Top PDF Study on Cardiovascular Risk Factors and its Management in Type II Diabetic Patients

The proposed work entitled “ Study on cardiovascular risk factors and its management in type II DM patients ” was carried out in a 750 bedded multi- speaciality hospital located at Coimbatore. The hospital is unique and it is well known for its services to people who come from various parts of country. The institution excels in diverse specialities like General Medicine, General Surgery, Obestrics and Gynecology, Peadiatrics and Neonatalogy, Orthopeadics, Psychiatry, Neurology, Radiology, Cardiology, Cardiothoracic surgery, Pulmunology and Critical care, Gastroenterology, Urology, Nephrology, E.N.T, Opthomology, Oncology, Dentistry, Plastic surgery and department of physical rehabilitation. The hospital has well-staffed Pharmacy and Drug Information Centre.

of motivated persons with type 2 diabetes. This selection may have underestimated the reported prevalences of albuminuria and shortcomings in disease management. However, the present study has also a number of strengths. Contrary to some prior studies, which were con- ducted in selected, e.g. clinic-based, patient groups [21,31] the present study was based on study participants recruited from the general population. Also, studies on this issue based on a well characterized study population as the present one including a great number of pheno- types, risk factors and comorbidities are scarce. Further- more, contrary to other papers on this subject [17,18] the present paper additionally contains data on antidiabetic and cardiovascular treatment. In addition, this study is one of relatively few from Germany dealing with micro- albuminuria. Thus, since type 2 diabetes is one of the most common health problems in primary care, we believe that our results can be applied to improve the management of cardiovascular risk factors, glycemic con- trol and microalbuminuria in patients with type 2 diabe- tes.

the actual potential of TZDs to reduce the risk of macrovascular complications beyond improvement of glycemic and lipid profiles remains yet to be proven. This would require the investigation of clinical end- points in long-term prospective studies that are not yet available [39]. While the results of the PROactive trial pointed in that direction in patients with established CVD [40-42], there is no evidence published in this regard among the general population of patients with T2D [43-46]. The results from the present study are of particular interest for the Pio + Met combination as they suggest that additive or, speculatively, synergistic nonhypoglycemic effects may occur to improve meta- bolic disturbances related to cardiovascular risk in patients with T2D. Metformin has been shown to have relevant positive effects on hard clinical endpoints [47,48] and, despite the reports of an enhanced risk of heart failure associated to TZD use [49], Pio has been associated with reducing the risk of nonfatal myocardial infarction, death, and stroke [40,50]. Additionally, sev- eral meta-analyses failed to show an association between

Obese and T2DM patients with dyslipidemia are having a higher risk to develop cardiovascular disease with a high amount of morbidity and mortality worldwide. Our results showing that T2DM patients with higher BMI are at higher risk of cardiovascular disease (Figure 1). Obesity, T2DM and dyslipidemia are closely related to each other e.g. obesity leads to insulin resistance which in turn causes type 2 diabetes and both together leads to dyslipidemia and cardiovascular disease. [9] This suggests that many of cardiovascular risk factors are driven by obesity. Wilmot et.al. have showed that the development of diastolic dysfunction in young people with Type 2 diabetes result from the additive effect of dysglycemia. This finding was further supported by the association of duration of diabetes diagnosis with diastolic strain rate. [10] We have also found that the T2DM patients with obesity are having higher diastolic and systolic pressure as compared to T2DM patients without obesity.

Materials & Methods: The study was performed at the outpatient diabetes clinic of Ardabil. We selected patients who had no evidence of pro- teinuria in urinalysis and without abnormal se- rum blood urea nitrogen (BUN) and creatinine. The patients were directed to provide timed 24 hour urine samples for assessment of urinary al- bumin twice in a period of 2-3 months. In the course of processing case histories the factors considered were duration of diabetes, hyperten- sion history, smoking habits and number of vis- its during the previous year. Laboratory investi- gations included FBS, HbA1c, Tg, Cholesterol (Total, HDL, LDL), BUN and creatinine.

