[ Herbal Remedies ]

Cardiovascular Diabetology

When a patient with diabetes mellitus presents with worsening polyuria and polydipsia, what is a sensible, cost-effective approach? A variety of factors can influence reference values. Anticoagulant Therapy Screening: A multidisciplinary effort to improve the rate of patients appropriately prescribed anticoagulants. U-500 regular insulin: inject 100 units (0.2 mL) subcutaneously three times daily before meals. Other blood parameters, including fasting blood glucose and serum creatinine, were also collected. The prevalence in the population age 65 and older is 18.4%, representing 6.3 million cases. It also affects polymorphonuclear lymphocytes causing decreased chemotaxis, diapedesis, and phagocytosis, leading to a decreased ability to fight infection.

As the management of the hypertensive individual aims to reduce cardiovascular risk, it should address these other risk factors, along with hypertension, allowing the establishment of actions with higher effectiveness and rationality in the use of the resources. The current analyses are based on a data set obtained in every patient including the etiology of ESRD (primary glomerulonephritis, secondary glomerulonephritis including systemic diseases such as diabetes mellitus, pyelonephritis/interstitial nephritis, hypertensive nephritis, congenital renal disease, unknown origin, others) and sociodemographic data (sex, age, occupational status, education, marital status, ethnic origin) 1]. You may remember lab values can change based on where you live and work (i.e sea level vs. APTT is commonly used to test the intrinsic coagulation pathway, where a prolonged APTT is a clinical indicator of either a factor deficiency or the presence of coagulation inhibitors [4]. Twenty of 735 (27%) high values triggered a therapeutic response that most commonly required administration of insulin for elevated serum glucose in 17 of 197 occasions in five diabetic PTs. hyperglycemia can cause a diabetic medical crisis and hyperglycemia can damage blood vessels and organs such as the kidneys. We then evaluated both baseline activation level and the ADP-induced activation response.

Blood sampling for routine laboratory values were: hemoglobin (Hb), 8.8 mmol/L; platelet count (Plt), 230,000 per mm3; white blood cells (WBC), 6,320 per mm3; creatinine, 98 μmol/L; urea nitrogen, 5.2 mmol/L; uric acid, 351 μmol/L; aspartate transaminase (AST), 0.35 μkat/L; alanine transaminase ALT, 0.47 μkat/L; Na, 132 mmol/L; K, 4.5 mmol/L; glucose, 19.5 mmol/L (351 mg/dL); Ca, 2.3 mmol/L; albumin, 43 g/L; erythrocyte sedimentation rate, 19 mm/h; C-reactive protein 2.1 mg/L; and an HbA1C of 0.0107 Hb fraction. However, although its role in the primary prevention of CV events is controversial, many physicians prescribe prophylactic aspirin therapy for their high CV risk patients, specifically diabetic patients. For patients needing eye exams and/or foot exams, the MA will ask them if they have had a recent exam and make note of any dates that the patient provides on the brochure. C. The Prevention of Progression of Arterial Disease and Diabetes (POPADAD) did not indicate any benefit of aspirin or antioxidants in the primary prevention of CV events [22]. In the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD), primary prevention with aspirin did not reduce the rates of all CV events, yet the rates of fatal coronary and cerebrovascular events, a secondary end point, were reduced [23]. For men, the normal level ranges from 13 to 18 g/dL; for women, the level ranges from 12 to 16 g/dL.

In addition, several other trials in which diabetic patients constituted only subgroups within broader trials of aspirin prophylaxis, yielded conflicting results [44–49]. For data management, a Microsoft Access 2003 database was used. Currently, both ADA guidelines and ESC/EASD guidelines recommend (level C) prophylactic aspirin therapy for high CV risk (10-year risk > 10 %) diabetic patients [30, 31], which includes most men aged >50 years or women aged >60 years who have at least one additional major risk factor (family history of CV disease, hypertension, smoking, dyslipidemia, or albuminuria) [30]. Thus, these recommendations essentially support the use of aspirin as a primary prophylaxis for the majority of diabetic patients. The results of our study do not support these recommendations, as our multivariate analysis did not detect an association between elevated Framingham Risk Scores and platelet markers of reactivity. Thus, herein, we present novel data suggesting that well-controlled diabetic patients without prior ischemic events have normal platelet functionality profiles, regardless of their CV risk. The main limitation of our study is that CV risk factors assessed in our population were well-controlled.

A complete physical examination was normal, as were a PA chest radiograph and an electrocardiogram (ECG). They also showed minimal aberrancies in lipid metabolism with relatively low smoking rates. Nevertheless, although somewhat limited to a well-controlled diabetic patient population, our results have merit. D.

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[ Diabetes Type 1 ]

Cardiovascular Diabetology

The interrelationship between obesity, type 2 diabetes, complications of diabetes, and immune dysfunction has been suspected for more than a decade1. Because as many as, two-thirds of the adult population and a growing number of children are overweight. Medication helped reduce the sensations. 2. For this purpose 78 patients (mean age 57.8 +/- 11.9 years, 55 women and 23 men) who had type II DM for 15 years maximally and 37 non-diabetic controls (mean age: 55.7 +/- 11.5, 27 women and 10 men) were randomly selected for inclusion in the study. A ten-year study of over 5,000 patients with newly diagnosed type 2 diabetes – The United Kingdom Prospective Diabetes Study (UKPDS) – found that the diabetes-related complications of retinopathy, nephropathy, and neuropathy were reduced significantly in study subjects with type 2 diabetes who practiced intensive blood glucose control (i.e., a median A1C of 7%). Scores of the screening instrument for depression, the CES-D was associated with the duration of diabetes mellitus (P = 0.018), fasting blood glucose (P = 0.029) as well as with 2-hour post prandial blood glucose (P = 0.017).

The hazard of any macrovascular complication in early-onset type 2 diabetic patients compared with control subjects was twice as high in usual-onset type 2 diabetic patients compared with control subjects (HR 7.9 vs. [21]. Instead, an increasing number of metabolically-intolerant, polarized, renegade macrophages use adipose tissue to stage a war of systemic low-grade chronic inflammation and pathology on an ever-increasing array of metabolically-imbalanced tissues. Thus, focusing on the interactions between insulin resistance, sympathetic nervous activity and beta-adrenoceptor polymorphisms might help in understanding the precise relationships between insulin resistance and sympathetic nerve activity in type 2 diabetes and obesity-related hypertension. “If you can’t hear, you don’t know what you’re missing,” she says. 6. However, as no study has yet reported the trajectory of HbA1c with treatment intensification, our unique findings are not directly comparable.

The mechanisms of increased risk of macrovascular events with hyperglycaemia are not fully known but may include oxidative stress, inflammation and thrombosis [40–42]. The ACCORD study in patients with 10 years of duration of T2DM could not establish any significant benefit of intensified glucose lowering treatment on macrovascular event during 3.5 years of median follow-up [6]. However, the meta analyses of four major cardiovascular outcome trials in patients with T2DM, including the ACCORD trial data, reported a 15–17% risk reduction in MI, 15% risk reduction in coronary heart disease and 9% risk reduction in major cardiovascular event associated with intensive glucose control therapy [9, 43]. While the UKPDS trial was based on newly diagnosed diabetes patients, the median duration of diabetes in the participants of ACCORD, ADVANCE and VADT trials was 9 years, and 34% of them had history of major cardiovascular disease before randomisation. obese women with type 2 diabetes is the level of both circulating proinflammatory cytokines and free fatty acids2. The recent cardiovascular outcome trials in established T2DM patients had about 5 years of follow-up and do not provide insight into any longer time benefit in terms of cardiovascular risk. Although hearing loss is not reversible, a hearing aid can help enormously.

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[ Herbal Remedies ]

Cardiovascular Diabetology

– Jennifer Middleton, MD, MPH The Eighth Joint National Committee (JNC 8) released its “2014 Evidence-Based Guideline For the Management of High Blood Pressure in Adults” last week. Hypertension is frequently associated with NIDDM, however the influence of antihypertensive therapy on these combined factors in the diabetic is at present unclear. Conversely, ACE inhibitors, angiotensin II receptor blockers, and calcium channel blockers (CCBs) have neutral or beneficial effects on these variables (2,3). glucose injection after 1 hr of sustained hypoglycemia. Ask your pharmacist about the side effects of each medicine you take. We were surprised to discover that calcium channel blockers inhibited TXNIP expression in INS-1 cells and human islets and that orally administered verapamil reduced TXNIP expression and β-cell apoptosis, enhanced endogenous insulin levels, and rescued mice from STZ-induced diabetes. In such patients, the increased risk of developing diabetes may exceed the benefit of blood pressure lowering.

In addition, they had a 10 percent reduction in the primary endpoint of fatal coronary heart disease and non-fatal heart attack, which did not reach statistical significance as the study was halted early due to the mortality benefit associated with the amlodipine based regimen. Previous studies demonstrated that ARBs possess various PPARγ activation activities. The median follow-up period was 18 months. Embryotoxicity and/or fetotoxicity in rats and rabbits were noted starting at doses of 50 mg/kg in rats and 25 mg/kg in rabbits, as demonstrated by increases in preimplantation loss, decreases in the number of viable fetuses per dose, and/or decreases in neonatal survival. Oxprenolol will not help to relieve the emotional symptoms of anxiety such as stress and fear – these will be treated separately. J Hypertens 2007;25:1105–1187. Indeed, candesartan was shown to improve insulin sensitivity through PPARγ-independent mechanism and to increase insulin content in pancreatic beta-cells by attenuating oxidative stress [27, 30].


Losartan, irbesartan and valsartan, and telmisartan have been shown to exert various anti-diabetic effects other than PPARγ activation, including augmentation of blood flow to muscle, direct modulation of insulin signaling and up-regulation of glucose transporter expression in muscle, reduction of islet fibrosis through inhibition of TGF-β, and activation of AMPK/SIRT1 pathway [31–35]. Chobanian AV, Bakris GL, Black HR et al. Specifically, numerous medications within this class are presently available that vary with regard to their glycometabolic effects2–5, a potentially important consideration in patients with diabetes mellitus (DM). First, this is currently the only study comparing diabetes risk for individual ARB. Second, this study is a nationwide population-based cohort study. • Mood stabilisers, such as clozapine, quetiapine and risperidone, which have been found to cause metabolic syndrome, including raised blood sugar and blood fat levels, abdominal obesity and high blood pressure. Third, the intention-to-treat analysis preserves the baseline comparability of the treatment groups, reduces the potential bias due to drug switching or discontinuation, and provides a conservative estimate.

Your heart is a very important organ, so medications that have an effect on the heart have to be monitored very closely. Diabetes is a strong risk factor of cardiovascular disease, renal failure, and retinopathy which imposes enormous economic burden to the health care system [36–38]. The changed diabetes incidence with different ARB therapy would translate directly to mortality and medical costs. Fourth, different analytic strategies, including the ITT and exclusive user analyses, showed similar results and indicated an internal consistency among these results. Our study has some limitations. First, this is an observational study but not a randomized clinical trial. Therefore, the association between individual ARBs and new-onset diabetes may be affected by unknown or unmeasured confounders.

