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Type 2 Diabetics (type 2 + diabetic)
Terms modified by Type 2 Diabetics Selected AbstractsParallel increase of plasma apoproteins C-II and C-III in Type 2 diabetic patientsDIABETIC MEDICINE, Issue 7 2009S. Béliard Abstract Aims, To determine plasma levels of apoprotein (apo) C-II and apoprotein C-III in Type 2 diabetic patients and to examine the clinical and biological factors that are associated with elevated apoC concentrations. Methods, We measured apoC-II and apoC-III in total plasma and in non-high-density lipoprotein fractions by an immunoturbidimetric assay in 88 Caucasian Type 2 diabetic patients and in 138 healthy control subjects. Results, Plasma levels of both apoC-II and apoC-III were increased in Type 2 diabetic patients. The clinical conditions associated with an increase of plasma apoC-II and apoC-III were abdominal obesity, body mass index, poor glycaemic control and lack of insulin treatment. However, when multivariate analysis was used, plasma apoCs levels correlated with triglyceride levels only. The apoC-III/apoC-II ratio was similar in the Type 2 diabetic and control subjects. Conclusions, Our study shows the parallel increase of apoC-II and C-III in Type 2 diabetic patients. This parallel increase is related to hypertriglyceridaemia only. [source] Peroxisome proliferator-activated receptor-, co-activator-1, (PGC-1,) gene polymorphisms and their relationship to Type 2 diabetes in Asian IndiansDIABETIC MEDICINE, Issue 11 2005K. S. Vimaleswaran Abstract Aims The objective of the present investigation was to examine the relationship of three polymorphisms, Thr394Thr, Gly482Ser and +A2962G, of the peroxisome proliferator activated receptor-, co-activator-1 alpha (PGC-1,) gene with Type 2 diabetes in Asian Indians. Methods The study group comprised 515 Type 2 diabetic and 882 normal glucose tolerant subjects chosen from the Chennai Urban Rural Epidemiology Study, an ongoing population-based study in southern India. The three polymorphisms were genotyped using polymerase chain reaction,restriction fragment length polymorphism (PCR,RFLP). Haplotype frequencies were estimated using an expectation,maximization (EM) algorithm. Linkage disequilibrium was estimated from the estimates of haplotypic frequencies. Results The three polymorphisms studied were not in linkage disequilibrium. With respect to the Thr394Thr polymorphism, 20% of the Type 2 diabetic patients (103/515) had the GA genotype compared with 12% of the normal glucose tolerance (NGT) subjects (108/882) (P = 0.0004). The frequency of the A allele was also higher in Type 2 diabetic subjects (0.11) compared with NGT subjects (0.07) (P = 0.002). Regression analysis revealed the odds ratio for Type 2 diabetes for the susceptible genotype (XA) to be 1.683 (95% confidence intervals: 1.264,2.241, P = 0.0004). Age adjusted glycated haemoglobin (P = 0.003), serum cholesterol (P = 0.001) and low-density lipoprotein (LDL) cholesterol (P = 0.001) levels and systolic blood pressure (P = 0.001) were higher in the NGT subjects with the XA genotype compared with GG genotype. There were no differences in genotype or allelic distribution between the Type 2 diabetic and NGT subjects with respect to the Gly482Ser and +A2962G polymorphisms. Conclusions The A allele of Thr394Thr (G , A) polymorphism of the PGC-1 gene is associated with Type 2 diabetes in Asian Indian subjects and the XA genotype confers 1.6 times higher risk for Type 2 diabetes compared with the GG genotype in this population. [source] How should peripheral neuropathy be assessed in people with diabetes in primary care?DIABETIC MEDICINE, Issue 5 2003A population-based comparison of four measures Abstract Aims To test the accuracy of four measures of peripheral diabetic neuropathy in a primary care population. Methods Type 2 diabetic (n = 544) and 544 non-diabetic participants aged 45,76 years were randomly selected from general practice registers. Neuropathy was assessed using vibration threshold (VT) and scores for light touch, thermal sense and modified Michigan Neuropathy Screening Instrument questionnaire. These measures were assessed for variation with diabetes status, age, diabetes duration, HbA1c, and presence of retinopathy and nephropathy. Light touch, thermal sense and questionnaire scores were assessed against VT using ROC curve analysis. Results Only VT and light touch were different between diabetic and non-diabetic groups (P = 0.02 and < 0.0001, respectively). All measures were significantly associated with diabetes duration and retinopathy, and