Current concepts of cardiovascular diseases in diabetes mellitus

The incidence of diabetes has reached epidemic proportions across the world. In patients with diabetes, there is a two to four times increased risk of developing coronary artery disease (CAD). Diabetes seems to eliminate the protective benefits of hormones in women against CAD. Patients with type II diabetes also have hypertension, dyslipidemia, obesity, endothelial dysfunction and prothrombotic factors, called 'the metabolic syndrome'. Not only the incidence of CAD is higher in diabetes, the mortality of the diabetic patients after a cardiac event is significantly increased as compared to non-diabetics, including sudden death. Although in the past 35 years there has been a decline in the rate of death due to CAD in the general population, this has not been seen among patients with diabetes. Primary prevention can play an important role in decreasing the incidence of CAD in diabetic patients. Aggressive treatment of hyperlipidemia and hypertension is essential. Recent knowledge about the protective effects of aspirin, statins, angiotension converting enzyme inhibitors, and glitazones in the diabetic patients, if used appropriately will go a long way in primary and secondary prevention of CAD in patients with diabetes.     

2型糖尿病患者生物阻抗式胃动力的测定

目的 观察2型糖尿病患者的胃动力情况并探讨其可能的影响因素.方法 采用基于小波转换的阻抗式胃动力采集系统检测65例2型糖尿病患者及30名健康志愿者的胃动力,并检测空腹血糖(FBG)和HbA1c.结果 65例2型糖尿病患者胃动力异常的发生率为53.85%,主要胃肠症状为腹胀、早饱、嗳气.2型糖尿病患者的胃动力主功率百分比较正常对照明显降低(P<0.05).HbA1c≥6.5%组患者的胃电主功率百分比较HbA1c<6.5%组显著降低(P<0.01).老年组胃动过缓功率百分比较青、中年组均显著增高(P<0.05).FBG及病程与2型糖尿病患者的胃动力障碍无关.结论 2型糖尿病患者胃动力障碍发生率高,HbA1c≥6.5%及老年患者更易发生胃动力障碍,FBG及病程与胃动力障碍无关.     

2型糖尿病胃动力障碍的临床研究

[目的]应用胃电图(EGG)研究2型糖尿病(DM)胃动力的变化.[方法]选取2型DM患者60例,正常对照30例,对两组EGG的主频(FP)、振幅(AP)、胃动过缓百分率(B%)的变化与血糖的关系进行研究.[结果]DM组与正常对照组的空腹和餐后FP无统计学意义.两组餐后AP均显著高于空腹(P＜0.05),但两组比较无统计学意义.两组餐前和餐后B%比较,DM组均明显高于正常对照组(P＜0.05).DM空腹血糖(FBG)与餐前、餐后B%呈正相关,随着FBG的升高,B%呈相关升高(P＜0.01).[结论]DM患者存在明显EGG异常,表现为胃动过缓明显增多的胃电节律紊乱.DM患者FBG与餐前、餐后B%呈正相关.     

Proximal gastric motility in critically ill patients with type 2 diabetes mellitus

AIM To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with longstanding type 2 diabetes mellitus.METHODS Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 ± 3 years) during two 60-min duodenal infusions of Ensure(R) (1 and 2 kcal/min), in random order,separated by 2h fasting. Data were compared with 15 non-diabetic critically ill patients (48 ± 5 years) and 10 healthy volunteers (28 ± 3 years).RESULTS Baseline proximal gastric volumes were similar between the three groups. In diabetic patients,proximal gastric relaxation during 1 kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/min infusion was initially reduced in diabetic patients (P ＜ 0.05) but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients.CONCLUSION In patients with diabetes mellitus,proximal gastric motility is less disturbed than nondiabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.     

Gastrointestinal motility disorders in diabetes mellitus

Diabetic patients are prone for the development of autonomic neuropathy with inclusion of the gastro intestinal system. The patients are mainly bothered by disturbances of motility. Depending on the localisation they manifest themselves as constipation or diarrhea. The knowledge of these complications is important, since therapeutic decisions may be influenced.     