Laboratory and anthropometric data such as fasting glucose or body mass index were not available in the NHI database. If you don’t take your medicines properly, you may be putting your health (and perhaps your life) at risk. Furthermore, our analyses have been fully adjusted for these baseline co-morbidities. Second, imperfect adherence to therapy or discontinuation of therapy could have attenuated our intention-to-treat effect estimate. Third, the definition of new-onset diabetes was made according to the ICD-9-CM code but not by screening tests. Although the definition algorithm using ICD-9-CM diagnosis code has a high positive predictive value, some diagnoses of diabetes might be missed. Nevertheless, the magnitude of increased risk associated with olmesartan changed little (from 7% to 5%) when more strict definition (diagnosis code plus anti-diabetic therapy) was applied in the sensitivity analysis.

The under-estimation due to un-diagnosed diabetes or latent diabetes should be minimal. Getting the most from your treatment Try to keep your regular appointments with your doctor. Telmisartan was not associated with reduced diabetes incidence. These findings suggest heterogeneous diabetes risks associated with different ARBs beyond a class effect, but the difference in diabetes risk does not seem to correlate with PPARγ activation activities. Further study is needed affirm this observation.

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[ Diabetes Type 1 ]

Cardiovascular Diabetology

Trialnet Diabetes Screening is available and free to eligible family members of people with type 1 diabetes through an international research effort and BRI. Texas A&M and The Texas A&M University System agencies jointly administer this process to select the proposal(s) that will be submitted to the sponsor in response to this solicitation. Currently, the only therapies for retinopathy are laser treatment and injection of drugs, which are used to slow down the progression of retinopathy, but are not able to reverse vision loss. Various kinases (ERK, JNK, IKKbeta, PKCzeta, PKCtheta and mTOR) are involved in this process. Twenty-five obese (body mass index 44.8 ± 4.4 kg/m(2)) nondiabetic (hemoglobin A1c 5.83% ± 0.27%) and 21 obese (43.4 ± 4.1 kg/m(2)) and T2D (hemoglobin A1c 7.66% ± 1.22%) subjects were included in the study. Chymotrypsin is one of the most abundant digestive enzymes in the gut where it cleaves food proteins into smaller peptide fragments. Hyperglycemia has been proposed to lead to large amounts of reactive oxygen species (ROS) in beta-cells, with subsequent damage to cellular components including PDX-1.

Soleus fatigue resistance was markedly reduced by diabetes, but restored to normal by treatment. Since aldose reductase has a high Km for glucose, it would mean that increasing hyperglycemia is likely to increase flux via polyol pathway proportionately. ‘ALANO pathway’) is proposed, revealing in part the mechanisms that account for human umbilical vein endothelial cell dysfunction programmed through the development of the fetus in gestational diabetes. The greater glucose availability over time (amount and duration) is, in part, a key reason for the increased flux through aldose reductase. Flux via polyol pathway has been associated with changes in cytosolic NADH/NAD+ the ratio [32–35, 39–41]. 3,52,58,60 The GLP-1 receptor agonists are associated with a much higher incidence of adverse GI effects such as nausea and vomiting, presumably also attributable to the pharmacologic levels achieved. In this study, we demonstrate that cytosolic lactate/pyruvate ratio, a measure of cytosolic NADH/NAD, is associated with increases in polyol pathway activity in type 2 diabetic BBZ rat hearts.


These data are consistent with our earlier studies [32–35], demonstrating increased flux via polyol pathway during ischemia resulting in increased cytosolic NADH/NAD+. The data presented here show that inhibition of aldose reductase or sorbitol dehydrogenase attenuates increases in cytosolic NADH/NAD ratio in type 2 diabetic rat hearts and is associated with changes in ATP levels and protection of hearts from IR injury. Although the present results show that elevated NADH/NAD+ can be blocked by either ARI or SDI treatment in this preclinical model, extreme caution should be exercised in regard to extrapolation of SDH inhibition to the clinical arena. This is warranted based on a) reports of increased neuronal axonal dystrophy observed in rat ganglia, [42]. and b) the discontinuation of an SDI clinical trial for adverse events that possibly might have been mechanism-related (Landau Z et al., manuscript in submission). In the diabetic rat model, increased occurrence of ganglionic lesions with SDI treatment notably was prevented by concurrent administration of an ARI [43]. Aldose reductase pathway inhibition attenuated the rise in EDP during ischemia in diabetic hearts.

Several studies have shown that the attenuation of the rise in EDP by interventions is linked to the maintenance of intracellular sodium and calcium homeostasis [44–49]. In our earlier studies, we have shown that inhibition of aldose reductase attenuated the rise in intracellular sodium and calcium during ischemia and reperfusion in Type 1 BB/WOR diabetic hearts [48]. Protection of the Type 2 diabetic ischemic hearts by aldose reductase or sorbitol dehydrogenase inhibitors in this study is presumably due to attenuation of changes in sodium and calcium homeostasis during ischemia – reperfusion. However, further studies are required to confirm this speculation. Overwhelming clinical evidence indicate that the diabetic heart in humans is sensitive to ischemic injury [1–6]. However, the animal studies addressing this issue have resulted in ambiguous results. In the type 2 ZDF rat hearts, in-vivo ischemia – reperfusion resulted in increased infarct size and poor functional outcome [50].

A study by Wang & Chatham, using isolated perfused heart models, showed that despite greater contracture during low flow ischemia the diabetic ZDF rat hearts exhibited improved functional recovery on reperfusion [9]. Our studies presented here in isolated perfused hearts demonstrate that ischemia/reperfusion increases injury and impairs functional recovery in type 2 diabetic BBZ rat hearts. In our studies and in the one by Wang and Chatham [9], ischemic contracture during low flow ischemia was significantly greater in Type 2 diabetic rat hearts than in nondiabetics. In our studies, increased ischemic contracture was also associated with greater ischemic injury and poor functional recovery on reperfusion. Thus, the data presented in our study are consistent with earlier studies demonstrating association between ischemic contracture, ischemic injury and functional recovery. Earlier studies by us [27, 28, 32, 33, 35] and others [51, 52] demonstrated that inhibition of aldose reductase affords protection to myocardium against ischemia-reperfusion injury. It should be noted that injury to myocardium occurs both at the ischemic and reperfusion period.

The presence of aldose reductase inhibitor throughout ischemic and reperfusion period indicates that injury during both ischemic and reperfusion phase was attenuated by aldose reductase inhibition. One aspect of injury to the myocardium not addressed by our data is the role of highly reactive oxygen species in mediating injury in the Type 2 diabetic hearts. Excess generation of highly reactive free radicals, both due to hyperglycemia and ischemia-reperfusion injury [53] can exacerbate injury in diabetics. The impact of aldose reductase inhibition in attenuating highly reactive free radicals, during ischemia-reperfusion, needs to be examined in the Type 2 diabetic hearts.

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[ Diabetes Type 1 ]

Cardiovascular Diabetology

Despite the high rate of occurrence of both diabetes and hypertension in humans, the cardiovascular effects of the two conditions have not been investigated when they occur simultaneously. LVH is more than just an adaptive response to hypertension. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Hypertension substantially increases the risk of both macrovascular and microvascular complications, including stroke, coronary artery disease, and peripheral vascular disease, retinopathy, nephropathy, and possibly neuropathy. Multiple step-wise logistic regression analysis was used to examine the independent relationship between the anthropometric indexes, age and smoking, and the odds ratio of having chronic conditions. The common fertile soil of insulin resistance and lost hormonal homeostasis (genetic and environmentally driven) links these two entities. Group 1, those with normoalbuminuria (n=63) and Group 2, those having microalbuminuria (n=50).

Other studies have reported similar low rates of treatment initiations, but higher rates of intensifications particularly for lipid-lowering therapy [11, 20, 21]. Am J Clin Nutr 1996;63(5):753-9. showed that patients adherent to hypertensive medication had three times the odds of having better overall blood pressure control than patients who were non-adherent [41]. That administration of rilmenidine decreases microalbuminuria suggests that it could exert nephroprotective effects. The development of CVE, and DN, defined as abnormal UPE (confirmed by also abnormal UAE) were considered as end points. Criteria for established hypertension were systolic and diastolic blood pressure ≥ 140/90 mmHg on repeated measurements [7]. All T2DM patients were treated with diet plus oral hypoglycemic agents.

In conclusion, the present study demonstrates that the over activity of RAAS may contribute in causing DM-2-related hypertension and consequent cardiovascular diseases in our population. Diabetes was diagnosed acoording to the standard criteria. Type 2 DM were identified as those with disease onset at the age of 30 years or after and no need of insulin teatment [6]. The average of FBG, chosen in this study, has been commonly used to monitor glycemic control in type 2 diabetics treated with diet alone or oral hypoglycemic agents. According to several studies, the retrospective average of FBG values is considered a good index to establish a previous long-term glycemic control on those patients [6]. Diabetic Nephropathy was established by microalbuminuria, according to the Gentoften-Montecatini convention [16]. It was considered present when the UAE in a 24-h urine or a short-time collected urine during daytime was in the range of 30-300 mg/24 h (20-200 μ g/min).

The upper range was corresponding to a UPE of approximately 0,5 g/l, which was previously considered to be the first marker of clinical diabetic nephropathy [17]. It has been well established that microalbuminuria predicts overt nephropathy in type 1 diabetics. The UAE and UPE are well-documented parts of monitoring those patients [18]. Some surveys also showed benefits on performing these methods in type 2 patients. Inclusion criteria were the following: all patients should be between 30 and 75 years of age, with body mass index (BMI) lower than or equal to 40 kg/m2, type 2 DM treated only with diet or oral glucose-lowering drugs (with no use of insulin), arterial hypertension, normal levels of serum creatinine and 24-hour proteinuria ( 140/90 mmHg in repeated measurements 20. 24-h ABPM was performed using a Spacelabs – 90207 automatic cuff-oscillometric devices (Spacelabs, Inc. Redmond, WA-USA) after 15 days washout of all antihypertensive drugs, after that all subjects restarted on their antihypertensive medications.

The monitor was installed in the morning period and it was drop out after 24 hours. The individuals were oriented to keep their regular activities and make a report discriminating the hours of each activity. The device was programmed to perform four measures during each hour. It was established an average systolic and diastolic pressure, during diurnal period, nocturnal period and in 24 hours. For the purpose of ambulatory blood-pressure monitoring, two different periods were defined. The daytime period included all readings obtained from 8 a.m. until 8 p.m., and the night time period included all readings from 8 pm until 8 a.m.

Measures of systolic BP higher than 260 mmHg and diastolic BP higher than 150 mmHg were excluded. The limit to detection of heart rate was between 200 and 20 bpm. The exam was accepted if at least 75% of the measures in 24 hours were successfully executed. Moreover, it was calculated the nocturnal BPF ({diurnal systolic BP – nocturnal systolic BP} × 100/diurnal systolic BP). It was considered normal values of nocturnal systolic BPF greater than 10% (dippers). Patients that showed BPF lower than this value were called “non-dippers”. M-mode, two-dimensional echocardiographic and cardiac Doppler studies were performed using a commercially available echo-Doppler unit (Esaote Biomedica, Florence, Italy; model SIM 5000) equipped with a 2, 5 MHz mechanical transducer.

It was performed with patients in the partial left lateral supine position. M-mode measurements were performed according to the recommendations of American Society of Echocardiography. Left ventricular mass (LVM) was calculated as previously recommended by Devereaux et al [19]. According to WHO recommendations for Caucasian populations, the thresholds for increased risk of comorbidities are BMI 25 kg/m2 men and women, WC 94 and 80 cm in men and women, respectively, and WHIR 1.0 and 0.85 in men and women, respectively.4 On the other hand, according to the recommendations for Asians, the thresholds for increased risk of comorbidities are BMI 23 kg/m2 in men and women, and WC 90 and 80 cm in men and women, respectively.25 The cut-off levels found in this study were lower than those in the Caucasian population and similar to those of the Asians. All examinations were analyzed by the same echocardiographer that was blinded to the dipping status. Transmitral blood flow signals were obtained on top of mitral valve by apical 4-chamber-view. All measurements of diastolic function were done with normal heart rate (60-100 bpm).

