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Diabetic Patients (diabetic + patient)

Distribution by Scientific Domains
Medical Sciences95%
Life Sciences2%
4 Other Domains3%
Distribution within Medical Sciences
Diabetes47%
Cardiovascular Disease6%
General & Internal Medicine5%
Pharmacology & Pharmaceutical Medicine4%
Dermatology2%
41 Other Subdomains31%

Kinds of Diabetic Patients

  • consecutive diabetic patient
  • female diabetic patient
  • ii diabetic patient
    		•
  • obese type 2 diabetic patient
  • type 1 diabetic patient
  • type 2 diabetic patient
    		•
  • type ii diabetic patient
  • young diabetic patient

    • Selected Abstracts

    ELECTROPHYSIOLOGICAL ABNORMALITIES IN DIABETIC PATIENTS

    JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2000
    B. Lanzillo
    We studied 476 patients affected by diabetes: 166 male (mean age 61.6 ± 10 years, range 27,91) and 310 female (mean age 61.5 ± 8.4 years, range 25,82). Mean disease duration was 11.3 ± 7.6 years, range 0.3,37). All patients underwent surface motor and sensory nerve conduction along median, popliteal, and sural nerve. Results. Median nerve: in 3.1% of subjects sensory action potentials (SAP) was absent; sensory nerve conduction velocity (SNCV) was reduced in 41.8% in distal segment and in 27.5% in the proximal segment. Motor nerve conduction (MNCV) was reduced in 29.9% of the subjects. Sural nerve: SAP was absent in 24.4% and SNCV was reduced in 32.7%. Popliteal nerve: MNCV was abnormal in 30.4% of the subjects. Combining electrophysiological data we observed that: 1. 28.6% of the subjects resulted normal 2. 12.8% were affected by a lower limbs sensory neuropathy 3. 0.2% had a lower limbs motor neuropathy 4. 5.9% had a lower limbs sensory-motor neuropathy 5. 6.1% had a diffused sensory neuropathy 6. 30.2% had a diffused sensory-motor neuropathy 7. 16.2% had a carpal tunnel syndrome. Patients were divided in 2 groups: patients with and patients without neuropahy: the latter showed a significantly shorter disease duration (12.7 ± 8.1 vs 9.0 ± 6.3; p < 0.0001). In addition, we observed a significant correlation between disease duration and distal latency, median and popliteal MNCV, and SNCV in median and sural nerve (Regression test; p < 0.0001). Patients on insulin showed a longer disease duration and more severe electrophysiological abnormalities. [source]

    CB1 Receptor Blockade and its Impact on Cardiometabolic Risk Factors: Overview of the RIO Programme with Rimonabant

    JOURNAL OF NEUROENDOCRINOLOGY, Issue 2008
    A. J. Scheen
    Rimonabant, the first selective CB1 receptor antagonist in clinical use, has been extensively investigated in the Rimonabant in Obesity (RIO) programme, comprising four 1,2 year placebo-controlled randomised clinical trials recruiting more than 6600 overweight/obese patients with or without co-morbidities. Rimonabant 20 mg daily consistently reduced body weight, waist circumference, triglycerides, blood pressure, insulin resistance and C-reactive protein levels, and increased HDL cholesterol concentrations in both non-diabetic and type-2 diabetic overweight/obese patients. Adiponectin levels were increased, an effect that correlated with HDL cholesterol augmentation, while small dense LDL cholesterol levels were decreased in patients receiving rimonabant 20 mg compared with those receiving placebo in RIO Lipids. Furthermore, in RIO Diabetes, a 0.7% reduction in glycated haemoglobin (HbA1c) levels was observed in metformin- or sulphonylurea-treated patients with type-2 diabetes, an effect recently confirmed in the 6-month SERENADE (Study Evaluating Rimonabant Efficacy in drug-NAļve DiabEtic patients) trial in drug-naļve diabetic patients. Almost half of metabolic changes occurred beyond weight loss, in agreement with direct peripheral effects. The positive effects observed after 1 year were maintained after 2 years. Rimonabant was generally well-tolerated, but with a slightly higher incidence of depressed mood disorders, anxiety, nausea and dizziness compared with placebo. In clinical practice, rimonabant has to be prescribed to the right patient, i.e. overweight/obese subjects with cardiometabolic risk factors and with no major depressive illness and/or ongoing antidepressive treatment, in order to both maximise efficacy and minimise safety issues. New trials are supposed to confirm the potential role of rimonabant in patients with abdominal adiposity, atherogenic dyslipidaemia and/or type-2 diabetes, i.e. at high cardiometabolic risk. [source]

    Is There Any Relationship between Metabolic Parameters and Left Ventricular Functions in Type 2 Diabetic Patients without Evident Heart Disease?

    ECHOCARDIOGRAPHY, Issue 7 2008
    Mehmet Yazici M.D.
    Background: The aim of the present study was to evaluate left ventricle (LV) systolic and diastolic function, using tissue Doppler echocardiography (TDE) and color M-mode flow propagation velocity, in relation to blood glucose status in normotensive patients with type 2 diabetes mellitus (T2DM) who had no clinical evidence of heart disease. Methods: Seventy-two patients with T2DM (mean age 49.1 ± 9.8 years) without symptoms, signs or history of heart disease and hypertension, and 50 ages matched healthy controls (mean age 46.1 ± 9.8 years) had echocardiography. Systolic and diastolic LV functions were detected by using conventional echocardiography, TDE and mitral color M-mode flow propagation velocity (VE). Fasting blood glucose level (FBG) after 8 hours since eating a meal, postprandial blood glucose level (PPG), and HbA1C level were determined. The association of FBG, PPG and HbA1C with the echocardiographic parameters was investigated. Results: It was detected that although systolic functions of two groups were similar, diastolic functions were significantly impaired in diabetics. No relation of FBG and PPG with systolic and diastolic functions was determined. However, HbA1C was found to be related to diastolic parameters such as E/A, Em/Am, VE and E/VE (,=,0.314, P = < 0.05; ,=,0.230, P < 0.05; ,=,0.602, P < 0.001, ,= 0.387, P < 0.005, respectively). In addition to HbA1C, LV, diastolic functions were also correlated with age and diabetes duration. Conclusion: Diastolic LV dysfunction may develop even in absence of ischemia, hypertension, and LVH in T2DM. FBG and PPG have no effect on LV functions, but HbA1C levels may affect diastolic parameters. [source]