Studies have now shown that the prevalence of hyperten- sion in T2DM patients is 1.5 – 3 times the prevalence of non-T2DM populations that match their age. 28 Hypertension is the basis for the occurrence of arterio- sclerosis, which can cause adverse consequences such as endothelial hyperplasia, sclerosis, vascular stenosis and even occlusion. A prospective study investigating T2DM patients in developing countries found that lower e-GFR in patients with hypertension is a major factor leading to the development of diabetic nephropathy, and pointed out that hypertension is an independent risk factor for diabetic nephropathy. 29 A study based on the Saudi National Diabetes Registry ’ s study of risk factors for DN in T2DM patients showed that hypertension is one of the most important risk factors for DN in people with type 2 diabetes. 26 This study is aimed to explore the risk factors of DN in obese patients with T2DM. Our result con fi rms that hypertension is a risk factor for DN in obese people with T2DM. This is similar to the results of previous studies, suggesting that hypertension is a risk factor for DN. And our result has important signi fi cance for obese people in T2DM patients to pay more attention to the prevention of hypertension.

Background: Adolescents with type 1 diabetes and obesity present higher cardiovascular risk and ambulatory blood pressure measurements (ABPM) has been shown to predict vascular events, especially by identifying the nondipper status. The aim of our observational cross-sectional study conducted in adolescents with type 1 diabetes, overweight subjects and healthy controls was to assess mean blood pressure parameters to identify subclinical cardiovascular risk. Methods: The study included adolescents patients with type 1 diabetes followed in our Pediatric Department in University of Catania between January 2011 and 2013. A total of 60 patients were enrolled, and 48 (32 male and 16 female) completed the study. For each subject we performed systolic and diastolic Ambulatory Blood Pressure Meas- urements (ABPM) during wakefulness and sleep recording blood pressure every 30 min for 24 h with the Tonoport V/2 GE CardioSoft V6.51 device. We compared the data of patients with those of overweight subjects and healthy controls. Results: ABPM revealed no significant difference between type 1 diabetic patients and overweight subjects in 24 h Systolic, 24 h Diastolic, Day-time Systolic, Night-time systolic and Day-time Diastolic blood pressure values but significantly different values in Night-time Diastolic blood pressure values (p < 0.001). We found significant differ- ences between type 1 diabetic patients and healthy controls in all 24 h Systolic (p < 0.001), 24 h Diastolic (p < 0.01), Day-time Systolic (p < 0.01), Night-time Systolic (p < 0.001), Day-time Diastolic (p < 0.05) and Night-time Diastolic (p < 0.001) blood pressure values. We detected hypertension in 12/48 (25 %) type 1 diabetic patients and in 10/48 overweight subjects (p = 0.62; OR 1.2; CI 0.48–3.29), whereas no-one of healthy controls presented hypertension (p < 0.001). We observed nondipper pattern in 40/48 (83.3 %) type 1 diabetic patients, in 33/48 (68.8 %) overweight subjects (p = 0.094; OR 2.27; CI 0.85–6.01), and in 16/48 (33.3 %) of healthy controls (p < 0.001; OR 10; CI 3.79–26.3). Conclusions: ABPM studies might help to define a subset of patients at increased risk for the development of hypertension. In evaluating blood pressure in type 1 diabetes and overweight subjects, ABPM should be used since a reduced dipping can indicate incipient hypertension.

This study was conducted in Physiology De- partment of Khyber Medical College Peshawar. Four hundred type 2 diabetic patients were se- lected from the three tertiary care hospitals of Peshawar i.e. Khyber Teaching Hospital, Lady Reading Hospital and Hayatabad Medical Com- plex. The age group selected was 40 to 60 years, irrespective of sex. Diagnosis of diabetes was based on the American Diabetes Association cri- teria. 7 Patients with impaired glucose tolerance test

ago and recorded in their files by physician. Also the complications due to diabetes were examined. The inclusion criteria were; T2DM, having file in diabetes research center, no history of diagnosed mental illness, no history of previous depression duo to other factors, no history of other disabling diseases (other than hypertension and hyperlipidemia), if existed one of the following conditions patients were were replaced; imperfect or confound file, dissatisfaction to do research, incomplete, imperfect or confound questionnaire, existed clinical examination and testing finding more than a month. Data were collected by using Beck Depression Inventory (30) ,also the following information was collected; gender (male, female), age (in years), disease duration (in years), type of insulin (oral, NOVO, NPH, LAN), hypertension (yes, no), hyperlipidemia (yes, no) and macrovascular complications (Cardiomyopathy, retinopathy, nephropathy). All laboratory tests were done in one laboratory by the way, kit and similar devices, and clinical examination were done by one specialists (ophthalmologist and endocrinologist in Yazd diabetes research center). Furthermore, with putting a text in the first part of the questionnaire and explaining the purpose of the study, received written consent.