UPE was performed through Kingsbury sulfosalicilic method adapted by Morales and Merino that has normal values below 150 mg in 24 hours. These were very high BMI patients with a “conically” shaped arm. UAE was determined by a turbidimetric immunoassay kit. Microalbuminuria was defined by the presence of a UAE rate consistently between 20 and 200 mg/min, as assessed by three 24-h urine samples collected at least 6 weeks after any urinary tract infections or acute hyperglycemic events, and after exclusion of all other causes of albuminuria [21]. To create a measure of the previous long-term glycemic control, the average of all FG values available before the study was calculated. If several FG values were recorded during a month, only the first value of the month was used. The same procedure was used to calculate previous indexes of office BP, TC and fractions, and TG.

These indices were referred to as the basal average of FG, office BP, TC and fractions, and TG values; and did not differ between the groups. All normally distributed values were given as mean ± SD and all other values were given as median (range). In comparison of the non-normally distributed variables, the Mann-Whitney test was used to test the differences between two groups and Wilcoxon test was used to compare the same groups before and after the follow up period. For all normally distributed variables, the unpaired student’s test was used for comparison between two groups and paired student’s test was used to compare the same groups before and after. For correlation analysis, correlation coefficients (Pearson or Spearman) were calculated. A P value (two tailed) less than 0.05 was considered statistically significant. All calculations were made with a commercially available program, SigmaStat 1.0 (Jandel Scientific Corporation, Chicago, Illinois).

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[ Diabetes Solutions ]

Cardiovascular Diabetology

In summary, our study shows that the prevalence of low BMD and fractures was similar in patients with type 1 and type 2 diabetes, although patients with type 1 were about 20 years younger than those with type 2 diabetes. It suppresses postprandial glucagon secretion and slows gastric emptying. Serum insulin and C-peptide were measured by radioimmunoassay, and lipids (total cholesterol, triglycerides, HDL cholesterol) by colorimetry. Combined incidence rate ratios for any macrovascular event were 0.38 (95% CI 0.26-0.56) in type 1 and 0.81 (0.73-0.91) in type 2 DM. Hence, this study was taken up to analyze the status of PON I activity in patients with Type 2 Diabetes Mellitus, attending the Diabetic OP of Sree Balaji Medical College and Hospital (SBMCH). Hormones are chemicals in your body that send messages from cells to other cells. Now, the cause of type 2 diabetes is quite different from type 1.


This pathway leads to both microvascular and macrovascular complications. The increased bone loss at the FN compared with the LS-BMD suggests that osteoporosis in diabetic patients preferentially develops within the appendicular skeleton with predominantly cortical bone. Its C(max) is reached within 20 minutes, and its t(1/2) is 48 minutes. In the majority of cases type 2 diabetes is now widely considered to be one component within a group of disorders called the metabolic syndrome. Factors characteristic of the metabolic syndrome, also known as dysmetabolic syndrome X, are abdominal obesity, atherogenic dyslipidemia (elevated triglyceride [TG] levels, small low-density lipoprotein [LDL] particles, low high-density lipoprotein cholesterol [HDL-C] levels), elevated blood pressure, insulin resistance (with or without glucose intolerance), and prothrombotic and proinflammatory states [7–10]. The factor that dominates in obesity is the permanent elevation of plasma free fatty acid (FFA) and the predominant utilization of lipids by muscles inducing a diminution of glucose uptake and insulin resistance. In Type 2 diabetes, there may be mild symptoms or no symptoms at all.

Hyperinsulinemia appears to be a compensatory mechanism that responds to increased levels of circulating glucose. People who develop type 2 diabetes usually pass through the phases of excessive adipogenesis (obesity), nuclear peroxisome proliferator activated receptors (PPAR) modulation, insulin resistance, hyperinsulinemia, pancreatic beta cells stress and damage leading to progressively decrease of insulin secretion, impaired glucose postprandial and fasting levels [11–14]. Fasting glucose is presumed to remain normal as long as insulin hypersecretion can compensate for insulin resistance. The fall in insulin secretion leading to hyperglicemia occurs as a late phenomenon and, in fact, separates the patients with metabolic syndrome from those with or without overt diabetes (Figure 1). Figure 1 The relationship between metabolic syndrome, insulin resistance, hyperinsulinemia and hyperglycemia (overt type 2 diabetes). An insulin-resistant state following nuclear peroxisome proliferator activated receptors (PPAR) deactivation is the key phase of metabolic syndrome initiation. Afterwards, there are 2 principal pathways of metabolic syndrome development: 1) With preserved pancreatic beta cells function and insulin hypersecretion which can compensate for insulin resistance.

Type 2 diabetes mellitus is an illness very different from Type 1 diabetes. overt type 2 diabetes). This pathway leads both to microvascular and macrovascular complications. Time-related scheme.

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[ Nutrition ]

Cardiovascular Diabetology

Genome-wide association study (GWAS) data showed that the protein tyrosine phosphatase receptor type delta (PTPRD) is associated with increased susceptibility to type 2 diabetes (T2D) in Han Chinese. Whether CKD273 is only related to renal damage or also reflects generalised vascular damage in patients with diabetes remains unclear. Sprague-Dawley rats were made diabetic by injection of STZ, followed by the administration of LMWF (50 or 100mg/kg/day) or probucol (100mg/kg/day) for 12 weeks. Now I’m not saying there were not challenges, any marriage has challenges, but when it came to the care of our kids we learned that discussions needed to be crucial for us to understand our roles and also the role of diabetes in our new normal. In preliminary studies we observed that Ca2+sensitization of contractions are significantly increased in vascular smooth muscle tissues isolated from type II diabetic mice. (8.8 mmol/l), at 2:00 P.M. These results demonstrate that 1) insulin secretion in non-insulin-dependent diabetes mellitus is suppressed by high physiological doses of exogenous insulin in both the hyper- and euglycemic states, the degree of inhibition being independent of the plasma glucose level; and 2) glucagon secretion is also inhibited by such doses of exogenous insulin.

Urinary protein excretion was increased in untreated and l-arginine–treated diabetic rats (142±25 versus 75±7 and 128±7 versus 89±7 µg/min per kidney) but not in diabetic rats administered l-citrulline (67±7 versus 61±5 µg/min per kidney). Being the hyper-contracture to AT-II reduced in DL group, we hypothesised that the in vivo AT1 receptor activation might play a fundamental role in determining AT-II effect in diabetic aortas. We have assembled a team of engineers and clinicians for this project. – Poy MN, Hausser J, Trajkovski M, Braun M, Collins S, Rorsman P, Zavolan M, Stoffel M.miR-375 maintains normal pancreatic alpha- and beta-cell mass. They will also ask if you are taking any medications to treat a medical or mental health condition. w. respectively at the 1 μM AT-II).

In the presence of HA-1077, diabetic aortas responded to AT-II similarly to normoglycemic animals. Increased ROCK1 signalling, in terms of protein expression and enzyme activity, was also demonstrated in diabetic aortas where ROCK1 protein expression and its activity were two and around 2–3 times higher respectively than that measured in N and NL rats. These results showed quite a good correlation between ROCK1 protein expression/activity with functional data. The most common reported cause of hypercarotenemia (and thus carotenoderma) is increased intake, either through increased dietary foods or nutritional supplements. The more insulin you take the more you might experience the ‘low’ post eating. Heb je vaker een hyper of is je waarde sterk verhoogd, overleg dan met het behandelteam of bel de Diabeter spoedlijn. People suffering from this condition can safely drink herbal teas, as well as coffee, as long as they don’t exceed 2-3 cups per day.

There I am saved – and I thank all the unknown people who did that. Soms stijgt de bloedsuiker zonder een duidelijk aanwijsbare reden. Dit kan er toe leiden dat omstanders de patiënt met ‘rare’ ogen bekijken. Members are nice, so having tea & a bit of conversation after class is a real treat!! Despite the considerable interest and the development of potent ROCK1 inhibitors, there is little information on clinical trials with selective ROCK1 inhibitors [37]. On the contrary, numerous clinical trials have extensively confirmed the efficacy and safety of losartan and other AT1 blockers in diabetic and or hypertensive patients [38, 39]. Although the STZ-rat is one among the experimental models of diabetes, it shows suitability for studying the basic mechanisms of diabetic cardiovascular complications and their time-dependent progression [25].

Thus, our data obtained on a model of “early diabetes”, could suggest a new molecular mechanism supporting the protective role of losartan in diabetic vascular complications.

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[ Diabetes Solutions ]

Cardiovascular Diabetology

Neural vascular insufficiency plays an important role in diabetic peripheral neuropathy (DPN). About 25% of dogs receiving veterinary care in Western countries are overweight to obese (1). 2012 Feb;35(2):218-225. The primary end point was reduced by the same percentage. TAG accumulation can result from a shift in the fate of fatty-acyl-CoA toward esterification with a corresponding decrease in oxidative rate, or from an imbalance between cellular fatty acid uptake and oxidation, with a more important increase in uptake than in oxidation, in the absence of any absolute decrease in lipid oxidation. Traditional risk factors were assessed at baseline, 4 months and 2 years after randomised treatment allocation to fenofibrate (200 mg daily) or placebo. The prespecified primary study endpoint was the difference in FMD between treatment groups at 4 months.

Overall, fibrates were cardioprotective in both men and women with type 2 diabetes. In terms of cardiovascular outcomes, fenofibrate did not reduce the risk of coronary heart disease (CHD) events to a greater extent than placebo in patients with type 2 diabetes in the FIELD trial. We believe that a proper co-administration of statins and fibrates, selected on basis of their safety, could be more effective in achieving a comprehensive lipid control as compared with monotherapy. Overall, fenofibrate reduced total cardiovascular events, compared with placebo (hazard ratio 0.89 [95% CI 0.80-0.99]; P = 0.035). Although less clinical intervention studies have been performed with fibrates than with statins, there are evidences indicating that fibrates may reduce risk of cardiovascular disease and particularly non-fatal MI [4–10]. Because of the patient’s presenting symptoms and recent initiation of fenofibrate therapy, her creatine phosphokinase (CPK) level was checked and found to be 5,632 units/l. There have been no direct head-to-head comparisons of a statin with a fibrate in any clinical endpoint trial.

However, compared with statins, fibrates appear to more selectively target the therapeutic goals in obese individuals with features of insulin resistance and metabolic syndrome (i.e. This effect is related, at least partly, to the correction of lipoprotein abnormalities, even those previously judged not to need treatment. The primary-prevention trial Helsinki Heart Study showed that treatment with gemfibrozil led to a significant reduction in major cardiovascular events [4]. Regarding secondary prevention, in the VAHIT study (Veterans Affairs High-density lipoprotein cholesterol Intervention Trial) – which included 30% of diabetic patients – gemfibrozil reduced the occurrence of major cardiovascular events by 22 % [5]. Similarly, reduction of cardiovascular disease with gemfribrozil was more pronounced in patients displaying above three of the features of metabolic syndrome [11, 12].

