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Diabetes AND macrovascular

Hui Shao, Shuang Yang, Vivian Fonseca, Charles Stoecker, Lizheng Shi
OBJECTIVE: Health utility decrements associated with diabetes mellitus complications are essential for calculating quality-adjusted life-years (QALYs) in patients for use in economic evaluation of diabetes interventions. Previous studies mostly focused on assessing the impact of complications on health utility at event year based on cross-sectional data. This study aimed to separately estimate health utility decrements associated with current and previous diabetes complications. RESEARCH DESIGN AND METHODS: The Health Utilities Index Mark 3 (HUI-3) was used to measure heath utility in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (N = 8713)...
February 19, 2019: PharmacoEconomics
Christoph Werner, Nicolle Müller, Ulrich Alfons Müller
AIMS: Agonistic autoantibodies directed against adrenergic, endothelin, and angiotensin receptors are known as pathogenic factors in disease-causing vascular impairments such as Buergers' disease, dilatative cardiomyopathy, dementia, and preeclampsia. Diabetes mellitus also causes micro- and macrovascular damages, but pathogenesis is still not fully understood. Following indications for a pathogenic role of the mentioned antibodies from our preliminary investigations, we investigated the prevalence in a bigger cohort of patients with longstanding diabetes with or without diabetic complications...
February 15, 2019: Acta Diabetologica
Prakash Deedwania, Tushar Acharya
Diabetes mellitus is a major risk factor for cardiovascular (CV) disease. Conversely, CV disease is responsible for a majority of the deaths in patients with diabetes. Many drug trials have concentrated on blood glucose (hemoglobin A1c ) reduction. This strategy, while reducing microvascular outcomes like nephropathy and neuropathy, has little or no effect on reducing macrovascular events like heart attack, stroke, and heart failure. It has been postulated that hypoglycemia may counterbalance some of the beneficial effects of anti-hyperglycemic agents, but this is not proven...
February 15, 2019: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Viswanathan Mohan, Mark E Cooper, David R Matthews, Kamlesh Khunti
There is currently a worldwide epidemic of type 2 diabetes (T2D) that is predicted to increase substantially in the next few years. With 80% of the global T2D population living in low to middle-income countries, there are issues with cost and of access to appropriate medicines. The objective of this symposium was to provide an overview of the efficacy and safety of glucose-lowering drugs, focussing in particular on sulfonylureas (SUs) in patients with T2D using data taken from both randomised controlled trials (RCTs) and real-world studies, the application of strategies to ensure optimal patient adherence and clinical outcomes, and the optimal use of SUs in terms of dose adjustment and agent choice to ensure the best clinical outcome...
February 13, 2019: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Leigh Perreault, Marilyn K Boardman, Jonathan Pak
INTRODUCTION: It is unclear whether patients and their loved ones appreciate that cardiovascular disease (CVD) is the major cause of morbidity and mortality in type 2 diabetes mellitus (T2DM). The purpose of this survey was to evaluate the degree of awareness regarding the link between T2DM and CVD. METHODS: An online survey was conducted among US adults (general population) and adults with self-reported T2DM. RESULTS: Of 13,027 participants recruited, 1505 completed the survey (12% response rate): 501 with T2DM and 1004 from the general population, of whom 364 knew someone with T2DM (e...
February 13, 2019: Advances in Therapy
Sushama Bhatta, Samir Singh, Santosh Gautam, Bidur Prasad Osti
BACKGROUND: Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia and associated with long term macrovascular and microvascular complications. Platelet parameters such as mean platelet volume and platelet count are indicators of thrombotic potential. These parameters have been reported to be increased in diabetic patients, leading to increased risk of vascular complications. The objective of this study was to determine mean platelet volume and platelet count in patients with Type 2 Diabetes mellitus, impaired fasting glucose and non -diabetic controls, and compare mean platelet volume and platelet count between the three groups...
January 28, 2019: Journal of Nepal Health Research Council
Qi Wu, Haojie Liu, Ming Zhou
BACKGROUND Diabetic retinopathy (DR) is a macrovascular complication that occurs in diabetic patients. Conventional treatments for the management of DR have many limitations. Thus, the present investigation evaluated the protective effect of fangchinoline against diabetic retinopathy (DR). MATERIAL AND METHODS DR was induced by streptozotocin (STZ; 60 mg/kg; i.p.) and rats were treated with fangchinoline 1, 3, and 10 mg/kg for 16 weeks. DR was confirmed by determining the concentration of advanced glycation end-products (AGEs) and morphology of retinal tissues...