An epidemiological link between elevated serum uric acid and an increased cardiovascular risk has been recognized for many years. Observational studies show that serum uric acid concentrations are higher in patients with established coronary heart disease compared with healthy controls. However, hyperuricemia is also associated with possible confounding factors including elevated serum triglyceride and cholesterol concentrations, blood glucose, fasting and post-carbohydrate plasma insulin concentrations, waist-hip ratio and body mass index.

The records of 50 type 2 diabetic patients with HF regularly seen between January 2014 and April 2015 at the Centre Hospitalier de Haguenau (Haguenau, France) were reviewed. From the eligible records, we extracted all the clinical data, echocardiographic data, and all further tests and cardiovascular imagings, laboratory tests, and any document with useful information. We collected the following data: demographic and anthropological parameters; past medical history and co-morbidities; the year of diagnosis of diabetes and HF; glycated hemoglobin (HbA1c) at the beginning and end of study (if available); LVEF and diastolic function and ventricular structural abnormalities; NT-pro BNP levels; serum creatinine levels with estimation of the glomerular filtration rate (CKD-EPI formula); the

For CVD, associations with increased levels of fibrinogen have been documented in a few studies of diabetic patients, but further adjustment for other risk factors seemed to diminish the fmdings^^’^^^’^^^. A cross-sectional study o f diabetic patients with (n=59) and without pre-existing vascular disease (n=57) demonstrated that fibrinogen was significantly associated with vascular disease and explained about 16% of this risk. This study combined both types of diabetes and did not distinguish between micro- and macrovascular complications^^^.The Framingham Study reported an initial significant relationship between fibrinogen and incident CHD only in women. Fibrinogen did not account much for the effect of diabetes on incident CHD, after adjustment for other risk factors^^^. The ARIC study reported that the highest quartile of fibrinogen concentrations was associated with incident CHD with a relative risk of 1.75 (95%CI: 1.12-2.73), but further adjustment for treatment status (insulin) diminished this result^^.

Nevertheless, this study had some limitations. First, because this was an observational study, it may be affected by bias and the poor control of confounding fac- tors. Second, the identities of patients were encrypted for privacy and data security reasons. As a result, we could not contact patients to discuss their use of pioglitazone. Third, several potential confounding factors, such as blood pressure (BP), serum glucose level, and lipid panel, were not included in the database. Nonetheless, the num- ber of antihypertensive drugs and oral glucose-lowering agents, and the intensity of initial stain therapy were PS matched to mitigate the bias associated with different levels of BP, blood sugar, and serum lipid between the two groups. Fourth, although experts from the NHI pro- gram regularly review randomly selected medical records to confirm the diagnosis from all hospitals, bias may still arise due to miscoding. However, the diagnoses in the NHIRD have previously been validated [30, 31]. Finally, as our study included only Taiwanese patients who may have been at a greater risk of developing ischemic stroke due to their Asian descent, our results may not be appli- cable to other populations.

such as superoxide dismutase 2 are depleted, and neu- ronal injury results [30]. Wide fluctuations in blood glu- cose level can trigger the same levels of oxidative stress as prolonged hyperglycemia. Postprandial hyperglycemia increased oxidative stress markers [31], and it was sig- nificantly higher in both the fasting state and the post- prandial state in diabetic patients, whereas there was no postprandial elevation of oxidative stress markers in healthy subjects [32]. In our study, mean glucose level measures (GA and HbA1c) and their variability did not have a significant difference for predicting CAN develop- ment (Additional file 3: Table S2). Even the CVs of GA or HbA1c level, which adjusted the effect of mean glucose exposure, remained a significant risk factor for CAN. Therefore, the finding that the predictive power of GA variability for CAN development outperformed that of HbA1c variability was partially explained by GA’s shorter half-life, which enables it to reflect glucose excursions more accurately than does HbA1c [6, 33, 34]. The 2-year fluctuations in GA level were actually greater than those in HbA1c level in this study.