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[ Diabetes Type 1 ]

Cardiovascular Diabetology

Glimepiride adalah obat dengan fungsi untuk mengontrol kadar gula darah yang tinggi pada penderita diabetes tipe 2. Prior to insulin dependence, pharmacological options for reducing hyperglycemia comprise the oral glucose-lowering drugs used in type 2 diabetes; however, none has been established as the drug of choice in LADA because of the scarcity of evidence for or against the various agents (2). Glimepiride and metformin seem to lack such characteristics. The CANTATA-SU study compared two doses of the sodium glucose cotransporter 2 inhibitor canagliflozin (CANA 100 and 300 mg) with the sulfonylurea, glimepiride (6-8 mg) in Type 2 diabetes mellitus patients inadequately controlled on metformin, over 52 weeks. min(-1))-euglycemic glucose clamp was performed on both occasions to determine insulin sensitivity. The percentages of patients with an HbA(1c) < 7.0% at week 30 were 52 and 60% in the sitagliptin and glimepiride groups, respectively. The patients were followed and HbA1c done after an average of 5 months.
If you have any of these symptoms, do not drive, operate machinery or do anything else that could be dangerous. The American Geriatrics Society’s Beers Criteria lists a strong recommendation based on high quality evidence that glyburide be avoided in the elderly due to the potential risks. SGPT levels were always higher than SGOT. Three of them were hypoglycemia and two patients had skin rash. The safety of liraglutide and rosiglitazone, specifically regarding minor and major hypoglycemic events, was also projected from the LEAD-1 study, probably underestimating the real effect in events and costs for a longer follow-up. Treatment with vildagliptin significantly increased the levels of active glucagon-like peptide-1 by 2.36-fold (p ≤ 0.0001) and suppressed glucagon by 8% (p = 0.01), whereas glimepiride significantly increased the levels of insulin and C-peptide by 21% (p = 0.012) and 12% (p = 0.003), respectively. Initial dose and dose titration: the usual initial dose is 1 mg once daily.

Although the model uses data from epidemiologic and clinical trials, some recently published studies have called into question the cardiovascular benefits of intensive glycemic control in patients with longer duration of diabetes and/or existing diabetes complications [18, 22]. Your doctor may increase or decrease the dose, depending on your blood glucose levels. The effect of rosiglitzaone on systolic blood pressure in LEAD-1 may be underestimated when compared to evidence from other trials [47]. One important caution when interpreting the results of the cumulative costs is that the costs of adding liraglutide or rosiglitazone to glimepiride treatment are not included because liraglutide is not on the market and the price is not known. More specific research will be required to determine the cost-effectiveness of the treatments. In the sensitivity analysis, only changes in HbA1c were considered, using the lower and upper limits of the 95% CI for every treatment as this was the primary endpoint of the LEAD-1 study. IJCRR, 5 (16), 20-26.

Finally, the utility of diabetes models to predict life expectancy and other disease outcomes with precision is open to criticism. Models are imperfect instruments of real world outcomes. Nevertheless, attempts to correlate diabetes model predictions of outcomes with the results of long-term trials have been undertaken. Written informed consent was obtained from each subject.

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[ Diabetes Type 2 ]

Cardiovascular Diabetology

Over the last 50 years, the incidence and prevalence of coronary artery disease (CAD) have climbed steadily in the majority of westernised countries (Centers for Disease Control and Prevention, 2004). These observations suggest that pharmacological strategies, which reduce inflammation, may be therapeutically useful in treating obesity, type 2 diabetes and associated CVD. The composition of bacteriota living in diverse parts of the intestinal tract is variable according to age, body weight, geological site, and diet as well. Having any one of these factors can boost your chances of developing additional medical problems. In 2007, the ESH-ESC committee decided against using the term “prehypertension” for several reasons (4). We review a few important definitions in this paper. Further research is needed to understand the role of more aggressive therapy in preventing type 2 diabetes and cardiovascular events in the population.

There were 8 papers utilizing data from longitudinal studies [14–16, 18, 20, 35, 39, 44], although strictly, none collected consecutive longitudinal information regarding cardiovascular risk factors at both baseline and follow-up. Further evidence is needed to support the concept that targeting inflammation pathways may represent a valuable option to tackle the cardiometabolic complications of obesity. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Having completed that at Monash University, I spent a year in London for post-doctoral work at Guy’s Hospital under Professor Harry Keen. Psychosocial problems are tracked as well. And it looks like environmental toxins may be driving our epidemic of type 2 diabetes and metabolic syndrome (aka “pre-diabetes”). And researchers from the U.S.

Conventional dietary wisdom called into question The researchers analyzed several different fish and non-ocean foods for levels of C17:0. These metabolic changes might potentially explain the lower plasma glucose and higher triglyceride levels, however the exact mechanism remains to be elucidated [8, 28]. Blood glucose may be high despite normal or increased amounts of insulin. Besides the conventional cardiovascular risk factors as hypertension, high LDL-cholesterol level, low HDL-cholesterol level, hypertriglyceridemia, also the level of advanced glycation endproducts (e.g. In a systemic review Innes et al22 have analyzed 70 previous studies on the effect of yoga and suggested that yoga may reduce the insulin resistance related risks in relation to cardiovascular disease. After your risk is determined, treatment to lower LDL to appropriate levels can begin along with treatment of other metabolic risk factors, including high blood pressure and insulin resistance. Here we also investigated the lipid traits and the CIMT, which was proved an independent preclinical marker of atherosclerosis and CAD.

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[ Diabetes Type 2 ]

Cardiovascular Diabetology

Compare and contrast the three types of diabetes. We searched 2296 consecutive abdominal MRI studies performed at our hospital on patients with no pancreas pathology between September 1, 2010 and February 28, 2013, for those who also had a fasting plasma glucose and/or hemoglobin A1C within six months of the MRI examination. Forty-six patients who presented to the Emergency Department with decompensated diabetes (serum glucose > 22.2 mmol/l and/or ketoacid concentrations > or = 5 mmol/l), had blood sampled prior to insulin therapy. Thus, the objectives in the management of type 2 diabetes are to maintain blood glucose levels within an acceptable range and to treat co-existing conditions, thereby diminishing the incidence and severity of long-term complications. Type I fibers compared with type II fibers have higher protein levels of the insulin receptor, GLUT4, hexokinase II, glycogen synthase (GS), and pyruvate dehydrogenase-E1α (PDH-E1α) and a lower protein content of Akt2, TBC1 domain family member 4 (TBC1D4), and TBC1D1. Repeated-measures ANOVA with contrast analysis compared change in outcomes across time. In contrast, while fasting serum insulin and C-peptide levels tended to be greater in the type II diabetic and IGT groups, the postprandial responses were blunted at 30 min in the IGT and type II diabetic groups when compared with the NGT group.

This suggests that factors other than gender disparities in treatment intensity are responsible. Even-chain SFAs that were measured (14:0 [myristic acid], 16:0 [palmitic acid], and 18:0 [stearic acid]) were positively associated with incident type 2 diabetes (HR [95% CI] per SD difference: myristic acid 1·15 [95% CI 1·09-1·22], palmitic acid 1·26 [1·15-1·37], and stearic acid 1·06 [1·00-1·13]). Some people with Type 2 diabetes say they are being unfairly stigmatized for developing a disease that has a strong genetic component. While there was no significant difference noted between the treatment groups in changes in BMI after initiation of insulin therapy, BMI tended to increase in the 30 Mix group, possibly due to the increase in body weight associated with the amount of insulin use that tended to increase in the 30 Mix group. In our study, IMT was measured as a surrogate endpoint to examine whether or not insulin therapy might promote atherosclerosis. If men predisposed to heart disease have a mean cholesterol level of 300 with a standard deviation of 30, above what cholesterol level should you diagnose men as predisposed to heart disease if you want the probability of a type II error to be 1%? One study cited showed that type 2 diabetes was associated with hippocampal and amygdalar atrophy (den Heijer et al.

In this regard, postprandial glucose levels were evaluated as factors linked to IMT. Postprandial hyperglycemia has long been known to be a risk factor for diabetic macrovascular complications [6, 7, 15–17], and in agreement with this, our study results also demonstrated that daily glycemic profile tended to be higher after lunch in the 30 Mix group after 6 months of insulin therapy than in the BB group (unpublished data), suggesting that more rigorous glycemic control may have contributed to the trend for a decrease in IMT becoming manifest in the 30 Mix group. Also, adiponectin was evaluated as factors linked to IMT. It has been suggested that methylation of DNA, modifications of histones, and noncoding RNA mediate epigenetic inheritance. In this regard, IMT and adiponectin are reported to be negatively correlated [18], consistently with the results of the current study. With regard to the relationship between exogenous insulin and adiponectin in vivo, there is one study in pediatric type 1 diabetes reporting an increase in adiponectin 1 month after initiation of insulin therapy [19], while, to date, there is no published study in type 2 diabetes. What is Rana Sylvatica and how does the author use it to illustrate survival?

Further research is required to clarify how these insulin resistance-related factors, as they come into play as confounding factors, may behave after initiation of insulin therapy to elucidate the relationship between exogenous insulin and adiponectin. QOL was shown to improve in both groups after initiation of insulin therapy compared to baseline, with no significant difference shown between the groups. The study subjects appear to have felt not so much stress in starting insulin therapy as satisfaction in being able to achieve better glycemic control, which likely contributed to an increase in their QOL. Insulin resistance in obesity and T2D is characterized by a decreased ability of insulin to induce signaling proteins proposed to mediate GLUT4 translocation by, for example, phosphorylation/activation of Akt (23–25) and/or TBC1 domain family member 4 (TBC1D4) (23,25). Therefore, it was felt that a crossover study might be required to account for differences, if any, in QOL associated with either injection regimen. After the DCCT and Kumamoto study that demonstrated the efficacy of insulin therapy in type 1 and type 2 diabetes, the advent of biphasic insulin formulations has added to the diversity of insulin regimens available. The study protocol was approved by the local ethics committees.

Of these, Joshi et al. [26] reported that HbA1c improved better with twice-daily insulin therapy using a biphasic insulin analogue than with basal-bolus insulin therapy using an ultra rapid-acting insulin analogue, while a recently published report from the 4-T study [27] showed that conventional therapy with a biphasic insulin analogue and basal-bolus therapy with an ultra rapid-acting insulin analogue produce comparable reductions in HbA1c. However, these reports provided very little insight into the impact of insulin therapy on diabetic complications, particularly progression of atherosclerosis. In this regard, ours is the first to demonstrate that there is no significant difference between the insulin regimens compared in their impact on progression of IMT. Inserting this into the definition of conditional probability we have .09938/.11158 = .89066 = P(B|D).

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[ Diabetes Type 2 ]

Cardiovascular Diabetology

Despite widespread use by patients with diabetes and anecdotal reports in the past regarding its efficacy, until recently, data in humans concerning chromium’s effects on insulin action in vivo or on cellular aspects of insulin action were scarce. We used an object-oriented approach, differential equations, and a construct we call “features.” The level of detail and realism was determined by what clinicians considered important, by the need to distinguish clinically relevant variables, and by the level of detail used in the conduct of clinical trials. Effect of reversion to NGT-6 m on incidence of type 2 diabetes mellitus (T2DM) was analyzed using the Cox proportional hazards model. Furthermore, the effect of recombinant human (rh)IL-11 on MLD-STZ diabetes, insulitis, cytokines, IKK-alpha, NF-kappaB, and AP-1 was analyzed in islets. The American Council on Exercise states that diabetes mellitus is a disease of carbohydrate metabolism, in which a deficiency of insulin results in an inability to metabolize carbohydrates normally. The combined data showed a statistically significant negative association between coffee consumption and subsequent risk of type 2 diabetes. Total cholesterol, LDL cholesterol, and triglycerides were all significantly decreased in hyperlipidemic patients.