February 11, 2019: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Adam de Havenon, Jennifer J Majersik, David L Tirschwell, J Scott McNally, Gregory Stoddard, Natalia S Rost
OBJECTIVE: To determine whether higher blood pressure mean (BPM) or hemoglobin A1c is associated with progression of white matter hyperintensity (WMH) on MRI in patients with type 2 diabetes, and whether intensive blood pressure or glycemic control can reduce that progression. METHODS: We performed a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD MIND) research materials. The primary outcome is change in WMH volume (ΔWMH) between a baseline and month-40 MRI, and the primary predictor is BPM and A1c between the MRIs...
February 8, 2019: Neurology
Lene R Madsen, Lisbeth M Baggesen, Bjørn Richelsen, Reimar W Thomsen
AIMS/HYPOTHESIS: The aim of this study was to examine the effect of Roux-en-Y gastric bypass (RYGB) surgery on diabetes remission, subsequent diabetes relapse and micro- and macrovascular complications in individuals with type 2 diabetes and obesity (BMI >35 kg/m2 ) in a real-world setting. METHODS: This was a population-based cohort study of 1111 individuals with type 2 diabetes treated by RYGB at hospitals in Northern Denmark (2006-2015), and 1074 matched non-operated individuals with type 2 diabetes...
February 6, 2019: Diabetologia
Florah Tshepo Moshapa, Kirsten Riches-Suman, Timothy Martin Palmer
Type 2 diabetes mellitus (T2DM) is increasing worldwide, and it is associated with increased risk of coronary artery disease (CAD). For T2DM patients, the main surgical intervention for CAD is autologous saphenous vein grafting. However, T2DM patients have increased risk of saphenous vein graft failure (SVGF). While the mechanisms underlying increased risk of vascular disease in T2DM are not fully understood, hyperglycaemia, insulin resistance, and hyperinsulinaemia have been shown to contribute to microvascular damage, whereas clinical trials have reported limited effects of intensive glycaemic control in the management of macrovascular complications...
2019: Cardiology Research and Practice
Huafeng Cheng, Xu Wan, Jing Ma, Bin Wu
PURPOSE: The goal of this study was to investigate the long-term economic outcomes of insulin degludec versus insulin glargine use in Chinese patients with type 2 diabetes mellitus (T2DM) whose oral antidiabetic drugs did not provide sufficient glycemic control. METHODS: A published and validated Chinese diabetes health policy model, which reflects Chinese T2DM epidemiologic profiles, was used to assess the lifetime economic outcomes of microvascular and macrovascular complications and mortality...
January 31, 2019: Clinical Therapeutics
P Choudhary, S de Portu, A Delbaere, J Lyon, J C Pickup
AIMS: To develop a novel interactive budget impact model that assesses affordability of diabetes treatments in specific populations, and to test the model in a hypothetical scenario by estimating cost savings resulting from reduction in HbA1c from ≥69 mmol/mol (8.5%) to a target of 53 mmol/mol (7.0%) in adults with Type 1 diabetes in the UK. METHODS: A dynamic, interactive model was created using the projected incidence and progression over a 5-year horizon of diabetes-related complications (micro- and macrovascular disease, severe hypoglycaemia and diabetic ketoacidosis) for different HbA1c levels, with flexible input of population size, complications and therapy costs, HbA1c distribution and other variables...
February 2, 2019: Diabetic Medicine: a Journal of the British Diabetic Association
Ralph A DeFronzo, Silvio Inzucchi, Muhammad Abdul-Ghani, Steven E Nissen
Type 2 diabetes individuals are at high risk for macrovascular complications: myocardial infarction, stroke and cardiovascular mortality. Recent cardiovascular outcome trials have demonstrated that agents in two antidiabetic classes (SGLT2 inhibitors and GLP-1 receptor agonists) reduce major adverse cardiovascular events. However, there is strong evidence that an older and now generically available medication, the thiazolidinedione, pioglitazone, can retard the atherosclerotic process (PERISCOPE and Chicago) and reduce cardiovascular events in large randomized prospective cardiovascular outcome trials (IRIS and PROactive)...
February 1, 2019: Diabetes & Vascular Disease Research
T A Chowdhury, P Jacob
Although micro- and macrovascular complications of diabetes are the most important cause of mortality and morbidity in people with diabetes, it is increasingly recognized that diabetes increases the risk of developing cancer. Diabetes and cancer commonly co-exist, and outcomes in people with both conditions are poorer than in those who have cancer but no diabetes. There is no randomized trial evidence that treating hyperglycaemia in people with cancer improves outcomes, but therapeutic nihilism should be avoided, and a personalized approach to managing hyperglycaemia in people with cancer is needed...