    Sural Nerve Pathology In Asymptomatic Minimally Neuropathic Diabetic Patients

    JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 3 2000
    Ra Malik
    12 diabetic patients aged 47.5 ± 9.4 yr., duration of diabetes (14.6 ± 10.3 yr.) and 15 control subjects were studied. In diabetic patients neuropathy symptom score =0, neuropathy deficit score = 4.5 + 0.7/30, vibration = 12.0 + 1.8 V, thermal perception (2.0 + 0.8°C), heart rate variation during deep breathing (17.8 + 2.3), 30:15 ratio (1.31 + 0.07) was normal. Baseline (n=12) and repeat neurophysiology (n=10) performed 8.7 + 0.6 years after sural nerve biopsy demonstrated normal values at baseline, with progression of neuropathy (peroneal motor nerve conduction velocity (ms,1) (42.3 + 2.9 v 39.4 +2.0), sural nerve conduction velocity (45.4 + 3.7 v 43.6 + 1.7). Myelinated fibre density, fibre and axonal area and g-ratio were not significantly reduced. Teased fibre studies showed paranodal abnormalities (p < 0.001), segmental demyelination (P < 0.01) with remyelination (P < 0.01) without axonal degeneration. Unassociated Schwann cell profile density (p < 0.04) and axon density (P < 0.001) were increased and axon diameter was decreased (P < 0.007) with a shift of the size frequency distribution to the left (skewness- 0.89 v 0.64, P < 0.03) suggestive of unmyelinated axonal atrophy/regeneration. Endoneurial capillary basement membrane thickening (P < 0.006), endothelial cell hyperplasia (P < 0.004) and luminal narrowing (P < 0.007) occurred. Current measures of neuropathy are too insensitive to detect significant nerve fibre pathology. The presence of microangiopathy provides support for a microvascular basis of diabetic neuropathy. [source]

    Early Detection Of Diminished Baroreflex Sensitivity In Diabetic Patients Without Evidence Of Cardiovascular Autonomic Neuropathy

    JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 3 2000
    D Ziegler
    Diabetic cardiovascular autonomic neuropathy (CAN) carries an increased risk of mortality. Decreased baroreflex sensitivity (BRS) has been identified as a predictor of increased mortality following myocardial infarction. We evaluated spontaneous BRS in 39 healthy control subjects (C: age (mean ± SEM): 41.5 ± 1.9 years) and 116 diabetic patients (64% Type 1, 36% Type 2; age: 45.8 ± 1.4 years; diabetes duration: 16.9 ± 1.0 years; HbA1c: 9.2 ± 0.2%) using cross-spectral analysis between systolic blood pressure and heart rate in the low-frequency (LF) and high-frequency (HF) bands as well as time domain (sequence) analysis in the supine and standing positions over 10 min. According to previously suggested definitions based on autonomic function tests (AFTs), 36 patients had definite CAN (CAN+: 3 of 7 indices abnormal), 13 had borderline CAN (CAN[+]: 2 of 7 indices abnormal), and 64 had no evidence of CAN (CAN,: 1 of 7 indices abnormal). Maximum gain in cross-spectral LF band (standing) was significantly reduced in CAN, as compared with C (5.2 ± 0.4 vs. 7.2 ± 0.8 ms/mmHg, p < 0.05). Moreover, maximum gain in cross-spectral HF band was significantly lower in CAN, than in C (supine: 12.0 ± 1.2 vs. 17.9 ± 2.5 ms/mmHg, p < 0.05; standing: 4.9 ± 0.5 vs. 8.7 ± 1.0 ms/mmHg, p < 0.05). The slope of the regression line between defined increases or reductions in systolic blood pressure and R-R intervals was significantly reduced in CAN, compared to C (supine: 10.6 ± 0.7 vs. 14.2 ± 1.6 ms/mmHg, p < 0.05; standing: 5.6 ± 0.4 vs. 8.1 ± 0.7 ms/mmHg, p < 0.05). Similar differences were obtained when comparing the CAN, and CAN[+] groups, the latter showing significantly reduced BRS by both techniques (p < 0.05). In contrast, no such differences were noted when comparing the CAN[+] and CAN+ groups. In conclusion, reduced spontaneous baroreflex sensitivity is an early marker of autonomic dysfunction at a stage when autonomic function tests do not yet indicate the presence of CAN, while cases with borderline CAN show a degree of BRS abnormality that is comparable to the level seen in definite CAN. Prospective studies are needed to evaluate whether reduced BRS is a predictor of mortality in diabetic patients. [source]

    The Frequency Of Arterial Hypertension Versus Orthostatic Hypotension In Diabetic Patients

    JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 3 2000
    C Ionescu-Tīrgoviste
    Aim: The aim of this study was to assess the relationship between supine high blood pressure and orthostatic hypotension both in Type 1 (T1DM) and Type 2 (T2DM) diabetic patients. Patients and Methods: Our study included 321 T2DM patients (153 M/168 F; mean age 62.3 (14.2 yr; duration of disease 12.1 (7.6 yr) and 116 T1DM patients (65 M/51 F; mean age 39.7 (9.2 yr; duration of diabetes 11.9 (8.1 yr). Patients with orthostatic hypotension were divided into 3 groups: A , without symptoms; B , mild/moderate symptoms (short and tolerable dizziness when standing); C , severe symptoms (persistent and disabling dizziness or even fainting in upright position). Results: Arterial hypertension was registered in 67.6% of T2DM patients (217 from 321 cases) and in 50.0% of T1DM patients (58 from 116 cases). Orthostatic hypotension (defined as a decrease in systolic blood pressure (30 mm Hg)) was encountered in 64.5% in T2DM patients (207 out of 321 cases) and in 60.3% of T1DM patients (70 out of 116 cases). From 207 T2DM patients with orthostatic hypotension, 105 were in Group A (50.7%), 89 in Group B (42.99%) and 13 in Group C (6.28%), while from 70 T1DM patients with orthostatic hypotension 14 were in Group A (20.0%), 51 in Group B (72.8%) and 5 in Group C (7.14%). An association of supine arterial hypertension with orthostatic hypotension was registered in 96 (29.9%) T2DM patients (68 of them receiving antihypertensive treatment) and in 25 (21.5%) T1DM patients (19 of which were on antihypertensive treatment). From the 18 patients with severe orthostatic hypotension (13 T2DM and 5 T1DM), supine arterial hypertension was registered in 5 cases (3 T2DM and 2 T1DM). In 4 of these 5 cases, patients were receiving antihypertensive treatment. Discontinuation of this treatment led to a decrease in the intensity of clinical signs of orthostatic hypotension in 4 out of 5 cases. An improvement of clinical symptoms of orthostatic hypotension was recorded in about 1/3 of hypertensive patients after discontinuation or just lowering of the dose of antihypertensive drugs (26 out of 87 cases). Conclusion: An association between hypertension and orthostatic hypotension is frequent both in T1DM and in T2DM, rising in difficulties for treatment. The treatment of hypertension in diabetic patients should take into account the possible orthostatic hypotension induced by some of the antihypertensive drugs. [source]