all except questionnaire score (P = 0.14) with age. None was associated with nephropathy and only questionnaire score was associated with HbA1c (P = 0.033). VT varied as expected across scores of light touch (,2 = 41.65, P = 0.0001), thermal sense (,2 = 15.86, P = 0.015) and questionnaire (,2 = 21.22, P = 0.047). Area under the curve values for light touch, thermal and questionnaire scores were 0.72 (95% confidence interval (CI) 0.63, 0.82), 0.63 (95% CI 0.52, 0.73) and 0.64 (95% CI 0.53, 0.74), respectively. Conclusions All measures had associations with risk factors for neuropathy, but light touch score (monofilament) had the strongest association with vibration threshold (the chosen gold standard) and thus appeared the most appropriate tool for use in primary care, because of its validity and simplicity of use. Diabet. Med. 20, 368,374 (2003) [source] Characteristic patterns of circadian variation in plasma catecholamine levels, blood pressure and heart rate variability in Type 2 diabetic patientsDIABETIC MEDICINE, Issue 5 2002K. 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] Alterations of oestradiol, testosterone, gonadotrophins and SHBG by type 2 diabetes in postmenopausal womenPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 9 2007Clinical implications for the incidence of breast cancer, cardiovascular risk in diabetic women? Abstract Sex hormones influence cardiovascular risk and bone mineral density. Total oestradiol is increased in postmenopausal women with type 2 diabetes, whereas its impact on androgens, sex hormone binding globulin (SHBG) and gonadotrophins in postmenopausal women is not so clearly understood. This study aims to clarify the impact of type 2 diabetes on sex hormone levels in Caucasian postmenopausal women. Type 2 diabetic (n=42) and non-diabetic (n=45) postmenopausal women were recruited. Venous blood samples were drawn and assayed for total oestradiol, total testosterone, luteinising hormone (LH), follicle stimulating hormone (FSH) and SHBG. Ratio of total testosterone to SHBG was used as an index of free testosterone (FT). Total oestradiol and FT were significantly higher in diabetic subjects compared to controls, oestradiol median: 59.5(25th,75th centiles: 41.5,74.5) vs 42.5(37.0,59.8)pmol/L, p=0.009 Mann-Whitney test; and FT: 0.038(0.021,0.070) vs 0.022(0.012,0.036), p=0.003. SHBG, FSH and LH were lower in diabetic subjects compared to controls, SHBG: 32(23.3,47.3) vs 55(37,70)nmol/L, p<0.001; FSH: 54.8(42.2,68.7) vs 71.8(55.9,98.9)iu/L, p=0.001; and LH: 27.9(20.6,39.7) vs 39.2(30.9,48.1)iu/L, p=0.011, but total testosterone was not different. The differences in oestradiol, SHBG and FSH remained when subjects were matched for BMI and age (n=29). Preliminary sub-group analysis suggests that these differences may be influenced by form of diabetic therapy and glycaemic control. Type 2 diabetes is associated with altered levels of total oestradiol, FT, SHBG, FSH, LH, in postmenopausal women. However, further research is required to determine the impact of diabetic therapy and glycaemic control, and also the clinical relevance of these alterations. Copyright © 2007 John Wiley & Sons. [source] Effects of ageing on carbonyl stress and antioxidant defense in RBCs of obese Type 2 diabetic patientsJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 3 2005Alina Constantin Abstract In this study we investigated the effects of ageing on the carbonyl stress (protein carbonyls and 4-hydroxy-2-nonenal groups) and glutathione antioxidant defense in red blood cells (RBCs) of obese Type 2 diabetic patients with/without hypertensive complications. To this purpose the following methods were used: spectrophotometry (protein carbonyls, glutathione and glutathione peroxidase assays), immunofluorescence (4-hydroxy-2-nonenal localization), western blotting (immunodetection of carbonylated proteins). The results showed that compared to RBCs of healthy subjects, in obese Type 2 diabetics, ageing is associated with: (i) an increase in the concentration and expression of carbonylated proteins, a marker of oxidative stress; (ii) a decrease of both non-enzymatic and enzymatic endogenous glutathione defenses; (iii) a severely disturbed oxidant/antioxidant balance when obesity was associated with hypertension. The simultaneous insults of high blood pressure, obesity, and diabetes conducted to the highest carbonyl strss, exposure of 4-hydroxy-2-nonenal Michel adducts at the outer leaflet of RBCs plasmalemma, and the lowest glutathione antioxidant potential, particularly in elderly patients. These results can explain