The GRSβ but not GRSIR predicted incident T2D among FOS and CARDIA whites. Topical use of aloe vera also helps… In comparison, other CV meta-analyses reported incidence rates for custom MACE ranging from 5.8 to 14.6 with sitagliptin, saxagliptin, or vildagliptin and 9.0 to 14.1 with comparators [23–25]. Thus, physician training improved guideline adherence in only 50% of the studies, improvement of disease control was reported in only 38%, and patient education was effective in only 44% of the trials. However, not all of these risk estimates achieved statistical significance (based on upper bounds of 95% CI below 1.0). This may not be the complete list of references from this article. In contrast, risk estimates were non-significant for sitagliptin 100 mg [RR 0.68 (95% CI 0.41-1.12)] and vildagliptin 50 mg and 100 mg [RR 0.84 (95% CI 0.64-1.14) and 0.88 (95% CI 0.37-2.11)] [24, 25].

Although the results of the different meta-analyses of DPP-4 inhibitors are not entirely comparable (due to differences in primary composite endpoints and CV adjudication methods), all are supportive of the hypothesis that, in general, DPP-4 inhibitor treatment does not have a deleterious impact on the incidence of CV events. The present analysis shows that linagliptin treatment does not increase CV risk and may even yield CV benefits in patients with T2DM. Although the five hospital districts of FIN-D2D formed a pilot area, the information of the importance of healthy lifestyles in the prevention of diabetes had also spread outside the FIN-D2D area, which was the aim of population strategy, as well. and the U.K. In addition, this meta-analysis was based on individual patient data from a consistently designed, large clinical development programme; this allows consistent derivation of endpoints and extensive subgroup analyses and minimizes between-study heterogeneity that can confound analyses of unrelated studies. There are several mechanisms that could underlie potential CV benefits for linagliptin. First, linagliptin may confer the beneficial effects of improved glycaemic control, including the lowering of postprandial glucose, without the potentially harmful effects of weight gain or increased hypoglycaemia [12, 26].

Second, linagliptin increases GLP-1 and GIP levels which may provide beneficial cardioprotection; experimental and clinical data suggest that GLP-1 elevation can positively modulate lipid metabolism [26], reduce infarct size and improve cardiac function [26, 27]. Everyone, stop saying “control!” I wish people would stop using that word. Lipids and Lipoproteins. The inverse relationship of 16α-OH estrone with diabetes could be secondary to more diluted urine in diabetics, a possibility supported by the lack of association after control for urine creatinine levels. This analysis has several potential limitations. First, despite a large total patient exposure of 3432 years, individual patient exposure was of a maximum duration of 1.7 years; further longer-term data are needed to confirm the current findings. Second, the low incidence of CV events, low rates of triple oral therapy, and lack of insulin treatment all suggest that a large proportion of patients had less advanced T2DM, and thus a lower CV risk than those with more advanced T2DM.

However, around 30% of patients had a baseline Framingham 10-year CV risk score of > 15% and more than a half also had > 5 years’ known disease duration, which indicates a proportion of the population were at increased CV risk. Finally, the observed CV risk reductions for the primary and secondary endpoints were influenced by the differences in CV events in one study with linagliptin versus glimepiride. It is possible for many people who have diabetes to still lead an active lifestyle. Moreover, analysis of the pooled placebo studies alone confirmed that linagliptin did not increase CV risk against placebo.

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[ Herbal Remedies ]

Cardiovascular Diabetology

N2 – Objective: To measure the association between endometrial cancer risk and obesity at age 18 and recently, adult weight gain, diabetes mellitus and hypertension. In a high insulin-resistance population, the effect of MetS accumulation was also observed in subjects with impaired fasting glucose [20]. Insulin resistance is a common feature between type II diabetes, hypertension and other risk factors. Diabetic nephropathy is an important factor involved in the development of hypertension in diabetics, particularly type I patients. Jensen J. However, it is now clear that 24-hour ambulatory blood pressure (ABP) monitoring provides data that are more closely linked to patients’ daily behavior.1 Compared with office blood pressure, the 24-hour ABP average may be closer to the individual’s “true” blood pressure. Hyperglycemia and increases in totalbody exchangeable sodium may lead to extracellular fluid accumulation and expansion of the plasma volume.

A statistically significant difference was found between the two groups; patients with diabetes mellitus were much more likely to have problems meeting the required standards at the workplace due to emotional and physical health issues compared to hypertensive patients. If hypertension is associated with diabetic nephropathy, our preclinical results suggest that coadministration of sorbinil with antihypertensive therapy may promote a positive synergistic effect further diminishing proteinuria. The number of people living with diabetes is expected to increase from 387 million in 2014 to 592 million by 2035 according to the 6th Edition of the International Diabetes Federation’s (IDF) Diabetes Atlas [1]. This association has also been confirmed in European adolescents [36]. Based on the current evidence, it is possible that milk/dairy products, when consumed in adequate amounts and mainly with reduced fat content, has a beneficial effect on the prevention of hypertension and diabetes. Analyses conducted by gender showed that in addition to the association of neck circumference with MC4R genotype, the trend toward higher waist circumference and Lipid Accumulation Product suggest an effect of the risk allele C on visceral obesity in women with hypertension. Mutation carriers on MC4R had increased lean mass [7] and the variant near MC4R could reflect this effect among in men, who had proportionally more free-fat mass comparing to women.


Furthermore, men and women had differences regarding metabolism of free fatty acids, which increased accumulation on visceral adipose tissue in women when compared with men [37]. Participants indicate informed consent by completing the questionnaires. However, when analyzed separated, neither MC4R nor FTO were associated with any individual metabolic syndrome feature, including waist circumference [39]. In this study, type-2 diabetes mellitus was associated with women carriers of risk allele C for MC4R rs17782313, which remained significant after control for age and BMI. Studies that assessed the contribution of polymorphisms in FTO and MC4R genes on type-2 diabetes mellitus are controversial, probably due to ethnic differences regarding body composition and lifestyle among populations (significant differences about the frequencies of several common obesity susceptibility variants in or near FTO and MC4R were found in class III obese Hispanic patients, i.e.) [40]. Among hypertensive women, the effect of risk allele C for MC4R rs17782313 on type-2 diabetes mellitus could be mediated by increased visceral adipose tissue. MC4R showed higher expression in mesenteric fat among obese and diabetic rats when compared with lean rats [18].

All statistical analyses were completed using SAS, version 9.1. It is also suggested that both type-2 diabetes and obesity had a common genetic etiology from the same 16.3 encoding region were FTO is located, and probably this is not the only susceptibility gene on this region which share the risk for both obesity and type-2 diabetes [41]. Genetic predisposition to obesity and FTO common variants contributed to increased insulin resistance among Europeans, but weakly increased type-2 diabetes risk, which is mediated by BMI itself [42]. As seen in morbid obese – with no hypertension and with rare mutations in MC4R gene, this sample of hypertensive individuals carrier of risk allele C for common variant near MC4R had lower levels of blood pressure in comparison to homozygote non-carriers. After adjustment for age and BMI, the association remained significant in men. It has been widely demonstrated in animal models the contribution of melanocortin system on cardiovascular function [43], and, in human beings, it has been shown how centrally expressed melanocortin 4 receptor (MC4R) not only conveys hypothalamic signals suppressing food intake, but it is also involved in blood pressure control [21]. Common variants near MC4R could reflect the same effect, but is unknown if anti-hypertensive drugs or changes in lifestyle could modify the expression of these genes or the effects of both polymorphisms on blood pressure, as it has been shown [44].

Among different model species, it has been demonstrated signaling cascades and transcription factors for several obesity genes that could be useful for development of new drugs and for translational research [45]. This study has some limitations and strengths that should be taken into account when interpreting the results. First, central obesity is one of the present MetS criteria, so subjects with central obesity wound inevitably have a higher number of positive MetS components than those without central obesity if we did not select subjects with the same number of metabolic abnormalities. Therefore, some associations that achieved statistical significance in the overall analysis remained only as a trend toward association (BMI and FTO genotype, for instance). In the other side, some associations remained significant, as neck circumference and FTO genotype, while others came up only for women (FTO and BAI). The associations of gene variants with anthropometric indexes should be confirmed in further studies, with statistical power to carry out analysis by gender. In conclusion, this study shows a negative effect of MC4R rs17782313 on mean arterial pressure and diastolic blood pressure among men.

Associations of some anthropometric indexes with polymorphisms are exploratory for both, men and women. The pathways for these associations are not completely understood, but genetic variants near the MC4R gene may reflect the complexity of such mechanisms.

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[ Diabetes Type 2 ]

Cardiovascular Diabetology

James Bertram Collip (1892-1965), always known as Bert, has been described as the forgotten member of the team which discovered insulin in 1921/2. A major concern has been the possibly increased risk of cardiovascular events. This nationwide case-control study included 760 cases newly diagnosed with type 1 diabetes under five years of age during 1992-1995. Poor health forced his retirement in 1932. Mindfulness-based Interventions (MBIs) can be seen as preventive and complementary interventions in DM, particularly for the relief of symptoms related to depression and anxiety in diabetic patients and also in the management of other factors, including mindful eating, physical exercises and treatment adherence. Areas covered: In this mini review, we aim to highlight a number of complications, cascades or pathways (polyol, hexosamine, protein kinase C, advanced glycation-end product) of events and cellular, sub-cellular and molecular mechanisms associated with DM-induced hyperglycaemia. The introduction of insulin, as well as improvements in general obstetric care, rapidly decreased maternal mortality.

Thus it was present in a high proportion of people with myocardial infarctions and in over 80% of women whose children had deformities of the limbs or spine. This section offers guidance as to how to access information from any of these sources. He also worked on the extraction of von Willebrand’s factor and wrote on the history of coagulation[2] and other aspects of medical history. Apollinaire BouchardatJoslin stated that Bouchardat was the first clinician to introduce patient education, including self-monitoring of urine glucose[1]. They did find diabetes to be a strong independent predictor of atherosclerotic coronary disease, but the distribution of atherosclerosis within the coronary arteries was not assessed. An analysis of pooled data revealed that coronary artery atherosclerosis in patients with diabetes mellitus is more extensive and accompanied by inadequate compensatory remodelling [23]. Additionally the progression of atheroma was more rapid in patients with diabetes, despite high use of well established and potent therapies.


He helped to found the WHO Multinational Study of Vascular Disease and became the inaugural chairman of the Diabetes Epidemiology Group of the IDF. What is a search filter? His work, with that of Rury Holman, paved the way to successive models of the dynamic interaction between glucose and insulin[1], and led on to the development of the famous HOMA model[2]. and, (3) was the lesion inter-capillary? Peripheral insulin resistance is strongly associated with atherosclerosis, even after adjusting for other more conventional risk factors [28]. Whether this relation is causal, can only be suspected [28, 29], other authors discussed whether an impaired fibrinolysis could be the link to atherosclerosis [30]. Thus, he succeeded in preparing salvarsan and neo-salvarsan.