    Arterial Rigidity And Cardiovascular Sympathetic Tone In Hypertensive Obese And Type 2 Diabetic Patients

    JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 3 2000
    P Valensi
    An increase of arterial rigidity and sympathetic activity has been suggested to contribute to essential hypertension. We have shown that vagal control of heart rate (HR) variations during standardized tests is similarly impaired in normotensive obese and type 2 diabetic patients. The aim was to compare cardiovascular vagosympathetic balance and the link between pulse pressure, an index of arterial rigidity, and sympathetic activity in normotensive and hypertensive obese and type 2 diabetic patients. Groups 1 and 2 consisted of 70 normotensive and 32 hypertensive obese patients, groups 3 and 4 of 18 normotensive and 14 hypertensive diabetic patients respectively. HR and blood pressure (BP) variations were studied with a plethysmographic system and spectral analysis (Finapres). During a 5 min-period at a controlled breathing rate, in the 4 groups, the high frequency peak of HR variations (vagal control) was significantly lower than in controls (19 healthy subjects), and the mid/high frequency peak ratio of HR variations was significantly increased. During a standing test, the mid-frequency peak of systolic BP variations (sympathetic activity) did not differ significantly in obese or diabetic patients, either normotensive or hypertensive, and in controls. This peak correlated significantly with pulse pressure in groups 2 and 4 and in the control group but not in groups 1 and 3. In conclusion, 1) spectral analysis confirms that in obese and diabetic patients vagal control of HR variations is similarly reduced and suggests that sympathetic activity is relatively increased ; 2) in hypertensive patients sympathetic tone is not higher than in normotensive ones, but may contribute to arterial rigidity. [source]

    Exercise Does Not Increase QTcmax and QTcd in Diabetic Patients with Autonomic Neuropathy

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2007
    MEHMET YAZICI M.D.
    Background:The purpose of this study was to examine the effects of exercise on maximum QTc interval (QTcmax) and QTc dispersion (QTcd) in diabetic patients without clinically evident heart disease. Methods: Seventy-six diabetic patients who had no coronary artery disease or hypertension (group I; mean age 48 ± 9 years old) and 40 healthy volunteers (group II; mean age 46 ± 13 years old) were enrolled in the study. Cases with clinically evident heart disease were excluded from the study. Resting 12-lead electrocardiogram (ECG) and maximal treadmill exercise test (according to Bruce protocol) were performed in all cases. The QTcmax interval was determined at rest (RQTcmax) and during peak exercise (PQTcmax). Also, the QTcd was measured at rest (RQTcd) and during peak exercise (PQTcd). Autonomic neuropathy was assessed by measuring the heart rate variability (HRV). Results: There was no significant difference between clinical characteristics of two groups. In group I, HRV parameters were significantly lower than group II. RQTcd, PQTcd, RQTcmax, and PQTcmax were significantly longer in group I (56 ± 16 vs 34 ± 11; P< 0.001, 62 ± 22 vs 40 ± 15; P < 0.001, respectively). In diabetic patients, there was no significant difference between RQTcmax and PQTcmax (428 ± 19 vs 420 ± 31; P > 0.05), and no significant difference was present between RQTcd and PQTcd (56 ± 16 vs 62 ± 22; P > 0.05, respectively). Conclusion: Exercise does not affect QTcd in patients with diabetes mellitus and without clinically evident heart disease. [source]

    Relationship Between Abnormal Microvolt T-Wave Alternans and Poor Glycemic Control in Type 2 Diabetic Patients

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2007
    GIULIO MOLON M.D.
    Background:Abnormal microvolt T-wave alternans (TWA) predicts the risk of ventricular arrhythmias and sudden cardiac death. Although type 2 diabetes is associated with an increased risk of these events, there is a dearth of available data on microvolt TWA measurements in type 2 diabetic populations. Methods:We studied 59 consecutive type 2 diabetic outpatients without manifest cardiovascular disease (CVD) and 35 non-diabetic controls who were matched for age, sex, and blood pressure values. Microvolt TWA analysis was performed non-invasively using the CH-2000 system during a sub-maximal exercise with the patient sitting on a bicycle ergometer. Results:The frequency of abnormal TWA was significantly higher in diabetic patients than in controls (25.4 vs 5.7%; P < 0.01). Among diabetic patients, those with abnormal TWA (n = 15) had remarkably higher hemoglobin A1c (HbA1c) (8.1 ± 0.9 vs 7.1 ± 0.8%, P < 0.001) and slightly smaller time-domain heart rate variability parameters (i.e., RMSSD, root mean square of difference of successive R-R intervals) than those with normal TWA (n = 44). Gender, age, body mass index, lipids, blood pressure values, cigarette smoking, diabetes duration, microvascular complication status, QTc interval, and current use of medications did not significantly differ between the groups. In multivariate regression logistic analysis, HbA1c (OR 13.6, 95% CI 2.0,89.1; P = 0.0076) predicted abnormal TWA independent of RMSSD values and other potential confounders. Conclusions:Our findings suggest that abnormal TWA is a very common condition (,25%) among people with type 2 diabetes without manifest CVD and is closely correlated to glycemic control. [source]