the gradual age-dependent diminishment of the detoxification potenital of RBCs that at the old age can not overcome the deleterious effects of the high systemic oxidative stress. [source] The potential of cinnamon to reduce blood glucose levels in patients with type 2 diabetes and insulin resistanceDIABETES OBESITY & METABOLISM, Issue 12 2009S. Kirkham Aim: Cinnamon has a long history as an antidiabetic spice, but trials involving cinnamon supplementation have produced contrasting results. The aim of this review was to examine the results of randomized controlled clinical trials of cinnamon and evaluate the therapeutic potential amongst patients with diabetes and insulin-resistant patients, particularly the ability to reduce blood glucose levels and inhibit protein glycation. Methods: A systematic electronic literature search using the medical subject headings ,cinnamon' and ,blood glucose' was carried out to include randomized, placebo-controlled in vivo clinical trials using Cinnamomum verum or Cinnamomum cassia conducted between January 2003 and July 2008. Results: Five type 2 diabetic and three non-diabetic studies (total N = 311) were eligible. Two of the diabetic studies illustrated significant fasting blood glucose (FBG) reductions of 18,29% and 10.3% (p < 0.05), supported by one non-diabetic trial reporting an 8.4% FBG reduction (p < 0.01) vs. placebo, and another illustrating significant reductions in glucose response using oral glucose tolerance tests (p < 0.05). Three diabetic studies reported no significant results. Conclusions: Whilst definitive conclusions cannot be drawn regarding the use of cinnamon as an antidiabetic therapy, it does possess antihyperglycaemic properties and potential to reduce postprandial blood glucose levels. Further research is required to confirm a possible correlation between baseline FBG and blood glucose reduction and to assess the potential to reduce pathogenic diabetic complications with cinnamon supplementation. [source] DPP-IV inhibition enhances the antilipolytic action of NPY in human adipose tissueDIABETES OBESITY & METABOLISM, Issue 4 2009K. Kos Context:, Dipeptidyl peptidase IV (DPP-IV) inactivates the incretin hormone glucagon-like peptide. It can also affect the orexigenic hormone neuropeptide Y (NPY1,36) which is truncated by DPP-IV to NPY3,36, as a consequence NPY's affinity changes from receptor Y1, which mediates the antilipolytic function of NPY, to other NPY receptors. Little is known whether DPP-IV inhibitors for the treatment of type 2 diabetic (T2DM) patients could influence these pathways. Aims:, To investigate the in vitro effects of NPY with DPP-IV inhibition in isolated abdominal subcutaneous (AbdSc) adipocytes on fat metabolism, and assessment of NPY receptor and DPP-IV expression in adipose tissue (AT). Methods:,Ex vivo human AT was taken from women undergoing elective surgery (body mass index: 27.5 (mean ± s.d.) ± 5 kg/m2, age: 43.7 ± 10 years, n = 36). Isolated AbdSc adipocytes were treated with human recombinant (rh)NPY (1,100 nM) with and without DPP-IV inhibitor (1 M); glycerol release and tissue distribution of DPP-IV, Y1 and Y5 messenger RNA (mRNA) were measured and compared between lean and obese subjects. Results and conclusion:, rhNPY reduced glycerol release, an effect that was further enhanced by co-incubation with a DPP-IV inhibitor [control: 224 (mean ± s.e.) ± 37 ,mol/l; NPY, 100 nM: 161 ± 27 ,mol/l**; NPY 100 nM/DPP-IV inhibitor, 1 M: 127 ± 14 ,mol/l**; **p < 0.01, n = 14]. DPP-IV was expressed in AbdSc AT and omental AT with relative DPP-IV mRNA expression lower in AbdSc AT taken from obese [77 ± 6 signal units (SU)] vs. lean subjects (186 ± 29 SU*, n = 10). Y1 was predominantly expressed in fat and present in all fat depots but higher in obese subjects, particularly the AbdSc AT-depot (obese: 1944 ± 111 SU vs. lean: 711 ± 112 SU**, n = 10). NPY appears to be regulated by AT-derived DPP-IV. DPP-IV inhibitors augment the antilipolytic effect of NPY in AT. Further studies are required to show whether this explains the lack of weight loss in T2DM patients treated with DPP-IV inhibitors. [source] The effects of lipid-lowering drug therapy on cardiovascular responsiveness in type 2 diabetic patientsDIABETES OBESITY & METABOLISM, Issue 1 2006Laurence Guy HowesArticle first published online: 18 MAR 200 Type 2 diabetes is associated with a high prevalence of dyslipidaemia and a high incidence of cardiovascular disease. Lipid lowering therapy with HMG Co-A reductase inhibitors (statins) reduce the risk of cardiovascular events in type 2 diabetic and