These alterations might be responsible for higher atherogenicity and more cardiovascular events in a diabetic population. have shown that PKCβ inhibits insulin-stimulated Akt phosphorylation [34]. Once there, he made a partial recovery and launched himself into a new career with undiminished energy. Regarding the presence of obesity and other SM components, the most appropriate action would be the early lifestyle change (diet + physical exercises) still in the pre-transplant period, according to the patient’s clinical condition and control over other risk factors, such as hypertension and dyslipidemia [5]. Basal insulins can normalise the fasting glucose but do not affect post-prandial glucose levels, and premixed insulin formulations may be useful in patients who need to cover both fasting and post-prandial glucose. Diverse diseases associated with hyperinsulinemia show an early and extended manifestation of atherosclerosis [38–43]. Opponents often stereotyped Joslin’s group as medical reactionaries, but increasing evidence gradually tempered their criticism and Joslin’s position was finally endorsed by the DCCT in 1993.

The structure of insulin brought a molecular dimension to insulin chemistry and to its biology, stimulated research into its chemical modification and pharmacology, and provided the framework for understanding its biosynthesis, processing, secretion and circulation. The single greatest problem with diabetes diagnosis is the failure to diagnose it, and the estimates of those who have the disease but are currently undiagnosed add another 4% or 8 million Americans. Those patients who showed elevated PAI concentrations as a sign of reduced fibrinolysis were at increased risk of reinfarction [44, 45]. High concentrations of von Willebrand factor antigen are supposed to be markers of endothelial lesions and present a procoagulative mechanism due to an enhanced platelet adhesion [46]. The question remains, how does diabetes mediate its specific effects towards a diabetic specific morphology? Some authors suggest that diabetics undergo invasive evaluation later than others due to their cardiac neuropathy and the resulting lack of symptoms, others, that the impact of the often combined risk factors (e.g. hypertension, high LDL etc.) may trigger an accelerated form of atherosclerosis.

This study extends these views by showing a close association between coronary morphology and a diabetic status with alterations of haemostasis and fibrinolysis, especially for distal coronary artery disease. Univariate and multivariate regression analysis revealed a strong relationship between the extent of coronary and especially distal coronary atherosclerosis and fasting glucose, PAI-1 and von-Willebrand-factor.

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[ Diabetes Type 1 ]

Cardiovascular Diabetology

The incidence of re-amputation following lower extremity amputations (LEA) among the diabetic patients referred to the Artificial Limb and Appliance Centers (ALAC) in South Wales, UK, was investigated. The data of each patient including clinical information, laboratory results and final outcome were collected and analyzed. Saudi National Diabetes Registry (SNDR), being a large database source, would be the best tool to evaluate this problem. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. Restenosis occurred in 94 patients, bypass failures in 36 patients, and recurrent ulcers in 71 patients. The proportion who had an amputation, had recurrence, and whose ulcer had healed was recorded. Those which were not supported with the diagnosis of diabetic CN were excluded and the 2 other charts without proper follow-up duration (6 months) for analysis were removed, resulting in the final sample size of N = 116.


Fasting blood samples were taken to assess lipid profile, blood sugar and glycated hemoglobin (HbA1C) levels. Considering the delay in presentation with DSF to the hospital, 86.7% presented after 1 week up to more than 2 months from the start of the lesion. Maureen I. Those who died were significantly older than the survivors (p = 0.038). The results of centers specialized in the treatment of patients with diabetic foot in Great Britain (Manchester) and the US (San Antonio) were reported by Oyibo et al. [14]. In 1998 and 1999, this observational study comprised 194 patients.

The wound data were classified according to the original UT-System. Only 26% of the ulcers were described to be neuroischemic. Unusual bony protrusions become the focus of repeated trauma and ulceration. The number of diabetes-related LEAs in border counties was 1,168, compared with 6,117 in nonborder counties. However, 14% of the patients underwent LEA due to non-healing ulcers. Four percent of the patients died, and 16% had persistent ulcers at the end of the study. Altogether, 65% of the initially existing ulcers healed completely.

The likelihood of calf amputations was 15 times higher for patients with diabetic foot affected by ischemia or infection compared to patients without these conditions.

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[ Herbal Remedies ]

Cardiovascular Diabetology

eNews May 24, 2011 Diabetes, whether due to insulin shortage or insulin resistance, is associated with many complications, among which are breakdowns in the vasculature’s functions and regenerative abilities (angiogenesis). Regarding serum FGF23 and bone fragility, there is contradictory data. Moreover, activity of NADPH oxidase, the primary ROS-generating enzyme in vascular cells, has been shown to be increased in T2D (2–5). We will show that while epidemiological studies link T2DM to Alzheimer’s disease as well as vascular dementia, neuropathological studies attribute the increased dementia risk in T2DM patients primarily to vascular lesions in the brain. The genesis of diabetic foot ulceration and prevention and management strategies is covered, as is the effects of neuropathy and microvascular changes in the diabetic foot. Interaction of AGEs with endothelial cells as well as with other cells accumulating within the atherosclerotic plaque, such as mononuclear phagocytes and smooth muscle cells (SMCs), provides a mechanism to augment vascular dysfunction. Human retinal endothelial cells (HREC) were purchased from ScienCell Research Laboratories (America).

Red arrows indicate negative effects, green arrows indicate beneficial effects. On stimulation of CAC with IL-3, STAT5 transcription factors are activated. Possibilities for therapeutic strategies specifically at the level of T2DM SMCs, including recent novel advances in the areas of microRNAs and epigenetics, will be evaluated. On the other hand, endothelial dysfunction has been previously related to the presence and levels of cardiovascular risk factors in T2DM patients [23, 29, 30], although not consistently [34], while vascular inflammation has been suggested to play a central role in the development of endothelial dysfunction [35]. It should be noted that compared to other reports [23, 29, 30], our study included T2DM patients with severely impaired FMD (mean FMD 1.98%) and a high prevalence of accumulated cardiovascular risk factors; in these patients longer duration of diabetes, and not other established cardiovascular risk factors, was the only important determinant of endothelial dysfunction. Hyperlipemia in the treated diabetic patient is neither so frequent nor so marked as has been commonly supposed. ► A life time perspective is needed on risk factors for dementia in T2DM.

*Adjusted for age, smoking status, body-mass index, and systolic blood pressure. In our study, decreased NMD was independently associated with older age, the presence of hypertension and higher fasting glucose. Several previous studies have not shown any significant associations of NMD with risk factors, glycemic control, inflammation or other diabetes-related factors in T2DM patients [13, 31]. In agreement with our findings, hyperglycemia was recently reported to be an independent predictor of impaired NMD in T1DM patients [40]. Treatment of maculopathy and proliferative retinopathy with laser photocoagulation prevents further loss of vision rather than restores diminished visual acuity. Arterial stiffness, as assessed by PWV, has been found to be increased both in prediabetes [41] and in T2DM patients compared to healthy controls [7, 20–22]. Any future treatments to boost angiogenesis will need to proceed with particular care since angiogenesis can worsen another diabetic complication, Dr.

University Gold medal for Community Medicine (MBBS). Both age and blood pressure are considered to be the two most important determinants of PWV in the general population [42] as well as in T2DM patients [9, 21]. In contrast to previous studies we found no association of PWV with glycemic control in T2DM patients [9, 21, 43, 44]. Furthermore, although inflammation, as assessed by hs-CRP, has been suggested to related to increased PWV in healthy subjects [45] as well as in hypertensive [46] and T2DM [47] patients, this has not been replicated in our study. Our population consisted of patients with T2DM with moderate glycaemic control and less than optimal control of other cardiovascular risk factors (blood pressure, cholesterol, obesity). These results cannot be extrapolated to all patients with T2DM; it is possible that including patients with optimal control of risk factors, important associations of risk factors with vascular indices may be revealed. In the phase 2 RESOLVE trial (16), 102 participants with type 1 or type 2 diabetes and DME were randomized to three monthly injections of a sham, 0.3 mg ranibizumab, or 0.5 mg ranibizumab followed by additional treatment as needed.

This was an observational study that could not reveal causal relationships. Furthermore, regression models in our study could predict a small part of the variability of vascular indices (5–25%) in our population indicating that other factors, not currently studied (e.g. insulin resistance, advanced glycation end-products, genetic factors) may play a more important role in vascular dysfunction in T2DM. Common insulin resistance/sensitivity indices were not assessed because a high proportion of the studied patients were receiving exogenous insulin.

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[ Diabetes Type 2 ]

Cardiovascular Diabetology

Patients The inclusion criteria were: age between 30-70 years, hypertensives with T2DM not treated with insulin before, normal values of urinary protein excretion, creatinine and urinary albumin excretion. Thus this study examined the vascular effects of simultaneous type 2 diabetes and renal hypertension on endothelial function. It is predictor a poor prognosis, independently of blood pressure levels. Can J Cardiol 2016; 32(5): 569-588. In recent years, adequate data from well-designed randomized clinical trials have demonstrated the effectiveness of aggressive treatment of hypertension in reducing both types of diabetes complications. RESULTS: The BMI cut-off to predict DM, HT, or dyslipidaemia varied from 25.2 to 26.6 kg/m2 in both men and women. Multiple metabolic toxicities contribute to the strong association of an underlying oxidative-redox stress and reactive oxygen species, resulting in endothelial dysfunction and microalbuminuria.

Group 2 patients showed higher blood pressure values as compared to Group 1. In a study in an US academic medical centre in 1997 to 1999, 30% with elevated LDL cholesterol levels received a treatment intensification, and 30% of patients with elevated SBP levels [21]. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). In the original study validating the Morisky Medication Adherence Scale, 75% of patients who reported high adherence had their BP under adequate control compared to 47% of patients who reported low adherence [31]. It is likely that these difference are reflective of differential distributions of the array of factors and these will be examined in more detail below. Additional file 1: Tables S1 and S2 provide data equivalent to Table 2 for those without and with type 2 diabetes, respectively. There were 705 individuals without diabetes during the first examination (2002–2006) that were reexamined in 2010–2014.

From this group, we detected 107 incident cases of type 2 diabetes during the average 8.5 year follow-up period yielding an incidence of 107/5978 person years or an annual incidence of 1.79 % (95 % confidence interval = 1.48–2.16 %). The annual incidence in those with prediabetes at the first examination was 3.48 % (2.80–4.3 %), fivefold higher than the 0.67 % (0.45–1.00 %) in those with normal glucose tolerance. Although HbA1c was not available during the first examination, we note that three additional individuals would be classified as having diabetes based on their HbA1c values at the follow-up examination.

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[ Diabetes Solutions ]

Cardiovascular Diabetology

ABSTRACT: Diabetes mellitus is a well recognized condition in human and veterinary medicine that can be induced by the administration of glucocorticoids. Age of onset is variable and the hypoglycaemia ranges from asymptomatic through to medically unresponsive hypoglycaemia. These levels were compared with non-diabetic humans. Impaired fetal growth not only results in elevated risk for short-term complications, with intrauterine fetal death being the most severe, but low birth weight also predisposes the child to cardiovascular disease and type 2 diabetes mellitus in the future [1, 2]. Plasma insulin levels in well controlled NOD mice with type 1 diabetes were measured 3 h and 17 h after their usual dose of insulin. The peak periods of hypoglycemia were 0:00∼2:00, 22:00∼24:00, 2:00∼4:00, 8:00∼10:00 and 10:00∼12:00.The symptomatic hypoglycemia accounted for 47.01%, The asymptomatic hypoglycemia accounted for 52.98%. Type 1 diabetes is caused by the autoimmune destruction of Langerhans islet cells that secrete insulin.