    Admission Hyperglycemia and Length of Hospital Stay in Patients With Diabetes and Heart Failure: A Prospective Cohort Study

    CONGESTIVE HEART FAILURE, Issue 3 2008
    Yohannes Gebreegziabher MD
    The authors assessed the relationship between glycemia and length of hospital stay (LOS) in a prospective cohort study of patients with diabetes mellitus and heart failure (HF). Of 212 patients with acute HF exacerbation, 119 (56%) also had diabetes. The mean age of the cohort was 63±0.87 years, and the mean body mass index was 29.3 kg/m2. Diabetic patients had significantly longer LOS compared with the nondiabetics (5.0±0.29 vs 3.4±0.19; P<.001). In patients with diabetes, the mean glycated hemoglobin A1c was 8.3%, admission blood glucose (BG) was 169±7.7 mg/dL, and average BG was 196±8.1 mg/dL. After adjusting for age, sex, weight, hypertension, renal function, and anemia, LOS was significantly correlated with admission BG (r=0.31; P<.001) and average BG (r=0.34; P=.001). In patients with acute HF exacerbation, diabetes significantly prolonged LOS. Hyperglycemia correlated with LOS. [source]

    Diabetes mellitus and alcohol

    DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 4 2004
    Albert van de Wiel
    Abstract Alcohol influences glucose metabolism in several ways in diabetic patients as well as in non-diabetic patients. Since alcohol inhibits both gluconeogenesis and glycogenolysis, its acute intake without food may provoke hypoglycaemia, especially in cases of depleted glycogen stores and in combination with sulphonylurea. Consumed with a meal including carbohydrates, it is the preferred fuel, which may initially lead to somewhat higher blood glucose levels and hence an insulin response in type 2 diabetic patients. Depending on the nature of the carbohydrates in the meal, this may be followed by reactive hypoglycaemia. Moderate consumption of alcohol is associated with a reduced risk of atherosclerotic disorders. Diabetic patients benefit from this favourable effect as much as non-diabetic patients. Apart from effects on lipid metabolism, haemostatic balance and blood pressure, alcohol improves insulin sensitivity. This improvement of insulin sensitivity may also be responsible for the lower incidence of type 2 diabetes mellitus reported to be associated with light-to-moderate drinking. In case of moderate and sensible use, risks of disturbances in glycaemic control, weight and blood pressure are limited. Excessive intake of alcohol, however, may not only cause loss of metabolic control, but also annihilate the favourable effects on the cardiovascular system. Copyright © 2004 John Wiley & Sons, Ltd. [source]

    Peripheral arterial disease in diabetes,a review

    DIABETIC MEDICINE, Issue 1 2010
    E. B. Jude
    Diabet. Med. 27, 4,14 (2010) Abstract Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischaemia. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI < 0.9 is not only diagnostic of PAD even in the asymptomatic patient, but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified, but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD. [source]

    Hospital outcome of acute myocardial infarction in patients with and without diabetes mellitus

    DIABETIC MEDICINE, Issue 2 2004
    W. Otter
    Abstract Aims To assess hospital mortality and morbidity in diabetic and non-diabetic patients with acute myocardial infarction and to compare the results between the two groups. Methods All patients admitted in 1999 to the intensive care unit of the Schwabing City Hospital with diagnosis of acute myocardial infarction were assessed for hospital mortality and co-morbidity. Results Three hundred and thirty patients with acute myocardial infarction were admitted. Of those, 126 (38%) were diabetic and 204 (62%) were non-diabetic patients. Mortality within 24 h after admission was 13.5% in diabetic patients and 5.4% in non-diabetic patients (P < 0.01). Mortality during entire hospitalization was higher in diabetic than in non-diabetic patients (29.4% vs. 16.2%; P = 0.004). Diabetic patients were resuscitated more frequently than non-diabetic patients (24% vs. 11%, P < 0.01). In diabetic patients, heart rate at admission was increased (91 ± 27 vs. 82 ± 23/min; P < 0.01) and presence of angina pectoris was reported less frequently (59% (n = 72) vs. 82% (n = 167); P < 0.001). Preceding myocardial infarction, microalbuminuria, peripheral artery disease and arterial hypertension were more frequent in diabetic than in non-diabetic patients. Diabetic patients demonstrated higher C-reactive protein (CRP) levels than non-diabetic patients (91.4 ± 78.2 mg/l vs. 45.2 ± 62.4 mg/l; P < 0.001). Conclusions In diabetic patients with acute myocardial infarction, early hospital mortality is increased and signs of cardiac autonomic dysfunction and microangiopathy are detected more frequently than in non-diabetic patients. The need for advanced treatment strategies early in the course of diabetic patients with myocardial infarction is emphasized. Diabet. Med. 21, 183,187 (2004) [source]

    Prevalence of diabetes and/or ischaemic heart disease in classes of increasing carotid artery atherosclerosis: an ultrasonographic study

    DIABETIC MEDICINE, Issue 8 2003
    S. Inchiostro
    Abstract Aims To evaluate the prevalence of non-diabetic subjects and diabetic patients, with or without ischaemic heart disease (IHD), in different classes of increasing carotid atherosclerotic damage. Methods Using high-resolution B-mode ultrasound, we studied 598 subjects without known cardiovascular disease (CVD) or diabetes, 74 diabetic patients without CVD, 74 non-diabetic subjects with IHD and 36 patients with both diabetes and IHD. Carotid atherosclerosis was classified as: normal; thickened intima-media; non-stenotic plaque; stenotic plaque. Results Compared with subjects without diabetes or CVD, the frequency of patients with diabetes without known CVD increased significantly from ,normal' to ,stenotic plaque' (4.1%, 6.4%, 13%, 14.8% for normal, thickened intima-media, non-stenotic plaque and stenotic plaque, respectively; P = 0.0057). The same figures were 6%, 7.6%, 10.2%, 23.3% (P = 0.0007) for non-diabetic subjects with IHD, and 0%, 2%, 5.6%, 15.9% (P < 0.0001) for diabetic patients with IHD. No difference was found comparing subjects with diabetes without CVD with non-diabetic patients with IHD (P = 0.56). Using polychotomous logistic regression analysis, diabetic patients without CVD and non-diabetic subjects with IHD showed a similar association with the increasing degree of carotid atherosclerosis (P = 0.59), but significantly stronger compared with subjects without diabetes or CVD (P < 0.03 for both). Conclusions Diabetic patients without known CVD show an advanced degree of carotid atherosclerotic damage similar to non-diabetic subjects with IHD and significantly higher compared with non-diabetic subjects without CVD. Our data support the need for an aggressive early prevention of CVD in diabetic subjects. [source]