non-diabetic patients, effects which are believed to be partly due to improvements in vascular function. The aetiology of abnormal vascular function in type 2 diabetics is likely to be multifactorial and the pattern of vascular dysfunction in type 2 diabetes may differ from that which occurs in non-diabetic patients with dyslipidaemia. Abnormalities in endothelium derived hyperpolarising factor (EDHF) mediated vasodilation in resistance vessels may be more prominent in both type 1 and type 2 diabetes than in non-diabetic patients with endothelial dysfunction. The effects of lipid lowering therapy on vascular responsiveness may differ in type 2 diabetic patients from those found in non-diabetic patients. Statin therapy does not appear to improve responses to endothelial dependent vasodilators in type 2 diabetics, but may alter the ratio between nitric oxide (NO) and EDHF mediated responses. Fibrate therapy improves flow mediated dilation of brachial arteries in type 2 diabetic patients, but only appears to improve endothelium dependant vasodilator responses in resistance vessels when given in conjunction with co-enzyme Q. [source] Spatial QRS-T angle: association with diabetes and left ventricular performanceEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 9 2006Ch. Voulgari Abstract Background, The spatial QRS-T angle obtained by vectorcardiography is a combined measurement of the electrical activity of the heart and predicts cardiovascular morbidity and mortality. Disturbances in repolarization and depolarization are common in diabetes. No data, however, exist on the effect of diabetes on QRS-T angle. In this study we examined differences in QRS-T angle between type 2 diabetic and non-diabetic subjects; in addition, the potential relationship between QRS-T angle and left ventricular performance as well as glycaemic control were also examined. Patients and methods, A total of 74 subjects with type 2 diabetes and 74 non-diabetic individuals, matched for age and sex with the diabetic subjects were examined. All subjects were free of clinically apparent macrovascular complications. Spatial vectorcardiogaphic descriptors of ventricular depolarization and repolarization were reconstructed from the 12-electrocardiographic leads using a computer-based electrocardiogram. Left ventricular mass and performance were measured using M-mode and Doppler echocardiography. Results, QRS-T angle values were higher (by almost 2-fold) in the diabetic in comparison with the non-diabetic subjects (P < 0·001). After multivariate adjustment, QRS-T angle was independently associated with age (P = 0·01), HbA1c (P = 0·003), and low-density lipoprotein cholesterol levels (P = 0·04) in the non-diabetic, and with HbA1c (P = 0·03) as well as Tei index (P = 0·003) in the diabetic subjects. Conclusions, The spatial QRS-T angle is high in subjects with type 2 diabetes and is associated with glycaemic control and left ventricular performance. The prognostic importance of the higher spQRS-T angle values in subjects with diabetes remains to be evaluated in prospective studies. [source] Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitisJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2007Ana Belén Navarro-Sanchez Abstract Objetives: The purpose of this study was to compare the local efficacy of nonsurgical periodontal therapy between type 2 diabetic and non-diabetic patients and the effect of periodontal therapy on glycaemic control. Background: A complex two-way relationship exists between diabetes mellitus and periodontitis. Material and Methods: After selection, 20 subjects (10 diabetic and 10 non-diabetic) underwent baseline examination, periodontal clinical study and biochemical analysis of gingival crevicular fluid (GCF). After the pre-treatment phase, subgingival scaling and root planing were performed. Subsequently, all subjects continued the maintenance programme and were re-examined at 3 and 6 months. Results: Diabetic and non-diabetic subjects responded well after therapy, showing a very similar progression during the follow-up period. Both groups showed clinically and immunologically significant improvements. Significant reductions were also found in the total volume of GCF and levels of interleukin-1, and tumour necrosis factor- ,. Diabetic subjects showed an improvement in their metabolic control. The change in glycosylated haemoglobin (HbA1C) was statistically significant at 3 and 6 months. Conclusions: The clinical and immunological improvements obtained were accompanied by a significant reduction in HbA1C values in type 2 diabetic subjects. Larger