Postoperatively, vitreous hemorrhage requiring washout, neovascular glaucoma, recurrent retinal detachments, and fibrovascular proliferation at the sclerotomy sites occurred in 4%, 4%, 3%, and 1%, respectively, of all eyes. In addition, studies have shown that insulin-treated DM patients had higher body mass index, hemoglobin A1c (glycosylated hemoglobin), and, blood urea nitrogen (BUN) levels than non-insulin treated DM patients, and were more likely to have a history of stroke, hypertension, congestive heart failure, and, acute coronary syndrome when compared with non-insulin treated DM patients [8]. The body needs more insulin to break down the extra glucose, and in certain cases, simply cannot cope with the demand. Patients receiving intravenous therapy, especially those having a fluid deficit, and those with biliary or intestinal intubation should be watched closely for early signs of acidosis. The later explains why discontinuation of BCG vaccination was associated with a decrease in type 1 diabetes in European children and a decrease in type 2 diabetes in Japanese children. Under the last condition, the symptoms of adrenal insufficiency showed complete recovery, together with good glycemic control. Normally, endogenous hyperinsulinemia of type 2 DM is associated with increased hepatic synthesis of cholesterol and triglycerides [12].

Studies have shown that glucose control in type 1 DM often requires exogenous insulin in amounts far greater than that secreted by normal beta-cells. [13],[18],[19],[20],[21] People with T2DM lose on average three productive days, with a mean length of hospital stay between 6.6 and 9.5 days, following a severe hypoglycemic attack. Although insulin injection significantly raised plasma levels of PCSK-9, the rise did not exceed that of nondiabetic mice with lower insulin levels. In addition to hyperglycemia, patients with HNF1B-MODY may have renal abnormalities [6, 7]. Alpha-glucosidase inhibitors can prevent starch or sucrose from being quickly absorbed. Also, insulin treatment in type 2 DM has been associated with increased platelet aggregation, a finding of particular concern given current controversies about ongoing risk for stent thrombosis after DES implantation [15]. Patient age was not a factor (odds ratio 1.03).

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[ Nutrition ]

Cardiovascular Diabetology

Anyone trying to lose weight knows it’s all about burning off the unhealthy excess fat. Along with Per Björntorp, Jules Hirsch and Lester Salans at The Rockefeller University were some of the early and influential investigators who were interested in adipose tissue growth and expansion and how these processes relate to the metabolic complications of obesity. In all but one of the research studies on fat and diabetes, it has been shown that it is the fat you carry internally (next to your internal organs) that contributes to your risk of diabetes the most. However, treatment with liraglutide significantly reduced these physical parameters. For instance, fat in the abdomen has previously been linked to the development of diabetes. In this cross-sectional study, we demonstrated that (i) age is positively correlated with visceral fat area (VF), independent of BMI, fat mass (FM), and subcutaneous fat area (SF) (Table 2 ). If you have a tummy tuck with fat on the inside wrapping around the intestines your tummy will still protrude and without a lot of loose skin you will not see her result.

Using imaging methods to determine the location and function of body fat, researchers are able to identify obese persons who are at a higher risk for developing Type 2 diabetes years before the disease appears. Marin et al’s study has shown IP fat, rather than RP or SC fat, more strongly correlated with systemic metabolic variables (e.g., plasma insulin, blood glucose levels, glucose disposal rate, and systolic blood pressure). The aim of our study was to compare the effects of 16-week steady-state exercise (SSE) program with high intensity intermittent exercise (HIIE) program on total abdominal and visceral fat mass in T2D postmenopausal women. Subcutaneous adipose tissue depots release fatty acids into the venous circulation, which are then transported to splanchnic tissues by the arterial circulation. Relatively recently, the liver has been recognized as a major target of injury in patients with insulin resistance or the metabolic syndrome. BPH In addition to raising prostate cancer risk, belly fat may increase the risk of BPH. In our study the VF/SF ratio did not correlate with peripheral insulin resistance.


Our results suggest that accumulation of both abdominal subcutaneous and visceral fat, independent of which regional fat depot predominates, is related to peripheral (muscle) insulin resistance in male subjects with T2DM. We used the technique of Armellini et al. Smoking prevention and smoking cessation play important roles in improving overall health, however, many teenagers and women start smoking mistakenly believing that it will help them lose weight. Adipose tissue is a complex and highly active endocrine organ that secretes multiple adipocytokines including leptin, IL-6, TNFα, resistin, adiponectin, MCP-1 and FFA [33, 34]. Adipocyte enlargement, as observed in obesity, is associated with dysfunctional fat cells which over-express and secrete excessive amounts of leptin, IL-6, TNFα, resistin, MCP-1 and FFA while under secreting adiponectin [35, 36]. Altered secretions of these adipocytokines have been implicated in the development of insulin resistance in obesity and T2DM [37]. Although there are differences in the expression/production/secretion of the adipokines between subcutaneous and visceral adipose tissue, they are expressed in both fat depots altered production and/or release from either fat depot can lead to altered circulating adipokine levels and impaired insulin action in peripheral tissues (primarily muscle).

Publication costs for this supplement were defrayed in part by the payment of page charges. In contrast, the PUFA diet increased lean tissue significantly more than the SFA diet. Jensen et al. reported that elevated plasma FFA concentrations in upper-body obesity arose from upper-body subcutaneous fat and increased abdominal SF and VF areas were positively correlated with abdominal subcutaneous adipocyte size [38, 39]. The researchers tested their results to see whether they were explained by other factors, such as whether people had diabetes. Redman LM, Heilbronn LK, Martin CK, et al. But when you overdo it, they end up turning into fat in your abdomen.

Thigh circumference (cm) was measured at mid-thigh on the right side, defined as the midpoint between the superior ridge of the patella and the crease of the groin. In the present study, VF/SF ratio correlated positively with the fasting plasma FFA concentration, although this concentration does not necessarily reflect the portal vein FFA concentration. In a previous publication, we demonstrated that only the VF area correlated positively with accelerated gluconeogenesis, but not with glycogenolysis. This observation is consistent with the concept that increased delivery of FFA from an expanded visceral adipose tissue mass to the liver enhances gluconeogenesis and causes hepatic insulin resistance [41]. In the present study, there were several limitations. First, the number of the study subjects is small and the subjects are not homogenous as far as age and the duration of diabetes. All selected data were analyzed with enCORE software (version 11.0; G.

Therefore, a further investigation using a large population with age- and the duration of diabetes-adjustment to be performed for obtaining a precise evaluation of VF/SF ratio in relation to peripheral and hepatic insulin resistance in T2DM.

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[ Diabetes Type 2 ]

Cardiovascular Diabetology

Indwelling catheters, also known as Foley catheters, are thin, flexible, hollow tubes made of latex or silicone, with a balloon on one end. ADW Diabetes offers a complete line of syringes made by Monoject. Box of 30 Catheters. These results suggest that the ability of higher doses of insulin to further stimulate glucose metabolism is primarily the result of increased glucose storage by peripheral tissues, most likely muscle. The catheters were infused with isotonic saline at a rate of 10 microL/h for 48 h. 1999;29:745–58…. Diabetic rats respond to vascular injury with increased influx of inflammatory cells, enhanced proliferative activity and greater intima formation compared with non diabetic rats [25].

Non-pulmonary vein triggers, such as interatrial septum, superior vena cava, left atrial appendage, crista terminalis, and coronary sinus, were identified. Research has shown that if the bladder is emptied regularly and completely before it gets overstretched, there is little likelihood of infection. More consistent and reliable insulin absorption will enable people with diabetes to achieve improved blood glucose control. In this procedure the catheter is advanced through a vein in the neck or the leg, up to the right chambers of the heart. Hunt GM, Oakeshott P, Whitaker RH; Intermittent catheterisation: simple, safe, and effective but underused. Potential therapies aimed at prevention of intimal hyperplasia are still needed. Nicorandil is a hybrid agent with ATP-sensitive potassium channel (KATP) channel opener and nitrate properties.

Our Catheter Supply-Care Specialists are trained to support these needs and wants in a caring, considerate, helpful and energetic manner. 30 degree to 45 degree angled sets come in 13 and 17 mm cannulas. The current transplantation technique offers patients natural glucose control for 1-2 years. A trend toward lower TLR was shown in diabetic patients undergoing PCI in a randomized control trial [4]. Coupled with the observation in these clinical studies, we observe that nicorandil significantly decreases intimal hyperplasia 14 days after balloon injury in diabetic rats. Nicorandil increases lumen area and decreases intima/media ratio and intima area after balloon injury in diabetic rats. Nicorandil also inhibits cell proliferation and macrophage infiltration in arterial lesions after 14 days of balloon injury.

VSMCs account for 93.6 ± 1.72 % of the ultimate intimal proliferation. Previous experiments reported that nicorandil inhibited SMCs proliferation in rat pulmonary arterial hypertension model and attenuated LPS-induced inflammation [13]. The bottom line is, whether you have heart disease, PAD, or carotid artery disease, the choice between surgery and catheter-based interventions like angioplasty and stenting must take into account your medical history and individual preferences, and should be made after a careful discussion with your physician. Throughout this period, the infant showed active movements in all of her limbs. Nicorandil inhibits intimal hyperplasia after balloon injury in non-DM rats, but the differences of lumen area and I/M ratio between non-DM-injury group and non-DM-injury-nicorandil group are of no statistical significance (data shown in Additional file 1: Figure S1). The reason is that non-DM rats developed less intima than diabetic rats after balloon injury. With more predominant intima in DM rats, nicorandil exhibits inhibitive effect on intimal hyperplasia.

Previous studies on nicorandil in diabetic animals yields conflicting results. 15 mg/kg/day nicorandil has no effect on plasma glucose and body weight in STZ-induced diabetic rats [12]. 30 mg/kg/day nicorandil does not affect the blood glucose or body weight in STZ-injected mice [30]. 15 mg/kg/day nicorandil decreases the fast blood glucose and increases body weight, although this difference is not statistically significant [31]. When 0.003 % nicorandil-containing-diet is given 2 days after STZ injection, body weight loss and blood glucose level were significantly lower than those of STZ-injected rats. The catheter insertion site may be closed with a suture or a “plug” made of material that works with your body to create a natural clot in the artery. In our preliminary study, nicorandil was given at the dose of 5 or 15 mg/kg/day from the 3rd day after STZ injection.


15 mg/kg/day nicorandil significantly inhibits intimal hyperplasia and is used in the later experiments. In the present study, 15 mg/kg/day nicorandil has no significant influence on body weight or glucose levels. The inhibition effect on intimal hyperplasia exhibited by nicorandil is not achieved through glycermic control. Several lines of evidence suggest that high glucose per se promoted VSMCs proliferation and exaggerated intimal hyperplasia [1, 20]. In the present study, 24 h of high glucose treatment induces VSMCs proliferation and migration in the presence of 1 % serum. High glucose has been found to induce hyperpolarization of ΔΨm in vitro [20]. A recent study found that hyperpolarization of ΔΨm promotes VSMCs proliferation and intimal hyperplasia [8].