    Characteristic patterns of circadian variation in plasma catecholamine levels, blood pressure and heart rate variability in Type 2 diabetic patients

    DIABETIC MEDICINE, Issue 5 2002
    K. Kondo
    Abstract Aims To investigate whether Type 2 diabetic patients exhibit characteristic patterns of circadian variation in plasma levels of catecholamines, blood pressure (BP) and heart rate variability (HRV). Methods Ten Type 2 diabetic and eight control in-patients were studied. Blood for catecholamine measurement was collected every 4 h, and non-invasive ambulatory BP and heart rate were monitored throughout the day. HRV was determined using frequency domain methods. Results Diabetic patients showed a different pattern of circadian variation in BP and HRV from that of controls, the diurnal-nocturnal differences (D-N) being significantly smaller. The mean 24-h HRV levels were reduced in diabetic subjects. The mean 24-h plasma noradrenaline level of 1.36 ± 0.12 nmol/l in diabetic patients was significantly lower than the 2.03 ± 0.20 nmol/l in controls (P < 0.01). In contrast, no significant difference in adrenaline levels was observed. The mean 24-h plasma noradrenaline level demonstrated a significant positive correlation with D-N in systolic BP (r = 0.49, P = 0.0153). Conclusions The present study demonstrated distinctive patterns of circadian variation in plasma noradrenaline level, BP and HRV in Type 2 diabetic patients, associated with an abnormal circadian pattern of sympathovagal modulation. [source]

    Rheological determinants of red blood cell aggregation in diabetic patients in relation to their metabolic control

    DIABETIC MEDICINE, Issue 2 2002
    K. Elishkevitz
    Abstract Aims To determine whether increased red blood cell adhesiveness/aggregation in diabetic patients is related to the extent of their metabolic control. Methods We measured erythrocyte adhesiveness/aggregation in a group of 85 adult patients with diabetes mellitus by using citrated venous whole blood and a simple slide test. The erythrocyte adhesiveness/aggregation was determined by measuring the size of the spaces that are formed between the aggregated erythrocytes. We divided the patients into those with either low or high erythrocyte adhesiveness/aggregation values. Results The erythrocyte adhesiveness/aggregation values of the two groups differed significantly in terms of their fibrinogen concentration, erythrocyte sedimentation rate, high sensitive C-reactive protein (CRP), total cholesterol and triglyceride concentrations. There was no difference between the two groups regarding the concentrations of HbA1c. Logistic regression was applied to construct a model to predict the belonging of a patient in the low or high erythrocyte adhesiveness/aggregation group. A linear regression was applied to construct a model to predict the erythrocyte adhesiveness/aggregation values. Both models turned out to include gender, age, fibrinogen, triglyceride, retinopathy, coronary artery disease and age and gender interaction. Neither HbA1c nor CRP entered the models. Conclusions The degree of erythrocyte adhesiveness/aggregation and several variables of the acute-phase response in patients with diabetes mellitus are not directly related to the degree of metabolic control as evaluated by means of HbA1c concentration. Diabetic patients might benefit from rheological or anti-inflammatory interventions regardless of their metabolic control. [source]

    The role of neuropeptides and neuropeptide-degrading enzymes in wound healing

    EXPERIMENTAL DERMATOLOGY, Issue 9 2004
    John E. Olerud
    Thirty to 40% of diabetic patients develop sensory neuropathy. Neuropathy is a major causal factor in diabetic ulcers. Only 31% of neuropathic diabetic ulcers heal in 20 weeks. Patients with neuropathy have a 15.5-fold excess risk of amputation. Diabetic patients with neuropathy particularly lose epidermal and papillary dermal sensory nerves which release neuropeptides such as substance P (SP). Neutral endopeptidase (NEP), the enzyme that degrades SP, is dramatically over expressed in patients with diabetic neuropathy. SP has positive effect on wound healing. Treatment strategies related to the nervous system for prevention and treatment of diabetic ulcers currently being studied include prevention of neuropathy with tight control of blood glucose, application of neuropeptides, nerve growth factors (NGF), and antagonists of NEP. [source]

    Mortality in diabetic patients undergoing non-cardiac surgery: a 7-year follow-up study

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2009
    M. KROLIKOWSKA
    Background: The prognosis of diabetic patients after non-cardiac surgery remains controversial. This study was designed to compare the long-term mortality between diabetic and non-diabetic control patients undergoing non-cardiac surgery and to evaluate the possible risk factors. Methods: We investigated 274 consecutive diabetic patients and 282 non-diabetic control patients who underwent non-cardiac surgery within 1 year in a tertiary care hospital in Finland. The control group was matched for the same type of operations. Patients were followed for up to 7 years on average. The main outcome measure was mortality within 7 years. Results: Mortality both in the short-term postoperatively (,21 days) and in the long-term (up to 87 ½ months) was significantly higher in the diabetic patients compared with the non-diabetic group: 3.5 vs. 0% (P<0.05) and 37.2 vs. 15% (P<0.00001), respectively. The major causes of death among diabetic subjects were diseases of the cardiovascular system (56.8%) compared with non-diabetic patients (18.6%), P<0.0001. We found that diabetes mellitus per se is not a risk factor for post-operative mortality but a combination of variables had a significant effect on both short- and long-term mortality. Conclusion: Diabetic patients undergoing non-cardiac surgery had a significantly higher incidence of short-term post-operative and long-term mortality compared with non-diabetic subjects. We propose a model of predictors of death among diabetic individuals undergoing non-cardiac surgery within a 7-year follow-up. The majority of deaths were associated with cardiovascular diseases. [source]