studies are needed to confirm this finding and establish whether periodontal therapy has a significant effect on glycaemic control. [source] Effect of quinapril on the attenuated heart rate recovery of type 2 diabetic subjects without known coronary artery diseaseCLINICAL CARDIOLOGY, Issue 8 2004Ilke Sipahi M.D. Abstract Background: Heart rate (HR) recovery at 1 minis a measure of the vagal reactivation that occurs after cessation of exercise. Despite ample evidence about the association of attenuated HR recovery with increased mortality, pharmacologic modification of this predictor has not been shown. On the other hand, angiotensin-converting enzyme (ACE) inhibitors are known to have vagomimetic activity. Hypothesis: We hypothesized that ACE inhibition would increase HR recovery in a group of subjects known to have reduced HR recovery, namely diabetics. Methods: Maximal treadmill exercise stress test was performed in 31 type 2 diabetic and 31 nondiabetic male subjects with similar age, body mass index, and hypertensive status. None of the subjects had known heart disease or evidence of myocardial ischemia during the test. The diabetic subjects, after 2 weeks of treatment with quinapril, underwent a second exercise test. A third test was performed 2 to 3 weeks after cessation of quinapril treatment. Results: At baseline, despite similar exercise capacity, the diabetics had a lower HR recovery at 1 min than nondiabetics (25 ± 8 vs. 31 ± 8 beats/min, p<0.01). Quinapril significantly increased HR recovery at 1 min in diabetics (25 ± 8 beats/min at baseline vs. 28 ± 8 beats/min with quinapril vs. 25 ± 7 beats/min off-therapy, p < 0.01 by analysis of variance). Conclusions: The attenuated HR recovery of type 2 diabetics can be improved by quinapril. Whether the improvement in HR recovery with ACE inhibition can lead to decreased mortality is currently unknown. [source] The effects of lipid-lowering drug therapy on cardiovascular responsiveness in type 2 diabetic patientsDIABETES OBESITY & METABOLISM, Issue 1 2006Laurence Guy HowesArticle first published online: 18 MAR 200 Type 2 diabetes is associated with a high prevalence of dyslipidaemia and a high incidence of cardiovascular disease. Lipid lowering therapy with HMG Co-A reductase inhibitors (statins) reduce the risk of cardiovascular events in type 2 diabetic and non-diabetic patients, effects which are believed to be partly due to improvements in vascular function. The aetiology of abnormal vascular function in type 2 diabetics is likely to be multifactorial and the pattern of vascular dysfunction in type 2 diabetes may differ from that which occurs in non-diabetic patients with dyslipidaemia. Abnormalities in endothelium derived hyperpolarising factor (EDHF) mediated vasodilation in resistance vessels may be more prominent in both type 1 and type 2 diabetes than in non-diabetic patients with endothelial dysfunction. The effects of lipid lowering therapy on vascular responsiveness may differ in type 2 diabetic patients from those found in non-diabetic patients. Statin therapy does not appear to improve responses to endothelial dependent vasodilators in type 2 diabetics, but may alter the ratio between nitric oxide (NO) and EDHF mediated responses. Fibrate therapy improves flow mediated dilation of brachial arteries in type 2 diabetic patients, but only appears to improve endothelium dependant vasodilator responses in resistance vessels when given in conjunction with co-enzyme Q. [source] A systematic review of the efficacy of non-pharmacological treatments for depression on glycaemic control in type 2 diabeticsJOURNAL OF CLINICAL NURSING, Issue 19 2008Mei-Yeh Wang Aims and objectives., This paper reported a systematic review of three randomised controlled clinical trials evaluating the efficacy of non-pharmacological treatment of depression on glycaemic control in individuals with type 2 diabetes. Background., Depression is associated with poor adherence to self-care regimen in individuals with diabetes. A significant relationship between depression and poor glycaemic control has also been suggested. Hence, the management of depression becomes an important aspect of diabetes care. Design., Systematic review. Methods., Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words , depression, mood disorder, depressive symptoms, diabetes mellitus, glycaemic control, glycated haemoglobin, glucose, psychological therapy, psychotherapy, non-pharmacological therapy and cognitive behaviour therapy. The publication date was limited from 1996,2007. Studies were selected if they used a