUND: Diabetes mellitus is a systemic disorder associated with inflammation and oxidative stress which may target many organs such as the kidney, retina, and the vascular system. The pathophysiology, mechanisms, and consequences of diabetes on these organs have been studied widely. However, no work has been done on the concept of the lung as a target organ for diabetes and its implications for lung diseases. AIM: In this review, we aimed to investigate the effects of diabetes and hypoglycemic agent on lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, pulmonary hypertension, and lung cancer...
November 23, 2018: Review of Diabetic Studies: RDS
Mikhail Kosiborod, Marilia B Gomes, Antonio Nicolucci, Stuart Pocock, Wolfgang Rathmann, Marina V Shestakova, Hirotaka Watada, Iichiro Shimomura, Hungta Chen, Javier Cid-Ruzafa, Peter Fenici, Niklas Hammar, Filip Surmont, Fengming Tang, Kamlesh Khunti
BACKGROUND: The global prevalence of type 2 diabetes-related complications is not well described. We assessed prevalence of vascular complications at baseline in DISCOVER (NCT02322762; NCT02226822), a global, prospective, observational study program of 15,992 patients with type 2 diabetes initiating second-line therapy, conducted across 38 countries. METHODS: Patients were recruited from primary and specialist healthcare settings. Data were collected using a standardized case report form...
November 28, 2018: Cardiovascular Diabetology
Shanshan Yu, Xiaoying Liu, Lili Men, Junjie Yao, Qian Xing, Jianling Du
Vascular endothelial apoptosis is closely associated with the pathogenesis and progression of diabetic macrovascular diseases. Selenoprotein S (SelS) participates in the protection of vascular endothelial and smooth muscle cells from oxidative and endoplasmic reticulum stress-induced injury. However, whether SelS can protect vascular endothelium from high glucose (HG)-induced apoptosis and the underlying mechanism remains unclear. The present study preliminarily analyzed aortic endothelial apoptosis and SelS expression in diabetic rats in vivo and the effects of HG on human umbilical vein endothelial cell (HUVEC) apoptosis and SelS expression in vitro...
November 28, 2018: Journal of Cellular Biochemistry
Sarah Louise Fishman, Halis Sonmez, Craig Basman, Varinder Singh, Leonid Poretsky
BACKGROUND: Traditional risk factors are insufficient to explain all cases of coronary artery disease (CAD) in patients with diabetes mellitus (DM). Advanced glycation end-products (AGEs) and their receptors may play important roles in the development and progression of CAD. BODY: Hyperglycemia is the hallmark feature of DM. An increase in the incidence of both micro-and macrovascular complications of diabetes has been observed with increased duration of hyperglycemia. This association persists even after glycemic control has been achieved, suggesting an innate mechanism of "metabolic memory...
November 23, 2018: Molecular Medicine
J Frank Wharam, Christine Y Lu, Fang Zhang, Matthew Callahan, Xin Xu, Jamie Wallace, Stephen Soumerai, Dennis Ross-Degnan, Joseph P Newhouse
Background: Little is known about the long-term effects of high-deductible insurance on care for chronic medical conditions. Objective: To determine whether a transition from low-deductible to high-deductible insurance is associated with delayed medical care for macrovascular complications of diabetes. Design: Observational longitudinal comparison of matched groups. Setting: A large national health insurer during 2003 to 2012...
November 20, 2018: Annals of Internal Medicine
Gui-Hua Wang, Kun-Ling Ma, Yang Zhang, Ze-Bo Hu, Liang Liu, Jian Lu, Pei-Pei Chen, Chen-Chen Lu, Xiong-Zhong Ruan, Bi-Cheng Liu
Platelet microparticles (PMPs) are closely associated with diabetic macrovascular complications. The present study aimed to investigate the effects of PMPs in diabetes on aortic vascular endothelial injury and to explore the underlying mechanisms. Peritoneal injection of streptozotocin was used to generate a diabetic rat model in vivo, and human umbilical vein endothelial cells (HUVECs) treated with PMPs were used in vitro. PMP levels in the circulation and aorta tissues were time-dependently increased in streptozotocin-induced diabetic rats at weeks 4, 8, and 12 (P < 0...
November 16, 2018: Acta Pharmacologica Sinica
Ioanna Eleftheriadou, Anastasios Tentolouris, Pinelopi Grigoropoulou, Dimitrios Tsilingiris, Ioanna Anastasiou, Alexandros Kokkinos, Despoina Perrea, Nikolaos Katsilambros, Nikolaos Tentolouris
AIMS: To study the impact of diabetic neuropathy, both peripheral sensorimotor (DPN) and cardiac autonomic neuropathy (CAN), on transcutaneous oxygen tension (TcPO2 ) in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 163 participants were recruited; 100 with T2DM and 63 healthy individuals. Peripheral arterial disease (PAD) was defined as ankle-brachial index (ABI) values ≤0.90. Diagnosis of DPN was based on neuropathy symptom score and neuropathy disability score (NDS), while diagnosis of CAN on the battery of the cardiovascular autonomic function tests...