Nicorandil directly opens the mitoKATP channel and depolarize ΔΨm [9, 10]. To investigate the role of mitoKATP channel in the inhibition effect of nicorandil on intimal hyperplasia, 5-HD was used in vivo and in vitro. Destruction treatment (catheter ablation). Blood sugar highs and lows take a toll on the body. Inhibition effect of nicorandil on VSMCs proliferation and migration is also significantly blocked by pretreatment of 5-HD in vitro. Taken together, nicorandil inhibits intimal hyperplasia, inflammation, VSMCs proliferation and migration by opening mitoKATP channel. PKC family consists of 11 related serine/threonine protein kinases.

The importance of PKC signaling for VSMCs growth and restenosis has been shown previously. αPKC and εPKC, together with atypical PKCs, mediated cell proliferation and survival [33]. Sustained inhibition of εPKC inhibited intimal hyperplasia in vivo and prevented VSMCs proliferation and migration in vitro [7]. New York: Field, Rich and Associates, 1986:323-8. Nicorandil inhibits the activation of εPKC by opening mitoKATP channel in myocardial infarction rat model [11]. In the present study, we observe εPKC activation in balloon-injured arteries in the diabetic rats. Nicorandil inhibits this εPKC activation, and this inhibition effect was significantly reversed by 5-HD.

The same εPKC activation trend is also observed in high glucose-stimulated VSMCs. In vivo εPKC knockdown is achieved by localized delivery of εPKC siRNA and identified by western blot. Knockdown of εPKC inhibits intimal hyperplasia in diabetic rats. When diabetic rats were treated with nicorandil and εPKC siRNA, the lumen area is larger than that of rats treated with nicorandil and scramble siRNA (data shown in Additional file 1: Figure S2). CD 68-positve macrophages and PCNA-positive cells in intima are also reduced by localized delivery of εPKC siRNA. In vitro εPKC knockdown is achieved by transfection of εPKC siRNA in VSMCs. εPKC siRNA transfection significantly reduces VSMCs migration area and proliferation.

Thus, nicorandil inhibited εPKC activation by opening mitoKATP channel. This is the mechanism involved in the beneficial effect of nicorandil on intimal hyperplasia after balloon injury in diabetic models. Some previous studies reveal that opening of mitoKATP channel stimulates εPKC activation. If you had a stent placed, you will need to take a blood-thinning medicine or antiplatelet therapy for a year or longer. However, NNC 55-0462, another novel potassium channel opener, does not promote εPKC activation [34]. In rat ventricular myocytes, diazoxide, a mitoKATP channel opener, induces εPKC translocation [35]. εPKC inhibitor cheleryhrine does not abolish infarct size-limiting effect of diazoxide in rabbit hearts, but it blocks the protective effect of diazoxide in rat myocardial infarction [19].

Nicorandil, diazoxide, NNC 55-3021 and NNC 55-0462 do not exhibit the same effect on εPKC activation in different animal models. The discrepancy may reflect species and organ differences in regulatory mechanisms of PKC and mitoKATP channel. In other studies, nicorandil reduces the production of reactive oxygen species [13], prevents endothelial dysfunction [36], inhibits VACM-1 expression [31], attenuates cardiac sympathetic nerve injury [37], and interferences platelet aggregation [36]. marcescens peritonitis. Future work is still needed to explore the detailed mechanisms of nicorandil on vascular injury, especially in diabetic models. In summary, our data highlight the inhibitive effect of nicorandil on the intimal hyperplasia after balloon injury in diabetic rats and propose the underlying mechanism. Nicorandil opens mitoKATP channel, inhibits the activation of εPKC and prevents inflammation and cell proliferation in balloon-injured carotid arteries in diabetic rats.

In vitro study reveals that nicorandil inhibits high glucose-stimulated VSMCs proliferation and migration by opening mitoKATP channel and inhibiting εPKC activation. No direct evidence of intimal hyperplasia inhibition has been observed in nicorandil-treated patients in clinical trials. Future clinical trials and basic studies should be performed to further reveal the protective effect of nicorandil on PCI-related complications.

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[ Diabetes Type 2 ]

Cardiovascular Diabetology


Diabetes mellitus type 2 is associated with devastating chronic complications including coronary heart disease, stroke and peripheral vascular disease (macrovascular disease) as well as microvascular disorders, leading to damage of kidneys (nephropathy) and eyes (retinopathy). EVOluTION will train 11 PhD students in the tissue-protective processes operative in our body, with exemplars and proof-of-concept investigations into 1) dietary approaches to augment synthesis and release of vasculo-protective mediators, 2) mechanisms, mediators and targets of the resolution of inflammation arena, and 3) chemical, biochemical and engineering approaches for therapeutic innovation. Comparing the prevalence of complications between Asians and Caucasians, the ischaemic heart disease rate was similar; peripheral vascular disease was less (3.7% Asian, 9.3% Caucasian, P less than 0.05); retinopathy was less (11.6% Asian, 32.3% Caucasian, P less than 0.01) but renal disease was more (22.3% Asian, 12.6% Caucasian, P less than 0.01). Standard diagnostic methodologies were used to test for micro vascular and macro vascular complications of diabetes. Furthermore, persistence of this altered state of the epigenome may be the underlying mechanism contributing to a ‘metabolic memory’ that results in chronic inflammation and vascular dysfunction in diabetes even after achieving glycaemic control. It may represent an evolutionary strategy adopted by multicellular organisms to prevent the survival of cells that would otherwise cause more disastrous consequences in the individuals and their descendants. On univariate analyses, in diabetes, kallistatin correlated with renal dysfunction (cystatin C, r = 0.28, p = 0.004; urinary albumin/creatinine, r = 0.34, p = 0.001; serum creatinine, r = 0.23, p = 0.01; serum urea, r = 0.33, p = 0.001; GFR, r = -0.25, p = 0.009), total cholesterol (r = 0.28, p = 0.004); LDL-cholesterol (r = 0.21, p = 0.03); gamma-glutamyltransferase (GGT) (r = 0.27, p = 0.04), and small artery elasticity, r = -0.23, p = 0.02, but not with HbA1c, other lipids, oxidative stress or inflammation.

An overall approach to the understanding and treatment of diabetes mellitus and its complications will be to elucidate the mechanisms of vascular disease and endothelial cell dysfunction that occur in the setting of hypertension and diabetes. In addition, based on our previous cross-sectional study [23], we classified the available subjects into active and inactive CAA progression groups.

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[ Herbal Remedies ]

Cardiovascular Diabetology

In February 2015, the Swedish National Board of Health and Welfare raised the recommended goal for systolic blood pressure (blood pressure when the heart is contracting) in their guidelines for diabetes care. This may lead to more patients suffering from stroke or heart attack, according to a new study from the Sahlgrenska Academy. The intervention in this trial, which carefully adjusts the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg), reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg. In February 2015, the Swedish National Board of Health and Welfare raised the recommended goal for systolic blood pressure (blood pressure when the heart is contracting) in their guidelines for diabetes care. Older adults are at an increased risk for depression and should therefore be screened and treated accordingly (1). BP should be closer to, but not below, 130/80 mm Hg for those subjects at the highest cardiovascular risk. Urging for guidelines around the world to reflect the new findings, author Professor Kazem Rahimi of the George Institute United Kingdom and the University of Oxford said this research provides fundamental evidence about how blood pressure should be treated in people with diabetes.


The researchers behind the new study are questioning this. Authors analyzed risks for multiple negative health events for which all diabetes patients are especially in danger of death as compared to the rest of our population and their risk of death. The present research is supported in part by grants K23HL086558 and UOIGM074492 from the National Institutes of Health (Dr Cooper-DeHoff). One study was sponsored by the National Heart, Lung, and Blood Institute (NHLBI) from the United States. For patients on one agent who are not at goal, an increase in dose or adding a second medication from any one of the four groups is recommend. 2015:313:603-615. Speech was dysarthric, but comprehension was good and she spoke in fully formed sentences.

Bethesda, Md. The ideal blood pressure is 120/80; as it rises above that threshold, the risk of heart attacks, strokes, and other health problems steadily rises. The optimal systolic blood pressure in 20,330 patients with a recent non-cardioembolic ischemic stroke at 2.5- year follow-up for first recurrence of stroke of any type or for a composite of stroke, myocardial infarction, or death from vascular causes was 130 to 139 mm Hg [13]. However, due to non-compliance and forgetfulness it is possible that fewer packages were documented than had actually been prescribed. Data regarding management goals for hypertension in elderly diabetics is sparse and inconsistent. The results of our population-based study fortify the findings of patient-based German and international studies. Recently, Berthold et al.

[12] described that approximately 60% of T2D patients from the German T2DSD-registry DUTY had uncontrolled systolic blood pressure  > = 140 mmHg and about 50% had uncontrolled LDL cholesterol values > = 3.4 mmol/l. These proportions differed slightly with atherosclerotic disease location. The German ESTHER Study published in 2008 found that 78% of diabetes patients had hypertension diagnosed by a physician and only 12.8% of those who received anti-hypertensive pharmacotherapy achieved blood pressure levels below 130/85 mmHg. Physician diagnosed dyslipidemia was reported in 50% of all patients [17].

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[ Diabetes Type 1 ]

Cardiovascular Diabetology

Median hs-CRP levels were significantly higher in individuals with central obesity with the MetS compared to individuals with central obesity without the MetS. Overweight/obese diabetic persons usually have normal/low LDL-cholesterol but high C-reactive protein (CRP) levels. The study appears in the Jan. We defined that diabetic patients without retinopathy and /or matched healthy persons constituted the control group, and patients with DR were the case group. The age-standardized incidence rate was 6.9 per 1000 person-years. In light of this controversy, studies examining the association of CRP with vascular outcome and mortality in patient populations, such as those with diabetes, where prospective data remain relatively sparse are to be welcomed. The median CRP level was 3.3 mg/L (range 0 to 59.3 mg/L), and estimated heritability for CRP was approximately 40%.

Endothelium-dependent vasodilation improved in the atorvastatin group compared with the placebo group (P < 0.05). To our knowledge, only one study has reported that CRP concentrations predict the development of the metabolic syndrome [25]. We have previously reported a higher prevalence of type 2 diabetes among HNF1A S319 carriers compared to non-carriers in this population [11], which is paradoxical in the context of the current finding of S319 carriers having a low level of CRP. Using median splits of indexes of insulin resistance and insulin secretion (insulin-to-glucose ratio), participants with greater insulin resistance had a more adverse CVD risk-factor profile, whereas insulin secretion had little influence on risk factors. HNF-1α protein binding to promoter regions of the CRP gene, down stream of the IL-6 responsive site, is known to be involved in synergistic trans-activation of CRP promoter [23–25]. Serum CRP at mean age 49 years was significantly associated with incident type II diabetes (270 cases) during thirteen years of follow-up. Therefore, under the acute-phase signaling mechanism, abnormal HNF-1α produced by S319 carriers may have an impact on CRP production explaining the lower CRP level observed among non-diabetic individuals with the HNF1A G319S polymorphism. Among individuals with diabetes who are likely under chronic inflammatory stress, however, another mechanism may be modulating increased circulating CRP. Stimulation of the CRP promoter caused by increased circulating IL-6 and/or other signaling factors involved may be responsible for the increase in CRP levels in diabetic subjects [27], while the synergistic effects of HNF-1α contributing to CRP expression would be masked in this setting [23–25]. Since ethnic variation in polymorphisms within the coding regions of HNFs has been reported in non-European populations [28–30], it was important to confirm the association of the population-specific polymorphism, HNF1A G319S, with CRP. Metabolic syndrome was defined by the National Cholesterol Education Program criteria (16).

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