randomised controlled trial design, were written in English, used non-pharmacological treatments for treating depression, included individuals with type 2 diabetes mellitus as participants and included depressive symptoms and glycaemic control (determined by haemoglobin A1C) as outcomes. Results., Non-pharmacological treatments of depression reduce depressive symptoms in diabetic patients. However, cognitive behaviour therapy did not improve glycaemic control. The treatment effect sizes for glycaemic control in the two collaborative-care programmes were also small. Conclusions., The available evidence indicated that non-pharmacological treatment of depression had limited effect on glycaemic control in individuals with type 2 diabetes. Relevance to clinical practice., The depression-focused interventions might not achieve optimal diabetes-related outcomes. The beneficial effect of psychological treatment for glycaemic control may be strengthened by employing treatments tailored to each individual's diabetes self-care needs in addition to depression management. [source] Dose,response relationship between periodontal inflamed surface area and HbA1c in type 2 DiabeticsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2009Willem Nesse Abstract Background: A dose,response relationship between the amount of inflamed periodontal tissue and HbA1c level, might be indicative for a causal association between periodontitis and type 2 diabetes. Aim: To assess a dose,response relationship between the periodontal inflamed surface area (PISA), as a measure of the amount of inflamed periodontal tissue, and HbA1c levels in type 2 diabetics. Material and Methods: Forty consecutive dentate type 2 diabetics attending their general practitioner for regular check-up, underwent full-mouth probing pocket depth and bleeding on probing assessment. From these data PISA was calculated. HbA1c levels were retrieved from patients' medical files. The dose,response relationship between PISA and HbA1c levels was assessed using multiple linear regression analyses, controlling for factors that might influence PISA or HbA1c levels. Results: The higher the PISA of type 2 diabetics was, the higher their HbA1c levels were. On a group level, an increase of PISA with 333 mm2 was associated with a 1.0 percentage point increase of HbA1c, independent of the influence of other factors. Conclusion: On a group level, there is a dose,response relationship between PISA and HbA1c in type 2 diabetics. This might be an indication of a causal relationship between type 2 diabetes and periodontitis. [source] Favorable Impact of a Vegan Diet with Exercise on Hemorheology: Implications for Control of Diabetic NeuropathyJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2003MF McCarty A little-noticed clinical report indicates that a low-fat, whole-food vegan diet, coupled with daily walking exercise, leads to rapid remission of neuropathic pain in the majority of type 2 diabetics expressing this complication. Concurrent marked improvements in glycemic control presumably contribute to this benefit, but are unlikely to be solely responsible. Consideration should be given to the possibility that improved blood rheology , decreased blood viscosity and increased blood filterability , plays a prominent role in mediating this effect. There is considerable evidence that neural hypoxia, secondary to impaired endoneurial microcirculatory perfusion, is a crucial etiologic factor in diabetic neuropathy; the unfavorable impact of diabetes on hemorheology would be expected to exacerbate endoneurial ischemia. Conversely, measures which improve blood fluidity would likely have a beneficial impact on diabetic neuropathy. There is indeed evidence that vegan diets, as well as exercise training, tend to decrease the viscosity of both whole blood and plasma; reductions in hematocrit and in fibrinogen may contribute to this effect. The fact that vegan diets decrease the white cell count is suggestive of an improvement in blood filterability as well; filterability improves with exercise training owing to an increase in erythrocyte deformability. Whether these measures influence the activation of leukocytes in diabetics , an important determinant of blood filterability , remains to be determined. There are various reasons for suspecting that a vegan diet can reduce risk for other major complications of diabetes , retinopathy, nephropathy, and macrovascular disease , independent of its tendency to improve glycemic control in type 2 patients. The vegan diet/exercise strategy represents a safe, ,low-tech' approach