October 12, 2018: Journal of Diabetes and its Complications
K A Iroshan, A D N De Zoysa, C L Warnapura, M A Wijesuriya, S Jayasinghe, N D Nanayakkara, A C De Silval
More than 8% of world population have diabetes which causes long term complications such as retinopathy, neuropathy, nephropathy and foot ulcers. Growing patient numbers has prompted large scale screening methods to detect early symptoms of diabetes (rather than elevated blood glucose levels which is a late symptom). Vascular tortuosity (twisted and curved nature of blood vessels) in retinal fundus images has proven to reflect the effect of diabetes on macrovasculature. However, large scale patient screening using retinal fundus images has limitations due to the requirement of a retinal camera...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Monika Fazekas-Lavu, Katherine T T Tonks, Katherine Samaras
Treated human immunodeficiency virus (HIV) infection is associated with high rates of type 2 diabetes mellitus (DM), metabolic syndrome and central obesity/body fat partitioning disorders. To our knowledge, there are no available data comparing diabetes care in people with both HIV+DM vs. DM alone (DM-controls) within the same service and evaluating if benchmarked standards of care are being met in people with HIV+DM. This study evaluated the frequency that people with HIV+DM met the benchmarked American Diabetes Association (ADA) standards of care in diabetes (targets for HbA1c, blood pressure, lipid levels, complication screening, and healthy weight), compared to age- and sex- matched controls with diabetes, in an urban teaching hospital...
2018: Frontiers in Endocrinology
Astrid Ledgaard Holm, Gregers Stig Andersen, Marit E Jørgensen, Finn Diderichsen
OBJECTIVE: The study aimed at analysing whether the 'Rule of Halves' framework applies for diabetes care in the Danish healthcare system with high levels of accessibility and equity. The Rule of Halves states that only one-half of people with a particular chronic condition are diagnosed; one-half of those diagnosed get treatment, and one-half of treated achieve desired therapeutic goals. DESIGN: The analysis is cross sectional based on available surveys, register data and clinical databases covering the adult population in Copenhagen...
November 13, 2018: BMJ Open
Tomas Karpati, Maya Leventer-Roberts, Becca Feldman, Chandra Cohen-Stavi, Itamar Raz, Ran Balicer
AIMS: To identify clinically meaningful clusters of patients with similar glycated hemoglobin (HbA1c) trajectories among patients with type 2 diabetes. METHODS: A retrospective cohort study using unsupervised machine learning clustering methodologies to determine clusters of patients with similar longitudinal HbA1c trajectories. Stability of these clusters was assessed and supervised random forest analysis verified the clusters' reproducibility. Clinical relevance of the clusters was assessed through multivariable analysis, comparing differences in risk for a composite outcome (macrovascular and microvascular outcomes, hypoglycemic events, and all-cause mortality) at HbA1c thresholds for each cluster...
2018: PloS One
E Grbić, A Peterlin, T Kunej, D Petrovič
Atherosclerosis is the leading cause of mortality and morbidity in the developed world. It is characterized by the formation of a plaque in the walls of middle and large arteries leading to macrovascular complications. Several risk factors are included, with diabetes being one of the most important for the onset and development of atherosclerosis. Due to an increase in the prevalence of diabetes in the world, the incidence of diabetic complications (microvascular and macrovascular) is increasing. Peroxisome proliferator-activated receptor γ (PPARγ) plays a important role in atherosclerotic processes...
June 2018: Balkan Journal of Medical Genetics: BJMG
Robert J Henning
The global prevalence of diabetes has risen in adults from 4.7% in 1980 to 8.5% in 2014. 90-95% of adults with diabetes have Type 2 diabetes (T2D). This paper focuses on the diagnosis and treatment of T2D patients who have or are at risk for cardiovascular disease. Hyperglycemia, insulin resistance and excess fatty acids increase oxidative stress, disrupt protein kinase C signaling and increase advanced glycation end-products that result in vascular inflammation, vasoconstriction, thrombosis and atherogenesis...
November 9, 2018: Future Cardiology
Gunjan Sharma, Md Umama Ashhar, Vidhu Aeri, Deepshikha Pande Katare
Preclinical investigation is the key mark of medical research, as the major breakthroughs including treatment of devastating diseases in biomedical research have been led by animal studies. Type 2 diabetes mellitus (T2DM) is a predominant metabolic disorder having high prevalence of morbidity worldwide which create an urgent need to understand the pathogenesis, complication and other possible influences by development of appropriate animal model. High-fat diet (HFD) fed animals (21 days) were treated with single cycle of repetitive dose (SCRD) of streptozotocin (STZ; 40, 30 and 20 mg/kg/per day in three respective group at 1st, 3rd, and 5th day) and double cycle of repetitive dose (DCRD) of streptozocin (STZ) (20, 10 and 5 mg/kg/per day in three respective group at 1st, 3rd, and 5th day in one cycle and 21st, 23rd, 25th day in second cycle of treatment) to induce late-stage diabetic complications...
November 5, 2018: Life Sciences
Ameena Madan Paramasivan, Archana Purushothaman, Cyrus Desouza
PURPOSE OF REVIEW: In recent years, Cardiovascular Outcome Event Trials (CVOTs) in type 2 diabetes mellitus (T2DM) have demonstrated that sodium glucose transporter 2 inhibitors (SGLT2i) could reduce major adverse cardiovascular events (MACE) and cardiovascular mortality independent of a glucose lowering mechanism. SGLT2i trials reported significant results that have generated biologically plausible theories with regard to the macrovascular benefit. In this review, we have summarized and discussed the results of the CANVAS program...
November 5, 2018: Current Diabetes Reports
Michael Morkos, Bettina Tahsin, Louis Fogg, Leon Fogelfeld
Objective: To characterize the clinical presentation of newly diagnosed type 2 diabetes of ethnic minority adults in Chicago and compare with other populations. Research design and methods: Cross-sectional study examining the data of 2280 patients newly diagnosed with type 2 diabetes treated between 2003 and 2013 in a large Chicago public healthcare system. Results: Mean age of the patients was 49±11.3 years, men 54.4%, African-Americans 48...
2018: BMJ Open Diabetes Research & Care
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