    Tumour necrosis factor-alpha plasma level in patients with type 1 diabetes mellitus and its association with glycaemic control and cardiovascular risk factors

    JOURNAL OF INTERNAL MEDICINE, Issue 1 2000
    M. Lechleitner
    Abstract. Lechleitner M, Koch T, Herold M, Dzien A, Hoppichler F (University of Innsbruck, Medical Centre Hentschelhof, Innsbruck, and Hospital Barmherzige Brüder, Salzburg, Austria). tumour necrosis factor-alpha plasma level in patients with type 1 diabetes mellitus and its association with glycaemic control and cardiovascular risk factors. J Intern Med 2000: 248: 67,76. Objectives. Diabetic patients reveal a significant increase in their cardiovascular risk. Beside glycaemic control and management of established risk factors, determination of cytokines, like serum levels of tumour necrosis factor-alpha (TNF-,), might offer a tool to determine patients at high risk. The cytokine TNF-, reveals a complex relationship with diabetes. It is involved in beta-cell damage leading to type 1 diabetes, causes insulin resistance associated with obesity and is of influence in the formation of atherosclerotic vascular lesions. We were interested in the possible association of this cytokine with metabolic control and cardiovascular risk factors in patients with type 1 diabetes. Design and Subjects. TNF-, plasma levels were determined in 44 outdoor patients (15 women, 29 men) with type 1 diabetes mellitus (mean duration 11.2 ± 8.7 years) and in 24 healthy controls by use of a solid phase enzyme amplified sensitivity immunoassay (TNF-,elisa, Biosource Fleurus, Belgium). None of our study participants suffered from inflammatory or other concurrent diseases. Relationships between variables were evaluated by non-parametric Spearman correlation coefficients. Results. TNF-, plasma levels were significantly higher in diabetic patients (19.3 ± 7.5 pg mL,1) than in non-diabetic subjects (11.1 ± 5.8 pg mL,1; P < 0.023), and revealed a significant positive correlation with glycated haemoglobin (HbA1c) (r = 0.43; P < 0.004) and fructosamine (r = 0.31; P < 0.049) values, and a negative correlation with HDL cholesterol (r = ,0.36; P < 0.018) and apoAI-levels (r = ,0.37; P < 0.015). These relationships could be observed in patients with a duration of diabetes for more than 5 years, as well as in patients with a shorter duration of diabetes. In the male group, TNF-, plasma levels revealed a significant positive correlation with plasma levels of thiobarbituric acid reacting substances (r = 0.61; P < 0.001). Plasma levels of thiobarbituric acid reacting substances showed a positive correlation with the duration of diabetes (r = 0.58; P < 0.008), as well as with the serum levels of the vascular adhesion molecules intercellular adhesion molecule (ICAM) (r = 0.34; P < 0.051) and vascular cell adhesion molecule (VCAM) (r = 0.30; P < 0.052). Conclusions. Our data indicate that TNF-, plasma levels are increased in type 1 diabetes mellitus and reveal a significant association with metabolic long-term control parameters, HbA1c and fructosamine for glycaemic control, and HDL cholesterol for triglyceride metabolism, as well with lipid peroxidation. [source]

    The association between antidepressant use and hypoglycaemia in diabetic patients: a nested case,control study,

    PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008
    Hieronymus J. Derijks PharmD
    Abstract Purpose Hypoglycaemia is a limiting factor for glycaemic management of diabetes with intensive insulin and/or oral antidiabetic drug (OAD) regimen. Case reports suggest that antidepressants may interfere with blood glucose metabolism in patients with diabetes mellitus potentially increasing the risk of clinically relevant hypoglycaemia. Comorbid depression treated with antidepressants could therefore further complicate glycaemic control. We have carried out a nested case,control study among diabetic patients to assess the risk of hypoglycaemia requiring hospitalisation associated with the use of antidepressants. Methods Diabetic patients treated with insulin and/or OADs were selected from the Dutch Pharmo system. Exposure to antidepressants was the primary determinant investigated. Use of antidepressants was further subclassified based on the receptor binding profile to investigate whether specific pharmacological properties could explain a potential influence on glucose homeostasis. Conditional logistic regression was used to estimate odds ratios and to adjust for confounding factors. Results From the base cohort (40 600 patients), 549 (1.35%) cases were identified and 1897 controls were selected. Current use of any antidepressant was not associated with a significantly higher risk of hypoglycaemia requiring hospitalisation (OR: 1.36 (95%CI: 0.84,2.20)). A trend for a higher risk on hypoglycaemia was identified for antidepressants with high affinity for the serotonin reuptake transporter. The risk on severe hypoglycaemia was increased after 3 years of use (OR: 2.75 (95%CI: 1.31,5.77)). Conclusions It is important for diabetic patients using antidepressants for more than 3 years to pay attention for symptoms of hypoglycaemia and strict blood glucose self-monitoring. Copyright © 2008 John Wiley & Sons, Ltd. [source]

    Cardiac modulation of startle eye blink

    PSYCHOPHYSIOLOGY, Issue 2 2009
    André Schulz
    Abstract As an alternative to interoceptive paradigms that depend on the participants' active cooperation, two studies are presented to show that startle methodology may be employed to study visceral afferent processing. The first study of 38 volunteers showed that startle responses were smaller when elicited during cardiac systole as compared to diastole. In the second study, 31 diabetic patients were divided into two groups, having normal or diminished (<6 ms/mmHg) baroreflex sensitivity (BRS). Patients with normal BRS showed the same results found in healthy volunteers. Diabetic patients with diminished BRS did not show this pattern. Because diminished BRS is an indicator of impaired baro-afferent signal transmission, it is concluded that cardiac modulation of startle is associated with intact baro-afferent feedback. Thus, pre-attentive startle methodology is feasible to study visceral afferent processing originating from the cardiovascular system. [source]

    Vascular endothelial growth factor gene transfer for diabetic polyneuropathy: A randomized, double-blinded trial,