Gastrointestinal motility disorders in patients with diabetes mellitus

Abstract. Disturbed gastric and small intestinal motility is an often overlooked clinical problem. Delayed gastric emptying of liquid and/or solid food in patients with type 1 and type 2 diabetes (gastroparesis diabeticorum) occurs in approximately 50% of the patients. Also, the interdigestive gastric and small intestinal motility is often affected. There is only a weak correlation between symptoms and objectively measurable motor disturbances. Patients with severe upper gastrointestinal symptoms usually have disturbed motility, but most patients with impaired motility are asymptomatic. Recent studies have clearly shown that, in addition to autonomic neuropathy, acute metabolic derangements are likely to contribute to disturbed motility. Elevated glucose levels impair gastric and small intestinal motility during fasting and after food intake. Hyperinsulinemia per se has effects similar to hyperglycaemia on the stomach and small bowel, and may be a mediator of the effects of hyperglycaemia in healthy subjects. The impact of insulin on motility in diabetic patients is still unclear. Treatment of the gastric motility disorder should include a stabilization of gastric emptying. Different therapeutic modes may be useful, e.g. application of prokinetic drugs and optimizing the metabolic situation.     

COVID-19 vaccination in patients with diabetes mellitus: Current concepts,uncertainties and challenges

Background and aimsTo summarize the available evidence on the use COVID-19 vaccines in patients with diabetes mellitus.MethodsWe performed a thorough literature search with regard to COVID-19 vaccines in patients with type 1 and type 2 diabetes mellitus.ResultsThe novel coronavirus disease (COVID-19) tends to portend a poor prognosis in patients with diabetes mellitus (DM). Primary prevention remains the mainstay for mitigating the risks associated with COVID-19 in patients with DM. A significant step in primary prevention is timely vaccination. Routine vaccination against pneumococcal pneumonia, influenza, and hepatitis B is recommended in patients with DM with good efficacy and reasonable safety profile. With clinical data supporting a robust neutralizing antibody response in COVID-19 patients with DM, vaccination in individuals with DM is justified. In fact, as the burden of the disease is borne by people with DM, COVID-19 vaccination should be prioritized in individuals with DM. Multiple unresolved issues with regard to preferred vaccine type, vaccine efficacy and durability, frequency of administration, vaccination in children (<18 years) and pregnant/lactating women however remain, and need to be addressed through future research.ConclusionsPatients with type 1 and type 2 diabetes mellitus are at a high risk of poor prognosis with COVID-19 and vaccination should be prioritized in them. However, many unresolved issues with regard to COVID-19 vaccination need to be addressed through future research.     

Motility disorders and gastric emptying in diabetes mellitus. Current diagnostics and treatment

Autonomic neuropathy of the gastrointestinal tract is a common complication of diabetes mellitus. However, it is seldom recognised properly as it is rarely considered. In some patients, it might be asymptomatic or hardly compensatable diabetes can be the only one sign. There are non-invasive diagnostic methods to assess gastric emptying rate (13C-octanoic acid breath test) or myoelectric activity of the stomach (electrogastrography). The principle treatment comprises optimal control of diabetes and use of prokinetics.     

糖尿病胃动力障碍和促胃动力药的作用

目的 研究2型糖尿病(DM)胃动力变化和观察西沙必利对DM胃轻瘫的疗效。方法 对74例2型DM患者以SPECT显像技术用核素标记~(113)In液体试餐、~(99m)Tc固体试餐测定胃半排空时间(GET_(1/2))和进行胃电图(EGG)检查,同时检测空腹血糖(FBG)。结果 (1)22例FBG≤7.8mmol/L的糖尿病患者,未见GET_(1/2)延迟;52例FBG>7.8mmol/L的糖尿病患者,36例(69.2％)固相GET_(1/2)延迟,其中14例伴液相GET_(1/2)延迟(P<0.01)。(2)正常对照组和DM组的空腹和餐后胃电图主频、平均过零频率差异均无显著性,两组餐后振幅均显著高于空腹(P<0.05)。DM组的胃电节律紊乱率较对照组显著增高(P<0.05)。(3)FBG>7.8mmol/L的DM患者,核素胃排空(RGE)与EGG相关。(4)36例DM胃轻瘫分两组:A组降糖药加西沙必利和B组单用降糖药用药4周。A组对胃轻瘫有效率85％,B组无效。结论FBG与DM患者胃排空呈负相关;血糖控制不良的DM患者,RGE与EGG相关;西沙必利对DM胃轻瘫有一定疗效。     