February 1, 2019: Diabetic Medicine: a Journal of the British Diabetic Association
Awadhesh Kumar Singh, Ambika G Unnikrishnan, Abdul H Zargar, Ajay Kumar, Ashok K Das, Banshi Saboo, Binayak Sinha, Kalyan Kumar Gangopadhyay, Pradeep G Talwalkar, Samit Ghosal, Sanjay Kalra, Shashank Joshi, Surendra Kumar Sharma, Usha Sriram, Viswanathan Mohan
The current diabetes management strategies not only aim at controlling glycaemic parameters but also necessitate continuous medical care along with multifactorial risk reduction through a comprehensive management concept. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of evolving antidiabetic agents that have the potential to play a pivotal role in the comprehensive management of patients with diabetes due to their diverse beneficial effects. SGLT2i provide moderate glycaemic control, considerable body weight and blood pressure reduction, and thus have the ability to lower the risk of macrovascular and microvascular complications...
January 31, 2019: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
R Livingstone, J G Boyle, J R Petrie
In 2011, the James Lind Alliance published a 'top 10' list of priorities for Type 1 diabetes research based on a structured consultation process. Whether reducing fluctuations in blood glucose can prevent long-term microvascular and macrovascular complications was one of these. In this narrative review, 8 years on, we have assessed the updated evidence for the assertion that increased glucose variability plays an independent and clinically important role in the complications of Type 1 diabetes, over and above mean blood glucose and the effects of hypoglycaemia: the 'glucose variability hypothesis'...
January 30, 2019: Diabetic Medicine: a Journal of the British Diabetic Association
Patil Suvarna, Kadam Shruti, Desai Maruti, Joglekar Charudatta
BACKGROUND: BKL Walawalkar Hospital is situated near the village of Dervan in the Kokan region of the state of Maharashtra in India. A survey of 2200 surrounding villages showed 51.8% adults had body mass index (BMI) below <18.5 kg/m2 and only 4.5% were overweight. A survey of 11521 adolescent girls from rural schools showed 64% prevalence of thinness. In the same region, government survey reported the prevalence of diabetes around 7%, and 70% prevalence of leanness. This reinforced the fact that the overall population of Kokan is lean...
January 15, 2019: World Journal of Diabetes
L Monnier, C Colette, J-L Schlienger, B Bauduceau, D R Owens
Recognizing the role of dysglycaemia, 'ambient' hyperglycaemia, 'metabolic memory' and glycaemic variability as risk factors for macrovascular diseases is mandatory for effective diabetes management. Chronic hyperglycaemia, also referred to as 'ambient hyperglycaemia', was only fully acknowledged as a risk factor for adverse cardiovascular events when the beneficial effects of intensive glucose-lowering strategies were consolidated in the extended follow-up (> 10 years) of patients included in the United Kingdom Prospective Diabetes Study (UKPDS) and Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study...
January 24, 2019: Diabetes & Metabolism
Carlos Aguiar, Rui Duarte, Davide Carvalho
Diabetes, a metabolic disease with vascular consequences due to accelerated atherosclerosis, is one of the 21st century's most prevalent chronic diseases. Characterized by inability to produce or use insulin, leading to hyperglycemia and insulin deficiency, diabetes causes a variety of microvascular (such as retinopathy and kidney disease) and macrovascular complications (including myocardial infarction and stroke) which reduce the quality of life and life expectancy of individuals with diabetes. We describe the close relationship between diabetes, cardiovascular risk factors, and cardiovascular disease, and examine multifactorial approaches to diabetes treatment, including reducing cardiovascular risk in individuals with type 2 diabetes...
January 23, 2019: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Yuliya Lytvyn, Lucas C Godoy, Rosalie A Scholtes, Daniël H van Raalte, David Z Cherney
PURPOSE OF REVIEW: Type 2 diabetes (T2D) is associated with an increased risk of diabetic kidney disease (DKD), cardiovascular disease, and heart failure, in part through activation of the renin-angiotensin-aldosterone system (RAAS). Although recent cardiovascular outcome trials have identified newer therapeutic agents such as sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1)-receptor agonists that reduce the risk of these complications, patients still exhibit residual cardiorenal morbidity and mortality...
January 23, 2019: Current Diabetes Reports
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