    ANNALS OF NEUROLOGY, Issue 4 2009
    Allan H. Ropper MD
    Objective Randomized, blinded trial of intramuscular gene transfer using plasmid vascular endothelial growth factor (VEGF) to treat diabetic polyneuropathy. Methods Diabetic patients with polyneuropathy were randomized to receive a VEGF-to-placebo ratio of 3:1. Three sets of injections were given at eight standardized sites adjacent to the sciatic, peroneal, and tibial nerves of one leg. Primary outcomes were change in symptom score at 6 months and a prespecified overall clinical and electrophysiological improvement score. Secondary outcomes were differences in symptoms, examination scores, visual analog pain scale, nerve conduction, and quantitative sensory testing. Results Thirty-nine patients received plasmid VEGF and 11 received placebo. Mean symptom score improved in both legs at 6 months, favoring VEGF over placebo (,1.2 ± 0.5 vs ,0.9 ± 0.5; p < 0.01 after adjustment for change in the untreated leg) and compared with the untreated leg (,0.7 ± 0.5; p = 0.02). The region of sensory loss and visual analog pain scale improved in the treated group (,1.5 vs ,0.5; p = 0.01). Twelve of 39 VEGF versus 2 of 11 placebo patients met criterion for overall improvement. Other measures including nerve conduction potentials did not improve. There were 84 adverse events in VEGF patients, and 22 were serious; there were 51 events in placebo patients, and 2 were serious. Interpretation Intramuscular plasmid VEGF gene transfer improved diabetic neuropathic symptoms, meeting primary end-point criteria for efficacy but not affecting most secondary measures. Treatment was associated with more serious adverse events that did not reach statistical significance. These results are not conclusive but may justify further clinical study. Ann Neurol 2009;65:386,393 [source]

    4335: Correlation of diabetic corneal neuropathy and retinopathy

    ACTA OPHTHALMOLOGICA, Issue 2010
    E NITODA
    Purpose Corneal confocal microscopy is a rapid, non-invasive and reiterative technique, suitable for the accurate detection and quantification of corneal subbasal nerve plexus. The aim of this study is to correlate corneal nerve fibre alterations with the abnormalities in the retina of diabetic patients and compare them with those of nondiabetic people Methods 278 diabetic corneas and 94 corneas of age-matched control subjects were included in the study. Diabetic patients were further classified with respect to the stage of retinopathy, according to indirect fundoscopy, fundus photography and fluorescein angiography. The central corneas were scanned with HRT II and we estimated nerve fibre density (NFB) nerve branch density (NBD), nerve fibre length (NFL) and nerve fibre tortuosity (NFT). Finally, we made out the glycemic and lipidemic profile of patients. Results NFD values for control, NDR, NPDR and PDR groups were 31.27 ± 0.99, 27.35 ± 0.77, 23.67 ± 0.83 and 18.77 ± 0.77 respectively and NBD values were 45.12± 2.85, 39.86 ± 3, 30.56 ± 2.71 and 24.98 ± 2.08 respectively. NFL values for control, NDR, NPDR and PDR were 16.58 ± 0.55, 14.82 ± 0.56, 12.27 ± 0.49 and 10.41± 0.45 respectively and NFT values were 5.78 ± 0.28, 6.6 ± 0.52, 6.57 ± 0.22 and 7.02 ± 0.39 respectively. NFD, NBD, NFL were significantly reduced and NFT appeared to be higher in diabetic patients, according to the stage of diabetic retinopathy. The glycemic profile was analogue to the retina status, but the lipidemic one appeared to vary. Conclusion Alterations in corneal nerve plexus are apparent in diabetic patients and more pronounced in PDR.Corneal confocal microscopy could be a promising technique for the early diagnosis and treatment of diabetic neuropathy. [source]

    Metabolic memory puzzle and progression of diabetic retinopathy

    ACTA OPHTHALMOLOGICA, Issue 2008
    R KOWLURU
    Purpose Retinopathy is one of the most feared complications of diabetes. Good glycemic control can inhibit its development, but the effects of good glycemic control on the progression of retinopathy are not immediate. Diabetic patients may take years after re-establishment of good glycemic control to show signs of arrest of its progression. Further, good glycemic control after a profound period of poor glycemic control does not immediately benefit the progression of retinopathy, and the imprinted effects of prior glycemic control produce the long lasting benefits of good glycemic control, thus suggesting a ,metabolic memory' phenomenon. Results Animal models of diabetic retinopathy, including dogs and rats, have duplicated this metabolic memory phenomenon. In rats, histopathology associated with diabetic retinopathy does not stop for at least six months when good glycemic control is initiated six months after induction of diabetes. Increase in retinal oxidative stress and peroxynitrite levels and activation of apoptosis execution enzyme-caspase-3 resist reversal after re-institution of good glycemic control. Hyperglycemia-induced inactivation of retinal glyceraldehyde dehydrogenase that is postulated to activate some of the key pathways associated with the development of diabetic complications remains inactive and covalently modified, and pro-inflammatory markers elevated. Conclusion This suggests that the process of metabolic memory is complex, and multiple pathways contribute to this resistance of diabetic retinopathy to arrest. Understanding the mechanism responsible for the tendency of diabetic retinopathy to progress after reestablishment of good glycemic control should help reveal targets for therapies to prevent its progression. [source]

    Ophthalmic artery blood flow velocity changes in diabetic patients as a manifestation of macroangiopathy

    ACTA OPHTHALMOLOGICA, Issue 2 2000
    Masanori Ino-ue
    ABSTRACT. Purpose: The hemodynamic characteristics of ophthalmic artery (OA) blood flow velocity in diabetic patients with ocular involvement were evaluated. Methods: Changes in OA blood flow of eyes with background diabetic retinopathy (BDR), proliferative retinopathy (PDR) and ocular ischemic syndrome (OIS) were ananalyzed by Color Doppler imaging. Results: Patients with BDR and PDR had significantly lower diastolic and mean blood flow velocities and higher pulsatility indices compared to controls. Diabetic patients with OIS had significantly lower systolic, diastolic and mean anterograde OA blood flow velocities than the controls. Pulsatility indices were higher in anterograde OA blood flow measurements compared to controls. Systolic blood flow velocities in rubeotic eyes with OIS were significantly lower than in rubeotic eyes with PDR. Conclusion: OA blood flow measurements by color doppler imaging may detect macroangiopathies in diabetic patients as manifested by carotid atheromas and arterio- and arterosclerosis of the OA and its branches. [source]