Current concepts of renal hemodynamics in diabetes

Glomerular hyperfiltration has long been recognized in insulin-dependent diabetes, and has been more recently recognized in patients with non-insulin dependent diabetes mellitus as well. Experimentally, glomerular hyperfiltration has been shown to result from elevations in the glomerular capillary blood flow and the glomerular capillary hydraulic pressure (P_GC). Of the hemodynamic determinants of hyperfiltration, it is glomerular hypertension that is most damaging to the glomerulus. Experimental and clinical studies have confirmed that antihypertensive agents that lower P_GC more consistently slow the progression of injury than do those that fail to control glomerular hypertension. The pathogenesis of diabetic hyperfiltration is multifactoral. Many mediators have been proposed, including changes due to the altered metabolic milieu, and alterations in endogenous levels of such vasoactive mediators as atrial natriuretic peptide, endothelial-derived relaxing factor, angiotensin II, prostaglandins, thromboxanes, and kinins, among others. It has more recently been suggested that local renal tissue levels, rather than circulating levels, play the more profound role in hemodynamic regulation. For example, the renin-angiotensin system (RAS) appears to be disproportionately active in the renal tissue, potentially explaining the renal vascular responsiveness to angiotensin-converting enzyme inhibition despite absence of systemic RAS activation. Little is yet known of the mechanisms by which glomerular hypertension leads to injury. Innovative new in vitro systems have been developed to address this question. These studies postulate that glomerular hemodynamic factors (shear stress, pulsatile flow) modify the growth and activity of glomerular component cells, inducing the expression of cytokines and other mediators, which then stimulate matrix production and promote structural injury.     

Disorders of gastrointestinal motility associated with diabetes mellitus

Gastrointestinal symptoms such as vomiting, constipation, diarrhea, and fecal incontinence occur frequently in patients with diabetes mellitus. In a survey of 136 diabetic outpatients, 76% had one or more gastrointestinal symptoms, the commonest symptom being constipation (found in 60%). In many cases these symptoms are thought to be due to abnormal gastrointestinal motility that, in turn, may be a manifestation of diabetic autonomic neuropathy involving the gastrointestinal tract. The pathophysiology of these gastrointestinal symptoms, clarified in recent studies, and the clinical features and treatment of these problems in diabetic patients are reviewed.     

Delayed gastric emptying in diabetes mellitus]

Function of gastric motility was studied in thirty one diabetes mellitus patients by testing gastric emptying time (GET). The test was performed by giving patients food labelled with 99mTc. The results showed that GET in patients with diabetes mellitus was significantly delayed as compared with that in the controls (P less than 0.001). 15 among the 31 diabetic patients had delayed GET, accounting for 48.4%. There was no difference in age, duration of the disease, treatment regimen and microvascular complications between patients with delayed GET and those with normal GET. The only difference was the obviously increased incidence of autonomic nerve dysfunction in the former group of patients (P less than 0.05). We concluded that the incidence of delayed gastric emptying time was higher in diabetic patients with autonomic neuropathy.     

Disordered gastric motor function in diabetes mellitus

Summary The application of novel investigative techniques has demonstrated that disordered gastric motility occurs frequently in diabetes mellitus. Gastric emptying is abnormal in about 50% of diabetic patients and delay in gastric emptying of nutrient-containing meals is more common than rapid emptying. The blood glucose concentration influences gastric motility in diabetes. In IDDM patients, gastric emptying is retarded during hyperglycaemia and may be accelerated by hypoglycaemia. Gastroparesis therefore does not necessarily reflect irreversible autonomic neuropathy and blood glucose concentrations must be monitored when gastric motility is evaluated in diabetic patients. There is a poor relationship between gastric emptying and gastrointestinal symptoms and the mechanisms by which abnormal motility causes symptoms are unclear. The introduction of new gastrokinetic drugs has improved therapeutic options for the management of symptomatic patients with gastroparesis considerably. The contribution of disordered gastric emptying to poor glycaemic control is unclear, but the demonstration that the rate of gastric emptying is a major factor in normal blood glucose homeostasis suggests that this is likely to be significant.Abbreviations IDDM insulin-dependent diabetes mellitus - NIDDM non-insulin-dependent diabetes mellitus