concentration, and the proportion of patients achieving a therapeutic target of HbA 1c ,7% at the end of the study. Safety data were analyzed for adverse events and all reported and confirmed hypoglycemia (fingerstick blood glucose level #50 mg/dL with associated symptoms). Efficacy was compared between patients with and without a history of CVD, patients with two or more cardiovascular risk fac- tors and with no more than one cardiovascular risk factor, patients with and without hypertension, and patients with and without statin use. In all studies reported in this overview, treatment-by-subgroup interactions were analyzed to detect the inconsistency of treatment effects between saxagliptin and control across subgroups. Analyses that resulted in P,0.1 were considered to be suggestive of differential treatment effects among subgroups without judgment as to the statisti- cal significance of the findings.

Left ventricular diastolic dysfunction represents the reversible first stage of diabetic cardiomyopathy2 which reinforces the importance of evaluation for early examination of diastolic ventricular function in patients with diabetes mellitus. Even in diabetic patients, the risk of heart failure is increased without the clinical evidence of CAD. Myocardial involvement in diabetes mellitus may occur early in the course of disease which impairs early diastolic relaxation initially and causes decreased myocardial contraction when becomes more extensive. Prior to the development of symptomatic congestive heart failure, sub-clinical left ventricular

dyslipidemia is the strongest risk factor of CVD [26,34]. In addition, in the present study the leptin levels were correlated positively and significantly with cholesterol levels in ESRD patients (r= 0.291, p< 0.05), while there were no significant correlations between leptin and other lipid profile parameters in the patient group. In accordance with the finding of this study. Svobodova et al, in their study, reported that the serum leptin level was correlated positively with serum cholesterol and triglyceride levels in heamodialysis patients 35 . There were many

Aiello et al found that, following ICCE, patients with or without background retinopathy were at particularly high risk of developing vitreous haemorrhage, presumably reflecting progression of the disease to PDR. Alparl and Pollock et al observed deterioration of diabetic retinopathy in some diabetic patients following either ICCE or ECCE, with the least progression occurring in patients who underwent ECCE with IOL implantation in the capsular bag. Although clinical evidence suggests that ICCE may have a more deleterious effect than ECCE on the postoperative course of diabetic retinopathy, the precise role of the posterior lens capsule in reducing vascular complications after cataract surgery in diabetic patients requires further investigation.

At the end of this study, all patients in both groups were informed in detail about the benefits of intensified multifacto- rial treatments, and the primary care providers to whom the patients were referred were educated about this approach. Patients were subsequently followed observationally for a mean of 5.5 years. This follow-up analysis demonstrated that the intensified multifactorial approach had sustained benefi- cial effects with respect to vascular complications: absolute mortality was reduced by 20%, and CV mortality was reduced by 13% in patients originally assigned to the intensively man- aged group, compared with those who received conventional therapy. 169 A recent study aiming to address the feasibility

T2D can be a complex condition with associated comorbidi- ties that significantly reduce the quality of life and increase mortality. The presence of multiple comorbidities can com- plicate the patient treatment pathway and result in care that does not always meet best practice. Approximately 80% of delegates believed that the EMPA-REG OUTCOME study should lead to changes in clinical practice, but how should this be achieved? Over 75% of delegates felt that local diabetes guidelines should be updated to reflect the latest data, which was a position that was supported by Dr Jarvis because, with the rationale that many primary care physicians (PCPs) find it difficult to challenge guidelines. She encouraged the special- ists in the room to assist in updating their local guidelines and to ensure that the guidelines reflect the latest data and best practice. Some in the audience felt that increased support and engagement with local medical societies could provide the necessary impetus and expertise to revise T2D guidelines and increase patient access to recent therapeutic advances.