    Restenosis and Progression of Coronary Disease after Balloon Angioplasty in Patients with Diabetes Mellitus

    CLINICAL CARDIOLOGY, Issue 12 2000
    Yoseph Rozenman M.D.
    Abstract Background: Patients with diabetes mellitus (D) (both insulin-requiring D [IRD] and non-IRD) who undergo angioplasty have worse long-term outcome than do non-D patients. Few data are available in the literature that explain these findings. Hypothesis: The study was undertaken to compare restenosis and progression of coronary disease after angioplasty in IRD patients, in non-IRD patients, and in non-D patients. Methods: Diabetic patients who underwent coronary angioplasty were separated into two subgroups: IRD and non-IRD patients. Their angiographic outcome was compared with non-D patients. We examined retrospectively 353 coronary angiograms of patients who were referred for diagnostic angiography > 1 month after successful angioplasty. Quantitative angiography was used to determine the outcome in dilated narrowings (restenosis) and in nondilated narrowings (disease progression). Results: Baseline clinical and angiographic characteristics were similar in all groups. Restenosis rate was higher in IRD (61 %) than in non-IRD (36%) and non-D (35%) patients (p = 0.04). Late luminal loss after angioplasty was two times greater in IRD patients than in the other two groups (p=0.01). Disease progression of nondilated narrowings was significantly more prominent in non-IRD than in non-D patients: Diameter stenoses were similar in the initial angiogram, but narrowings were significantly more severe (p=0.02) in the final angiogram (70 ± 27% and 60 ± 33%, respectively). New narrowings were more common in non-IRD than in non-D patients: there was a 23% increase in the number of narrowings in the follow-up angiogram in non-IRD patients compared with only 12% in non-D patients (p < 0.003). These new narrowings were more common (p=0.01) in angioplasty arteries (57 narrowings on 420 arteries,13.6%) than in nonangioplasty arteries (54 narrowings on 639 arteries,8.5%). Conclusion: Restenosis is more common in IRD patients and explains the high rate of adverse cardiac events within the first year after coronary intervention in these patients (mainly target lesion revascularization). Disease progression (including new narrowings) is the main determinant of patient outcome > 1 year after coronary intervention and is accelerated in non-IRD compared with non-D patients. [source]

    Rediscovering bile acid sequestrants

    DIABETES OBESITY & METABOLISM, Issue 12 2009
    D. S. H. Bell
    Aim: In the recently published The Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) mega-trial, rosuvastatin significantly reduced cardiovascular events at the expense of a small but significant increase in the risk of developing type 2 diabetes. The increased risk of new-onset diabetes was in keeping with a recent meta-analysis which suggested that statins, with the possible exception of pravastatin, marginally increase the risk of developing type 2 diabetes. Methods: Although the net effect of rosuvastatin was obviously very positive, we hypothesized that the addition of a bile aid sequestrant to a statin would not only further decrease lipid levels and potentially further decrease cardiovascular events but also protect against the development of diabetes. This is particularly relevant because the bile acid sequestrant, colesevelam, has recently been approved for therapy of diabetes. Results: Colesevelam like other bile acid sequestrants lowers low-density lipoprotein levels by 16% and C-reactive protein by 22% beyond the reductions that occur with statin therapy alone. Bile acid sequestrants confer lipid-lowering, glucose-lowering, and anti-inflammatory benefits, and have been shown to reduce risk of cardiovascular events. Conclusions: Therefore, colesevelam should be the most effective and logical agent to add to a statin in the diabetic and insulin-resistant patient, because in addition to lowering cardiac risk it may prevent the development of diabetes, as well as improving glycaemic control in the established diabetic patient. [source]

    Treatment of diabetic hypertension

    DIABETES OBESITY & METABOLISM, Issue 5 2009
    David S. H. Bell
    Insulin resistance and hyperglycaemia combine to make hypertension more prevalent in the type 2 diabetic patient. Blood pressure goals below those for the non-diabetic subject have been shown to be more effective in lowering mortality and cardiovascular events in the diabetic patient. To achieve these goals in most cases, three to five antihypertensives from different therapeutic groups need to be utilized. Suppression of the renin,angiotensin system (RAS) with angiotensin-converting enzyme inhibitors, angiotensin 2 receptor blockers or a renin inhibitor should be the primary therapy. A second goal should be suppression of the sympathetic nervous system utilizing a beta-blocker that does not increase insulin resistance. The addition of a diuretic, calcium channel blocker or a vasodilator to suppressors of the RAS and sympathetic nervous system aid in achieving hypertensive goals in the diabetic patient. Achieving hypertensive goals with suppression of the RAS and sympathetic nervous system should result in a decrease in mortality and cardiovascular events in the diabetic hypertensive patient. In this review article, the benefits and disadvantages of the different antihypertensive therapies in the diabetic patient are discussed. [source]

    Peripheral arterial disease in diabetes,a review

    DIABETIC MEDICINE, Issue 1 2010
    E. B. Jude
    Diabet. Med. 27, 4,14 (2010) Abstract Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischaemia. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI < 0.9 is not only diagnostic of PAD even in the asymptomatic patient, but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified, but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD. [source]

    Reversible cognitive deterioration after a single episode of severe hypoglycaemia: a case report

    DIABETIC MEDICINE, Issue 12 2004
    T. Kubiak
    Abstract A case of a male 34-year-old Type 1 diabetic patient who experienced a prolonged severe hypoglycaemic episode is presented. After the hypoglycaemic event, the patient suffered from moderate to severe neuropsychological impairments. On the basis of neuropsychological assessment results, diabetes therapy was modified (less complex insulin regimen, fixed insulin doses and fixed carbohydrate distribution). At a follow-up examination (3 months), presumable complete recovery of cognitive function was observed. This case demonstrates the possible detrimental neuropsychological effects of severe hypoglycaemia, that, in this case, turned out to be reversible. It highlights the clinical implications of impaired cognitive function on self-care and self-management abilities and the usefulness of neuropsychological testing in clinical diabetes care. [source]