to managing diabetes that deserves far greater attention from medical researchers and practitioners. [source] Effect of quinapril on the attenuated heart rate recovery of type 2 diabetic subjects without known coronary artery diseaseCLINICAL CARDIOLOGY, Issue 8 2004Ilke Sipahi M.D. Abstract Background: Heart rate (HR) recovery at 1 minis a measure of the vagal reactivation that occurs after cessation of exercise. Despite ample evidence about the association of attenuated HR recovery with increased mortality, pharmacologic modification of this predictor has not been shown. On the other hand, angiotensin-converting enzyme (ACE) inhibitors are known to have vagomimetic activity. Hypothesis: We hypothesized that ACE inhibition would increase HR recovery in a group of subjects known to have reduced HR recovery, namely diabetics. Methods: Maximal treadmill exercise stress test was performed in 31 type 2 diabetic and 31 nondiabetic male subjects with similar age, body mass index, and hypertensive status. None of the subjects had known heart disease or evidence of myocardial ischemia during the test. The diabetic subjects, after 2 weeks of treatment with quinapril, underwent a second exercise test. A third test was performed 2 to 3 weeks after cessation of quinapril treatment. Results: At baseline, despite similar exercise capacity, the diabetics had a lower HR recovery at 1 min than nondiabetics (25 ± 8 vs. 31 ± 8 beats/min, p<0.01). Quinapril significantly increased HR recovery at 1 min in diabetics (25 ± 8 beats/min at baseline vs. 28 ± 8 beats/min with quinapril vs. 25 ± 7 beats/min off-therapy, p < 0.01 by analysis of variance). Conclusions: The attenuated HR recovery of type 2 diabetics can be improved by quinapril. Whether the improvement in HR recovery with ACE inhibition can lead to decreased mortality is currently unknown. [source] Oral antidiabetic treatment in patients with coronary disease: Time-related increased mortality on combined glyburide/metformin therapy over a 7.7-year follow-upCLINICAL CARDIOLOGY, Issue 2 2001Enriqe Z. Fisman M.D. Abstract Background: A sulfonylurea ,usually glyburide,plus metformin constitute the most widely used oral antihyperglycemic combination in clinical practice. Both medications present undesirable cardiovascular effects. The issue whether the adverse effects of each of these pharmacologic agents may be additive and detrimental to the prognosis for coronary patients has not yet been specifically addressed. Hypothesis: This study was designed to examine the survival in type 2 diabetics with proven coronary artery disease (CAD) receiving a combined glyburide/metformin antihyperglycemic treatment over a long-term follow-up period. Methods: The study sample comprised 2,275 diabetic patients, aged 45,74 years, with proven CAD, who were screened but not included in the bezafibrate infarction prevention study. In addition. 9,047 nondiabetic patients with CAD represented a reference group. Diabetics were divided into four groups on the basis of their therapeutic regimen: diet alone (n = 990), glyburide (n = 953), metformin (n = 79), and a combination of the latter two (n = 253). Results: The diabetic groups presented similar clinical characteristics upon recruitment. Crude mortality rate after a 7.7-year follow-up was lower in nondiabetics (14 vs. 31.6%, p<0.001). Among diabetics, 720 patients died: 260 on diet (mortality 26.3%). 324 on glyburide (34%), 25 on metformin alone (31.6%), and 111 patients (43.9%) on combined treatment (p<0.000001). Time-related mortality was almost equal for patients on metformin and on combined therapy over an intermediate follow-up period of 4 years (survival rates 0.80 and 0.79, respectively). The group on combined treatment presented the worst prognosis over the long-term follow-up, with a time-related survival rate of 0.59 after 7 years, versus 0.68 and 0.70 for glyburide and metformin, respectively. After adjustment to variables for prognosis, the use of the combined treatment was associated with an increased hazard ratio (HR) for all-cause mortality of 1.53 (95% confidence interval [CI] 1.20,1.96), whereas glyburide and metformin alone yielded HR 1.22 (95% CI 1.02,1.45) and HR 1.26 (95% CI 0.81,1.96), respectively. Conclusions: We conclude that after a 7.7-year follow-up, monotherapy with either glyburide or metformin in diabetic patients with CAD yielded a similar outcome and was associated with a modest increase in mortality. However, time-related mortality was markedly increased when a combined glyburide/metformin treatment was used. [source] | ||||||||||